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HomeMy WebLinkAboutTORRES, MARTIN 5City of Santa Ana Clerk of the Council AGREEMENT TERMINATION FORM Please complete this form when the attached agreement and all amendments (if any) are no longer in effect. Return form to the Clerk of the Council Office (M-30). Call 647-6520 if you have any questions. The agreement with COTC Office Use Only No. N-2002-079 was completed on 6/30/03 and final payment has been made. (List all amendments. Use space below if needed.) V, Department: PRCSA N- foal -MCI Phone/Ext.: 5254 Signature: eS�}�1�.�,� ��POV0 Date: Revised 08-23-10 `/ CONSULTANT AGREEMENT ,T ON FILE WWK MAY ''; ?ROCEED CLERK Pi COUNCIL D DATE- 0 THIS AGREEMENT, made and entered into this J day of ,n b , 2000 by and between Martin Torres, a sole proprietor (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 karate instruction to conduct karate classes. 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 $9,450.00 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. 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, 2001, 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 Parks, Recreation and Community Services and the City Attorney. irw 1, w 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 prpvided 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. 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. c. 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. %✓ .d 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. (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. e. 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: (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 of the 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 of the 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 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 *ad 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 of law; 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 Santa Ana, CA 92702-1988 telefacsimile (714) 647-6956 With courtesy copies to: Executive Director of Parks, Recreation and Community Services City of Santa Ana 20 Civic Center Plaza (M-23) P.O. Box 1988 Santa Ana, California 92702 telefacsimile (714) 571-4235 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: Martin Torres 12692 Rancho Way Garden Grove, California 92843 A party may change its address by giving notice in writing to the other parry. 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, 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. `.. 1104000 #1361 i.ry 0 Gorki n 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 governed and construed in accordance with the laws of the 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 his 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 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: PAT IA E. HEALY Clerk of the Council APPROVED AS TO FORM: JOSEPH W.FLETCHER City Attorney By:i.r r Ct. Laura Sheedy Deputy City Attorney RECOMMENDED FOR APPROVAL: Cleve liams Executive Director of the Parks, Recreation and Community Services Agency CITY OF SANTA ANA AVID N. REAM City Manager CONSULTANT VMS 615-38-0946 Employer ID # or Individual SS # ..d EXHIBIT A SCOPE OF SERVICES A. Consultant will conduct aerobic classes to children and adults for a period of six months, teaching classes periodically as follows: Karate classes will be held at Jerome Recreation Center on Monday and Wednesday from January 8, through June 30, 2001, (Beginning 6:00pm - 6:50pm & Advance 7:OOpm to 7:50pm & Adults 8:OOpm-8:50pm). No classes will be held between December 25 - January 7, 2001, and January 15th, February 19th and May 28, 2001. B. Consultant will provide and be responsible for equipment, records, personnel and clean up of the facilities and material necessary to insure the effectiveness of said instruction. Class Size Registration A. The minimum number of participants is 10 per class, up to 50. B. No registration shall be accepted after the second week of classes. C. In the event the minimum number of enrollees is not realized by the second week of classes, the class shall be canceled and Consultant will be under no obligation to provide services, and City will be�under no obligation to pay Consultant compensation. Fees A. The fee to participants shall be no more that $15 per month per enrollee. No refunds shall be made to participants, unless class is canceled by the Parks, Recreation and Community Services Agency. B. City shall collect said fees from each participant in the class during the period of registration. Consultant shall not collect fees and refer participants to Center office. City agrees to pay Consultant seventy percent (70%) of the total fees within fifteen (15) working days after completion of said class period. City and Consultant agree that City shall retain thirty percent (30%) of the fees collected. C. Consultant agrees that City representative shall be entitled to audit Consultant's records to insure compliance with the Agreement. ,.r 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 92701; 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 of the 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 8 Authorized Representative AC -ORA CERTIFICATE OF LIABILITY INSURANCI�SNA DAMD oa2/oi PRODUCER Fitness & Wellness Insurance THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Agency HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 380 Stevens Ave., First Floor ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Solana Beach CA 92075 POUCY EXPIRATION DATE MWDDIYY Phone:800-395-8075 Fax:858-519-0822 INSURERS AFFORDING COVERAGE INSURED INSURER A: Specialty National Insurance INSURER B: Karate Do Kiai #376126 Bff: 1/10/02 INSURER C, 12692 anchero Way Garden Grove CA 92843 INSURER D: INSURER E: 01/10/02 COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF 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. INSR LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MMIDDA(Y) POUCY EXPIRATION DATE MWDDIYY LIMITS GENERAL LIABILITY The City Effective Of Santa Ana 1/10/02 EACH OCCURRENCE $1,004,000 A $ COMMERCIAL GENERAL LIABILITY 3XZ126451-01 01/10/02 01/10/03 FIRE DAMAGE (Any one fire) $100,000 CLAIMS MADE C OCCUR MED EXP (Any we person) $ 2, 50 0 PERSONAL B ADV INJURY 31, 000, 000 A X Nisc Professional GENERAL AGGREGATE S 3, 000, 000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMPIOP AGO $1,000,000 PICY PRO- OLLOC ECT AUTOMOSILE LIABILITY ANYAUTO COMBINED SINGLE LIMIT (Ea acadent) $ BODILY INJURY $ (Per Pecan) ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY $ (Per SC eni) HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE $ (Peraccidenq it GARAGE LIABILITY V ..� AUTO ONLY - EA ACCIDENT S OTHER THAN EA ACC $ ANYAUTO AUTO ONLY: AGG $ EXCESS LIABILITY EACH OCCURRENCE $ OCCUR FICLAIMS MADE AGGREGATE $ DEDUCTIBLE AP PRO , --- --,)R $ $ S RETENTION S WORKERS COMPENSATION AND EMPLOYERS' LIABILITY U 1 ,S I1CCdy - "' TORY LIMITS ER E.L. EACH ACCIDENT S E.L. DISEASE - EAEMPLOYE $ Deputy City AtU)rm _y E.L. DISEASE -POLICY LIMIT S OTHER A Sexual Abuse 100,000 300,000 DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS It is understood and agreed that the following entity is added as an additional insured but only as respects the operations of the named insured except that liability resulting from the additional insureds sole negligence CERTIFICATE HOLDER IN I ADDITIONAL INSURED; INSURER LETTER: CANCELLATION ACORD 25S (7/97) 1 - WAGUKU GUKPUKAIIUN TsnB CITYSAA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL The City Effective Of Santa Ana 1/10/02 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR 20 Civic Center Plaza REPRESENTATIVES. Santa Ana CA 92701 ACORD 25S (7/97) 1 - WAGUKU GUKPUKAIIUN TsnB EXHIBIT B :.�) �T� 1 •7f gaff;, a D •• ffu gt, I 'f Insurance Company Specialty National Insurance This endorsement modifies such insurance as is afforded by the provisions of Policy # 3XZ126451-01 relating to the following: 1. The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701; 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 Pizza, Santa And, Califo„tia 92701. (Completion of die following, including countersignature, is required to make this endorsement effective.) Effective 1-10-02 this endorsement form as a part of Policy # 3XZ126451-01 Issued to Karate Do Kai#376126 Named Insured Countersigned by / / A ILL d Re sentative ID APPROVED AS TO FORM Laura Shee y ilcnuty City Attornev FROM : 5819 MOTORS FRX NO. : 714-245-2365 Jan. 14 2002 12:56PM P2 rn Cer4 F CSacon At M,:rrm IF, �h lneu•. , a Age,p, ir:_ 7c Kurz to Co Pia •57612. ru'+• (655)2.9 6069 :a(: 1/11102 09.31 AM F,;ge 2 012 SPECIALTY NATIONAL INS'JRANC£ A NEMPER COMPANY CERTIFICATE OF LIABILITY INSURANCE Policy Number: 3%Z126461-01 Fitness and Wellness Purchasing Group _ CeRificate Number: 0376126 - IDEA .,AAwE0 Karate Do KIM 0376126 AGENT Murria & Frick Insurance Agency, Inc. NSUREO EH: 1110/02 NAME 380 Stevens Avenue, $115 ANDING 12892 Ranchero Way HALING ANSolana Beach, CA 92075 ADDRESS Garden Orm, CA 82843 ADDRESS 800-395-8075 POLICY PERIOD: From 01/10/2002 To 01110/2003 TOTAL PREMIUM: THIS CERTIFICATE OF LIABILITY INSURANCE FORMS A PART OF THE POLICY REFERENCED ABOVE. INSURANCE AS IDENTIFIED BELOW HAS BEEN ISSUED, IS IN FORCE, AND CONVEYS ALL THE RIGHTS AND PRIVP-EGES AFFORDED UNDER THE POLICY. THE INSURANCE COVERAGE PROVIDED UNDER THIS CERTIFICATE IS SUBJECT TD ALL THE ue,nuc ne Tuc nm Iry in&WTiOen annVE COVERAGES LIMITS OF INSURANCE $1,000,000 Each Occurrence Limit $ 100.000 Damage to Premises Renteo to You Lim,t - any one premises $ 2,500 Medical ansa Limit - any One Person 31.000.000 Personal and AdvertisinginjuryLimit - an one person or or aniz. L $1,000 000 Each Profassional Incident General Liability —S3.000.000 General Aggregate Limit /ether than PrcouctelCorn feted Operations) S3.000.000 Products: Com eted Operations Agarocate Limit $3.000.000 Aagregate Limit - Professional Llability None Hired Auto Liability Sexual and/or Physica! Abuse Liabilityj $100,000 $300,000 Each Cialm Annual Aggregate Limit - Sewal and/or Physical Abuse Liability None Each Employsa Limit Employee Benefits Liabilit • None Agaregate Limit - Em to ee Ben Ifts Liability Employer's Liability (Only available in the 'ollowing States: ND. OR VA, WA and VVYI $ 100,000 S 100,000 3 500,000 States} where this Insurance applies Bodily Injury by Accident - Each Accident Bodily Injury by Disease - Each Employee Aggregate Limit - Employer's Liabili Liqucr Liability None None Each Common Cause Limit Aggregate, Winit - Li uor Llabil" Classiflption and Premium' �c t o C�ssTcaton Health or Rate Advance Premium Cede No. Premium Basis Pre rt0 s I Frad Comc ! Prem:ODs Prod/Cam 44311 Der Schedule Per SchecIvIe on :.e Per Schedule on File Exercise Cube on File (_— Location of all premises you own, rent or occupy: 1)Various 3) 2) <) IF YOU HAVE ANY QUESTIONS CONCERNING TH15 caw I P'UA It WN -Au I Ir�nn,r. n -r.o.� ,•.+..• •-�• ••-� • •---• -- • -- Bo0-395.8075 je/{sry E Fv cit JANUARY 14, 2002 Authorized Representative Data 825772 (5100) APPROVED AS TO FORM ,r Mura Shecdy Deputy City Attorney