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Home My WebLink AboutBASILIO ASSOCIATES INC. 1D-2004 0: ;;f-lÇ LM.G~) N-2004-156 AMENDMENT TO AGREEMENT THIS AMENDMENT, made and entered into this / sf-' day of September I, 2004, by and between Basilio Associates Inc. ("Consultant") and the City of Santa Ana, a charter city and municipal corporation duly organized and existing under the Constitution and laws of the State of California ("City"), collectively refeITed to herein as "the Parties". RECIIALS A. The Parties entered into that certain agreement entitled "Consultant Agreement" dated September 13, 2001, hereinafter refeITed to as "said Agreement", for providing general "on-call" architectural services. B. The Parties hereto now desire to amend the TeITll and Compensation sections of said Agreement in order to in order to provide continuous uninteITUpted service under the Agreement. WHEREFORE, in consideration of the mutual and respective covenants and promises hereinafter contained and made, and subject to all of the teITllS and conditions of said Agreement as hereby amended, the parties hereto do hereby agree as follows: 1. Section 2 of said Agreement pertaining to "Compensation", is hereby amended to increase the compensation as total payment for its services, in an amount not to exceed $5,000.00. 2. Section 3 of said Agreement, pertaining to TeITll is hereby amended to extend the teITll of said Agreement for one year to expire on September I, 2005. 3. Except as hereinabove modified, the teITllS and conditions of said Agreement remain unchanged and in full force and effect. IN WITNESS WHEREOF, the parties hereto have executed this Amendment to said Agreement the date and year first above written. ATTEST.:. - fI ~--- 15 PATRICIA E. HEALY Clerk ofthe Council CITYOF¡8~TA ~¿{C .. DAVIDN.REAM City Manager A i';:',~ APPROVED AS TO FORM: INSURANCE. NO 1 üN riLE WORK MAY NOT PROCEED CLERK OF COUNCIL DATE~ ;;¿ / /~ / DS C"1~~~' l CONSU TAm, ~Oú::\72. ~f-.'?, l u. \J AlA. ¡:>~ç\Lt'u !¥£ct. 'iv'lL' JOSEPH W. FLETCHER City Attc¡¡rney , ' ^. !! \ :!, 1/ r By: ,l ivl. ~ A_~-'> Michåel Vïgliotta : Deputy City Attorney' RECOMMENDED FOR APPROVAL: '''\:\\~~~~N......, ~~~ ~ Francisco GutieITez Executive Director of the Finance Agency TaxID# h.J.:> -ûC¡ 'ZSD7J: D~tel 3/27/2006 .. Tim81 4109 PM TOI Ghi::zi, Mario Ii 17146475421 1- 510 - 452 - 2193 Paqel 002.:,( I !:...!W!J . BASILASSO ACO&.D~ CERTIFICA'lrE OF LIABILITY INSURANCE N rJ N .' N- N- ..tL:... '_" COVERAGES /V.- ._ THE POLICIES OF INSURANCE LISTED BEW~E BEEN ISSUED TO THE INSURED NAMED ABOVE FOl<THE POliCY PERIOD INDICATED. NOTWITH:TANDM ANY REQUIREME:::NT. TERM OR CONDInO~1 OF nfY CONTRACT OR OTHER DOCUMENT WITH RESPECl TO WHICH THIS CERTIFICATE MAY BE If tiUED ()~ MAY PERTA..." THE INSURANCE AFFORDED BY TH ~ POliCIES DESCRIBED HEREIN lS SUBJECT TO ALL THE TERrIotS. EXClUSIONS AND CONDITION) OF SU:' POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BE EN REDUCED BY PAID CLAIMS. NSR TYPE Of INSURANCE PC UCY NUMBER LI Y EffE TlVe Basilio Associates, Inc. 12 "J" Mauchly, Suite 100' Irvine, CA 92618 THIS CERTIFICATE Iii ISSUED AS A MATTER OF INFORI ONLY AND CONFE I~S NO RIGHTS UPON THE CERTI HOLDER. THIS CE =:nFICATE DOES NOT AMEND, EXTI' ALTER THE COVEI!'GE AFFORDED BY THE POLICIES I INSll ~ERS AFFORDING COVERAGE :",;wOI-18?. INSURER A United Stall;, Fidelity & Guaranty .,),Do;;' - 14-3 INSURER B St. Paul Fi..: & Marine Ins. Co. ::\003-13-"' INSURER C ?ooo"- 0;;'::>- INSURER 0; ~(X}1-i,(p ;'o05-/.A? INSURER E; . ?'OO(c-O:JD . DA 11: (Mft"OOfVV) 03127/1"1 'IATIOI~- FICATE .ND OR IELOV!. PRODUCER Dealey, Renton & Associates 199 S Los Robles Ave Ste 540 Pasadene, CA 91101 626 844-3070 INSURED A GENERAL LIABILITY X COMMERCiAL GENERAl LlAB LlTV CLAiMS MADE ~ OCCUR BKO'I8958!'2 09/13/05 P L YEXPIR . 09113106 ~,&.I~IN -- UIIIrTS EACH OCCURRENCE .100011 FIRE DAMAGE {Any Me t1M) .300 00 ~~P{Anroneplt(l!lon) .10000 PERSONAL & ADV INJURY '10001/ GENERAL AGGREGATE .200011 PRODUCTS -COMPJOP AGG .20001 ~, COMBINED SINQLE LIMIT $1,000,1 (EaBccldBnt) BODILY 'NJURY I (PBrpe15~) _. BODILY INJURY '. fPerdc~enl) PROpERTY DAMAGE . (PBfBi::cldsnl) AUTO ONLY .EAACCICENT . OTHER THAN EAACC . AUTOO~Y: AGG . EACH OCCURRENCE . ~GATE I . -- . . ilX~~Tf~;, I 10JIt E.L EACH ACCIDENT . ~~ASE .EAEMPLOYEE $ E,L. DISEASE. POUCY LIMIT I $ $1,000,000 par claim $1,000,000 annl aggr. " .1L-_ !_-. GEN'L AGGREGATE LIMIT APPLIES PER ; PRO. loe !1L-_ I~- ~~- A AUTOMOBILE UAEULITV ANY AUTO ALL OWNED AUTOS ~ SCHEDULED AUTOS X HIRED AUTOS ,X NON.QWNED AUTOS BK011895892 09/13105 09/13106 flI0 B OTHER Professional lability QP03B0922i I I 09113/05 09/13106 . GARAGE LIABILITY " , ANY AUTO EXCESS lJABILITY OCCUR 0 CLAIMS MADE tlESCRIPTION Of OPERA110NSILOCA110NBIVEHfCLE8IEXCUSi JNS ADDED BV ENDORSEMENTI8PEClAL PROVISIONS City of Santa Ana, its officers, agents, volun':eer8 and representatfves are named as en additional Insured as raSIl8cts general liability for claims arising from the operations of the named "'ourad. \i; CERTIFICATE HOLDER /~7-/P. ADDITIONAL INStIll SE 'INSUReftLETTER: CA CELLAnON City of Santa Ana Building Maintenance Dlvh,ion All": Mr. Mario Ghlzzi 20 Civic Center Piau, M.11I PO Box 1988 SHOULD ANl'OfTHEABOYE DES::RIBED POLICES BE CANCELLED BEFORE THE EX 'IRAn:>> DATE THEREOF, THE I8SUfN(llfISURER WI~ TOMAlL3IL-DA.'8\WRfITIC~ NOTICETOTHE CERTFICATI: to.DERNMtED TOTHELEFT,XIU(JU8 rJOUIctClIMI8:fl :0I"~1tlII.-"l~Ka... .-laJlOIIQf #S1S~1219IM138542 ---j <;) ACORD CORPOR'TION II IE ACORD 25-8 (7/97)1 of 1 - AAF 1..., ~'''''I~uutJ 'J.'lmel 4109 PM TOI Chiz-:i, Mario Ii 171464754:U . 1.510.452.2193 Pa<:el 003 003 , Policy Number: BK0189589:, OwnersbLessees or Contractors (Form B) ADDITI NAL INSURED Change(s) Effective: 03/27/1'6 THIS ENDORSEMENT CliAN'3ES THE POLICY. PLEASE REAl) IT CAREFULLY. This endorneml;nt modifies insurance policy under Ihe following: LIABILITY COVERAGE PART: Name of Person or Orgal1lzalion: City of Santa Ana Building MaintenancE! D:_ vision Attn: Mr. Mario Ghizzi 20 Civic Center Plaza, ~-11 PO Box 1988 Santa Ana, CA 9270:;! Schedule SECTION" - WHO IS AN INSURED is amended to include as an il1sured the person or organization shown 'r! the Schedule, but only with respect to liability arising out of "your work" for thet insured by or for you. City of Santa Ana, its officers, agents, volunteers and representatives are nar~ed as an additional insured as respects gener,,] liability for claims aJc:lsing from the operations of the named insurec.. PRIMARY INSURANCE: IT IS UNDERSTOOD AND Am~EED THAT THIS INSURANCE 11:, PRIMARY AND ANY OTHER INSURANCE MAINTAINED BY THE ADDITIOl'iAL INSURED SHALL BE EXCESS ONLY AUD NOT CONTRIBUTING WITH THIS INSURANCE. SEVERABILITY OF INTEJ:<.Et;T: IT IS AGREED THAT EXCEPT WITH RESPECT TO THE LIMIT OF INSURANCE, THH; COVERAGE SHALL APPLY A1l IF EACH ADDITIONAL INSURf;D WERE THE ONLY INSUR;:D AND SEPARATELY TO EACH INSURED AGAINST WHOM CLAn! IS MADE OR SUIT IS BROUGHT. WAIVER OF SUBROGATION: IT IS UNDERSTOOD AND AGRSED THAT THE COMPANY WAIVE,3 THE RIGHT OF SUBROGATION AGAINST THE l\BOVE ADDITIONAL INSURED '.S I, BUT ONLY AS RESPECTS THE JOB OR PREMISES DEt;C:<.IBED IN THE CERTIFICATE ATTACHED HERETO. CUBF 22 40 03 95 ~ ;</z_ _._". /0(/ Date: 10/30/2006 Time: 1202 PM To: Gonzales, Griselda @ 17146475421 ' 1-~10-452-2193 Page: 002 - ACORD," CERTIFICATE OF L1AB~L1TY INSURANCE I DATE fMMIDOI'fYY'f) 10/3012006 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Dealey, Renton & Associates ONLY AND CONFERS NI) RIGHTS UPON THE CERTIFICATE 199 S Los Robles Ave Ste S40 HOLDER. THIS CERTIFIC:ATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BYTHE POLICIES BELOW. Pasadena, CA 91101 626 844-3070 INSURERS AFFORDING C')VERAGE NAIC# INSURED INSURER A:. United States I:idelity & Guaranty Basilio Associates, Inc. INSURER B: 12 "J" Mauchly, Suite 100 INSURER c: Irvine, CA 92616 INSURER 0: INSURER E: Client#" 8210 B ~SILASSO COVERAGES THE POliCIES OF INSURANCE LISTED BELOW HA \IE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE PO JCY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR. CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHJC~ THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY T'-lE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERJ.. S. EXCLUSIONS AND CONDITIONS OF SUCH POlICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUceD BY PAID CLAIMS. ~ = TYPE OF INSURANce POLICY NUMBER POLICY EFFECTIVE POLICY EXP1RA nON LIMns A GENERAL LIABILITY BKfJ1895892 09/13106 09/13107 EACH OCCURRENCE '1 000 000 r::- DAMAGE TO RENTED '300 000 X p~ERCIAL GENERAL LIABILITY I CLAIMS MADE ~ OCCUR MED EXP (Anyone pelllon) .10000 r- .1 000 000 - PERSONAL & ADV INJURY GENERAL AGGREGATE .2 000 000 - .2 000 000 ~'LAGG~nE LIMIT APFlS PER: PRODUCTS - COM PlOP AGG POLICY rC8i LOC A ~TOMOBII..E LIABILITY BK01895892 09113106 09/13107 COMBINED SINGLE LIMIT '1,000,000 ANY AUTO (EsflccidIlJlt) - t- ALL OWNED AUTOS BOorLYINJURY (perpellion) . SCHEDULED AUTOS rx HIRED AUTOS BODilY INJURY t)( . NON-OWNED AUTOS (Pllraccidenl) - - PROPERTY DAMAGE . (per 8~cidenl) 3MG' '~BI"'Y AUTO ONLY. EA ACCIDENT . ANY AUTO OTHER THAN EA ACC . AUTO ONLY: AGG . EXCeSSlUMBRELLA LIABILITY EACH OCCURRENCE . :J OCCUR 0 CLAIMS MADE AGGREGATE . . R ~EDUCTIBlE . RETENTION . . WORKERS COMPENSATION AND we STATU. 10~~. EMPLOYERS' LIABILITY . ANY PROPRIETORIPARTNERlEXECUTlVE E.L. EACH ACCIDENT OFFICERIMEMBER EXCLUDED? E.L. DISEASE. EA EMPLOYEE $ Ifyss,dllBcribllurlller . SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT OTHER i\PPf>, DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES I EXCLUSIONS ADDeD BY ENDORSEMENT I SPECIAL PROVISIONS .~ , , " I City of Santa Ana, its officers, agents, volunteers and representatives are named as an ~~ ( additional Insured as respects general liability for claims arising from the operations of ------r ,/~ L/ the named insured. v' 'Z , /\"<"'.:.i;, ; y' , "" ,', ,'".. / >1(rvl "--.- CERTIFICATE HOLDER CANCELLATION City 01 Santa Ana Account Clerk 1 Attn: Griselda Gonzales 20 Civic Center Plaza, M~11, PO Box 1988 Santa Ana, CA 92702 SHOULD ANY OF THE ABOVE DES':RIBED POLICIES BE CANCELLED BEFORE THE EXPlRA110N DATE THEREOF, THE ISSUING INSIIRER WILL ENDEAVOR TO MAIL ....3ll.... DAYS WRmEN NOTice TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LlABI_ITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR ACORD 2S (2001/08) 1 of 1 #S1765631MI74867 AAF @ ACORD CORPORATION 1988 lD-3D"2Dpa 13:13 . FROM-PROFESSIONAL PRACTICE INSURANCE BROKERS + T-273 P.DD2/DD3 F-252 ACORb.. Cllenll: 8ll1W2 SASIASO CERTIFICATE OF'LlABILITY INSU~NCE I f:::"IYYY"f.- TItIS CERllFlCA'l151$ Ill8UED AS A MATTEIl Of INfORMATION . - DIU.'" AND CONFEIIS NO Il/GlITlI UPON TItE CEllllF1CATE HOLPEIl. TItIS CERTlfICA'l15 DDI'15 NOT AlIIENO, EXTEND 011 ALTEIlTItE COVERAGE AFfORDED BvTItE POUClES BEJ..OW. ,- - HIlH Professional Practice Insurance Broke",. Inc, 10 California Street Redwood City, CA ~151a IMSu~ Basilio A5sac:iatn. Inc. 12 J Mauchly, Suite 100 Irvine, CA 92&18 INIIURERS AFFORDIIIG COVERAGE _R'" US S,,"iany Insurance COllIpany INSIJRfR B: INSlJRER c: INSURER D: __e. HAle # 29599 .- COVERAGES T"'f'O~lCln OF'~~/"",VC llfI!>IfS$Ul:P ""THI!.tlllllUll<O.llAI4Ell_nl PQl.\Ql! I!I'.IlIOQ 1lIPJC.\=, NQlWITHSTANQIN!l AI'ly Rl!Qu,~IONT. TEIlM OR Com>ITION OF ANY CONTllACT OR OTMER DO<:ur.IENT WIT!< ~~CT TO W"1C>l nus CERTIFlCA~ l4AY ll1' ,SSuEt> OR ~y feFlTAIN. THE INSUPANCt:: AfFOfIDEt) BY1'H1! POJ..fell!S OUCRleED HEREIN IS SUaJecr TO ALl. THIi 'TERMS. EXCLUSIONS AND CONgrnop,jS OF SUCH pouc,a AGGReGAlli UMtTS SI<OWN MAY I1I\VE Il<EN REPuCl!P IN PAID CLAI..S. T\'PEOFI~1L\NCf! JWM8IR GElrtERAl. UAau..m COMMERCIAI..~~~I-l"" CLNMS ~E 0 OCCUR . - '- - UIIInl . $ QIM.~"DA'O::UMrT~t::f~ F'Ol.teY LOC AUTOII08q.E /...tAaIUJY ANY'I<Jt(l AU., OWNED AuTOS SC/1,ipuUiP ,Al,l'TOS I1IA~AUTOS hOIIl.QWNEP AUTOS ~~An ) ~'ArN~'f $ Gi!NEAAa.~TE 5 PROPuC'f1S . (:QMP'IOP AGG s GAR.we: UAaIUlY _AUTO COMB.INSO StNOl.E l-IWT $ (101_ 1'0011- Y IN-Jul\l . (~fp8/lOr!) aooll..Y INJURy $ IPwacctl8N.) ~- $. Ol'H&RTtfAN AUTOOt<<.r: ALlTOONl-y.It.\ACClDEHT S EA""" . N:;G $ $ . . $ .. EXCtEI:SIUMlftaL..\ UItIUUTY OCCIJR 0 CLAIMS MAPfi EACh OCCU~C;f!: AGGflSGATll DED\ICTJaLt: Il&TE . WQfltCeRG C0IIPENU.11ON AND --'1JAllIUTY "'" PflOl'I>ISYOAiPART>E""""""'T''''' OFFlCE~RExO.uDED'1 1fv..~kIKlDr P ROvfStONS belli,. A OTHER Profus./onal US0tl1242301 09/22106 011122/07 L/ablll DES'CRIPllO.,OF OPERATI~'I.ClCATfONS'v&HICLE8/~~PY~'~1lJfT/1PIiClAL PRa~ All Operallon$ <If the Named In8~r8d, P"'feHionllll.iabilily only. . WCITAl\j: OTtf. E+.~ACQgm,rr $ E.L. DISSASe . J fl'.I.. $&ASE - POlJCt ur.DT $ $1.000,000 Per Claim $1.000 000 ale \ '. p~V FORM !, CERTlFlc.o.TI; HOLDER Mr. Mar;o Ghtm B~lIdlng Mallllenen"" Manager Bllildlng Malm-nonCll DIYl$lon 20 Civic Cenler Plaza. M.1 PClS! Office Box 1988 S 2 ACORD 2S (20111/06) 1 of 2 #8368767/M3Il1l78li i\ . CANCeLLATION Dav NnticA mr Non.payment of P.....iI'Ilum '1 SftOlJLD ANY' OF T1tIi oUIOVf ~ua POYCJIiIU CANCELi.ED PEF~ Ttao. ~MTIC:I I : ;,1.; oX.1E~.THliIS$UlNOINSuR&JcWK.L'U 1ItQ:M4JI.. -3JL. DAY5Wf11TlEN MOTICE C~Tl! TOTHEI.EFT..lIIJltMllfte..,t- r~~ l< .. ACOIlP CORPORATION 1t IS , 10-30-1026 13:13 . FROM-PROFESSIONAL PRACTICE INSURANCE BROKERS + T-273 P.003/003 F-252 IMPORTANT II llIe certifil"lte holder i. an ADDITIONAL INSURED, the pOllcy(i...) must be en<lOrsold. A statemen' on thi. certifiCate aces not confar rigl118 to the certifica", holder in lieu "F sueh endorsement(.). -If. SUIlROGA-TION 1$ -WAIVEO...lIIIbject -">-the lelms anq lODnd/licOll.of"1ll pcI/QX. ClII'llIin..P\lIll(l~ 1710&. require an endorsement. A _men! cn this certifjarte does no, confer righllS 10 the cetli~cale holder in lit:lu 01 .uch endorsemenl(s). DISCLAIMER The Certifiarte of Insulilnce on !he reverse Si<le 01 tnis form does not constiMe a COnlraCl lle1Wllel1 the "",uing In"'f8f(sl. O_ri=<l rcp......,"'...e or prc<f"""" and the comlflcme 1)01_, nor aoes h affirmatively or neglllively emend, eXlend or llllar !he coverage afforQ",j by the policies listed thereon. ACORP 25-6 12001/P8l 2 of 2 tl$36S7671M369768 12/12/2007 15:25 9497274210 BASILO ASSOC INC PAGE 01/02 f:lient#: R0042 BASIASO A,CORDT" CERTIFICATE OF LIABILITY INSURANCE I DATE (MMIDIlIYY) 12/03/07 PRODUCER THIS CERTIFICATf' IS ISSUED AS A MATTER OF INfORMATION HRH PrOfessional Practice ONLY AND CONFERS NO RIGHTS UPON THE cERTIF.ICATE 100 Marine Parl(way, #200 HOLDER.. lHIS CERTIFICATE DOES NOT AMEND, ~ENO OR ALTER THE COVERAGE AFFORDED BY THE F'OLlCIES B~lOW. Redwood City, CA 94065-1517 650 369-5900 INSURERS AFFORDING COVERAGE INliVRED INSURER A, US Specialty In8uraoc~ Company Basilio Associates, Inc. INSURER B: 12 J Mauchly, Suite 100 INSURER c: hVine, C/\ 92618 INSUReR D: I INSURER E: COVERAGES THE POLICIES OF INSURA!'JCE LISTED BEI,.DW HAVE 8~EN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD I!'JOlep-TED. NOTWlTti5TANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACt OR OTHeR DOCUMENT WITH RESPECT TO WHICH Tl'lIS CERTIFICATE MAY BE ISSUEO OR MAY PEfl.T AIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUElJIiOCt TO ALL THE TERMS, EXCI,.USIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN ReDuCED BY PAlO ClAIMS. INJ!R TYPE OF INSURANCE POLICY JWI.IMBIOR POLICY S'FI!~ POUt:YEXPlRATION l.-IMITS L"fA ~NEML LIABILITY EA,CH OCGURRENCE $ f-- COMM ERCIAL l:;;l;NERAL LIABILITY FIRE OAMAGE (AnY OM 1I~\ $ -- f-- o CLAIMS MADE 0 OCCUR MED EXP (AnY one ~1$OIl) $ f-- PERSONAlll. APV INJURY $ A-2006-033 Ge.lERI'J.. A(;G~EG:ATi: $ f-- n'L AGGR.EA LIMIT APnF'ER: N-2000-155 PRODUCTS -COM~OPAGG $ POLICY ~~g: LOC ~TOMoeILE LIABILITY N-2001-182 N-2002-143 CDMBINEib SlNGLE LIMIT $ ANY AUTO (Ee aoold&nl) - N-2003-136 ALL OWNED AUT05 BOOIL Y INJURY - $ SCHEDULED AUT OS N-2004-022 {F'erp..'Bon} - - HIRED AUTOS N-2004-156 BODilY INJURY (Per ..ecldent) $ - NON-oWNED ALlTOS N-2005-129 - -. N-2007-045 pROPERTY DAMAI3E $ {F'''rlO<Oid"n~1 ~I;ll' LIABILITY AUTO ONI Y - Ell ACCIDENT $ A,'1VA,UTO OTHER THAN EAACC $ AUTO ONl.. Y: AGG $ EXCESS LIAI3IUTY EACH oCCURRENCE $ :::rOCCUR 0 CLA,IMS MADE AGGREGATE $ $ =i DEDUCTIBLE $ RETENTION $ $ WORKEIl$ eOMPENSA now. AND ~~~T~:~... r TOJ~ EMPLQnRS' l-lABlUTY E.L EIICI-l ACCIDENT $ E.L. DISEASE - EA E;MPL DYEE $ i:.L DISEASE - POLICY LIMIT $ A OTHER Professional US071242302 09/22107 09/22108 $1,000,000 Per Claim lability $1,000.000 Aaareaate D~IPTlON OF OPERA'IlONSlLOCATlONSIVEHICLESlEXCLUSIONS ADDEtl BY ENDORSEMENT/$PEClAL PROVISIONS All operations of the Named Insured. ;f!5hp:!JL / // CERTIFICATE HOLDER I I ADDlTl(lNAL INSURl:O 'INSURER L~R; CANCELLAtiON Tan n..u / . stl OIJ I.P ANY 01' THE Aa~ D ESCREED POLICIES Be CAllCEL~EiiP BEFORI! THE EXPIftAllON CIty Of Santa Ana DAn; THE~OF, THE ISSUING INl;I,JR;!::R W1~ TOI\WL30...-lJ.\YSWRlTTEN Attn: Mr. Mario Ghizzl, Facility Manager NOllCEiiTOTHE r;I!PmfICATE HOLD I!RNAMED TOTHE LEF1'~ 20 Civic: Center Plaza, M-11 PO Box 1988 Santa Ana, CA 92702 AUTIOOIa1;::~TNE I ~ ACORD 25-5 (7197) 1 of 2 #S398953/M396952 AXC @ ACORD CORPORA liON 1988 12/12/2007 15:25 9497274210 BASILO ASSOC INC PAGE 02/02 IMPORTANT If the certificate holder is an ADDITIONAL INSURED. the policy(les) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the osrtlficate holder in lieu of such endorsen'lant(s). DISCLAIMER The CElrtificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s). authorized representative or producer, and the certificate holder. nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25-$ (71il712 of 2 #S396953/M396952