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HomeMy WebLinkAboutTRI-COUNTY INTERIORS 1 r\ . AGREEMENT TERMINATION Please complete this form when the attached agreement is no longer in effect. Return form to the Deputy Clerk of the Council (M-30). Cali 647-5238 if you have any questions. ------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------ The agreement with 1Yi-~~ hrknor, No. ~-.;2.DD 1- o't:\- was completed on 1.\/18/0& and final paymlfll! hasere.!fl made. It\ Z_ tb 4:~ <t:=> Ii ~3 ,.., ~',; i.L ,_ '-'~.::J !ili l',:.:: 1IC C> 0::: >-w l!!; ......J ~ (3(..) Department: e.;DA y, 5?J10 ~:t~ Signature: Date: City of Santa Ana Clerk of the Council Rev.ed 05-22-lJB N-2007 -044 INSURANCE ON FILE WOR". MI.. r'KOCEED UI~ IlL iHSURANCE EXPIRES CLEi~~lo~~lf AGREEMENT FOR PROVISION OF SERVICES DATE: J,Jt rrl1i1/ THIS AGREEMENT, made and entered into this --!-;- day of ~, 2007, by 0: CbII 0-) and between Tri-County Interiors, a California corporation (hereinafter "Contractor"), and the If' ^ ,!".J~Il) City of Santa Ana, a charter city and municipal corporation duly organized and existing under lV~ the Constitution and laws of the State of California (hereinafter "City"). RECITALS A. The City desires to retain a Contractor having special skill and knowledge in the field of general construction services. B. Contractor represents that Contractor is able and willing to provide such services to the City. C. In undertaking the performance of this Agreement, Contractor represents that it is knowledgeable in its field and that any services performed by Contractor 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 Contractor shall perform on-call services, as needed, for minor building and grounds repairs and renovations. The Depot Management (City) shall inform Contractor when work is needed and Contractor shall respond within five (5) working days with a written formal bid proposal. The City may accept, reject or negotiate with Contractor regarding said proposal. Contractor shall perform said services only after receiving written approval ofthe proposal from Depot Management. Contractor is hereby authorized to perform all services using guidelines attached hereto in Exhibit A to this Agreement. 2. COMPENSATION a. City agrees to pay, and Contractor 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 $15,000.00 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. 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 terminate when all funds are expended. 4. INDEPENDENT CONTRACTOR Contractor 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, a joint venture relationship, or to allow the City to exercise discretion or control over the professional manner in which Contractor performs the services which are the subject matter of this Agreement; however, the services to be provided by Contractor shall be provided in a manner consistent with all applicable standards and regulations governing such services. Contractor 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, Contractor shall maintain and shall require its subcontractors, if any, to obtain and maintain insurance as described below: a. Commercial General Liability Insurance. Contractor shall maintain commercial general liability insurance naming the City, its officers, agents, volunteers, and employees 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 Contractor'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. Contractor shall supply the 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 Legal Counsel. 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, Contractor, if Contractor 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, Contractor agrees to obtain and maintain any employer's liability insurance with limits not less than $1,000,000 per accident. 2 d. If Contractor 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 Contractor pursuant to this section: (i) Contractor 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 Legal Counsel. (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 Contractor 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 Contractor's right to be paid for its time and materials expended prior to notification of termination. Contractor waives the right to receive compensation and agrees to indemnify the City for any work performed prior to approval of insurance. 6. INDEMNIFICATION Contractor agrees to and shall indemnify and hold harmless the City, its officers, agents, employees, Contractors, 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 Contractor 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; 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 hannless 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 ofthe terms of, or effects, arising from this Agreement. The Contractor further agrees to indemnify, hold hannless, 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. 3 7. CONFIDENTIALITY If Contractor receives from the City information which due to the nature of such information is reasonably understood to be confidential and/or proprietary, Contractor 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. "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 Contractor disclosed in a publicly available source; (c) is in rightful possession of the Contractor without an obligation of confidentiality; (d) is required to be disclosed by operation of law; or (e) is independently developed by the Contractor without reference to information disclosed by the City. 8. CONFLICT OF INTEREST CLAUSE Contractor 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: Deputy City Mgr. for Development Services Community Development Agency - City of Santa Ana 20 Civic Center Plaza (M-25) P.O. Box 1988 Santa Ana, California 92702 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 4 To Contractor: Tri-County Interiors, Inc. 1592 N. Batavia Orange, CA 92867 Attn: Dan Rosa 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 Contractor, 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 Contractor. The parties agree that any terms or conditions of any purchase order or other instrument that are inconsistent with, or in addition to, that terms and conditions hereof, shall not bind or obligate Contractor 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 Contractor, Contractor 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 Contractors retained by City. 12. TERMINATION This Agreement may be terminated by the City upon thirty (30) days written notice of termination. In such event, Contractor shall be entitled to receive and the City shall pay Contractor compensation for all services performed by Contractor prior to receipt of such notice of termination, subject to the following conditions: 5 a. As a condition of such payment, the City Manager, or his designee, may require Contractor 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 Contractor 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 Contractor 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. Contractor 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 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 Contractor 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. Contractor shall notify the City immediately and in writing of her 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 wan-ants 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. APPROVED AS TO FORM: JOSEPH W.FLETCHER City AKt,~t~o/~rney /' Lisa E. Storck Assistant City Attorney RECOMMENDED FOR APPROVAL: lu/Y1 !c.C.r~l~ ~f,4tephen G. arding, Deputy City Manager V for Develo ent Services CITY OF SANTA ANA Ix"" David N. Ream fk CityManager CONTRACTOR: Tri-Cou/ry Interiors, Inc. t -~ By: Name: Dan Rosa Title: j~A"l. Tax ID# OS- 063 yL1ll~ rauceia n. Healy Clerk of the Council ... ~rss 6rn,: e Tri-County Drywall & Interiors, Inc. Januazy 31, 2006 City of San[a Ana The Depot at Santa Ana 1000 East Santa Ana Blvd. Santa Ana, California 92701 Ref: Labor Rates (Full Burdened) Trade: Straight Time Overtime Double Carpenter Journeyman $46.40 $62.64 $77.27 Carpenter Foreman $48.40 $65.34 $88.21 Carpenter Superintendent $65.00 $87.75 $118.46 Laborer $36.00 $48.60 $65.61 Acoustical Journeyman $46.40 $62.64 $77.27 Acoustical Foreman $48.40 $65.34 $88.21 Acoustical Superintendent $65.00 $87.75 $118.46 Drywall Journeyman $46.40 $62.64 $77.27 Drywall Foreman $48.40 $65.34 $88.21 Drywall Superintendent $65.00 $87.75 $118.46 Cabinet Maker $51.20 $69.12 $93.31 Project Manager $75.00 $101.25 $136.69 Administration $38.25 $51.64 $69.71 Painting Journeyman $46.70 $63.05 $85.12 Painting Foreman $49.50 $66.83 $90.22 Concrete Journeyman $48.00 $64.80 $87.48 Concrete Finisher $46.00 $62.10 $83.84 Tile Satter $49.60 $66.96 $90.40 Sub Contractor Mark Up (Cost Pl us) 15% Material Mazk-Up (Cost Plus) 10% Equipment mark-up (Cost Plus) 10% Regular Hours: 6:00 a.m. to 2:30 p.m. Monday thm Friday. Overtime: 3:00 p.m. to 12:00 Weekdays. 6:00 a.m to 6: 00 p.m. Saturday Double Time: 12:00 a.m. to 6:00 a.m. Weekdays. After 6:00 p.m. Saturday. Sunday's and Holidays. 1592 N. Batavia, Orange, California 92867 714/864-7243 Fax 714/455-7766 ACORD~ i DAT03w Dzo~97 YYI CERTIFICATE OF LIABILITY INSURANCE PRODUCER PMre: 171097}14]6 FY 1710 tl1'iYRll TW9 GERTRIDATE 19 ISSUED AS A PATTER OF IIIFORM1L710R ELMCO INSURANCE, INC. ONLY AND CONFERS NO RIGNTS UPON THE CERTEICAiE 1901 N. MAIN STREET HOLDER. TFtlb CERTIFlCATE DOES NOT AMEND, EXTEND OR SANTA ANA CA 92706.4779 ER THE COVERAGE AFFORDED BY THE POLCCI S BELOW. INSURERS AFFORDWG COVERAGE i NAIC lF _p~9~LicJk 0509747 _ ...._... _ __ -_. .. --- ------ - - IHCUace • GOLDEN EAGLE INS CORP. _. INSURED ~~---~ - - TRI-COUNTY DRYWALL AND INTERIORS, INC I INSURER 8~ _ __ _, -____._ r _ .............. 1692 N. BATAVIA. SUITE 2 1NSUREa C' OFL4NGE CA 94997 . _.. _.._ _. .. ._-_-._._. _._ . { 4NSURER D- , INSURER E: __ THE POLN:IE6 OF INSWANCE L16TE0 9ELOYY NAVE 9fiEN 1931£(1 TO THE e13uRE0 NAMED weDYC run Ine rNJLYY rcnrw ~•.~•• •- 0N OF ANY CONTRACT On DTHEA DOCtMLENT WITH RESPECT TO YMRCN TNIS CERrwGiE MAY BE IS9UE0 OR 1 1 ANY REOUYGEMENT, TERM OR COND1 TFE INSURANCE AFfDRDEO BT THE MAY IERTAN POLICIE6 DESCR16E0 HFREM IS SWIECT TO All THE TERM6. EXCLUSIONS AND CONDITIONS OP SUCH . YU11{:IES AGGREGATE LIMITS 9HOYM MAY INYL OEEN REDUCED YY PAq CLAMAS ncR ^ODU TYPE OF WSURANCE POLICY NUME[R vOLKY!'FSC*IIN i POLKY E%FMTION 01T! SAT! DMITS LTG NWC GPNRRAL LIAOILITY CBP9241272 02/2N07 D2/24109 wCH «eUR0.9NCE i 7,000,000 . XCOMMERCIAL GENERAL LNeIUTYI j %wwcl rollEHrim } ._.. . rnvlHEi¢PONMNw1 ---50.000 __ _.... I iC1wW5MADELX, OCCUR' MED. EXPUVryOnP pvsm) $" .,1000 A ~ i YtnaUNNl4AW nuuNT iF ... _._ 1000000 i F.__ _....... _ O GENERAL AGGaEGATE 1 S 2 000 OW i GENL AGGIIEGATE LRAIT APPLIES PER: ~ ~O ~ PRODUCT6LOMPIOP AG6 IS _. ____ 1~WO,OW. POLICY I , JECT ILW .. ~ • ~ I BUTY AUTOMON ~E ~~ ~ R K I EDMOINE~D 301GI.E UMR 13 1 I ~0 -.__ O Ge .?e .,a OYh y ~` .._ _ -_~_. I .__......_ _._.__ lLLL ONMED AUTO6 ' ~ ~~ 6CNEOULEO AUTOS ' tt . 4• ~.~7P' rI~ A ~~ ka1Yt G 6OOLLY WJURY !IPRrPNlGDI If ' _.. --------._._ .__. - HIRED AUT09 i NDN-OWNED AUTOS ~ SIS I J~~ PS I~ ~ + ~ BODRY INJURY s (Po xcmMN) • ~~ PROPERTY DAMAGE IS I IPN IWNLnO GARAGE LIABILITY i AUTO ONLY: EA ACCMJENT S ~ _ ANY AUTO f OTHER THAN W ACC S - IAUTOONLY' AGG R EA1:2S51 UMBRRIA LNOILRT EAQI OCGURRP•NGF• 3 __ ~ OGCVa 1 CUIMS MADE pGfJ19GATE Y s I DEWCTERE I _a i j aETENTgN S i I 'i WC SY/,T4 ~ vdORKfl0.800WFNtAT1[W AMD i OTKDi TORY LY9TM (EMPLOYERS U0.01UTY ' 4 E.L.fACNACLHNiNi S ~INY PRDIIUEroRPM1NERRXEWIn! ~ ' ~~.__ OFFIlEMMSYSER E%4UDEOV i EL. 015EA36-FA EMPLOYEE IS ~N wu,dxNbundw ~FPFLMLrAOGMNGn YMOr 1 I ~ E.L.DREASE•PO4CY twat S O HER: I, OESCRIPTJON OF OPERATIONSILOCATION9NEHICLES/E%CLUSIONSRDDED BY ENDORSEMENT/ SPECUIL PROVISIONS SEE 5UPPLENRN7 AL CERTIFICATE INFORMATION C6ClTIFICA'f6 MOLDER CANCELLATION CITY OF SANTA ANA SNOUtD ANY Of THE ABOVE DE6CRME0 POLICIES eE CANCELLED BEFORE THE ' THE DEPOT AT SANTA ANA 70 GAYS WRIRFN E%PRATION DATE THEREOF. THE ISSIHNG NSURER WLLL MAE NOTICE TO THE CERTIFICATE MOlOER NAMED TQ THE LEFT TWIT t. SAN IA ANA BLVD STE 109 SANTA ANA CA 9]707.3900 AUTHDR@D REPRE6ENTATVE ~^~ Att ti ~.~{,/~ ~'~200W9 ~' _ en on: ACORD $ (]II07/OB- CERNlt9te 9 36053 8) ACORD CORPORATION 7989 49dhl~ti 6 'ieW awil pan~aae~ POLICY NUMBER; CBP8241272 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ THIS CAFZEFULLY RDDITIONAL INSURED PRIMRRY COVERAGE This endorsement modifies insurance provided under the following; COMMERCIAL GENERAL LIABILITY COVERAGE PART This insurance is prlmary fw thR person or organization shown in the schedule, but only with respell to liability arising out of your work or that insured by or for you. Other insurance afforded to that insured will apply as excess and not contrmute as prlmary to the insurance afforded by this endorsement. All other endorsement provisions, conditions and exclusions of this insurance Shall remain unchanged and apply to the additional insuretl and described below. SCHEDULE ADDITIONAL INSUREb CONTRACT/PROJECT CITY OP SANTA ANA THE DEPOT AT SANTA ANA 1000 E. SANTA ANA BLVD STE 1 DS SANTA ANA CA 92701-390D NAMED INSURED 7RI-COUNTY UKYVVALL AND INTERIORS, INC 1592 N. BA7AVIA, SUITE 2 ORANGE CA 92867 ~ y®~ A1~Yg~~D P-a K P , STOR~raey 415ant t;t'ry A Sts ~~ Cenificate to 36n53 Wdhl:y . 6 ',eW awil paniaaaa PATE SUPPLEMENT TO CERTIFICATE C}F LIAaiL.~ ~ ~ IIV~7 ~hJDDJ.7 MAR807 OESCI2JPTION OF OPERATIONSILOCATIONSNEHICLESISPEGIAL ITEIUIS CONTRACTOR -DRYWALL -COMMERCIAL WORK ONLY -70 DAY NOTICE DUE TO NONPAYMENT OF PREMIUM CERTIFICATE HOLDER NAMED AS ADDITIONAL INSURED ON GENERAL LIABILITY ONLY AS RESPECTS NAMED INSURED"S OPERATIONS Pl;R ATTACHED ADDITIDNAL INSUREDS CONTRACTS ENDORSEMENT GECG802 (09104), cennwaie ~ aovw +•iar Mar. 9. 2007~1(~19AM 'aa.,c~ ~i~ r.~~i o 9 r.Y WdVI~G '6 ',aW a~~il paniaaa~ ADbITIONAL. EtiHPQ~RSFa+IEINT FQR {YIIMMK_R~ar GEN~RALI~7~~IL»POT.SCY Insnrarvice Cotnpe~y Golden Eagle Insurance Gompany 'llns endorsement ruodiflas such inbutancc as is afFarded by ale provisions of policy # CBP8241272 rr181iug ~, ~ fnllua~g: t. The Citya£Satrta ~. ZO Civic Ceomer Playa, 5mta Ana, Calif'atnia 92701; its officers, employees, agents, votuuteers and r~trnsves are nsmai ds additional iaBUicd ("additional instmd") with regard to liability and deB~use of suite arising from the apdations sue rases performed by or on behalf of the 1~rlCYl msUte$. 2. With rcupect m claitns arising out of the behalf of &c namaed iasueed, sneh LtlSnran „ ac is sfi'[mi and uses p~arforozed by or on 3. This instttance applies separately to each insured against whom claim is made ar suit is brought except wirir respect w tbts compuzps limits of IiabilitY. 'me inciual~ of any perms or orgauizaiicn as an insured shalt sot affect say right which such pCdaplr ar orsanizartion would have as n claimant if not so included. 4. With reaDect to the additional insured, this iresptaace shall not be ea¢loetled, or ~ m~aberially reduced in coverage or limits eacopt niter thirty (30}days wrrtten nonce iras been given to the city of Santa Ana, 20 civic center Plaza, Bazars Ana. Ca3iforaia 9z7O1. (Complcrion of the following including cotm~teraignatum, is required fb make this endorsement e~ctiva.) Effective 3/9/07 feria etuaOtsornetrt fowl as a part Of Polrcy# C$P8241272 IssuCdto T1 i_ ~`nnnry 11r~wa11 ap Tnta.~ime Tnr Named T~'mc'ut Cotrtrtersigecd by - ~ ~~ Authorized l~'49entative ~ ~QM ,, ^1t T.t}ffi~"!' AC~tSr~IANY 7~E am ~ L151~ ~ ~Ly ~r++oy. ~ ~~ ~~ ~~ I keceived Time Mar• 8 9;16AM WdUI~V '6 'a~W ew,l paniaaa~ CERTMOLDER CORY sc STATE p0 BOX 420A07, SAN FRANCISCO.CA 94142-Oa07 COaaP'QNSATION IN SURANCe FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 09-09-2007 GROUP; 000229 POLICY NUMBER: 0023078-2007 CERTIFICATE ID: tte CERTIFICATE EXPIR65: Ot-01-2008 O1-Ot-2007/01-01-2008 CITY OF SANTA ANA THE DEPOT AT SANTA ANA 5G 7000E SANTA ANA BLVD SANTA ANA CA 82701-3900 This is tv certify that we have Iswed a valid Workers' Compensation Insurance policy in a farm approved by the Colitornia Insurance C.ommieeinnar to the emDlOyar named below for the pDh Gy perl0d indl Cdted, 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 pvticy ba cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend ar alter the coverage aiiordetl by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this cerh}icate of insurance may be issued or to which it may pertain, the insurance of icrdad by the nnllny dwenrihad herein is subject to all the terms. exclusions, and conditions. v} such pollcv. THORIZED REPRESENTATI PRESIDENT ENP LOYER'S LIABILITY LIMIT INCLUOINC DEFENSE COSTS: 51,000,000 PER OCCURRENCE. ENDORSENENT M2066 ENTITLED CER7I F'ICA7E HOLDER5r NOTICE EFFECTIVE 01-01-2005 IS ATTACHED TD AND FORNS A PART OF THIS POLICY. ,QAO " - SSORCKneY ~\SA E ~tt`/ A~Ot ~SlStart ~~ ,J ~ EMPLOYER /OR TRI-COUNTY ORYYALL B INTERIORS I C. 1992 N OATAVIA tiT STE 2 ORANGE L'A 82867 (B I O,SP] Iaev.t•vsl PRINTED 03-08-2007 IMPORTANT ~:y - g aeW-awij paniaaa If the 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 SUl3ROGA710N IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not conf®r rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between lire issuing Insurer(s), authorized rcpresentativa or producer, and the certifir..atw holder, nor does If affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.