Loading...
HomeMy WebLinkAboutCYCOM DATA SYSTEMS, INC. 1-2003INSURANCE ON FILE N~2OO3-0~8 WORK MAY PRDCEED UNTIL INSURANCE IRES _~ ~-- ~ -off'' CLERK OF. CDUNCIU LICENSE AGREEMENT DATEd g-/~-o3 Cab THIS LICENSE AGREEMENT ("Agreement") is entered into as of the ~ day of (5'0~~~) , 2003, by and between the CITY OF SANTA ANA, a charter city and Fr rl municipal corporation duly organized and existing under the Constitution and laws of the State of California ("City") and CYCOM DATA SYSTEMS, INC., a California corporation ("Cycom"). RECITALS A. The parties entered into Citylaw License Agreement, (hereinafter, "Citylaw Agreement") dated April 3, 2000, by which Cycom granted to City a non exclusive license to use Cycom proprietary software (hereinafter "Citylaw"), all related materials, documentation and information, updates and improvements, along with training and maintenance and support for the softwaze. B. The City desires to obtain a license for a softwaze module which will integrate Citylaw softwaze with Microsoft Outlook. C. Cycom represents that Cycom is able and willing to provide such services to the City. NOW THEREFORE, in consideration of the mutual and respective promises, and subject to the terms and conditions hereinafter set forth, the parties agree as follows: 1. SCOPE OF SERVICES A. Cycom hereby grants to the City, and the City accepts from Cycom, a nonexclusive, nontransferable perpetual license to Cycom's sofrwaze program which integrates Cycom's Citylaw software modules with Microsoft Outlook functions (hereinafter "Product"), more particularly described in Exhibit A-1, attached hereto, subject to the terms and conditions of this Agreement. City acknowledges and agrees that this license grants City no right of ownership in the Product. Said license shall include installation, training and modification of said Product to accommodate City use of Product. B. The parties agree to renew the annual Software Maintenance and Support services pursuant to Section V of Citylaw Agreement, at the rate set forth in Cycom's invoice, attached hereto as Exhibit A-2. 2. COMPENSATION The City shall pay to Cycom, and Cycom agrees to accept from City, as full compensation for said Product, including installation, training and support, an amount not to exceed $2,000.00. The total sum to be expended under this Agreement shall not exceed $9,600.00, during the term of this Agreement. 3. TERM The term of this Agreement shall commence on July 1, 2003 and terminate on June 30, 2004. The license granted under this Agreement shall commence upon the delivery of the Product to the City and shall continue in perpetuity unless sooner terminated in accordance with the provisions of this Agreement. 4. ACCEPTANCE OF THE PRODUCT The City shall have sixty (60) days from completion of installation of the Product to test whether the Product materially conforms to the operational, functional and performance specifications represented by Cycom. Failure of the City to notify Cycom that the Product fails to materially conforms to the specified performance standards shall be deemed to constitute acceptance of the Product. 5. MAINTENANCE AND SUPPORT A. Maintenance and Support Subject to the terms, conditions and charges as set forth in this section, Cycom will provide the City with maintenance and support services for the Product as follows: 1. Cycom will provide such assistance as is necessary to cause the Product to perform in accordance with Exhibit A-1. Cycom will provide reasonable remote consultation, assistance, support and technical assistance to the City between the hours of'J:00 a.m. and 5:00 p.m. (pacific time). Cycom will respond to any system failure and begin corrective action within four (4) hours of notification from the City. 2. Cycom will provide updates to the Product if and as required to cause it to operate under new versions or releases of the operating system so long as such updates are technically feasible. B. Renewal 1. No later than sixty (60) days prior to the anniversary of each term, Cycom shall give the City written notice of Cycom's Software Maintenance and Support charges for the next one-year term. This notice may be given in the manner in the form of an invoice for Cycom's Software Maintenance and Support charges. It is hereby agreed by the parties that the renewal rate for the Maintenance and Support Agreement shall either be the same as the current year's rate, or at an increase not to exceed the Bureau of Labor Statistics, US Department of Labor for the State of California, Los Angeles/Long Beach Region Consumer Price Index (CPI). 2. If the City, for any reason whatsoever, chooses not to renew the Agreement for Software Maintenance and Support, it shall deliver a notice ofnon-renewal to Cycom at least ten (10) days prior to the expiration date of the contract, as set forth in pazagraph 3 above. 3. If Cycom, for any reason whatsoever, chooses not to renew the Agreement for annual Software Maintenance and Support, it shall deliver a notice ofnon-renewal to the City six (6) months prior to the expiration date set forth in paragraph 3 above. 6. TRADE SECRET, PATENT AND COPYRIGHT IDENTIFICATION A. Indemnity Cycom agrees to defend, indemnify and hold the City harmless from all damages awarded against the City, and all reasonable expenses and attorney fees incurred by the City as the result of any claim of trade secret, patent or copyright infringement asserted against the City by virtue of the City's use of the Product as delivered by Cycom and maintained on the City's computers; provided, however, that Cycom is given prompt notice of any such claims and the right to be involved in the investigation, defense and settlement of each such claim and further provided that the City shall cooperate with Cycom in connection with the foregoing, provided further, however, that Cycom shall not admit liability on behalf of the City. B. Trade Secret Should the Product as delivered and as customized, modified or otherwise altered by Cycom become, or, in Cycom's opinion, be likely to become, the subject of a claim of infringement of a trade secret, patent or copyright, Cycom may, at its option and expense either: 1. Procure for the City the right to continue to use the Product as contemplated in this Agreement; or, 2. Replace or modify the Product and/or modify its use to make its use under this Agreement non-infringing. PAYMENT Cycom will invoice the City for the amounts due on delivery of the Product. Subsequent charges will be invoiced at the beginning of the period to which they apply. All payments shall be due and payable within thirty (30) days of the City's receipt of an invoice from Cycom. 8. CONFIDENTIALITY; NONDISCLOSURE A. Confidentiality by Cycom Cycom hereby agrees to exercise reasonable care in safeguarding the confidentiality of the City's data and information to which it may become privy in performance of this Agreement. B. Confidentiality by City The City hereby agrees that: 1. The Product received by the City from Cycom under this Agreement, whether received orally, in writing, or in any other medium, are, and shall be, treated as the confidential property of Cycom; 2. The City shall exercise at least the same degree of care to safeguazd the confidentiality of the Product as the City would exercise to safeguard the City's confidential property; 3. Neither the Product, nor any part thereof, received by the City from Cycom under this Agreement shall be duplicated (except for normal security backup purposes) or in any way disclosed to others, in whole or in part, without the prior permission of Cycom. Such prohibition on disclosure and duplication shall not apply to disclosures and duplication by the City to its employees and agents, provided such disclosures and duplications are reasonably necessary to the City's use of the Product; and provided, further, that the City shall take all reasonable steps to ensure that the Product is not duplicated or disclosed by such employees and agents in contravention of this Agreement. C. Survival It is expressly understood and agreed that the obligation of this Section shall survive the expiration or termination of this Agreement or any provision hereof. 9. TERMINATION A. Basis for Termination by Cycom Cycom shall have the right to terminate this Agreement without further obligation or liability to the City if: 1. The City is delinquent in making payment of any sum due under this Agreement and continues to be delinquent for a period of thirty (30) days after written notice by Cycom of such breach; or, 2. The City commits any other material breach of this Agreement and fails to remedy such breach within thirty (30) days after written notice by Cycom of such breach; or, B. Basis for Termination by City The City shall have the right, without further obligation or liability to Cycom, to terminate this Agreement: 1. If Cycom commits any material breach of this Agreement and fails to remedy such breach within thirty (30) days after written notice to Cycom of such breach. Upon thirty (30) days prior written notice for any reason. C. Effect of Termination Termination of this Agreement following Acceptance of the Product by the City shall have no effect upon the City's right to continued use of the Product without maintenance and support. 10. INSURANCE Prior to undertaking performance of work under this Agreement, Cycom shall maintain and shall require its subcontractors, if any, to obtain and maintain insurance as described below: a. Commercial General Liability Insurance. Cycom shall maintain in full force and effect, for the period covered by this Agreement, comprehensive general liability insurance. This commercial general liability insurance shall name the City, its officers, agents, volunteers, and employees as additional insureds) and shall include, but not be limited to protection against claims arising from bodily and personal injury, including death resulting therefrom and damage to property, resulting from any act or occurrence arising out of Cycom's operations in the performance of this Agreement, including, without limitation, acts involving vehicles. The amounts of insurance shall be not less than the following: single limit coverage applying to bodily and personal injury, including death resulting therefrom, and property damage, in the total amount of $1,000,000 per occurrence. b. Reserved. c. Worker's Compensation Insurance. In accordance with the provisions of Section 3300 of the Labor Code, Cycom, if Cycom has any employees, is required to be insured against liability for worker's compensation or to undertake self-insurance. Prior to commencing the performance of the work under this Agreement, Cycom agrees to obtain and maintain any employer's laibility insurance with limits not less than $1,000,000 per accident. d. Professional liability (errors and omissions) insurance, with a combined single limit of not less than $1,000,000 per claim. e. Certificates and policies shall state that the policies shall not be canceled or reduced in coverage or changed in any other material aspect without thirty (30) days prior written notice to the City. Cycom shall supply the City with a fully executed additional insured endorsement in substantially the form attached hereto as Exhibit B. f If Cycom fails or refuses to produce or maintain the insurance required by this section or fails or refuses to furnish the City with required proof that insurance has been procured and is in force and paid for, the City shall have the right, at the City's election, to forthwith terminate this Agreement. Cycom waives the right to receive compensation and agrees to indemnify the City for any work performed prior to approval of insurance by the City. ll. GENERAL A. Waiver, Amendment or Modification The waiver, amendment or modification of any provision of this Agreement or any right, power or remedy hereunder shall not be effective unless made in writing and signed by the party against whom enforcement of such waiver, amendment or modification is sought. The terms of this Agreement shall not be amended or changed by the terms of any purchase order or acknowledgment even though either party may have accepted or signed such documents. No failure or delay by either party in exercising any right, power or remedy with respect to any of its rights hereunder shall operate as a waiver thereof. B. Notice All notices, consents, approvals, requests, invoices, and other communications, (herein collectively call "Notices") required or permitted under this Agreement shall be given verbally followed by written form, or as a written notice mailed by first-class mail addressed as follows: If to Cycom: Mr. Don McGregor, President Cycom Data Systems, Inc. P.O. Box 92437 Long Beach, CA 90809 If to the City: City of Santa Ana -Clerk of the Council 20 Civic Center Plaza (M-30) P.O. Box 1988 Santa Ana, CA 92702-1988 With a Courtesy Copy to: City Attorney -City of Santa Ana 20 Civic Center Plaza (M-29) Santa Ana, CA 92702-1988 All Notices shall be deemed given three (3) days after deposited in the United States mail, duly registered or certified, with postage prepaid, addressed as set forth above. Either party to this Agreement may change its address or the receipt of notices any time by given notice to the other as provided. Any Notice given by a party must be signed by an authorized representative of such party. Notwithstanding the requirement above as to the use of first class mail, breach of agreement notices, termination notices, change of address notices, or other notices of legal nature, shall be sent by certified mail, postage prepaid, return receipt requested. D. Entire Agreement Exhibit A and these general terms and conditions constitute the entire agreement between the parties in connection with the subject matter hereof and supersede all prior and contemporaneous agreements, negotiations and discussions, whether oral or written, of the parties, and there are no warranties, representations and/or agreements between the parties in connection with the subject matter hereof except as specifically set forth or referred herein. E. Successors and Assigns All the terms and provisions of this Agreement shall be binding upon and inure to the benefit of the parties hereto and their successors and assigns and legal representatives, except that neither party may assign this Agreement or any right granted thereunder, in whole or in part, without the other party's prior written consent, which shall not be unreasonably withheld. F. Governing Law/Venue The validity, construction and performance of this Agreement and the legal relationships among the parties to this Agreement shall be governed by and construed in accordance with the laws of the State of California. Both parties agree that Orange County, California, shall be the venue for any action or proceeding that may be brought or arise out of, in connection with, or by reason of this Agreement. G. Conflict of Interest Cycom covenants that it presently has no interest, and shall not acquire any interest, direct or indirect, which would conflict in any manner with the performance of the services under this Agreement. Cycom further covenants that, in the performance of this Agreement, no person having any such interest shall be employed. Cycom further covenants that no officer, member or employee of the City and no other public official who exercises any functions or responsibility in the review, approval or carrying out of the Agreement has any personal or financial interest, direct or indirect, in this Agreement. Cycom will not and has not employed any person to solicit or secure this Agreement, directly or indirectly. If this condition is breached, the City may, at its option, terminate this Agreement. IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first above written. ATTEST: ' Patricia E. Healy Clerk of the Council CITY OF SANTA A A J q L ` DAVID N. AM City Manager APPROVED AS TO FORM: JOSEPH W.FLETECHER City Atto ey By: aura Sheedy Assistant City Attorney tCOM DATA SYSTEMS ~~.-.~ m McGregor ~sident ax ID# 3 3 -c~o3 8l3 u EXHIBIT B ADDITIONAL INSURED ENDORSEMENT Insurance Company This endorsement modifies such insurance as is afforded by the provisions of Policy # relating to the following: 1. The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701; its officers, employees, agents and volunteers are named as additional insureds ("additional insureds") with regazd to liability and defense of suits azising from the operations and uses performed by or on behalf of the named insured. 2. With respect to claims arising out of the operations and uses performed by or on behalf of the named insured, such insurance as is afforded by this policy is primary and is not additional to or contributing with any other insurance carried by or for the benefit of the additional insureds. 3. This insurance applies separately to each insured against whom claim is made or suit is brought except with respect to the company's limits of liability. The inclusion of any person or organization as an insured shall not affect any right which such person or organization would have as a claimant if not so included. 4. With respect to the additional insureds, this insurance shall not be canceled, or materially reduced in coverage or limits except after thirty (30) days written notice has been given to the City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701. (Completion of the following, including countersignature, is required to make this endorsement effective.) Effective ,this endorsement form as a part of Policy # Issued to Named Insured Countersigned by Authorized Representative 10 CityLaw° OUTLOOK INTEGRATION CityLaw will integrate and synchronize between the system's master calendar and Outlook. A tab added to the Outlook view shows the connection between entries in Outlook and their related CityLaw matter. Calendar and Task entries may originate, or be modified, from either system. • Calendar and task items originally entered within CityLaw are automatically routed to Outlook. • Entries originally made within Outlook are automatically replicated in the CityLaw system. Any modifications made to entries within either system are synchronized to maintain consistency. Synchronization is accomplished though two functions. • The Server function performs synchronization from CityLaw to Outlook, using Exchange. Appointment or task entries made in CityLaw are captured and routed to the Outlook calendar or task list for the designated staff member. • Synchronization from CityLaw is performed by an Outlook add-in dll and ocx. Appointment or task entries made in Outlook may be associated with a matter. Based on this association, the appointment or task is inserted into the CityLaw calendar. Synchronization Server Requirements The program synchronizing CityLaw entries may run on the Exchange server or on any stable client machine. All source code is available for review. The synchronization program requires: • Exchange 5.0 and later. • Administrator rights to the Exchange server, to enable it to remotely login to the various user accounts. • Outlook 2000 SP2 or Outlook 2002 SPl. • An Outlook profile for each user whose calendar is to be synchronized. • The same network connectivity to the CityLaw database as other user client machines. EXHIBI~i A CYCOM Data Systems, Inc. June 5, 2003 CityLaw Outlook Integration t CYCOM Data Systems, Inc. INVOICE For PROFESSIONAL SERVICES 5/19/03 Invoice # WS1043SA To: Office of the City Attorney Attn: Ms. Juanita Hernandez 20 Civic Center Plaza Santa Ana, CA 92701 Pay To: Cycom Data Systems, Inc. P.O. Box 92437 Long Beach, CA 90809-2437 FID# 33-0038134 Ref: CityLaw Contract CityLaw for Windows Software Annual Support and Maintenance March 1, 2003 through February 28, 2004 $7,609.00 Outlook Integration Implementation 1,750.00 Outlook Support 8 months -July through February 200.00 TOTAL DUE $9,559.00 .-~ Don McGregor CYCOM Data Systems, Inc. EXHIBIT g P.O. BOX 92437 LONG BEACH. CA 90809-2437 (88S) 292-6688 FAX (800) 479-5563 www.legalsysCcycomi nc.com AC~RD~, CERTIFICATE OF LIABILITY INSURANCE os/o3/zoo3 PR,7DiICER (714)905-1923 FAX (714)905-1910 Ha and Ti 1 tOn & ROl app ~ License #0614365 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 25529 Anaheim, CA 92825-5529 INSURERS AFFORDING COVERAGE INSURED CycOm Data Systems, inc. INSURER A: Hartford Casualty Insurance Co 6835 Roberta Rd. S.W. INSURER B: American Int'1 Specialty Lines Ocean Isle Beach, SC 28469 INSURER C: INSURER D: INSURER E: COVERAGES THE POLICIES Of INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OF MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OFINSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATKN LIMITS GENERAL LIABILITY 725BAN71649DX 06/04/2003 06/04/2004 EACH OCCURRENCE $ 1 ODO X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Any ona fire) $ 3DD D CLAIMS MADE ~ OCCUR MED EXP (Any ane peron) $ 100 A PERSONAL d ADV INJURY $ 1 OOO DO GENERAL AGGREGATE $ 2 OOO OO GENL AGGREGATE LIMB APPLIES PER: PRODUCTS-COMP/OP AGG $ 2 DDO POLICY PRO LOC JECT AUT OMOBILE LIABILITY 7256ANJ1649DX 06/04/2003 D6/D4/2DD4 COMBINED SINGLE LIMIT ANY AUTO (Ee acdOenQ $ 1 OOO ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) A X HIRED AUTOS BODILY INJURY $ X NON-OWNED AUTOS (PeraaiEent) - PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY-EA ACCIDEN7 $ ANV AUTO OTHERTHAN EA ACC $ AUTO ONLY: AGG $ EXCESS LU181LITY ,',~'[-jJRpVED - ~ `~)~` EACH OCCURRENCE $ OCCUR ~ CLAIMS MADE AGGREGATE $ DEDUCTIBLE - ) $ ` Y RETENTION $ $ WORKERS COMPENSATION AND 1_"~~~~' A U- TORV LIMITS Eft EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $ E.L. DISEASE-EA EMPLOYE $ E.L. DISEASE-POLICY LIMIT $ o~ i l Li bili 787654 07/16/2002 07/16/2003 51,000,000 Aggr. Incl Expenses r ess ona a ty B 51,000,000 Each Wrongful Act 525,000 Retention DESCRIPTION OF OPERATION OCATIONSNEHICLES/EXCLUSIONS ADDED BV ENDORSEMENTISPE IAL PROVISIONS l en days notice o cancellation given for non-payment oi premium. ertificate Holder, its officers, employees, agents and volunteers are Additional Insured as respects neral Liability per attached Additional Insured Endorsement 5504490593 City of Santa Ana Office of the City Attorney Attn: ]uanita Hernandez 20 Civic Center Plaza Santa Ana, CA 92701 SHOULD ANV OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 3O DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATON OR LIABILITY AUTHORIZED REPRESENTATIVE ITS AGElRS OR REPRESENTATIVES. IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. .. ~iE HARTFORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: 72S8ANJ1649 BUSINESS LIABILITY COVERAGE FORM C. Who is an insured in the BUSINESS LIABILITY or losses covered uhde~ the BUSINESS C. Who is an insured in the BUSINESS LIABILITY For losses covered under the BUSINESS COVERAGE FORM is amended to include as an LIABILITY COVERAGE of this pol(cy this insurance is Insured fhe person or organization shown in the primadly to other valid and collective insurance which Is Declarations but dnly wkh respect to liability adsing available to the person or organization out of the operations of the named insured. shown in the Declarations as an Additional Insured. Additional Insured: Af'YliO ~ Elt AS 7 O FORM ;~ _i La ra Sher.dy 'k;puty City Atto nev Form SS 04 49 05 93 Printed in U.S.A. (NS) Copyright, Hartford Fire Insurance Company, 7993 RTHOLDER COPY SP ATE P.O. BOX 807, SAN FRANCISCO,CA 94142-0807 COMPENSATION' p IN5UF3ANCE N-oZfi(~.3 -o~7a FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ~; _ ~G~ 3 _ ~ ~~~~~ ISSUE DATE: 12-31-2004 GROUP: 000528 - POLICY NUMBER: 0000318-2004 CERTIFICATE-ID: 28 - CERTIFICATE EXPIRES: 12-31-2005 12-3t-2004/12-31-2005 OFf1CE OF THE SANTA ANA LITY ATTORNEY JDe: ATTN MS JUANITA HERNANDEZ 20 CIVIC CENTER PLAZA SANTA ANA CA 92701 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner tc the employer named below for the pofcy period indicated. This policy is not subject to cancellation by the Fund except upon 3p days' advance written notice to the employer. We will also give you 30 days'advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extender alter the coverage afforded by the polices Ustetl harem. fVOtvvrthstanding any requirement, term, or condition of any contract or other document. with respect to which this ceftificate of insurance may bessued or may pertain, the insurance afforded by the policies described herein is subject to all the terms, exclusions and conditions of such policies. AUTHORIZED REPRESENTATIVE PRESIDENT ,EMPLOYER'S 1IA5ILITY LIMIT INCLUDING DEFENSE COSTSa $7,000;000.00 PER OCCURRENCE. `- ENDORSEMENTX2055 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE"12-31-2004 'IS ATTACHEDTO AND '::FORMS A PART OF TNIS POLI#;Y. - EMPLOYER AIECOM DATA SYSTEMS, 1055 ELIZABETH DR' RICHMOND KY 40475': (REV.3-03) LEGAL NAME INC CYCON DATA SYSTEMS, INC ,. , oo~~mmor~. 11/17/2004 ~ ACORD CERTIFICATE OF LIABILITY INSURANCE °"'~ ,~ ~ 03-24-2006 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION HAYWARD, TILTON&ROLAPP INS~PHS ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 185019 P: (866)467-8730 F: (877)905-0457 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. PO BOX 33015 - SAN ANTONIO TX 78265 INSURERS AFFORDING COVERAGE INBDaED -~~;3-4T ' INSURERA:Hartford Casualty Ins Co 1J. aoo3-U 78-d1 - /J 3-0~7 (j-Cy ~ INSUflER B: . [)p CYCOM DATA SYSTEMS INC N 3pc3-c~h-c3 INSURER C: 6 8 3 5 ROBERTA RD . S . W . A ~ 31XZ~ v 9 wsUREq o: . OCEAN ISLE BEACH NC 28469 '' ___ INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANV CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSU F D OR . MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGAT[ LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTa TYPE OF INSURANCE POIK:Y NUMBER DATETE IM FDD/YYI DATEYIMMIDOT/VYN LIMITS GENEIIAL LIABILITY EACH OCCURRENCE 1 0 0 0 O O O 5 , , A COMMERCIAL GENER A L LI A8ILITV 72 SBA NJ1649 06/04/06 06~04~O7 FIRE DAMAGE IAny one fiml 53OO, 000 ~ y ~ J CLAIMS MADE 1 " 1 OCCUR MED EXP IAny one petnon) 91 O , O O O X Bus>ness Liab PERSONAL&ADVINJURY j Sl OOO OGG , , GENERAL AGGREGATE 52 0 0 0 O O O , , GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG SZ , O O O , O O O POLICY PRO JECT X Loc AUT OMOBILE LIABILITY A ANV AUTO 72 SBA NJ1649 06/04/06 06/04/07 COMBINED SINGLE LIMIT IEa a~cltleml Sl, OOO, OOO ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per perm) S i X HIRED AUTOS X NON-OWNED AUTOS BODILY INJURY IPer accident) LLL S PflOPERTY DAMAGE S _ IPer accitlentl GARAGE LIABILITY AUTO ONLY ~ EA ACCIDENT 5 ANY AUTO OTHER THAN EA AUTO ONLY : AGG 5 EXCESS LIABILITY EACH OCCURRENCE S OCCUR a CLAIMS MADE -,* \;~ AGGREGATE _ ~_ I " ~ S DEDUCTIBLE A., _, ~- S ------~-- RETENTION 5 __ 1 4 WORNEAS COMPENSATpN AND -~ ~ WC STATU- OTH- EMPLOYEAS' LIABILITY TD __. E.L. EACH ACCIDENT 9 E.L. DISEASE - EA EMPLOYEE 9 ~- - C.L. DISEASE -POLICY LIMIT 5 ---~ OTNE11 I DESCRIPTgN OF OPERATIONS/LOCATIONSAIFNX:LESIE%CLUSNINb ADDED BY ENDORSEMENT/SPECIAL PROVISgNS Those usual to the insured's opertations. CERTIFICATE HOLDER ADDITNINAL INSUaeD: INSURER IETTER: CANCELLATION City Of Santa Ana its Officers SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Employees Agents & Volunteer EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOT C , I E 110 DAYS FOR NON-PAYMENT) TO THE CERTIFICATE Office of the City Attorney HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO 20 C1V1C Center Plaza OBLIGATION OR LIABILITY OF ANV KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. Santa Ana, CA 92701 A ORI D R ESE~N~]ATI1~f~~~~.~ ern°n oc c t~IO~r _ /~ ~~~'~~ `°-° '"""' ~' ACORD CORPORATION 7988 ~. II ACORD,N CERTIFICATE OF LIABILITY INSURANCE ' 03-23pT2007 II I rwwucEN 'I THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION I, I HAYWARD, TILTON&ROLAPP INS~PHS '. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE ', HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 185019 P: (866)467-8730 F: (877)905-0457 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. ' PO BOX 33015 INSURERS AFFORDING COVERAGE I SAN ANTONIO TX 78265 _ (INSURED n/-aQ03-p7g ''.wsuRERA:Hartford Casualty Ins Co N-~DO3_o~B--OI 'INSDgERa: ------ CYCOM DATA SYSTEMS INC /J~aD0,3-07S-Oa INSUREg c: I PO BOX 92437 078- 0 INSURER D: __ LONG BEACH CA 90809 N "aLb3- .3 'L INSURER E: COVERAGES r ANV REQUIREMENT, TERM OH CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICAI E MAV BE ISSUED OR ~ MAY PERTAIN, THE INSURANCE AFFORDED BV THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BV PAID CLAIMS. LTfl I TYPE OF INSURANCE POLICY NUMBER ~~"~~ `~"°~°` °`~°~ `°`~O°O"° LIMITS _ DATE IMMIDDIYYI DATE IMMIDDIVYI - _ _ IIA ' GENERAL LIABILITY ' COMMERCIAL GENERALLIABILITV 72 SBA NJ1649 06/04/07 EACH Of.CURRENCE I Sl , p p p, O p 0 1 06/04/08.HgEDAMAGEIAnyonerrel Is300,000 1 'I CLAIMS MADE X OCC R I II U 'I MEO E%P (Any one Pereonl ~I. 51 O , O O O L , X Business Llab 'I I I PERSONAL&ADV INJURY 51 , OOO, OOO ~ I ~ GENERAL AGGgEGATE 52 , 0 0 0, O O O 'L AGGREGATE LIMIT APPLIES PER: ~ ' ! P HODUCTS-COMP/OP AGG '~ 52, OOO, OOO _ POLICY ! PE OT I X LOC I ~' ~ ~~ A AUTOMOBILE LIABILITY ~ ANVAUro I 72 SBA NJ1649 ~ ' ~- ~ 'coMBINED SINGLE UMIr 51, 000, OOO I 0604/07 06~04~08 I IEsa°omenn I ', j 'ALL OWNED AUTOS ~~ ' BOUIIY INJURY SCHEDULED AUTOS 5 I IPer Persom I X HIRED AUTOS i '. -~i NON-OWNED AUTOS ~ 80DILV INJURY 5 I IPer accrdeml ~ ~ I PROPERTY DAMAGE 5 P i er acc I denU - GARAGE LIABILITY AUTO ONLY ~ EA ACCIDENT I S ' ANV AUTO '. II OTHER THAN EA ACC I S I I I AUTO ONLY.- AGG 15 '''~ EXCESS LIABILITY ' EACFI OCCURgENCE 5 I OCCUq I~~ CLAIMS MADE ~~ I AGGREGATE 5 _- DEDUCTIBLE 'i 5 1 '' S 1 ~` RETENTION 5 I 5 WORKERS COMPENSATION AND ' WC STATU- ~OTH- L_IOflY LIMITS ' ER~ EMPLOYERS LIABILITY _i I I E L. EACH ACCIDENT 5 L.L. UISEASt ~ to EMPLOYEE E.L. DISEASE ~ POLICY LIMIT V INEN ocawmmN m orcnw uons/COCA 110NS/V ENICLESIFXCLUSIONS ADDED BV ENDORSEMENTISPECIAL PROVISIONS Those usual to the insured's opertations. INSURER IETTFR: (City Of Santa Ana its Officers (Employees, Agents & Volunteer (Office of the City Attorney 20 Civic Center Plaza IlSanta Ana, CA 92701 JULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE '(RATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN NOTICE 110 DAYS POR NON-PAYMENT( TO THE CERTIFICATE LDER NAMED TO THE LEFT, BUT FAILURE TO DO SO Sh1ALL IMPOSE NO LIGATION OR LIABILITY OF ANV KIND UPON THE INSURER, ITS AGENTS OR 'RESENT ATIVES. A ORI D R E]~BEN~ATI1IF~y - /V Nt:uecu 25-5 V/97) '~ ACORD CORPORATION 1988 ~/ - ~Yv3 -~~ g' ~c~ ~-~ SUsf~mSi I~~c OATS DaWOIYYYYI ACORD CERTIFICATE OF LIABILITY INSURANCE 6 19/2007 PRODUCER (714)905-1923 PAYE (714)905-1910 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION AND CONFERS NO RIGHTS UPON THE CERTIFICATE HayLFarB Tilton & Rola Iasuranao Associates, pp ONLY HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 614365 # ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. License 0 888 S. Disneyland Dr. ST8 400 Aaahaim CA 92302 INSURERS AFFORDING COVERAGE NAIC K IN811RED INSURER A:BartfOrB CaaUSlt 29424 Cycom Data eysteEUE, Inc. INSU+Ene:Coatlaeatal Casualt P.O. Hox 92437 INSURERC I RER Long Heaa6 CA 90309-2437 INSURER E: THE POLIGES OF OISURANCE LISTED BELOW HAVE BEFN ISSUED TO THE DISURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NDTWITHSTANDING ANY TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY 6E ISSUED OR MAY PERTAIN, R£OIIIREMFM , THE INSURANCE AFFORDED HY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, IXCLUSIONS ANO CONDIT10N5 OF SUCH POLICIES. WEA TYPE OF UgURANCE POLICY IIUYBEa ~~ EFFECTIVE DAiE EEPI TON UYIn s 1, 000,ODO ~ ~ I Itt ~~OE ~ E 300, OD0 S RC IAL GENERALLWIL COI .Of A CLAIMS MADE ® aCCUR 7]HBAHJ1649Dr 6/4/10D7 6/4/]DOB DExP o S 10,000 s 1,000,000 E s 2,000,000 OENL AGGREGATE LIMITAPPLIESPER: E ],000,000 $ P L AUT OMOBILE LIABILITY COMBWED SINGLE LIMB s ANY A TO LEA xuoan) A U ALL DWNEDAUTGS T]SHAHJ166 PDr 6/4/]DOT 6/4/2003 BODILY INIURY s D AUTOS H IPe, P++1onl EDULE SC HIRED AVTOS BOOCY INJURY E NONdYINEDAUT05 IPa•acoesnD PROPERTY OHMAGE E (Pp unam) GARAGE WIBILRY AUTOONLY~EA ACCIOEM s ANY AUTO OTHERTHAN AUTOONLY: E ElCESSNYBRELIA W1&LRY E ~ CWMS IMDE C ~ UR OC ~ i R ~ / lS ~ ~' C ~ ~ I U~~M EDUC7uAE s D YiORNlRB COIPENSAT(ON AND ' J Cf;l Sr.! ~ ` LiIJ LWNIJTY EMPLOYERS /t Sb: iA li ' - CH ACCIDENT S ANYPROPRIETOR/PARTNFJLE7(ECUTNE . , t,.1 y jj( Ur•~•,,. OFFICERAAEMBER EXCLL(OEDT E.L DERiA4E •EA EMPLOYEE EYO, maalte lFleer I E H DTHER Errors a Omissions ]67B9B03B 7/16/]006 7/16/]007 Raoe cialm $1,000,000 Liability ABSragata 83. DOD, 000 DsduaLlEla 810,000 OEECRIPDON OF OPEIGTON&LOCATONINEXIOLEBIFXCLUNOMB ADDED HY EInOREFMENDSPECIAL PROM&ON8 Proot o[ lnsoranoo •10 Day HoCioa at Caneallsiioa !or Hon-Payment o! Pxemiw, 4,CRIRII,NIG RVWGn ~ ~- 9NDULD ANY OF THE ABOVE OEBCRDM97 PODCIES BE CAMClLLFD BEFOR! T11E City Of Santa An8 L.r%RA710N OAT! 7NERlOF. THE mSUIN6 INSURlR WILL ENDEAVOR TO MAIL ATTt1t Offiae of the City Attorney 30* DAYS WRITTEN NOTOE TO INS CER7IRCATE HOLDER NAYEO TO TXE LEFT.BUT 20 Civic Center Plana FAIWRE TO DO 80 SHALL UIP08E NO OBMOA7NJN OR LW81LfR'OF ANT qND UroNTHE Banta Ana, CA 92701 INSURER 178 AOENi80R RB-RESENTA71VE8. ~$~ AUTNORIa.D pEMEtlNTATIV! ~R.a n,..,~-~ V Julianne Spriggs/JJS n nneene wrlnu •mae IN8025 tololl.oEF P.ge 1 wl ACORD CERTIFICATE OF LIABILITY INSURANCE 6/19/2007' PRODUCER (714) 905-1923 FAX: (714) 905-1910 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Ha and Tilton ~ Role Insurance Associates, Y~ PP HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR License #0614365 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 8B8 S. Disneyland Dr. STE 400 Anaheim CA 92802 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURERA:HB.rt£Ord C88u81t 29424 Cycom Data Systems, inc. INSURER B: Continental Casualt P.G. EOX 92437 INSURER C: ~ INSURER D: Long Beach CA 90809-2437 INSURER E: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY OE ISSUED OR MAV PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGR LIMIT H WN V EEN RED CED BY PAI INSR AOD'L D TEY EM DD YE TION P C LIMITS TYPE OF INSURANCE POQCY NUMBER A I IY DAT E MMIDO GENERAL LIABILITY EACH OCCURREN E $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMGEiO RENTEDna $ 300,000 A CLAIMS MADE OCCUR 7288AHJ1649Dr 6/4/2007 6/4/2008 MED E%P An one arson $ 10,000 PE NAL ADVI $ 1,000,000 GENERAL AGGREGATE $ 2.000.000 GEN'L AGGREGATE LIMITAPPLIES PER: PR T - OMPIOPA E 2,000,000 g POLICY PrEO LOC AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accidenQ $ ANY AUTO A ALL OWNEDAUTOS 728BAHJ1649D8 6/4/2007 6/4/2009 gODILV INJVRY (Per person) E SCHEDULED AUTOS HIRED AUTOS BODILY INJURY E NON-0W NED AUTOS (Per accitlenq PROPERT'DAMAGE E ^yj ~ (Per accitlenQ GARAGE LU161LITY -S (~ S - ~ AUTO ONLY-EA ACCIDENT $ ANV AUTO nn~ - t'~ OTHER THAN $ J /'~ -~ AUTO ONLY: AGG $ E%CESSlUMBRELLA LIABILITY i ~ $ OCCUR ~ CLAIMS MADE ', V`. ~ ~(`.~-~ AGGREGATE $ ~ .u ' i,Sy $ ~/ - +~t L DEDUCTIBLE SL°' $ t , ,„ RETENTION WC STATU- OTH- WORKERS COMPENSATION ANO EMPLOYERS' LIABILDY ROPRIETOWPARTNER/EXECUTIVE E.L. EACH ACCIDENT $ ANY P OFFICERlMEMBER EXC W DED? E.L. DISEASE - EA EMPLOYEE $ If yes, describe under PE IAL PR VIS ON 1 w E.L. DISEASE-POLICY LIMIT 8 H OTHER grrorH & OmiHeiOne 267898038 7/16/2006 7/16/2007 sacb Clnim $1,000,000 Liability Aggregate $1,000,000 Deductible $10,000 DESCRIPTION OF OPERATIONS7LOCATIONSNENICLES/EXCLUSIONS ADDED BY ENDORSEMENf15PECIAL PROVISIONS Proof of Ineurnace •30 Day notice of Cancellation for non-Payment of Premium. rconxlreTC unl naa CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE City OE SHIIt8 AIIa E%PIRATIDN DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAIL ATTN: Office of the City Attorney 3O* DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT 20 Civic CeIItel PSaEB FAILURE TO DO SO SHALL IMPOSE NO OBDGATION OR QABILITY OF ANY KIND UPON THE Santa Ana, CA 92701 INSURER ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ~- li S i s/JJS v J anne pr gg u ACORD 25 (2007108) INS025 (DI oel.aea © ACORD CORPORATION 7988 Page 1 of 2 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certifcate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 INS025 poi oel.oea j ACORDTM CERTIFICATE OF LIABILITY INSURANCE o3-26ATZOOB PRODUCER ~~ THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION HAYWARD, TILTON&ROLAPP INS/PHS ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEN'J OR ' 18 5 019 P : (8 6 6) 4 6 7 - 8 7 3 0 F : (8 7 7) 9 O 5 - 04 5 7 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. PO BOX 3 3 015 1N-2003-078 I SAN ANTONIO TX 78265 INSURERS AFFORDING COVERAGE ~iNSURED ~' N-20033-07 ,;NS H~Rg.Hartford Casuall~Ins Co ___ l i ~ -- CYCOM L)ATA SYSTEMS INC N-2003-078-03 ~INSURERC -- PO BOX 9 2 4 3 7 N-2003-078-04 INSLwER °: ' ?,nNG BEACH CA 9 0 8 0 9 Ir.;suRER E: ___, --- COVERAGES ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHLCH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL TFiE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INTR TYPE OF INSURANCE POLICY NUMBER ___ LIMITS i DATE IMMFDDTYYE DATEYIMMIDD YION - GENERAL LIABILITY ~ '~ ~~ ~' EACH OCCURRENCE S Z , O O O , O O O , . A ~~ ~ COMMERCIAL GENERAL LIABILITY , 7 2 SBA NJl 64 9 ~ it 0 6 / 04 / 0 8 ' 0 6 / 04 / 0 9 ~ FIRE DAMAGE IAny one fire) ~, S 3 0 0 , 0 0 0 ~'~ ~' 'CLAIMS MADE ~~. X I, OCCUR ~! ~ MED EXP IAny one person) ~ S 1 0 , 0, 0 Il h l7e?le rcl l iL 1 ap I ~ '~ PERSONAL & ADV INJURY S l, 0 0 0, 0 O 0 T '. I ''. GENERAL AGGREGATE S 2, 0 0 0, O O O GEN'L AGGREGATE LIMIT APPLIES PER: '~ '~~ '~ PRODUCTS - COMPIOP AGG ~'I S2 , O O O , O O O ', i -- ~-',, POLICY ~'. II PRCT Iii X ~ LOC I -r -- ' .AUTOMOBILE LIABILITY _ ~ I ~ '. i, ' I COMBINED SINGLE LIMIT ~, Sl , 0 0 0 , 0 0 0 '~ accidentl 'IE ANYAlTiO ~A ~- ~72 SBA NJ1649 a 06/04/08(06/04/09 - Al L OWNED AUTOS 'r-i i i I ~ I ~ BODILY INJURY S !SCHEDULED AUTOS i 'i I, (Per person) ~~. ~, , ~' ~X '. HIRED AUl OS ~ ~~ I ' --? ~,, ~;, '~, BODILY INJURY '~ S ,. I ~y X 'NON-OWNED AUTOS I iPer accident) I _ ___ i I~ !i PROPERTY DAMAGE S I '~ I ~ (Per accident) _____~ ~~ GARAGE LIABILITY ~'~ AUTO ONLY - EA ACCIDENT ~~.,, S '~ 'r-~'~ ANY AUTO ~I ',. ', '~. OTHER THAN EA ACC~S '. I~ ', AUTO ONLY: AGG S ~ ' EXCESS LIABILITY ' I' ''~. EACH OCCURRENCE '. S ~~ i ', J' OCCUR I~~~I CLAIMS MADE ~ I ~ AGGREGATE 5 I ' , '„ S ~; DEDUCTIBLE !,I ~,.., S ~ i !RETENTION 5 + I I ~ S ~ i i WORKERS COMPENSATION AND WC STATU I OTH-I I , TORY LIMITS ~ ER i i I EMPLOYERS' LIABILITY I ~ '~ i ' I E L. EACH ACCIDENT 5 - I . '. i I ~.~. E.L.. DDISEASE - EQ EMPLOYEE ! S --- ' -_ 1_ ~~ '~ E.L. DISEASE -POLICY LIMIT i S OTHER i I I DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLESIEXCLUSN)NS ADDED BY ENDORSEMENTISPECIAL PROVISIONS (Those usual to the insured's opertations. ~~~ ~~ - - - - - CERTIF_I_CAT_E__HO_L_DER_ ~-AODITroIUAL INSURED; INS_uRER LETTEn: ,___ _CANCELLA_TIO_N ___ I i i SHC)ULD ANV OF THE ABOVE DESCRIBED POLICIES BE CANCELl.FO BEFORE THE ' ~ City Of Santa Ana its Officers EXPIRATION DATE. THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ' ~ Employees , Agents & Volunteer 30 DAYS WRITiE.N NOTICE (lU DAYS FOR NON-PAYMENT) TO THE CERTIFICATE i~ I Off 1Ce of the Clt Attorne HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO y y (OBLIGATION OR LIABILITY OF ANY KIND UPON 1 tIE INSURER, I fS AGENTS OR I20 C1V1C Center Plaza (REPRESENTATIVES. (Santa Ana, CA 92701 - ,' A ORI D RE ESEN AT1 I , ACORD 25-S (7/97) '~ ACORD CORPORATION 1988 WORKERS' COMPENSATION DECLARATION I Suzanne Gatti, Vice President and Secretary, hereby affirm under penalty of (Name/Title) perjury, the following declaration I certify on behalf of KOO Developments, Inc. that during the term of my (Organization Name) contract with the Public Works Agency, City of Santa Ana, I will not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. DATE: Apri14, 2008 By: KOO Developments, Inc., a California corporation f-~ - ~~:~,,. ~ r ~~~-~ By: ~' Suzanne Gatti, Vice President and Secretary Telephone: (310 200-2151 WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. ;, ,, ~'~~