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HomeMy WebLinkAboutCYCOM DATA SYSTEMS, INC. 1A-2004N-- ao~d. ~ ~e d l ~. INSURANCE ON FILE WORK MAY PROCEED UN~IL~ A~C~EXPIRES CLERK OF COUNCIL DATE,. "1 /5--a`{ FIRST AMENDMENT TO LICENSE AGREEMENT C -' C 14® THIS FIRST AMENDMENT TO LICENSE AGREEMENT, is entered into on as (~• P~cc,~~~ of the l sc day of July, 2004, by and between Cycom Data Systems, Inc., a California corporation ("Cycom") and the City of Santa Ana, a charter city and municipal corporation of the State of California ("City"). Recitals: A. The parties entered into Citylaw License Agreement no. A-2000-059, (hereinafter, "Citylaw Agreement) dated April 3, 2000, by which Cycom granted to City a nonexclusive 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 software. B. The parties entered into License Agreement#N-2003-078, dated July 1, 2003 to purchase a software module which integrates Citylaw software with Microsoft Outlook and which renewed the Citylaw Agreement Sofware Maintenance and Support services for an additional one year period (hereinafter, "said License") C. In accordance with the terms and conditions of the Agreement, the parties wish to renew said License for an additional one-year period. Wherefore, in consideration of the covenants contained in said License, and subject to all the terms and conditions of said License, except those amended in this First Amendment to License Agreement, the parties agree as follows: 1. The parties agree to renew the annual Software Maintenance and Support services pursuant to Section V of said License, at the rate set forth in Cycom;s invoice attached hereto as Exhibit A-3. 2. Section 2, COMPENSATION,is amended to read as follows: "The total sum to be expended under this Agreement shall not exceed $8,000, during the extended term of this Agreement, from July 1, 2004 through June 30, 2005." 3. Section 3, TERM, is amended to extend said License to June 30, 2005. 4. Except as hereinabove amended, all terms and conditions of said Licenses shall remain in full force and effect. PROVAL: CITY OF SANTA ANA AVID .REAM City Manager CYCOM DATA SYSTEMS, INC. ~~ --~ Don McGregor President 33-00381~~ Tax ID # or Soc. Sec. # IN WITNESS WHEREOF, the parties hereto have executed this First Amendment to License Agreement on the date and year first written above. ATTEST: PATRICIA E. HEALY Clerk of the Council APPROVED AS TO FORM: JOSEPH W.FLETCHER City Attorney ~ / r~ La a Sheedy Assistant City Attorney ~~ DATE (MMroD1YYYr- .~~'C?fZD CERTIFICATE ~~ LIABILITY INSURANCE os/17/zoo4 PRODUCER (7147905-1923 f (714)905-1910 THlS C TIFIGAT IS ISSUE AS A MA ER OF IN ORMATI N ONLY AND CONFERS NO RIGHTS UPON THE CERT1FlGATE Hayward Tilton & Rol app Ins . Assoc . , Inc , HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTENp OR License #0614365 ALTER THE COVERAGE AFFORDCD aY THE POLICIES BELOW. P.O. Box 25529 INSURERS AFFORDING COVERAGE NAIC # Anaheim, CA 92825-5529 INSURER A; INSURED Cycom Data Systems, Inc. Hartford Casualty Insurance Co 29424 INSURER 0; Cpntlnental Casualty 6835 Roberta Rd. S.W. Ocean Isle Beach , S[ 28469 INSURER C; INSURSR D: INSURER E: COVERAGES TWE POLICIES OF INSURANCE LISTED BELOW NAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE PC ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WWIC POL C ESTAIGGREGATE LM TS SHOWN MED HAVE SEEN RIEDUCED BY PAID CLAIMS. SUBJECT TO ALL THE TERI 4TR N3 TYPE OF INSURANCE PODGY NUMBER GATE MM1RR DATE MM1bD GENE.RALLIABILITY 725BAN71649DX 06/04/2004 06/04/2005 X GOMMERCIALGENEIRA~L~LIABILITY, CLAIMS MADE 171 I OCCUR A GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY jECT LOC AUTOMOB[LE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS '4 )( HIRED AUTOS ]( NON-OWNEb AUTOS 72SBANJ1649DX 06/04/2004 ~ 06/04/2005 GARAGE I.IABILITT ANV AUTO EXCE95/UMBRELLA LIABILITY OCCUR ~ CLAIMS MADE DEDUCTIBLE RETENTION § k ~w~ ~~`xy- " ~ ~-_ WORKERS COMPENSAnCtN AND EMPLOYERS' LIA6ILITY ANY PROPRIETORlPAR7NERrEXECUTIVE OFFICER/MEMBER EXCLUDED? If y65~ desCrlb6 UntlAr SPECIAL PROVISIONS belw+ rofessional Liability B 003 LiCY PERIOD INDICATED. NOTWITHSTANDING i THIS CERTIFICATE MAYBE ISSUED OR rIS, EXCLUSIONS AND CONDITIQNS OF SUCH uMITs EACH OCCURRENCE $ Z, OOO OOO OO $ 3 OO PR MISES Ee OCWren , MED EXP (Any one person) $ 1Q , QO PERSONAL & AOV INJURY $ ~ r OOO r 00 GENERAL AGGREGATE $ 2 ODa, OO PRODUCTS - COMPIOP AGG $ 2 ' QOO , OO COMBINED SINGLE LIMB E (Ea acdaenU 1 000, 00 GORILY INJURY S (Per person) BODILY INJURY § (Per aCCld~~) PROPERTY DAMAGE ~ (P¢r a~cideni) AUTO ON("Y , EA ACCIDENT $ OTHER THAN EA ACC S AUTO ONLY: AGG $ EACH OCCURRENCE S AGGREGATE § S § TORY LIMITS ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE S E.L. DISEASE -POLICY LIMIT b 51,000,000 Aggr. Incl Expenses 51,000,000 Each Wrongful Act 510,000 beductible attached Additional SCRIPTION OF DPERAITION$ J LOCATION51 VEHICLE91 EXL!-USIONS ADDED BY ENDORSEMENT! SPECIAL PROVISIONS rtY~°icate Holder is Additional Insured as respects General Liability per sured Endorsement 55 04 49 05 93. en days notice of cancellation given for non-payment of premium. CERTIFICATE City of Santa Ana Office of the City Attorney Attn: Juanita Hernandez 20 C1vic Center Plaza Santa Ana, CA 92701 ACORD 25 (2001/06) INCELLATION SHOULD ANT OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE ExPIRATION GATE THEREOF, THE ISSUING INSURER WILL ENbEAVOR TO MAIL ,~~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED T4 THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SMA44 IMPOSE NO OBLIGATION DR LIABILITY OF ANY IOND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVE$_ rlioielxED REPRESENTATIVE L e hen Mori ama ML5 Ste I1e~ Ot r yam q @AEORD-CORPORATIt~N 1988 ~. ,,~HE t TFO~D THIS ENDORSEMENT CHANGES THE PpLtCY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: 72SBANJ1649 BUSINESS LIABILITY COVERAGE FORM G. Who is an Insured in the BUSINESS LIABILITY ar losses covered under the BUSINESS C. Wha is an insured in the BUSINE55 LIABILITY For losses covered under the BUSINESS COVERAGE FORM Is amended to include as an t,IABILITY OVERAGE of this policy this Insurance Is insured the person ar organization shown in the primarily to other valid and collective insurance which Is Declarations but only with respect to Ilabitity arising available to the person or organization out of the operations of the named Insured. shown In the Declarations as an Additional Insured. Additional Insured: City of Santa Ana 20 Civic Cemter Plaza Santa Ana, CA 9270t -~ ,I ~ l~ ,, ~ Form SS 04 49 05 93 Printed in U.S.A. (NS) Copyright, Hertford Fira Insurance Company, 1993 CERTHOLDER COPY STATE P.O. BOX 420807, SAN FRANCISCO, CA 94142-0807 COMPENSATION I N S U R A N C E FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 06-17-2004 GROUP: 000626 POLICY NUMBER: 31s-2003 CERTIFICATE ID: zs CERTIFICATE EXPIRES: 12-31-2004 12-31-2003/12-31-2004 OFFICE OF THE SANTA ANA CITY ATTORNEY ATTN MS JUANITA HERNANDEZ 20 CIVIC CENTER PLAZA SANTA ANA CA 92701 This is to certify that we have issued a valid Worker's Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 30 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, extend or alter the coverage afforded by the policies listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued 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 ~D~ ~ . ~ PRESIDENT EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #1600 - CLIFFORD DON MC GREGOR, PRES - EXCLUDED. ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 12-31-2001 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. ~,~. EMPLOYER CYCOM DATA SYSTEMS, INC 1055 ELIZABETH DR. RICHMOND KY 40475 INR,SPj PRINTED: 06-17-2004 SCIF 10262E Accept this certificate only if you see a faint watermark that reads "OFFICIAL STATE FUND DOCUMENT" PAGE 1 OF 1 RTHOLDER COPY SP ATE P.O. BOX 807, SAN FRANCISCO,CA 94142-0807 COMPENSATION' INSURANCE ~ 1_~~~_D.7 ~1 FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE Ili _ ~CJC~3-C7~'-C%/ ISSUE DATE: 12-31-2004 GROUP: 000828 - POLICY NUMBER: 0000318-2004 CERTIFICATE ID: 28 - CERTIFICATE EMPIRES: 12-31-2005 12-3t-2004/12-31-2005 OFf1CE OF THE SANTA ANA CITY ATTORNEY Joe: ATTN MS :fUANITA 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 tho omploycr named below for the pofcy period indicated. This policy is not subject to cancellation by the Fund except upon 30 days' advance written notice to the employer. We will also give you 30 days'aduance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extendor alter the coverage afforded by the polices Ustetl harem: Notwithstanding any requirement, term, or condition of any contract or other document. wnh respect to which this deftificate of insurance may be-issued 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 COSTS: 57,000;000.00 PER OCCURRENCE. `- ENDORSEMENT X2085 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE"72-31-2004 'IS ATTACHEDTO AND 'FORMS A PART OF TNIS POLICY. - EMPLOYER wev LYCOM DATA SYSTEMS, INO--- 1055 ELIZABETH DR' RICHMOND KY 40475'.. LEGAL NAME CYCONDATA SYS7EM5, INC oo~~iror~. 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. ;, ,, ~'~~