HomeMy WebLinkAboutR.M. SYSTEMS, INC. 1 - 2004
N-2004-065
INSURANCE NOT ON FILE
WORK MAY NOT PROCEED
CLERK OF COUNCIL
DATE: ~-5 -öt CONSULTANT AGREEMENT
t: tt>f1 Lit^-
(t'. Pi I~} THIS AGREEMENT made and entered into this /7 day of ::IMG ,2004 by
. 1t and between R.M.Systems, Inc., a California corporation (hereinafter "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").
RECITALS
A. The City desires to retain a consultant having special skill and knowledge in the field of
public address system installation, retrofit and repair.
B. Consultant represents that Consultant is able and willing to provide such services to the
City.
C. In undertaking the perfonnance of this Agreement, Consultant represents that it is
knowledgeable in its field and that any services perfonned by Consultant under this
Agreement will be perfonned in compliance with such standards as may reasonably be
expected from a professional consulting finn 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 perfonn those services as set forth in Exhibit A to this Agreement.
Consultant shall perfonn additional services relating to the upgrading of the public address
system at the Santa Ana Depot, as requested in writing by the Executive Director of the
Community Development Agency.
2.
COMPENSATION
a. City agrees to pay, and Consultant agrees to accept as total payment for its services
relating to the installation of a public address microphone, the rates and charges identified in
Exhibit A. The total sum to be expended under this Agreement, shall not exceed $9,000.00
during the tenn of this Agreement.
b. Payment by City shall be made within thirty (30) days following receipt of proper
invoice evidencing work perfonned, subject to City accounting procedures. Payment need not
be made for work which fails to meet the standards of perfonnance set forth in the Recitals
which may reasonably be expected by City.
3.
TERM
This Agreement shall commence on the date first written above and tenninate on June 30,
2005, unless tenninated earlier in accordance with Section 12, below. The tenn of this
Agreement may be extended upon a writing executed by the Executive Director of the
Community Development Agency and the City Attorney.
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4.
INDEPENDENT CONTRACTOR
Consultant shall, during the entire tenn of this Agreement, be construed to be an
independent contractor and not an employee ofthe City. This Agreement is not intended nor
shall it be construed to create an employer-employee relationship, a joint venture relationship, or
to allow the City to exercise discretion or control over the professional manner in which
Consultant perfonns 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
perfonnance 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. Consultant shall supply City with a fully executed
additional insured endorsement in substantially the fonn attached hereto as Exhibit B upon
execution of this Agreement and shall be approved in fonn by the City Attorney.
b. 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 perfonnance 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.
c. The following requirements apply to the insurance to be provided by Consultant
pursuant to this section:
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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 perfonnance 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 of Community Development
City of Santa Ana
20 Civic Center Plaza (M-86)
P.O. Box 1988
Santa Ana, California 92702
telefacsimile (714) 647-6939
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
To Consultant:
R.M. Systems, Inc.
P.O. Box 4013
Orange, California 92863-4013
Telefacsimile (714) 633-0924
Attn:
Rejean Royer
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
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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 tenns of this Agreement and any attachments hereto, the
terms of this 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 tenns 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 perfonned by City personnel or by other consultants retained by City.
12.
TERMINATION
This Agreement may be tenninated by the City upon thirty (30) days written notice of
tennination. In such event, Consultant shall be entitled to receive and the City shall pay Consultant
compensation for all services perfonned by Consultant prior to receipt of such notice of tennination,
subject to the following conditions:
a. Payment need not be made for work which fails to meet the standard of perfonnance
specified in the Recitals of this Agreement.
13.
DISCRIMINATION
Consultant shall not discriminate because of race, 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, tennination or
5
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 ofthis 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 ofthis 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.
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IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year
first above written.
ATTEST:
;J_. ~
(,..;)~~ I .
PATRICIAE.HEALYv .'
Clerk of the Council
CITY OF SANTA ANA
J
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City Manager
APPROVED AS TO FORM:
JOSEPH W. FLETCHER
City Attorney
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By: \[I.tJv\{L, 1 \} (¡~I
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Laura Sheedy I
Assistant City Attorney'
RECOMMENDED FOR APPROVAL:
CONSULTANT
JO~EKSI1N
Executive Director of the
Community Development Agency
~~~
Gl;;l1l::Ial Faltl1e1 pRoJ t'~T MaIL'
Tax ID# Ó 1- 01 'lJ I \.{ S-
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R. M. SYSTEMS INC.
P.O. Box 4013
Orange, Ca 92863-4013
633-0913 Fax (714) 633-0924
State License # 640032
PRO'POSAL
The Depot At Santa Ana
1000 E. Santa Ana .
Santi' Ana C~.92701
Att: Carolyn Fullerton .
PROJECT: The Depot Office Microphone
----..-"
PROPOSAl. No.4
DATE: 3/25104
This proposal supersedes any oral quotation which ml!Y have been furnished by :st:ller to buyer with respect to the
above mentioned project. The prices and tenns on this proposal are not subject to oral changes or other agreements
unless approved by seller in vmtmg. Proposals are 'laird for 30 days but cancelable In the event of strikes, accIdents.
fires and material availability and all other causes beyond seller's control. Tenus inconsistent with order will not be
binding on seller. Prices cover only materials listed below based on our interpretation of plans and specifications.
Additional equipment unless negotiated prior to order placement shall be bIlled accordingly and become an integr.d
part of any Contract, Written Agreement, or Purchase Order. There is a re-stocking fee equal to a minimum of 25%
of the mnnufacturc's list price on all retumw material.
DK~CRIPTION
---~---
1. Provide labor and material to add microphone outlet with microphone and wire back up to
sound rack looated in main electrical room
Bid Amount $ 1,650.00
Ifyoll have any questions' concerning this proposal or any other matter, Please feel free to call
an)1ime.
Respectfu tly;
Rejcan Royer
PLEASE SEE PAGE TWO FOR TERMS A1~D CONDITlOlliS
EXHIBIT
p.2
A'~
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
8
.. ...- -_.~. ,. ._.~. - .... .............- r-o...,.. II''''' ,........... '1'111 ...n,JILl"\1 1""'1.
U & A Insurance Agency ONl.Y AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Unick~l & Assoc. Lic#0827703 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P.O. Box 10727 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW,
San Bernardino CA 92423-0727
Phone:909-793-6810 Fax: 909-798-3959 INSUHERS AFFORDING COVERAGE NAIC#
INSURED þ/- ~Lf- olÔ INSURER A: Clarendon America
INSURER B: Golden Eagle Insurance Corp
R.M. S~stemsé Inc.
ATTN: ob Mc lary INSURER c:
P. O. Box 4013 INSURER 0:
Orange CA 92613 INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOH THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT "0 WHICH THI:3 CERTIFICATE MAY BE ISSUED OR
MAY PËRTAIN, 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.
LTR N8R TYPE OF INSURANCE POLICY NUMBER PD~TE;MMíoò',w;E DATE MM/DDfYy\N LIMITS
GENERAL LIABILITY EACH OCCURRENCE $1,000,000
A X ~--COMMERCJAL GENERAL LIA81L1TY HXOOO09156 02/09/04 02/09/05 I pRËMiSb fEa occurence) $ 50,000
i ! CLAIMS MADE [iJ OCCUR MED EXP (An~ one person) $5 000
I P PERSONAl & ADV INJURY $ Included
GENERAL AGGREGATE 82,000 000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPfOP AGG 82,000,000
~- POLlCyn- jr& - n-lOC
AUTOMOBILE LI¡\ßILITY COMBINED SINGLE LIMIT $1,000,000
-'-'- BA9505683 07/31/04 07/31/05 (Eaeccidønt)
B ANY AUTO
-
ALL OWNED AUTOS BODJL Y INJURY
- 8
..!£. SCHEDUL.ED AUTOS (I3erpen;on)
f HIRED AUTOS BODILY INJURY
(Peraccidenl) $
NON-GWNËD AUTOS
I ..!£. Comp Ded $500 PROPERTY DAMAGE $
IXICo1 Ded $500W (Per accident)
GARAGE UABILITV AUTO ONLY - EA ACCIDENT $
~ ANY AUTO OTHER THAN EAACC 8
AUTO ONLY. AGG $
EXCESS/UMBRELLA UABILITY EACH OCCURRENCE $
=:J OCCUR 0 CLAIMS MADE AGGREGATE 8
I 8
I ~=I ~EDUCTIBlE ,b. /h. .
RETENTlOi'l $ .AO/ $
WORKERS COMPENSATION AND VV 7 ' " - ==-, I TÕRY" ~'~\TS J I VEl.'
EMPLOYERS' LIABILITY !
ANY PROPRIETDRlPARTNERfEXECUTIVE / ,~ EL EACH ACCIDENT 8
J':;
O¡=FICI!PJMEM8ER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $
Ifv<!~. describe under
ì SPE(:IAL PROVISIONS below EL DISEASE. POLICY LIMIT $
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAl PROVISIONS
*Exc&pt 10 day noticQ of cancellation for non payment of premium. Cert
holder and the City of Santa Ana, 20 Civic Center Plaza, Santa Ana Ca 92701,
its officers, employeCils, agents, and representativQ are named addi tional
insurGd regarding GGnQral Liability per the attached CG2010 11/85, Primary
wording applies, endorsement to follow from the company.
CERTIFICATE HOLDER
CANCELLATION
DEPOT-1
SHOULD ANY OF THE. ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPlRATlO
DATE. THEREOF, THE ISSUING INSURER WILL i MAIL :3 0* DAYS WRITTEN
NOTICE TOTHE CERTIFICATE HOLDER NAMED TOTHE LEFT, ~I"'''A'' u_- -- -- '"^ C!UIIII
~ .-- ~._...." ",rANT ....,.--. -..--- -n ''''''.'''''/''If
The Depot at Santa Ana
Attn: Carolyn
1000 E. Santa Ana Blvd, ,
Santa Ana CA 92701
#108
@ACORD CORPORATION 198
ACORD 25 (2001/08)
2'd
!:it''!!l
dS2:!O YO ¿O das
ADDITIONAL INSURED-OW~ERS.. LESSEES OR CONTRACTORS (FORM B)
This endorsement modifoes insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name of Person or Organization:
Any person or Organization Subject \0 Section II (Who is an Insured)
That the Named Insured Is Required by Valid Contract to name as an Additional
Insured per Schedual on fila with tile company
(If nO entry appears above, Information required to complete this endorsement will be shown in the Declarations as
applicable to this endorsement.) .
WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the
Schedule, but only with respect to liability arising out of 'your work' for that Insured by or for you.
~.?f'
J ,~. ,.-:-- . B' ~'-.-':/
CL 246 (11-85)
CG20101185
Copyright, Insurance Services Office, Inc., 1984
Page 1 of 1
E'd
1:1''111
dSG:I0 VO ¿O das
U & A Insurance Agency ....... --,~... .-.,.... .... ,................,...,.. "'''''' I ....... VI".. ""...nnl"\. ,......
ONl.Y AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Un~ckøl & Assoc. Lic#0827703 HOL.DER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P.O. Box 10727 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
San Bernardino CA 92423-0727
Phone: 909-793-6810 Fax: 909-798-3959 INSURERS AFFORDING COVERAGE NAIC#
INSURED þ/- ~-olÔ INSURER A: Clar9ndon America
INSURER 8: Golden Eagle Insurance Core
R.M. S~stemsé Inc.
ATTN: ob Me lary INSURER c:
P. O. Box 4013 INSURER D:
Orange CA 92613 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 DOCUME:NTWITH RESPECT 1"0 WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAliII, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL IHE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
POLICY NUMBER ~<¡TEh.fM)OD TIVE N LIMITS
LTR ~NSR TYPE OF INSURANCE DATE MM/DDlYY
Ix GENERAL LlABIL.ITY EACH OCCURRENCE .1,000 000
A ~~M6RCIAl G6N6RAlllABIlITY HXOOO09156 02/09/04 02/09/05 PRÉMìSEs'E~~r~nœ) '50,000
" ! CLAIMS MADE liJ OCCUR MED EXP (Antone person) .5 000
I i PERSONAL & MJV INJURY $ Inoluded
p GENERAL. AGGREGATE .2,000 000
ñ'L AGGREGATE LIMIT APñS PER: PRODUCTS" COMP/O? AGG $2 000 000
vnPRO-
POLICY JECT LOC
R"°MOBIl6lIAB'UTY COMBINED SINGLE LIMIT $1,000,000
B ANY AUTO BA9505683 07/31/04 07/31/05 (Eaaccident)
I ALL OWNED AUTOS BODilY INJURY
(Pefpt¡lr$on) .
f.~ ","',"""'"
X HJRED AUTOS BODILY INJURY
(Per Bccldent) ,
X NON-OWNED AUTOS
I X Comp Ded $500 PROPERTY DAMAGE $
IX ICol Ded $500W (Peraccidenl)
RRAG6 LIABILITY AUTO ONLY - EAACCIDENT $
ANY AUTO OTHER THAN EAACC $
AUTO ONLY. AGG ,
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $
~ OCCUR 0 CLAIMS MADE AGGREGATE $
$
~l ~EDucnBlE t-. ¡J.... $
RETENTION $ AD/ $
WORKERS COMPENSATION AND V~ / .... -' 0 ]ToRY ~1;:':i'S I U~~.
EMPLOYERS' lIABILITY ..
ANY PROPR;ETORlPARTNERfEXECUTIVE / E.L. EACH ACCIDENT $
O;=FIC:RlMEMBER EXCLUDED? J ~ .. E.L. DISEASE" EA EMPLOYEE $
Ifv'3s.describeunder
I SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $
I OTHER
ì
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES' EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
*ExCQpt 10 day noticQ of canoellation for non payment of premium. Cert
holder and the Ci ty of Santa Ana, 20 Civic Center Plaza, Santa Ana Ca 92701,
its officers, employeQs, agents, and representative are named addi tional
insurGd regarding CQnQral Liability per the attaohed CG2010 11/85, Prima.ry
wording applies, endorsGmant to follow from the company.
CERTIFICATE HOLDER
CANCELLATION
DEPOT-1
SHOULI) ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPlRATlO
DATE THEREOF, THE ISSUINÇ; INSURER WILL. i MAIL 30* DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE lEFT, ~..... r... u_- -- -^ co..... c>uA'l
II --- ..- ~ ,(,-....., v. "'I'IT ,..",- . - .--- -A ."''''.'''11 "'Y
The Depot at Santa Ana
Attn: Carolyn
1000 E. Santa Ana Blvd.,
Santa Ana CA 92701
#108
ACORD 25 (2001/08)
@ACORD CORPORATION 198
2'd
l:i1"111
dS2:10 VO LO das
ADDITIONAL INSURED-OW~ERS.. LESSEES OR CONTRACTORS (FORM B)
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name of Person or Organization:
Any Person or Organization Subject to Section II (Who is an Insured)
That the Nsmed Insured Is Required by Valid Contract to name as an Add~lonal
Insured per Schedual on file with the Company
(If no entry appears above, information required to complete this endorsement will be shown in the Declarations as
applicable to this endorsement.) ,
WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the
Schedule, but only with respect to liability arising out of "your work' for that insured by or for you.
~~.I:...
. " .
/'''. ..- . . .,- ---<I
CL 246 (1 HIS)
CG20101185
Copyright, Insurance Services Office, Inc., 1984
Page 1 of1
E'd
1 :lEq 11
dSZ:10 vO ¿o das
Jul OS 04 OS:08a
. . ~7Ie9/2ee~ e9: ee
Tllagl
7I ~633e92~ .
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PAGE e2
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Ullicbl. Â"w", INSURANCE AGENCY
1'. O. Bo. 10127 SOD lleraudblo, CA '241).4721
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P"ODe (!189) "UIJO P...(PGP) "8-3'"
lkw'_rDU7'/OJ
Date:
July 6, 2004
Agency Code: 1189 J
F"" Number: 714-633-0924
NWllber ofPago:s: 04
To:
Linda
Finn:
R.M. Systems. Inc.
patty Chacon
From:
RE:
Oeneral Liability
Moss.,e;
FoHowing is the oertìñc:ate ofimuranoo for The Depot of Santa Ana /lQd ld<IJtiOll8I
íD5lll'ed endol'lel!lent. AIBO the company Y\~11 not do tho City', endol'8ement, I placed Ibe
additional pl'llmium amowns fur 112.t 114, OC will not honor #3.
ShQUd you have any QU8ltÏons or if we "-II be of ftIrth.r 818istance, plea.. do not
hesitate to give mo a call.
If you do not received aJl the pages ploue ,:a1J back as Boon !S pouible.
Original to foJlow by mail_Yos ...LNo
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occe L3~~3S~1 dH
W~9a:¡T .002 90 ¡nr