HomeMy WebLinkAboutRUSSELL & SONS, INC. 4~ ~ C~20oG
AGREEMENT TERMINATION
Please complete this form when the attached agreement is no longer in effect.
Return form to the Sr. Deputy Clerk of the Council (M-30). Call 647-5238 if you have any
questions.
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` The ag~em~t ~yith~~,1~~' ~ ~ ~.~~;~ -, ,~tC. , No. tiA~-~~-(7~ -C?I
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was c~nplet~d ~~n ~~.~', ~ ~ ~ ~/// ,and final paymen has been made.
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Department: ~ ,Q j
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~ N 2004-095
_ _ Signature.
-- -- -
--
~- ';,~ `--: ~ N-2004-095-01
~. Date:'~~JA/ ~ ~~
Revised 8-7-03
City of Santa Ana
Clerk of the Council
...
N-2004-095
INSURANCE ON FILE
WORK MAY PROCEED
UNTIL iNSURANCE EXPIRES
5-~-O5
CLERK ÒF COUNCIL ¿,
DATE: It-I 7 -Dï
t!-: e b{l. THIS AGREEMENT, made and entered into this 15t day of July, 2004 by and between
(t.r::ul~) Russell & Sons, 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").
CONSUL T ANT AGREEMENT
RECIT ALS
A. The City desires to retain a consultant having special skill and knowledge in the field of
plumbing.
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 on-call plumbing services at the Santa Ana Regional
Transportation Center at the rates set forth in Exhibit A to this Agreement. Except in the event
of emergency repair services, City shall request a proposal from Consultant which proposal shall
set forth the cost and time line of said repair. City may accept, reject or negotiate any said
proposal. Consultant shall not commence work without written authorization, signed 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,
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 the date first written above and terminate on June 30,
2005, 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, a joint 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 $1 ,000,000 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. Reserved.
2
e. The following requirements apply to the insurance to be provided by Consultant
pursuant to this section:
(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)
f. 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,
3
"
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 of the Community Development Agency
City of Santa Ana
20 Civic Center Plaza (M-25)
P.O. Box 1988
Santa Ana, California 92702
telefacsimile (714) 647-6549
and
City Attorney
City of Santa Ana
20 Civic Center Plaza (M-29)
P.O. Box 1988
Santa Ana, California 92702
4
To Consultant:
telefacsimile (714) 647-6515
Russell & Sons, Inc.
2122 S. Wright Street
Santa Ana, California 92705
Telefacsimile (714) 545-0105
Attn:
Steve Russell
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 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 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.
TERMINA TION
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
5
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compensation for all services performed by Consultant prior to receipt of such notice of termination,
subject to the following conditions:
a. As a condition of such payment, the Executive Director may require Consultant to deliver
to the City all work product completed as of such date, and in such case such work product shall be
the property of the City unless prohibited by law, and Consultant consents to the City's use thereof
for such purposes as the City deems appropriate.
b. 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 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, 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.
COMPLIANCE WITH GOVERNMENTAL REQUIREMENTS
Consultant shall carry out all services pursuant to this Agreement in substantial
conformity with all applicable laws, ordinances, statutes, codes, rules, regulations, orders, and
decrees of the United States, the State of California, the County of Orange, the City, and of any
other political subdivision, agency, or instrumentality exercising jurisdiction over the City,
including all applicable federal, state, and local occupation, safety and health laws, rules,
regulations and standards, applicable state and labor standards, prevailing wage requirements, the
City zoning and development standards, City permits and approvals, building, plumbing,
mechanical and electrical codes, as they map apply, and all other provisions of the City and its
Municipal Code (as they may apply), and all applicable disabled and handicapped access
requirements, including, without the limitation, the Americans With Disability Act, 42 U.S.C. §
12101 et seq., Government Code § 4450 et seq., and the Unruh Civil Rights Act, Civil Code § 51
et seq.
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
6
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.
IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year
first above written.
ATTEST:
CITY OF SANTA ANA
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6AVIDN.REAM
City Manager
APPROVED AS TO FORM:
JOSEPH W. FLETCHER
City Attorney
By'
L á Sheedy
Assistant City Atto
MENDED FOR APPROVAL:
CONSULTANT
æc.
~~
STEVE RUSSELL
President
Tax ID# ~~) \b'70b
, ~ ~Jf,
A~_PATRICIA C. WHITAKER
"l\YExecutive Director of the
Community Development Agency
7
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JAMES H~ RUSSELL & SON, INC
2122 S. WRIGHT ST.
SANTA ANA, CA.. 92705
'-'-"
6-16-04
ATIN:CAROLYLN
LABOR RATES ARE AS FOLLOWS:
SERVICE CALL INCLUDES TRIP CHARGE AND THE FIRST ~ HOUR
OF LABOR.........S69.00
EACH ADDmONAL ~ HOUR OF LABORh.......S36.SO
OVERTIME AND WEEKEND RATES ARE AS FOLLOWS:
$103.50 SERVICE CALL WInCH HNCLUDES FIRST ~ HOUR OF LABOR
$54.75 EACH ADDITIONAL ~ HOUR OF LABOR
MATERIAL CHARGES ARE APPOXlMA TL Y 20% OVER COST
IF YOU HAVE ANY QUESTIONS PLEASE CALL
~TEVE RUSSELL
PRESIDENT JAMES H. RUSSELL AND SON, INC.
"A ,.
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...
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 9270 I.
(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
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PIIOOVCER
DATE (MM/ÐOIYYJ
07/27/04
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTlACATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR
At TEA THE COVERAGE AFFORDED BY THE POLICIES BELOW-
COMPANIE~- AFFORDING COV~_G~-, - -
COMPANY FEOERATED MUTUAL INSURANCE COMPANY OR
A FEDERATED SERVICE INSURANCE COMPANY
,NSURfD
FECERATED MUTUAL INSURANCE COMPANY
5701 W. Talavi Boulevard
Glendale, AZ 85306
Phone: 602-944-5566
Home Office: Owatonna. MN 55060
JAMES H RUSSELL & SONS INC
2122 S WRIGHT ST
SANTA ANA CA 92705
.--------
~15-~2 I CO~ANY
¡
I COM~ANY
COMPANY
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---------- ..- .
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THIS IS TO CERTIFY THAT THE POliCIES OF INSURAIIICE 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 BE ISS\JED OR MAY PERTAIN, THE INSURANCE AFfORCED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS ANO CONomON$ OF SUCH POUCIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
&~ i TYP!OF~RANCf I -. POl~-MlMIIEA --. i :-~~.:~~~ ~~v~i;:~~ í--" .-,--:Ir~' -- m
; GENalAl.L.IA81UTY ¡ GENERAl.A~GfleGATe . 2,000,000
r~OMMliRCIALGEN£I\AlLIA8IL TY ¡ PIIODiJCTS-COMPIQPAGG . 2000.000_-
A' I CLAIMS MACE ']]ocÇ\Jft 9801504 I 05120104 OS/20105 PERSONAL~ACV'NJUAY i.~-J.900,OOO_-
: OWNER'S & COl'lTftACTOR'S P~T fACt-! OC~~RRc:N~,'..J.ßOO,Q.oo -
X ~1NE.SSOWNEA'5POuCV .fIRE ~~~E_~~ ""!!~','!l.' 59.000
MED EXP {Anyone personl \ $
~:::~N;:~:~:~~ LI~IT__--t: .
¡ fJer potscnl
-., -- .-'".------'-
~p~a~~:~~RY .
~OMOIIIlÙIAUlUTY
h ANY AUTO
!--J AU OWNED AVTOS
l ~' SCHEDULED AUTOS
HIREC AUT~
H NON.OWNED AIITOS
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--""-'-.
I PROP(Rl"Y OAMAGe
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ANY AVT 0
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~~~~- ,E, 'A A,C, _CIOEN.~ .;-"-
. OTHER THAr:'.A\J_':O ONLY. ¡
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we ST'" u- ¡ TH.
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EL EAC" ACCID!'NT -f!
EL D1SEASE - POLICV.LI~- p---- n__-
EL DISCASE - EA ~PLCYEE I $
, EXCESS UABlLfTY
[l UMBRElLA FORM
I OT~ 'OiAN UMIIREU,A fORM
WORKERS COMPENSATION AND
ENlPiOl'ERS' UA8llITY
THE I'IIOPRLETOR/
PAI'TIIIERS/EXECiJTIVf
. OI'FIC91S ARE:
01)1£1\
INCL
EXCL
DE6CR1PT1O!\1 Of OPÐIATIOfIS/I.C)CATlONSNEHICLfS/SÆClAL ITEMS
SEE ATTACHED PAGE
\~..~i,l!Ç4t~Ø~~~b;:~:l@f~j1¥Æj¥W@@¡i¡~%ti~tl~~~@Jf¡j;@@%~(fl;%@U@i¡:~~~,gUb$HfB1.;ß:?Nm::;¡¡¡.:j;;¡":HF-.;'{:i:f:r};:!.';(;.¿<!i,i:j:j:i/;i::., " .:'::"':.""":".,.,
THE DEPOT OF SANTA ANA 94 SiIOULD ANY Ot TfIE ABOVE DESCRIBED POUClfS at CAI\ICE\.LEO BEFOIIE THE
1000 EAST SANTA ANA BLVD
SUITE 108
SANTA ANA CA 92701
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CERTIFICATE OF INSURANCE
INSURED
315-990-2
JAMES H RUSSELL & SONS INC
2122 S WRIGHT ST
SANTA ANA CA 92705
DESCRIPTION OF OPERATIONSlLOCATlONSJVEHICLESlSPECIAL ITEMS
CERTIFICATEHOLDER IS AN ADDITIONAL ¡NSURED SUBJECT TO THE
CONDITIONS OF THE ADDITIONAL INSURED BY CONTRACT ENDORSEMENT
FOR BUSINESSOWNERS LIABILITY.
RE: PLUMBING MAINTENANCE
INSURANCE PROVIDED BY THE BUSINESSOWNERS LIABILITY IS
PRIMARY AND NONCONTRIBUTORY OVER OTHER INSURANCE.
ADDITIONAL INSURED INCLUDES: THE CITY OF SANTA ANA, 20 CIVIC
PlAZA SANTA ANA CA 92701, ITS OFFICERS, EMPLOYEES, AGENTS
AND REPRESENTATIVES.
~2A
CERTIFICATE HOLDER
THE DEPOT OF SANTA ANA
1000 EAST SANTA ANA BLVD
SUITE 108
SANT A ANA CA 92701
94
08/04/2004 WED 09:06
FAX 714+565 4020 CITY OF SANTA ANA
!4J 002/005
This cenities that
CERTIFICATE OF INSURANCE
0 STATE FARM FIRE AND CASUALlY COMPANY, Bloomington, Illinois
~ STATE FARM GENERAL INSURANCE COMPANY, Bloomington, Illinois
0 STATE FARM FIRE AND CASUALlY COMPANY, Scarborough, Ontario
0 STATE FARM FL.ORIDA INSURANCE COMPANY, Winter Haven. Florida
0 STATE FARM LL.OYDS, Dallas, Texas
¡n:sures the following policyholder for the coverages indicated below:
Name of policyholder JAMES H: RUSSELL &. SON INC-
Address of policyholder 2122 S WRIGHT STREET SANTA ANA, C)\ 92705
Location of operations ALL OPERATIONS
Description of operations PLUMBING
The policies lisled below have been issued to the policyholder for the policy perIods shown, The insurance described in these policies is
subject to an the terms exclusions, and conditions of those policies. The limits of liability shown may have been reduced by any paid claims,
POLICY PERIOD liMITS OF LIABILITY
POLICY NUMBER TYpE OF INSURANCE Effective Date: Expiration Date (at beginning of policy period)
Comprehensive ' BODILY INJURY AND
,
. PROPERTY DAMAGE
Business Liability :
. This ¡ñsu'räñëèi ¡"ëiüdeš:-' - -Li- Prodüëïs. ~ Cõmpleted ofjåiåt¡ciñš..".""'."".'" - -- - no -
0 Contractual Liebiliiy
0 Underground Hazard Coverage Each Occurrence $
0 Personal Injury ¡/f./
0 Advertising InJury ~ General Aggregate $
0 Explosion Hazard Coverage
0 Collapse Hazard Coverage Products - Completed $
0 Operations Aggregaie
[j
POLICY PERIOD BODILY INJURY AND PROPERTY DAMAGE
EXCESS LIABILITY Effective Date: ExpllBtJon Date (Combined Single Umit)
0 Umbrella ' Each Occurrence S
.
0 Other ' Aggregate $
,
, Part' STATUTORY
.
,
, Part 2 BODIL. Y INJURY
,
,
Workers' Compensation I
,
,
and Employers Liability . Each AccIdent S
,
. Disease Each Employee $
.
,
, Disease - Policy Limil
' $
,
POLICY PERIOD LIMITS OF LIABILITY
POUCY NUMBER TYPE OF INSURANCE Effective Date ¡ Expiration Date (at beginning of policy period)
F20-074l-AOl-7SC "'FLEET POLICY 07/0J/04 . 07/01/05 1 MILLION
.
,
, *STATE FARM MUTUAL AUTOMOBILE
,
T'IIIS. COMPANY
, +HIRED,NON-OWNED, SCHEDULED AUTOS
'
,
CERTIFICA'l'E HOLDER IS NAMED ADDITIONAL Ir>lSURED.
ADDITIONAL INSURED ENDORSEMENT ATTACHED.
THE CERTIFICATE OF INSURANCE IS NOT A CONTRACT OF INSURANCE AND NEITHER AFFIRMATIVELY NOR NEGATIVEL. Y
AMENDS, EXTENDS OR ALTERS THE COVERAGE APPROVED BY ANY POLICY DESCRIBED HEREIN.
If any of the described policies are canceled belore
Its expiration date, State Farm will ~ mail a written
notice to the certificate holder 30 days before
cancellation. If ~e\l\,'8\"8f. ore fa;1 te ""ail el:l8A l'1etiee,
"'I; I;ltliaSli81'! Sf lIee:lit) ~:JI ~e :1'l"I !5e.,ed ðP'l Oiaið
Name and Address of Certi1icate Holder
e
THE DEPOT AT SANTA ANA
ATTN: CAROLYN FULLEB.TON
1000 E SANTA ANA BLVD, STE lOB
SANTA ANA, CA 92701
07/19/04
QQS.994 Q,3 04-1999 Printed in U.S.A.
SToIITE JAIN
A
KELLY DAVII. Agent
Uc. #0671405
2677 North Main Street, Suite 150
Santa Ana, CA 92705
Title
I Age",'. Code Siam,
AFO Code KELLY DAVIS
SANTA ANA
Dare
8602
F418
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08/04/2004 WED 09:06 FAX 714+565 4020 CITY OF SANTA ANA
14J00J/005
~ul IS 04 09~00a
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THIS SHEET MUST BE COMPLETED AND ACCOMPANY
THE CERrIFlCATE OF INSURANCE
"
ADDITIONAL INSURED ENDORSEMENT
Insurance company STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY
This 8ndor5ement modifies &UGh insurance as is afforded by the Jrovisions of
Policy No.F20-0741-A01-'75C relating to the following:
1.
The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, Califomia 92701 its
office r5 , employees, agents, and representatives are named as additional
insureds ("'additional insuredsj with rsgard to liability and defense of suitS arising
from the operations and uses performed by or on behalf of1l1e named insured.
2.
With respect to claims arising out 01 the operations and uses performed by or on
behalf of the named insured, such ìnsuranee 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 øpplies 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 i~cluded..
Wirh respect to the additional insureds, this Insurançe shall not be cancelled Dr .
materially reduced in coverage or limits except after thirty (30) days written notice
has been given to the City of Santa Ans. 20 Civic Center Plaza. Santa Ana,
Caljfomia 92701.' .
4.
~
(COmpletion of the folloWing, including countersignature, is required to make this
endorsement effective.)
Effective
JULY 1, 2004
I this endorsemenl form is a part of
Policy No. J20-07 41 -A01-75C
Issued to J~ES H RUSELL & SON INC ~--,~_.__.- ---
Named Insured
':'
KEL~ ~~~
Countersigned by
H:misc;Ct<lÌfiØtI; of ID'1lfõ\II1: addXlœ~1 mdanl:l1Iml
08/04/2004 WED 09:06
FAX 714+565 4020 CITY OF SANTA ANA
!4J 004/005
CERTHOLDER COPY
STATE
P.O. BOX 420e07. SAN FRANCISCO. CA94142-0e07
I;O"",,..NSATIQN
INSURANCe
FUN D CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
ISSUE PATE: 07-20-2004
GROUP: 000046
POLICY NUMBER: 11385-:2004
CERTIFICATE ID: S9
CERTIFICATE EXPIRES; 02-01-2005
02-01-2004/02-01-2005
THE DEPOT AT SANTA ANA
ATTN CARLYN FULLERTON
1000 E. SANTA ANA BLVD STE 108
SANT~ ~A CA 92701
)
This is to cenlfy that we have Issued a valid Worker.s Compensation Insurance policy in a form approved by the Califomia
Insurance Commissioner to the employer named below for the policy period indicated.
This policy is not subject to cancellaüon by the Fund except upon 30 days advance writien notice to the employer.
We will also gIve you 30 days advance notice should this policy be cancelled priorto'ils normal expiration.
This certlf1cate 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 ms¥ pertain, the Insurance afforded by the policies
described herein is subject to all the terms, exclusions, and condITions, of such policies.
~
,ð~
c.
1)£
AUTHORIZED REPRESENTATIVE
PRESIDENT
EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE.
ENDORSEMENT #0015 ENTITLED ADDITIONAL INSURED EMPLOYER EFFECTIVE 07-20-2004 IS
ATTACHED TO AND FORMS Ä þA}(.T O~ THIS POLICY. NAME OF ADDIT'!'ONAL INSURED:
THE DEPOT AT SANTA ANA
ENDORSEMENT #lS00 - STEVEN J RUSSELL, PRES¡DENT - EXCLUDED.
ENDORSEMENT #1600 - MARCIA L.RUSSELL, SEC,TREAS. - EXCLUDED.
ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIV~ O~-01-2004 IS
ATTACHED TO AND FORMS A PART OF THIS POLICY.
I~
EMPLOYER
JAMES H RUSSELL & SON, INC
2122 S WRIGHT ST
SANTA ANA CA 9~705
SClF 1 a~i2¡¡
ACOIIpllhls celUllCIIle 0IVy II yo¡¡ see s fIIInl ~slernulrl< IIISI fellde "OFFICIAL 5TATE FUND DOCUMENT"
~~~~~: 07.200~OO4
PAGe 1 OF 1
08/04/2004 WED 09:07
FAX 714+565
4020 CITY OF SANTA ANA
141 005/005
\,
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" :"",1>'; ":. ' ': :'POLt'CY NUMBER:. ':"1' 'Qo11~85-2Ö04
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" 1O'OO:'["SANTA "NA. BLVD 300' '" " r: \qi"",.,""" ,
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,,:" ",:,'i; , ~'Tn'is i$ :to certify th~~ ~e, I hsve" ;s5ued ,~", va;id ~or~e~~'" C~mp¡~sJ~~i~~' i~S~~~':~8 ,~o~~'~ ' i'n":~' ""~:~:~'~' '¡~pr~V'èd' by th~'
,California' Insur¡nc8 Commis'Sioner to tne: ernPloy.er named: Þel~)or,~e ::pôlicy ~~dod'jrid¡clÌj;ëd.,,: ' , ,',.',
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0e : ~iU '~,I~O give ~o~ 30:"~~;~ '~dvanç ~otice should, th~s :p~1i ~~ be" c~~eJlBd',,:'prjor )0' 'itS:. :~~~~;'1e~'Þirati'on::' .. I,; "
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,This. certificate: ',~f:) in5,¡¡rcin:c~" is~ l1öt,.,: ìh ,ip~~an'ce policy,' ,al:l~' dd~~ ,,:,oi;¡.~e,~q, ,lIx'!ënd' or . álter;.~~he, ,~.Ç?,v,~r~~~: ~fforded
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