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ARC MID-CITIES 1 -2007
N-2007-070 INSURANCE ON FlLE WORK MAY PROCEED UN11L INSURANCE EXPIF~ ^1 C.y .. /9 ~~~ VL~~t~P ~NC~ 0lQE: 6 -a6 -p7 o: PWA C2~CC~-Meroxlo) AGREEMENT FOR GRAFFITI REMOVAL 5ERVICE9 THIS AGREEMENT, made and entered into this I~` day of May, 2007 by and between Arc Mid-Cities -Orange County, a California not for profit corporation (hereinafter "Contractor"), and the City of Santa Ana, a charter city and municipal corporation organized and existing under the Constitution and laws ofthe State of California (hereinafter "City"). RECITALS A. The City desires to retain a Contractor having special skill and knowledge in the field of graffiti removal, to supervise removal in the City of Santa Ana. B. Contractor represents that Contractor is able and willing to provide such services to the City through its vocational training program. 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 provide workers, materials and transportation to provide graffiti removal, as set forth in Exhibit A to this Agreement. 2. COMPENSATION a. City agrees to pay, and Contractor agrees to accept as total payment for its services, a monthly fee of $1,350.00. The total sum to be expended under this Agreement shall not exceed $25,000.00 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 ofperformance set forth in the Recitals which may reasonably be expected by City. 3. TERM This Agreement shall commence on July I, 2007 and terminate on June 30, 2008, unless terminated earlier in accordance with Section 12, below. The term of this Agreement may be extended upon a writing executed by the Executive Director of the Public Works Agency and the City Attorney. 4. INDEPENDENT CONTRACTOR Contractor 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 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, employees, agents, volunteers and representatives as additional insureds) 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 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, 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. d. 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 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 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 by the City. 6. INDEMNIFICATION Contractor agrees to and shall indemnify and hold harmless the City, its officers, agents, employees, Contractors, 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 Contractor 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. CONFIDENTIALITY If either party receives from the other party information which due to the nature of such information is reasonably understood to be confidential and/or proprietary, the receiving party 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. 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: 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 copy to: Executive Director of Public Works City of Santa Ana Attn: Will Hayes 220 South Daisy Santa Ana, California 92703 telefacsimile (714) 647-3345 To Contractor: Arc Mid-Cities -Orange County Attn: Zolton Cunningham 302 North Tustin Ave., Suite 100 Santa Ana, California 92705 Telefacsimile (714) 285-2649 A party may change its address by giving notice in writing to the other party. Thereafter, any communication shall be addressed and transmitted to the new address. 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. 1f 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 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, the 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 either party 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. 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 has been executed and delivered in the State of Califomia 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 Grange 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. I5. PROFESSIONAL LICENSES Contractor shall, throughout the term of this Agreement, maintain all necessary certifications, 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 its inability to obtain or maintain such certifications, 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 ofthis Agreement. [N WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first above written. A ST:. ~,' - o~`at ~ ~, PATRICIA E. HEALY `~ Clerk of the Council APPROVED AS TO FORM: EPH W.F ETCHER City Attorney APPROVAL: Executive Director of the Public Works Agency CITY OF SANTA ANA DAVID N. R City Manager -~~-/~'1 z GQ-- ~! ~i ES (~j?,clc. 6~,0.~ ~s~- 6f~~r ARC MID-CITIES, ORANGE COUNTY OHN WA NER President -F t,+~~iv~ ,Z irGcT~1'' Tax ID# 95-2468486 EXHIBIT A SCOPE OF SERVICES Contractor shall provide graffiti removal services through its vocational training program as follows: • Contractor will provide one (1) on-site job coach and three (3) workers to perform graffiti removal three days per week • Contractor will assign one (1) 100% Direct Quality Working Control Job Coach, who shall be qualified as defined in Welfare and Institution Code §4512, including approval through the California Highway Vehicle Safety Course. • Training and supervision of the workers will be provided by Contractor, on the assigned work sites from 8:30 am to 12:00 pm Monday, Wednesday and Friday • Contractor's supervisor will receive training and information regarding required work skills, rules, regulations and procedures. The Supervisor shall convey the information to Contractor's workers assigned to provide services, on an individual basis and in daily safety group meetings for the first two weeks of this agreement. Thereafter, the information will be reviewed monthly. • Contractor will conduct sample inspections for quality control on all work performed on a daily basis. Supervisors will conduct a site visit at least once a week during the first two months of this agreement, and monthly thereafter. • Contractor shall observe the following paid holidays: New Year's Eve New Year's Day Martin Luther King Day President's Day Memorial Day Independence Day Labor Day Thanksgiving Day The Friday after Thanksgiving Christmas Eve Christmas Day CITY RESPONSIBILITIES • City shall train Contractor's supervisor regarding work skills, rules and regulations, procedures and interpersonal skills necessary to successfully perform this Agreement. City shall provide paint, paint rollers, pans and gloves necessary to perform this Agreement. • City shall conduct on-going job related training sessions for Contractor's supervisors, EXffiBIT B ADDITIONAL INSURED ENDORSEMENT FOR COMMERCIAL GENERAL LIABILITY POLICY Insurance Company GENERAL IRS• CO. OF AMERICA This endorsement modifies such insurance as is afforded by the provisions of Policy # 240009375420 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 sa 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 JULY 7~, ~n og ,this endorsement form as a part of Policy # 240009375420 Issued to ARC MID-CITIES Named Insured Countersigned by Authorized Representative Jun 26 07 08:42a Public Works 7146473345 P,2 `~ACORQ„ CERTIFICATE OF LIABILIT'I! III'Il~4~i4JRANCE °"" ,`""'~ " r PawIICBR RFPINSURANCEACiENCY 8807 WESTSLAU80NAVE,SUITEZ60 THIS !~EF.TIFICATE 18 IS$UEO AS A IBATTE•It OF CNLY !1116 CONFERS NO F8gfi8 UPON THE HOLDiF. 1'NF9 CERTIFICATE DOER NOT AMEND il; COVERAGE AFFORDED BY THE POL /ILTE!;_C INF'ORNATION CERTIFICATE EXTEND OR ICIES E9ElAW. CULVERCITY,CA80230 , Phone (310) 8424983 Fax (370) 848J950 0d'iIURli ~04 A=FORDING COVERAGE NAIL# weuRED ARC MID•CITIES 74208 TOWNE AVENUE INS1,xFrt,;. ~'3EIlIERAL INS COMPANY O ERICA ,'I,NC:RICAN STATES IN URANCE COMP IRS{1REi~ , CA 90081 LAS ANGELES Mfi URE9 , _._,.. _ IhANRE R ' _ _ __ IASURER I'. COVERAGES 'THE POLICIEb OF INSURANCE LISTED GELOW HAVE SEEN ISSUED TO THE INSUREiO NA' IE A AEOVE FDR THE POUCY PERE)D INDICATED. NOTWITHSTANDING TERM OR CONDRION OF ANY CONTRACT OR OTHER DOCUMEN ' I'll T~I RESPECT TO WHICN THIS CERTIFICATE MAY SE ISSUED OR ANY REOUIREMEFIT , THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIPI IS 61. G, li CC TO ALL THE TERMS, E7(ClUSIONS ANO CONDRIONS OF SUCH MAY PERTAIN , POLICIES, AGGREGATE LIMBS SHOWN AMY HAVE BEEN REDUCED BV PAID CIAMF _ '-POLICY NUMnEA <e'.iT~i~ii~t__'~O1M'' LINIt E fi!!!~ l1AaRITY EACH OCCURRENCE 6 7 OOO 000 X COMMERCIAL OEHEMLLIASILfiV 24 CC 0997642D 711eV.209F T/1980D7 PN t6E e o a s 200 0 A ClAIM6 MODE ~ OCCUR MED EIIP A a,e i 7O OOO PERSONAL iADVIWUIiY 57,000,000 GENERALAGGREOATE ~ 3 2 O00 000 DFMAGGRE(IATE LIMIT APPLIES PEP: PRODUGT6-CDMPIDP AUG 17000 O00 ~' POUCY MiO LOC ._.__,.___.. AIT OMOMLE W161UTY COMBINED SINGLE LIMB 5 7,DOO,000 AM' AUTO 812;!1200!: 912 312 0 0 7 #"PI~ 24 CC 088'158 20 ALL OMTW AUTOS BODILY RJJURY i E! X SOHEUULEO AUTOG fP.`P~~1 x HIRED AVIOB BODILY WIRY a X NqI-0NMEOAUTO6 fPr.cede,O MMA(n: PERtt a ~~ ~ y~,I~~TM ADroGIa.v•EAACCIDENr a ANY AUTO OTHERTFYJ! EA Atx S PTO ~Y' AGO i MBRELLALInMU7Y ' ' EACH OCCURRENCE i PROV A~ D .AS TII r ~RM DCCUR ~CWMB MADE AGGREGATE i { t OEDUCTM E : C C' ~: ~ 1' , L 8 . REfENTiON S . . .. . . 8 •` I lI ~ I~'~~': s Ai9ENSA1gNANO KER ASSISL' Ol _.IIY s .L ciIf C}' 'A'CS A OTF4 WOR Ef EMPIOYERE' LU1&LRY E,L EACHACCIDEN7 1 ANY PROPRIEIC„R'APTNERIFJIGCViNE OFFICERMM,i9i EXCLUDEDi EL gf~AEE•EA EMPLOYE 5 RYK bec,ba ultlar SPEGUL P N6 DNOx ._. ._.. _ ~ • E.L. OIEEASE•PgJCY LIMR i 7ne1z997 ~++~ LP na44sD A n79lza~cl ~ 7,aoo,oooe,ooo,ooe A PROFE:S810NAL VA&uTY 24 CC 09376420 7119120011 7/198007 580.000/600,000 SEXUAL MISCONDUCT 000 • DED. ¢H00 26 EMpiOYEE DEBNOxESTr 24 CC 09378420 7/Nl1128101 ~ 7N 98007 , DvroNaPaPERAnETxtwgLnowlvENNa.EarE~DxEAOOeoEYU+DDR~IENricieaRi ~wcin;tqu THE CITY, ITS OFFICERS, EMPLOYEES, ACfENTS, VOLUNTEERS /',FID R ;:F'iLFSEN7ATiVES IS HAFBED AS ADDITIONAL INSUREn(S). CLERK OF THE CITY COUNCIL CITY OF SANTA ANA 20 CMC CENTER PLAZA (Ma0} P.O. aox 7969 SANTA ANA, CA 82702-7968 ;aNir;,LLAIrroN :SIM11n~ I t~N Y ~llF TIE AEOV@ D1gCMREO POLICI!$ Q OnINx~' ~ aaPDla THE EIRIMION ~InTS Ia11 i[ i; 7NE OYIMa RNURER MILL EMDGYgI m MAR 3O DATE MRRItB] aTE:I TI !Ili CiRTIi1CATE IgLDEn N0.NEC m TIE LEFT, EUT FIYLLINE m ED ED Ilwl MPtMI nt: GSLJtmTaN aR LIIIEILRY OP ANY xvlD uwn me INeuRER, rtE AMMr*i txt LAM'. I! Y!i TVPB ^1 VUIN01'.D[RiPR~NfAT1VE ~ / 1 - Jun 26 07 08:42a Public Works 7146473345 p.3 ADDI'T'IONAL INSCIR:EJ) :iCll:)ORSEMENT POR COMMERCIAL GEN):i_1~b;,_l:,~.ABII.ITYPOLICY Insurance Company GENERAI, CId~3 , ~:0. OF AMERICA This endorsement modifies such insurance as is fltfotry:lexl by the provisions of Policy # 24CC09375420 relating to thefoltowin.~;: 1. The City of Santa Ana, 20 Civic Cu;nte r Plaza, Santa Ana, California 92701; its officers, employees, agents, voltmteers and represent t~v,~s are named as additional insureds ("additional insuureds") with regard to liability and dcxl bc~ se of suits arising from the operations and uses performed by or on behalf of the rlamcc~ in:a :r ~ d.. 2. With respect to claims arising out of !~ ~e operations and uses pexformed by or on behalf of the named insured, such insurance as is 3fl:c pled by this policy is primary and is not additional to or contributing with any other instu aneE: c.: uried by or for the benefit of the additional insureds. 3. This insurance applies separately t~ e, cl ~ insured against whom claim is made or sui# is brought except with respect to the company's 1 x~:: is of liability. The inclusion of any person or organization as an insured shall not a£!e:ct , m;; ~ ,tight which such person or organization would have as a claimant if not so included. 4. With respect to the additional ins~!lred ~, It;.is insurance shall not be cancelled, or materially reduced in coverage or limits except,rl3e!r ~l,:rry (30) days written notice has been given to the City of Santa Ana, 20 Civic Center F''laa.! i•, i.mta Ana, California 92701. (Corpletion of the following, including countersig~x dire, is required to make this endorsement affective.) Effective 3tILY 1,Q., 2onn _„_,_ tl'us endorsement form as a part of Policy # 24CC09375420 ___ Issued to ARC MID-CITIES _ Named wcued APPROVED AS 'T(] F~Ui=~iv', !? `~` 2 untersigned by .~~~ ~fi'J/i,.Q~ci i.ttut ~ Still '0dy r;,~s~d;,, ~~~ „~wr~~v ,F~.i:horized Representative Jun 26 07 08:42a Public Works 7146473345 p,4 STATE P.O. BOX 420807, SAN FRANCIS{;C).C'Fr !:~4"142-0807 gOMPBNSATI ON INaaURAN Ci FUND CERTIFfCATE OF WORKERS' COMFEN5/~ TIIUIIr IN5jAiANCE ISSUE GATE: 04-12-2007 q4C U=' PLA.•Ctr 14UMB6i: 1880642-2006 CIcpTIF°~CATE ID. 61 CII~TIFICATE EXPIRES: 07-O7-2007 07-01-2006/07-01-2007 CLERK OF THE CITY COUNCIL SC CFTY OP SANTA ANA 20 CIVIC CENTER PLZ M-30 SANTA ANA CA 92701-4068 Thie is to certify that vve Fuve issued a valid Workers' 6ompensadcn Inst. -ar~w: policy in a form approved by the Calltornia Insurance Commissioner to the employer named below fog ffio mlinr period indicated This pellcV is not subject to caneellaGOn by the Fund except upon 3tl dr. ~s cchvance written notice to the employer. We will also give you 30 days advance notice should this policy ba cane II•a f IPrior to its normal expiration. This cekitioate of utsurance Is not an insurance policy end does nr,l: emc•'d, extend or altar the covera0e affoMed by the policy listed herein Notwithstanding any roqulrement, term o~~ conr::dcn of any contract or other document Nnth respect to which this oertificeta of Insuranw may be i99ued rR to .,~hi.:!• it may pertain, the insurance afforded by Me policy descr[bed herein Is subject to all the terms nxc4.:d~tt., and conditions. of such policy. l„J~( ORIZEO REPRESENTATI FT,ESIC:~I'" EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: S1 O~CO„000 PER OCCURRENCE. ENDORSEMENT B001B ENTITLED ADDITIONAL INSURED EMPL1;%'ER:ifFfE6TIYE 2007-04-13 IS A7TAf31ED TO AND FORMS A PART OF THIS POLICY. NAME Ilif' A~QIII"I ICRUIL INSURED: CLERK OF THE CITY COUNCIL ~ENOORSEMENT N2085 ENTITLED CERTIFICATE FpLDERS' ND1'tCE !FI!lftTIVE 07-Oi-2006 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. _ ENDORSEMENT /2670 ENTITLED WAIVER OF SIl6ROGATION E9'FEC7;1'1:!t007-04-13 IS ATTACHED TD AND FORMS A PART OF THIS POLICY. THIRD FART ''fU14E: CLERIC~OF THE CITY COUNCIL EMPLOYER ASSOCIATION FDR RETARDED CITIZENS MID-CITIES (A NON PROFIT CORP) 14208~TOWNE AVE LOS ANGELES CA 90061 aura SiiLt Sl';.:c~. ~~~_......___._ 1s:,ls[ant City .Alwr~,v IB13,5C) PRINTED 04-13-2007 IRFY.1-081 ACORD CERTIFICATE OF LIABILITY INSURANCE DATE IMMIDDII'YYV) rx 7/18/2007 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMA710N RFP INSURANCE AGENCY ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 5601 WEST SLAUSON AVE., SUITE 250 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR CULVER CITY, CA 90230 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Phone (310) 642-1933 Fax (310) 6453150 INSURERS AFFORDING COVERAGE ~ NAIC # INBURED I INSURER A: ARC MID-CITIES //~~`` 14208 TOWNE AVENUE (~, ~~.~U~ -v ~ ~ INSURER B: LOS ANGELES, CA 90061 1 - INSURER C: Cf1VFRA GFF THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTNITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO YJHICH 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. INBR ADD' POLICY EFFECTNE I POLICY EXPIRATION LIMITS LTR POLICY NUMBER I GENERAWABILITY .EACH OCCURRENCE - $ 1 DDD DDD X ,COMMERCIAL GENERAL LIABILITY PHPK249054 7/1912007 DAMAGE TO RENTED 7119!2006 PREMISES )Eaocc~rence $ 300000 A ~, ~ CLAIMS MADE X OCCUR MED EXP (Pny or,e pe~ $ 15 DDD __ `PERSONAL&AW INJURY $ 1,DDD,DDD '~, II GENERAL AGGREGAT'c $ 2,DDD DDD GEN'L AGGREGATE LIMIT APPLIES PER'. ~~I __ PROIXICTS-COMP/OP AGG _ 5 2,QQD DDD ~~ - oOLIC1' ~ PRO- LOC i ' AUT OMOBILE UABIIIT' I UTO NY I COMBINED SINGLE LIMIT 51,DDD,DDD ~ (Eaacatler2) A A 24 CC 096458 20 19123/2006 ALL OW NED AUTOS 9/23;2007 _ - 80DIlY INJURY $ B x SCHECULED AUTOS ~! ~ (Per person) I X HIRED AUTOS ~! BODILY INJURY $ X NON-OWNED AUTOS (Per accitlenD _ PROPERTY DAMAGE ~~ P r itl n[ ~ $ ) e acc e ) I ( ' GARAGE LIABNTY AUTOONLV-EA ACCIDENT $ _ANY AUTO OTHER THAN EA ACC $ ' AUTO ONLY'. AGG'", $ %CESSNMBRELLA LIABILRY E i EACH OCCURRENCE $ t ~ OCCUR ~ CLAIMS MADE AGGREGATE $ _ I i DEDUCTIBLE ~ $ RETENTION $ I $ WC STAPJ- 'OTH- I WORKERSCOMPENSATIONANO TORY!IMITS I ER EMPLOYERS' LIABILITY I '~ E L EACH ACCIDENT $ PNV PfmPRIETORIPARTNERlIXECUTIVE OFFICERJMEMBER EXCWDED? E.L. DISEASE-EA EMPLOYEE $ If Yes. tlescribe under SPECIAL PROVISIONS OeIOw ~ _ E.L. DISEASE-POLICYLIMIT $ orHER PHPK249054 OFESSIONAL LIABILITY ~ 7/19/2007 711912008 '1,000,00012,000,000 PR pHPK249054 A SEXUAL MISCONDUCT 7119!2007 .711912008 500,000/500,000 ~I EMPLOYEE DISHONESTY PHPK249054 ~ 25,000 - DED. $2,500 7M 9/2007 '' 7/19/2008 DESCRIPTION OF OPERATIONS I LOCATIONS! VEHICLE51 EXCLUSIONS ADOEO BY ENDORSEMENT I SPECIAL PROVISIONS THE CITY, ITS OFFICERS, EMPLOYEES, AGENTS, VOLUNTEERS AND REPRESENTATIVES IS NAMED AS ADDITIONAL INSURED(S). !`FRTICIC ATF LIf11 rIFR Oddi}jnnal IOS11rAf} CANCEL I CTION CLERK OF THE CITY COUNCIL SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION CITY OF SANTA ANA DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3O DAYS WRITTEN 20 CIVIC CENTER PLAZA M-30 1 I ( ~ fi '~tn ^ } ( ~ ' Q{T CFr TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO 00 SO SHALL ~ ~ ~ , w" ` S t P.o. sox /sae : 'I ~ NO OBLIGATION OR LIABILRY OF ANY KING UPON THE INSURER, ITB AGENTS OR PO SANTA ANA, CA 927D2-1988 1 REPRESENTATNES. 3 AUTHORIZED REPRESENTATIVE ( - -- ~e~ ACORD 25 (2001!06) ,crccml celTST noi~gr~L715t iity Attnr. ~' v~+cvrcu wrcrurcATn ~ Taaa EXHIBIT B ADDITIONAL INSURED ENDORSEMENT FOR COMMERCIAL GENERAL LIABILITY POLICY Insurance Company PHILADELPHIA INSURANCE COMPANY This endorsement modifies such insurance as is afforded by the provisions of Policy # PHPK249054 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 afrer thirty (30) days written notice has been given to the City of Santa Ana, 20 Civic Center Plaza, Santa Ana, Califomia 92701. (Completion of the following, including countersignature, is required to make this endorsement effective.) Effective JULY 1 9 2007 ,this endorsement form as a part of Policy# H~054 Issued to ARC MID-CITIES Named Insured Countersigned by ~~,~~t,~/ ~//,~.~'_ L-f Authorized Repres ntative ~' Ai°I'ItUW~;'a A4 `CI} rtJ71M ra sr.~c s:.~~~;, Aseis[ant City At~orsey POLICY NUMBER: PHPK249054 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -DESIGNATED PERSON or ORGANIZATION This endorsement modifies insurance provided undesthe•fgl{owing: COMMERCIAL GENERAL LIABILITY COVERA~ PART SCF{EDl7L1s. Name of Person or Organization CLERK OF THE CITY COUNCIL, CITY OF SANATA ANA 20 CIVTC CENTER PLAZA (M-30 P.O. BOX 1988 - SANTA ANA, CA 92702-7988 {If no entry appears above, infoririatin~ r@quired to complete this endorsement will be shown in the Declarations as applicable to this endorsement.} WHO IS AN INSURED (Section IIJ is amended to include as an insured the person or organization shown in the Scheiiule, but only with respect to liability arising out of your operations or premises owned by or rented to yo'u. CG 20 26'11 B5 ~nrRav~~~ ~s ~r~ ~,~~~,~ As,rsrsar Lity 4rton:ev STATE COMPENSATION INSURANCE FuNo AUGUST 2, 2007 CLERK OF THE CITY COUNCIL CITY OF SANTA ANA 20 CIVIC CENTER PLZ M-30 SANTA ANA CA 92701-4058 IN REPLY REFER TO: CERTIFICATE OF WORKERS' ----------------------- COMPENSATION INSURANCE ---------------------- CANCELLATION/CONVERSION NOTICE ------------------------------ RE: CERTIFICATE DATED APRIL 13, 2007 THE WORKERS' COMPENSATION COVERAGE PROVIDED UNDER THE POLICY LISTED BELOW IS BEING CONVERTED TO A NEW POLICY EFFECTIVE JULY 1, 2007. THE NEW POLICY WILL PROVIDE UNINTERRUPTED COVERAGE. YOU WILL RECEIVE A NEW CERTIFICATE OF INSURANCE UNDER THE NEW POLICY NUMBER: 567-0001087-07. IF YOU HAVE ANY QUESTION5, PLEASE CONTACT THE CUSTOMER SERVICES UNIT AT THE NUMBER LISTED BELOW. EMPLOYER: ARC MID-CITIES 14208 TOWNE AVE LOS ANGELES, CA 90061 POLICX 1833542-06 CUSTOMER SERVICES UNIT LOS ANGELES DISTRICT OFFICE (323) 266-5000 1275 Market Street • San Francisco, CA 94103- 1410 Mailing Address: P.O. Box 420807 • San Francisco, CA 94142-0807 ~, ,~~o N~~' SCIF 19102 CERTHOLDER COPY STATE P.O. BOX 420807, SAN FRANCISCO,CA 94 i 42-0807 COMPENSATION INSURANCE FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 09-27-2007 GROUP: 000567 POLICY NUMBER: 0001087-2007 CERTIFICATE ID: 40 CERTIFICATE EXPIRES: 07-01-2008 07-01-2007/07-01-2008 CITY CLERK OF THE CITY OF COUNCIL SC ~ ~ ~ U07~O i O CITY OF SANTA ANA 20 CIVIC CENTER PLZ M-30 SANTA ANA CA 92701-4058 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 10 days advance written notice to the employer. We will also give you 10 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. THORIZED REPRESENTATI PRESIDENT EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: 51,000,000 PER OCCURRENCE. ENDORSEMENT 110015 ENTITLED ADDITIONAL INSURED EMPLOYER EFFECTIVE 2007-09-27 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. NAME OF ADDITIONAL INSURED: CITY CLERK OF THE CITY OF COUNCIL ENDORSEMENT X2570 ENTITLED WAIVER OF SUBROGATION EFFECTIVE 2007-09-27 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. THIRD PARTY NAME: CITY CLERK OF THE CITY OF COUNCIL EMPLOYER ASSOCIATION FOR RETARDED CITIZENS AND MID-CITIES (A NON PROFIT CORP) 14208 TOWNE AVE LOS ANGELES CA 90061 f"' "'~ I"t7 -~ ;'1 t~ t .... ,::~ --~ ..~» C') ~" .. t" Z ~ SC sc [613,SC] IREV.2-05) PRINTED 09-27-2007 STATE COMPENSATION I N S U R A N C E Fu ni v OCTOBER 11, 2007 ~ ~~ r s ~ QTY OF` v~~dTA AMA E~ER~t c~= eov~ci~. CITY CLERK OF THE CITY OF COUNCIL CITY OF SANTA ANA 20 CIVIC CENTER PLZ M-30 SANTA ANA CA 92701-4058 CERTIFICATE OF WORKERS' ----------------------- COMPENSATION INSURANCE ---------------------- CANCELLATION NOTICE ------------------- RE: CERTIFICATE DATED SEPTEMBER 27, 2007 IN REPLY REFER TO: THE WORKERS' COMPENSATION INSURANCE POLICY FOR THE EMPLOYER NAMED BELOW HAS BEEN CANCELLED EFFECTIVE OCTOBER 25, 2007 AT 12:01 A.M. IF YOU HAVE ANY QUESTIONS REGARDING THIS NOTICE, PLEASE CONTACT THE EMPLOYER NAMED BELOW EMPLOYER: ARC MID-CITIES 14208 TOWNE AVE LOS ANGELES, CA 90061 POLICY 567-0001087-07 CUSTOMER SERVICES UNIT LOS ANGELES DISTRICT OFFICE (323) 266-5000 1 275 Market Street • San Francisco, CA 94103- 1410 Mailing Address: P.O. Box 420807 • San Francisco, CA 94142-0807 SCIF 19102 STATE COMPENSATION IN SIJRANCE FUND ~~~ ~~ ~ ~ ~~ IN REPLY REFER T0: OCTOBER 24, 2007 C~ i ~', ,.`', A~~~ CITY CLERK OF THE CITY OF COUNCIL CITY OF SANTA ANA 20 CIVIC CENTER PLZ M-30 SANTA ANA CA 92701-4058 CERTIFICATE OF WORKERS' ----------------------- COMPENSATION INSURANCE ---------------------- CANCELLATION WITHDRAWAL NOTICE ------------------------------ RE: CERTIFICATE DATED SEPTEMBER 27, 2007 THE CANCELLATION HAS BEEN WITHDRAWN FOR THE WORKERS' COMPENSATION INSURANCE POLICY FOR THE EMPLOYER NAMED BELOW. THIS LETTER SUPERSEDES THE NOTICE OF CANCELLATION SENT TO YOU ON OCTOBER 19, 2007. THIS EMPLOYER'S WORKERS' COMPENSATION INSURANCE COVERAGE CONTINUED UNINTERRUPTED. REP 03 EMPLOYER: ARC MID-CITIES 14208 TOWNE AVE LOS ANGELES, CA 90061 POLICY 567-0001087-07 CUSTOMER SERVICES UNIT LOS ANGELES DISTRICT OFFICE (323) 266-5000 1 275 Market Street • San Francisco, CA 94103- 1410 Mailing Address: P.O. Box 420807 • San Francisco, CA 94142-0807 SCIF 19102 r' •OCT~16-2007(TUE) 12:02 RFP Insurance Agency (FAX}1 310 645 3150 P. 002/032 .~ • .~ORDM C~R7IFICAT'" t~F LIABIL ~~~ <FP INSURANCE AGENCY '5601 YYEST SLAUBdN AYE, SUITE 2S0 ,' CULVER CRY, CA 900 ` Phono (310) 644-1933 Fax (310) 85.1150 N - o~ ~ ~ 7 - Q r/ """RED ARC MID»CITlES 14208 TOWNI: AVENUE LOS ANGELES, CA 80081 ITY IN$URAh~ ~;E D^~~°°^^~ 07 ' THIS CERTIFICATE 19 ISSUED AS A MATfEii OF tNFdR111ATION ONLY AND CONFER8 NO RIGHTS UPON THE CEltTIFlCATB HOLDER. THIS CERTIFlCATE DO&8 NdT AMLNp, pCl'ENa OR AL THI: COVERAG AFFORDED BY THE POLICIES BStQW. INSURERS A~ORDFNG GOYERAC318 NAIC 8 INSURER A: H! NGEMNITY INS. '~. A+, X INSU+zeR ~ _ IN9URCR ~ INSURER D; INSURER F THE AOLICIES OF INSURANCE LISTED BELOW HAVE BEEN I55UE0 TO THE IN6UREA NAMED ABOVE FOR THE ANY REQUIRl7~Nr, TERM OR CONOmpN OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HERdN IS SUBJECT TO ALL 71iE TI POLICIES_ AGGRFQATE UMm; SHOWN MAY NAVE BEEN RWUCED BY PAID GLAMdS. Jl Cp1f-AERCW. sC'Q• IERAt. WIdILfTY PHPKZ49054 A cwr+IS MgDe ~ OCCUR 6EN1, Aooar_aAT[ Unur App~g PER AYT CYOBIIR LIABtUr7 ANYauTO PHPI(267$56 AtL DwNED AUi05 " A X sclEnu>ED AIJTO$ x IIIREJ7 AUTQ$ X NON.pWNEpAUTOS . COMP. 8 ICOLLISlON c11wIOE uASwrY ANYAUTO ~iNMBhFSU NAaRl=7 occuR ~ cwMS a~AD~ DEDUCTIBLE --. RETENTIC+N S ' Tr011 AND AOPFICERAIEfrBER D(CLIIO&D? A ~ PI~FESSlONAL LIA81lirr PHPK2490S4 I S©CUAL NR1$CONDUCT PHPK249054 7M 912007 ~ 711912008 9/29/2007 ~ 9123I2D08 711912007 (7H912008 7M8/2007 71'1812008' POLICY PERIOD lND1CATED. NOTwITttSTAN01N6 WHICW TH15 CERTIFICATE MAY BE ISSUED OR .RMS. bIGLUSIONS AND CONDf110NS OP SUCH 1 warts EACw oCCURRElJCC s D 000 s 00 MEO om !Am ane s 1 0 PERSOxuaADVw,pxrY s 1,000,000 c;sNewu. aooR,~A,s s 2000 000 PRODUCTS-C011PJOPAbC S 2L~OO,D00 CWdBq~l:DSINGL6I.WR (Eaaaopeny = 1,D00,000 BOAILY RVJURY ; (Parpelaan) eDDn.Y INJURY ~ (Par~oddilrtl ~ DAMAcIe t u AIltDOn1>_Y.EAACCIDEN'i 5 oTl•IER THAN ~ Acc s Al,rro ONLY. AflQ s eAOr+occl~NCe t AGGRC•GATF S i I: WC STA L• L 6ACN ACCIDENT S E~L.D~EASE.EA i EL DISEA9C • POLICY LBUpT 1,000,00012,000,000 600,0001600,000 25,000 ~ DED. ¢2,500 NAMED A5 AODITlaFIAI, lNSURED(S). THE CI'11iY, ITS OFFICERS, EMPLOYEES, AGENTS, VOLUNTEERS AND REPRESENTATIVES I: ~s CL>=RK OF THE CITE COUNCIL CITE ~ SANTA ANA 20 awc CENTER PlJ~ZA I;IUI~oy P.d. BOX 1988 SANTA ANA, CA 92702»1888 aNOUI.D Arn ow arts AadY! B!lCRWSD Pal.lgea RE ~PDIIi 711E mD~M+I-'rtoN Dsre THDlEOF, TrrH nscaNO gall. >s10FAIlOR TCt aao. 30 a1YS wAAT71El1 Notes to nle aaT1fICATa twLDea wwlEa TO fHB s.err, evr FAILURe TO DO 90 awlcl. IMFOi! NO OBr.l0iA110N OR wWIJIY 4P ANY IDNA UrON THE INSUIIER, Ifs A6iENTa OR REPLREOBrffATNfiS. ~ r ACQRD ~5 (2007!08) I C01t# 1 HotdarJ122 ®AC D CORI~ORATIO ie68 ~,•,OET~1-fi-2007(TUE) 12;02 RFP Insurance R9en~y (FAX)1 310 6Q5 3150 P. 003/032 POLICY NUMEt:R: PFiPK249054 - COMMERCIAL GENERAL LIAaILITY THIS ENDOFi5EM1=N7 CHANGES THE Pt]LICY. PLEASE READ IT CARE~LILLY, ADDITIGNAL. 1NSUREb -DESIGNATED PERSGN or gRGAN1ZATION . This endorsement mcdii•ies insurance provided unde~~:~Mglr~wirig: COMMERCIAL GENERA. LIA81L1TY GeJVEI~ PART S~Ii,„~ , Name' of i~erson or Organizatioi~ ~ , CI;I;RR bF TI3E CITY COUNCIL, CITY bF' SANTA ANA 2Q CIVIC CENTER PT,AZA {~q_gp~ P_O. BOX 1988 SA(~TA ANA, GA 927p2-198 , {!t no entry appears above, Infcr~`~i~quired to complete this endorsement will be shown In the Declarations as applicable to this endorsement} WHd lS AN INSURED (Section !ly is amended to include as an Ensured the person or arganizatfon shown in the 5checlule, but onty with respect to liability arlslny out of your operations ar premises avmod by or rented to yoti. Cta 20 26~'i1 B5 • .+ •QCT~,P6-2007(TUE) 12:03 RFP Insurance R9ency (FAX)1 310 6d5 3150 ~; ~. EXHIBIT' B ADI~l"I'1nNAl, [NSI.JR.I?I) )uN.DQ}ZSFMENT FQR COMMERCIAL G'lJ'NEIi.AL LIABILITY PAt,1CY Insurance Company pHZLADELPHIA IN171;MNITY I-NS _ C0 , This endorsement modifies such insurance as is afforded by the provisions of Policy # rixPx249054 relating to the following: l . The City of Santo Ana, 20 Civic Center ~Pta~,a, Santa Ana, California 92701; its officers, empIoyxs, agents, volunteers and representatives are named as additional insureds ("additional insureds") with regard to liability and defense of suits arising from the opcr-tions and uses performed by or on behalf of the named insured. 2. Vttith respect to claims arising out ofthe opcratYans and uses performed by ar on behalf of. the named insured, such insurance as is af!'orcIed by Ibis policy is primary and is not additional to or contribufing with any other insurance carried lsy or for the benefit of the additional insureds. 3. This insurance applies separately to each insured against wham elairn is made or suit is brought except with respect to the company's limits of liability. The inclusion of any person or organical3an as an insured shall not affect any right which such person or organizatiat, would have as a. claimant if not so 'included. 4. With respect to the additional insureds, this insurance sha11 not be cancelled, or materially reduced in coverage or limits except after thirty {30~ days written notice has been given to the Cily of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701. (Completion of the fallowing, including countet;~ignature, is required to make this csndorsement effective.) Elyective . JULY 19 , 2 0 0 7 th i s endorsement form a5 a part of Policy # HPx249054 Issued to C M -CITIES Named Ensured Countersigned by -~..-, ~.t.~.,.• r Authorised Representative P. 004/032 OEfisl34-2007(THU) 1629 RFP Insurance Rgency (FF?()1 31D 645 315D P. 002/003 ,. CERTHOLDER CQPY sc ~7 !I a~~ P.O. BOX 420807, SAN FRANCISCO,CA 94142-0907 CQMPENSpTtON i N S U R A H C E ~,,,,~ ~ ~ Cl~RTIF(CATE pF WORKERS' COMPENSATION INSt !RANGE ISSUE dA't'E: Q9-27-2007 GFiQUP: 000667 PODGY M1tUMOl:R oootoa7-3007 GERTIFICATE IQ; 40 CEgTIFICATE F~c~IRE;S:a7-o1-2008 O7-Ot•200~/07-Oy-20O9 CITY CLERK Of THE CITY OF COUNCIL SC CITY OF SANTA ANA 20 CIViC CENTER PLZ N-30 SANTA ANA CA 82701-4058 This is to certify that we have Isxued a valid Workers' Cgmpensatign Insurance policy In a fprm approved by the California Insurance Commissloner to the employer named below for the pulley period indicated. This policy is not subject to cancellation by the Fund except upon 1o days advance K Bitten notice to the emploYer• Wo wil! also give you 10 days advance notice should this policy be cancelled prior to its normal expiration. This tart!#icate of insurance is not an insurance policy and does nqt amend. extend ar alter the cgvorage afforded by ti-e Polley Ilsted heroin. Notwlthstandin any requirement, term or condition of any ~ :ontract or other doeumert with respect to which this oertlficate of insurance may be issudd or to which it may iortaln, the insuranae afforded by the policy described herein is subject to all the terms, exclusions, and cc idttions, of such pol{cy i r^~~.~ '~ ~r r~ MORiZED REPRESENTAT PRESIDENT r EMPLOYER'S LIASILiTY LIMiT INCWDING DEF~1S8 GOS'1'S: St,000,000 P:ER OCCURRENCE. ENDORSEMENT NODiS ENTITLED ADDITIONAL INSURED EMPLOYER EFFEGTIVE :!007-09-27 IS ATTACHED YO ANb FORMS A PART OF THIS POLICY. NAME OF ADDITIONAL I115URED: CITY CLERK OF THE CITY OF COUNCIL ~~ ENDORSEMENT N2570 ENTITLED WAIVER OF SUBROGATION EFFEC'CIVE 2007-O.i-27 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. THIRD PARTY NAME: CITY CLERK OF THE CITY OF COUNCIL i EMPLOYER ASSOCIATION FDR RETARDED CITIZENS ANo MID-CITIES (A NON PROFIT CORD) 14208 TOMNE Avt 605 ANGELES CA 90081 ~`''~ ~ C~~ ~~~~ 1 `, ~ ~~~ ~~ a\~`~' i sc [l313,SC Ittl;v.x-osr P ZIli'I'EO 08-27-2 07 ,: .4 ,~ STATE COMPENSATION I N S U R A N C E FUND OCTOBER 11, 2007 ~~t~ ~' QTY Q~' ~~~P~Tq A1~~ CLERK ~~= C~UNCIi. CITY CLERK OF THE CITY OF COUNCIL CITY OF SANTA ANA 20 CIVIC CENTER PLZ M-30 SANTA ANA CA 92701-4058 CERTIFICATE OF WORKERS' ----------------------- COMPENSATION INSURANCE ---------------------- CANCELLATION NOTICE ------------------- RE: CERTIFICATE DATED SEPTEMBER 27, 2007 IN REPLY REFER T0: THE WORKERS' COMPENSATION INSURANCE POLICY FOR THE EMPLOYER NAMED BELOW HAS BEEN CANCELLED EFFECTIVE OCTOBER 25, 2007 AT 12:01 A.M. IF YOU HAVE ANY QUESTIONS REGARDING THIS NOTICE, PLEASE CONTACT THE EMPLOYER NAMED BELOW EMPLOYER: ARC iiID-CITIES 14208 TOWNE AVE LOS ANGELES, CA 90061 POLICY 567-0001087-07 CUSTOMER SERVICES UNIT LOS ANGELES DISTRICT OFFICE (323) 266-5000 1 275 Market Street • San Francisco, CA 94103-1410 Mailing Address: P.O. Box 420807 • San Francisco, CA 94142-0807 SCIF 19102 ACORD CERTIFICATE OF LIABILITY INSURANCE TM DATE(MMIDDlYYYY) 10/14/2008 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION RFP INSURANCE AGENCY ~ _~J /q /) ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE D ^~~ ~' 5601 WEST 5LAUSON AVE., SUITE 250 0~4i / HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR CULVER CITY CA 90230 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. , Phone (310) 642-1933 Fax (310) 645-3150 ~ ~~ 7 ~Q ZD INSURERS AFFORDING COVERAGE NAIC # INSURED ARC MID-CITIES INSURER A: NONPROFITS' INS. ALLIANCE OF CA. A+ X 14208 TOWNE AVENUE INSURER B: NORTH AMERICAN ELITE INS. CO. LOS ANGELES, CA 90061 INSURER c: PHILADELPHIA INDEMNITY INS. CO. A+ X INSURER D: INSURER E: 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 ADD• POLICY NUMBER POLICY EFFECTNE POLICY EXPIRATION p LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1 OOO OOO X COMMERCIAL GENERAL LIABILITY 200823628-NPO 7/19/2008 7/19/2009 PREMISES Ea occurence $ 3OO OOO A CLAIMS MADE ~ OCCUR MED EXP (Any one person) $ 15 OOO PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ Z OOO OOO GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG $ 2 OOO OOO POLICY PROT LOC AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT E id t $ 1,000,000 ANY AUTO PHPK348858 9/23/2008 9/23/2009 a acc en ) ( ALL OWNED AUTOS BODILY INJURY C X SCHEDULED AUTOS (Per person) $ X HIRED AUTOS BODILY INJURY X NON-OWNED AUTOS (PeracGdent) $ COMP. 8r COLLISION ROPERTY DAMAGE ~ $ DEDUCTIBLE $1,000 Per accdent) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSNMBRELLA LUIBILITY ! SS ' EACH OCCURRENCE $ OCCUR ~ CLAIMSMADE ~aDlOll 1UY,]S? !;) 1B" AGGREGATE $ ~r,,. I ~ YIl ~ . , $ DEDUCTIBLE ~~'~ ~~~~ $ RETENTION $ G ~ $ WORKERS COMPENSATION AND ~, « n ~ WC STATU- OTH- EMPLOYERS' LIABILITY V ~ U~ ~ ANY PROPRIETOR/PARTNERlEXECUTIVE p E.L. EACH ACCIDENT $ OFFICERlMEMBER EXCLUDED9 E.L. DISEASE - EA EMPLOYEE $ Ii yes, describe untler SPECIAL PROVISIONS below E.L DISEASE-POLICY LIMIT $ OTHER 200823628-NPO 7/19/2008 7/19/2009 000/2 000 1,000 000 A.) PROFESSIONAL LIABILITY , , , A.) SEXUAL MISCONDUCT 200823628-NPO 7/19/2008 7/19/2009 500,0001500,000 e.) EMPLOYEE DISHONESTY CBW0007843-00-23628 7/19/2008 7/19/2009 250,000 - DED. $2,500 DESCRIPTION OFOPERATIONS /LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT t SPECIAL PROVISIONS THE CITY, ITS OFFICERS, EMPLOYEES, AGENTS, VOLUNTEERS AND REPRESENTATIVES IS NAMED AS ADDITIONAL INSURED(S). CERTIFICATE HOLDER Additional Insured CANCELLATION CLERK OF THE CITY COUNCIL SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION CITY OF SANTA ANA DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3O DAYS WRITTEN 20 CIVIC CENTER PLAZA (M-30) NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL P.O. BOX 1988 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR SANTA ANA, CA 92702-1988 REPRESENTATIVES. y AUTHORIZED REPRESENTATNE rv{ ~ y ACORD 25 (2001108) ARCMI Ce1t# 1 Holder# 22 ©ACOf~Cf CORPORPyTION 1988 / ~' ?OL1CY t\1l1MBER: 200823628-NPO COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ~-~~i"~'ic~N1,~-L INSURE®- ®ESiGRie4TE® PERS(JiV or rJRG~~l~ia~~°iGi~ . This endorsement modifies insurance provided underthir:.:fi~lfowirig: COMMERCIAL GENERAL LIABILITY COVER'4,f'sE PART ~-CHEDl7,~.1.~ Name of Person or Organizatior CLERK CITY OF COUNCIL CITY OF SANTA ANA 20 CIVIC CENTER PLAZA (M-30) P.O. BOX 1988 SANTA ANA, CA 92702-1988 {If no entry appears above, inforatinr~%ri?quired to complete this endorsement will be shown in the Declarations as applicable to this endorsLinent.} WHO IS AN INSURED {Section II) is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of your operations or premises owned by or rented to yo'u. CG 20 26 1 '1 85 EXHIBIT B ADDITIONAL INSURED ENDORSEMENT FOR COMMERCIAL GENERAL LIABILITY POLICY Insurance Company NONPROFIT"S ALLIANCE OF CA This endorsement modifies such insurance as is afforded by the provisions of Policy # 22n R ~ ~~~pQ-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 0 7~ 1 9 / 0 8 ,this endorsement form as a part of Policy # 200823628-NPO Issued to ARC MID-CITIES Named Insured Countersigned by /, ~~? ~ ~/~' ut orized Representative CERTHOLDER COPY SC ~~A~~ P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807 COMPENSATION I N S U R A N C E N ® CERTIFICATE OF WORKERS' COMPENSATION INSURANCE IS5UE DATE: 10-14-2008 GROUP: 000567 POLICY NUMBER: 0001087-2008 CERTIFICATE ID: 51 CERTIFICATE EXPIRES: 07-01-2009 07-01-2008/07-01-2009 CLERK OF THE CITY COUNCIL SC CITY OF SANTA ANA 20 CIVIC CENTER PLZ M-30 SANTA ANA CA 92701-4058 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, of such policy. THORIZED REPRESENTATI PRESIDENT EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #0015 ENTITLED ADDITIONAL INSURED EMPLOYER EFFECTIVE 2008-10-14 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. NAME OF ADDITIONAL INSURED: CLERK OF THE CITY COUNCIL ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 10-14-2008 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. ENDORSEMENT #2570 ENTITLED WAIVER OF SUBROGATION EFFECTIVE 2008-10-14 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. THIRD PARTY NAME: CLERK OF THE CITY COUNCIL EMPLOYER ASSOCIATION FOR RETARDED CITIZENS AND SC MID-CITIES (A NON PROFIT CORP) 14208 TOWNE AVE LOS ANGELES CA 90061 ~~~R~u t=,1~ A.C TO FbRM ~~,~? Assisiaul ~~ty A~turney, [B13,SC] IREV,Z-D51 PRINTED 10-14-2008 /1,1-~,?L~a7-o7o ACORD~, CERTIFICATE QF LIABILITY INSURANCE °^'~~'°D^~ I~owDEa THIS CERTIFICATE IS ISSUED AS A MATTER OF 84FORMATIOE RFP INSURANCE AGENCY ONLY AND CONFERS NO RHiHTS UPON THE CERTIFICATE 5801 WEST SLAUSON AVE., SURE 250 HOLDER. THIS CERTIFICATE pOES NOT AMEND EXTEND OF -. CULVER CITY, CA 90230 ALTER THE COVERAGE AFFORDED BY THE POL3CIFS BELOW Phone 1310) 842-1933 Fax [310} 645.1150 INSURERS AFFORDING COVERAGE NAICO RsuaEB ARC MID•CI71E3 BrsImER.t AEG • COM ERCE & fN STRY fN3. CO. 19208 TOWNE AVENUE INSURER e: LOS ANGELES, CA 90061 ,,,n„~,,, THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE NSUREO NAMED ABOVE FOR THE POLICY PERIOD NDICATED. NOTWRHSTANONG ANY REQUIREMENT, TERM OR CONDITION OF AN1' CONTRACT OR OTHER DOCUMEM WRN RESPECT TO WHX:H THIS CFRTtFICATE MAY BE RSUED OR MAY PERIAN, THE INSURANCE AFFORDED BY THE POUCIE.S DESCRIBED HEREJN LS SUBJECT TO ALL THE TERMS, IXCLU9gNS ANp CONDIRONS OF SUCH POLICIES. AGGREGATE UMRS 3HOWN MAY HAVE BEEN REDUCED BY PAID efS R CLAIMS. ' OEIIERAL I OI.IC7 EF~T POLICY NUYBER P ryE POLICY TIWi ~' L ABLLJfY coMMERCwL cEI~nAL LIABarn EACH OCCUpRENCE : CWLIS LIAOE ^occuR ~ L¢D FJiP ore 9 PERSONAL 6 ADV BLRIRY : OENLAGC.REBATE LB.eTAPPDES PER OFNERAI.ABGREOATE ~ POLICY PRO- LOC PRODUCTS-COYPBJP AOO i AU rgN]B4JiLU1BILl1r ANY AUTO j NGIE LBAR ~ M ~ . I a ar:J dSR s ALL OWNEDAUTOS SCHEDULEOAUTDB . BDOILYINAMV . .. . (Prpaaany = NIRED AUTOS , NON-0WNED AUTOS BOOILYINRRiY ' s AT ecgde.3) lP ROVED AS TO FO °A"1A°E s ~~„q DARAOE tuaB Rr . ' i AUTO ONLY-EAACpOENT { ANY AIlI O 'CL~ ~ ~ r,. C / ~ OTf1EliTWW EA ACC { E%CER9NNBRBLLA LIABILRY ,~a„ AIlTOONLT. AGG 6 occuR ~cwNS UaDE nti,,,Ia ity Attorney EACH OCCURRENCE _ ABCBi£OgTE s DmucnBLE s RETEAflION f s NOANHISCORB'ENBATNINANO EINIAYERC L7AeBR'y 3429138 1/27/2009 WC AM 0tµ imn616 R E A ANY PRDPRIETORlAARTNERIFJO:CUTIVE OFFICERRAEMBER EXCLUDED? EL EACHACCIOEM f 1099009 YE~ Rrvs, doeaBa uNer EL DISEASE-EA s 1 OOD 660 SPECWL PROVISIONS b0bw , , DRIER EL DISEASE-POLICY LMIR S 160 969 DESCRIPDONOFOPEA11tIONB f LOCATIOND fYEHICL~lEXCppIOli3AOB® BYEIlDOR991kM1614tW. PRONefOL18 EMPLOYER'S LU4BILRY LIMfr3 INCLUDING DEFENSE COSTS: 51,000,000 PER OCCURFJ9CE ENDORSEMENT ENTRILED WARIER OF SUBROGATION EFFECTIVE if271p9 IS ATTACHED TOAND FORMS A PART OF THIS POLICY, THIRD PARTY NAME: CLERK OF THE CETY COUNCIL, CITY OF SANTA ANA. CLERK OF THE CRY COUNCIL clrY of sacra aNA ZO CMC CENTER PLA7A M30 SANTA ANA, CA 92701.4058 SHOULD ANY OF 7118 ABOVE DEBCRIBBp POLICIES BB CANCELL® BEHLR@TNE E%PBtl,TA]N DATB rNERBOF, tlr IBBURIB meuRER vRLa ENDEAVOR ro YAB. 30 OAYB vrmrEx NDtICE'f0 iHB CERIIRGTE NOI.OER xAIL®ro iNB ISf, BUi FABIeiE ro W BO SHALL BPoBE xo OeLKiAYIDN DR LYBRIry CP ANY ICIb UPON THE BIBURER, (rE ABBLYS OR ACORD CERTIFICATE OF LIABILITY INSURANCE °ATE(MM/°D/YYYY) ,~ 10/7 4/2008 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION RFP INSURANCE AGENCY ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 5601 WEST SLAUSON AVE., SUITE 250 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR CULVER CITY, CA 90230 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Phone (310) 642-1933 Fax (310) 645-3150 INSURERS AFFORDING COVERAGE NAIC # INSURED 'ARC MID-CITIES INSURER A: NONPROFITS' INS. ALLIANCE OF CA. A+ X 14208 TOWNE AVENUE INSURER B: NORTH AMERICAN ELITE INS. CO. LOS ANGELES, CA 90061 INSURER C: PHILADELPHIA INDEMNITY INS. CO. A+ X INSURER D: INSURER E: 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 ADD'L POLICY NUMBER Pp LICY EFFEpTNE POLICY EXPIRATION LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1 OOO OOO X COMMERCIAL GENERAL LIABILITY 200823628-NPO 7/19/2008 7/19/2009 PREMISES Ea ocwrence $ 300 000 A CLAIMS MADE ~ OCCUR MED EXP (Any one person) $ 15 000 PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2 000 000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG $ 2 OOO OOO POLICY PRO- T LOC AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1 OOQ 000 ANY AUTO PHPK348858 9/23/2008 9/23/2009 (Ea accident) , ALL OWNED AUTOS C X SCHEDULED AUTOS BODILY INJURY (Per person) $ X HIRED AUTOS X „ '~ BODILY INJURY $ NON-OWNED AUTOS ~ ~ (Per acGdent) COMP 8 COLLISION ~ ~ . ~ ~ ' DEDUCTIBLE $1,000 ,~ ~' ~ PROPERTY DAMAGE (Peraccidenq $ GARAGE LIABILITY .QY j~ ~ / j I `;,,.`^'° 4 AUTO ONLY- EA ACCIDENT $ ANY AUTO ~ Ji /tl ~- /L ~ ~,', ~ ~~ : `~~ OTHER THAN EA ACC $ '( ~~ ~ \~i) S~. ~ AUTO ONLY: ~ AGG $ EXCESSlUMBRELLA LU181UTY v ~ a~~ EACH OCCURRENCE $ OCCUR CLAIMS MADE SSls P* AGGREGATE $ DEDUCTIBLE RETENTION $ $ WORKERS COMPENSATION ANO WC STATU- OTH- EMPLOYERS' LIABILITY 1 ANY PROPRIETOR/PARTNERIEXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? If yes describe under E, L. DISEASE - EA EMPLOYEE $ , SPECIAL PROVISIONS below E.L. DISEASE-POLICY LIMIT $ OTHER A.) PROFESSIONAL LIABILITY 200823628-NPO 7H 9/2008 7/19/2009 1,000,000/2,000,000 A.) SEXUAL MISCONDUCT 200823628-NPO 7119/2008 7/19/2009 500,0001500,000 e.) EMPLOYEE DISHONESTY CBW0007843-00-23628 7/19/2008 7/1912009 250,000 - DED. $2,500 DESCRIPTION OF OPERATIONS !LOCATIONS! VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT! SPECU-L PROVISIONS THE CITY, ITS OFFICERS, EMPLOYEES, AGENTS, VOLUNTEERS AND REPRESENTATIVES IS NAMED AS ADDITIONAL INSURED(S). CERTIFICATE HOLDER Addlt>lonal Insured CANCELLATION CLERK OF THE CITY COUNCIL CITY OF SANTA ANA 20 CIVIC CENTER PLAZA (M-30) P.O. BOX 1988 SANTA ANA, CA 92702-1988 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3O DAYS WRITTEN NOTICE TO THE CERTiFlCATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILnY OF ANY KIND UPON THE INSURER, ITS AGENTS OR AUTHORIZED REPRESENTATNE ACORD 25 (2001/08) ARCMI Cert# 1 Holder# 22 _ ©ACO CORPORA/ ION 1988 EXHIBIT B ADDITIONAL INSURED ENDORSEMENT FOR COMMERCIAL GENERAL LIABILITY POLICY Insurance Company NONPROFIT"S ALLIANCE OF CA This endorsement modifies such insurance as is afforded by the provisions of Policy # ~ ~~ 2 ~ ~ ~ R _NpCL_ 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 0 7 / 1 9 / 0 8 ,this endorsement form as a part of Policy # 200823628-NPO Issued to ARC MID- TT . Named Insured Countersigned by ~'r.~ / ~~ ut orized Representative POLICY NUMBER: 200823628-NPO COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ~~DtTtC7N~-L tNSURE® ~- ~EStGNATE® t~~RS+~Jid ~~- rJR~~~t?~Tt~t~ _ This endorsement modifies insurance provided under>tki~:<fi~l~f~wilig: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHE:D;t~.L~~ Jame of Person or Organizatior CLERK CITY OF COUNCIL CITY OF SANTA ANA 20 CIVIC CENTER PLAZA (M-30) P.O. BOX 1988 , SANTA ANA, CA 92702-1988 {lf no entry appears above, inforiTrat-~~ required to complete this endorsement will be shown in the Declarations as applicable to this endors~inent.} WHO IS AN INSURED (section 11) is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of your operations or premises owned by or rented to yo'u. CG 20 26 '! 1 85 CERTHOLDER COPY STATE P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807 COMPENSATION IN S U R A N C E ® CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 10-14-2008 GROUP: 000567 POLICY NUMBER: 0001087-2008 CERTIFICATE ID: 51 CERTIFICATE EXPIRES: 07-01-2009 07-01-2008/07-01-2009 CLERK OF THE CITY COUNCIL SC CITY OF SANTA ANA 20 CIVIC CENTER PLZ M-30 SANTA ANA CA 92701-4058 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, of such policy. ~ ~`;,p~ THORIZED REPRESENTATI PRESIDENT EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE C05TS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #0015 ENTITLED ADDITIONAL INSURED EMPLOYER EFFECTIVE 2008-10-14 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. NAME OF ADDITIONAL INSURED: CLERK OF THE CITY COUNCIL ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 10-14-2008 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. ENDORSEMENT #2570 ENTITLED WAIVER OF SUBROGATION EFFECTIVE 2008-10-14 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. THIRD PARTY NAME: CLERK OF THE CITY COUNCIL AS ~~ ~~~~~~s ApPRpV ED _ .,-- ~...,,. ~hc,;d'y ,~auta SC, y ~~``,~„~ _~ Assls~~nt EMPLOYER ASSOCIATION FOR RETARDED CITIZENS AND SC MID-CITIES (A NON PROFIT CORP) 14208 TOWNE AVE LOS ANGELES CA 90061 [B13,SC] SC IREV.2-oel PRINTED 10-14-2008 AC4RDr,,, CERTIFICATE OF LIABILITY INSURANCE DATE(MMlDDfYYYY) 2112/2009 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION RFP INSURANCE AGENCY ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 5601 WEST SLAUSON AVE., SUITE 250 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR CULVER CITY, CA 90230 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Phone (310) 642-1933 Fax (310) 645-3150 INSURERS AFFORDING COVERAGE NAIC # INSURED ARC MID-CITIES 14208 TOWNE AVENUE LOS ANGELES, CA 900fi1 INSURER A: AIG -COMMERCE 8r INDI INSURER B: INSURER C: INSURER D: 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 D' INSR POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occun:nce $ CLAIMS MADE ~ OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'LAGGREGATELIMITAPPLIESPER: PRODUCTS-COMP/OPAGG $ POLICY PRO LOC AUT OMOBILE LU181LnY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL ODUNED AUTOS BODILY INJURY $ SCHEgULED AUTOS (Per person) C.- HIRED AUTOS NON-OWNED AUTOS RUVED E1 ~^r~ L, 1~-/ 1 ~~ BODILY INJURY (Per accident) $ App `` .~~ PROPERTY DAMAGE $ (Per accident) GARAGE LUU31LnY ~`~ _ t SL '"~- S1 1(: y AUTO ONLY-EA ACCIDENT $ ANY AUTO : -I, ra e~ t CI' t , y iOfriBy OTHER THAN EA ACC $ an A$s>$ AUTO ONLY: AGG $ EXCES5AIMBRELLA LUU3ILITY EACH OCCURRENCE $ OCCUR ~ CLAIMS MADE AGGREGATE $ DEDUCTIBLE RETENTION $ $ WORKERS COMPENSATION ANO EMPLOYERS' LIABILnY 3429138 1 /27/2009 1/27/2010 X TOR STA IUS OTH A ANY PROPRIETOR/PARTNERlEXECUTIVE E.L EACH ACCIDENT $ 1,000 OOO OFFICER/MEMBER EXCLUDED? YES E L DISEASE EA EMP 1 000 000 If yes describe under . - LOYEE $ , , , SPECIAL PROVISIONS below E.L DISEASE -POLICY LIMIT $ 1,000 000 OTHER ~w~mr ~ run ur urtrwuvrv5 r LocATION5! VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT / SPECUU_ PROVISIONS EMPLOYER'S LIABILITY LIMITS INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURENCE. ENDORSEMENT ENTITILED WAIVER OF SUBROGATION EFFECTIVE 1/27/091S ATTACHED TO AND FORMS A PART OF THIS POLICY. THIRD PARTY NAME: CLERK OF THE CITY COUNCIL, CITY OF SANTA ANA. CERTIFICATE HOLDER Additional Insured CANCELLATIAN CLERK OF THE CITY COUNCIL CITY OF SANTA ANA 20 CIVIC CENTER PLAZA M-30 SANTA ANA, CA 92701-4058 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL .3O DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO 50 SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR AUTHORIZED REPRESENTATNE ACORD 25 (2001108) ARCMI Cert# 3 Holder# 6 ©ACORD CORPO - TION 1988 -. ~ ~~~ Zo~l 7-~ icy ~~! 2 Aleorrd C~RTIFICAI'~ 4F LIABtL1TY INSURANCE °"o1r~i~n a ~"'~ PRDDUf~.R HIS C FICATION $SUB AS A M OF NF TION ONLY AN17 CONFERS NO RlC~FIT9 UPON THE CERTIFICAT@ CAIOUO INSURANCE AGENCY HOJ~R, THIS C~RTIFlCATE I>4ES NOT ANNF.~ID , FJ(TEND OR 9100 s. SEPULVFI~A rit.vu. SUITE 109 ALTER THE COVERAGES APFOROE6 BY THG pOIJCI E$ BELOW. LOS ANGELES, GA 90V46 INSURERS AFFQRp1NG COYERAG7= NAIC 11 PH. 310 348-993$ FAX 310 34&9525 -_... .. d- _ IN6UR~ A: LIBERTY MUTUAI-INSURANCE COIdP - INSUR ARC MIP GITIES IHSURr.FI a _ , ._.... _ .... 9i208TOWNEAVENUE INSORt7tC: _ _... ._ ~- -- LOS ~4NGELE=3. CA 90081 INSURER D: - re n ~urureYcen Nf] STANbING THE PO F INSURANCE LISTED EteLpW HAVE a[:Ero 1`.+'SUCO Tv Tne ~n~unr„ rovnw ..o...~ ...., .. ~ . -_.- .. _. -- - -- OOCUtAENT WITH RESPECT TO WHICH THIS CERTIFICATE IMY SE ISSUED OR ATIY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACTOR {17HER EXCLUSIONS AND CONDffIONS OF SUCH THE TERMB BJECT TG Atl S . U MAY PERTAIN, THE INSURANCE AFFOft[7ED SY THE POLICIES OESCRISED kEREIN 1~ , POLICIES. AGGREGJ1l't LIMITS SHOYYN NNT I1AVE 6El:N ItEDUCEP BY PAID CLAlA1S. - -- - .. ..... • • POLICY EiFECTIY! YOLSCY E]CPIRA eV A 'TYPE Of INSURANCE. P°UCY NUMBER DATE MMIOWYY DATE (MMlpplYTYY LTR INS LIMITS „, EACH CIS;CURP;FJ~CC 3 pF.gERAL LIAilILI fY _. ~ OQL1~~~1 s -" COMMERCNLGCNERALLWBILIIY ._ - S ' l (;thtlUSMADL ~ OCCUR xP(AiryORl4lri7AY . .._ - MFbF ' -- i ___ . .... PGRSQKAI. f ADV INJUk'+ .... ~- (jI;I~RALAQCTiOG~TE f .-- (itNL AGGRECa4TE LA~AR APPLES PER: PN(717UCTS • COMPIOP ACG i . . POLICY JECaT LOC i AUT - OMOBILFLIAaLLJTY COMBWEU8INGLFUNR Iho ocddri) i ANY AUTO .. _ _ ..~ ALL OY\IrED RU K)S @ODRY INJURY i IPbr pol7on) SGHEDUU~Alf1OS - _ , . HgtEDAU'TV5 ~PPRO ED AS O FORivI eoDILVINJUHT i ... (Per ~dnN I ...._ NGI~FOWNEp PIl14S ~~. )~ ~ • - ..,.. PROPERTY DAMWP i . ~. %• ~ ~ ~~~ ~ IPeracogaMl ~ , UaHAGt UABII ITY / L ura Stitt Sh dy ~ AuTOO."_Lr'eo''~.'u°eNr s ANYAVTO Assis ant City At orney EA ACC UIH~~ - i '~ AurpoNLr. acs i L~7IClbb f UMBRELLA LYIBWTY F.4CH OCxl1RRENCt •, i _ ... _.. OCCUR u CLAid6 MAl~lo ~ ACNIrLi4'I'C •, S .. '- _ i CTe •• i - " D~DU LE NF: f6NTION i YIORKiRBCONP~11M710NAND 0127!2010 D1/27JZ011 3C ToRYUMfT9 FN. .. A EMPLOY6136' LU1~RY Y! N WCi$I1-43fa0B8-01 U „ • E.L EACH PCCIDP.Ni i 1.~IU,OOO ~- ANY PROPRIETORlPARTHEN~I~CUTIM ~ OFFICER+MENNfFHkxCLU°GD'1 Y,• .- .. E.L.016tASE-EA6IYWI.OYt: 1 1,000,000 - t A~~w OaNV~ 6.L DkiEA9E' I'UI IGY UNIIi i 1,~0,~ OTMFft i DP.'JGRtPTtlN Oi OPEMl10Nb! I.QCATIONII14li1MCLE4lfJlCl-UER)W6ADnE~f1Y ENDORiLMENTIiPECfAL M'CYISYONS EMPLOYER'S LIABILITY LIhAITS INCLUdINO L)EFEN5E COSTS: 31,000,000 PE.R OCCURENCE. ENDORSEMENT ENTITLELI WAVER OF 51JBRAGATION EFFECTIVE 01R7h010 lS ATTAGHCD TO ANO FO RMS A PART OF THIu POLICY. THIRD PARTY NAME: CiERK OF THE CITY COUNCIL, CITY OF SANTA ANA C,LE42K Of-THE CITY COUNCIL Cf1Y OF $AN•fA ANA 2V CIVIC CENTCFi I'1A7J1 M-30 SANTA ANA GA 92701-4058 TION m N]ULD ANY v 7HK ABO4E D84~lrStlCllb BP• GNC~I~TYEF(i1lE TNR l11MNATR741 Ti TNe~elOF, b~E IN51ALL'R YMLL DIPEAMOR 70 M11R . ~ vwYi IAlliUll'rEH TiGF. S>5 ~ CERTUICP.7R QLflER NAMED Tit YH6 LEiT, 1yIJT FAR.YRk'YD Fm SCI SHALL 109E NO .MiA7%)II OR C1r AN`~la~ UPON T4~ RIYURER, RS AOCNTD WR ACOI~D 25 (2gQW01} ~ RG7~)~ '~T b~rxz. •~ ®1862009 ACi The ACOR4 narrls snd logo are regl64~r*d mark! 41 ACORD Zd IJdSS:~O 0I0Z SZ '~EI.1 6~£~~BI£: 'ON :{H~ TK)N. All rids reserved 5~ I l I ~-Q I bJ72ki : W0~ CERTIFICATE OF WORKERS' COMPENSATION COVERAGE T Feb 3 2012 PRODUCER NonPro£ts' United Workers' Compensation Group THIS CERTIFICATE IS ISSUED AS MATTER OF INFORMATION ONLY 431 1 Street, Suite 200 AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. Sacramento. CA 95814 Phone- (916) 764-005 6 THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE Fez: (916) 880.5251 COVERAGE AFFORDED BY THE POLICIES BELOW. Marsh Risk 8c Insurance Services 345 California Street Suite 1300 _ San Francisco, CA 94104 INSURERS AFFORDING COVERAGE INSURED INSURER A Non Profits' United Workers' Compensation Group Association tDr Retarded Citizens Mitl-Cities INSURER B: ACE American ]nsurance Company [NAIL a 22667) '14208 Towne Ave. Los Angeles, CA 9006'1 N,?OU'7-O?O INSURER C: ? / Y / t ? U '? t - INSURER D- - ? Z ? U y ? ? INSURER E COVERAGES This Certificate is not intended to s eci all entlort;emenls, Covera es, terms, contlitions aril exdusions of the olicies shown. THE POLICIES OF COVERAGE LISTED BELOW HAVE BEEN ISSVED TO THE AFFILIATE MEMBER NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REOUIREM ENT, TERM, OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS GE RTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE COVERAGE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SVBJECT TO ALL THE TERMS, E%CL USIO NS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDVGED BY PAID CLAIMS. INSR LTR TYPE OF COVERAGE POLCY NUMBER POLICY EFFECTIVE DATE POLICY E%PIRATON DATE LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY RRE DAMAGE (Any one fire) $ CLAIMS MADE OCCUR MED EXPENSE (Any one person) $ GENERAL AGGREGATE LIMIT APPLtE9 PER: PERSONAL 8 ADV IWURY $ POLICY PROJECT LOC GENERAL AGGREGATE $ PRODUCTS-GOMPIOP AGG $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (??.>_?TTTa (? ?? , O 1 (Each aori0enl) $ ALL OWNED AVTOS ? ?? ?"? d (_? AA'' )?D??,?p?tURY $ SCHEDULED ALROS \- (Per pereo^I $ HIRED AUTOS -°?rr?. -'__: ? BODILY INJVRY $ NON-OWNED AUTOS j-[I ( `. _, ,? (Per ecotlent) --- $ ?. SSI.tiI R;] -, ,I;?r(1y l ?: [ PROPER TY DAMAGE $ y /f, I f ? ? 1"rl C (Per accoenfJ $ WC STAT X OTHER WORKERS' COMPENSATION LIMITS A AND NPLJ-WCG OOI-2012 1/27/12 I/1/l3 E.L. EACH ACCIDENT $500,000 EMPLOYERS LIABILITY E.L. DISEASE - EA EMPLOYEE $ $00,000 E.L. DISEASE -COVERAGE LIMIT $ $00,000 OTHER B EXCESS Workers' Compensation WCL 046245283 1/27/12 I/1/13 535,000,000 x E500,000 WC $2,000 000 x $500.000 EL DESCRIPTION OF OPERATIONSA_OCATIONSNENICLES/E%CLUSIONS ADDED BY ENDORSEMENT/SPECIAUPROVISIONS Evidence of Workers' Compensation Coverage: Waiver of Subrogatio n provided by Endorsement No. NPUWCG-ARCMIDC-06 CERTIFICATE HOLDER woDlnoNAL INSURED; INSURER LETTER: CANCELLA"1'1(lN NPUWCG-ARC MIDC-W SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED Cit f S nta Ana BEFORE THE EXPIRATION DATE THEREOF NOTICE WILL BE DELIVERED y o a IN ACCORDANCE WITH THE POLICY PROVISIONS. Clerk of the City Council 20 Civic Center Plaza PO Bor 1988 Santa Ana,CA 92 702-1 988 ? " ? ? ??? ? ? Based on ACORD 25 (2009/09) POLICY CHANGE DOCUMENT POLICY NO.: PHPK733498 Philadelphia Indemnity Insurance Company 110917 Caiquo Insurance Agency NAMED INSURED Arc Mid-Cities MAILING ADDRESS 14208 Towne Ave Los Angeles, CA 90061-2653 POLICY PERIOD: FROM 07/19/2011 TO 07/19/2012 at 12.0 A.M. Standard Time at your mailing address shown above. CHANGE EFFECTIVE 04/26/2012 CHANGE # 2 DESCRIPTION In consideration of the premium reflected, the policy is amended as indicated below: Added: Additional Insured The City of Santa Ana its officers, employees, agents volunteers and representatives 20 Civic Center Plaza Santa Ana, California 92701 CG2026 Additional Insured-Designated Person or Organization Only as respects the primary insured's operations Per attached Path ID 6185976 Total Annual Additional/Return Premium $ 0.00 NO CHANGE Total Prorate Additional/Return Premium $ 0.00 NO CHANGE COUNTERSIGNED BY (Date) Insurance Policy (Authorized Representative) Page 1 of 1 POLICY NUMBER= PHPK733498 COMMERCIAL GENERAL LIABILITY CG 20 26 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE The City of Santa Ana its officers, employees, agents volunteers and representatives Section 11 -Who Is An Insured is amended to in- clude as an additional insured the person(s) or or- ganization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property dam- age" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: A. In the performance of your ongoing operations; or B. In connection with your premises owned by or rented to you. CG 20 26 07 04 ©ISO Properties, Inc., 2004 Page ? of ? O NONPROFIT uivz-rEr?? THIS ENDORSEMENT CHANGES THE MEMORANDUM OF COVERAGE PLEASE READ IT CAREFULLY WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Non Profits' United Workers' Compensation Group Memorandum of Coverage: NPU-WCG 001-2012 This endorsement modifies the coverage provided under the following: Memorandum of Coverage: PART ONE: WORKERS' COMPENSATION COVERAGE Paragraph H. RECOVERY FROM OTHERS is amended with respect to the following: Name and Address of Person or Organization: City of Sonta Ano 20 Civic Center P/ozo, PO Box 1988 Sonto Ano, CA 92 702-1 988 DESCRIPTION OF OPERATIONS/LOCATIONS ADDED BV ENDORSEMENT: - With regard to the City, its Officio/s Officers, Agents and emp/ogees. NPU-WCG waives any right of recovery it may have against the person or organization shown above because of payments made by NPU-WCG for injury or damage arising out of the Members' operations done under a contract with that person or organization shown above and included in the coverage provided by the Memorandum of Coverage. This waiver applies only to the person or organization shown on the Schedule Above. This endorsement is part of the Memorandum of Coverage and is effective on the date shown below. All other terms and conditions remain unchanged. Effective Date: January 27. 2012 Expiration Date: January 1. 2013 Member: Association for Retarded Citizens Mid-Cities Endorsement No: NPLlWCG-ARCMIDC-06 Date Issued: Feb 3. 2012 Aut prize epresent to ve fior P -W NPU-WCG Page 1 MOC: NPCi-WCG 001-2012