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Home My WebLink AboutSAN JOAQUIN CHEMICALS 3A - 2004 !\i _,'),003-0"4 - 0/ AMENDMENT TO AGREEMENT THIS AMENDMENT, made and entered into this i~ day of September 2004, by and between San Joaquin Chemical 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 referred to herein as "the Parties". RECIIALS A. The Parties entered into that certain agreement entitled "Consultant Agreement" dated September I, 2003, hereinafter referred to as "said Agreement", for providing general water treatment and chemical services. Parties now desire to again Amend said agreement to extend the Term of and provide additional compensation under the terms of said Agreement. B. The Parties hereto now desire to amend the Term and Compensation sections of said Agreement in order to in order to provide continuous uninterrupted 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 terms and conditions of said Agreement as hereby amended, the parties hereto do hereby agree as follows: 1. Section 2, Compensation of said Agreement, pertaining to money paid for services is hereby amended to increase the amount not to exceed $9,340.00 to pay for services under said Agreement. 2. Section 3, Term of said Agreement, pertaining to the expiration of said Agreement is hereby amended to extend the tern from September 1, 2004 until September 1, 2005. 3. Except as hereinabove modified, the terms and conditions of said Agreement remain unchanged and in full force and effect. IN WITNESS WHEREOF, the parties hereto have executed this Amendment to said Agreement the date and year first above written. ~~.~/ PATRICIA E. HEALY Clerk of the Council CITY OF SANTA ANA c~~ /L~ MVID N. REAM City Manager APPROVED AS TO FORM: JOSEPH W. FLETCHER . City Attorney . By: !vtL / .~ Michael Vigliotta Deputy City Attorney INSURANCE ON FILE WORK MAY PROCEED UNTIL INSURANCE EXPIRES .Lj-30-0S CLERK OF COUNCIL ')AlI':3 jig-IDS OR APPROVAL: y~/ qt+-~:J..1 ;L7~ SE~-30-~04 THU 11:43 AN FAX NO, p, 02 ACORD", SANJOAQ-02 AYo, PRQO,,"" (558) 432-0222 OiB..duo & DeFendilllnsurance Brokers, LLC License l#Oe02096 P.O. Ball 6479 Frtl4Ino, CA 83755-5479 CERTIFICATE OF LIABILITY INSURANCE I "";J:;;.;;vl THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONI'ERS NO RIGHTS UPON THE CERTIFICATj; HOLDeR, THIS CERTifiCATE DOES NOT AMEND, EXTEND OR ALTeR THE COVERAGI': AFFORDED BY THE POLICIES BELOW. tJ - dC(3 -D f4 INSURERS AFFORDING COVERAGE INsu_A,American lnlarnationiii Specialty Lines IN......., Commerce & Industry !nsurance Com pan ...... .!NS__ c, State Compens~on InlIurance Fund.. IN$~RER c: NAle, 1_. San Joaquin"Chemicals Inc. 4&84 Enl Hedge, Ave Fresno, CA 93703-0000 I COVE THE POLICIES OF INSURANCE LIST!D BELOW HAVE 8&EN ISSUEO TO "!liE INSURED NAM!DAIlOllI' FOR THE POlICV PERIOD INDICATED. NOTWlrHSTANDING Am REQUIRI:MENT, TERM OR CONCITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, "!liE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, exCLUSIONS AND CONDITIONS OF SUCH I POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN RrnueED BY PAID ClAIMS. MWr '.. ... f10UCYNUMIER POucYI!!~CTlVE POIJ~exMRAllb'~ .'.'LJMITI ,~--- ~.'IW.L.WII"'TT ~.._' 1,0~~~ A X CO""ERCIALG'N.AAll,..,LI1Y eG1115770e 4130/%004 4130/%005 ~~ $ 100,001 '-0 ew........ [!] OCCUR MOlliJ<P/An,cno""".LI' ,~~ PERSONAl. & AllV INJURY II l,OOO,Ooc ~ .. -..- ... 2,000,00' r--:-: OM GENERAl- 4GGReGAT_E S _. GEN'LAGGR~,"'MITAPPLIESPER: PROcue!.~.co""IOPAGG I 2:000,~ DpOLIC'(j_ ,~ill-OC ~Le.1A8ll.I1Y ..! ANY AUTO 1_ AlL aWNEC A.lJTOS SC"'~OUL~D AU10$ r-- r- HIRED AUTOS I NON-QWNEDAUTOS -- INSURER E: I 9 GMAGE UABIUTY I ANY AUTO --1 EXCu:wMBREUA lIABilITY OCCUR 0 CWMSNACE. h/i ~n...A J'S../' / .. 1/3 COM&INEO SINGLE LlMrr $ 1,000,001 4130/2005 (EililOCjllenl) -..... - BODIL V INJURY $ IP<< P8~on) r--' -..- aoOIL v INJuA'r' $ (P....ecld!n[l - PROPeArY DAMAGE , fF'rtr.cci~enIJ CA50531117 413012004 A,UTOONL,(-EAACC'i:l~T Ii OTHER: THAN ~ ACC $ AUTO ONL v; A.GG S .-- II. EGU1B5n09 4130/2004 4130/2005 ~q~CURRENCE AGG~GATE . . . I l,OOO,DlIl ........-= 1,000,001 = n DEDUCTIBLe :.!l~'t<NTlON s 10,000 N WORKeRS COMPEt4ATlDN AND EMPLCYUS'LIAIIUTY ANV r-AOPRI&TOfWARTNERlEXECUTlVE: , O"I"'CI!~MilEA: EXclU05:D? i lfYn,glSCl1tl8~!!~.~_ I SPEC", Flp;jOV)SIUNS below OTHER r-" -- 1611187504 8/29/2004 1/2912005 '..~ 1,000,001 , ,000,001 1,000,Ooc ~PTION ap OPIERATI?NS / LQc:ATIONII VEHICLQ I EXCLIaON:I ADDID av IilNDDJilBENE-'lT I IPlCw. MOVtIIOHS Ity of Santa Ana, ,ts officers, Clllployees, agenta, voluntoere end r"preaentalive. ara namad as Addillonallneured, Such insurance J ia afforded by thill policy i. Primaty end i. not addilionallo or contributing with any other ineurance ".rri"d by Or for th. ben"fil of . additional insured. ERTIFICATE HOLDEI'{ City of Santa Ana Building Maintenance Diviaion 20 Civic Canter Plaza tIM.11 Sanla Ana, CA 92702. CAHCI': TrON IIHOl.lLD AN'" DF THE ABOVE DUCNlUO POLICIES BE CANClllED 8EJ'O~ THE EXPlfII\no~ DATE nwIEoF. THlISIUlNG INSURtiA WILL ~DfAVOR TO MAIL 3~ D.t.YS WRm'tN" Nance 10 TNIi ClOR1'lACATf: HC~!1Il: ~ TO THE l.eFr. IUT FA&LURI to 00:50 SMAU. IMflOSIE NO 08UGAnON OR UA8ILrrY OF Af!lY I<lND IJPON ~.. NK.IAI:R. ITS AGI!,,", OM REPRElJIiNT"'I1VES. AUTI1DIIlZEORE-'EIlTATM ~ ~ ~ SEP-3o-2~04 THU 11:44 AN , FAX NO, p, 03 ~ SANJOACI-Q2 A YO, IMPORTANT If the certificate holdElt' is an ADDITIOIIIAL INSURED, the pollcy(las) must be endorsed, A statement On this certifioete dCes not comer rijjhts to the certificate holder In lieu of such endorsement(s). If SUBROGA'J'ION IS WAIVED, subject to the terms and condlnons cflhe policy, certain pOlicies may require an endorsement. A statement Cn this certificate does not confer rights to <he certificate holder In lieu of such endol"llement(s). DISCLAIMER The Certificate of Insurance on the reverse side of ihls form does not ctlnstilUle a contracl between the issuing insurerls), authorized repre.entative or producer. and Ihe certificate holder, nor does n effirmatlvely or negatively amend. exlend or alter the coverage afforded by the policies listed thereon. ~/.rj3 . SEP~3o~2U04 THU 11:44 AN FAX NO, p, 04 .-- ,--'" ENDORSEMENT NO. 1 , This endorsement, effective 12:01 AM: April 30, 2004 Forms a part of polley no,: EG 1957708 Issued to: SAN JOAQUIN CHEMICALS, INC. By: AMERICAN INTERNATIONAL SPECIALTY LINES INS. CO. THIS ENDORSEMENT CHANGES THE POLICY. PUlASE READ IT CAREFULLY COVERAGE A, B, AND C I;NHANCEMENT ENDORSEMENT ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS FOR COVERAGES A, 6. AND C This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY POLLUTION LEGAL LIABIUTY COVERAGE FORM SCHEDULE Name of Person or Organization: Where Required by a Written Contract ~dy $.13 (If no entry appears above, information required to complete this endorsement will be shown in the Dec. larations BS applicable to this endorsement) With respect te Coverages A, B, and C, WHO IS AN INSURED (Section II) is amended to include as an inSured the person or organization shown in the SChedule. but only with resptlct to liability arising out of your ongoing operations performed for that insured. a~ AUTHORIZED'REPRESENTATIVE -,,,,.- or cOLlnterslgnature (In _tea where applicable) . SANJOAQ-02 AYDA . I DATE (MMIDDNYYY) A CORp. ,eERTIFICATE OF LIABILITY INSURANCE 8/15/2005 PRODUCER (559) 432-0222 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION DiBuduo & DeFend is Insurance Brokers. LLC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR License #OE02096 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 5479 Fresno. CA 93755-5479 . INSURERS AFFORDING COVERAGE ~ NAIC # -- ----- ------ ---- ------ ---------- . --- ____no" ------ ~--- -- -- -.------ INSURED San Joaquin Chemicals Inc. ;.J- 7,003'-0,s-'/ 0~SURER A: Hudson Insurance Company ----- .---------... ..' -------- --. ,------ ------.---.....,.--.- 4684 East Hedges Ave INSURER B: St~e CO~P_~':1s~!~~n Ins~~~_r:'~El'J:un~__ _ . Fresno. CA 93703-0000 IV -,;ltJ<'J.3 -o,s--I-oJ .. -- \ IN_~~ER C ____ _ ~:~:::-~~- ------ -- ----- ----- --- .-- . ---- .. ------- 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 DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR~Db'L LTR -POLICY' EFFECTIVE /0 NY POLICY-EXPIRATION M /DNY LIMITS EACH OCCURRENCE I $ , DAMAGE TO REJiJTI:D --- '~ _E'BEMI.SE:9 (Ea o.ccuren~_. . .5. ME~~~P(Any on~_~rson) _?_ PERSONAL & ADV INJURY . $ ---~-_...- POLICY NUMBER A I X GENERAL LIABILITY r'X-;: COMMERCIAL GENERAL LIABILITY !CHEPL00099 '---.-, ; CLAIMS MADE I_X_..... I OCCUR' ~-~r GENERAL AGGREGATE i $ ----- - ------+-----.- 4/30/2005 4/30/2006 GEN'L AGGREGATE LIMIT APPLIES PER- i POLICY I j~8T LOC A 'I' ;~rOA:~B~~~~IABILlTY X ALL OWNED AUTOS x.... SCHEDULED AUTOS X HIRED AUTOS , i NON-OWNED AUTOS CHEPA000100 4/30/2005 GARAGE LIABILITY I ANY AUTO I A , EXCESS/UMBRELLA LIABILITY ~I _~ OCCUR CLAIMS MADE ICHEPU000101 DEDUCTIBLE I ~ RETE~!~~~__':____ !O'OOlO -- --- WORKERS COMPENSATION AND EMPLOYERS'L1ABILlTY 168187505 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? If yes desCribe under SPECIAL PROVISIONS below I OTHER 4/30/2005 6/29/2005 6/29/2006 B EL. DISEASE - EA EMPLOYEE DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Cancellation: Ten day notice of cancellation for non-payment of premium Laura Stit ,heedy Assistant C'y Attorney 1.000.00 100.00 5.00 1.000.00 2.000.00 2.000.00 1.000.00 2.000.00 2.000.00 1.000.00 1.000.00 1.000.00 City of Santa Ana, its officers, employees, agents, volunteers and respresentatives are named as additonal insureds as per written contract for general liability. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL~MAIL 3~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BKI)t~~XI>>XI. x.JlailtlllOlilO6X_IIi>>lfltX_lCilCilU6J{li(~106IIiK~lO!i( )@loXiltiXilOX_ AUTHORIZED REPRESENTATIVE ~~____~ @ACORD CORPORATION 1988 City of Santa Ana Building Maintenance Division 20 Civic Center Plaza #M-11 Santa Ana. CA 92702- ACORD 25 (2001/08) SANJOAQ-02 AYDA IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the 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 certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. APPROVED AS TO FORM ~ ?-II/ , Laura Still Sheedy Assistant City AttorneY ACORD 25 (2001108) ~ business in connection with the sale of the product; (6) Demonstration. instailation, servicing or repair operations. except such operations performed at the vendor's premises in connection with the sale of the product; (7) Products which, after distribution or sale by you. have been labeled or relabeled or used as a container. part or ingredient of any thing or substance by or for the vendor. c. This insurance does not apply to any insured person or organization from whom you have acquired such products, or any ingredient part or container. entering into, accompanying or containing such products. 3, AGGREGATE UMIT PER LOCATION (1) Under SeCtion III - Limits of insurance the General Aggregate Limit applies separately to each of your "locations" owned by or rented to you. (2) Under Section V - Definitions. definition 20. is added as follows: 20. "Location" means premises involving the same or connecting lots, or premises whose connection is interrupted only by a street, roadway. waterway or right-of-way of a railroad. 4. AUENA TED PREMISES Under Section I - Coverage A. Paragraph 2 Exclusions. j. (2) is replaced in its entirety with the following: (2) Premises you sell. give away or abandon. if the "properlY damage" arises out of any part of those premises and occurred from hazards that were known by you, or should have reasonably been known by you, at the time the property was transferred or abandoned. Under Section V - Definitions, definition 3. "bodily injury" Is replaced in its entirety with the following: 3. "Bodily injury" means bodily injury sickness or disease sustained by a person. This includes mental anguish. mental injury shock, fright or death resulting from "bodily injury" sickness or disease. 6. BROAD FORM PROPERTY DAMAGE - Borrowed Equipment, Customers Goods, Use of Elevators 1. Under Section I - Coverage A. paragraph 2, Exclusion j. is amended as follows: Paragraph (4) does not apply to "property damage" to borrowed equipment while at a jobsite and not being used to perform operations. Paragraphs (3). (4) and (6) do not apply to "properly damage" to "customers goods" while on your premises nor to the use of elevators. 2. Under Section V . Definitions. definition 21. is added as follows: 21. "Customers goods" means property of your customer on your premises for the purpose of being: a. Worked on; or b. Used in your manufacturing process. 3. The insurance afforded under this provision is excess over any other valid and collectible property insurance (including deductible) available to the insured whether primary, excess, contingent or on any other basis. 7. INCIDENTAL MALPRACTICE.cmployed Nurses, EMTs and Paramedics Under Section II . Who Is An Insured, paragraph 2.a.(l)( d) does not apply to a nurse, emergency medical technician or paramedic empioyed by you if you are not engaged in the business or occupation of providing medical, Chepi-4 (9104) Page 3 @1994lncludescopyrightedmalerialofISO Properties, r"AWi{tj~~o~\S TO FORM ,~ f/(C; Laura Stitt Sheedy Assistant City Attorney 5. BODILY INJURY REDEFINED ~ ~ -MAY-25-2005 WED 05:05 PM FAX NO, p, 02/04 , SANJOAQ.()2 AYDA _CEO (559) 432'()222 DiBuduo & DeFendis Insurence Brokers, LLC License #OE02096 P.O. Box 5479 Fresno, CA 93755.5479 ACORD", CERTIFICATE OF LIABILITY INSURANCE DA~~;;;r' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMENO, EXTENll OR ALTER THE COVERAGE AFFORDED BY THe POLICIES BI;LOW. IN!.up!r;;f1 Sa" Joaquin Chemicals Inc. ~:n~~~::~~;;':;;o IV- vl0C>:J,-OJ '/ A,I - ,3L'03 -OS'1 -UI INSURERS AFFORDING COVERAGE "';SUR'R" Hudson insurance Company l~sURER B: State corn.penS8tion Insu~~c. Fund INSUR~A; S.: INSURf;RD: INSURER Ii: NAle# COVERAGES THE POLICIES OF INSURANCE LISTED BEL.OW HAVE aEEN ISSUED TO THE INSURED NAMED AaOVE FOR THE POl-ICY PERIOD INDICATED. NOTWIUSTANDING ANY REaUIREM~NT, TERM OR CONDITION OF ANY CONTRACT OR OTHER POCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUEJ OR MAY PERTAIN, THE INSURANC. AFFORDED BY THE POLICI~S DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS 'IF SUCH ~~:;f:;S' AGG~~~GATE LIMITS SJ:iOWN MAY H4,Ve,.~EEN REDUCED ,BY PAID ClAIMS:.,," PRkI.fJ ExPIRATION ~,.,. -....- POLICY NUMBER POl-...'SY EFFECTIVE LlMIT$ i~~r;RAL LIABIUTY EACH OCCU~CE . I,OOO,OOC A X ..!. 3MMERelAL GENERAL LIASILrT'f CHEPLOOOSS 413012005 4/30/2006 ~gE"IUI'U:.NIt:lJ...\ . "rotooc PREMISES lEa oeaJrcnce _._ CLAIMS MADE [!] OCCUR . . ;iJ~;; ~~(AnyOI'lCj;lCl"&OI'1)" . f- -'.,. .._~ PERSONAL. & AOY INJURY I 'l~OOO, .... GENERAl AGGREGATe . . - 2.000,00 "0.- "- I_Z'OO~,~ ~'~ AGG~EnEtIMIT APnS PI'iR PROOUCTs-eOMP~PAGG PO~ICY ! f~8T LOC A ~TObllOBJLE LlABIUTY COMBINEO 5INGL..E LIMIT . 1,000,001 ..! ANY AUTO CHEf'AOO0100 4/30/2005 4/30/2006 lEaaccldent) -'- -'--"- - AI-I- OWNED AUTOS 800ll Y INJURY SCHEDULED ""UTOS (PerpMO"') . - APPROVED -- -- "- - HIRliD AUTOS A~ TO POR ~ BODilY INJURY , NON-OWNED AUTOS (PfIraccldenll /~ 1-- -------~ I-- - .;7', J, j _ __ \ 1/ /? PROpeFl'rY DAMAGE , - ,.c. (Per~tleoll ROE UABlLITY , Laura ~tl!t pheedy Assistant City ~.C?Nl v. 5A ACCIOENT , '-----,- ANY AUTO Attornev EAA~_ , OTHER THAN AUTO ONL v: AGG S ~~$JlJMIiIRiLl...A UA8lLITY EACH OCCURRENCE . 1,000,000 A OCCUR 0 CLArMS MACE CHEPUOO0101 4/30/2005 4/3012006 I_~~ ~~REGATE ~ IDI:DUC"r18lli - S ___ X RETENTION , 10,000 -- '.--- , WORKIiRS COMPENSATION AND _J we StATU; I 10.... B EMPl.OYEfUj:' UAIllI.ITY 168187504 .TORY LIMtr~ ';-j-,OOO.OOI ANY F'ROPRIETOR/F'ARTNE'RIliiXECUTlVE: 6129/2004 6129/2005 ~t:!.~CCIDENT .,._ OF~ICERlMi;MBE!R EXCI-I.lOEO'i' ;---, ,0Qo-;Daj ~~~~V~g~NS below e.l. DISE.-'se . e~ EMPI.OYEf OTHER 1i.1-, DISEASE. POLICY LIMIT . 1,000.001 ~CRl"TJON OF OPERATIONs. I LOCATIONS I VEHICt.ES f ~I:LUSION$ AgDED BY ENOORSEMEN'r I SIi'ECJAl,.. PROVISIONS City of Santa Ana, its officers, employees, agenls, volunteers and r8$presentatlvGS are named as addltonal insureds as per wlinen contract for general liability. CERTIFICATE HOlDER City of Santa Ana Building Maintenanclfit Division 20 Civic Center Plaza #M-ll Santa Ana, CA 92702- CANCELLATION SHOULD AlIIV' OF THE ABOvE OESCRlB~ POLICIES BE OANCIi~ BEFORE THE IiJPIRAT10N DATE THEFlIiOF. THE I$SUlNO INSUR!ft WILL l6lAlVM.VJOlMAlL 3L- DAYS WRlTIIlN NOTICETOTHEC~ATlfICATEHO~NAMI5D TO T)tf:UfT. ~~ )("''''''~'''''''''''''fllll''''-lllQlrV.Y'''~lIllO''~ ~~ AUTHORIUD REPRESENTATIVE ;::;? ACORo 25 (2001/08) @ACORDCORPORATIC'N1988 .' , -MAY-25-2005 WED 05:06 PM FAX NO, p, 03/04 SANJOAQ-Q2 AYOA IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the pollcy(ies) 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 certijicate hoider in lieu of such endorsement(s). DISCLAIMER The Certificate of Insuran,;:e on the reverse side of this form does not constitute a contract between the issuing insurer(s), eulhorl2ed 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. APPROVED AS TO FOIVW \ /; ~- / LauT; Slit~; I\.ssist'" . heed}' <dIt ell Y Attorney ACORD 25 (2001/08) · - MAY-25-2005 WED 05: 06 PM , I'I'lY-2s-2eIil5 09'1'13 FAX NO, p, 04/04 SAi J1:RlU IN a-EM I CR. 559 252 9514 P.B4 UKutrr B .lnnmONAL INSUlOID ENDORSEMENT FOR mMMRR~JAI. GENl!RAL LJABll.ITY POLICY ~COItlplPl)' HUASDn I::'n<ill'ld..K'\c.(. ThiJ 1I!ll00000000Dnt modifies _ in51l\'lDCll as i, afForded by tile p.lI)viIiou ofPolioy * ~HEPlOD~ft~~mDW~~ 1. '/'be City ofSlDta ^"" 20 Civic em. P/.aa, &adlI ADB, Clllif"onl.ia P2701; 115 ofticcn,llIIptO)'llllll, 1IpIts, ",,1UllIlIIIn lllId l'llpPllllltatiWll are llIInCd lU lddiliOlllll i~ ("~ iIIswQ", with Illpl'd tQ u.bili1y and doteaIsc ofllli18 aririD& f'rIlm tbe ~ -- p..ro.wed by or on bIlbaJt oflbt 1lIIllICd iIlsured. 2. Wldll1eSp\lCt III c1Qns ari~ t:nIl of1be OI*IllOIll aad 11M JItlfoamed by or OD. bcbaIf oflbt IllIlaf i!llllnd, such inIuraace 11$ islil'orcllid by dIl.I policy is)ldmary aI1d ~ JIlIt Idditionalto \lI' DOIIlrIlNtiDs YIIl1llllly other insutam:e caJried by or for the benefit of the additiGolI httureds. 3. ThiI ill_CCllpJIUIlI .........e.Iy to each iasamI api.lm whom ClJaioJ is macIc or suit is brvIIght ellCll!pl wilh IWpect to tho coJDPa../slimits of JiablUly. The inclu!ion of llIlY JleJ1lIIl or ~ as III iJlsured Illall not lIffcct alY n,ht which such peuon or \lI'8lIlliJllioD WVUld 111M; u. clailllllllllfnot !ICI included. 4. W'~ A.pect to lb. addItiauaJ iIlsured5, tbili ~ sbaU not be CIIIICCllllll, or hIlIW.l1aI1y mtuced 1ft ~ or littrit$ ex<:e)lt after IIIlrty (30) days wrln.a1lOlb hllll baen aiVlm to the City of SIIIIIa An-. 20 CIvic ~ Pa.. Santa Ana. Ce1ifVmia 92701. (Comp\tllioa oftlll= to:ilowiq. iachldillg COUIIlCISi~.11 requirIld rn 1Illllcc This endonemtnt c/foctiw.) Bftbctive L/ / 2) 0 2. D 0 ~ J't)lic)'#~)L ISWld to tIWI eadonemlllll fmrIl8 . Jl&ft of APPROVED AS TO FORM 7S~. .f.<, "'1'" . ~,/" './ Laura Stitt Sheedy Assistant City Attorne\ ('\ Ia.IIlI'Cd Cvunum~by ~~~aR . !1'lV-25-i!8e5 1lB' 58 647S421 S'1% P.e:s NE CERTHOLDER COpy STATE COMPENSATION INSURANCE FUND P.O. BOX 807, SAN FRANCISCO,CA 94142-0807 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE 06-29-2005 GROUP, POLICY NUMBER, 1681875-2005 CERTIFICATE ID, 27 CERTIFICATE EXPIRES, 06-29-2006 06-29-2005/06-29-2006 CITY OF SANTA ANA BUILDING MAINTENANCE DIVISION 20 CIVIC CENTER PLAZA, #M-II SANTA ANA CA 92702 NE .JOB: This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 30 days' advance written notice to the employer. We will also give you 30 days' advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend. extend or alter the coverage afforded by the policies listed herein. Notwithstanding any requirement, term, or condition of any contract or other document with respect to which this certificate of insurance may be issued or may pertain, the insurance afforded by the policies described herein is sub ject to atl the terms, exclusions and conditions of such policies. ~ A~c &L- AUTHORIZED REPRESENTATIVE PRESIDENT EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000.00 PER OCCURRENCE. ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE OB-29-2005 IS ATTACHED TO ANO FORMS A PART OF THIS POLICY. EMPLOYER APPROVED AS TO FORM /~ Laura S . '. . 1m Sheedy ASSIslanl Chy Al torney LEGAL NAME SAN JOAQUIN CHEMICALS INC 4684 E HEDGES AVE FRESNO CA 93703 SAN .JOAQUIN CHEMICALS INC (REV.3.03) PRINTED: .. . :. . . . JUN-12-2007 1? ~ S8 SRN TURQLI I IJ CHEPII ~RLS 888 808 9514 P.02 SANJUAt1-U2 ATUA ~400R0 CERTIFICATE ~F LIABILITY INSURANCE TN °A'~'MNYDO""""' 4/26!2007 Pnooucen (559) 432.0222 DiBuduo $ DaFendis lnaurance Brokers, LLC Lie ~ ti'OEO20sS THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ~O~DER.DTHIS CERTIFICATE DpES NpN A~EAEwa EkTEND OR ALTER THE COVERAGE AFFORDED BY THE POIacIES eEtOW. P.O. .ax 5479 Fresno, CA 93755.5479 INSURERS AFFORDING COVERAGH NAIC # InsugEC San Joaquin Chemicals Inc. IXSUREaA. American Irltemational S cialty Lines 4684 East Hedges Ave INSURER °: Commerce 8 Industry InsuraTlee Compan Fresno, CA 93703-0000 wsuRER a State Cgrppen8aG4n Insurance Fund alaURER D'. P+SURER E COVERAGES THE POLICES OF w$uRArvcE u3YEh 6ELGW HAVE BEEN ISSUED TO THE INSURED NAMED A60VE FOR THE POLIOY PERIOD AYDICATED. NOTWI7HSTANDiNG nNr REqunirlJAENY, TERM OR CONDITION QF ANY CONTRACT OR OYHER DOCUMENT WITH RESPECT T4 VJHIDH THIS cERnPlcarE nuv BE ISSUED OR M4Y PERTAIN, THE INSVRANCE AFFORDED BY THE PDLICIE3 DESCRIBED HEREIN IS SUBJECT 70 ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BT PAID CLAIMS POLICY LAUNDER POLICY EFFECTIVE POLL Y E% gATN)N LXIITS CENEML LLLDLITY EACH OCCURRENCE f i,DDD,~ '~ X X COMMERCML GENERAL LLL@ILiTY 7DD4964 4/3W~D07 4/3012DD6 GD aD , pgEMISE3 E ONItalICE 5 f CLAIMS MgOE ~OGLUft MED E%P1Mrana loon! S S,DB PERSONAL aADVMJURY S ir000A GENERAL AGGREGATE S 2,009,00 GEN'l0.GGREGATE LIMIT APPLIES PER. PRODUCTS •GGMPfOPAGG ; 2,99D,00 POLN;Y PRO- LOG AYT DMOBILELUBILITY COM@INED SINGLE LIMIT 000 1 09 B X ANYAUTp 7004966 4130/2007 413012008 (Ee u6tlen!) , , 5 X ALL OKMEO Aurae X sonar IN.NRr n Pw = $CXEIXILED AUTOS PROP I 1 X MREDAUTOS BODILY INJURY 5 XON•OWNEO AUT09 ~ (Par E[GI°Mt) PROP TY D ER AMAGE t (Par aee.eaAq DAMOE LMe1LIlY AUTO ONLY•EA ACCIDENT 5 ' ANT AUTO EA ACC OTHER THAN ; ANTO ONLY. AOG 5 EJfC~ytIMORILLA LI1RILiT1' EACN OCCURRENCE E 6,Q66,dD A X OCCUR ~ CLAIMS MADE 7004985 4!3912007 4/30/2008 AGGREGATE i 3 S,DOOiUO R ~DUCnaLE 5 X RETENTION : 19,000 s WBRNEPS COMPEN9ATDN AND X WC STATU- OT1H 1 C EIPpLOYEgs• uaewTr 168187507 6/2912007 612912008 E L E CH 0.C ENT 000 000 1 ANY PROP0.1ETOtUPARTNERlEXECl7TME . A OIO , , a DFFIGEn/MEMRER E%GLWEO? E.L, DISEASE • EA ENFRO+'E 5 1,000, YyRe asvlW uMa, SFE IALPRONEIONSmIVrv E.LaISEASE-POLICYLNdn 4 1.990, oTXER DESGNpnDN OF OPERATEJN9 f LOCATITWS I VEHNAES r E%CLUSIDN9 AOOf6 aY ERDCRSEMENT! SpECMI PROY191QN9 anceilation: Ten day notice of cancellation will apply for n8n•payment of premium. Cancellation: Tan day notice of cancellation for nonpayment of premium. BrGFcata holder is nametl as addl0onal In:ured as respect to general liability per attached AIG Company Conn. to officers, employees, agents, volunteers and reapresantativea are elan Hamad as additonal insureds city of Santa Ana Building 8falrltenanee Division 2d Civic Canter Plazgt~I'~V'~L'17 ftti T~3 Santa Ana, CA 927022- bNOULO AMY OF TXE ABOVE OE°CNeEO POLfCiES CC OARCELLED BEFORE TFIE E~ENTDX DATE TXEREOF, TXE ISEVINN IN9Vn$q WILL~MAIL 30 DAYS WRITTEN NQt~GE TD THE CERTInEATF XDL66R NAKED Ta SNE LEFT, A s.,fstaat ~:;Ll/ ^.[torr,c~ "~~•'•,~~"~• JUN-12-2997 1252 6aN J9RL~UIN CHEMICRLS 222 892 9,14 P.9:; ulgiiYVRi[~Vi AIYl1 IMPORTANT Ii the certificate holder is an ADDITIONAL INSURED, the policy(ies) must t>e endorsed. A statement on this certificate does rl6t Confer rights to the certificate holder in lieu of such endrusemeni(s). If SUBROGATION IS WAIVED subject to the terms and conditions of the policy, certain polities may require an endorsement A statement on this cert~Cate does not confer rights to the certificate holder in lieu of such end0rsertl@i1t(s}. DISCLAIMER The Certificate of Insurance on the reverse Side of this farm does not constitute a contrail between the issuing insurer(s), authorized representative or protlucer, and the cert~cate holder. nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. n1`PRp1/ii.i) A:i~')'O E'UtLM Lauri tir_tc Si:.:c~iy As~IS[2nt arty Atlon,ey IUN-12-2997 12 58 SR11 79RUUIN CHEMitRLS ENDORSEMENT N0.7 TFrls endats0ment, aHfxtlv0 TOOT AM, April 30, 2006 Forms a part of Pollcy No: EQ 70049(14 laaued tu: SAN JOAQUIN CHEMICALS, MC tly: AMERICAN INTERNATIONAL 9PEC7AL7Y LINES INS. CC. 888 898 9514 P.94 THIS ENDORSEMENT CHANGES THE POLICY, PLE#SE REAP IT CJIREFULLY COIIEFtAOE A, e, AND C ENHANCEtAENT ENDOR9EMENT ADDITIONAL INSURED • OWNERS, LESSEES OR CONTRACTORS fOR COYEAAGES A, 9, AND C This endorsement modrfies Insurance provided under the folicwing: COMMERCUIL GENERAL CiA81LffY POLLUTION LEGAL LUtBILfTY GOVERAGE f~RM SC~iEDULE Name of Parson or Organization: Where requtred hY written contract, Qf n0 6nlry appears aCGV9, iMtXmation rBgVifed tD compi6te this enrorsement will be shown in the t?6G lsratfans as tlpp9caWe tb tnls enawaement} VY4h respect to Coverages A, e, and C, YVHD IS AN IN9UtaED (Set:Gon II) ~ amended to include as en insured the person or organization shown In the Schedule but with res ility ariany out of your angcing aperetrona performed for that Insured. _. q > ED REPRE$ENTpT11lE of twuntxsipneture (kr etas where aprpttcable~ ti5386{2198) As~istnat C:h~ .^•.r , ~ , aosas PAG@ 1 OF 1 TOTRL P.94