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<br />lA.1y-OT-OZ OB::Oim From-ROBERT F DRIVER <br /> <br />+B49-Z51-1663 <br /> <br />T-BTO P 001/00Z F-Z06 <br /> <br />Vf"JDORS/CONTRACTORS GENERAL LIABILITY REOUEST TO BIND COVERAGE <br /> <br />Contractors Program - Coltlpfete lOp set:tion and return 10 R. F. Dri~er 10 Bind. <br />Anemwn: Monique Ntlvarro. ACcount Administrator <br /> <br />(COVERAGE NOT IN FORCE UNTD.. BINDER RECEIVED FROM COMPANY) <br />Date:~~--..!E... <br /> <br />Public Entity: <br /> <br />City of Santa Ana <br /> <br />Fax: <br /> <br />(714) 647-5311 <br /> <br />Contact: <br /> <br />Rosa Flores <br /> <br />Vendor I Contractor: <br /> <br />SyneC tecology - AnN; Todd Brody <br /> <br />Vendor I Contnlctor Mailing Address: <br /> <br />10232 Overhill Drive <br /> <br />Description of Conlrnet: <br /> <br />Santa Ana, CA 92705 <br /> <br />Noise StlXly <br /> <br />Conlrnet Value: <br /> <br />$7,000 <br /> <br />Scope of Work: <br /> <br />Consulting - Noise Study <br /> <br />Term of Conlrnct: From 5/06/02 To: 4/20/03 Hazill'd: <br /> <br />I <br /> <br />Rate: <br /> <br />Flease hind the above aCCOUIlI effeclive -2...J_~.J~ <br /> <br />$359.75 <br /> <br />Toul POUey PrelDium: S 359.7'5. <br />State Tax (3%); S 9.00 <br />Stlllnplng Fee (.25%): S .7"; <br />Certificate Fee: S SSO <br />Total AmouDt: S 535'1.71)". <br /> <br />...._-....._._...~._........-._..,....._......-......_-.._._..~._...._-._----.----...._-_.._~..._..._..._.......---._..,.....-_......_,..,~ <br /> <br />Date: -.:;i;-=L/M <br /> <br />Aulhonzed Representative <br />R.E. Chaix & Associates losur""cc Brokers, mc. <br />License ~0726213 <br /> <br />3,.........:t"'GI&.<~OItNIrc.'en..Dn. <br /> <br />Sample of POlicy is on file witl. the Puhlic Entity aDd can be provided upon request. <br /> <br />1I)11'200J <br />