HomeMy WebLinkAboutAXION INTERNATIONAL 1-2001
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INSURANCE ON FILE
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INSURANCE !!.Q1 ON FilE (. -r-',A/ U~JT/L lfiSUfVJ"C:: m::'lES -
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CU:!(l'( OF COUN CONSULTANT AGREEMENTC,,'IC 1'/-/"0 I
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THIS AGREEMENT, made and entered into this IY day of cJc.:{Olf~ , 2001 by
and between Axiom International, (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"),
RECITALS
A. The City desires to retain a consultant having special skill and knowledge in the field of
converting hard copy drawings to MicroStation files,
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 perform those services 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 $10,000 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. 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
Z,.Io4L
This Agreement shall terminate on January 01, 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 Public Works Agencv and the City Attomf>V
,.
4. INDEPENDENT CONTRACTOR
Consultant shall, during the entire term of this Agreement, be construed to be an
independent contractor and not an employee ofthe City. This Agreement is not intended nor
shall it be construed to create an employer-employee relationship, ajoint 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. If Consultant is or employs a licensed professional such as an architect or engineer:
Professional liability (errors and omissions) insurance, with a combined single limit of not less
than $1,000,000 per claim.
e. 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 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 proofthat 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: (1) 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 1 of this Agreement; and (2) from any claim that personal injury, damages, just
compensation, restitution, judicial or equitable relief is due by reason ofthe terms of or effects
arising from this Agreement. This indemnity and hold harmless agreement applies to all claims
for damages, just compensation, restitution, judicial or equitable relief suffered, or alleged to
have been suffered, by reason of the events referred to in this Section or by reason of the terms
of, or effects, arising from this Agreement. The Consultant further agrees to indemnify, hold
harmless, and pay all costs for the defense ofthe City, including fees and costs for special
counsel to be selected by the City, regarding any action by a third party challenging the validity
of this Agreement, or 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. City may make all reasonable decisions with respect to its
representation in any legal proceeding.
7. CONFIDENTIALITY
If Consultant receives from the City information which due to the nature of such
information is reasonablv understood to be confidential and/or nronnp!arv rono,,!!an! aOTPPO
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 ofthe 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 ofthe City 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 Public Works
City of Santa Ana
20 Civic Center Plaza (M-21)
P.O. Box 1988
Santa Ana, California 92702
telefacsimile (714) 647-5622
and,
"
City Attorney
City of Santa Ana
20 Civic Center Plaza (M-29)
P.O. Box 1988
Santa Ana, California 92702
te1efacsimi1e (714) 647-6515
To Consultant:
Robert F. (Bob) DiVenuti
MicroStation Management Consultant
1805 Drew Street
Clearwater, Florida 33765
Te1efacsimi1e (727) 442-8344
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 te1efacsimi1e, 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,
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,
"___..1.__. __"H nn' 000;"" 'ronof"r tl"l""ate. or subcontract any interest herein without the prior
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 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 and all questions relating to its validity, interpretation, performance, and
enforcement shall be government and construed in accordance with the laws ofthe State of
California. 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 her inability to obtain or maintain such permits, licenses,
_____u__,_ ..._:..___ n_-' ovo~nt;~no I<oi,l inohilitv .hall he cause for termination of this
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:
CITY OF SANTA ANA
'-
.h~
DAVIDN.REAM
City Manager
PATRIClAE. HEALY
Clerk ofthe Council
APPROVED AS TO FORM:
JOSEPH W. FLETCHER
City Attorney, I (j /
By: r
Benj . Kaufinan
Chi fA sistant City Attorney
RECOMMENDED FOR APPROVAL:
CONSULTANT
t?dfJLt
Robert F. (Bob) DiVenuti
MicroStation Management Consultant
~7-108U67
Employer ID # or Individual SS #
..
Customer Information:
Mindy Ly
Santa Ana, City of
PO Box 1988
Santa Ana, CA 92702-1988
USA
Phone: (714)647-5665
Fax: (714)647-5635
~
Axiom International
1805 Drew Street
Clearwater, Florida 33765 USA
Phone: 727-442-7774
Fax: 727-442-8344
Conversion Services Quotation/Order Form
Date: 26 September 2001
Reference #:092601radOl
US dollars
Qty Service Description Unit Price Extended Price
23 V-Cv-DGN Converting Paper to DGN $8,841.00 $8,841.00
(23 drawings at $17 hour, plus $3 per scan. Total hours: 516)
Total $8,841.00
The above quotation was prepared/approved by: ROBERT F. (Bob) DlVENUTI:_,6;:I fJo'--"_.
Conversion Service Terms and Conditions:
1. Axiom will do the specified work at the specified price provided that the density (complexity) and size
of the drawings in the project Itself are not materially greater than the density and size of the customer-
submitted sample drawings from which the price was derived and, for hard copy drawings, that the
condition of the hard copy drawing itself Is not materially worse than that of the customer-submitted
samples. In the event the density, size and condition of the actual digital files or hard copy medium
vary materially from the originals, Axiom reserves the right to modify the cost of conversion
proportionally to the change In its cost for converting each drawing.
2. All shipping, handling and Insurance costs Involved with getting hard copy media or raster files to
Axiom and, where applicable, back to the customer are the responsibility of the customer. The
customer must inform Axiom whether a return of media, once the conversIon work Is complete, Is
required and If so, provide specific instructions for theIr handling, including carrier, method, insurance
value and shipping account numbers.
3. The price above Is based on ail the work (hard copy media or digital files) being shipped to Axiom at
one time or in the scheduled segments shown above. If there is a delay in shipping or transmitting the
hard copy media or digital files that causes an increase In Axiom's cost of production, due to non-
I.tili.,a.... "rll"llla...+_rlarll,..~+ftrl "'D.p~....r.......1 Awl....... .................,.. ......... .1....... +n ......."" ....... url.....,.,,"-.I........ ,..""'...t...." +h...+ .........1+
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4. The price above is based on the number of drawings given. If the number actually sent is materially
less than the number upon which the price was derived, Customer acknowledges that the price per
drawing may be increased.
5. It is assumed by Axiom that the specifications for the conversion are accurate and appropriate to the
drawings sent. Any incorrect conversions that are the result of inaccurate, erroneous or inappropriate
specifications supplied or approved by the Customer's authorized contact may certainly be corrected, if
the Customer so chooses, however corrections in such cases will be accomplished at an additional cost
to the Customer and are not grounds for delaying acceptance of completed work. A new quotation will
be issued to the Customer for the additional costs of implementing the specification changes.
6. Axiom invoices for payment when the delivered work is accepted by the customer. For this reason, we
need the Customer's cooperation in quickly checking and accepting delivered work. Unless alternate
arrangements are made in writing prior to the beginning of the conversion work, the Customer hereby
consents that any converted files that have been delivered to the Customer for acceptance and on
which the Customer has not responded, for a period of one week, are automatically considered
accepted by the Customer and invoiced.
7. Payment of each invoice is due within thirty (30) days of Invoice date. late payments are subject to a
1.5% late fee once past due and again each 30 days past due after that.
For immediate se",ice, complete this form andfax to 727-442-8344.
I authorize the work described above and have read and agree to the terms and conditions.
Authorized Signature for Santa Ana, City of
Date:
Invoicing Information
Attention:
Company:
Address:
If paying by credit card fill in blanks below.
Name:
Expiration Date:
City, State Zip:
Country:
Phone:
Credit Card #:
Fax:
The authorized contact for providing specifications is:
.-
EXHIBIT B
ADDITIONAL INSURED ENDORSEMENT
FOR COMMERCIAL GENERAL LIABILITY POLICY
Insurance Company
This endorsement modifies such insurance as is afforded by the provisions of Policy
# relating to the following:
1. The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 9270 I; its
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 of the 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 if not 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 ofthe following, including countersignature, is required to make this endorsement
effective. )
Effective
Policy #
Issued to
, this endorsement form as a part of
Named Insured
Countersigned by
Authorized Representative
ACORQ., CERTIFICATE OF LIABILITY INSURANCE
MXOKIR 7 30- 4 'AX 7)5......5
Jlck il1c:1 lntu.anc., Inc.
nOlo 5. ..1c"'. Rd.
La..." FL J3 773
O,OTlllIIIIIlDI'I'Il
10 05 001
I"I'OIWA
ONLY AND CONPIU NO R1GMTa UPON TMI cI!RWICA~
flOl.DI!Il. THlI CIltTlPICATI DOD NOT Ml!ND,IXTIND OR
AL Tilt TMI COVIIWJ~ A1'~ClIIID!D IV THlI'OUClllIILOW.
INIUIU!RlI AJlPORDINO COVIRAH
COVIIWIP
TNI 'OUClU 01' INIUIWlCIIJ8'liD liLOW HAVE BIIN I$&U!~ TO Till! INIUMO NAMED ABOVE '011 TNE POI.ICY PERIOD lI1DICA.T!D, NOTWITHSTANDING
I<N'f 1Im1JNl/lllHT, 'IINII 0" CONDmOIl 0' Atlt CONTAAOT Oil 01HIII DOCUMlNT WITH IWlPECT TO WHICH TNIS o!llTl'!CA.T! MAY _Ilium OR
MAY ~J.llIE INlUIlANCRM'OftDal BY THIl POUCI!I DIItC".ID HillElN I' IUIJECTTO ALL THE Te_ IiilCWIIClNll AND CONnmON8 OF SUO"
POl.lCIU. ......_T! LIl1II& IHCWIl MAY H/,W 11&" REWCID IY PAID OLAIMS.
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City 0' SlIlta AnI. it. off1~.I, _loyee., IlI*ntl volunWAl'II IIJll1 repr..entatives are additional
nlur.d with re.,.ets to gen.r.l liability Ind dlf~' of su1tl ar1ling 'rom thl operations and us.s
erfol'lllld by or 011 lMIh1l' of thi& l11111C1in.urlll. "s.. Attach.nt"
.. ex,..t :LO DIYI ,or NOII-'ar-t
CANCELLATION
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IMPORTANT
If the ~CIte holder II en ADDITIONAL INSURED, the poIley(lel) mutt be andoread. A ~lTIlInt
on 11111 ctI1liIcall doea not ggnflt riQ1IlI to I!Ie 1IIflllI0II1I hold... In leu olluch end~....ment(I).
If 8UBROGATlON IS WAIVED, IUbJecI 10 1I1.lIrma end condllloni oItht poUcy, cer\$1n polloi.. mlY
l'8lluile ... .,cIorMmltll. A ItIl8mIlll on 11I11 CIIrl1f1oete dOli noI confer rlglRI to lI1e CllItI1ICIIt.
holCllI'ln lltlu of suCh 1!ld0raemenl(l),
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The CerlIfIoele 01 fnllftnce on the _. IICII oflh111orm doOl nO! conl~ . OQ/\lrllCI be\1H8ll
thllllllins Inlurt/(ll), luthOrtud raprelllnl8l1ve or ProcIueer,lI\d th. OIIrt111C11l1 holder, nor doealt
aftIrm.tIYIIY or n811atlve1y emend, extend or liter IhI CO\'llTIOI aI'Iordld by the pollclee tiiteclllltflOn.
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. Ci ty of Santa Ana
CB~f1ca" 1,.UM to c;:ity of Santa Ana 10/05/2001
~ck R~nc.. Inc;.
l0/12/l001
With re~pacts to c1.im5 arising out of thl operations and usss plrformed by or on behalf of the namld .
insured, such 1n.urant. .. is affordld by this po11cy 1& pr1lary and 1s not add1t10nl' to or contribu~ing
with .ny other insurance cartiad by or for the benefit of the additional insured..
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APPROVED AS TO FORM
ACORD.. CERTIFICATE OF LIABILITY INSURANCE I DATE (MMlDDlVYI
10/05/2001
~RODUCER (727)530-0684 FAX (727)536-9985 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Jack Rice Insurance, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
13080 S. Belcher Rd. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Largo, FL 33773 INSURERS AFFORDING COVERAGE
INSURED Axlom Internatlonal INSURER A: Transportation Insurance Company
Axiom Services, Inc. dba INSURER 8: Transcontinental Insurance Company
1805 Drew Street INSURER c:
Clearwater, FL 33765 INSURER 0:
I INSURER E:
COVERAGES
LIMITS
$
FIRE DAMAGE (Anyone fire) S
MED EXP (Anyone person) S
PERSONAL & ADV INJURY S
GENERAL AGGREGATE $
PRODUCTS. COMPIOP AGG $
05/10/2000 05/10/2003
COMBINED SINGLE LIMIT
(fa accident)
BODILY INJURY
(Perperlon)
BODILY INJURY
(Peraocident)
-
PROPERTY DAMAGE
(Peraceldenl)
.
~GE LIABILITY
I ANY AUTO
EXCESS UABILlTY
:rOCCUR D CLAIMS MADE
I DEDUCTIBLE
I RETENTION $
~RSCOMPEN8AnoNAND
EMPLOYERS' UABIUrY
APPROVED AS IV
~ aL. W-."
.>I.4'T ,
L UTa Sheedy
a City AttOrn Y
Deputy
EACH OCCURRENCE $
AGGREGATE S
$
$
$
AUTO ONLY. EA ACCIDENT $
EA ACe s
OTHER THAN
AUTO ONLY:
AGG $
I T~:m:mfsT
E.L. EACH ACCIDENT
E.l. DISEASE. EA EMPLOYE
E.L. DISEASE - POLICY LIMIT
r1C224472783
01/02/2001 01/02/2002
IU~,\'-
$
$
$
B
OTHER
1 000,000
100,000
10,00
1 OOO,OO(
2,OOO.00(
2,000,00(
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~ OF OPERATIONSILOCATtONSlVEHICLESJEXCLUSIONS ADDED BY ENDORSEMENTISPECIAl PROVISIONS
e: ProJect: CAPO Conversion
he City of Santa Ana, its officers, employees, agents volunteers and representatives are additional
nsured with respects to general liability and defense of suits arising from the operations and uses
Ierformed by or on behal f of the named insured. "See Attachment"
* Except 10 Days for Non-Payment
CERTIFICATE HOLDER I I ADDrnoNAL 'NSURED, INSURER LETTER
CANCELLATION
City of Santa Ana
Public Works Agency
Attn: Taig Higgins
20 Civic Center Plaza M-36
Santa Ana, CA 92701
SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ~ MAIL
*30 DAYS WRITTEN NonCE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
~X
XXXXX
d7?(J)~
..
AUTHORIZED REPRESENTATIVE
Sandi Vernacchio/FLN
@ACORD CORPORATION 1988
ACORD 25-8 (7/97)
,
IMPORTANT
Ifthe certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may
require an endorsement. A statement on this certificate does not confer rights to the certificate
holder in lieu of such endorsement(s).
DISCLAIMER
The Certificate of Insurance on the reverse side ofthis 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-S (7197)
I
.
City of Santa Ana
Certificate issued to City of Santa Ana 10/05/2001
Jack Rice Insurance, Inc.
10/12/2001
With respects to claims arising out of the 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.
APPROVED AS TO FORM
. cY'(LLUia.J/~O~
Laura Sheedy
Deputy City Attorney