HomeMy WebLinkAboutDEKRA-LITE 1. .
City of Santa Ana a,,
=~,. ` Clerk of the Council C o2C0 (,
AGREEMENT TERMINATION FORM
COTC Office Use Only
Please complete this form when the attached agreement and all amendments (if any)
are no longer in effect. ~m~ rre I ~ bt
- - ~: t ~- 33
Return form to the Clerk of the Council Office (M-30).
The agreement with ~rQ. - Li
No. ~- 20 pS -- ~ 2,(o was completed on ~ ~ D ~(o
(List all amendments. Use space below if needed.) and final payment has been made.
Department: C[>~
Phone/Ext.: JC ~~~
Revised 07-22-09
Signature: GL. ~, -
Date: ~j
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'IN~URA\\Lt c., riLl
)/{IO" :1f1~ rhOLsD
UIUlL INS~~~I1CE EXPIRES
4''j,OIP
CLERK Of COUNCIL
DATE, 1).-IJ-aS THIS AGREEMENT, made and entered into this 3rd day of October, 2005 by and
between DEKRA-LITE, a California corporation (hereinafter "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").
N-2005-l26
CONSULTANT AGREEMENT
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O.V'
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RECITALS
A. The City desires to retain a consultant having special skill and knowledge in the field of
installing holiday lighting and banners.
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 install, remove and store City owned decorations, as set forth in Exhibit
A to this Agreement.
2. COMPENSATION
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 expended under this
Agreement shall not exceed $8,000.00 during the term ofthis 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. Payment need not
be made for work which fails to meet the standards of performance set forth in the Recitals
which may reasonably be expected by City.
3. TERM
This Agreement shall commence on the date first written above and terminate on June 30,
200&, 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 Community
Development Agency and the City Attorney.
4. INDEPENDENT CONTRACTOR
Consultant shall, during the entire term ofthis 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. Commercial General Liability Insurance. Consultant shall maintain commercial
general liability insurance naming the City, its officers, employees, agents, volunteers and
representatives as additional insured(s) and shall include, but not be limited to protection against
claims arising from bodily and personal injury, including death resulting therefrom and damage
to property, resulting from any act or occurrence arising out of Consultant's operations in the
performance of this Agreement, including, without limitation, acts involving vehicles. The
amounts of insurance shall be not less than the following: single limit coverage applying to
bodily and personal injury, including death resulting therefrom, and property damage, in the total
amount of $1 ,000,000 per occurrence. Consultant shall supply City with a fully executed
additional insured endorsement in substantially the form attached hereto as Exhibit B upon
execution of this Agreement and shall be approved in form by the City Attorney.
b. Business automobile liability insurance, or equivalent form, with a combined single
limit of not less than $1,000,000 per occurrence. Such insurance shall include coverage for
owned, hired and non-owned automobiles.
c. 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.
d. 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.
2
.'
(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 or changed in any other material aspect without
thirty (30) days prior written notice to the City.
f. 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
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, which may arise from the
direct or indirect 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. The Consultant further agrees to indemnify, hold harmless, and pay
all costs for the defense of the City, including fees and costs for special counsel to be selected by
the City, regarding any action by a third party asserting that personal injury, damages, just
compensation, restitution, judicial or equitable relief due to personal or property rights arises by
reason of the terms of, or effects arising from 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,
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.
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
3
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 Council
City of Santa Ana
20 Civic Center Plaza (M-30)
P.O. Box 1988
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) 647-6939
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:
DEKRA-LITE
Jeff Lopez
3102 W. Alton Avenue
Santa Ana, California 92704
Telefacsimile (714) 436-0612
A party may change its address by giving notice in writing to the other party. If sent by
mail, 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, 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
4
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,
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,
13. DISCRIMINATION
Consultant shall not discriminate because of race, 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.
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 California,
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.
5
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 if fully 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:
<--/~
PATRICIA E. HEAL
Clerk of the Council
/HG2
1..4'
DAVID N. REAM
City Manager
APPROVED AS TO FORM:
JOSEPH W, FLETCHER
City Attorney
jff'
By:! ' {{.'ct: y,,, <'1'7
Laura Sheedy
Assistant City Attorney
CONSULTANT
NDE~ Ffj ~PPROV AL:
t~
PA lCIA C. WHITAKER
Executive Director of the
Community Development Agency
TaxID# 32, -0(..3.(,0')0
6
EXHIBIT B
ADDITIONAL INSURED ENDORSEMENT
FOR COMMERCIAL GENERAL LIABILITY POLICY
Insurance Company Go(d"rl
po C.iJC" 'i;; ,u (em I (L
This endorsement modifies such insurance as is afforded by the provisions of Policy
# CM\? 0 J C;;; 17 ~ relating to the following:
1. The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701; their
officers, employees, agents, volunteers and representatives are named as additional insureds
("additional insureds") with regard to liability and defense of suits arising from the operations
and uses performed by or on behalf of the named insured,
2, With respect to claims arising out ofthe operations and uses performed by or on
behalf of the named insured, such insurance as is afforded by this policy is primary and is not
additional to or contributing with any other insurance carried by or for the benefit of the
additional insureds,
3. This insurance applies separately to each insured against whom claim is made or
suit is brought except with respect to the company's limits of liability. The inclusion of any
person or organization as an insured shall not affect any right which such person or organization
would have as a claimant ifnot so included,
4, With respect to the additional insureds, this insurance shall not be cancelled, or
materially reduced in coverage or limits except after thirty (30) days written notice has been
given to the City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701,
(Completion of the following, including countersignature, is required to make this endorsement
effective. )
Effective
Policy #
Issued to
o LlI fY'J I,lj:;of'
C,f1,P<{l~1r;,17~
e...~ ~ 'Y1n-f"
, this endorsement form as a part of
Ana .
Named Insured
Countersigned by
~~
Authonz presentative
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INVOICE
ORDOO607]
DEKRA-LITE
"The Light Before Christmas"
3102 W,AltonAve. (714436-0705)
Santa Ana, CA 92704
www.dekra-Iite.com
Date 9/2]/2005
11111~IOOIIIIIII.mRlIIR
Bll..L TO:
SANtA ANA DOWNTOWN DEVELOP.
305 E 4TI1 STREET STE. 201
SANtA ANA CA 92701-4S39
SHIP TO:
SANTA ANA DOWNTOWN DEVELOP,
305 E 4TI1 STREET
SANTAANACA 92701-4639
DANELL MERCADO
PHONE (714) 565-4027 &1. 0000
FAX (714) 565-4020 Ext. 0000
JESSE A.
INSTALL DATE NOV. 1, 2005
REMOVALDATE 1an5-Hl,2006
PO Number Customer lD Salesperson lD Shipping Method Payment Terms Req Ship Date Master No.
R SAN028 S1 INSTALL 50/50 0/0/0000 9,159
Ordered Item Number Description Unit Price &1. Price
71 PMIRSM Pole M01IIlt lns1aJlalion. Rmnova1I11ld. SIAl",,,,, $79.00 S5.609.00
<lfcualomer ownedpou. def;oratiOlUl.
10 LABORlRS Labor lDstal1ation mmovaJ am ._ senriees 5419.00 S4.190.00
of customer owned overhead 81l'eamor1,
270 LBC9C7WXCLXXSTK C9, 130 Volt, 7 Watt, Clear BUlb $0.59 $159,30
1 RllFUR.BtsH DECOR Replaccmcnt ofFliUers fi:Jr Slllt buerts S3]5.00 $315.00
5 STORAGE Storuc SO.OO SO.OO
for overlmad dec<lr llIIiu @$375.00 each. (No
Cbatge)
SALESDISCOUNT Sal_ Diaeoont ($2,400.00) ($2,400.00)
atvlf"(;~f2~ /2e1/lf;/4,A-f 9/1! ~r'
X (j);/fIIi2 ~
Subtotal
Tax
Freight
Total
Amount Due Upon Acceptance of Proposal
Balance Due Upon Installation Or Delivery
$7,873.30
$36.76
$0.00
$7,910,06
53,973-4]
$3,936.65
EXHIBIT A
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POlley PERIOD INDICATED NOTWITHSTANDING ANY
REOUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,
THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO AlL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLlC!ES
AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED 8Y PAJD CLAIMS.
il\lS~I~OO'L' TYPE OF iNSURANCE POLlCY NUMBER PJ>1-+~~~~8;Q~)E Pg~ifJ,~~~~~~N ,
LTR INSRD LlMITS
~NERAL LIABILITY EACH OCCURRENCE \, 1000000
~ ~lMERCIAl GENERAL LIABILITY B~~~g,~J9E~~uEr?enCe\ '$ 100000
A ' CLAIMS MADE [iJ OCCUR CBP8016173 4/9/2005 4/9/2006 MED EXP An" Gfle """son) $ 5000
I-- - PERSONAL & ADV INJURY , 1000000
I-- I GENERAL AGGREGATE , 2000000
nlAGGREGATE LIMIT APPLIES PER I PRODUCTS. COMPIOP AGG $ 2000000
n PRO- n
POLICY JEeT i LOC
i ~TOMOBiLE LIABILITY COMBiNED SINGLE l!MIT 1000000
(Ea acdd.ent~ ,
~ ANY AUTO
A f- ALL OWNED AUTOS CBP8016173 4/9/2005 4/./2006 aODIi..'i INJURY
{Per person) $
Ji.. SCHEDULEDAlJTOS ~
-"- HIRE'O AUTOS REVISE D I BODilY INJURY
,
-"- NON-OWNE D AUTOS (Pffao;;iclenl)
~ PROPERTY DAMAGE $
.,., I......,....""...""'.,.... ,- lPffacddenl)
~RAGE UABIUlY -. , - -. $
I 12 AUTO ONLY. EA ACCIDENT
ANY AUTO DATE 0__-.-:______ 00 OTHER THAN EAACC $
-"-.-.-----
AUTO Q,\JlY' AGG ,
EXCESS/UMBRELLA UABILfTY EACH OCCURRENCE $ 3000000
IX OCClJR o CLAIMS MADE AGGREGATE , 3000000
,
A 8 DEDUCTIBLE CUBOI7i73 4/9/,005 4/9/,006 ,
X RETENTION $10,000 ,
WORKERS COMPENSA TlON AND I T~~}~~I~JNs j 1 OJ~'
EMPLOYERS' LIABILITY I
I ANY PROPRIFTORIPARTNERlEX"CUT:VE E.L ~ACH ACCIDENT ,
j OFFICER/MEMBER EXCLUDED? I E.L. DISEASE. EA EMPLOYEE $
If yes, <.JescribeunOJer
SPECIAL PROVIS!ONS below , EL DISEASE. POLICY LIMIT ,
A OTHER Equipmen t Floater CBP8016l73 4/9/2005 4/9/2006 Leased/Rented Equip. 50000
Hired Physical
Damage Limit 50000
DESCRIPTJON OF OPERATIONS/LQCATtONSNEMICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Certholcter-: The Community Redevelopment Agency of Santa Ana. Its Officers, Agents, and Employees are named as
additional insured to all job operations performed by the named insured per attached CG2037. Insurance is primary and
non~contributory.
30 days NOe except non-payment I 10 days g~ven.
ACORD 25 (2001/08)
Eft _.,.,' INS025 (0108).05
"
...
AkQ8l)~ CERTIFICATE OF LIABILITY INSURANCE , DATE IMMIDolYYYYI
10/6/2005
PRODUCER (6261275-)000 FAX (626) 275-0130 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Golden Pacific Insurance Services ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
181 W. Huntington Drive ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Suite 200
Monrovia CA 9l016~3494 INSURERS AFFORDING COVERAGE NAIC#
INSUREO INSURERA:Golden Eaale Ins Corp
Dekra-Lite Industries, Ine. INSURER 8
3102 W. Alton Avenue INSURER c:
INSURER 0:
Santa Ana CA 92704 INSURER E:
COVERAGES
CERTIFICA rE HOLDER
CAN CELLA TlON
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE iSSUiNG iNSURER WilL ENDEAVOR TO MAIL
30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT
FAILURE TO 00 SO SHALL IMPOSE NO OBLIGATION OR LlABIUn' OF ANY KINO UPON THE
City of Santa Ana
Downtown Development Dlvision
305 E. ?ouLth Street, Ste 201
Santa Ana, CA 92701
APPROVED AS TO FORM
iNSURER,ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTA.TIVE
- ;:z.~_-..=-c=-c.__
@ACORDCORPORATlON1988
ORMS, !~jC . (800)327.0545
Pagelof2
.
rUJllllllY a pan or
Policy Number: CBP8016173
Coverage is Provided In PEERLESS INSURANCE COMPANY - A STOCK COMPANY
i
!
Named Insured:
DEKRA-L1TE INDUSTRiES INC
Agent:
GOLDEN PACIFIC INSURANCE SERVI
Agent Code: 4295138
Agent Phone: (626i-27&.300D
I
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - COMPLETED OPERATIONS
This endorsement modifies Insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
Section II - Who Is An Insured is amended to include as an insured the person or organization shown in the
Schedule, but only w.h respect to liahillty arising out of "your work" at the location designated and descrioed in the
sctledule of this endorsement performed for that insured and included in the "products-completed operations hazard",
SCHEDULE
Name of Person or Organization:
ANY PERSON OR ORGANIZATION FOR WHOM A CERTIFICATE OF
INSURANCE IS ON FILE WITH THE COMPANY.
Location And Description of Completed Operations:
ANY JOB PERFORMED WITHIN THE POLICY TERM FOR THE ABOVE
NAMED.
INCLUDED
APPROVED AS TO FORM
~ 2/'L
" Laura Stitt Sheedy
Assistant City Attorney
Additional Premium:
(If no entry appears above, Information required to complete this endorsement will be shown in the Declarations as
applicable to this endorsement)
CG 20 37 (10101)
@ISO Properties. Inc.. 2000
INSURED COpy
SP
CERTHOLDER COPY
STATE
COMPENSATION
IN SUFtANCE
FUND
P.O, BOX 420807, SAN FRANCISCO,CA 94142-0807
CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
ISSUE DATE: 10-06-2005
GROUP: 000364
POLICY NUMBER: 0000202-2005
CERTIFICATE ID: 612
CERTIFICATE EXPIRES: 10-01-2006
10-01-2005/10-01-2006
CITY OF SANTA ANA
DOWNTOWN DEVELOPMENT DIVISION
305 E 4TH ST STE 201
SANTA ANA CA 92701
SP
JOB: DOWNTOWN
DEVELOPMENT
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 pOlicy 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 to which it may pertain. the insurance
afforded by the policy described herein is subject to all the terms. exclusions. and conditions. 01 such policy.
~
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AUTHORIZED REPRESENTATIVE
EMPLOYER'S LIABILITY LIMIT
PRESIDENT
INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE,
ENDORSEMENT #0015 ENTITLED ADDITIONAL INSURED EMPLOYER EFFECTIVE 2005-10-06 IS
ATTACHED TO AND FORMS A PART OF THIS POLICY, NAME OF ADDITIONAL INSURED:
CITY OF SANTA ANA
ENDORSEMENT #1600 - JEFFREY LOPEZ PRESIDENT TREASURER - EXCLUDED,
ENDORSEMENT #1600 - NANCY LYNN LOPEZ SECRETARY - EXCLUDED,
______ ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 10-01-2001 IS
ATTACHED TO AND FORMS A PART OF THIS POLICY.
EMPLOYER
.. ,) AS TO FORM
1~~e~7
City Attoraey
DEKRA-LITE INDUSTRIES, INCORPORATED
3102 W ALTON AVE
SANTA ANA CA 92704
SP
(REV.2-QSI
PRINTED
ICMJ,SC]
10-06-2005
SP
POLICYHOLDER COPY
STATE
COMPENSATION
INSURANCE
FUND
P.O, BOX 420807. SAN FRANCISCO.CA 94142-0807
CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
ISSUE DATE: 10-06-2005
GROUP: 000364
POLICY NUMBER: 0000202-2005
CERTIFICATE 10: 612
CERTIFICATE EXPIRES: 10-01-2006
10-01-2005/10-01-2006
CITY OF SANTA ANA
DOWNTOWN DEVELOPMENT DIVISION
305 E 4TH ST STE 201
SANTA ANA CA 92701
SP
~08,DOWNTOWN
DEVELOPMENT
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 wilt also give you 30 days advance notice should this policy he 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 policy 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 to which it may pertain, the insurance
afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy.
~
J.~t
~
AUTHORIZED REPRESENT A TIVE PRESIOENT
EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE.
ENDORSEMENT #0015 ENTITLED ADDITIONAL INSURED EMPLOYER EFFECTIVE 2005-10-06 IS
ATTACHED TO AND FORMS A PART OF THIS POLICY, NAME OF ADDITIONAL INSURED:
CITY OF SANTA ANA
ENDORSEMENT #1800 - ~EFFREY LOPEZ PRESIDENT TREASURER - EXCLUDED,
ENDORSEMENT #1600 - NANCY LYNN LOPEZ SECRETARY - EXCLUDED.
______ ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 10-01-2001 IS
ATTACHED TO AND FORMS A PART OF THIS POLICY,
EMPLOYER
OEKRA-LITE INDUSTRIES, INCORPORATED
3102 W ALTON AVE
SANTA ANA CA 92704
SP
mEV.2-QSl
[CMJ,SC]
PRINTED , 10-06-2005
SP
CERTHOLDER COPY
STATE
COMPENSATION
INSURANCE
FUND
P,O, BOX 420807, SAN FRANCISCO,CA 94142-0807
CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
riD
GROUP: 000364
POLICY NUMBER: 0000202-2005
CERTIFICATE ID: 612
CERTIFICATE EXPIRES: 10-01-2006
10-01-2005/10-01-2006
ISSUE DATE: 10-06-2005
CITY OF SANTA ANA
DOWNTOWN DEVELOPMENT DIVISION
305 E 4TH ST STE 201
SANTA ANA CA 92701
SP
~OB,DOWNTOWN DEVELOPMENT
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 writt~n 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 policy 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 to which it may pertain. the insurance
afforded by the policy described herein is subject to all the terms. exclusions, and conditions. of such policy"
~
~~t
~
AUTHORIZED REPRESENTATIVE PRESIDENT
EMPLOYER'S LIABILITY LIMIT INCLUDING OEFENSE COSTS: $1,000,000 PER OCCURRENCE,
ENDORSEMENT #0015 ENTITLED ADDITIONAL INSURED EMPLOYER EFFECTIVE 2005-10-06 IS
ATTACHED TO AND FORMS A PART OF THIS POLICY, NAME OF ADDITIONAL INSURED:
CITY OF SANTA ANA
ENDORSEMENT #1600 - ~EFFREY LOPEZ PRESIDENT TREASURER - EXCLUOEO,
ENOORSEMENT #1600 - NANCY LYNN LOPEZ SECRETARY - EXCLUDED,
______ ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 10-01-2001 IS
ATTACHEO TO AND FORMS A PART OF THIS POLICY,
EMPLOYER
APPROVED AS TO FORM
( "
, l-- {F("'c:/
Stitt SheedY
Laura "t Attorney
Assistant Cl Y
DEKRA-LITE INDUSTRIES, INCORPORATED
3102 W ALTON AVE
SANTA ANA CA 92704
SP
{REV.2-05}
PRINTED
[CMJ,SC)
10-06-2005
.
SP
POLICYHOLDER COPY
STATE
COMPENSATION
INSURANCE
FUND
P,O. BOX 420807, SAN FRANCISCO,CA 94142-0807
CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
ISSUE DATE, 10-06-2005
GROUP: 000364
POLICY NUMBER: 0000202-2005
CERTIFICATE ID: 612
CERTIFICATE EXPIRES: 10-01-2006
10-01-2005/10-01-2006
CITY OF SANTA ANA
DOWNTOWN DEVELOPMENT DIVISION
305 E 4TH ST STE 201
SANTA ANA CA 92701
SP
.JOB, DOWNTOWN
DEVELOPMENT
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 he 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 policy 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 to which it may pertain, the insurance
afforded by the policy described herein is subject to all the terms, exclusions, and conditions. of such policy.
~
4~c
~
AUTHORIZED REPRESENTATIVE PRESIDENT
EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS, $1,000,000 PER OCCURRENCE.
ENDORSEMENT #0015 ENTITLED ADDITIONAL INSURED EMPLOYER EFFECTIVE 2005-10-0B IS
ATTACHED TO AND FORMS A PART OF THIS POLICY. NAME OF ADDITIONAL INSURED,
CITY OF SANTA ANA
ENDORSEMENT #lBOO - .JEFFREY LOPEZ PRESIDENT TREASURER - EXCLUDED,
ENDORSEMENT #1600 - NANCY LYNN LOPEZ SECRETARY - EXCLUDED.
------ ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 10-01-2001 IS
ATTACHED TO AND FORMS A PART OF THIS POLICY,
;"RUV cd AS TO FORM
EMPLOYER
~~:ttdY
".Hdli~ City Attorney
OEKRA-LITE INDUSTRIES, INCORPORATED
3102 W ALTON AVE
SANTA ANA CA 92704
SP
/REV.2'051
PRINTED
[CMJ,SC]
10-06-2005