HomeMy WebLinkAboutGOLDEN BELL PRODUCTS, INC. 2City of Santa-.-.na
z_ Clerk of the Council
- AGREEMENT TERMINATION FORM
Please complete this form when the attached agreement and all
are no longer in effect. I
Return form to the Clerk of the Council Office (M-30).
Call 647-2520 if you have any questions.
The agreement with ZA,
No. N--121 - was completed on
`Etiss.ail.Mwawrw?awts. Use space below if needed.)
ReWsed 07_22-09
COTC Ofl?eyse Only
(if Of S a° NTA ANA
CLERK OF COUNCfL
and final payment has been made.
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INSURANCE ON FILE
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UNTIL INSURANCE EXPIRES
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CONTRACTOR AGREEMENT
N-2009-121
C ~ ~ ~~ THIS AGREEMENT, made and entered into this 24`" day of September, 2009 by and
~ between Golden Bell Products, Inc., a California corporation, (hereinafter "Contractor"), and the
City of Santa Ana, a charter city and municipal corporation organized and existing under the
Constitution and laws of the State of California (hereinafter "City").
RECITALS
A. The City desires to retain a contractor having special skill and knowledge in the field of
pest control, to apply insecticide to manhole covers in the City.
B. Contractor represents that Contractor is able and willing to provide such services to the
City.
C. In undertaking the performance of this Agreement, Contractor represents that it is
knowledgeable in its field and that any services performed by Contractor under this
Agreement will be performed in compliance with such standards as may reasonably be
expected from a professional contractor 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 apply insecticide to City manhole covers, 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,
the rates and charges identified in Exhibit A. The total sum to be expended under this
Agreement shall not exceed $25,000 during the term of this Agreement.
b. Payment by City shall be made within thirty (30) days following receipt of proper
invoice evidencing work performed, subject to City accounting procedures. Payment need not
be made for work which fails to meet the standards of performance set forth in the Recitals
which may reasonably be expected by City.
3. TERM
This Agreement shall commence on the date first written above and terminate upon the
expenditure of funds, unless terminated earlier in accordance with Section 12, below.
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. Consultant shall maintain commercial
general liability insurance which shall include, but not be limited to protection against claims
arising from bodily and personal injury, including death resulting therefrom and damage to
property, resulting from any act or occurrence arising out of Consultant's operations in the
performance of this Agreement, including, without limitation, acts involving vehicles. The
amounts of insurance shall be not less than the following: single limit coverage applying to
bodily and personal injury, including death resulting therefrom, and property damage, in the total
amount of $1,000,000 per occurrence, $2,000,000 in the aggregate. Such insurance shall (a)
name the City, its officers, employees, agents, volunteers and representatives asadditional
insured(s); (b) be primary with respect to insurance or self-insurance programs maintained by the
City; and (c) contain standard separation of insureds provisions.
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: (1) for personal
injury, damages, just compensation, restitution, judicial or equitable relief arising out of claims
for personal injury, including health, and claims for property damage, which may arise from the
direct or indirect operations of the Contractor or its contractors, subcontractors, agents,
employees, or other persons acting on their behalf which relates to the services described in
section 1 of this Agreement; and (2) from any claim that personal injury, damages, just
compensation, restitution, judicial or equitable relief is due by reason of the terms of or effects
arising from this Agreement. This indemnity and hold harmless agreement applies to all claims
for damages, just compensation, restitution, judicial or equitable relief suffered, or alleged to
have been suffered, by reason of the events referred to in this Section or by reason of the terms
of, or effects, arising from this Agreement. The Contractor further agrees to indemnify, hold
harmless, and pay all costs for the defense of the City, including fees and costs for special
counsel to be selected by the City, regarding any action by a third party challenging the validity
of this Agreement, or asserting that personal injury, damages, just compensation, restitution,
judicial or equitable relief due to personal or property rights arises by reason of the terms of, or
effects arising from this Agreement. City may make all reasonable decisions with respect to its
representation in any legal proceeding.
7. CONFIDENTIALITY
If Contractor receives from the City information which due to the nature of such
information is reasonably understood to be confidential and/or proprietary, Contractor agrees that
it shall not use or disclose such information except in the performance of this Agreement, and
further agrees to exercise the same degree of care it uses to protect its own information of like
importance, but in no event less than reasonable care. "Confidential Information" shall include
all nonpublic information. Confidential information includes not only written information, but
also information transferred orally, visually, electronically, or by other means. Confidential
information disclosed to either party by any subsidiary and/or agent of the other party is covered
by this Agreement. The foregoing obligations of non-use and nondisclosure shall not apply to
any information that (a) has been disclosed in publicly available sources; (b) is, through no fault
of the Contractor disclosed in a publicly available source; (c) is in rightful possession of the
Contractor without an obligation of confidentiality; (d) is required to be disclosed by operation of
law; or (e) is independently developed by the Contractor without reference to information
disclosed by the City.
8. CONFLICT OF INTEREST CLAUSE
Contractor covenants that it presently has no interests and shall not have interests, direct
or indirect, which would conflict in any manner with performance of services specified under
this Agreement.
9. NOTICE
Any notice, tender, demand, delivery, or other communication pursuant to this
Agreement shall be in writing and shall be deemed to be properly given if delivered in person or
mailed by first class or certified mail, postage prepaid, or sent by telefacsimile or other
telegraphic communication in the manner provided in this Section, to the following persons:
To City: Clerk of the City Council
City of Santa Ana
20 Civic Center Plaza (M-30)
P.O. Box 1988
Santa Ana, CA 92702-1988
Fax 714- 647-6956
With courtesy copies to:
Public Works Agency -Water Resources Division
City of Santa Ana
220 South Daisy, Bldg A
Santa Ana, California 92702
Fax 714- 647-3345
and
City Attorney
City of Santa Ana
20 Civic Center Plaza (M-29)
P.O. Box 1988
Santa Ana, California 92702
Fax 714- 647-6515
To Contractor: Golden Bell Products, Inc.
Michelle Webster
1200 N. Jefferson St., Unit M
4
Anaheim, CA 92807
Fax 714-630-4807
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. If 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 the City upon thirty (30) days written notice of
termination. In such event, Contractor shall be entitled to receive and the City shall pay Contractor
compensation for all services performed by Contractor prior to receipt of such notice of termination,
subject to the following conditions:
a. As a condition of such payment, the Executive Director may require Contractor to deliver
to the City all work product completed as of such date, and in such case such work product shall be
the property of the City unless prohibited by law, and Contractor consents to the City's use thereof
for such purposes as the City deems appropriate.
b. Payment need not be made for work which fails to meet the standard of performance
specified in the Recitals of this Agreement.
13. DISCRIMINATION
Contractor shall not discriminate because of race, color, creed, religion, sex, marital
status, sexual orientation, age, national origin, ancestry, or disability, as defined and prohibited
by applicable law, in the recruitment, selection, training, utilization, promotion, termination or
other employment related activities. Contractor affirms that it is an equal opportunity employer
and shall comply with all applicable federal, state and local laws and regulations.
14. JURISDICTION -VENUE
This Agreement has been executed and delivered in the State of California and the
validity, interpretation., performance, and enforcement of any of the clauses of this Agreement
shall be determined and governed by the laws of the State of California. Both parties further
agree that Orange County, California, shall be the venue for any action or proceeding that may
be brought or arise out of, in connection with or by reason of this Agreement.
15. PROFESSIONAL LICENSES
Contractor shall, throughout the term of this Agreement, maintain all necessary licenses,
permits, approvals, waivers, and exemptions necessary for the provision of the services
hereunder and required by the laws and regulations of the United States, the State of California,
the City of Santa Ana and all other governmental agencies. Contractor shall notify the City
immediately and in writing of its inability to obtain or maintain such permits, licenses, approvals,
waivers, and exemptions. Said inability shall be cause for termination of this Agreement.
16. MISCELLANEOUS PROVISIONS
a. Each undersigned represents and warrants that its signature hereinbelow has the power,
authority and right to bind their respective parties to each of the terms of this Agreement, and shall
indemnify City fully, including reasonable costs and attorney's fees, for any injuries or damages to
City in the event that such authority or power is not, in fact, held by the signatory or is withdrawn.
b. All Exhibits referenced herein and attached hereto shall be incorporated as if fully set
forth in the body of this Agreement.
///
///
6
IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year
first above written.
ATTEST:
MARIA D. HUIZAR~~
Clerk of the Council
CITY OF S:~I~1TA ANA
/~j, , /~
G
DAVI N. AM
City Manager
APPROVED AS TO FORM:
JOSEPH W.FLETCHER
City Atto~ ey
,~
By: r ;~ ~
Lau'r'a Sheedy
Assistant City Attorney:
RECOMMENDED FOR APPROVAL:
~/~ ~
GEORGE ALOAREZ ~~
Acting Executive Director
Public Works Agency
GOLDEN BELL PRODUCTS, INC.
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(Name) 1`~ urr- I I (1 F~clcim5
(Title) `~ re~S~d~,nt,
Tax ID# 33 ~ d l ~.~- 4 (o ~ 4
EXHIBIT A
SCOPE OF SERVICES
i
°O nROOUCis. itvc.
1200 N. Jefferson St. "M" Anaheim, CA 92807 - Phorre (714) 630-3861 /Fax {714) 630-4807
www.goldenbellpmoducts.com
Friday, September t $, 2009
Citx ,oi Saute AnA
Rudy, Rows.
220 S,Dai,~ Ave ;,JrM-85~
,zS„anta Ana,,GA 92703
Der Rudy:
Golan BeN Products b provide aN labor, mater~l and suppYes requited b coat sanitary sewer rtrarrholes wltt
INSECTA, ineecYddal Iatex coaling for server roach conlrot.
SCOPE OF VVOfiiC
Golden Be0 Prodrxds b perform the 9 iterrrs:
• Apply an approved product for sewer roach oontrd appficaflat ~ sanitary rtrat-hdes.
• Treat b depth of eight (ti) feet or less, wMr an approximela area of 100 square feet per ttantrole.
• ~Ndl prepare and treat aocadkrg b manufacturer's spectRcations for preparation irabuctions.
• Appy coatitg !rased on tire rtranufaduers recorrrrrerrded label vales, live {~ manholes per galls!, not to
exceed three (3) pills per rrtarthole.
• Mark each manhole cover with an idetttiying cobr aNer being trued.
• Provide proper supervision at the Job site during aN phases of work.
• 8e respot-sible br coord'inadrrg the work b be done. Wak wll take place in alleys, yards. packing bfs. and
attests.
• Guarantee the appftcation for Two (2) furl years 6om the date of Ueattrrent. ff more than 50 ~g roadies are
found in a manhole drrrkrg lire wartardy period, the manhole trxwt ttren be rebeabd by Golden BeN Products at
no addMional charge or obfgation b Cusoemer. Golden ttel Products will retied any manhole wfrlch
krspections report ivs roactres witltin fourteen (14) cwldrdar days after notification'
• WiY report nunber of metrlroles and dearrorr<s bested when subrn7tkrg bNNrrg itwokres. Golden l3eN Prodrrct$
wtll irrdirwte h writing on each quarter section wrap. the rnaMer of manholes and dearauts !reeled. applicator's
name wifh the date of cortipletiort. Thb wAl serve as the record of aprpicdlotr for the rteoessaty Ag~enctes and
warranty hfortrratiorr.
• Cusbnrer wilt supply quarter sethon maps irdicabng exact locatiorts of mentales and deanoats.
• Customer wiN make accessible aN manholes and clearrouts b be coated. ti not accessible Golden
BeN Products wrl tatty Customer b expose. tF Cusbrtrer chooses Golden BeN Products will expose and beat
This wfN incur an addNiortal dratge.
• Customer will provide inspection and asaislarrce where rreoessary.
• No more than if0 calendar days wiN elapse between date of ratios b proceed and completion of the
appYcation. A reaeor>Hble tiros for potet>daNy urhnvtable weather wiN be agreed upon by Cusforner
and Gokten 13efi Products
• Requiremerds may ba added or del8bd from the above Scope of Work, however both parties prig ~ the
carrrnerroerrrerR otwork must agree these upon.
• The cost of additional perrnla andtar tloerraes, oUrer Urea Uroee aheady requied b!- fre stale, regrind wlMn
dir FMIs b perform work wlNn that ~ wit be a~raned by the dly.
Golden Bel Products wit soppy a1 appropriate irrsrrarrce coverage requYed by the stake Noerwing agerraes to
apply roach oorrtrd product b sewer merrtrolas.
Speaal Noce: Some asalsterroe wlh tratlc corrUd in beauty trav~ed arms may be requied.
'NOTE: T'he krsadtadaFtatex coafkrg !s trot a repelrerrt and thereibre, rr8 not repel naarahes They mast resi on it
to ef!<nhrate them!
Pricing Per trta-rlrole /Ippkcation costa
For loss dun f 00@ llsrrholes b =19~Ob a.
For more dun 1000 ltarrhoNa & =16.50 s>r.
(This is aservice - No Safes Tax}
Example Prfrd-g:15f 5 martlrofes ~ 516.50 ead- is 524,997.50
7riere fs a 150 marrfrale mbrirnrsn 1~Or aM jobs
This proposal is good through June 30, 2010. Thank you for lhls opporturdy. N you have arty questions pleave
contact Michele Webster at 7141ti30-3861.
~.
Midreie Webster
Program Manager
10
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STATE P.O. SbX 420$07, SAN FRANCISCD,CA 94942--0807
COMF~SNSA7tON
lNSUFtANCE
Q CERTIFICATE OF WORKERS' COMPENSATION iNSURANGE
ISSUE DATE: 10-04-2008 GROUP:
POLICY NUMBER: 9714034-2008
CERT(P[CATE 1D: 83
CERTIFICATE EXPIRES: tp-04-2009
90-Oa-2008/10-04-2D08
~ CITY ^F SAFt9'A ANA 5P c1OB:MA#~ItfOLE SPRAYING FOR RbAC}1 CDNTRDL
20 CIVIC CENTER PLZ RM a29
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 indica#ed.
This policy is not subject to cancellation by the Fund except upon 10 days advance written notice to the employer.
V11e will also give You tp days advance notice should this policy be cancelled prior to its normal expiration.
This certificate of insurance !s not an insurance policy and does not amend, extend ar alter the coverage afforded
by the policy fisted herein. Natwithstandiny any requirement, term or condition of any contract or other document
with respect t4 which this certl#lcate of insurance may be issued or to which it may pertain, the insurance
a##orded by the policy described herein is subject io all the terms, exclusions, and conditions, of such policy.
Ck~'~ r~t~
HQRIZED REPRESENTATI PRESIDENT
EfAPLOYER'5 LIABILITY LIMIT INCLUDING DEFENSE COSTS: 51,000,000 PER OCCURRENCE.
~~a~~~~ ~- ~ ~~
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~SSlS`ant
EMPLOYER
GDLDEN BELL PRODUCTS, ING
t2p0 N JEFFERSON ST ST#: M
ANAHEIM CA 82807
SP
SP
MlJ4 t0
(sev.2-o51 PRINTED : 03-t7-2008
lUJl3fLU08 15:17 FA3 SBA 43I 1355
~IUVJ
AGC)Rt? CERTfFICt+,TE ~J~ ~~ABILII~ INSURANCE ,a }~ °'Y"Y"'
PRIJDl1CCl!
•~CaiCoast Iasurattcs ea
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P.O: Boa lefa THIS CERTIFICATE I& ISSUED AS 4 MaTT1:R OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. T'H15 CERTIFICATE DOES NOT ANfEND. EXTEND OR
ALTER THE CDV®tAC3e APigDRDED 8Y TFti_ POLICIES BELOW.
Las Alenlhos, CA. 9072e
__~
NSURERS AFFORDING COtJERA(iE
tYA1C 14
wlauRao olden 3ei! Prxiuds lac. ` NSURGiiA: NerCU Cas Coat
1200 N. detFeaoa Avenue SIN ~ 9taEe saGaa lnaorana Fumf
Mahsim, GA. 89720
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rrnrconr_as
THE POLICIES OF INSJRANCE LIBTED BEI~CiW HAVE BEEN 188UED TD THE WSU9ED NAMED ABOVE FOR THE POLICY PERIOD tN61CJ-TED. Nb'tYVI't}sSTNVDINO
ANY REQUIHE~NT. TERM DR CONDITION C= ANY t30N7AAGT DR OTHER OO~l61ENT iNITH RE&PECT TO WHIOIi THIS CER'f~IJ-Tt: MAY BE ISSUED OR '
i~WY P4~iTA1N. THE t'rSURANCE AFFORDED a~ THE PQUQE.S D6"atSt186D !ii~N t& TO ALL THE TERNS. EXCLUSIONS AND CONDITIONS OF SUCH
POL1CJTeS. AGOREGATL LIAaT$ SHOWN NAY HAl E BEEN R®UCED BY PAID CLAIMS.
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La~rl Stitr Sig •~dy ~~
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10 day notice of cancsllalion for non-paymalt o E pn~adinn.
Ws have that tito CINfINcab Holder be Dated es Add-dional insured.
Clhr of Sank Ma
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- f ~- Saata Ma, CA. lt702
~-•- ~ ; FEa: 714~T--3345
BFpU{,eIWYCFTIEABOYEG~GRIe®PO~LIGES~CAAIG~.ED eEWRE THE EXPIRATION
OAT'! Tl1ERCOR Ti1G ISSUi~IG SURER IIYlLI. QNDFAYOR TO MAIL ~ DAYS YtRRTEN
NvrroeTOTlIa oeerlrloas>: Ho~oeRwrr®Ta rNa LeE~r, sur~u~ra aosoar~ALL
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POLICYHOLDER COPY
P.O. BOX 420807, SAN 1=RANCISCO,CA 94142-0807
CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
ISSUE DATE: 10-04-2009
CITY OF SANTA ANA
20 CIVIC CENTER PL2 RM 429
SANTA ANA CA 92701-4058
GROUP:
POLICY NUMBER: 1? 14034-2009
CERTIFICATE ID: 83
CERTIFICATE EXPIRES: 10-04-2010
10-04-2009/10-04-2010
SP JOB:MANHOLE SPRAYING FOR ROACH CONTROL
This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the
Califiornia Insurance Commissioner to the employer named below for the policy period indicated.
This policy is not subject to cancellation by the Fund except upon ~ 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 /{1600 - MURRILL ADAMS. PRESIDENT - EXCLUDED.
ENDORSEMENT !12065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 10-04-2003 IS
ATTACHED TO AND FORMS A PART OF THIS POLICY.
EMPLOYER
GOLDEN BELL PRODUCTS, INC
1200 N JEFFERSON ST STE M
ANAHEIM CA 92807
SP
V E~~ ~~ ~~ ~pa~M
APpgO
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Laut~~Stitt Sh
Assistant City Actornc)
SP
M0410
(REV.2-o5- PRINTED 09-17-2009
~~ ~Rl`JM GOLDEN BELL FAX N0. 17146304807 Nov. 09 2009 11:39RM P2
iiv •, 1 LV Ji I I,~'Y Ynlu ~i L.IdLY :IY ~'J 'l^'~~Y Y~L IYV, J7L r
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aaoouosa THIS Cs°RTIFICATE IS kSBUED AS A MAlT6R OF INFGRM
Yan Saaraas 7wa, sere. J:11Q. ICinOsburp ONLY AND CQIYFFERS 1110 RIGHTS L3RQfd TWE CERTIF
vd BaY 67, a6oo Draper stroot HOLDEk. TFIIS C~'tlNICATE DOES NOT AMEtYm, EX1'E7Y
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~: ffisabCle apzayiag fps svACh ev~ptrpl ~t YAC~Y9Y.Yi0 loeatioae, 7:1r ie ngs~y~ tthaa tlse Y:ity of 3eatn llJl
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Santa AAa Cg D27 pZ-p0a0 AU7}YOl~O R!/i~YLATIYE
ACOrZD 2S (2oovct8j ~~ >s+AWRD CORPORATION 18EE
• FRL1M GOLDEN BELL FAX N0. 17146304807 Nov. 09 2009 11:40AM P3
i~,~~ ~ ~ i~~'~n iiin U~LtL L'4 _~iJ„:111,14. tiU. Jy:
~~ ~
PQI.JCY NI;iM9El~: G91PGgbT131 CQt{AMERGtAL [~t?NEfZA4. LIABILITY
Golden Bell Products, Inc, i~ xp 1010 93
7HI8 ENDQRSEMEN7 CHANGES 711~~ POLICY. RL~ASE READ lT CAREI=tJI.LY.
AC~~ITIC?h1AL INSURED ~ OWNERS, LESSEES OR
CONTRAC70RS (FOf~M B)
Th1s endorsement modifies insurance cravtded under the faliowing,
~cMm~RCUU. GENERAL LIABILITY cOVEI?AC~13 PART
Name of Person or Ot'ganftatibn:
sc»1=_1~uLl:
City 4'~ 8anta Ana
!ts oflloers, employees. agents, and representatives
20 Chrlo Center Plaza, F~TJt 2,49
Santa Arta, CA 92702
(!f no entry appears above, infomya~on requited to completer this endorsement will be shown in ~e
Dedax~tions as appliGabie to this endorsement.)
WHO IS AN INSURED (Section I~ Is amended to include as an insured the pefson or organization shown in
the Schedule, but only with respect to liability arlSirlg out of your ongoimg aperstions per('ormgd for ±t1at
insured.
It is a~resd such insurance as is afForrlad by this policy for the benefit ot'tne addEtlonal
insureds) shown in the endorscmpnt, shah be primary insurance. Arty other Insurance
meint$ined by the additional inaured(s) shsfl be excess and non-contribu~r~ not only as
respeoE to arty claim, loss or liability arising out of the aperaffons df the named irl5Uretl,
and only if such a claim, loss or IiabiGty im determined to ba solely the negligence or
resporfsibt~l(y of the named insured.
GG ~p 1010 q8 Copyright. Inswranae Services Qtfioe, InG, f 992 p
•~ FRt*]M GOLDEN BELILI FAX N0. 17146384887 Nov. 09 2889 11:41AM P1
~~~U, L L7~Ji ( idFldl tiHl~ i~~Cfl. i1 CV !T. ~~'~i~ri,Uv: ~V V, '~;~ L.`~
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IMPORTANT
I ff the cerldicate hakJer ie an ,q(yp1T1bNAL 1N5UR1=D, tie po3lc~r(1es) must be endorsed. A stetatnar~t
on this certificate daea not center rights to the Cert~COltC holder in lieu of such endorsement(s).
E IF SUBR043ATI0N tS WP,~V~p, subject to the terns and conditlans of the peaty, certain palftdes may
i n,yulre an er+aorsement A stnternent On this certtficsle does not asnfrx rishis to the cerfifirs3te
' holder in flea of sud'~ endorsement(s)_
OISQLAIMER
Tha Certificate aF lnaurante on the reverse side aF thla fmm does not constitute a cbrnre~t ta.twsen
the issuing tnaurer(sr), authoti;pq rgpr®sentstive er producer, and the certiftcste holder, rror dew a
attirmatvely or nagati.•ey arrsDnd, 87dend ar eker the coueraga anortled by the pe:teies Ilsted thereon.
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