HomeMy WebLinkAboutUnderwriters Laboratories 1City of Santa Ana
Clerk of the Council
AGREEMENT TERMINATION FORM
Please complete this form when the attached agreement and all
amendments (if any) are no longer in effect.
Return form to the Clerk of the Council Office (M-30).
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COTC Office Use Only
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The agreement with Underwriters Laboratories, Inc
No. N-2004-129 was completed on 6/30/05 and final payment has been made.
(List all amendments. Use space below if needed.)
Department: Fire
Phone/Ext.: 714 647-5712
Signature:
Date: 5/11/10
Revised 04-12-10
INSURANCE ON FILE
WORK MAY PROCEED
UNTIL INSURANCE EXPIRES
16-/ - 05
CLERK OF COUNCIL
DATE: 10 ~ll./-()t/ CONSULTANT AGREEMENT
c.: l=l) THIS AGREEMENT made and entered into this ~t/'I1 day of IJUA/J6.f ,2004 by
(~.e:n;~) and between Underwriters Laboratories, Inc., a not-for-profit-corporatio~
"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-2004-129
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RECITALS
A. The City desires to retain a consultant having special skill and knowledge in the field of
examination and safety testing of fire department equipment, including ground ladders.
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 examine and safety test all ground ladders in the Santa Ana Fire
Department, as set forth in Exhibit A to this Agreement.
2.
COMPENSATION
a. City agrees to pay, and Consultant agrees to accept as total payment for its services,
$2.00 per foot of ground ladder, as set forth in Exhibit A. The total sum to be expended under
this Agreement shall not exceed $3,200.00 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 Fire Chief and the City Attorney.
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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. 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.
c. The following requirements apply to the insurance to be provided by Consultant
pursuant to this section:
(i)
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.
(ii)
(iii)
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d. 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: (1) 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 1 ofthis 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.
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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 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:
City of Santa Ana Fire Department
120 W. Walnut
Santa Ana, California 92701
telefacsimile (714)
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:
Underwriters Laboratories, Inc.
333 Pflingsten Road
Northbrook, Illinois 60062-2096
Telefacsimile (847) 272-8129
Attn: Dorothy McLean
A party may change its address by giving notice in writing to the other party. Thereafter,
any notice, tender, demànd, 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
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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.
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,
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.
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
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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 and all questions relating to its validity, interpretation, performance, and
enforcement shall be governed and construed in accordance with 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.
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IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year
first above written.
ATTEST:
CITY OF SANTA ANA
PATRICIA E. HEALY
Clerk of the Council
~~
City Manager
APPROVED AS TO FORM:
JOSEPH W. FLETCHER
City Attorney
BY;.tw,,~o°l¡-
La a Sheedy
Assistant City Attorney
RE:J... E. N.. .rJ> FOR APPROVAL:
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PHILLIP GARCIA /
Fire~Chief
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CONSULTANT
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Tax ID# 3¿'-1<iC¡~ 375"'
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@ Underwriters laboratories Inc. @
June 2, 2004
333 Pfingslen Road
Northbrook, Illinois 6Q062-~096
United Stales Country Code (1)
(847) 27HBOO
FAA No, (847) 272~129
http://www.uI.com
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SENT VIA V AX
Santa Ana Fire Department
MI. Owen Gibson
120 W. Walnm
Santa Ana, CA 92701
D~ Mr. Gibson:
UL is a not-for-profit organization that has been working for years with the fire service by testing fire
eXl:ÏIlguisher3. pumpers, hose, buildmg materials, and other equipment to ensure thcir minimum safety
characteristics. Several years ago, we added the Aerial Device and Ground Ladder Certification Programs
in order that Fire DepartmCIlts can secure dependable BJ1d unbiased testing of their equipment.
UL's Aerial Certification Program includes mspection techniques employing state-of-the an technologies
that follow ANSIINFP A Standard 1914, 1997 Edition. This testing program helps £Ie departments across
thß coun1l'y keep their equipment ÌI1 serviceable condition.
The base price for the test work, 1ududing the nondestructive examination of one aerial device, is $850.00.
However, we do offer multiple unit discounts:
2-3 Units - $775.00
4 + UDits - $725.00
GroUDd ladders are tes~d to ANSJ/NFP A Standard 1932, 1999 Edition. The price for the testing of ground
ladders is $2.10 per fool, with a minimum charge of $ 300.00. However, we are not going to raise
the price that you paid last year. We will charge your department $2.00 per foot We are
equipped to inspect up to 500 feet of ground ladders per day. Please note that many of the tests
in the 1932 Stnndard can be destructive depending on the age and condition ofthe ladders as well
as the standards to which they were designed and built.
The CQst to your dcpartment for the examination and test of 1542 feet of ground ladders WQuld be S3084.00. .
Thank you for your interest in our program. lfyou have any other questioT1S concerning this program, or
wish to schedule aerial device or ground ladder inspections, please do Dot hesitate to contact me at 1-800-
677 -5227, ¡md press 2 at the menu.
Very trUly yours,
~tj~
DOROTHY EAN
Project Hand
Fie1d Services
;:.t; 3~ iT?
A not.for-profit ar9anizalion
dedicated 10 public salety and
commrlled 10 quality 5etvice
EXH i B rr
A
EXHIBIT A
SCOPE OF SERVICES
GROUND LADDER EXAMINATION AND TEST SPECIFICATIONS
Intent:
It is the intent of this specification to obtain for the City of Santa Ana, the most thorough and
complete inspection of Fire Service ground ladders.
General:
1. Prior to examination and test of ground ladders, the actual person performing the inspection
shall present, for review, proof of hislher SNT - TC-l A Level II rating for Magnetic Particle
inspection, Dye Penetrant inspection and Ultrasonic inspection techniques. In cause of
noncompliance with this requirement, the bid will be awarded to the next successful bidder.
2. The examination and test report provided to the City shall specify the method used to
conduct each test performed on the ground ladder during the day of examination and results
of such examinations and tests.
3. Upon successfully meeting the requirements of all test work, as outlined here. The testing
company shall issue a Certificate of Ground Ladder Examination and Test stating the total
footage that is in compliance with the NFPA 1932, Standard on Use, Maintenance, and
Service Testing of Fire Department Ground Ladders, 1999 Edition, or most current revision.
4. The testing company shall notify the Fire Department Maintenance Division, a minimum of
forty-eight (48) hours prior to the commencement of testing. All testing shall be at a location
designated by Santa Ana Fire Department Maintenance Division, and shall be coordinated
through the same. Santa Ana Fire Department Maintenance Division can be reached at (714)
647-5745.
5.
The Fire Department Maintenance Division will make final acceptance of the work.
CONSUL T ANT REQUIREMENTS:
1. Consultant is and shall remain a nationally recognized testing laboratory recognized by
OSHA in accordance with the OSHA regulations set forth at 29 Code of Federal Regulations,
Section 1910.7, Appendix A, "OSHA Recognition Process for Nationally Recognized
Testing Laboratories. "NO EXCEPTIONS".
2. Consultant shall comply with following American Society for Testing and Material
Standards. "NO EXCEPTIONS".
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A. ASTM E543, "Standard Practice for Determining the Qualifications for non
destructive Testing Laboratories."
B. ASTM E548, "Preparation of Criteria for Use in the Evaluation of Testing
Laboratories and Inspection Bodies.
PERSONNEL:
1. The inspectors actually performing the test work shall be certified SNT - TC-l A Level II in at
least magnetic particle inspection, ultrasonic inspection, and dye penetrant inspection and
techniques.
2. Prior to submittal to the Fire Department, an ASNT Level III shall review the final report
with a Bachelor of Science Degree in engineering and a Registered Professional Engineer
both of whom are directly involved with ground ladder certification program at their
company.
3. The testing company shall comply with American Society for testing and Materials (ASTM)
Standard ASTM E543 "Determining the Qualifications for Nondestructive Testing
Agencies. "
WELDING STANDARDS:
1.
All structural weldments shall be inspected for compliance with the American Welding
Society (A WS) Standard A WS "Classification and Application of Welded Joints for
Machinery and Equipment". All structural weldments shall meet the requirements of a Class
IV weld quality as shown in Table 7.17.4, Page74.
The following criteria shall apply:
Cracks:
No cracks of any type (transverse, toe, longitudinal, crater, etc.) are permitted
Surface Holes:
The sum of 3/32-inch maximum diameter surface holes not to exceed % inch in 12 linear
inches of weldment length.
Lack of Fusion:
In addition to the above defects, lack ofweldment fusion with the parent metal (such as
cold laps) shall not exceed 2/3 T (where T is the throat depth), Of% inch maximum
length of lack of fusion. Also, The sums of all lengths of all lack of fusion defects shall
not exceed 1 inch in 6 lineal inches of weldment.
Undercoat:
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Undercut shall not exceed 1/32 inch in depth.
NONDESTRUCTIVE TESTING PROCEDURE:
1.
Ultrasonic inspection shall be conducted in accordance with the following American
Society for Testing and Materials (ASTM) Standards:
A.
ASTM #114-75 (81), Standard Recommended Practice for Ultrasonic Pulse-Echo
Straight-Beam Testing by the Contact Method.
ASTM E797-81, Standard Practice for Measuring Thickness by Ultrasonic Pulse-
Echo Contact Method.
ASTM E500-74, Standard Definitions of Terms Relating to Ultrasonic Testing.
B.
c.
2.
All magnetic particle inspections shall be conducted in accordance with the following
American Society for Testing and Material (ASTM) Standards:
A. ASTM E709-80, Standard Recommended Practice for Magnetic Particle Inspection.
B. ASTM E269-80, Standard Definitions of Terms Relating to Magnetic Particle
Inspection.
3.
All dye penetrant inspections shall be conducted in accordance with following American
Society for Testing and Material (ASTM) Standards:
A. ASTM EI65-80, Standard Practice for Liquid Penetrant Inspection Method.
B. ASTM E270-80, Standard Definitions of Terms Relating to Liquid Penetrant
Inspection.
4.
The application of a particular nondestructive testing technique shall be recommended by
the American Welding Society (A WS) Standard AN S II A WS B1.0-77 entitled "Guide For
The Nondestructive Inspection Of Welds."
CERTIFICATION:
When the unit successfully meets all the requirements outlined below, the testing company shall
issue a certificate of ground ladder examination and test stating compliance with NFP A 1932,
1999 Edition.
VISUAL INSPECTION
Method:
All welds, rivets/bolts, rungs, side rails, hardware, butt spurs, heat sensor labels of the ladder are
to be visually inspected for discontinuities and proper installation. Visual inspection may be
supplemented by the following nondestructive testing (NDT) techniques:
1.
Ultrasonic Inspection
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2.
3.
Dye Penetrant Inspections
Hardness Inspection
Results
Welds - No cracks of any type are permitted.
Rivet/Bolts - Must be tight and snug
Rungs - Must be snug and tight, free of dents, holes, or deformation.
Side Rails - Must be free of cracks, splintering, breaks, gouges, checks, wavy conditions, or
deformations.
HardwarelButt Spurs - No excessive wear or other defects.
Heat Sensor Labels - No change indicating heat exposure.
HORIZONTAL BENDING TEST:
METAL FIBERGLASS LADDERS
Method:
The ladder is placed in a flat, horizontal position, supported under the first rung from each end of
the ladder. The ladder is extended to its maximum extended length, with pawls engaged, for this
test. The test load is applied equally to the center span covering 16 inches each side ofthe center
inclusive. A 350-pound pre-load is applied for 1 minute at the center section. The pre-load
applied includes the weight of the test surface. After removal of the pre-load, the distance
between the bottom edge of each side rail and the ladder support surface is measured. All
measurements are taken as close to the center ofthe center of the ladder as possible. A 500-
pound load is then applied and allowed to remain in place for 5 minutes. The load is then
removed. After 5 minutes, the distance between the bottom edge of each side rail and the ladder
support surface is again measured. See Notes 1.
Results:
Differences in measurements taken shall not exceed the following values:
Ladder Length
25 ft. or less
26 ft. or more
35ft. or more
Measurement Difference
~ inch
1 inch
l-l/2 inch
Note 1 - Folding ladders shall be tested with a pre-load weight of 160 pounds applied equally to
the center span covering 8 inches each side of the center. A final test weight of 225 shall be
applied for 5 minutes. The measurement difference for this test shall not exceed ~ inch.
HARDWARE TEST (Extension Ladders Only):
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The ladder is placed in a flat horizontal position, extended a minimum of one rung beyond the
bedded position. A test load is placed on the ladder in such a manner as to subject the lock
hardware to a 1 ,OOO-pound load. The test load is applied for a minimum of 1 minute.
Results:
The ladder shall sustain this test load with no permanent deformation or other visible weakening
of the structure.
HOOK TEST (Roof Ladders Only:
The ladder hook angle relative to the ladder side rail is recorded. A load of 1,000 pounds is then
applied to the hook tip, parallel to the ladder side rails. The test load is maintained for a
minimum of 1 minute. The test load is removed and the roof hook angle relative to the ladder
side rail is again measured.
Result:
There shall be no permanent deformation.
HARDNESS TEST (Metal Ladders Only)
METHOD:
A hardness test shall be performed at a test point located between every rung on both side rails.
For beams of truss construction, the test points are located on both the top chord, and the bottom
chord of the truss, between every rung on both side rails.
Results:
All hardness readings recorded must be at or above the minimum reading as specified by Table
5-4.4 ofNFPA 1932.
HEAT SENSOR LABELS:
The testing company shall check all heat sensor labels for current date and proper location. If
heat sensors are needed, they shall be provided by Santa Ana Fire Department.
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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 ot
# relating to the following:
1. The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 9270 l; 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
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ACORDTM
PRODUCER
Aon Risk Services, Inc. of Illinois
200 East Randolph
chicago IL 60601 USA
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY
AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE
COVERAGE AFFORDED BY THE POLICIES BELOW.
PHONE-(866
283-7122
FAX- 847
953-5390
INSURERS AFFORDING COVERAGE
INSURED
underwriters Laboratories Inc.
333 pfingsten Road
Northbrook IL 60062 USA
INSURER A:
Federal Insurance Company
NAIC #
20281
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INSURER B:
INSURER C:
INSURER D:
INSURER E:
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICA TED, NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIACA TE MAYBE ISSUED OR MAY
PERTAIN, THE INSURANCE AFFORDED BY lHE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.
AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR ADD'
L TR INSR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE POLICY EXPIRATION
DATEO'''MIDD\YY) DATE(MMIDD\YY)
06/01/04 06/01/05
LIMITS
A
~E~~~I~::~~~::ENERAL LIABILITY
j CLAIMS MADE ~ OCCUR
D
35815734
EACH OCCURRENCE
DAMAGE TO RENTED
PREMISES (Ea occureoce)
MED X (Am one person)
$1,000,000
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PERSONAL & ADV INJURY
$1,000,000
$8,000,000
$1,000,000
GENERAL AGGREGATE
GEN'L AGGREGATE LIMIT APPLIES PER:
m POLICY D PRO- D LOC
L.:J JECT
PRODUCTS - cmlP/oP AGG
A
Al'TOMOBILE LIABILITY
A
x
ANY AUTO
ALL OWNED AUTOS
74982896
AOS
74982897
TX
06/01/04
06/01/05
06/01/05
COMBINED SINGLE LIMIT
(Ea accident)
$1,000,000
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06/01/04
SCHEDULED AUTOS
BODILY INJURY
( Per person)
HIRED AlïOS
NON OWNED AUTOS
BODILY INJURY
(Per accident)
PROPERTY DAMAGE
(Per aœidenu
GARAGE LIABILITY
B ANY AUTO
EXCESS ¡UMBRELLA LIABILITY
D OCCllR D CLAIMS MADE
Ic~
AUTO ONLY - EA ACCIDEi\'T
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OTHER THAN
AUTO ONLY:
EA ACC
AGG
EACH OCCURRENCE
AGGREGATE
DDEDUCTIBLE
DRETET\'TION
WORKERS COMPENSA TION AND
EMPLOYERS' LIABILITY
ANY PROPRIETOR / PARTNER / EXECUTIVE
OFFICER/MEMBER EXCU'DED'
OTH-
ER
A
If yes. describe uoder SPECIAL PROVISIONS
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LL DISEASE-POLICY LIMIT
$1,000,000 =
$1,000,000 =
$1,000,000 iiÏ:Iïi
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DESCRIPTION OF OPERATIONS/LOCATIONS!\'EHICLES/EXCLt:SIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Evidence of coverage for testing the Ground Ladders for the Santa Ana Fire Department. The city of Santa Ana, its
officers, employees, agents, volunteers and representatives are included as additional insureds under the general
liability coverage with regard to liability arising from the operations and uses performed by or on behalf of the
City ot Santa Ana
Attry: Ms. L~ura sheedy,
Asslstant Clty Attorney
1439 S. Broadway
Santa Ana CA 92707 USA
SHOVLD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSl'ING INSl'RER WILL ENDEAVOR TO MAIL
>" DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.
BUT FAIlXRE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KI"-iD UPON THE INSURER. ITS AGENTS OR REPRESENTATIVES,
AVTHORIZED REPRESENTATIVE
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Attachment to ACORD Certificate for underwriters Laboratories Inc.
The terms, conditions and provisions noted below are hereby attached to the captioned certificate as additional description of the
coverage afforded by the insurer(s). This attachment does not contain all terms, conditions, coverages or exclusions contained in the
policy.
INSURER
I"iSURED
underwriters Laboratories Inc.
333 pfingsten Road
Northbrook IL 60062 USA
INSURER
INSURER
INSURER
ADDITIONAL POLICIES
INSURER
If a policy below does not include limit information, refer to the corresponding policy on the ACORD
certificate form for policy limits.
ADD'L POLICY NUMBER POLICY POLICY
INSR II\SRD TYPE OF INSURANCE POLICY DESCRIPTION EFFECTIYE EXPIRA TION LIMITS
LTR DATE DATE
DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
named insured. See attached endorsement.
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T.0i--L{~'-1 (I ,
Certificate No:
570010916276
.£:
CHUBB
Liability Insurance
8
Endorsement
Policy Period
Effective Oa Ie
Policy Number
Insured
Name of Company
Date Issued
JIINE I, 2()()4 TO JUNE I, 2()(),'i
JUNE I, 21)()4
35XI-57-34 CIII
IJNDEI{WRITERS LABORATORIES INt:.
1:1 ])ERAI, INSlJ RANCI: COM!' ANY
JUNE 11,2004
:::~::::7::::::::::::::::::=:::::::::::::::::::::;:::;;:::;:::;:::;:::::::::;:;:;:;:;:::;:;:::::::;:::::::::;::::::::::::::::::::::::~:::::::~:;::~:::::::::~:~::::::;::::::::::::::::::::::::::::::::::::::::::~:::::::::;:::;:::::::::::;:::;:;:;:::::::::::::::::::::;:::::::;:;:::::::::::::;:::;:::::::::::;:::::::::::::;:::::::::::::::::::::::::::::::::;:::::;:::;:::::::;:::;:::::::;:;:::;:;:::;:::::;:;:::::::::::;:::::::::::::;:::::::::::::;:::::;:::::;:::::::::::::::::::::::::::::::;::::::::;:::::::::::::::::;::;~::~:x::::::;:::;;::
This Endorsement applies to ¡he following forms:
GENERAL LI^BILlTY
8
:::::::::::::::::::::::;:::;:;:::::::;:;:;:::;:;:::::::;:::::;::::::::::::::::::::;:;:::;:::::;:::::~:::::::::::;:::;:::::;:::::::::;:::::::;:::::;;::::;:::;:::;:::::::::;:;:;::::::::::;:::;;:;:;:::;:;:::::;:::;::;;;:;;;::;:::::::::::;:::::::::;:::::;:;:;:;::::;::;::;::;:::::::::::::::;:::::::::::::::::::::;::::::::::::::=::::::::::::::::::::::::;:::::::::;:::;:;:g;:;:;:::;:;::::::::::::::::;:;::::~::::::::;:;::3::::::::::::::::::::::::;::::;:::::::::::;;::::;:;;:::::::;:~::~;:;:::~;::::~::;:::::~~:;:;;::::::;:::::;:;~:;::~:::;
Who Is An Insured
Designated Person Or
Organization
8
Liability Insurance
Form 80-02-2367 (Rev 4-01)
Under Who Is An Insured, the following provision is added:
^ny person or organization designated helow is an insurt!d; hut they arc insureds only wilh
respect \0 liahility arising out of your operations or premises owned hy or n:ntel! 10 you.
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Additiona/lnsured ~ Designated Person Or Organization
Endorsement
continued
Page 1
Who Is An Insured
Designated Person Or
Organization
(continued)
2 Liability Insurance
Form 80-02-2367 (Rev. 4-01)
Designated Person Or Organization
Where Required By Written Contract
All other terms and conditions remain unchanged.
Authorized Representative
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Additional Insured - Designated Person Or Organization
Endorsement
lasl page
Page
0
0
0
OATE(MM/OO/YYYY)
0~(9:L~99"~
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY
AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. TIllS
CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE
COVERAGE AFFORDED BY THE POLICIES BELOW.
1 ACORa.
PRODUCER
Aon Risk services, Inc. of Illinois
200 East Randolph
chicago IL 60601 USA
PHO'" " 866 283-7122
FAX- 847 953-5390
INSURERS AFFORDING COVERAGE
INSURED
underwriters Laboratories Inc.
333 pfingsten Road
Northbrook IL 60062 USA
INSURER A:
INSURER B:
Federal Insurance company
INSURER C:
INSURER D:
NAIC#
20281
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THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO TIlE INSURED NAMED ABOVE FOR THE POLlCY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH TInS CERTIFICA IE MAYBE ISSUED OR MAY
PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRlBED HEREIN IS SUBJECT TO ALL 1HE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.
AGGREGA IE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR ADD
LTR INS
TYPE OF INSURANCE
POLICY ~lJMBER
POLICY EFFECID'
DATE/MM\DDWYl
06/01/05
POLICY EXPIRATION
DATE(MMIDD\YYj
06/01/06
EACH OCCURRE~CE
LIMITS
A r'''~ 35815734
x CO\fMERClAL GENERAL LlABILlTY
CLAI!l1S :\lllDE ~ OCCCR
GES'L AGGREGATE LI:\lIT APPLIES PER:
I2l POLICY D PRO- 0 LOC
SECT
A Al'TOMOBILE LL4..BlLlT\' 74982896
ANY AUTO AOS
A 74982897
ALL OWNED AUTOS TX
SCHEDCLED AUTOS
HlRED AUTOS
r-;or-; O",",'1:D AUTOS
DAMAGE TO RENTED
PREMISES rEa occurence)
lAnyoru:personj
PERSONAL & ADV INJURY
GENERAL AGGREGATE
PRODUCTS - CO;"fPIOP AGG
06/01/05
06/01/05
06/01/06
06/01/06
COMBINED SINGLE LIMIT
(Eaaccident)
BODILY INJURY
(Perper:;on)
BODTL Y INJURY
(Peraccidem)
PROPERTY DAMAGE
(Peraccidenl)
GARAGE LlABILlT\'
B ANY ACTO
EXCESS flTMBRELLA LIABILITY
o OCCUR D CLAIMS MADE
AUTO ONLY EA ACCIDENT
OTHER TI-lAN EA ACC
AUTO ONLY :
AGG
EACH OCCURRENCE
AGGREGATE
A
DDEDUCTIBLE
IDRETENTION
WORKERS COMPESSA TlOl'\" AJ'I,1)
EMPLOYERS' LIABILITY
ANY PROPRIETOR I PARTNER! EXECUTIVE
OffiCER/MEMBER EXCLUDED?
If yes. describe under SPECIAL PROVISIONS
belo\l,'
E.L. DISEASE-POLlCY LIMIT
OTHER
E.L. D1SEASE.EA EMPLOYEE
$1,000.000
$1,000,000
$8,000.000
$1.000,000
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DESCRIPTION OF OPERATIOI\'SILOCA TIOI\"SIVEHICLESIEXCLUSIOI\'S ADDED BY E~DORSEMENTfSPECIAL PROVISIONS
Evidence of coverage for testing the Ground Ladders for the Santa Ana Fire Department. The City of Santa Ana, its
officers, employees, agents, volunteers and representatives are included as additional insureds under the general
liability coverage with regard to liability arising from the operations and uses performed by or on behalf of the
tiJmT
city of Santa Ana
Attn: Ms. Laura sheedy,
Assistant City Attorney
1439 S. Broadway
Santa Ana CA 92707 USA
SHOULD ANY OF TIlE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TIiE EXPIRATION
DATE THEREOF, THE ISSUING INSURER ""lLL ENDEAVOR TO MAIL
30 DAYS \VRITTEN NOTICE TO THE CERTIFICATE HOLDER !'>lAMED TO THE LEFT,
BUT FAILURE TO DO SO SHALL fMPOSE NO OBLIGATIO}; OR LIABILITY
OF ANY KIND UPON THE INSURER, ITS AGEJ\'TS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
Attachment to ACORD Certificate for underwriters Laboratories Inc.
The terms, conditions and provisions noted below are hereby attached to the captioned certificate as additional description of the
coverage afforded by the insurer(s). This attachment does not contain all tenns, conditions, coverages or exclusions contained in the
policy.
INSURER
INSLTRED
underwriters Laboratories Inc.
333 pfingsten Road
Northbrook Il 60062 USA
INSURER
INSURER
INSURER
INSURER
ADDITIONAL POLICIES
If a policy below does not include limit information, refer to the corresponding policy on the ACORD
certificate form for policy limits.
ADD'L POLICY NUMBER POLICY POLICY
INS, I'iSRD TYPE OF INSt:RANCE POLICY DESCRIPTION EFFECTIVE EXPIRA nON LIMITS
LT' DATE DATE
DESCRIPTION OF OPERATlOI'\SfLOCATlONSfVEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
named insured. See attached endorsement~
"n
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Certificate No:
570013856781