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HomeMy WebLinkAboutC.J. AVERY 1-2004 . iNSURltl'vt. ON He" WORI' ¡;,;.:: :'ROCEl\) UNTIE INSURANCE EXPIRES 1!2'IO -01- CLERK Of COUNCIL CONSULTANT AGREEMENT DATE, 3-/7-0'/ . THIS AGREEMENT, made and entered into this ~ day of YYiaých ,2004 by C. Cb~. and between C. 1. Avery dba C. J. Avery Building General Maintenance (hereinafter ljIja)dj~ "Consultant"), and the City of Santa Ana, a charter city and municipal corporation organized and existing under the Constitution and laws of the State of California (hereinafter "City"). N-2004-020 RECITALS A. The City desires to retain a consultant having special skill and knowledge in the field of general maintenance to board up unoccupied buildings owned by the City. B. Consultant represents that Consultant is able and willing to provide such services to the City. C. In undertaking the performance of this Agreement, Consultant represents that it is knowledgeable in its field and that any services performed by Consultant under this Agreement will be performed in compliance with such standards as may reasonably be expected from a professional consulting firm in the field. 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 Consultant shall perform board-up services as requested by City, as set forth in Exhibit A to this Agreement. 2. COMPENSA nON a. City agrees to pay, and Consultant agrees to accept as total payment for its services, the rates and charges identified in Exhibit A. The total sum to be expended under this Agreement, shall not exceed $10,000.00 during the term of this Agreement. b. Payment by City shall be made within thirty (30) days following receipt of proper invoice evidencing work performed, subject to City accounting procedures. Payment need not be made for work which fails to meet the standards of performance set forth in the Recitals which may reasonably be expected by City. 3. TERM This Agreement shall commence on February 1,2004 and terminate on June 30, 2004, unless terminated earlier in accordance with Section 12, below. The term of this Agreement may be extended upon a writing executed by the Executive Director of the Community Development Agency and the City Attorney. 4. INDEPENDENT CONTRACTOR Consultant shall, during the entire term of this Agreement, be construed to be an independent contractor and not an employee of the City. This Agreement is not intended nor shall it be construed to create an employer-employee relationship, ajoint venture relationship, or to allow the City to exercise discretion or control over the professional manner in which Consultant performs the services which are the subject matter of this Agreement; however, the services to be provided by Consultant shall be provided in a manner consistent with all applicable standards and regulations governing such services. Consultant shall pay all salaries and wages, employer's social security taxes, unemployment insurance and similar taxes relating to employees and shall be responsible for all applicable withholding taxes. 5. INSURANCE Prior to undertaking performance of work under this Agreement, Consultant shall maintain and shall require its subcontractors, if any, to obtain and maintain insurance as described below: a. Commercial General Liability Insurance. Consultant shall maintain commercial general liability insurance naming the City, its officers, employees, agents, volunteers and representatives as additional insured(s) 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 Consultant'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$I,OOO,OOO per occurrence. Consultant shall supply City with a fully executed additional insured endorsement in substantially the form attached hereto as Exhibit B upon execution of this Agreement and shall be approved in form by the City Attorney. b. Business automobile liability insurance, or equivalent form, with a combined single limit of not less than $1,000,000 per occurrence. Such insurance shall include coverage for owned, hired and non-owned automobiles. c. Worker's Compensation Insurance. In accordance with the provisions of Section 3300 of the Labor Code, Consultant, if Consultant 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, Consultant agrees to obtain and maintain any employer's liability insurance with limits not less than $1,000,000 per accident. d. The following requirements apply to the insurance to be provided by Consultant pursuant to this section: 2 (ii) Consultant shall maintain all insurance required above in full force and effect for the entire period covered by this Agreement. Certificates of insurance shall be furnished to the City upon execution of this Agreement and shall be approved in form by the City Attorney. 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. (i) (iii) e. If Consultant 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. Such termination shall not effect Consultant's right to be paid for its time and materials expended prior to notification of termination. Consultant waives the right to receive compensation and agrees to indemnify the City for any work performed prior to approval of insurance by the City. 6. INDEMNIFICATION Consultant agrees to and shall indemnify and hold harmless the City, its officers, agents, employees, consultants, special counsel, and representatives from liability: (I) for personal injury, damages, just compensation, restitution, judicial or equitable relief arising out of claims for personal injury, including health, and claims for property damage, which may arise from the direct or indirect operations of the Consultant or its contractors, subcontractors, agents, employees, or other persons acting on their behalf which relates to the services described in section I of this Agreement; and (2) from any claim that personal injury, damages, just compensation, restitution, judicial or equitable relief is due by reason of the terms of or effects arising from this Agreement. This indemnity and hold harmless agreement applies to all claims for damages, just compensation, restitution, judicial or equitable relief suffered, or alleged to have been suffered, by reason of the events referred to in this Section or by reason of the terms of, or effects, arising from this Agreement. The Consultant further agrees to indemnify, hold harmless, and pay all costs for the defense of the City, including fees and costs for special counsel to be selected by the City, regarding any action by a third party challenging the validity of this Agreement, or asserting that personal injury, damages, just compensation, restitution, judicial or equitable relief due to personal or property rights arises by reason of the terms of, or effects arising from this Agreement. City may make all reasonable decisions with respect to its representation in any legal proceeding. 7. CONFIDENTIALITY If Consultant receives from the City information which due to the nature of such information is reasonably understood to be confidential and/or proprietary, Consultant agrees that it shall not use or disclose such information except in the performance of this Agreement, and further agrees to exercise the same degree of care it uses to protect its own information of like importance, but in no event less than reasonable care. "Confidential Information" shall include all nonpublic information. Confidential information includes not only written information, but also information transferred orally, visually, electronically, or by other means. Confidential information disclosed to either party by any subsidiary and/or agent of the other party is covered by this Agreement. The foregoing obligations of non-use and nondisclosure shall not apply to any information that (a) has been disclosed in publicly available sources; (b) is, through no fault of the Consultant disclosed in a publicly available source; (c) is in rightful possession of the Consultant without an obligation of confidentiality; (d) is required to be disclosed by operation of law; or (e) is independently developed by the Consultant without reference to information disclosed by the City. 8. CONFLICT OF INTEREST CLAUSE Consultant covenants that it presently has no interests and shall not have interests, direct or indirect, which would conflict in any manner with performance of services specified under this Agreement. 9. NOTICE Any notice, tender, demand, delivery, or other communication pursuant to this Agreement shall be in writing and shall be deemed to be properly given if delivered in person or mailed by first class or certified mail, postage prepaid, or sent by telefacsimile or other telegraphic communication in the manner provided in this Section, to the following persons: To City: Clerk of the City Council City of Santa Ana 20 Civic Center Plaza (M-30) P.O. Box 1988 Santa Ana, CA 92702-1988 telefacsimile (714) 647-6956 With courtesy copies to: Executive Director the Community Development Agency City of Santa Ana 20 Civic Center Plaza (M-25) P.O. Box 1988 Santa Ana, California 92702 telefacsimile (714) 647-6736 and, City Attorney City of Santa Ana 20 Civic Center Plaza (M-29) P.O. Box 1988 Santa Ana, California 92702 telefacsimile (714) 647-6515 4 To Consultant: C. J. Avery Building General Maintenance P.O. Box 1105 Placentia, California 92871 Telefacsimile (714) 996-1901 A party may change its address by giving notice in writing to the other party. Thereafter, any notice, tender, demand, delivery, or other communication shall be addressed and transmitted to the new address. If sent by mail, any notice, tender, demand, delivery, or other communication shall be effective or deemed to have been given three (3) days after it has been deposited in the United States mail, duly registered or certified, with postage prepaid, and addressed as set forth above. If sent by telefacsimile, any notice, tender, demand, delivery, or other communication shall be effective or deemed to have been given twenty-four (24) hours after the time set forth on the transmission report issued by the transmitting facsimile machine, addressed as set forth above. For purposes of calculating these time frames, weekends, federal, state, County or City holidays shall be excluded. 10. EXCLUSIVITY AND AMENDMENT This Agreement represents the complete and exclusive statement between the City and Consultant, and supersedes any and all other agreements, oral or written, between the parties. In the event of a conflict between the terms of this Agreement and any attachments hereto, the terms ofthis Agreement shall prevail. This Agreement may not be modified except by written instrument signed by the City and by an authorized representative of Consultant. The parties agree that any terms or conditions of any purchase order or other instrument that are inconsistent with, or in addition to, the terms and conditions hereof, shall not bind or obligate Consultant nor the City. Each party to this Agreement acknowledges that no representations, inducements, promises or agreements, orally or otherwise, have been made by any party, or anyone acting on behalf of any party, which are not embodied herein. 11. ASSIGNMENT Inasmuch as this Agreement is intended to secure the specialized services of Consultant, Consultant may not assign, transfer, delegate, or subcontract any interest herein without the prior written consent of the City and any such assignment, transfer, delegation or subcontract without the City's prior written consent shall be considered null and void. Nothing in this Agreement shall be construed to limit the City's ability to have any of the services which are the subject to this Agreement performed by City personnel or by other consultants retained by City. 12. TERMINATION This Agreement may be terminated by the City upon thirty (30) days written notice of termination. In such event, Consultant shall be entitled to receive and the City shall pay Consultant compensation for all services performed by Consultant prior to receipt of such notice of termination. Payment need not be made for work which fails to meet the standard of performance specified in the Recitals of this Agreement. 13. DISCRIMINATION Consultant shall not discriminate because ofrace, color, creed, religion, sex, marital status, sexual orientation, age, national origin, ancestry, or disability, as defined and prohibited by applicable law, in the recruitment, selection, training, utilization, promotion, termination or other employment related activities. Consultant affirms that it is an equal opportunity employer and shall comply with all applicable federal, state and local laws and regulations. 14. JURISDICTION - VENUE This Agreement has been executed and delivered in the State of California and the validity, interpretation, performance, and enforcement of any of the clauses of this Agreement shall be determined and governed by the laws of the State of California. Both parties further 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. 15. PROFESSIONAL LICENSES Consultant shall, throughout the term of this Agreement, maintain all necessary licenses, permits, approvals, waivers, and exemptions necessary for the provision of the services hereunder and required by the laws and regulations of the United States, the State of California, the City of Santa Ana and all other governmental agencies. Consultant shall notify the City immediately and in writing of its inability to obtain or maintain such permits, licenses, approvals, waivers, and exemptions. Said inability shall be cause for termination of this Agreement. 16. MISCELLANEOUS PROVISIONS a. Each undersigned represents and warrants that its signature hereinbelow has the power, authority and right to bind their respective parties to each of the terms of this Agreement, and shall indemnifY City fully, including reasonable costs and attorney's fees, for any injuries or damages to City in the event that such authority or power is not, in fact, held by the signatory or is withdrawn. b. All Exhibits referenced herein and attached hereto shall be incorporated as if fully set forth in the body of this Agreement. II II II II II 6 IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first above written. CITY m' 2 ~AM City Manager APPROVED AS TO FORM: JOSEPH W. FLETCHER City Attorney By: Laura Sheedy Assistant City Attorney! RECOMMENDED FOR APPROVAL: CONSULTANT ~~'kJ~ t IU'OHN P. EKSTIN Executive Duector of the Community Development Agency J j. ~ -3/lIkN C.J. AVERY Owner TaxID# 13o.!¿ J' 'i6~ 7 roposa C.J. AVERY BUILDING GEN. MAINT. General Contractor P.O. Box 1105 PLACENTIA, CALIFORNIA 92871 Lic. #554601 Fed. 1.0. 330328962 (714) 996-4240 FAX (714) 996-1901 E-Mail cavery5348@aol.com Pr_1 Submitted To Phone City of Santa Ana, Housing Division M-37 (714) 667-2294 Page No. of .. ~ 2/18/2004 20 Civic Center Plaza, P.O. Box 1988 Sarita Ana,Ca. 90702 e ArchRect Dale 01 Plene eme George Garcia /I Arabela Saldivar on Asst Propertys. We Hereby eubmR epecIllcellone end 8811I11III88101': Tl1is bid is to set pricing, as requested in areas as listed below. 1. Service call : For purpose of Evaluation or to do a certain called item. 2. Normal board up of propertys for City of Santa Ana: Interior style only. a. Windows 2' X 3' and smaller. b. Windows 3' X3' and up to 4' X 5' c. Windows 4' X 6' and up to 4' X 8' d. Windows Larger are by bid only, based on time & materials needed. e. Normal FHA Door board up with heavy duty hindges + hasp & lock (Front only.) f. Doors larger than 36" X 80' are by bid or by time & materials. g. Single garage doors, board up. (No entry ) h. Double garage door, board up to 18' X 7' (No entry) i. Any door brace on interior. 2X4's double style. j. Other than new door add hasp to lock dosed, for entry by inspector. k. All other board up done by Time & Materials. 3. Special note any project if it is over $ 350.00 No Service call will be charged. 4. Ether need combo of locks needed, fumished or not, if not regular Masters used ?? Notice Contractors are required by law to be liCensed and regulated by the Contractors' State License Board. Any questions concerning a contractor may be referred to the Registrar Contractors' Slate Ucense Board, 9835 Gaeth Road, Sacremento. Calilornia 95827. Mailing address: P.O. Box 26000, Sacramento, Camornla 95826. You, as Owner or Tenant, have the right to require the Contractor to have a Performance and Payment Bond. Page. e $ $ $ $ $ $ $ $ $ 75.00 25.00 45.00 65.00 Open 125.00 Open 185.00 295.00 25.00 25.00 OPEN You, as the buyer, may cancel this transaction at any time prior ot midnight of the third business day after the date of this transaction. f:- thA AttA~hAl'l nntl~A nl ~An~AiI"'inn form lor An A>cpIAnAtion of thl. right . I manner a:x:ordng to -.I ¡ndioo& Any alteration or deviation from above spclflca- ~ r~=g .=a:...:. beth.~,:,iY r =~=r=~ """idents or delays beyond our control. Ov",ar to cerry fire, - ..,d other necessary insurMC8. Our worka'" ara luily covered by Wori<men's Compensation insurance. Acceptance of Proposal. The above prices. specilications and conditions are salisfactory and are hereby accepted. You are authorized Si!J1Eture 10 do the work as specified. Payment will be made as outllnedabove. Dale of Acceptance: SI!J1a/1Jre days. EXHIBIT B ADDITIONAL INSURED ENDORSEMENT FOR COMMERCIAL GENERAL LIABILITY POLICY 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, volunteers and representatives are named as additional insureds ("additional insureds") with regard to liability and defense of suits arising 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 cancelled, 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 Policy # Issued to , this endorsement form as a part of Named Insured Countersigned by Authorized Representative J 'ACORD .CERTfFICATI: OF LIABILITY INSURAJ<'CE " DATE MMlDOIYYYY) -- ., . 10/23/2003 PRODU.ER (714)245-2777 FAX (. ~4)245-1788 THIS CERTIFICATE Iv .":SUED AS A.~TTER OF INFORMATION Assistance Insurance Agency, Inc. ~~tb:~~~I~~::iìF~2A'r;~Ò~~~<Ö~ :.~g~~J::~~~OR 400 N. Tustin Avenue Ste 470 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Santa Ana, CA 92705 INSURERS AFFORDING COVERAGE COIIIIIercial Lines NArc # INSURED C J Avery Buildlng General Malntalnance INSURER A' Colony Insurance Company P.O. Box lI05 INSURER B' American Employers Group Placentia, CA 92870 INSURER c, INSURER 0-. INSURERE: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSUREO NAMEO ABOVE FOR THE POLICY PERIOD INDICATEO. NOfWlTHSTANOIN ANY REQUIREMENT. TERM OR CONDITION OF AN'( CONTRACT OR OTHER OOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES OESCRIBEO HEREIN IS SUBJECT TO All THE TERMS. EXCLUSIONS AND CONDmONS OF SUCH POliCIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REOUCEO BY PAID CLAIMS. LTIt NSR TYPE OF INSIlRANCE GENERAL UAIIII.ITY X COMMERCIAL GENERAL LIABILITY ClAIMS MADE ill OCCUR POLICY NUIIBER OATE Llms ffl(+W2004 EACH OCCURRENCE $ """'" """" $ MEOEXP(Any"""peoson) $ PERSONAL S AOV INJURY $ GENERAL AGGREGATE $ PROÐUCTS.COMPiOPAGG $ A COMBINED SINGLE LIMIT (Eo acdd",') BODILY INJURY (f'e< peoson) BOOILYINJURY (P...-dent) OCT 2 9 2003 ANY AUTO OTHER THAN AUTO ONLY, EACH OCCURRalCE AGGREGATE PROPERTY DAMAGE (""acddenll AUTO ONLY - EAACCIOEHT $ EAACC $ AGG $ $ $ $ $ $ EXCE.SSIUMBRELlA LIABILITY OCCUR 0 ClAIMS MADE DEOUCTIBI.£ RETENTIOH WORKERS COMPENSATION AHO EMPLOYERS' LIABIUTY B ~~~..w~N,16~'6?ŒCUTIVE ~~~S-- OTHER 236680 01/22/2003 01/22/2004 10000 10000 100000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I PROVISIONS 'er Jobs Contracted on the. Property Rehabilitation Loan Program. See additional insured endorsement .ttached. 0 day notice of cancellation clause for non-payment of premium. CERTIFICATE HOLDER Crai The Community Redevelopment Agency Of The City Of Santa Ana" The City Of Santa Ana Its Officers, Agents, " Employees Atten: Arabela Saldivar P.O. Box 1988-M-26 Santa Ana, CA 92702 ~CORD 25 (2001/08) .fÞ1ÞT i' IOI2J120(13 P: 2~ f714."~2ï88 .. '-À~'šl'~~;"'c.e i~;;,~r-;¿~~u. uc.. "'" """"" "',,; "'4PM P2 So~'c} Sanl",...c'J. Av",y ~/i ...... ~ Colony In8Uraace ~OIIIP4nY r"Ct~~~71"'" dIOCIIØM ~~..... """""'GIIIIOf NIq ~GI:-1:~....~~~=:'-"'~,I ~='r'-= ............~- - ...4.0"""""""'" - " I.....""'. .............. CO - - r' . ........,......... . ....... ... .... ..... .... -... ~ "- iid -...... .., - - w.tF d""'" ...... . 2. WIIII......- 8O"" ..... .. "* .......... - JIIIII.-I Þ)' .... ...... fit.. -- --. -. --- . .. ..... ... .. ,.." .If ~ .. .. ........ .. l1li' - 11\...'" ..,...,..... -s.41Q1-"" ... .......atilt................ . !I. .... -- =--........, . "'1IfI8I8l...... -- dabø lit :=::=~~ . ~:'JI!8=zr.-:.~w:.J:... ~OI'-.".. '-.-..-..cIIIiII8t...........", .c. 'WIlla ~ . .. ....... ......... .... ~ IIWI- .. """"""~""""""""" I' -I!drtfÇlCf_'llftlll8a. "",-""".",~ ',"1F1- J .~""CiIlciSlrø A8.. 111 ~ CMW II8Ia ~.... -. CíìIRInk D?O L (CoAIpSeII1II fII tile ~. ....,.. ~ Is rap.InI4 to 1ntb thiI """"y8J JI8c8.,. 1'8IIIl¥. :(..-I.. 10-23-2003 ,..... l' 'T'ta....f*t"" ~~~:~~~ ::.~£ m-~<;'4 k- APPROVED AS TO FORM "'.""'."""""""""""'" . -----"- --"."".".. , ,,~,,- ,~. . ,.~JJU.JU. r"L>'~::>""""+l";"~HMt-';;S '.. . . INTERINSURANCE EXCHANGE of the Automobile Club ~ AUTO CLUB MEMBERS' PREFERRED PERSONAL UMBRELLA POLICY RENEWAL DECLARATIONS PLEASE REAO; 'rhese daoIarallol>S constltulo our olle' 10 renew this ln~urÐnce for lhe policy period shOwn below. Ronowal is contingent upon your payment otthe Balance Due belo,e or on the Due Date shOwn in the detaahable Insurance G~ling bolow. Fa«ure ra oay the Balanc. Duo before or on the Due Dot. shah mean that you rojo<:tod this renewel oIfer. AU coverago allorøoø by this poIioy w¡' 111sn \Ofmlna'o at 12:01 8.m.. . Paaifro SlandarØ rom. on tho Ef!ecUve Dete shown in these doclaraUon. under .policy Poriod.' The.. d.cl.,.r;on.. roo.rh.' ",ilh Ihe con"a.'."" the endorsements In .Uoc~ comploto your policy. ITEM 1. YOUR NAME AND ADDRESS A AVERY. CARROL AND DORIS 1331 LIMERICK DR PLACENTIA. CA 92870 POLICY NUMBER UP 6831867 ITEM 2. lIMfT OF lIASIUTY: $ 1.000.000 IN EXOESS OF THE LIMITS OF LIABILITY OF PRIMARY INSURANCe POLICY PERIOD: Pacific $10_'" Tin'e FROM 10/10/03 ~2~\o10/10/04 Á.~~' EFFECTIVE DATE EXPIRATION DATE DEDUCTIBLE: $250 ITEM 3. SOHEDULE OF REQUIRED MINIMUM PRIMARY INSURANCE LIMITS OF LIABILITY DESCRIPTION &ODIL Y INJIJIIY t'ROI'ER'rv OAMAGI: LIAbiLITY COMPREHENSIVE PERSONAL LIABILITY $500,000 (OR HOMEOWNERS LIABILITY) AUTOMOBILE LIABIL!TY $500,000/500,000 $100,000 ~ATERCRAi:r lIA8lUTY $500,000 WARNING: THE "MAINTENANCE OF PRIMARY INSURANOE" PROVISION OF YOUR POlICY INVOKES COVERAGE LIMIT ATION$ IF PRIMARY INSURANCE IS NOT MAINTAINED. PL£.6.SE REVIEW YOUR POlIOY CAREFULLY. TEM 4. ENDORSEMENTS IN EFFECT PREMIUM 2355 - AMENDA:rORY ENDORSEMENT s 0 TEM 5. POliCY PREMIUM !XI'OSuRf PAEMIUM BASIC - eIlEOlTNO. TEAPJTORY ëXPOSlJ!OE PREMI\}M '""OOIU~, )' PII!!MIUM HIGH LfMrr PREMIUM CA SUFICHARGE TOT At POlICY PReMIUM 1593-19 1 $ $ $ ~ $ ,. I SEE REVERSE I - ,.. FOR QUESTIONS OR CHANGeS. CALL TOLL-FREe V DETACH HERE AND RETURN WITH PREMJUMPAYMENT V 1-800.924-6141 '~ t'o-"" '."0.'