Loading...
HomeMy WebLinkAboutINFOSEND, INC. 1A -2008A-2007-050-01 INSURANCE ON FILE WORK MAY PROCEEQ UNTIL INSURANCE EXPIRES -~/-c~ 9 CLERK OF COUNCIL ~~ oaTE:APR 1 6 0 U. FMS Cr~~{su~v~ ~~ FIRST AMENDMENT TO AGREEMENT M,r~ella Vnr~Gs THIS FIRST AMENDMENT TO AGREEMENT is entered into on March 27`n 2008, by and between InfoSend, Inc., a California corporation ("Consultant") and the City of Santa Ana, a charter city and municipal corporation of the State of California ("City"). RECITALS: A. The parties entered into Agreement # A-2007-050, dated February 20, 2007, (hereinafter "said Agreement") by which Consultant has provided municipal bill printing and mailing services and electronic bill presentment an payment services. B. In accordance with the terms and conditions of said Agreement, the parties wish to amend said Agreement to reflect the initial term of three years, with an option to extend for an additional period. WHEREFORE, in consideration of the covenants contained in said Agreement, and subject to all the terms and conditions of said Agreement, except those amended in this First Amendment to Consultant Agreement, the parties agree as follows: I . Section 2.C, COMPENSATION, shall be amended to read, in full, as follows: "The printing and mailing unit prices quoted may increase at the commencement of successive one-year terms if the costs of materials increases. Any such unit price increase will be no more than the annual CPI percentage change for Los Angeles/Orange/Riverside. Consultant shall notify the City at least thirty (30) days prior to the new one-year term if any such price increase is requested. During the term commencing April 1, 2008, the per piece price for print and mail will be $0.142." 2. Section 3, TERM, shall be deleted in its entirety and replaced with the following: "This Agreement shall commence on April 1, 2007 and terminate on March 31, 2010, unless terminated earlier in accordance with Section 12, below. The term of this Agreement may be extended for an additional two years upon a writing executed by the City Manager." 3. Except as hereinabove amended, all terms and conditions of said Agreement shall remain in full force and effect. IN WITNESS WHEREOF, the parties hereto have executed this First Amendment to Consultant Agreement on the date and year first written above. CITY OF SANTA ANA ATTEST: ~~ l~ ,~ '~ ~ ~ fit;, PATRICIA . HEALY DAVID .REAM Clerk of the Council City Manager APPROVED AS TO FORM: JOSEPH W.FLETCHER City Attorney ~~ BY~ ~;~ti~~C-,~~~c~~~C~° Laura Sheedy Assistant City Attorney INFOSEND, INC. ~._~~~,_ MAHMOOD REZAI President & CEO ,,. ACORD CERTIFICATE OF LIABILITY INSURANCE DATEIMMlDD1YY) ,M 311 812 0 0 8 PRODUCER JONES AND COMPANY INSURANCE AGENCY THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 505 S. VILLA REAL ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR SUITE 115 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. ANAHEIM HILLS CA 92807 (877) 566-3726 _.. ---- --___ _..- ----- INSURERS AFFORDING COVERAGE - INSURED Z067-OSd~~ -- - -- wsuRERA EMPLOYERS FIRE INSURANCE COMPANY ( ~- ~ INFOSEND INC , . wsuRERB 1041 S. PLACENTIA AVE INSURER C INSURER D'. FULLERT N CA 92831 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REOUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR I '~ j LTR '~ TYPE OF INSURANCE POLICY NUMBER ~ POLICY EFFECTIVE ~ POLICY EXPIRATION DATE MMIDD/YY I DATE MMIDD/YY LIMITS GENERAL LIABILITY ~ EACH OCCURRENCE j $ 2,000,000 X ~ COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Any one fire) $ 300 000 _~ CLAIMS MADE X ~ OCCUR ' I , MED EXP (Any one person) $ 5,000 A i 1 U46885 ---. _-- -----__. __.--. 2/24/2008 II 2/24/2009 PERSONAL & ADV INJURY $ 2,000,000 j ~__ _ _ ___ _ __ _ - _ '~, ~ GENERAL AGGREGATE $ 4,000,000 I GEN'L AGGREGATE LIMIT APPLIES PER: 'I _ _ _ . PRODUCTS -COMP/OP AGG i $ 4,000,000 I X POLICY ~ ~ PRO- ~. LOC ~ JECT - _-~ ~~ ~'~r. AUT OMOBILE LIABILITY I I COMBINED SINGLE LIMIT `~ 2,000,000 ANY AUTO ~. (Ea accident) -~ ALL OWNED AUTOS j BODILY INJURY $ A SCHEDULED AUTOS II 1 U46885 2/24/2008 2/24/2009 (Per person) X HIRED AUTOS !. BODILY INJURY $ X NOfJ-OWNED AUTOS ~, (Per accident) --- - _ _ _____ __ _____!j ' ! PROPERTY DAMAGE $ , (Per accident) I GARAGE LIABILITY ~' AUTO ONLY - EA ACCIDENT $ ', - ANY AUTO ~ EA ACC OTHER THAN _- $ ___. _ __. __. '~.. AUTO ONLY: AGG $ BILIT I E EACH OCCURRENCE $ 1,000,000 OCCUR X CIAfMSMADE AGGREGATE ~ $ 1,000,000 __ A 1 U46885 2/24/2008 2/24/2009 __ -- ~ $ ~ X DEDUCTIBLE 10 000 I ~ I ,, ~ -- I - --- ____ ! RETENTION $ ~' 3 WORKERS COMPENSA TIv'N AND ~' ~ ~' ~ ~ I WC STATU- OTH- ~TGRYLIM'Si I_CR -- _ - -- ---- \ ~.. I EMPLOYERS'LIABILITY ~iJ - ~ ~ .. E.L EACH ACCIDENT _ _._ _- $ __. _ . ~ ~ I E.L. DISEASE - EA EMPLOYEE $ I '~ E.L. DISEASE -POLICY LIMIT $ 'OTHER i i i DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS '`*10 DAYS NOTICE OF CANCELLATION FOR NON-PAYMENT OF PREMIUM. CERTIFICATE HOLDER X ADDITIONAL INSURED; INSURER LETTER: CANCELLATION 25 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BrE~FORE THE EXPIRATION CITY OF SANTA ANA DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL JO DAYS WRITTEN MARELLA VARGAS NOTICE TO THE IFIC E THE LEFT, BU LIRE TO DO SO SHALL PO BOX 1964 IMPOSE BLIGAT R ILITY IND UPON THE INS ER, ITS AGENTS OR 9 SANTA ANA ACORD 25-S (7/97) LM'. LPW vt9.8 on 3!18/08 - 11:45 by UserName CA 92702 O ACORD CORPORATION 1988 LP'. LPW v1.9.8 on 3/18/08 - 11:45 b serName PF v1.D.1 Da4e Emmlddtyy} <:: Af ALJ 1~~~~~~~~P~~ ~~' A ~~~~~~~ ~~ ~~ ~ ~.. w i ~ i7 Air, V i ~ 12/1412007 Producer Noneh t_uhrassebi THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. Wood Gutmann & Bo art Insurance Brokers THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE 15901 Red Hill Ave., ~Ulte 1 OO COVERAGE AFFORDED BY THE POLICIES BELOW. Tustin CA 92780 714 505.7000 INSURER National Fire Insurance Co of www.wgbib.com HAI License No. 0679263 INSURER Houston Casuaity InsUf INSURER Infosend Inc /.~ -o2pdrl-OSO- 0 INSURER 1041 S Pl i . acent a Ave. Fullerton CA 92831 INSURER E ~~v~flQ~ES 'itiE Pi}LIC3ES C-F iNSURAIICE LISTED SEL04N HAVE BEEN iSStiED TU TKE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDECATED_ NOTWITHSTANDING ANY RE4UIREMENT, TERM OR CONDITION OF ANY CONTRACY OR OTHER DOCUMENT WITH RESPECT TO WHICH TIdIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL T#IE TERMS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY POUCv NSR EFFECTIVE EXPIRATION LTR TYPE OF INSURANCE POLICY NUMBER DATE DATE ~ LENS M D M D A GENERAL LIABILITY BEACH OCCURRENCE ~ s COMMERCIAL GENERAL LIAS ' FIRE DAMAGE (Any one fke) 'r' CLAtlNS MADE ~iBCCUR MED EXP (Any one Person) PERSONAL 8 ADV INJURY N'L A LIMIT AP GENERAL AGGREGATE PUE PER PRODUCTS-COMP/OP AGG POLICY RWECT LOC A UTp1iOBILE LU161LITY ANY AUTO COMBINED SINGL£ LIMfi S ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS {Per person) E HIRED AUTOS A BODILY INJURY NON-OWNED AUTOS fPer eccWent) E PROPERTY DAMAGE IPer aceldeet) E G ARAGE LIABILITY AUTO ONLY - EA ACCDDENT E ANY AUTO OTHER THAN EA ACC S AUTO ONLY: AGG _ EXCESS UABILETY EACH OCCURRENCE i OCCUR ~ CLAIMS MADE AGGREGATE Y E DEDUCTIBLE S RETENTIONS r WORKERS' COMPENSATION & EMPLOYERS' L B STATUTORY LIMIT THER _ _ EA ILE77 EL EACH ACCIDENT ______._ _..__ .- __. E EL DISEASE - EA EMPLOYEE S EL DISEASE -POLICY LIMIT E rrors mmesslons 707-17039 1211 2007 12/1 2008 1,0 0,000 A A B Proof of Coverage l~E~~'tl~l~ATE Ili#~I.f,?ER ~AIVCILLATION SHOULD AHY OF TNt ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Proof of Coverage EXPIRATION DATE THEREOF, THE ISSUING COf~ANY WILL ENDEAVOR TO MAIL ~ 30' DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFY, BUS FAILURE TO MAZE SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LU161L177 OF ANY KIND UPON THE COMPANY, IYS AGENTS OR REPRE- SENTATIVES. ' t0 Days for Non-Payment of Premium AUTHORIZED ~ REPFIESENTATIVE - - - 7 ,~ Jeff Sachs J ACOiil 2S-S {?197j - '" ~ t1C(}Ri>! CdRPORATtON i888 POLICYHOLDER COPY P.©. BOX 420807, SAN FRANCISCO,CA 94142-0807 CC+MPENSATtON INSURANCE CERT1FlCATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 03-18-2008 GROUP: 000562 POLICY NUMBER: 0001424-2007 CERTIFICATE ID: 18 CERTIFICATE EXPIRES: 02-01-2009 02-o1-aoo8to2-o1-2009 CITY OF SANTA ANA SP PO BOX 1964 SANTA ANA CA 92702-1964 This. is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California insurance Commis+oner 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. VVe will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. Ti;is 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. ~k~~,~..c.,~/ ~/ THORIZED REPRESENTATI PRESIDENT EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #1600 - REZAI, MANHOOD P,S T - EXCLUDED. ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS` NOTICE EFFECTIVE 02-01-2008 YS --~-- ATTACHED TO AND FORMS A PART OF THIS POLICY. EMPLOYER INFOSEND INC. SP 1041 S PLACENTIA AVE FULLERTON CA 92831 ev.2-oel % PRINTED 03-18-2008 SP /~ '.?oo7-c~ v -o/ AcoRU,~ CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YY) 4/20/2009 PRODUCER JONES AND COMPANY INSURANCE AGENCY THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 505 S. VILLA REAL ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE SUITE 115 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. ANAHEIM HILLS CA 92807 (877) 566-3726 INSURERS AFFORDING COVERAGE INSURED - --------- _ . - - -. --- -. _. -- - .._ _.- INSURERA Employers Fire Ins Co N 2048 INFOSEND INC. ___ , INSURERS United Financia! Casualty Go N~' IC#11770 ` - --- 1041 S. PLACENTIA AVE ~ _ _ - -"- -~ - -- wsuRERC: AXIS Surplus Insurance Compa3ny NAIC#26620 I --------- -- - _._. INSURER D FULLERT N t CA 92831 - -- _--- ----- --_- ----- ---.-~- - -- INSURER E: r~nvconr_c~ 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 ~" BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS EXCLUSIONS~\MD C019DITIONS OF SUCH POLICIES AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS ----.-_. , ~. . ,,, __--.......------ INSR' LTR TYPE OF INSURANCE I --~~~----POLICY EFFECTIVE POLICY EXPIRATION -~~--~--- ~"yam--~--""--' ---~-~- POLICY NUMBER DATE MMIDD/YY DATE MM/DDIYY LIM --------~ ---~__...__. GENERAL LIABILITY f- ~ I EACH OCCURREN ~ ~0 -- 2,000,000 I X I. COMMERCIAL GENERAL LIABILITY ~-- ~ 1 CLAIMSMADE i X _ -------- --._......__.._ -.------- FIRE DAMAGE (Any one fire) $ - _-- ---- _- --------' ----- 300 000 -------- i OCCUR r q ~ ' MED EXP (Any one person) $ - ___ - - - ---- 5,000 - - --- ---_ 1046885 2/24/2009 2/24/2010 PERSONAL&ADV INJURY $ ~~ 2 OOO,OOO GE ~ N L AGGREGATE LIMIT APPLIES PER: I ! GENERAL AGGREGATE _$_ $ PRODUCTS -COMP/OP AGG ~ 4,000,000 4,000 000 i X POLICY ~ PRO- ~ ~ LOC JECT I I - _ ~ - _ _ _- , AUT OMOBILE LIABILITY I ~_ ] _ __ ANY AUTO I I I COMBINED SINGLE LIMIT j $ (Ea accident) 1 000 000 ~ r ALL OWNED AUTOS '' ~ I - ~- X ~ ' SCHEDULED AUTOS BODILY INJURY $ B X '.. 06546.590-0 i HIRED AUTOS 2/13!2009 8/13!2009 I (Per person) I f -- ----- -- NON-OWNED AUTOS ~ ~h ~~~{J~ ~,3~ A ~ ~rl ~:; . /", ~ V y ~~i~;'a BODILY INJURY i $ (Per accident) i ~ t___ ___.-__._ .. _.____.. r____ _ ___-... l-_ I _ _ .........-.. -----_.-_ -. ..---__--- i / ~ 'G, , ~. I ~ PROPERTY DAMAGE j ~ (Per accident) i $ GARAGE LIABILITY I 1 ANYA - -' _ '`~_+._._--~----^-°""' ~ ~~L gUt~ J -lT. ~L!C ~~~ AUTO ONLY-EA ACCIDENT $ _._ ~. UTO ~ 1 ice, I L -~ 1 ~ ~' '-'- A SJ IS L'd~I- Y rti ~ OTHER THAN EA ACC ~ $ ~---_ ~ ------~~ , . i AUTO ONLY: AGG $ E CESS LIABILITY i-, I ~ X J OCCUR I CLAIMS M I ~ ~ EACH OCCURRENCE j $ - t-.----- 2 000 OOO -~--- ~ ADE A ~ ~ ~ ~ ~ ~ ~ AGGREGATE _ --~" - -- ~ 2 000 0 -__- , , OO -- 1046885 2/24/2009 j I 2/24!2010 I $ -- - ~ X~ DEDUCTIBLE 10,000 I --- --_ '- --.. - $ -- - __- I RETENTION $ G ~ ----- - --..-.- -I--. -. _ _--- - - --- i $ ;WORKERS COMPENSATION AND I EMPLOYERS' LIABILITY I ~ WC STATU- OTH i ~ TORY LIMITS _ J ER _I - - - - _ .- i --- --- -- ~ i E.L. EACH ACCIDENT ~ $ I ' i I E.L. DISEASE - EA EMPLOYEp $ OTHER j E.L. DISEASE • POLICY LIMIT i $ C /PROFESSIONAL LIABILITY EC EACH ACT 1,000,000 N9970801 j 12/1/2008 12/1/2009 TOTAL LIMIT 1,000,000 I RETENTION 5 000 DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESJEXCLUSIONSADDED BY ENDORSEMENTISPECIAL PROVISIONS , ADDITIONAL INSURED: CITY OF SANTA ANA, PER FORM CG2010 07/04. (attached) '"'10 DAYS NOTICE OF CANCELLATION FOR NON-PAYMENT OF PREMIUM. (`FRTICIf ATC LIAI nGn _-- , i .. n..., n.a~rtcu- wsuntK Lhr IhR: CANCELLATION i -_ CITY OF SANTA ANA MARELLA VARGAS PO BOX 1964 SANTA ANA '25 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 SO SHALL IMPOSE NO OB~ION OR LIABILITY OF ANV KIND UPON THE INSURER, ITS AGENTS OR CA 92702 ACORD 25-S {7/97) ©ACORD CORPORATION 1988 LM: LPW vt.9.8 on 4!20/09 - 9:51 by UserName LP: LPW v1.9.8 on 4/20109 - 9:52 by rName PF v1.0.1 ~~~ One Beacon 1 V S l' K A k C E CG 20 10 07 04 ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCFIEDULE Name of Additional Insured Person or Organization: CITY OF SANTA ANA Location(s) of Covered Operations: 1041 S PLACENTIA AVE Information required to complete this Schedule, if not shown above, will be shown in the Declarations, A. Section II -Who Is An Insured is amended to include This insurance does not apply to "bodily injury" or "prop- as an additional insured the person(s) or arganization(s} erty damage" occurring after: shown in the Schedule, but only with respect to liability 1. All work includin materials for "bodily injury", "property damage" or "personal and ~ g ,parts or equipment „ furnished in connection with such work, on the proj- advertising injury caused, in whole or in part, by: ect (other than service, maintenance or repairs) to be 1. Your acts or omissions; or performed by or on behalf of the additional insureds) 2. The acts or omission of those acting on your behalf; at the location of the covered operations has been in the performance of your ongoing operations for the completed; or additional insureds) at the location(s) designated above. 2. That portion of "your work" out of which the injury or B. With respect to the insurance afforded to these additional damage arises has been put to its intended use by insureds, the following additional exclusions apply: any person or organization other than another con- tractor or subcontractor engaged in performing oper- ations for a principal as a part of the same project. Poucr rvuMSEa: 1046885 INSURED COPY j; ~'' POLICYHOLDER COPY STATE P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807 COMPENSATION FNSUFtANCE FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 04-20-2009 GROUP: 000562 POLICY NUMBER: 0001424-2008 CERTIFICATE ID: 40 CERTIFICATE EXPIRES: 02-01-2010 02-01-2009/02-01-2010 CITY OF SANTA ANA gp ~~`~ PO BOX 1964 SANTA ANA CA 92702-1964 r a .. w 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. r':_.~- This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to th~~+~rployer.~"' ~D ~ 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 #1600 - MAHMOOD REZAI,PRES,CEO - EXCLUDED. ENDORSEMENT #1600 - RUSTEEN REZAI, CEO - EXCLUDED. ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 02-01-2008 IS ATTACHED TO AND FORMS APART OF THIS POLICY. gPPItO V ~i~ ~~ ~ ~:~ `~- Laura Stitt Shzeci;,~ Assistant City ~~~~~~~~~~~ EMPLOYER INFOSEND INC. 1041 S PLACENTIA AVE FULLERTON CA 92831 SP [JG8,CS] SP (REV.2-05) PRINTED : 04-20-2009 ACUKU CERTIFICATE OF LIABILITY INSURANCE 1//27/27/ DADDI20112 2 PRODUCER (562) 493-3521 FAX: (562) 430-5300 Alandale Insurance Agency 11022 Winners circle, Ste. 100 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Los Alamitos CA 90720 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Sentinel Insurance Company 11000 INFO SEND, INC. INSURER B:Hartford Underwriters Ins CO 30104 4240 E LA PALMA AVE INSURER C. Twin City Fire Ins CO 002235 INSURER D. ANAHEIM CA 92807 INSURER E THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TOTHE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTAN DING 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 BYTHE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS EXCLUSIONS AND CONDITIONS OFSUCH , POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR DD'L U21Q TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MMfDDIYYYY) POLICY EXPIRATION DATE MMIDDIYYYY LIMITS GENERAL LIABILITY EACH OCCURPENCF $ 1,000,000 X COMMERCIAL GENERAL LIABILITY D111 TO I) P REMISES Ea occurrence $ 1 000 000 A X CLAIMS MADE OCCUR 2SBAZB7916 2/24/2012 2/24/2013 MED EXP (Any one person) $ 10 000 PERSONAL & ADV INJURY $ 1 000 000 , , GENERAL AGGREGATE $ 2 000 000 , , GEN1 AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG $ 2,000,000 X POLICY PRO- 7 LOC AUT OMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 B X ALL OMEDAUTOS 72UECPE3966 2/18/2012 2/18/2013 X BODILY INJURY $ 6CHEDULED ^.UT06 (Per person) X HIRED AUTOS X BODILY INJURY $ NON OWNED AUTOS (Per a cci dent) PROPERTY DAMAGE (Per aca dent) GARAGE LIABILITY ;'j [? ':; J •, , .. ,.., '?.; 1 - AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONL'YAGG $ EXCESSIUMBRELLALIABILITY - - °--- EACH OCCURRENCE $ 5 000 000 X OCCUR F 1 CLAIMS MADE AGGREGATE $ 51000.000 ..,,.1.,..,. y.... $ A DEDUCTIBLE 2SBAZB7916 2/24/2012 2/24/2013 $ X RETENTION $ 10,000 $ C WORKERS COMPENSATION ' VLC STATU- 0TH- AND EMPLOYERS LIABILITY YIN X Tnp LIMITS ANY PRO PR I ETORIPARTNER/EXECUTIVE ? OFFICERIMEMBER EXCLUDED? E.L. EACH ACCIDENT $ 1,000,000 (Mandatory in NH) If yes, describe under 2WECLU6992 2/1/2012 2/1/2013 E.L. DISEASE-B4 EMPLOYEE $ 1,000,000 SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT $ 1 000 000 OTHER , , DESCRIPTION OF OPERATIONS I LOCATIONS/ VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENTI SPECIAL PROVISIONS Certificate holder is named as additional insured as their interest may appear per when required by contract. *10 days notice of cancellation for nonpayment of premium /'CGT CI f?ATI`111 ??? CITY OF SANTA ANA PO BOX 1954 SANTA ANA, CA 92702-1964 ACARn 95 IonnO/n41 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL *30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR AUTHORIZED REPRESENTATIVE Stacy Marshall/STACYM ?_-??"??-.,. 'w I"aa-Luu`J ALLJKU ULJKPOKATIUN. All rights reserved. INS025 (200901) The ACORD name and logo are registered marks of ACORD IMPORTANT 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 SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER This Certificate of Insurance does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2009/011 NS025 (200901)