HomeMy WebLinkAboutTolerico's Electric 11aCity of Santa Ana
._ , ~ Clerk of the Council
AGREEMENT TERMINATION
2~?r crp _3 ~~ ~•
.,~
Please complete this form when the attached agreement is no ~~r~, ~6
Return form to the Clerk of the Council Office (M-30). ~~~~ effect.
Call 647-2520 if you have any questions.
_______________________________
The agreement with ~ ~P~YI ~'p S .,~~~~'C G~ f ~G -_---
No. N - 20 ®L~.. - ISO ~ ~
and final payment has been made.
Revised 05-04-08
was completed on ~' ~ ~~
Department: L' ~/~ ' /~lYn~h
Phone/Ext.: Jr'~3 (~Q
Signature: ~~ ~t~~1,~~~(LGtJ
Date: ~ 1-~ /
"
tJ ~;).l'O 'I-ufo - D j
INSURANCENOi iLL
WORK MAY NOT PROCEED
CLERK OF COUNCIL
DATE: 2c.;c -os
FIRST AMENDMENT TO AGREEMENT
(, . (.\:1(1
~. (~\.t4vV\)
THIS FIRST AMENDMENT TO AGREEMENT is entered into on June 30,
2005, by and between Tolerico's Electric, Inc., a California corporation ("Consultant")
and the City of Santa Ana, a charter city and municipal corporation of the State of
California ("City").
Recitals:
A. The parties entered into Agreement N-2004-080 dated July 1,2004, (hereinafter "said
Agreement") by which Consultant has provided on-call electrical installation, lighting
and repairs.
B. In accordance with the terms and conditions of said Agreement, the parties wish to
extend the term for an additional one-year period and increase compensation to pay
for services during the extended term.
Wherefore, in consideration of the covenants contained in said Agreement, and subject
to all the terms and conditions of said Agreement, except those amended in this First
Amendment to Agreement, the parties agree as follows:
L Section 2.a., COMPENSATION, shall be amended to increase compensation
$9,000.00, by deleting said section in its entirety and replacing it with the following:
"City agrees to pay, and Consultant agrees to accept, as full payment for its services,
the rates and charges set forth in Exhibit A to said Agreement The total sum to be
expended pursuant to said Agreement shall not exceed $9,000.00 during the 2005-
2006 fiscal year."
2. Section 3, TERM, shall be amended to extend the termination date from June 30,
2005 through June 30, 2006.
3. Except as herein amended, all terms and conditions of said Agreement shall remain in
full force and effect
II
II
II
II
,
IN WITNESS WHEREOF, the parties hereto have executed this First Amendment to
Agreement on the date and year first written above.
CITY OF SANTA ANA
ATTEST:
j tl- ". ::IzL
'_r.~~~. ~
PATRICIA E. HEALY' J
Clerk of the COlUlcil
~ tWJ. "tv. ~ (7it\
DAVID N. REAM ~
City Manager
APPROVED AS TO FORM:
JOSEPH W. FLETCHER
City Attorney
By: ',:!, 't.y" i./
Laura Sheedy
Assistant City Attorney
APPROVED AS TO CONTENT:
TOLERICO'S ELECTRIC, INC.
ATRICIA C. WHITAKER
Executive Director
Community Development Agency
~ gc-__
<.'i?.2"'<;' I"..,r.?"..,p~/
KENNETH TOLERICO
President
04/12/2005 TlIE 14: 05 FAX 714.565 4020 CITY OF SANTA ANA
;-'.-1l'~'::~~~:~ 'I<:'~ 11:)(( ~'I~ir"'R~~:"':'~ 1'1'" ~'[ I", ,~I'I. J '",<: ~..~;~~~- , ... '
~ ' '''''' .. " . d,'
Qlll V~!l~ ~-Il,~c,,~'}:r.!,AJl-
~~~ CITY ATTORNEY
-,-""...., 1"':~'-'~,-"" i:W-,f"',"."
~ 002/003
,',
~-,..-t",'.
_-_.-_~"~~;{Q.e_t.
'D"-~?I.'
-........
''''''~::'',"'--:'.~-'!
" r
I
,
,
""'~<:'''':'-..c;,~-'- ".... -,
!J!;P{lD_ CERTIFICAt) OF LIABILITY INSUFU. :CE 01120 2005
P''M)DUCDl (114) 461-8726 nus cERnFICATE IS ISSUEO AS A MATTER OF INFORMATION
o"llY ANO CO"fER5 NO RIGHTs UPON lltE CERnFtcA,TE
Profcll5..i(ll'(loOJll Choice In,ur_nCG SV.D HOLDER. THIS CERTIFICATE- DOES NOT AMEND, EX1ENO OR
500 ti 8t.atl;l College Blvd. '550 ALl'ER; THE COV~CE AFfORDED BY THE POUOIES BELOW.
Oran II
l"SURrO
TDlericols ~l&Ctrio
123~1 Moan. Way
CA n868-16l3
INSUReRS AfFORDING COVERAGE
.,"';III:A' LineolD. GcDera1 Ins. Co.
lNSIJIlUl:.
INSUA~R C
INS 0
.....1\.I1U:1l!
NArc,
{" ),([1/ - r S ()
{,J - -)I/O '-I - oM 0/
c;.;...X'den Q.ro9'e
COVERAGES
CA. 92840-
THE. POLICIES Of IN~U""'NCE lISTED BELOW HAVE BEEN ISSUED TO l1'IE INSURED NHdEDAIIOVE FOR THE POlicY PERIOD INOICATBJ, NOT'Vl4'rnSTANDlNC ANY
REOUIREMeNT, TERMOR CCNDITlOH OF ANY C'ON'T'AACrOR OTMER DOC\JMENT \IIIITH RESPECT TO\ll4HfCH THIS CERTIFICATE MAY BE ISSUEO OR MAY PERTAIN,
TME INGUAANCE AJ'FOJIDED BY' THE pOUCl1i1O Of$CRIOCD ~EIN 18 BU8JEC'l 1-0 ALL 1l1E 'TERMS, eXCLU6IONS AND COtoI04TIONS OF 8UCH POLICIeS,
l'l.GGRft'Arr Ul\IIITS SfiO\'IJN ~y HA.VE BEEN REDUCED BY PAID ClAIMS
t.!!' ~.'!'!! TYnOFIMM/tU.,.CI! l"OI..IOytrNftl.... f'~lIIt~CT~'-O ~ ,....
DAlt:....-afWYl' CATti MM
A X .!!"uw.. UoUul.JT'I .11(01200511 "T 01/:15/2'005 01/15/2006 EAC"QCC"'~~ . 1,OOO,aDO
X r.-.-clN.. Otf'fEML LWlLlTY J'A[MIS{.$~~\ . 100,000
_ ::::lC1.AlM~N/'IDC 0 Q(:CUllt I I I I ~DI!JU"I_"'---:l . 5,000
prf.~QNAl &AOV IM,lUIlY . 1,000,000
I I I I ~JrEIlIU.AGr:w::C.1'( . 2.000,000
@~AGCO~nt~~n'~fR: .I;(IUIIIOP...CC I: 2,000,000
X POlICY JIE.~ I..oc: I I I I
~UA.lIIUJY I I I I COMIINfO III\lGll: la.lll
1t:.~J .
~ _TAlnO
>-- .AlL~OAUf08 I I I I IK)DI.'(IMJURY
,
'- !ICMEDI,.tLIi'O"'UTOI. (P......~~
'- HlRI:O AUras I I I I lK)()(lYINJUR'f"
~.0lC:>IW~ .
'- NQIw<Nwc!O .IW1'OIi
'- I I I / PAOPElItTl' OJllllllUJE
1"-'1C'CilteftQ .
o.AIUl(;~u...1lIIIJTY AlTI'1IONl""~aCc;Itl'ENr .
~~"'N'f...tJTO I I I I OTH{RTW#oN M-C'
AUTO Ol\IlY: -.
:J~IAI"~UA8rlIYV I I I I tACH OCClmAEHC'E .
OOClM 0 ClAI"" "'IOE AOGAcalAn: .
--- .
~ OEOUCTlllf I I I I .
~TOII"tQlll I: .
WOfMloIIdI COIINflMTION ANI) I I I I 1~1t~ I~.
OIPlO\'ERS' UMIIU'n'
_l'PWOIPt:b''fORIPAA1NlEJWX[.Cll'l1vE E L I!Io04ACCIOOIT .
0Ff1C1:~R.~' I I I I E.l, Ola~1E .1:" fMPt"ovU ,
lI'",,~Ul'I4clr
'P€CJIl,l~IOI\r'~ l.L. t>>~""1E . JtOUCI LNrr ..
0.... I I I I
I I I I
I / I I
ClESCRlPlIOM OV Cf'lMl'IONSlLOCATIONiMatClE.II8C\.U1IIOmI AOOEa IV ENDOftIINOOIIP[aAI. ""M"'ISl~
C8Xt~t~c~tQ HoldOr, 1t. ol~ic8~.. ~l~, .~nt, and ~p~..Oftt.tlyc. ace Da~ ~. Md.:1t:t.o~l llUlurecS.
Nh"'U GpQt'.Uonll II. oo.....~8d b:v thill po l-.cy,
M; JQlntenance/re,pa.i.r .'to lOtiO 1:. B~nta be Blvd. 11(18
10 dill' no~iC'O c.anc!QU.1tJ.on ~~ non ~t of pX'Oai.ua
CERTIRCA TE HOlDER
I )
CANtELLAllON
lIttOULb AIIT OF nilE" AI!IOVE OUC"'11IolD POUQ[.S lit CANC.fl.1m Ga'OIU:: 'nil;
IEJlPIIUInON OIll.TE 11lIEIIF.Df. lNE liStiNG IlIdulCC1ll WILL __ 1"0 IIWl
~ a." WRlrn;N NO'DCI: TQ 1M:: COl!TIF1C'AT1! IIOI..DBl:t ~AMED TO TNI< un."
",CORl> ZS (2001108)
4 .It<lS02~ t01Oll1.D6
....
W\.EC1IW1lMC lA$ER f.OI\MS. "'C. .(lCqm~"
- . -.-..
J..!. ,.~.ww,_..WIf
Ci'ty of .san t.a Ju,a
1000 E~ S~ta Ana Blvd. '108
Slanta An., CA. g2701
-""'~....'1~:J~:'
'.'.""",-",""""',".':':""
. ______~lilLAS_.IO__EQ.R_M_--n
.. // /1
'/ ,Ly'U-< )('1 I' 2
"Laura Stitt Sheedy
Asg~r;:ei[y Atti~rn~~\ '''''~''.'''''-''''--_._~- '
,-...~.,.........~~
~ OOJ/OOJ
...... ~ ....;,~ ..f?,..,tl::.... ".i
... ""'"'';:IIl!'..!',z~ PD.2..",cc' ".~.n ~. c,
POLICY NUMBER: 6320019316 00
COMI\EiIC/Al. GENERAl. UABllITY
CG20 10 1001
llflS ENDORSEMENT CHANGES THE POUCY. PlEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - SCHEDULED PERSON OR
ORGANIZATION
This Dodo""""",,, modifies Insurance prolllded under l/le following:
COMMERCIAL ,GENERAL UABllllY COVERAGE PART
SCH"DULE
_ or """"""' or OIpJizallon;
CITY OF SANTA ANA
PROJECT LOCATION: 1000 E. SAlSITA ANA BLVD. # 108
1000 E. SANTA ANA BLVD. # lOB
SANTA ANA, CA USA 92101-0000
(If no enlJy appeom above, information required to compl918 IIl1s entlorsemen' will bs shown in Ihe Declarations
lIS appllc8ble '" this endorsement)
A. Sedion n - Who I. An 1_ Is armndod to
inolude ... en Insured the pers"" or orgenTl:aIion
shown In lhe Sd1edule. but only with raspect to
UiIlllllly artsiog out of your ongoing ope/aHons
performed ror thai iosured.
8. Wil~ "'.pecl 10 lhe insurance atforded to lI18se
odd/dona! Insuneds. Ihe lollowlng ""cfusion Is
aided:
2. ElldWlions
This insurance doe. not applv to "bodily In-
jJryR or .properrv danage'" occurring after:
(1) All work, Indutljng maIIlrHIIs. palls Of
eqUlpmBnt furnIshed In connection
with such woll<. on lIle project (01119'
Ihan aervlc:a, mainl9nance or 1Bpait.)
10 be perlormod by 0< 01'1 be/1a11 or 1he
odditional Insured(s) at 'he Bile 01 the
rovered operaUons ~... been corn-
p1e19d; or
(2) ThaI portion or "your work" out 01
~ictI I~e In)u/)' or dllrl18(le 8,1"". has
been put to ilB intended use by any
p9rsan or organJz:atlon other Ulan 8IlR
other conlractor or subcontractor en~
98QAd in performing operations tor 3
principal Q9 ,8 pari ollho same proJect.
CG 20 10 10 01
o ISO P,operti... loc.. 2000
Pagel 011
o
'\PPROVED A~~;XQ"FORM
'-/~ '? ? / 2.
----.--- ._-;~:;~ (Stit-t Sheedy
,\sistant City Attorney
~~,;:;.:~-
'~C1\'C:or'.'
'-;-:-:'.",~:r:"7"
":~:';~:'.'~"
"',,-"~"'~'....~.:-~"
, Mar ,06 06 OS: 52a Tllagl
03/03/20D6 FRI 11:19 FAX 714 46' 8731 Professional ChC?ice
p.2
rdJ002/00 2
ACORD~
CERTIFICATE OF LIABILITY INSURANCE
I DATE.{MMIDDNYYY)
01/25/2006
THIS CERTIFICATE IS ISSUED AS A MATTER Of INFORMATION
OHL Y AND CONFERS NO RIGHTS UPON THE Ce:RTIFrCA TE
HOlDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW,
'.OOUCE. (714) 467-8726
Professional Ch02ce Insurance SV$
500 N State College Blvd, M550
OranCl"@
INSURED
Tol~rico's Electric
12321 Moana Way
CA 9:2B6B-1613
N-(}.,ooif-080
N - d.oi:J'I -OJ'O -0/
INSURERS AFFORDING COVERAGE
INSURER A: L;~co~Q~en~_;:a}.__!n.~_.__~o.
INSURER B:
NAIC;'
lNSUReRC
Garden Grove
COVERAGES
CA 92840-
~g~n:,.
I'~'D'R'
THE PQlJCtES OF INSURANCE USTEO BElOW HAVE 6EEN ISSUED TOlHE INSURED NAMED ABQVE FOR THE POliCY PERIOO INDICATED. NOTWlTHSTANDING ANY
REQllIREMEN", TERM OR CONDITION" OF ^~ CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,
THE INSURANCE A.FFORDED BY THE POlICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXClUSlOOS AND CONDITIONS OF SUCH POLICIES
AGGRI:GAT I: LIMITS SHOWN MAY HAVE BEEN REDUCED BV PAID CLAIMS
l!'l~~ I~~: TYPE Of INSURANCE PQUtY NUMBER P8A~,:'~8~1! "&'i~(~~ lIMITS
~NERAl UAelllTY 0200'19976 01 01/15/2006 01/15/2001 EACH OCCURRIONCE . 1,000,000
'-"- D~ERClAl GENERAL LlABtlITY ~~~~~?e~~~~nce\ , 100,000
A X - ClAIMS MADE [!] OCCUR 1 f f f Ml"DEXfl'tAnvonepernoo) , 5,000
- PERSO~'''' . ~...." INJURY I l,OOO.OQ()
- 1 1 1 1 GFNERAl A6GREG~TE , 2,000,000
~'lAG~EnLIMll n~PEr~: PRODUcrs-~-';:';;oP""'''' $ 2,000,000
X POLlCY m?-i loe 1 1 1 1
~rONoBILE llABILllY 1 1 1 1 COMBINED SINGlE llMlT
I
- Nf'fAUTO (EaaCClderll)
- All OWNED AUTOS 1 1 1 1 BOna Y If>LJIJRY
(petplitSQl1) ,
- SGHEWlEDAUTOS
- ~IREO AUTOS 1 1 1 1 eODllY INJU~Y
(r'eraoxident) ,
- NON-OWNEO AUTOS -'-~ --
1 f 1 f PROPER7YOM.......Gt:
(Per ~c~H1el'll) ,
R~GE lIMlUTY _~~Tt::'ONLY -~ACCIDENT I
...."lVAUTO f 1 1 f OTJ.lERTUAN -.!.~A(:C I ,~~
AUTO ONlY: AOG I
D~SJU"BRl!lLA lIABILITY f f 1 1 EA,CH OCCtJRRENCE .
OCCUR 0 CLAltIIS MAOr AGGREGATE ,
,
R ~UCTIBLE 1 f f f . ---
RETENTION $ I
WQRKERS COMPENSA nON AND I' fO, iV11 1 IT'(\~~lil.lNsl JOJ;!' .-
EMPLOY2RS' UABlUTY ;f;fJv eEl
ANY PROPRIETORlPARTNERlEXECUTlVE di~__ FL EACH ACCIDENT ,
OFFICER/MEMBER EXCWDCO? 1 1 E.L DISEASE. EA EMPLOYEE S
Uyes.des.r.rihAundl'l' -.--
SPEClALPROVISIONSbeltlW E.1. llISE...sE. POUCY LIMIT 5
OTHER (/ ,7 'I 1 1
, 1 /' 1 1
1 1 1 1
DESCRIPTION OF O~RAT1ONSlLOCAnoNSM;HICl~XClUSlDNSAO[)I:O 8Y ENOORSEMENTlSPeClAl PROVlSIDNS
Certif~cat9 Ho~de~, 1t~ orricers, Ulployeas, ag&nc~ and rs~e~.ntaL~v.. ~e named ~$ Addi~iQn~~ In.ou:sdfi'.
RE: All oparations as covered by this policy. uCOVERAGE IS PRIMARY AND NON-CONTRIBU'rORYu
R)~: Molintanancwhvpair 41. ~Oi)O I. Santa AncI. Bl.vd. 11.08
10 day notice cancellation for non paymont o~ prlQllliUJ.ll.
CERllACATE HOLDER
(714) 565-2690 TQl
(714) 565-2693 Fax
CANCELLATION
SHOULD ANY Of THE ABOVE DESCRIBED POUCIES 1If; CANCElLED BEFORE IHt
EXPIRATION DATI!: THEREOF, TtI!' ISSUING INSURI!!R WILL .........-,,^.. TO MAIL
10 D"YS WRlTTl"H NOlJC.. TO THE CERTIFICATE HOLM'R NAIlED TO THE LEI'T. IMI:I'
ELECTRONIC LASER FORMS, INC.. (1100)327.0545
WJ.-
City of Santa Ana
1000 E. S~nt4 Ana Blvd.
Santa Ana CA
ACORD 25 (20U1/06)
ftn.-INS02S\010&).OS
il08
92701
ACORD CORPORATION 1188
Pagelofl
c y-
Mar 06 06 09:52a Tllagl
~ 03/06/2006 HON 9: 33 FAX 114 457 8131 Ptofessional. Choice
p.3
1JJ003/003
POLICY NUMBER: 6320019316
COMMERCIAL GENERAL UABlUTY
CG 211101001
THIS ENDORSEMENT CHANGES THE POUCY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - SCHEDULED PERSON OR
ORGANIZATION
This endorsement modHles insurance provided under the following:
COMMERCIAl GENERAlllABIUTY COVERAGE PART
SCHEDULE
Name of Person or Organization:
CITY OF SANTA ANA
PROJECT LOCATION: 1000 E. SANTA ANA BLVD. # 108
1000 E. SANTA ANA.BLVD. # 108
SANTA ANA, CA USA 92101-0000
([f no entry lIPll6ars abo..., information required to complete Ihls endo"",ment will be shown in \he Declaralions
as applicable \0 this endorsement)
A. Section /I - Who Is An Insured is amended to
include as an insured the person or organization
s~own In !he Schedula. but only with r""pectto
liability arising OUl of your ongoing Operations
performed for that Insured.
B. \I\W1 respect to \he insurance afforded to these
additional insureds. the followillg exclusion is
added:
:t Exokl$lons
This insurance does not apply to 'bodily In-
jury' or "property damage' occurring after:
(1) All wolk, including materials, parts or
eqUipment furnished in connection
with such work, on the project (other
than service, maintenance or repairs)
to be performed by or on behalf of the
additional insured(s) at the site of the
co--,d operations has been com.
pleted; or
(2) That portion of '\four work" out 01
which tho injury or damage ariSes has
been put 10 its intended use by any
person or organization other than an-
other contractor or subcontraotor en-
gaged in performing operations lor e
principal as.a part of the same project.
/68?/~ __h
CG20 10 1001
@ ISO Properties, Inc., 2000
Page 1 oft 0
.-..d 0Jpy
. Mqr .09,06 03: 48p Tllagl
03/~9/2005 THU 15:26 FAX 714 467 8131 Professional ehoice
p.2
l.IJoo 2/002
Policy #
6320019376.01
ENDORSEMENT
LINCOLN GENERAL INSURANCE COMPANY
Named Insured Tolerico's Electric
Agent. Name
PROFESSIONAL CHOICE INSURANCE
Effective Date: 01/15/2006.
1:2:01 A.M., Standard Time
SERVICE!Agenl No. 014118
LG CG 20 10 02 06
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIO~ INSURED- Ow,NERS, LESSEES OR
CONTRACTORS - SCHEDULED PERSON OR
ORGANIZATION INCLUDING PRIMARY COVERAGE
.
This endorsement modifies insurance" provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name of Person(s) or Organization(s) :
City of Santa Ana -1000 E. Santa Ana Blvd. #108
f8~~tr~hCfs'~p1covered operations:
1000 E. Santa Ana Blvd. #108 Santa Ana, CA 112701
(If no entry appears above, information required to complete this
schedule, if not shown above, will be shown in the Declarations.
A. Section 11- ~ho Is An Insured is amended to include as. an insured
the person(s) or organization(sl shown in the Schedule,but only with
respect to liability for "bodi~ injury", 'property damage" or
"personal and advertising injury caused!, in whole or in part, by:
1. Your acts or omiss ons; or .
2. The acts or omissions of those acting on your behalf; in the
performance of your ongoing o~erations for the additional insured(s)
at the locat~on(sl designated above,
B. With respect to the insurance afforded to these additional
insureds, the following exclusions apply;
This insurance does not apply. to IIbodily. injuryN or Ilproperty damage II
. occurring after:
1. All work, including materials, parts or equipment furnished in
connection with such work, on the project (other than service, .
maintenance or repairs) to be performed by or on behalf of the
additional insured(s) at the location of the covered operations has
been completed; or .
? That portion of "your,work" out of which the injury or d?mag~
arrses has been put to ~ts rntended use by any person or organrzatlon
other than another contractor engaged in performing operations tor a
principal as part of the same project.
C. The insurance afforded by the policy to the Additional Insured(s)
listed in the Schedule for the described loca-tion(s) is primary
insurance.> Any other insurance or self-insurance maintained by the
Additional Insured(s) is excess of this insurance and Shall not
contribute to it.
LG CG 20 10 02 06 Contains Copyrighted Material of the Insurance
Services Office, I~c 2004
MAN-GL (01/00)
ProduClrCopr .
~83!3
...
...~ .
ACORD... CERT~. .CA TE OF LIABiliTY INSUR. _. ~CE I OA TE (MMlOOIYYYY)
03/09/2007
PRODUCEIl: (714) 467-B726 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
l'~ofessional Choice Insurance Svs ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE OOES NOT AMENO, EXTEND OR
500 N State College Blvd, #550 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
I
I
Oranqe CA 92868-1613 INSURERS AFFORDING COVERAGE NAIC#
- N"~()j?- 08'?
INSURED INSURER A Linoo~n GenQral Ins. Co. I
--
Talerico's Electric AI" :lOe)6 -OYJ-O/ INSIIRER B:
12321 Moana Way IV.... ci606 "O8~ INSURER C !
---..--"
INSURER D' .
Garden Grove CA 92840- #";1.00 Y . OK(J-o ~SURER E: !
COVERAGES A/.. ;;U'J(jJ.l - 0 KIf -t'J, A/... tJ.Dn -V.. (') ylJ
THE POliCIES OF INSURANCF.lISTED BELOW IlAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POliCY PERIOD INDICATED. NOTWITHSTANDING ANY
REQUIKEM",NT, TERM OR CONDITION Of ANY CON.RACT OR OTHER nOCUMENT WITH RESPECT TO WHIClf THIS C(;RTIFICA TE MA Y 13~ ISSUED OR MA Y PERTAIN,
THE INSURANCE AfFORDED BY THE POLICIES DESCRIBED HEREIN IS SllBJECT TO ALL THE TERMS. EXCL~JSIONS AND CONDITIONS OF SUCH POliCIES.
AGGRECATE LIMITS SHOWN M~Y HAVF BE'EN REDUCED BY PAl 9. CLAIMS. ..- -.--
I~:: ~~~.~ TYPE OF INSURANCE I POLlCY NUMB Ell PJ'ili~~::J85~~ Pg~iil~m,~~N LIMITS
A X GENERAll.lABIUTY I 6320019376 02 01/15/2001! 01/15/2008 EACH OCCURRENCE S 1,000,000
~. I ~~~~~~?E~~J~r?onc.) .- ..
~Lr"'ERCI""l GENERAlllABlLlTY . S 1,000,000
>-- Cl.J\IMS"'....OE W OCCUR! / / / ( MED FXP (Anyone PC"'"") S 5,000
f'ERSON....l & ADV INJURY S 1,000,000
-.. / / I / / GENERAl AGGREGATE $ 2,000,000
-il' AGC~I~E liMIT I~ES PER 1 PRODUCTS. COMPIOP AGG $ 2,000,000
X POliCy ~:N!T lOC I /
( ( /
~TO!,lOBllE LIABILITY : / / I I COMBINED SINGlE lMrr
(Ea acdd.nl) S
-- ANY AUTO r---'.'
- All OWNED AUTOS I / I / BODIlY INJURY
tPef per-sM) $
-- SCHEDULED AUTOS
HIRf:U AUTO.s I I / / DODlt V lNJURY
I-- S
NON-OWNED AUTOS (P81 a.:-cldcml)
-- c---'
I I i I / PROPERTY DAMAGE
-- S
(Po( occJctenl)
GARAGE LIABILITY I AUTODNLY.EAACCIO[Nf $
n ANY AUTO .-
/ / I I OTHER THAN EAACC S
AUTO ONLY. AGG $
EXCESSIUMBRElLA liABILITY / / ( / EACH OCCURRENCE $
D OCCUR 0 CLAIMS MADE AGGREGATE $
S
~ DEDUCrlBlE / / I / $
RFTENTI(lN S t
WORKERS COMPENSATION AND / / / ( I T'6~~ mANs I IOTH-
ER
EMPLOYERS'UABllITY
ANY PROPRIETOR/PARTNER/EXECUTIVE Lt.. EACH "'CCrDENT 3 '-
OFFICER/MEMBER EXCLUDED? I / / / !'.c. OI$EASE. FA EMI'\.OYEE S
~kcl~~tio~;~~~~ b~ow E.l. DISEASE. POLICY liMIT S
OT1<ER / ( / /
/ / / /
I I / I
VESCRIPnON OF OPERATlONSILOCATIONSNEHICLESlEXCLUSIONS ADDEO BY E//DDRSENENTiSPECIAL PROVlSIONS
The City of Santa Ana, 20 Civic Center P~azaf Santa Ana, Ca1ifornla 92701; l.ts officersr employees I agents ( vo~unt6er.
and repras9ntstiveg are na.med as "additional in3uredn wi th X"'e'ga.rd to liabili.ty and defense of suits ari.sing from the
operation. and U58S performed by or on behalf of tho naAed ~n.u~&d.
Re: All Dperatio~s as eovered Oy th1B policy.
CERTIFICATE HOLDER
(714) 565-2690 Tel
(714) 565-2693 Fax
CANCELLA liON
SHOULD ANY OF lliE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATlON DAn; THEREOf. THE JSSUlNG INSUR~~ WILL <, -.. -- TO MAll
30 ()AVS WRI~N NOTICE TO tHe CSRfIF'(CATl! HOLDER NAMED TD mE LEFT, BUT
,...,Lllllr TG Be 69 SII,I.,lL 'IIIPEl8~ '19 9BYS1TIQtJ 9R ll,l,SlllFr Sf AllV Hille !,jpell~ IE
City of Santa Ana
20 Civic Center Plaza
Santa Ana CA 92701
ACORD Z5 (2001/08)
ft.v. INS025 (0'08).05
988
. (800)3270545
1 of 2
Il:6 WV Ll 9flV lIDZ
,{~~! (h__
2"d
1 ~e 111
dvE:20 LO SO Jew
i -. ...
.~.,
~ "I
Lj
POLICY NUMBER: 6320019376 02
!"'-}
COMMERCIAL GENERAL UABIUTY
. I.G CG20 100206
THIS ENDORSEMENT CHANGES THE POUCY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - SCHEDULED PERSON OR
ORGANIZATION INCLUDING PRIMARY COVERAGE
COMMERCIAL GENERAL LIABILITY COVERAGE PART
This endorsement modifies insurance provided under the followIng:
SCHEDULE
Name of Person(s) or Organlzation(s)j LOcatior~s)of cowred o~rations; Additlonallnsured(s) Address:
CITY OF SANTA ANA
RE; 1000 E. SANTA ANA BLVD, SANTA ANA, CA 92701
20 CIVIC CENTER PLAZA
SANTA ANA, CA 92701
(If no entry appears above, information required to complete this schedule, [f not shown above, will be shown in .
the Dedarations..
A Section IJ. Who Is An Insured is amended Ita
include as an insured the person(s) or org;3fliza-
tion(s} shown in the Schedule, but only wHh re-
spect to liability for "bodily injury", "property darn-
. age" or "personal and advertising injury" caused,
in whole or in parI, by;
1. Your acts or omissions; or
2. The.acts or omissions of those acting on
your behalf;
in the performance of your ongoing operations
for the additional insured(s} at the location(s)
designated above.
B. With respect to the insurance afforded to these
addllionaJ insureds, the following exclusions ap-
ply:
This insurance does not apply to "bodily injury"
or .property damage" occurring after:
(1) All work, including materials, parts or
equipment furnished in connection with
such work, on the project (other than ser-
vice, maintenance or repairs) to be per-
formed by Or on behalf of the additional
insured{s) at the location of the covered
operations has been completed; or
(2) That portion of ''your work" out of which
the injury or damage arises has been put
to its intended use by any person or or-
ganization otherlhan another contractor
~. engaged in performing operations for a
. / principal as part of the same project.
. . The insurance afforded by the policy to the Addi-
/ tionallnsured{s) listed inlhe Schedule for the de-
scribed locetion{s) is primary insurance. Any other
insurance or self-insurance maintained by the Addi-
tionAl Insured(s) is excess of this insurance and
shall not contribute to it..
LGCG20100206
Contains Copyrigt:lted Material of the Insurance Services Office. Ine
2004 .
Page 10f 1 0
1/0 L{ L
E.d
PrMIlf"''''r r..nn-.,
r~ell.1
dSE:GO LO 60 ~ew