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Home My WebLink AboutHOUSTON HARRIS PCS INC 2CAGREEMENT TERMINATION 15 Ptj 3: � Please complete this form when the attached agreement is no longer in effects"TA ANA CLERV Return form to the Deputy Clerk of the Council (M-30). Call 647-5238 if you have any questions. The agreement with PCs,O—h c- z No. if A-,-20og-;)�- ) i2Gi was completed on A2111 / ZO0 T and final payment has been made. A ZOpy 220 CacAfe " Department: WA- W A M 7— DI10 l IJ h• 2004-.220 -61 CIO Signature: Date: q/�//� City of Santa Ana Clerk of the Council Revised 05-22-08 0�' 7/2q/-2008 16:38 1989422"H41 A,a,pp6—lil Ik•�oo`f-�2n A 7yoY-yu,-o( pC.O-4Q_ CERTIFICATE OF LIABILITY INSURANCE ni6eriun i �iliant IaaareOOs 8srviwa,Ina way AND CowasNoe0113eI ILia-oC366g1 NOIA88 rA9C8R1 mA1MDM P O Bur 3260 ALUM THECOWOM APPORK yen 8ernardiao G 92133-3260 p),ewl09-986-9961 FaX:909-666-2033 D8118MNSAPPOMWCMAPU6! f�b11 Xenia Ioe u Or'aannd err,a• 13 1r can COrtaAON q l is m~ TomCmCQWMOw�MVF saa '&a%WTMiDOMM allfaAaaa vawmO rNme r arm"VM WAN" AIMaWU+aaeR, Tmle DI tC�aRmN6 an CgnbGY W aaR DOCIMSII am+acawerca YaaCw MataYleraYl WY�aaaDDa *7aµLTM[R/aA�ICitlaOIRM000NatIOMa KluCq VAT90 AOBIKAANKPANU MOR OW aUllCmlfRlt•R+WjLOM puma -Sim se �uaulr A X X eDWAW&/aw mLLwmm Oi/21/06 06/24/0 0AMOMM NIOMU'k MOW wp PIMMMALi.aD40Y aPaorIr' al 000 00 a100,000 ,SO 000 a1 60D 000 aeaaesalOFAWs 00 s2 00 0 PVAXKM.CMWW s2 00 000ocarwKa 0 aatY X i0c aua aVAwmftw a8089181/ 06/24/08 66/2/69 D a wLe uars1.000,0 aoaaoksamaarAersrr Y YY f taceWOARM X mmowma X MmaoYMDA1Rn Mswamam AMMwro A&MON Y-a+1Ca99a a pp!tl!�e�� la Ate iWlDuwr. AM a a mKocamiamCI /2 000,000 aoaawn s2 OOQ,ODO A �aWA X ooea ❑wasmAaa 30AMUS2109 Oi/21/08 06/21/09 Is s a �CYAPA en MOW a amira umueir+eu..o arwaruaann C.Lewaare0ar a uw .De•ae a d tra m IL awe -Pan J4 a A A urMM 8gaipasat Floater MZUOBGD171 320891811 06/24/03 1 06 1 08 06/2009 061241191 Bea below dam Below St Applies If Amlies N r Opavationa pwtsiain4 to naeed insured for aartholdar. City of saata Ana and Ste offi0arl, a9sata, rePBaaantetives, volanteer8, f 0*10,ees are add', snWPrie ard8 raapwte 9=11 liab Per C07158 12/03 i CC7253 09/D3. •30 days MOC for noes-Dayeaat GROMPt 10 deye MCC for wOa-Paymant. CIBAp06 810atsaMYplaa�laDW anoeaa raeassuM9uaewca[w�aasra.na aaaseep,DaaaaW aMaMMLLeldalaa�Vau 30• aaaManel City Of Santa Aes ashes �aveeiseraa7S M/IaaRaa�A11R t6CeI/T aaalea 7000bawiu M-21 80ss Anaea Ith 9lr s,nosa �earmewee�wamvrnioomarnawusaa.iMNwea 20 Civic Center PIMM ■ommm"01114" Santa Ana G 92701 b6S -- 2 _A�QRD CERTIFICATE OF LIABILITY INSURANC 0,Pw XG °"'E'MINOOYTIY) HOVST-2 09 08 09 MoOLCER Alliant Insurance Servicas, Ina (Lie-OC36861 ) 735 Carnegie Drive, Ste 2 DO THIS CERTMICATE 16 ISSUED A$ 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. San Bernardino CA 92408 Phone:909-886-9861 Fax:909-886-2013 IWAMD-------...--f---`---------------+PS INSURERS AFFORDING COVERAGE m URERA: Firean's Fund Ins Cc NAIC0 -- INSURER & INSURER C, -- Houston 6 Harris PCS Inc 21831 Saxton Roadd- Grand Terrace CA 92313 -- [PSURERO: -------------- --- W9URERE: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REOUBiMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFOROM BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REOWED BY PAID CLAIMS. LIM TR ON - --TYPE OF INSURANCE POLICY NUMBER^_ O�Ip pA MMAIINYY LIMITS A X GENERAL LIABILITY ICOMMERCIAL GENERAL LIABILITY CLAIMS MADE K OCCUR ------�- GEM- AGGREGATE LIMIT APPLIESPE, POLICY X JECT LOC b=80907585 06/24/09 06/24/10 EACH OCCURRENCE S 1 , 000 , 000 PREMISESJE,, mr . f 100,000 MEO EXP (Any we PMbn) 110,000 PERSONAL S AOV INJURY $1,000,000 GENERALAGGREGATE t2,000 000 PROOUCTB-COMRTJPAGG t2,000,000 A AUTOMO&LY X X X LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HMEDAUTOs NON -OWNED AUTOS MZX80907585 APPRO L 06/24/09 Eli AST �, U[B $Gtt C 06/24/10 FORM d COMBINED SINGLE LIMIT (Es acri]enJ) tl,000,000 BODILY IMURT (Par"' t BODILY INJURY LPsa titlent) f PROPERTY DAMAGE (Px acclmn) f GARAGE LIABILITY ANYAUTG Ass Ste DL C1 l nmOY AUTO CITY -EA ACCIDENT f OWERTHAN EAACC AUTO ONLY: AGG S _ f A EXCESSAMBRELLA LIABILITY X OCCUR CLAMSMADE DEDUCTIBLE RETENTION f XRE80862188 06/24/09 06/24/10 EACHOCCUARENCE t2 000,000 AGGREGATE f2 000,000 3 f f WORKERS COMPENSATION AN/ EMPLOYERS LIABILITY ANY PROPRIETORIPARTNEREXECUTWE OFFICERRAEMBER EXCLUDED? yyeess dow" eular SPECIALPROVEikONSEe. 191 - T RY LMRS ER E.L EACH ACCDEM t E.L. DISEASE - EA EMPLOYEE t El. DISEASE -POLICY LIMIT E A A OTHER Equipment Floater Property MZX80860171 MZX80907585 06/24/09 06/24/09 06/24/10 06/24/10 see Below If Applies see Below If Applies OESCRIPTIOM OF OPERATIONS 1 LOCARONS! VlNCLES I EXCWSIONSADDED BY EN OMMENT f SPECIAL PROVISIONS Operations pertaining to named insured for cartholder. City of Santa Ana -and its officers, agents, representatives, volunteers, S employees are add'1 ined/prim wrdg as respects gen'1 liab per and'ts CG7159 12/03 S CG7253 09/05 *30 day N O C except 10 day for non-paymant of premium. CARRIER WILL NOT MODIFY CANCEILLILTION-CLAUSEMO XX OUT. Null S Voids prior cert 07/28/09. City of Santa Ana Public Works Agency M-85 220 S. Daisy Ave Santa Ana CA 92703 CISAN06 I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCEI I— BEFORE THE EXPIRATW' OATS THEREOT,TI@ ISSUING INSURER WILL ENDEAVOR TO MAIL 30* DAYS wRrTTEN ROTICE TO THE CERTMTCATE HOLDER NAMED TOTHE LEFT, PUT FAN.IIAE TO DO SO WALL IMPOSE NO OBLIGATION OR LIABILITY OF AM KIND UPON THE 1NSURER.IT$ AGENTS OR REPRESENTATIVE& 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 The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. Policy Holder: Houston & Harris PCS Inc Policy Number: MZX80907585 MuldCoveis - CG 71 58 12 07 YOlicy Amondmanl(s) Cornmerdal Oanaal Liabllgy Coverage Form Your Commercial Ooncral Liability Coverage Fonn is revised as follows 1. Broadened Named Inured A. SEMON Il - WHO IS AN INSURED, item 3., in deteted and replaced by the foitmw ing: 3. Any orgoolization thpt you own at the inception of this policy, or Newly acquire or form during the policy period, and over which you maintain during the pol- (cy period majority ownership or major- ily [worm, will. qualify as a Named Insured it. a There H w other similar insurance availdlle to that orgmizatioa: and b. The first Named hued shown to the Declaration has the responsi- bility of placing insurance for that orpinbe don; and o. That organization 6hoo epraaed or -organized under tho laws of the Uaud States of America. However: (1) Coverage triter this provision 3 is alfarrled only Until the start acem- ring annual mniveaary of the he - ginning of the policy period shown in dx Deductions. or the end of the policy period, wbichaver is earlier; and (2) Cowrage A does we apply to bodily Injury or praperty damage that oo- turned before you acgoirod or formed the otganictalio, and (3) Coverage B does no apply to pot, "Not ■ed advarBaleg Injury arising out or to DMnro comorittod before you acquired or formed the organ- irstim. D. SUMON H - WHO IS AN INSURED, the Ise paragraph, is deleted and replaced by the No person at argamintion is an inured with respect to the conduct of my Carnal or past partnership„ joint venture, or limited liability company flat is nor shown as a Named in- sured is the Oeelmstions. However, this does not sp$y to a thniled liability company that meets all of the conditions in Section H - Who Is An Inured, item 3., above. 2. Additional Insured SECTION It - WIIO is AN INSURED, sub- section 2.e., is added M lellows: a. Any per" or organization in inchded as an additional inured, but orally to the eldest such person or orgenintbn is belt strain fob bodily lu)ury, Pr%mtydmgp or peraeaad mad advertising injury novel by yaw acts a oarias[®a. With respect to the instruction at - forded to such banned, all of -the following additional psovisioas apply: (1) You and such person or orgmhtttloo flaw ngrood in a aria» Insured eostrad that such persuti or organization be added as an additional insured under this Policy, (2) the bodily Injny, property dwana or pointed and ad outidag Injury for which said person or organization is held liable oo= subsequent to the c texamion of such hound eontraet; This Porn MM be.dotled u anc4s Ender evand who inued afar du policy I nearer pee of he FTweee9 Vona iarwuw Cbeponla®n inroed la 1M policy v � rraodee Cu7in lam Coprftu M. rnwdr Poet W Coernr. rraeera. CA. AN lief nnwvd. rood. wpmlpud ivmhl ofleawwa ser,kw rake, lea, o r in p Iuaa Par 1 of 7 (3) The areal we win pay is the lem r of either the Limits of Insurance sham in the Deelarstvon or the Ileeita of inans- anoe required by to Inland cmtroet; (4) Such person or organization ism insured only with respect to: (a) Their ownership, maintenance, or use, of that pad of the promisee, or lead owned by, rented to, a leased to you, except such permit a or- ppnizetim is net an insured with re, spect to strodund alteraimus, now eoamuction or demolition oper- alone performed by or on behalf of such person or organization; (b) Your ongoing operations performed far that idwvj; (c) Their financial Cooled of yea, ex- cepr such person or organization is not an insured with respect to in=. duel allemiom, new eo i mtmr or demolition operations perfumed by or on behalf of such persm rr organization; (J) The maimemnce, operadrm or we by yen of equipment leased to you by amh person a arganization; (e) Operations performed by you or an your behalf and for which a state or political subdivision has Issued a permit, provided such operations ace not parfoymed for such .state or yob kiwi subdivision, and an not in, eluded within lke produate plated operations hazard; (5) This insurance does not apply to bodily Injury property damage, penmul aid sdverllabng Injury, occurrence or otfemse: (a) Which takes place at a particular premises after you come to be a tenant of That premises; (b) Which takes piece after all work. In - eluding onueriels, pans or equip- mem furnished in connection with such suck to be performed by or on behalf of the sdhional Insured at the site of flee covered opeordom, has been completed; (c) Which takes piece riser that pardon of year, work out of which the injury ur damage ad"$ has hear put to its Intended use by any other person ar organization other then mother contractor of subcontractor wileged in performing operations foe a Ado- edpol as part of the "me project; (d) Which lakes placeafterthe expira- lon of my equipment lease to which (4)(d) above applies; (6) With respect to archheeta, engineers or surveyors, coverage does not apply to bsdgy Injury, property damage or per, renal sad adveroklag Injury arising om Of the rendering or failure to render any professional services by or for you, in- cluding: (a) The prepariag, approving, or foiling to prepare or approve, reaps, shop dnwinge. opinions. reports, surveys, fold arders, chrage orders, or dmvl- hip and speohjcalions; (b) Supperrrrisory, inspection, orchiteo- turd, or millneering services. Howevm; if m Additional Insured eodonemem Is attached to this policy that specifically manes a parson or organization so an insured Ibm two subsectao 2.a does not apply to such Perseus or orgmizelioa. 3. Additional insured -Vmdoro Unless the pndwrircoarpkfed operations hazard is excluded from Ibis pokry, SECTION tl - WHO IS AN INSURS17, item 2.L is added as follows: r. Any vmror of your is inclmkd as an addd- flonal inured, but any with respect to booty Injury or. property damage caused by your products which me dishfbueti or sold in the regular course of the ardor's business, sub- ject to the following additional contusions: (1) Do insurance afforded she vendor does not apply to; MAU a.m7 CM iopi peapyrialaN brill era tmi.�..:`n sort am k'c +n w pivmw `d Page 2 of 7 • (a) gedlly InJnry or property damage for which the vendor is obfigaled to pay damages by random of the, aasmnp• fire of liability in a contract or agreameaz. Thlo exclusion doe not apply to liability for thumps that the vendor would have in the ab- sence of de connect a agreallenr (b) Any express wmrimly unauthorized by you: (c) Any physical a chmokol change in the product made Intentionally by the vanda; (d) Repackaging, union unpaerad solely for the purpose of inspection, draw omWnlion, lestiag, or the substi. motion of part& under imtruclions tan the manuhcaurm, and than re- packaged in the original container, (a) Any feilun to make such in. speatirms, adJusimeda, tests or ser- vicing as the vender has weed to make or normally mulabli a to make In the usual coutse of busi- am, In conduction whit the dlurib- ullon or ask of the products; (t) DemoumMted, installation, serwcw ing or root opaatioM except such opmatiom perforated by the vender in Nil compliance with the mon- uh"mmes written instructions at the vendor's premises in cormacdon with the sale of the Product; (g) Products which, after dWributka or sale by you, have Men labeled or relabeled or deed as a container, part or ingredient of any other thing or arbst&ns by or for the vends; or (h) Donny Injury or property damap arising out of the liability of the vender for its and aces or omissions a those of its employees or Buys" else acting on it& behalf. (2) This immance item rot. apply to any in- sured person or organization from whom you lava acquired such products a any ingredient. pan at container, entering iala, accompanying or containing such prodhrcts. However, Iran Additional Insured - Vcndom ctdossimmat is 811do cd to this policy that spedtkallymov m a person or orgavindon ae an hundred, than this subsection 21 does not apply to that person or c rganiadion 4. Additional insured - Limolted Primary and Non- caalrlbotery Provhlon The following is added as a second paragraph to Section IV Conditions, Condition L Other Insur- ance, foltowingpemgroph b.(2): However, if you !rave added any potter, orgaaiaa- tied a vendor of yawn as an additional insured to this policy by way of this Mult(CoverO r donor mad and have agreed in a wrine .Insured contract than thla insurance is primary and was4oneibu- tory with other insuzu. available to that oddi- lional hrsured, this Instrument, is printery and we will dot seer contriMdon &am such additional insruad's otker handsome. This provision does not apply to other insurance to which such additional Insured has been added is on additional headed, S. Wrivwr ofgubreganon SECTION IV - COMMERCIAL GENERAL LIABILrfY CONDMONS, item S-, is dekeed and replaced by the fIlowkgc S. Tramifnr of Right& of Recovery Against Oth- ers to Us mind Blanket Waiver of Subroptio. a. If the insured had rights b Weaver Olt or part of any payment we lava made under this Coverage part those rights are ttnafared a an, The insured must do nothing at= No Ions to Impair those rights. At our request, the intend will bring suit in transfer dhoo rights to us and help us edforce than. b. If required by a written intend em tram . executed prior to the warrant or of - fang, we waive hey right of recovery, we my have against any person er organ- ization land in such Insured contract, because of payments we make for injury a damage arising out of your operations or yaw work for that pars= or argon- knti=. Mal" la-01 NVeyida, run. Fluna's Pad hrumnw Cw ney. ?oaten CA. Ad arm corms. rrluan wvy,ctae oul¢iN of lewnnt 8m,ixr aha. tend. dhvsrarmeiaa Page 3 or 7 11 6, Caneelleflon - 11E Days Common Policy Coad'dtom eadi mo ment I1.0017, A. Cancellation. horn 2.b. is deleted and replaced by the following: h 120 days before the efiactiva data of cencelle- lion if ws cancel fa say other reason.. 7. - Liberatluden SECTION 1V - COMMERCIAL GENERAL LIABILITY CONDITIONS , the following is ad. ded as ea additional Coudition: Libemgxdlon in the Declaration, for property damage to any one premium while framed to you, or In the coo of damage by fire, expla. siuq sprinkler leakage, oe lightning while reined to you, temporarily occupied by you with the ptrmiudon of the aware, or managed by yea under a written agree art with the owmar, Is the greater of., a. $1,000,000Any One Premium; or it. The Damp To Pretuisea Rented To You Limit shown in Ore Deala- rdions. If we adopt a cheap In our forms or roles which C. SECTION IV - COMMERCIAL GfsN- wotdd bmaden the coverap provided by any tarn ERAL LIABBITY CONDITIONS, 4. that Is a par of this polity without an extra - Other Insmarrcet, h F.xcems Immance, (1), premium charge, tho Invade coverage will apply iteats (b) and (4 me fielded oral replaced by to this policy. This exlemaion is efftctivoupou the the follow approval of soak brads coveap in yam star ing' S. Firm, Esplamaq Sprinkler Leakage, or Llgktmmg Legal Liability Coverago A. SECTION 1 - COVERAGE$, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, 2. Exclusions, the lam paragraph, ix deleted and replaced by the following: Eultnions a through o. do not apply to damage by fire, explosion, sprinkle leakage. or lightning to prasdus wino: 1. Rented to you; 2. Temporarily ocarpied by you with the permission of the owner; or 3. Managed by you under a writers agren- mew with the owner. A separate limit of Intestinal applies to Ibis coverage as described in Section IlI - LIMITS OF INSURANCE. B. SECTION III - LIMITS OF INSURANCE item 6., is deleted and replaced by the fo0ow- ing: 6. SthJecl to 5. abovo, the Damage to Premium Rented To You Limit shows Cause s2m Ceprd111,l 2010, A, Pod hoes M-Wy, nnwla CA All daa„earved. rndrde, Wdo sd .uu,Yt orhm. sv a o1M, he, tla me ptndmm. (b) Thd u Fee, E.xplmian, Sprinkler Leak- ap, or Lighbdng bu amuw fir pramlmrr while mated to you, seapsaerily acca- pied by you with permission of the owner, or managed by you under a writ- ten aaraemem with the owner, (c) That Is insurance purchased by you to cover your liability as a amount far property damage to premium acted to you, tarspourily otrimpied by you who the permission of the owse, or teenaged by you under a wr0let agrerme A with the owner; or D. SECTION V - DEFINITION,, 9. Insured Caerlract, item L. is deleted and replaced by the following (a) A contract for a it= of premhm. However, that portion of the contact fa a lase of premiums them isdemnifnro my plum or orpnizubn for damp by fnq expla". sprinkler lekagq or lightning to psamisoe while rented to yon. tempaaily occupied by you with Imo' mission of rite owner, or mYNged by you under a written agmememt with the owner, is not an Insured contact; Page 4 of 7 0 9. Damage to InAlme' Aubmabila hem Paging Tram ter Tree Limbs - Lladted Coverage Thee coverage applies to direct physical damage to automobiles owned by invitma subject to awl of the following: 1. Provided such damage originates from item ou promises owned, meusged, Weed or rented by on insured; 2. Coverage applies only to Invitees of an In, small or so insured's tenant; 3. Such damage is directly mused by wind-rhi. van ibllingtrees or see limbs; 4. The most we wiE pay for any one Ions is the lowest of. A. the actual cash "Ian of the damaged au- tomobile m of the time of the least; at b. de cost of repairing the damaged amu- mobile; or c. the cost of replacing the damaged auto. mobile with mother automobile of like kind and quality. Regardless of do number of commences, losses or chino. this coverage Is subject. to a limit of $25J1t10In any one policy porlod; 5. This eowtop to nol subject to the General Liability 13enetal Aggregate Limit; and 6. We will make payment under. Chia Covemge without regard to fantt. 10. Naa-Owsed ter Chartered WaharaR SECTION i - COVERAGES, COVERAGE A BODILY IMRTRY AND PROPERTY DAM- AGE LIABILITY, 2. Eaolusiuoe, item 9. Aircraft, Auto, or WstercraB, item (2), is deleted and re- placed by the following: (2) A watercraft yam do not own that is: (a) Lau then 51 ket long; and (b) Not being used for public transportation, or as a common carries; 11. Chartered AlrenO SECTION I - COVERAGES, COVERA06 A BODILY INJURY AND PROPERTY DAM. AGE LIABILITY. 2. Exclusians, 9. Aircraft, Auto Or Wateaera0, item (6), Is added ae foBowa: (6) An aircraft in which you have no ownership Interest sod that you have chartered with crew. 11 Corsage Territory - Broadened SECTION V - DEFINITIONS, item 4.a., is de - head and raplsced by the bEowing: a. The United Steam of America (excluding its u rrimries and possessions), Puerto Rim, Canada, Bermuds, the Bahanue, The Cayman Islands, and fire British Virgin Islands; 13. Pmuut and Advertising Injury- Contactual Unless peramn! and advertWng lejury Is excluded Burn Ibis policy the fnllowkng appllec SECTION I - COVERAGM COVERAGE B, 2. Eulmioet, Item a., is deiexd. 14. reltow grnptsyse Cowraga SECTION It - WHO 13 AN ENSURED, 2.a., item (1) is dotmed and replaced by the following: (I) Naomi mad advertising Igjvyr However, subsections (a), (b), (c) and (d) of item (1) remain unchanged. 15. Bodily injury 08111altleq - Broadened SECTION V - DEFINITIONS, 3. Bedlly Injury is deleted and replaced by the following: Be ft injury mum bod(hy i &q. sickness or db- ease sustained by a pan= including death ter Imadal aagutah amxking fssen any of these at arty time. Mmtod anguish muve any type of motet or enodond illxter or disease. 16. Boasted or Intended Injury - Amandmant to Es - elision SECTION I. Coverage A Bodily Injury and Pro- perty Damage Liability, 2. EXCLUSIONS. a. Es- peetod or Intended Injury, is dieted sad replaced by the following: Canoe ram CM4104 son, Parav,m ore bap C*M;w,. Nrwe. CA All mlaa,we..L 1st wr/.Sbet arch .r6, ewtromr.. Iaa.,n.haroxk ;es Page 5of7 s Expected or InWoded Injury Bodily Injary ar property damage oxpcdcd or intended Gan dke standpoint of the insure. This MOIWIOn does act apply to bodily Injury Of property damsp resulting Gorr the me of reasonable [tree to protect persons of prop may 17. Utdntsmoual 'FaRare to Disda" Hosards SEMON IV . COMMERCIAL GENERAL LIABILITY CONDITIONS, item 6. Represertua. tiara, the Pollowing It added: d. If you unintentionally fail to disclose any be. zards existing at the inception dab of this Policy, we will not deny coverage under this Covmge Norm because of wdt Whom. However, this provision does no affect or right to collect additional premium or exercise out right of cancellation or »onnaawaL IS. SuPPkmetlary Payments - [sormord Limits SECTION f • COVERAGES, SUPPLEMEN. TARY PAYMENTS - COVERAGES A AND B, item I.b. and I.d., am deleted and replaced by rho Wowing: L Tim coal of bail bonds required because of accidents or traffic law vbMion$ wising om of the wee of any vehicle to which One Bodily Injury Liability Coverage applies. We do act have to famish these bonds d All rescuable expenses incurred by The in- sured at our request to insist us ins like inves- dilation or dehnse Of the cisim or soft, including substantiated toss of comings up to $500 a day because of tins off form work. 19. Dollar In the Event of an Occarverhm, onsta, Cdim Or gull - Amended SECTION IV - COMMERCIAL GENERAL LIABILITY LONDMIONS, item 2.a. G delved and replaced by the fallowing (a) You, ifyou are an individual; (b) Your pmtuer or member, if you ate a partnership or Joint venture; (a) Yaw member, if yen are a limited liabil- ity ciassistain (d) Your taeeud" officer if you are an or- gaoization other than a part mMI% johd venture at limited liabilky company. or (c) Your authorized rcpresomadve or immr- ones manager. Knowledge of on moornnoa or otRnss by persons other then time limed above does ant imply that throe Rated above also have such knowledge. (2) To the went possible, notice should include: (a) How, when and when the Ocearhenes or affemse kink phce; (b) The Dame and addrosxre of any injured parsons and whmewer, and (c) The mature mad location of any injury or damage wising out of the met rrome or Off== 20. Man Employment Discrimination Liability Unless personal sad advert[dug Injury is excluded from this policy the following eppRes: A. SECTION V-DEFINITIONS, It personal and adnrdsing Injury, item h. is added an Poi• Iowa: It. D4erhMmtion. B. BECKON V - DEPINrrX*M item 23. is added as follmve: (1) YOU mad sea to it that we of any licensed agcM of "a are notified of a Gomel C. Liability mrarremce or offccee which may re - suit In a claim as soon as practicable after it becomes known to: CO]IA ht-m Copyaiiia W. Fh000tl Fund luanow Ccmirr, sirs,{ CA M apr romea wlu ."dBkM marsid or learn name Oak, he -„la iu mudmwa 23. Discriminations mans the unlawBtl bvd- need of a panne Or class of penaW be- cause Of dtsb spociBeraae, color, ollgion. geadar, oge, or national origin in com- Petiwn to One at not persous who ate no nsombers of be specified class SECTION I - COVERAGES, COVERAGE B PERSONAL AND ADVERTISING INJURY LIABILITY. 2. Exduslun; the following are added: Page 6 of 7 p. Disch go ilea directly or Indirectly re- lated to die past emptoymear, employ- ment of prospective employment of my ponom or class of person by any insured; q, ninrimdmarfoa directly or Indkrcaly re. Wed to the sole, "Rai. lease of sublease or pm Ptaive "So, renal, lease or sub• leave of any dwelling a pammment lodg. ing by or at the direction of any insured; r. IYACH tlnottoa, if Imareme 1Mreof is pmhibiled by law; or I. Pins, penhies, specific performance, or injunction levied or imposed by a gov. errunemni Badly. gove .. that code, law, or statute becewo of dbulal tetton. 21, Medical Paynudt Unless COVERAGE C MEDICAL PAY- MENTS. or the pmduoft a aplolad oPentlan harard list bean excluded iron this policy the fol- Imving applics: caress txo7 C"P*U 2W, rpm tYd bmae Caqury, NMI, CA. ADA"mv,M aKAde, <epydtmtd mrMilol nllmwea S,Meu nRm im. +'vY lepe,ekam A. SECTION i - COVERAGES, COVERAGE C MEDICAL PAYMENTS, 2. Exclnlom item L, is deleted and replaced by We follow- ing; f Producta-Complated Operation IIasard Incktded within the produ taeompleted Operations hasard Howovor, this exclu- sfoa dms not apply to expenses for den- tal services R. Section 1 - COVERAGES, COVERAGE C MEDICAL PAYMENTS, is amended to in- chate item 3. as rollover 3. Limit ofInsunsov The Medical Expense Limit of Im amco shall be the gram 0. a. $20,000Any Om Person; or b. The atttouat shorn A the Declare- tions. Page 7 of 7 Polley Bolder: assistant 4 gamin PCs Inc Palday llo;set MZX8N07585 Amendmenttis Condition 4. Other Insurance - CG 72 53 09 05 Policy &MMMO a(a) Commpcial GwMI Liability The following is added as a mwW parV*h to Sec. tion IV Condltiwa, Cwdhion C Other hinu mice. fol. Weed ie a writhes lawred esaaraa drat thin inneutoa lowing paragraph bQ), - B Prineny and n cwt ibe" with Gabor iwtirsrma available to that additional inaowd, aW imaanw is However, if yea ham added a my radon, oryermatirn Primary and we will nee reek eoambktioe frost ouch add lkiml inaord'a aber imilmice. This provision m Vendor of yoen as an addillc W inwred W this does doesna apply a Odlar imaaoca m which fafb addi- policy by way of. MnleCavma endoncmrnt and lawn umtmd boa been added as as additional wweL thin for are he .eaAw w ChOW Edonrwa ohm weed one as Pak) m mirb, m.r Nde n,.r.i . Y..e le.raarrt.ap..b r rerr0 is as Paaf acne) ae 9C484 CERTIFICATE OF LABILITY INSURANCE GP ID RG 11ODST-2 09 08 09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Alliant Insurance Services, Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE (Lic-OC36861) HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 735 Carnegie Drive, Ste 200 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. San Bernardino CA 92408 Phone:909-886-9861 Pax:909-886-2013 INSURERS AFFORDING COVERAGE NAIC#INS- INSVRlD INSURER Xvaa..t H Lj1 a1 [neuennea Cn INSURER IL Hoton i Harria pC9 Inc ;NWRERC: 21637, Harton Rpad INSURER D: Grano Terrace CA 92313 THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANOING ANY REOUIREMEN T, 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 SUBIECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ._—._—TYPEOFINSURANCE —�Y ILA SR POLICY NUMBER OA LVw" LIMITS GENERAL LIABILITY EACH OCCURRENCE f �IrCOMMERCIAL GENERAL LIABILITY 1 CLAIM MADE _n OCCUR 1 PREMISESEsoaar. f' MED EXP (MYone Perwn) S PER9ONPL&AOVIWURV 8 GENERAL AGGREGATE _ 3 GENL AGGREGATE LIMIT APPLIES PER POLICY SEC: i LOC PRODUCTS-COMPAP AGG 5 AUTOMOBILE LABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea a dmtl f ALL OWNED AUTOS SCHEDUtEDAUTOS BODILY INJURY (Par person) E HIRED AUTOS NONowNEDAUTOS -' ..-Appi VED A5 �y r, ,L 0 �OS�lYl 1 BODILY 'INJURY cP«e�;aem) 3 PROPERTY DAMAGE (ParPERTY) S GARAGE LIABILITY S Iced AUTOONLY.EAACCIDENT f ANY AUTO aura Stitt '$IaLBIIt City tNrney AUTO TRAIN FA AGO AUTOONLY: AGO f 3 EXCESSAIMBRELIA UA131UTY OCCUR El CLAIMS WOE EACHOCCURRENCE $ AGGREGATE 5 __ f S DEDUCTIBLE S RETENTION f WORKERS COMPENSATION AND A ANY PRORIETORPm ANY OMMEETOR EXCLUDED? UTIVE OFFICEPoMEhIBER EXCLUDED? tt yYm, Aunder 3PECWLPRO PROVISIONS DNaw 7600003267091 09/02/09 09/01/10 X I TORYLIMRS ER E.L. EACIL AcaDENr sl 000, 000 _ El DISEASE -EA EMPLOYE SS DOD, ODO E.L DISEASE -POLICY LIMIT 15 1 OOO OOO i OTHER DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Operations pertaining to named insured for certholder- City of Santa Ana and its officers, agents, representatives, volunteers, i employees; Work Comp Waiver to follow. *30 days HOC for non-payment except 10 days NOC for non-payment. CARRIER WILL NOT HODIBY CANCELLATION CLAVBE/NO xx OUT. Null i Voids prior certificate issued 09/02/09. aCa:I I I a Ltl_\I-1:u1 R N a: N,1: TN tl■ a\ i r,l! CISANO6 SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE EXPIRATIO City of Santa Ana DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30• DAYSYMATEN Public Works Agency NOTICE TO THE CERTIFICATE HOLDP-N NAMED TO THE LEFT. BUr FAILURE TO 0050 SHALL M-85 220 S. Daisy Ave IMPOSE NO OR LIASBITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR Santa Ana CA 92703 REPRESENTATIVES. AUTHO D EPRESENT AGOR025 J20017091 — •' - ® ACORO CORPORATION 1950 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 The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.