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HomeMy WebLinkAboutCYCOM DATA SYSTEMS, INC. 1B-2005/~/`- 2~l %O~i - 07 8 -~-,-Z iNSURNN~[ uN FiL:. WORK fJ'~Y PF.OCkED UNTlL !vSURIIlUCF. EXPIRES Cu - ~' u C^_ _ _ CLERK CF( uQCNC'~ ~n~" SEP 2 0 20D5 C ~. y~at,~.~~v~ SECOND AMENDMENT TO LICENSE AGREEMENT THIS SECOND AMENDMENT TO LICENSE AGREEMENT is entered into as of the 15` day of July, 2005, by and between Cycom Data Systems, Inc., a California corporation ("Cycom") and the City of Santa Ana, a charter city and municipal corporation of the State of California ("City"). RECITALS: A. The parities entered into Citylaw License Agreement #A-2000-059, dated April 3, 2000, by which Cycom granted to City a nonexclusive license to use Cycom proprietary software (hereinafter "Citylaw"), along with training and support for the software. B. The parties entered into License Agreement #N-2003-078, dated July 1, 2003 to purchase a software module which integrates Citylaw with Microsoft Outlook and which renewed the Citylaw Agreement for an additional one year period, (hereinafter, "said License"). C. In accordance with the terms and conditions of the Agreement, the parties wish to renew said License for an additional one-year period. WHEREFORE, in consideration of the covenants contained in said License, and subject to all the terms and conditions of said License, except those amended in this Second Amendment to License Agreement, the parties agree as follows: 1. The parties agree to renew the annual Software Maintenance and Support services pursuant to Section V of said License, at the rate set forth in Cycom's invoice attached hereto as Exhibit A-3. 2. Section 2, COMPENSATION, is arnended to read as follows: "The total sum to be expended under this Agreement shall not exceed $8,500, during the extended term of this Agreement, from July 1, 2005 through June 30, 2006." 3. Section 3, TERM, is amended to extend said License to June 30, 2006. 4. Except as hereinabove amended, all terms and conditions of said Licenses shall remain in full force and effect. IN WITNESS WHEREOF, the parties hereto have executed this Second Amendment to License Agreement on the date and year first written above. ATTEST: PATk1C1A E. HEALY Clerk of the Council APPROVED AS TO FORM: JOSEPH W.FLETCHER City Attorney By: ~'~ ~.._ .. ~ • ~ ~~ Laura Sheedy ' Assistant City Attorney PROVAL: CITY OF SANTA ANA ' / DAVID N. REAM City Manager CYCOM DATA SYSTEMS, INC. DON MC GRE R President I Ite: 9/7/2005 Time: 11:24 AM To: ® 96476515 714-905-1910 Paqe: 001-006 ACORD CERTIFICATE OF LIABILITY INSURANCE o9io i oYs' PRO WGER (714)905-1923 FAX (714)905-1910 Hayward Tilton & Rol app Ins. Assoc. , Inc. License k0614365 THIS CERTI FICATEIS ISSUED ASAMATTER OFINFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERII FICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED 8Y THE POLICIES BELOW. P.O. Box 25529 Anaheim, CA 92825-5529 INSURERS AFFORDING COVERAGE NAIC# INSURED Cycom Data Systems, Inc. IN~uRER A Hartford Casualty Insurance Co 29424 6835 Roberta Rd. SW I/,SURERH Continental Casualty Ocean Isle Beach, SC 28469 IN~u6ER~ k51J4FF' G P!'iIJREP L frIVFQ OG CC THE POLICIES OF INSURANCE LISTED BELOYV HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQU IREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCU MENT W ITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSU ED OR MAV PERTAIN, THE INSURANCE AFFORDED BV THE POLICIES DESCRIBED HEREIN IS SUBJ ECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DD' TYPE OF INSURANCE POLICY NLMBER POLICY EFFECTNE POLICY EXPIRATION LIMITS GENERAL LIABILITY 7258ANJ1649DX 06/04/2005 06/04/2006 EACH~~~~`L RRENCE s 1,000,000 X F~SMMERrIAL~,ENERALLIARILIT+ DAMAGE T4RENTEG $ SOD,000 ~:LPIMS MADE ~~_QUR MEC~EFP IAIi$nnr Veiwlq $ 1D, DDD A PER$[INALF 4LlV IV.I l1 R~/ $ 1 ODD DDD _ , , -EraERAL AGGREGATE t 2,000,000 BEN"~ n,;,;PE54TE LIMIT APPLIES RER FRO PRnpltTS ,,VMP/SP A56 S 2, OOO, DDD R~, ~.~./ - LOC IEI T AU TOMOBILE LIABILITY ~./MBINED SI PULE IJMIT ,~ APII' AUTO (Ea a~mmit ALL ~9VNJED A11T0`_. &~DILY INJURY $ ;~ Ht ~uLm Al R~+ IPerpersorl HwFG ul n ~~. BODIL° NJUHV $, NoN~_INhFn AUT~~S (Fe.: ~ulonq PRGPERT' ~APAA2E $ (Fa accitlenl) OARAGE LIABILITY AH-n ONLY EA Af CIDEM1T $ /wv Ann ~~~P y Il I ~J, ; '~ EA nce $ . , 1 ., ..-r;e nnrPnlAnl gllni oruLr Ac3 s EXCESSNMBRELLA LIABILRY i. ~ ~ / EACH F~~~ uRRENrc $ Ji_i'lIG VLAI MS MADE ___ , ~ ~ A'SGREG FTE $ _ _~,,,,L.. L .... _~~,: =.[< $ OEDWdTIELE ---- - $ F'ETENTION $ - WORKER6COMPENSATIONAND WC STATU CTH- EMPLOYERS'LIABILnY 1~ PY 11 - F 4NY PRCPRIETJkIPAHTNER/ExE,IITIVE EL EACH ACCIDENT $ OFFI~:FH/MCMREk t ur LUpCR^ Ilyus, tlswme under CL OItiE/SE EA EMPLOYE $ SPECIAL PFnvlsl0^ds below EL DISEAtiF FOLICVLIMIT S POro~essional Liability 267898038 07/16/2005 07/16/2006 51,000,000 Aggr. Inc! Expenses B 51,000,000 Each Wrongful Act 510,000 Deductible DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES 1 EXCLUSIONS ADDED BV ENDORSEMENT I SPECIAL PROVISIONS ertificate holder is named as additional insured as respects to general liability but only as respects o services provided by the named insured. 'CANCELLATION: 10-day notice for non-payment of premium. SHOULD ANV OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE ~lty of Santa Ana EXPIRATION DATE THEREOF, THEISSUING INSURER WILL ENDEAVOR TO MAIL Office of the City Attorney 30-DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT Attn: Juanita Hernandez BNT FAILURE TO MgIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 2D Cl V1C Center Plaza OF ANY KIND UPON THE INSURER, rtSAGENTS OR REPRESENTATNES. Santa Ana, CA 92701 AUTHORIZED REPRESENTATVE ~~ Valerie GallardoNHC ACORD 95 !9007/0M1 FAX: (7141647-6575 ' :te: 9/7/2005 Time: 11:24 AM To: ® 96476515 714-905-1910 Paqe: 002-006 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 certrficate 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), authored representative or producer, and the certrficate holder, nor does it affirmatwely or negatively amend, extend or after the coverage afforded by the policies listed thereon. ~~ ~_ ._.-_.__-. _...- iL~ ~J1__ ~~ ~: SI~~ ,_ HI:VKU 20 (2UU1/08) Ite: 9/7/2005 Time: 11:34 AM To: ~ 96476515 714-905-1910 Paqu: 003-006 ACORQ CERTIFICATE OF LIABILITY INSURANCE o9io %zoos PRODUCER (714)905-1923 FAX (714)905-1910 THIS CERTI FICATE IS ISSUED AS A MATTER OFINFORMATION Hayward Tilton & Rol app Ins. Assoc., Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AMEND, EXTEND OR License N0614365 ALTER THE COVERAGE AFFORDED 8Y THE POLICIES BELOW. P.O. Box 25529 Anaheim, CA 92825-5529 INSURERS AFFORDING COVERAGE NAIC# INSURED Cycom Data Systems, Inc. ncUaeRA Hartford Casualty Insurance Co 29424 6835 Roberta Rd. SW INSLRBRR Continental Casualty Ocean Isle Beach, SC 28469 IvsIIReRr Ir'.l l,i[R 17 Vd9.RFF t R ES COV AG THE POLICIES OF INSURANCE LISTED BELOVY HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. N07WITH STANDING TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCU MENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR ANY REOU IR EMENT , MAY PERTAIN, THE INSURANCE AFFORDED BV THE POLICIES DESCRIBED H EREIN IS SU BJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR OD' TYPE OF INSURANCE POLICY NLMBER POLICY EFFECTNE POLICY EXPIRATION LIMITS GENERAL LIABILRY 72SBANJ1649DX 06/04/2005 06/04/2006 eArH T~z~.uRRENSe ~ 1,000,000 X TOtdMEPCIAL SHJEHAL LI NPDILITY DAMAGE TO RENTED g 300 SOD ~__AIME MADE ~uT~'UR MED E*P (ATy ~,nE peuun S 10, DDD A vBRSONALa ADV IrlduRr a 1,000,000 tiEIJERAL AGGREGATE $ 2, DDD, ~~~ SCN'L AGGREG=ATE Li MIT APPLIE>PER PP.OCUGT_ !~IMP~TP AI'-6 S 2, ODD, DOO F'RG PCLL'f JECT Ln~_ AUT OMOBILE LIABILITY V MBI NLD S VDLE LIMIT 5 (Ea acs deny AN'i AIIT AC- OWNCD AUTT'= EDGILY Vu.IURv t - IPer pemanl vrIILDUI FU AJLOS HIRFD AUTO ti Eau DIL NJUR'Y $ (Pvr ac.~.lenq NON NVNcD PI IP r.- PROPERTY L`AMA,;E £ IFe' ecv]Rnq GARAGE LIABILRV AUT! ~ ONLY ~ EA AT CIDENT 5 AIJ'! AUT!' uTl ICP'HAN EP AO- $ NUT!~pNL" Pf.G $ E%CESSIUMBRELLA LIABILRY FA~_H ~~TT,RRtT1GE 8 ~w~UR ~ CLAIMS MADE AGGREGATE V S DEDUCTINLE $ _ RETEfJTIOIJ $ ~ WC 9TPTU- OTH- WORKERS COMPENSATION AND TTRY I I EMPLOYERS' LIABILRY I TN E T E T EL EACH A'J-1DEN- $ ERIEA AIJY RFOPRIET~ R/RAR C J IV ~,EHGTH/MEMHiHrx(;UID6["I tL DISEASE EA EMPLOYE R If yes, tlas~.'Ibx unJer 3FEJAL PROVSIONS belrnrv t I DISi ASG POLICE I IMIT $ l Li bili o~` 267898038 07/16/2005 07/16/2006 $1,000,000 Aggr. Incl Expenses essiona a ty r f l A h B Wrong ct E1, 000, 000 Eac u Y10,000 Deductible DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMEM I SPECIAL PROVISIONS ertificate holder is named as additional insured as respects to general liability but only as respects o services provided by the named insured. ~ '~~ ~// =CANCELLATION: 10-day notice for non-payment of premium. - . -- r.._-<_... ._...----_. CFRTFII`ATF UnI nFR CANCELLATION ~ ' SHOLLD ANV OF THE ABOVE DESCRIBEDPOLICIES BE CANCELLED BEFORE THE E%FMiAT10N DATE THEREOF, THE ISSUING INSURER W ILL ENDEAVOR TO MAIL Clty of Santa Ana 3O" DgYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. Office of the City Attorney Attn: 7uanita Hernandez BIfT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATON OR LIABILITY 2D Cl V1C Center Plaza OF qNY KIND UPONTHE INSURER, rtS AGErQ3OR REPRESENTATIVES. Santa Ana, CA 92701 Al1THORIZEO REPRESENTATVE ~~,~ q- ~ ~ ~j Valerie Gallardo MG (J '° ' -_ ACORD 25 (2001109) FAX: (714)647-6515 oOACORD CORPORATION 1989 ' rte: 9/7/2005 Time: 11:34 AM To: ® 96476515 719-905-1910 Page: 004-006 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, subled to the terms and wnddions 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 aRer the coverage afforded by the policies listed thereon. _.~~_ i - ------ :,i:. ti~ ML.VRU LO (LUUI/Utl) I Ite: 9/7/2005 Time. 11:24 AM To: ® 96476515 714-905-1910 Page: 005-006 ACORDM CERTIFICATE OF LIABILITY INSURANCE 09 /07/2 00 51 PRODUGTER (714)905-1923 FAX (714)905-1910 Hayward Tilton & Rol app Ins. Assoc., Inc. License #0614365 THIS CERTIFICATE IS ISSUED ASAMATTER OFINFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 25529 Anaheim, CA 92825-5529 INSURERS AFFORDING COVERAGE NAIC# INSURED CYCOm Data Systems, Inc. ~.wuIRERn Hartford Casualty Insurance Co 29424 6835 Roberta Rd SW IN`,IRERe Continental Casualty Ocean Isle Beach, SC 28469 INSURERr INSURER o ~SLIPCR r THE POLICIES OF INSURANCE LISTED BELWV HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAV 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 DD' TYPE OF INSURANCE POLICY NUABER POLICY EFFECTNE POLICV E%PIRATON LIMITS cENERAUTAee-rrv 72SBANJ1649DX 06/04/2005 06/04/2006 EACH ~~~:aRRENCE R 1,000,000 X ~.UMMERCIAL6ENERAwABIUrV DAMA6ET~~RENTEG a 300,000 A._AIMS MHDE ~OCOLR MEM EXF Nny onx VAU,cnl $ 10 DDD A PERSUNALZ ADV IN~uuv s 1 000 000 eENERHL Ao:gREGATE , , a 2 DOO 000 _ eENLAC„RE~;HTEUMIT APPLIES PER l PROOU~TS-~oMP/VP AGG , , $ 2,000,000 POLICI JC~T Lni_ AU TOMOBILE LIABILITY ~.OMBINED~NoLE LIMIT $ ANY AUTO (Ea a_am~tl ALL a WNEG RUTS b BOpILr VJduRY $ 3,.HEUIR FR AI OO`~ IPer RB(SOPI HIRFEi AI IIOti _ enolL~ nlduuv F NoN nwNEn HUI~~a fPe: acodtiuq - PRnP RT~ E DAMAGE f Pyr aCSltl9nl) GARAGE LIABILffY HI IT ~ pNL+ -H'~A~CIGENT $ HNY AUTO E/AA~~ T~iHER TI IAV $ AUTO ONLY hG~. $ E%CESSIUMBRELLA LIFBILfTY EHCH Vt.C_IRRENIE $ GCUR ~ CLAIMS MACE 4s~,RESATE 4 DEUIJ LTI BLE R ReTENTION $ ~ WORKERS COMPENSATION AND WC STATLI 0TH. EMPLOVERS'LIABILITY T~ RY IMIT R ANY PROPRIETOR/PARTMERIEXE~LTIVE ~:FFIC R EL EP~H H~CIDENT $ E /MEMBER Ex~TUDFG^ Il ye des!~Ibe un Jer EL GISEASE-CA EMPL~~YE $ ?PENAL PRON310N;belwr EL [)ISFA9E-P/'i'~.VIIMT _ $ ro~essional Liability 267898038 07/16/2005 07/16/2006 f1, 000,000 Aggr. Incl Expenses B !1,000,000 Each Wrongful Act !10,000 Deductible DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES 1 E%CLUSIONS ADDED BV ENDORSEMENT I SPECIAL PROVISIONS ertificate holder is named as additional insured as respects to general liability but only as respects o services provided by the named insured. /~~'~'I~',~;}`IILL ` ~ _ , , ;,; t,,,:,,, %" .. i, CANCELLATION: 10-day notice for non- t f i ~---~--- ~ paymen o prem um. ----- ---i __ :_.__-_. _. ~,. SHOLLD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Clty of Santa Ana EXPIRATION DATE THEREOF, THEISSUING INSURER WILL ENDEAVOR TO MAIL Office of the City Attorney 3O=DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT Attn: Juanita Hernandez BUT FAILURE TO MAIL SUCH NOTCE SHALL IMPOSE NO OBLIGATION OR LIABILITY 20 Cl V1C Center Plaza OF ANY KING UPON THE INSURER, ITS AGENTS OR REPRESENTATNES Sanid Ana, CA 92701 AUTHORIZED REPRESENTATIVE ~~ Valerie Gallardo NMG ACORD 25 !2001/0el FAX: (714 ite~ 9/7/2005 Times 11.24 AM Toy ~ 96476515 714-905-1910 Pages 006-DD6 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 condftions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certrflcate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract betvveen the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or after the coverage afforded by the policies listed thereon. ,- J. ._-____. f.__,.~.. -- _---_-_.. ACORD 25 (2001108) { TN CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) o9/o7/zoos PRODUCER (714)905-1923 FAX (714)905-1910 Hayward Tilton & Rol app Ins. Assoc. , Inc. License #0614365 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. P.O. Box 25529 Anaheim, CA 92825-5529 INSURERS AFFORDING COVERAGE NAIC # INSURED Cycom Data Systems, Inc. INSURER A. Hartford Casualty Insurance Co 29424 6835 Roberta Rd. SW INSURER e. Continental Casualty Ocean Isle Beach, SC 28469 INSURER c: INSURER O INSURER E. COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANV REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSU RANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAV HAVE BEEN REDUCED BY PAID CLAIMS. INSR DD' TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY E%PIRATION LIMITS GENERAL LIABILITY 7256ANJ1649DX 06/04/2005 06/04/2006 EACH OCCURRENCE $ 1~000~QQQ X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED S 300 OOO , CLAIMS MADE ~ OCCUR MED EXP (Any one person) $ 1Q , QQQ A PERSONAL 8 ADV INJURY S 1 ~ QQQ ~ QQQ GENERAL AGGREGATE E 2,000,QQQ GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS -COMP/OP AGG E 2 , OOO, OOO POLICY PRO- LOC JECT AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT S ANV AUTO (EB BCCitlant) ALL O WNED AUTOS BODILY INJURY S SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accitlenU PROPERTY DAMAGE (Per accitlen0 S GARAGE LIABILITY ., AUTO ONLY-EA ACCIDENT E ANV AUTO OTHER THAN EA ACC $ AUTO ONLY AGG E EXCESS/UMBRELLA LIABILITY _ _ •e :_- ._ _.____. _ Y - EACH OCCURRENCE E OCCUR ~ CLAIMS MADE T AGGREGATE E E DEDUCTIBLE E RETENTION $ E WORKERS COMPENSATION ANO WC STATU- OTH- EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE E l EACH ACCIDENT $ OFFICERIMEMBER EXCLUOED9 E.L. DISEASE - EA EMPLOYE $ If yee, tlescribe untler SPECIAL PROVISIONS below El DISEASE -POLICY LIMIT $ ro~" i l i bili 267898038 07/16/2005 07/16/2006 $1,000,000 Aggr. Incl Expenses ona ess L a ty B $1,000,000 Each Wrongful Act $10,000 Deductible DESCRIPTION OF OPERATIONS I LQCATIONS I VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS ertificate holder Ts named as additional insured as respects to general liability but only as respects o services provided by the named insured. °CANCELLATION: 10-day notice for non-payment of premium. City of Santa Ana Office of the City Attorney Attn: Juanita Hernandez 20 Civic Center Plaza Santa Ana, CA 92701 ACORD zs(zooveal FAX: (714)647-6515 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3O*° DAYS WRITTEN NOTICE TO TXE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR AUTHORIZED REPRESENTATIVE Valerie GallardoNMG ~ nernen rnaanaennu ~DRI 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 cert~cete 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 Certifcate 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, eMend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2001108) ~ ACORD CERTIFICATE OF LIABILITY INSURANCE °"'~ ,~ ~ 03-24-2006 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION HAYWARD, TILTON&ROLAPP INS~PHS ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 185019 P: (866)467-8730 F: (877)905-0457 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. PO BOX 33015 - SAN ANTONIO TX 78265 INSURERS AFFORDING COVERAGE INBDaED -~~;3-4T ' INSURERA:Hartford Casualty Ins Co 1J. aoo3-U 78-d1 - /J 3-0~7 (j-Cy ~ INSUflER B: . [)p CYCOM DATA SYSTEMS INC N 3pc3-c~h-c3 INSURER C: 6 8 3 5 ROBERTA RD . S . W . A ~ 31XZ~ v 9 wsUREq o: . OCEAN ISLE BEACH NC 28469 '' ___ INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANV CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSU F D OR . MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGAT[ LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTa TYPE OF INSURANCE POIK:Y NUMBER DATETE IM FDD/YYI DATEYIMMIDOT/VYN LIMITS GENEIIAL LIABILITY EACH OCCURRENCE 1 0 0 0 O O O 5 , , A COMMERCIAL GENER A L LI A8ILITV 72 SBA NJ1649 06/04/06 06~04~O7 FIRE DAMAGE IAny one fiml 53OO, 000 ~ y ~ J CLAIMS MADE 1 " 1 OCCUR MED EXP IAny one petnon) 91 O , O O O X Bus>ness Liab PERSONAL&ADVINJURY j Sl OOO OGG , , GENERAL AGGREGATE 52 0 0 0 O O O , , GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG SZ , O O O , O O O POLICY PRO JECT X Loc AUT OMOBILE LIABILITY A ANV AUTO 72 SBA NJ1649 06/04/06 06/04/07 COMBINED SINGLE LIMIT IEa a~cltleml Sl, OOO, OOO ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per perm) S i X HIRED AUTOS X NON-OWNED AUTOS BODILY INJURY IPer accident) LLL S PflOPERTY DAMAGE S _ IPer accitlentl GARAGE LIABILITY AUTO ONLY ~ EA ACCIDENT 5 ANY AUTO OTHER THAN EA AUTO ONLY : AGG 5 EXCESS LIABILITY EACH OCCURRENCE S OCCUR a CLAIMS MADE -,* \;~ AGGREGATE _ ~_ I " ~ S DEDUCTIBLE A., _, ~- S ------~-- RETENTION 5 __ 1 4 WORNEAS COMPENSATpN AND -~ ~ WC STATU- OTH- EMPLOYEAS' LIABILITY TD __. E.L. EACH ACCIDENT 9 E.L. DISEASE - EA EMPLOYEE 9 ~- - C.L. DISEASE -POLICY LIMIT 5 ---~ OTNE11 I DESCRIPTgN OF OPERATIONS/LOCATIONSAIFNX:LESIE%CLUSNINb ADDED BY ENDORSEMENT/SPECIAL PROVISgNS Those usual to the insured's opertations. CERTIFICATE HOLDER ADDITNINAL INSUaeD: INSURER IETTER: CANCELLATION City Of Santa Ana its Officers SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Employees Agents & Volunteer EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOT C , I E 110 DAYS FOR NON-PAYMENT) TO THE CERTIFICATE Office of the City Attorney HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO 20 C1V1C Center Plaza OBLIGATION OR LIABILITY OF ANV KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. Santa Ana, CA 92701 A ORI D R ESE~N~]ATI1~f~~~~.~ ern°n oc c t~IO~r _ /~ ~~~'~~ `°-° '"""' ~' ACORD CORPORATION 7988 ~. II ACORD,N CERTIFICATE OF LIABILITY INSURANCE ' 03-23pT2007 II I rwwucEN 'I THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION I, I HAYWARD, TILTON&ROLAPP INS~PHS '. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE ', HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 185019 P: (866)467-8730 F: (877)905-0457 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. ' PO BOX 33015 INSURERS AFFORDING COVERAGE I SAN ANTONIO TX 78265 _ (INSURED n/-aQ03-p7g ''.wsuRERA:Hartford Casualty Ins Co N-~DO3_o~B--OI 'INSDgERa: ------ CYCOM DATA SYSTEMS INC /J~aD0,3-07S-Oa INSUREg c: I PO BOX 92437 078- 0 INSURER D: __ LONG BEACH CA 90809 N "aLb3- .3 'L INSURER E: COVERAGES r ANV REQUIREMENT, TERM OH CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICAI E MAV BE ISSUED OR ~ MAY PERTAIN, THE INSURANCE AFFORDED BV THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BV PAID CLAIMS. LTfl I TYPE OF INSURANCE POLICY NUMBER ~~"~~ `~"°~°` °`~°~ `°`~O°O"° LIMITS _ DATE IMMIDDIYYI DATE IMMIDDIVYI - _ _ IIA ' GENERAL LIABILITY ' COMMERCIAL GENERALLIABILITV 72 SBA NJ1649 06/04/07 EACH Of.CURRENCE I Sl , p p p, O p 0 1 06/04/08.HgEDAMAGEIAnyonerrel Is300,000 1 'I CLAIMS MADE X OCC R I II U 'I MEO E%P (Any one Pereonl ~I. 51 O , O O O L , X Business Llab 'I I I PERSONAL&ADV INJURY 51 , OOO, OOO ~ I ~ GENERAL AGGgEGATE 52 , 0 0 0, O O O 'L AGGREGATE LIMIT APPLIES PER: ~ ' ! P HODUCTS-COMP/OP AGG '~ 52, OOO, OOO _ POLICY ! PE OT I X LOC I ~' ~ ~~ A AUTOMOBILE LIABILITY ~ ANVAUro I 72 SBA NJ1649 ~ ' ~- ~ 'coMBINED SINGLE UMIr 51, 000, OOO I 0604/07 06~04~08 I IEsa°omenn I ', j 'ALL OWNED AUTOS ~~ ' BOUIIY INJURY SCHEDULED AUTOS 5 I IPer Persom I X HIRED AUTOS i '. -~i NON-OWNED AUTOS ~ 80DILV INJURY 5 I IPer accrdeml ~ ~ I PROPERTY DAMAGE 5 P i er acc I denU - GARAGE LIABILITY AUTO ONLY ~ EA ACCIDENT I S ' ANV AUTO '. II OTHER THAN EA ACC I S I I I AUTO ONLY.- AGG 15 '''~ EXCESS LIABILITY ' EACFI OCCURgENCE 5 I OCCUq I~~ CLAIMS MADE ~~ I AGGREGATE 5 _- DEDUCTIBLE 'i 5 1 '' S 1 ~` RETENTION 5 I 5 WORKERS COMPENSATION AND ' WC STATU- ~OTH- L_IOflY LIMITS ' ER~ EMPLOYERS LIABILITY _i I I E L. EACH ACCIDENT 5 L.L. UISEASt ~ to EMPLOYEE E.L. DISEASE ~ POLICY LIMIT V INEN ocawmmN m orcnw uons/COCA 110NS/V ENICLESIFXCLUSIONS ADDED BV ENDORSEMENTISPECIAL PROVISIONS Those usual to the insured's opertations. INSURER IETTFR: (City Of Santa Ana its Officers (Employees, Agents & Volunteer (Office of the City Attorney 20 Civic Center Plaza IlSanta Ana, CA 92701 JULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE '(RATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN NOTICE 110 DAYS POR NON-PAYMENT( TO THE CERTIFICATE LDER NAMED TO THE LEFT, BUT FAILURE TO DO SO Sh1ALL IMPOSE NO LIGATION OR LIABILITY OF ANV KIND UPON THE INSURER, ITS AGENTS OR 'RESENT ATIVES. A ORI D R E]~BEN~ATI1IF~y - /V Nt:uecu 25-5 V/97) '~ ACORD CORPORATION 1988 ~/ - ~Yv3 -~~ g' ~c~ ~-~ SUsf~mSi I~~c OATS DaWOIYYYYI ACORD CERTIFICATE OF LIABILITY INSURANCE 6 19/2007 PRODUCER (714)905-1923 PAYE (714)905-1910 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION AND CONFERS NO RIGHTS UPON THE CERTIFICATE HayLFarB Tilton & Rola Iasuranao Associates, pp ONLY HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 614365 # ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. License 0 888 S. Disneyland Dr. ST8 400 Aaahaim CA 92302 INSURERS AFFORDING COVERAGE NAIC K IN811RED INSURER A:BartfOrB CaaUSlt 29424 Cycom Data eysteEUE, Inc. INSU+Ene:Coatlaeatal Casualt P.O. Hox 92437 INSURERC I RER Long Heaa6 CA 90309-2437 INSURER E: THE POLIGES OF OISURANCE LISTED BELOW HAVE BEFN ISSUED TO THE DISURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NDTWITHSTANDING ANY TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY 6E ISSUED OR MAY PERTAIN, R£OIIIREMFM , THE INSURANCE AFFORDED HY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, IXCLUSIONS ANO CONDIT10N5 OF SUCH POLICIES. WEA TYPE OF UgURANCE POLICY IIUYBEa ~~ EFFECTIVE DAiE EEPI TON UYIn s 1, 000,ODO ~ ~ I Itt ~~OE ~ E 300, OD0 S RC IAL GENERALLWIL COI .Of A CLAIMS MADE ® aCCUR 7]HBAHJ1649Dr 6/4/10D7 6/4/]DOB DExP o S 10,000 s 1,000,000 E s 2,000,000 OENL AGGREGATE LIMITAPPLIESPER: E ],000,000 $ P L AUT OMOBILE LIABILITY COMBWED SINGLE LIMB s ANY A TO LEA xuoan) A U ALL DWNEDAUTGS T]SHAHJ166 PDr 6/4/]DOT 6/4/2003 BODILY INIURY s D AUTOS H IPe, P++1onl EDULE SC HIRED AVTOS BOOCY INJURY E NONdYINEDAUT05 IPa•acoesnD PROPERTY OHMAGE E (Pp unam) GARAGE WIBILRY AUTOONLY~EA ACCIOEM s ANY AUTO OTHERTHAN AUTOONLY: E ElCESSNYBRELIA W1&LRY E ~ CWMS IMDE C ~ UR OC ~ i R ~ / lS ~ ~' C ~ ~ I U~~M EDUC7uAE s D YiORNlRB COIPENSAT(ON AND ' J Cf;l Sr.! ~ ` LiIJ LWNIJTY EMPLOYERS /t Sb: iA li ' - CH ACCIDENT S ANYPROPRIETOR/PARTNFJLE7(ECUTNE . , t,.1 y jj( Ur•~•,,. OFFICERAAEMBER EXCLL(OEDT E.L DERiA4E •EA EMPLOYEE EYO, maalte lFleer I E H DTHER Errors a Omissions ]67B9B03B 7/16/]006 7/16/]007 Raoe cialm $1,000,000 Liability ABSragata 83. DOD, 000 DsduaLlEla 810,000 OEECRIPDON OF OPEIGTON&LOCATONINEXIOLEBIFXCLUNOMB ADDED HY EInOREFMENDSPECIAL PROM&ON8 Proot o[ lnsoranoo •10 Day HoCioa at Caneallsiioa !or Hon-Payment o! Pxemiw, 4,CRIRII,NIG RVWGn ~ ~- 9NDULD ANY OF THE ABOVE OEBCRDM97 PODCIES BE CAMClLLFD BEFOR! T11E City Of Santa An8 L.r%RA710N OAT! 7NERlOF. THE mSUIN6 INSURlR WILL ENDEAVOR TO MAIL ATTt1t Offiae of the City Attorney 30* DAYS WRITTEN NOTOE TO INS CER7IRCATE HOLDER NAYEO TO TXE LEFT.BUT 20 Civic Center Plana FAIWRE TO DO 80 SHALL UIP08E NO OBMOA7NJN OR LW81LfR'OF ANT qND UroNTHE Banta Ana, CA 92701 INSURER 178 AOENi80R RB-RESENTA71VE8. ~$~ AUTNORIa.D pEMEtlNTATIV! ~R.a n,..,~-~ V Julianne Spriggs/JJS n nneene wrlnu •mae IN8025 tololl.oEF P.ge 1 wl ACORD CERTIFICATE OF LIABILITY INSURANCE 6/19/2007' PRODUCER (714) 905-1923 FAX: (714) 905-1910 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Ha and Tilton ~ Role Insurance Associates, Y~ PP HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR License #0614365 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 8B8 S. Disneyland Dr. STE 400 Anaheim CA 92802 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURERA:HB.rt£Ord C88u81t 29424 Cycom Data Systems, inc. INSURER B: Continental Casualt P.G. EOX 92437 INSURER C: ~ INSURER D: Long Beach CA 90809-2437 INSURER E: 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 OE ISSUED OR MAV PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGR LIMIT H WN V EEN RED CED BY PAI INSR AOD'L D TEY EM DD YE TION P C LIMITS TYPE OF INSURANCE POQCY NUMBER A I IY DAT E MMIDO GENERAL LIABILITY EACH OCCURREN E $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMGEiO RENTEDna $ 300,000 A CLAIMS MADE OCCUR 7288AHJ1649Dr 6/4/2007 6/4/2008 MED E%P An one arson $ 10,000 PE NAL ADVI $ 1,000,000 GENERAL AGGREGATE $ 2.000.000 GEN'L AGGREGATE LIMITAPPLIES PER: PR T - OMPIOPA E 2,000,000 g POLICY PrEO LOC AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accidenQ $ ANY AUTO A ALL OWNEDAUTOS 728BAHJ1649D8 6/4/2007 6/4/2009 gODILV INJVRY (Per person) E SCHEDULED AUTOS HIRED AUTOS BODILY INJURY E NON-0W NED AUTOS (Per accitlenq PROPERT'DAMAGE E ^yj ~ (Per accitlenQ GARAGE LU161LITY -S (~ S - ~ AUTO ONLY-EA ACCIDENT $ ANV AUTO nn~ - t'~ OTHER THAN $ J /'~ -~ AUTO ONLY: AGG $ E%CESSlUMBRELLA LIABILITY i ~ $ OCCUR ~ CLAIMS MADE ', V`. ~ ~(`.~-~ AGGREGATE $ ~ .u ' i,Sy $ ~/ - +~t L DEDUCTIBLE SL°' $ t , ,„ RETENTION WC STATU- OTH- WORKERS COMPENSATION ANO EMPLOYERS' LIABILDY ROPRIETOWPARTNER/EXECUTIVE E.L. EACH ACCIDENT $ ANY P OFFICERlMEMBER EXC W DED? E.L. DISEASE - EA EMPLOYEE $ If yes, describe under PE IAL PR VIS ON 1 w E.L. DISEASE-POLICY LIMIT 8 H OTHER grrorH & OmiHeiOne 267898038 7/16/2006 7/16/2007 sacb Clnim $1,000,000 Liability Aggregate $1,000,000 Deductible $10,000 DESCRIPTION OF OPERATIONS7LOCATIONSNENICLES/EXCLUSIONS ADDED BY ENDORSEMENf15PECIAL PROVISIONS Proof of Ineurnace •30 Day notice of Cancellation for non-Payment of Premium. rconxlreTC unl naa CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE City OE SHIIt8 AIIa E%PIRATIDN DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAIL ATTN: Office of the City Attorney 3O* DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT 20 Civic CeIItel PSaEB FAILURE TO DO SO SHALL IMPOSE NO OBDGATION OR QABILITY OF ANY KIND UPON THE Santa Ana, CA 92701 INSURER ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ~- li S i s/JJS v J anne pr gg u ACORD 25 (2007108) INS025 (DI oel.aea © ACORD CORPORATION 7988 Page 1 of 2 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 certifcate 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. ACORD 25 INS025 poi oel.oea j ACORDTM CERTIFICATE OF LIABILITY INSURANCE o3-26ATZOOB PRODUCER ~~ THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION HAYWARD, TILTON&ROLAPP INS/PHS ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEN'J OR ' 18 5 019 P : (8 6 6) 4 6 7 - 8 7 3 0 F : (8 7 7) 9 O 5 - 04 5 7 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. PO BOX 3 3 015 1N-2003-078 I SAN ANTONIO TX 78265 INSURERS AFFORDING COVERAGE ~iNSURED ~' N-20033-07 ,;NS H~Rg.Hartford Casuall~Ins Co ___ l i ~ -- CYCOM L)ATA SYSTEMS INC N-2003-078-03 ~INSURERC -- PO BOX 9 2 4 3 7 N-2003-078-04 INSLwER °: ' ?,nNG BEACH CA 9 0 8 0 9 Ir.;suRER E: ___, --- COVERAGES ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHLCH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL TFiE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INTR TYPE OF INSURANCE POLICY NUMBER ___ LIMITS i DATE IMMFDDTYYE DATEYIMMIDD YION - GENERAL LIABILITY ~ '~ ~~ ~' EACH OCCURRENCE S Z , O O O , O O O , . A ~~ ~ COMMERCIAL GENERAL LIABILITY , 7 2 SBA NJl 64 9 ~ it 0 6 / 04 / 0 8 ' 0 6 / 04 / 0 9 ~ FIRE DAMAGE IAny one fire) ~, S 3 0 0 , 0 0 0 ~'~ ~' 'CLAIMS MADE ~~. X I, OCCUR ~! ~ MED EXP IAny one person) ~ S 1 0 , 0, 0 Il h l7e?le rcl l iL 1 ap I ~ '~ PERSONAL & ADV INJURY S l, 0 0 0, 0 O 0 T '. I ''. GENERAL AGGREGATE S 2, 0 0 0, O O O GEN'L AGGREGATE LIMIT APPLIES PER: '~ '~~ '~ PRODUCTS - COMPIOP AGG ~'I S2 , O O O , O O O ', i -- ~-',, POLICY ~'. II PRCT Iii X ~ LOC I -r -- ' .AUTOMOBILE LIABILITY _ ~ I ~ '. i, ' I COMBINED SINGLE LIMIT ~, Sl , 0 0 0 , 0 0 0 '~ accidentl 'IE ANYAlTiO ~A ~- ~72 SBA NJ1649 a 06/04/08(06/04/09 - Al L OWNED AUTOS 'r-i i i I ~ I ~ BODILY INJURY S !SCHEDULED AUTOS i 'i I, (Per person) ~~. ~, , ~' ~X '. HIRED AUl OS ~ ~~ I ' --? ~,, ~;, '~, BODILY INJURY '~ S ,. I ~y X 'NON-OWNED AUTOS I iPer accident) I _ ___ i I~ !i PROPERTY DAMAGE S I '~ I ~ (Per accident) _____~ ~~ GARAGE LIABILITY ~'~ AUTO ONLY - EA ACCIDENT ~~.,, S '~ 'r-~'~ ANY AUTO ~I ',. ', '~. OTHER THAN EA ACC~S '. I~ ', AUTO ONLY: AGG S ~ ' EXCESS LIABILITY ' I' ''~. EACH OCCURRENCE '. S ~~ i ', J' OCCUR I~~~I CLAIMS MADE ~ I ~ AGGREGATE 5 I ' , '„ S ~; DEDUCTIBLE !,I ~,.., S ~ i !RETENTION 5 + I I ~ S ~ i i WORKERS COMPENSATION AND WC STATU I OTH-I I , TORY LIMITS ~ ER i i I EMPLOYERS' LIABILITY I ~ '~ i ' I E L. EACH ACCIDENT 5 - I . '. i I ~.~. E.L.. DDISEASE - EQ EMPLOYEE ! S --- ' -_ 1_ ~~ '~ E.L. DISEASE -POLICY LIMIT i S OTHER i I I DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLESIEXCLUSN)NS ADDED BY ENDORSEMENTISPECIAL PROVISIONS (Those usual to the insured's opertations. ~~~ ~~ - - - - - CERTIF_I_CAT_E__HO_L_DER_ ~-AODITroIUAL INSURED; INS_uRER LETTEn: ,___ _CANCELLA_TIO_N ___ I i i SHC)ULD ANV OF THE ABOVE DESCRIBED POLICIES BE CANCELl.FO BEFORE THE ' ~ City Of Santa Ana its Officers EXPIRATION DATE. THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ' ~ Employees , Agents & Volunteer 30 DAYS WRITiE.N NOTICE (lU DAYS FOR NON-PAYMENT) TO THE CERTIFICATE i~ I Off 1Ce of the Clt Attorne HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO y y (OBLIGATION OR LIABILITY OF ANY KIND UPON 1 tIE INSURER, I fS AGENTS OR I20 C1V1C Center Plaza (REPRESENTATIVES. (Santa Ana, CA 92701 - ,' A ORI D RE ESEN AT1 I , ACORD 25-S (7/97) '~ ACORD CORPORATION 1988 WORKERS' COMPENSATION DECLARATION I Suzanne Gatti, Vice President and Secretary, hereby affirm under penalty of (Name/Title) perjury, the following declaration I certify on behalf of KOO Developments, Inc. that during the term of my (Organization Name) contract with the Public Works Agency, City of Santa Ana, I will not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. DATE: Apri14, 2008 By: KOO Developments, Inc., a California corporation f-~ - ~~:~,,. ~ r ~~~-~ By: ~' Suzanne Gatti, Vice President and Secretary Telephone: (310 200-2151 WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. ;, ,, ~'~~