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<br />tiay-07-0Z 09:j'Dam From-ROBERT F DRIVER <br /> <br />+94i-ZS1-I6B3 <br /> <br />T-970 P 001/002 F-206 <br /> <br />VENDORS/CONTRACTORS GENERAL LIABILITY REQUEST TO BIND COVERAGE <br /> <br />Contractors Program - CO/rlplete lOp semon fI/ld return to Roo F. Drit1er to Bind. <br />Artellt;on: Mon;que NIl~arro, ACcount Admini$trator <br /> <br />(COVERAGE NOT IN FORCE UNTO.. BINDER RECEIVED FROM CO~ANY) <br />Date~~~ <br /> <br />Public Entity: <br /> <br />City of Santa Ana <br /> <br />Fax: <br /> <br />(714) 647-5311 <br /> <br />Vendor I Contractor: <br /> <br />SynectecolORY - AnN: Todd Brody <br /> <br />Vendor I Conlrllctor Mailing Address; <br /> <br />10232 Overhill Drive <br /> <br />Santa Ana, CA 92705 <br /> <br />Description of Contract: <br /> <br />Noise Study <br /> <br />Contract Value: <br /> <br />Scope ofWark: <br /> <br />Consulting - Noise Study <br /> <br />Contact: <br /> <br />Rosa Flores <br /> <br />$7,000 <br /> <br />Term of Contract: From 5/0&/02 To: 4/20/03 Hazard: <br /> <br />I <br /> <br />Rate: <br /> <br />$359.75 <br /> <br />Please bmd the above account eff~clive 2-I_.Q~_J--.fg <br /> <br />TOlal Policy Premium: <br /> <br />Stale Tax (3%): <br />Stamping Fee (.25%): <br />Certilicate Fee: <br /> <br />Total AmouDl: <br /> <br />S 359. 7~_ <br />$ 9.00 <br />S .7", <br />S $SO <br />S 5359.7"; <br /> <br />....--.....-.-......-........-..,....--......-......--..---..-.-....--.-----.-.-.-..-..--...-...-.-.--.....-----.-...,....--.....--.....- <br /> <br />BINDER ACKNOWLEDGEMENT <br /> <br />Dale:~.:L/cM: . '0 'L.lJ AS TO FORM <br />Ai..i..~' 'v.t..:. <br />Contractor is Bound Ef!ect;ve: ~ 1 ~/O d-Fulcrum Insurance Company. _/ 1..J ~ <br />Master Policy Number: CP.1002566 .$1.1..1A ~ 0 P r- <br />Laura Sheedy <br />COVERAGE IN FORCE FOR NAMED CONTRACT ONLY. ~eputy' ttorney' <br />Public Entity is Named as Addirionallnsurcd: r/:) <br /> <br />61sq-- -:: ev~'~~ .~ ;7 <br /> <br />Robert F. Driver Ph: (949) 756-0271 <br />P,O. Box 6450 Fax: (949) 756-2713 <br />Newport Beach, CA 92660 <br />License IIOC36861 <br /> <br />Sample of POlicy is all file with the Public Entity and can be provided UpOD request. <br /> <br />1~~'~&"'Ien...". <br /> <br />l'IIr:zDCll <br />