HomeMy WebLinkAboutWilliam Hezmalhalch Architect 2City of Santa Ana
" _T ~ Clerk of the Council
AGREEMENT TERMINATION
C o~00s
Please complete this form when the attached agreement is no longer in effect.
Return form to the Clerk of the Council Office (M-30). ';=-
Call 647-2520 if you have any questions. ,._ _
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The agreement with ~x~j (~i Li.l~1 ~1t 7 ik ~~ dl i~ ~ ~'I ~` f ~ ' t~~t ~ ~ ~ Gi ~' -
No. ~.~ ~ ~~ ~ ~ ~ 3 was completed on ~"~iU7~~
and final payment has been made.
Revised 05-04-08
Department: C Dl~ -
Phone/Ext.: 5~i ~ `~
Signature: ~~ ~\~ ~.~=--'
Date: ~~~ ~~ I U
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INSURANCE ON fiLl
WORK MAY PROCEED
UNTIl INSURANCE EXPIRES
9-1- ()5 CONSULTANT AGREEMENT
CLERK Of COUNCil
DATE:5f-21'/D5 / L .
THIS AGREEMENT, made and entered into this ~ day of , 2005 by
and between William Hezmalhalch Architects, Inc., a California corporation (h reinafter
"Consultant"), and the City of Santa Ana, a charter city and municipal corporation organized and
existing under the Constitution and laws of the State of California (hereinafter "City").
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N-2005-063
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RECITALS
A. The City desires to retain a consultant having professional skill and knowledge in the
field of architecture.
B. Consultant represents that Consultant is able and willing to provide such services to the
City.
C. In undertaking the performance of this Agreement, Consultant represents that it is
knowledgeable in its field and that any services performed by Consultant under this
Agreement will be performed in compliance with such standards as may reasonably be
expected from a professional consulting firm in the field.
NOW THEREFORE, in consideration of the mutual and respective promises, and subject to the
terms and conditions hereinafter set forth, the parties agree as follows:
1. SCOPE OF SERVICES
Consultant shall design and prepare a site plan to make the sidewalk at the Depot in Santa
Ana ADA and California Building Code compliant, as set forth in Exhibit A to this Agreement,
which is incorporated herein in full.
2. COMPENSA nON
a. City agrees to pay, and Consultant agrees to accept as total payment for its services,
the rates and charges identified in Exhibit A. The total sum to be expe1'lded under this
Agreement shall not exceed $5,000.00 during the term of this Agreement
b. Payment by City shall be made within thirty (30) days following receipt of proper
invoice evidencing work performed, subject to City accounting procedures.
3. TERM
This Agreement shall commence on the date first written above and terminate on April
30,2006, unless terminated earlier in accordance with Section 12, below. The term of this
Agreement may be extended upon a writing executed by the Executive Director of the
Community Development Agency and the City Attorney.
4. INDEPENDENT CONTRACTOR
Consultant shall, during the entire term of this Agreement, be construed to be an
independent contractor and not an employee of the City. This Agreement is not intended nor
shall it be construed to create an employer-employee relationship, a joint venture relationship, or
to allow the City to exercise discretion or control over the professional manner in which
Consultant performs the services which are the subject matter of this Agreement; however, the
services to be provided by Consultant shall be provided in a manner consistent with all
applicable standards and regulations governing such services. Consultant shall pay all salaries and
wages, employer's social security taxes, unemployment insurance and similar taxes relating to
employees and shall be responsible for all applicable withholding taxes.
5. INSURANCE
Prior to undertaking performance of work under this Agreement, Consultant shall
maintain and shall require its subcontractors, if any, to obtain and maintain insurance as
described below:
a. Worker's Compensation Insurance. In accordance with the provisions of Section 3300
of the Labor Code, Consultant, if Consultant has any employees, is required to be insured against
liability for worker's compensation or to undertake self-insurance. Prior to commencing the
performance of the work under this Agreement, Consultant agrees to obtain and maintain any
employer's liability insurance with limits not less than $1,000,000 per accident.
b. Professional liability (errors and omissions) insurance, with a combined single
limit of not less than $1,000,000 per claim.
c. The following requirements apply to the insurance to be provided by Consultant
pursuant to this section:
(i) Consultant shall maintain all insurance required above in full force and
effect for the entire period covered by this Agreement.
(ii) Certificates of insurance shall be furnished to the City upon execution of
this Agreement and shall be approved in form by the City Attorney.
(iii) Certificates and policies shall state that the policies shall not be canceled
or reduced in coverage Of .j"tuged III any OlheI III"leI;,,1 uope€t without
thirty (30) days, ten (10) days in the event of non-payment of premium,
prior written notice to the City.
d. If Consultant fails or refuses to produce or maintain the insurance required by this
section or fails or refuses to furnish the City with required proof that insurance has been procured
and is in force and paid for, the City shall have the right, at the City's election, to forthwith
terminate this Agreement. Such termination shall not effect Consultant's right to be paid for its
time and materials expended prior to notification of termination. Consultant waives the right to
2
receive compensation and agrees to indemnify the City for any work performed prior to approval
of insurance by the City.
6. INDEMNIFICATION
Consultant agrees to and shall indemnify and hold harmless the City, its officers, agents,
employees, consultants, special counsel, and representatives from liability for personal injury,
damages, just compensation, restitution, judicial or equitable relief arising out of claims for
personal injury, including health, and claims for property damage, to the extent caused by direct
or indirect negligent operations of the Consultant or its contractors, subcontractors, agents,
employees, or other persons acting on their behalf which relates to the services described in
section I of this Agreement.
7. CONFIDENTIALITY
If Consultant receives from the City information which due to the nature of such
information is reasonably understood to be confidential and/or proprietary, Consultant agrees
that it shall not use or disclose such information except in the performance of this Agreement, or
as required by law,and further agrees to exercise the same degree of care it uses to protect its
own information of like importance, but in no event less than reasonable care. "Confidential
Information" shall include all nonpublic information. Confidential information includes not only
written information, but also information transferred orally, visually, electronically, or by other
means. Confidential information disclosed to either party by any subsidiary and/or agent of the
other party is covered by this Agreement. The foregoing obligations of non-use and
nondisclosure shall not apply to any information that (a) has been disclosed in publicly available
sources; (b) is, through no fault of the Consultant disclosed in a publicly available source; (c) is
in rightful possession of the Consultant without an obligation of confidentiality; (d) is required to
be disclosed by operation oflaw; or (e) is independently developed by the Consultant without
reference to information disclosed by the City.
8. CONFLICT OF INTEREST CLAUSE
Consultant covenants that it presently has no interests and shall not have interests, direct
or indirect, which would conflict in any manner with performance of services specified under
this Agreement.
9. NOTICE
Any notice, tender, demand, delivery, or other communication pursuant to this
Agreement shall be in writing and shall be deemed to be properly given if delivered in person or
mailed by first class or certified mail, postage prepaid, or sent by telefacsimile or other
telegraphic communication in the manner provided in this Section, to the following persons:
To City:
Clerk of the City Council
City of Santa Ana
20 Civic Center Plaza (M-30)
P.O. Box 1988
3
Santa Ana, CA 92702-1988
telefacsimile (714) 647-6956
With courtesy copies to:
Executive Director of the Community Development Agency
City of Santa Ana
20 Civic Center Plaza (M-25)
P.O. Box 1988
Santa Ana, California 92702
telefacsimile (714) 647-6736
and
City Attorney
City of Santa Ana
20 Civic Center Plaza (M-29)
P.O. Box 1988
Santa Ana, California 92702
telefacsimile (714) 647-6515
To Consultant:
William Hezmalhalch Architects, Inc.
2850 Redhill Avenue, Suite 200
Santa Ana, California 92705-5543
telefacsimile (714) 250-1529
Attn: Ron Strother
A party may change its address by giving notice in writing to the other party. Thereafter,
any notice, tender, demand, delivery, or other communication shall be addressed and transmitted
to the new address. If sent by mail, any notice, tender, demand, delivery, or other
communication shall be effective or deemed to have been given three (3) days after it has been
deposited in the United States mail, duly registered or certified, with postage prepaid, and
addressed as set forth above. If sent by telefacsimile, any notice, tender, demand, delivery, or
other communication shall be effective or deemed to have been given twenty-four (24) hours
after the time set forth on the transmission report issued by the transmitting facsimile machine,
addressed as set forth above. For purposes of calculating these time frames, weekends, federal,
state, County or City holidays shall be excluded.
10. EXCLUSIVITY AND AMENDMENT
This Agreement represents the complete and exclusive statement between the City and
Consultant, and supersedes any and all other agreements, oral or written, between the parties. In
the event of a conflict between the terms of this Agreement and any attachments hereto, the
terms of this Agreement shall prevail. This Agreement may not be modified except by written
instrument signed by the City and by an authorized representative of Consultant. The parties
agree that any terms or conditions of any purchase order or other instrument that are inconsistent
with, or in addition to, the terms and conditions hereof, shall not bind or obligate Consultant nor
the City. Each party to this Agreement acknowledges that no representations, inducements,
4
promises or agreements, orally or otherwise, have been made by any party, or anyone acting on
behalf of any party, which are not embodied herein.
11. ASSIGNMENT
Inasmuch as this Agreement is intended to secure the specialized services of Consultant,
Consultant may not assign, transfer, delegate, or subcontract any interest herein without the prior
written consent of the City and any such assignment, transfer, delegation or subcontract without
the City's prior written consent shall be considered null and void. Nothing in this Agreement
shall be construed to limit the City's ability to have any of the services which are the subject to
this Agreement performed by City personnel or by other consultants retained by City.
12. TERMINATION
This Agreement may be terminated by the City upon thirty (30) days written notice of
termination. In such event, Consultant shall be entitled to receive and the City shall pay Consultant
compensation for all services performed by Consultant prior to receipt of such notice of termination,
subject to the following conditions:
a. As a condition of such payment, the Executive Director may require Consultant to deliver
to the City all work product completed as of such date, and in such case such work product shall be
the property of the City unless prohibited by law, and Consultant consents to the City's use thereof
for such purposes as the City deems appropriate.
b. Payment need not be made for work which fails to meet the standard of performance
specified in the Recitals of this Agreement.
13. DISCRIMINATION
Consultant shall not discriminate because ofrace, color, creed, religion, sex, marital
status, sexual orientation, age, national origin, ancestry, or disability, as defined and prohibited
by applicable law, in the recruitment, selection, training, utilization, promotion, termination or
other employment related activities. Consultant affirms that it is an equal opportunity employer
and shall comply with all applicable federal, state and local laws and regulations.
14. JURISDICTION - VENUE
This Agreement has been executed and delivered in the State of California and the
validity, interpretation, performance, and enforcement of any of the clauses of this Agreement
shall be determined and governed by the laws of the State of California. Both parties further
agree that Orange County, California, shall be the venue for any action or proceeding that may
be brought or arise out of, in connection with or by reason of this Agreement.
5
15. PROFESSIONAL LICENSES
Consultant shall, throughout the term of this Agreement, maintain all necessary licenses,
permits, approvals, waivers, and exemptions necessary for the provision of the services
hereunder and required by the laws and regulations of the United States, the State of Cali fomi a,
the City of Santa Ana and all other governmental agencies. Consultant shall notify the City
immediately and in writing of its inability to obtain or maintain such permits, licenses, approvals,
waivers, and exemptions. Said inability shall be cause for termination of this Agreement.
16. MISCELLANEOUS PROVISIONS
a. Each undersigned represents and warrants that its signature hereinbelow has the power,
authority and right to bind their respective parties to each of the terms of this Agreement, and shall
indemnify City fully, including reasonable costs and attorney's fees, for any injuries or damages to
City in the event that such authority or power is not, in fact, held by the signatory or is withdrawn.
b. All Exhibits referenced herein and attached hereto shall be incorporated as iffully set
forth in the body of this Agreement.
IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year
first above written.
ATTEST:
CQUC€cr(=-c;:
PATRICIA E. HEAL Y
Clerk of the Council
~~,.
CITY OF SANTA ANA
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City Manager
APPROVED AS TO FORM:
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JOSEPH W. FLETCH
City Attorney
RECOMMENDED FOR APPROVAL:
CONSULTANT
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Presiaeflt D''-.'-.... MitE lbi2/LI'= 6o'\lUt":"
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Tax 10# .33-/)/7YI'N-
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~t1{j'ATRICIA . WHITAKER
Executive Di ctor
Community Development Agency
6
EXHIBIT A
I. SCOPE OF SERVICES
A. Consultant will provide site plan at existing transit center (The Depot) parking area
adjacent to north side of existing building. Scope of work is limited to approximately
I05'x5' existing walk to be removed and reconstructed to comply with ADA and
California Building Code required minimum width and maximum slope. Existing fence
and planters will also be removed. Existing post-mounted light fixtures will be relocated.
B Provide coordination of Consultant services with City staff.
C. Provide assistance with City review and permit issuance as requested by City.
SERVICES NOT INCLUDED
Survey by civil engineer of existing finished surface elevations. This service is necessary
and is to be provided by City.
II. COMPENSATION
A. Fee: The work described above shall be time and materials with an estimated budget
figure of $4,420.00. Work will be commenced upon receipt of a fully executed
agreement.
Senior Principal
Principal(s)
Senior Professional
Associate
Professional
Color Designer
Intermediate Professional
Technical Staff
Jr. Technical Staff
Administrative/Operations
$200.00
$175.00
$150.00
$120.00
$110.00
$100.00
$85.00
$75.00
$65.00
$50.00
B. Reimbursables: Consultant shall be reimbursed at 1.15 times the cost for all materials,
graphic supplies, blueprinting, CADD disks, CADD plotting, mylar reproducibles, photo
work/reductions for record sets, governmental fees, messenger charges, automobile
mileage, transportation and living expenses in connection with out-of-town travel
authorized by City. Mileage will be billed at the standard IRS rate. Payment for
reimbursable expenses will be due in full on a monthly basis, as set forth in Section 2.b.
of the Agreement.
7
III. GENERAL PROVISIONS
The parties agree that the services provided pursuant to this Agreement are preliminary in
nature. If the project proceeds to actual development by the City, the City will negotiate a
new Agreement with Consultant, or another appropriately licensed architect to perform the
services required to be performed by an architect.
City will provide Consultant with all information in City's possession which is relevant to the
services provided hereunder. Consultant is entitled to rely on the accuracy and completeness
of such information without independent review or checking, unless such additional review is
specifically part of Consultant's Scope of Services hereunder. City agrees to indemnify and
hold harmless Consultant, form any claims or liability arising from the use of information
provided by City.
Consultant shall deliver to City all work product which results from the services provided,
including conceptual or preliminary plans or reports. In regard to such material produced as
a deliverable under this Agreement, Consultant understands and shall ensure that all of
Consultant's affected officers, employees, agents, contractors, and volunteer workers also
understand that (a) other such material may not be copyrighted without prior review from the
City and (b) the authors of all such material, whether copyrighted or not, award to the City,
and to its officers, agents and employees acting within the scope of their official duties, as a
condition of payment to the Consultant, a royalty- free, nonexclusive, irrevocable license
throughout the world for governmental purposes to disclose, publish, translate, reproduce,
and use such materials.
8
.A CORD~ CERTIFICA - - OF LIABILITY INSUR NCE I DATE (MMIDOffyYY\
. 1012712004
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Dealey. Renton & Associates ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P. O. Box 10550 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Santa Ana, CA 92711-0550
714427-6810 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: United States Fidelity & Guaranty
William Hezmalhalch Architects INSURER B: St. Paul Fire & Marine Ins. Co. ,
2850 Redhill, Suite 200 INSURER c:
Santa Ana, CA 92705-5543 INSURER D:
INSURER E:
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLlCY 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.
LTR N R TYPE OF INSURANCE POUCY NuMBER P.?f...s~~~~f Pg~IfJI~~~ UMITS
A ~NERAL L1ABIUTY BK01461996 09/01/04 09101/05 EACH OCCURRENCE $1 000 000 i
X COMMERCIAL GENERAL LIABILITY General L1ab. DAMAGE TO RENTED $1 000 000
I CLAIMS MADE [X] OCCUR excludes claims MED EXP (Anyone person) $10000
I-- arising out of PERSONAL & ADV INJURY $1 000 000
the performance GENERAL AGGREGATE $2 000 000
~'~ AG~nEILtMIT APnS pER: of professional D RECE VED BY PRODUCTS. COMP/OP AGG $2 000 000
POLICY I ~r9y. LOC services WNTOWN D~VIlj
A ~OMOBlLE UABIUTY BK01461996 09/01/04 09/01/05 COMBINED SINGLE LIMIT
ANY AUTO ocr; l 2004 (Eaaccidenl) $1,000,000
-
- ALL OWNED AUTOS BODILY INJURY
(Per person) $
"x SCHEDULED AUTOS CITY OF 1 lANTA ANA
HIRED AIJTOS BODILY INJURY
F $
~ NQN..()WNEO AUTOS (Peraccldenl)
I- PROPERTY DAMAGE $
(Per accident)
RRAGE UABILITY AUTO ONLY. EA ACCIDENT $
ANY AUTO EA ACC $ ,
OTHER THAN
AUTO ONLY: AGG $
:5:SSlUMBRELLA UABIUTY EACH OCCURRENCE $
OCCUR 0 ClAIMS MADE AGGREGATE $
$
R ~EDueTIBlE $
RETENTION $ $
B WORKERS COMPENSAllON AND WVA7726881 09/01/04 09/01/05 X I we STATU- 10!~.
EMPLOYERS' UABILlTY ,1 000,000
ANY PROPRIETORIPARTNERlEXECUTIVE E.L. EACH ACCIDENT
OfFlCERfMEMBER EXClUoED? E.L. DISEASE. fA EMPLOYEE ,1 000,000
~~~~~~~6NS below E.L, DISEASE. POLICY LIMIT ,1,000,000
B OTHER Professional QP03801862 09/20/04 09/20/05 $1,000,000 per ciaim
Liability $1,000,000 annl aggr.
DESCRlPllON OF OPERATIONS 1 LOCATIONS / VEtlClES I EXCLUStot{S ADDED BY ENDORSEMENT' SPECIAL PROVISIONS .. . .. ... I~!.....:~ /~=~ TC F,~_''-';IM
-Except 1 0 days notice of cancellation for non-payment of premium. .. .
The City of Santa Ana, Its officers, agents, volunteers and employees are ~/E_..
additional Insured on General Liability coverage but only as respects to .--
work being performed by the Insured. )'.'.-;;; , q (': -".
.J..~~.J _ ',' ._. ,J.._A......j
Coverage afforded the additional Insured Is primary and non-contrlbutory. AS.:;.;,L.H ....:dy.., .',
CERllRCA TE HOLDER
COVERAGES
City of Santa Ana
Alln: Danell Mercado
Downtown Development Division
305 E. Fourth Street, S#201
Santa Ana, CA 92701
CANCELLATION
SHOULD ANY OF THE. ABOVE DESCRIBED POLICIES BE CANCELLED flEFORE THE EXPIRATlON
DATE THEREOF, THE ISSUING INSURER WILL E~K.~L ~ DAYS WRITTEN
NOl1CE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BIJOeII)t)lacxx~n~xx
.Iil:lillXQClX :bS(lKDXC6JAGIOIXkOi'8CXXX
mftUtldJJXDl3CX
AUT ORIZEDREPRE~N~
ACORD 25 (2001/08) 1 of 1
#M113249
THC
@ ACORD CORPORATION 198t
.
Policy Number: BK01461996
Owners;....Lessees or Contractors (Form B)
ADDlTluNAL INSURED
Change(s) Effective: 10/27/2004
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT
CAREFULLY. This endorsement modifies insurance policy under the following:
LIABILITY COVERAGE PART:
Schedule
Name of Person or Organization:
City of Santa Ana
Attn: Danell Mercado
Downtown Development Division
305 E. Fourth street, S#201
Santa Ana, CA 92701
SECTION II - WHO IS AN INSURED is amended to include as an insured the
person or organization shown in the Schedule, but only with respect to liability
arising out of "your work" for that insured by or for you.
The City of Santa Ana, its officers, agents, volunteers and employees
are additional insured
PRIMARY INSURANCE:
IT IS UNDERSTOOD AND AGREED THAT THIS INSURANCE IS PRIMARY
AND ANY OTHER INSURANCE MAINTAINED BY THE ADDITIONAL INSURED
SHALL BE EXCESS ONLY AND NOT CONTRIBUTING WITH THIS
INSURANCE.
/..:-; n-'., ~";CR_M
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CUBF 22 40 03 95
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- I
ACORD~ CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDf'(y'N)
05/09/05
PRODUCF~ THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
. Dealey, Renton & Associates ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P. O. Box 10550 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Santa Ana, CA 92711-0550 n___
714427-6810 INSUltERS AFFORDINO COVERAGE NAIC#
INSURED !NSURE'.RA: United States Fidelity & Guaranty
William Hezmalhalch Architects , _?- . /__ INSURER 6: St. Paul Fire & Marine Ins. Co.
2850 Redhill, Suite 200 jJ' CI,)l ~ 24 INSURER c:
Santa Ana, CA 92705-5543 I~' -,::),cu5 -- 0&3 INSURER 0:
-
INSURER E:
Client#. 6546
WILLlHtiM
COVERAGES
THE POLICIES OF lNSURA.NCF 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 '/lIHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJE:CT TO ALL THE TERMS, FXCLUSIONS AND CONDITIONS or SUCH
POLlCIES_ AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
~ ~ TYPE OF lN8URA~CE POLICY NUMB"'" _ _ PI'IO...LiS~Jt~g;V.j'\E P2~.s:.Y ,~~r!,,~,!I9.N LIMITS
A ~NERAL LIABIliTY BK01461996 09/01104 09/01/05 EACH OCCURRENCE 11 000 000
X COMMERCIAL GENERAL lIAtl.ILlTY General Liab. DAMAQE TO RENTED .1 000 000
, "0 . . .
l CLAIMS MADE ~ OCCUR excll/des claims MED EXP (Any one P6~(I(\} '10000
- arising out of PERS01\AL &. AOV INJURY .1 000 000
--
- the performance GENERAL AGGREGATE .2 000 000
~'L AGG:EAE LIMIT APAS PI:.H.' of professional PRODUCTS _ COMPIOP AGG .2 000 000
POLICY :~~RT LOC services.
A ~TOMOBILE LIABILITY BK01461996 09/01/04 09/01/05 COMBINED SINGLE LIMIT
ANY AUTO (Eaaccident) 11,000,000
-
ALL OWNED AUTOS BOalL Y INJURY
(p~per$on) .
- SCHEDULED AUTOS
1<... HIRl:ll AUTOS BODILY INJURY
1
~ NON-OWNED AUTOS (Peraccidenl)
~ PROPERlY DAMAGE .
(PflrflCCldent)
RAGE LIABILITY AUTO aNL Y . EA ACemENT ,
ANY AUTO OTHER THAN EA ACC .
AUTO ONLY: AGG .
OESSnJMBRELLA UABIlITY EACH OCCURRENce $
OCCUR 0 CLAIMS MADE AGGREGATE $
I
R D>UUCTlRIF I
RETENTION . ---- I-- $
B WORKERS COMPENSATION AND WVA7726881 09/01/04 09/01/05 X -L\'i,},T,~J.'!" I JO!~- .
EMPI.OVERS' LIABILITY $1,000 000
ANY PROPRIETORJPARTNERIEXECUTIVE E.L EACH ACCIDENT
OFFICERlMEMBER EXCLUDED? EI. DISEASE. EA EMPLOYE ,1,000,000
lfy0$,deseribcunder EL DISEASE -POLICY llMIT $1,000,000
SPECIAL PROVISIONS below
B OTHER Professional QP03801862 09/20/04 09/20/05 $1,000,000 per claim
liability $1,000,000 annl aggr.
OESCRIPTlON OF OPERATIONS I LOCATIONS I VEHICLES 'EXCLUSIONS ADDED BY ENDORSEMENT ISPf!C1AL PROVISIONS APPROVEI) l\~ iU I'(h, d
'Except 10 days notice of cancellation for non. payment of premium.
Re: All Operations as pertains to named Insured. "-.?--! .i II,
The City of Sanla Ana, its officers, employees, agents and representatives /-,:) ",'_c ,'C,: ' .:....=.)_ .----.
are Additional Insured on General Liability coverage In accordance with the / L',(ufa Stilt S{;l~d>
(See Attached Descriptions) As~,i:-,:tant C:i!~"\li\'r .. ,
CERTIFICATE HOLDf:R
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED DEFORE THE EXPIRATION
The Depot of Santa Ana DATE THEREOF, THE lSSUING INSURER WilL ENJI!~IL ~ DAYS WRmEN
Attn: Carolyn Fullerton NOTIC:: TO THE G~RTIFlc;.ATE J-lOt.D~R NAM~O TO THE LEFT. BlJI)f)OU(~~~xx
1000 E. Santa Ana Blvd., #108 IllIlllUllOO< Hl:lrIJl_~xxx
Santa Ana, CA 92701 E8lI[U6aJJXD.x
3=EPREiN~
ACORD 25 (2001108) 1 of 2
#S126340/M123544
TMN
@ ACORD CORPORA liON 1988
2.d
T:ileTT.L
dS2:20 SO ~T ~ew
Ma~ 17 05 02:2Sp
Tllagl
p.3
DESCRIPTIONS (Continued from Page 1)
policy terms, but only as respects to work being performed by the insured.
Coverage afforded the Additional Insured is Primary and Non~contributory.
APPROVED j\S iU [,O,U"
hi''l) ; I,)
.t .- , _~_._._._._
Laura Stitt Sheedy
Assistant City /,.tu,n
AMS 25.3 (2001/08)
2 of 2
#S126340/M123544
Ma~ 17 05 02:29p
T11ag1
p.4
Policy Number: BK01461996
Owners..... Lessees or Contractors (Form B)
ADDITluNAL INSURED
Change(s) Effective: 05/09/05
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT
CAREFULLY. This endorsement modifies insurance policy under the following:
LIABILITY COVERAGE PART:
Schedule
Name of Person or Organization:
The Depot of Santa Ana
Attn: carolyn Fullerton
1000 E. Santa Ana Blvd., #108
Santa Ana, CA 92701
SECTION II - WHO IS AN INSURED is amended to include as an insured the
person or organization shown in the Schedule, but only with respect to liability
arising out of "your work" for that insured by or for you.
The City of Santa Ana, its officers, employees. agents and
representatives
PRIMARY INSURANCE:
IT IS UNDERSTOOD AND AGREED THAT THIS INSURANCE IS PRIMARY
AND ANY OTHER INSURANCE MAINTAINED BY THE ADDITIONAL INSURED
SHALL BE EXCESS ONLY AND NOT CONTRIBUTING WITH THIS
INSURANCE.
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