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HomeMy WebLinkAboutPITNEY BOWES PRESORT SERVICESINSURANCE ON FILE VVGRK MAY PROCEED UNTIE INSURANCE EXPIRES N- 2011 - 111 -001 t LERK OF COUNCIL AMENDMENT to the MAIL PROCESSING AGREEMENT DATE: Fg 2 $ 2013 G FM SIT This Amendment (the "Amendment ") to the Mail Processing Agreement dated July 3, 'C�av, 2006, is entered into by and between Pitney Bowes Presort Services, Inc. ( "PBPS ") and City of 4ers<Iileb Santa Ana ( "Customer "), as of the 27th day of January, 2013 ( "Effective Date "). PBPS and Customer may be referred to collectively as the "Parties ". WHEREAS, PBPS and Customer entered into a Mail Processing Agreement on July 3, 2006 ( "Agreement "); and WHEREAS, the Agreement provides that PBPS may, at its option, terminate or modify the Agreement in the event the United States Postal Service ( "USPS ") adopts any new postal regulations, procedures, rates or incentives; and WHEREAS, the USPS has adopted new postal regulations, procedures, rates, or incentives effective January 27, 2013; and WHEREAS, the Parties desire to amend some terms of the Agreement. NOW, THEREFORE, for good and valuable consideration, the Parties mutually agree as follows: 1. Unless otherwise defined herein, all capitalized terms used herein shall have the same meaning as set forth in the Agreement. 2. Attachment A is hereby amended and replaced in its entirety. The attached Attachment A replaces and supersedes any and all previous Attachment A versions. Except as amended herein, the terms of the Agreement remain in full force and effect and are hereby ratified and affirmed. PITNEY BOWES PRESORT SERVICES, INC. By: U "j)W= Printed Name: Itcole M. Ziska, VP Finance Pitney Bowes Presort Services, Inc. Title: Date: Z(Z l l l AWESi: MARIA D. HUIZAR CLERIC OF THE COU ' Proprietary and Confidential PBPS Contract Management - Rev Nov 2012 CITY OF SANT ANA By: Printed Name: Kw lti1 C' (nun - Ise Title: Date: RECOMMENDED FOR APPROVAL: Francisco Gutierrez Executive Director Finance and Management Services APPROVED AS 'TO Page 1 of 3 Z///K�w /�&/ Laura Str eedy Assistant Vy Attornev ACC>R" CERTIFICATE OF LIABILITY INSURANCE DATfi(mmlODmrr) CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, 01/22/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the pol)cy(les) must be endorsed. 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). PRODUOER N ,E. Maras USA Inc., Multinational Incoming Unit a service. of Seabury and Smith, Inc. 9830 Colonnade Boulevard, . Suite 400 WANE A/C Na: n-rqj -4100 E -MAIL ADDRESS: 1NSURER(6LAFFORDINO COVERAGE NATO# PC Box Box 659520 San Antonio, TX 78265 -9520 INSURERA: NAT'L UNION FIRE INS CO of PA A 0 TO ELATE PREMISES fee Ocaurrec _ INSURED INSURERS: All_i_anz Global Risks US Ins Co $10 000 INSURERC_ S10 ADO 000 Dynamex Operations West, LLC. I/y /// T oil 2051 Raymer Ave, Unit A A/- Fullerton, CA 92833 INSURER D.: INSURER INSURER E: INSURER P: GENERAL AGGREGATE 310 000, 000 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE USTEO 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 ANDCONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE 13EEN:REDUCED BY PAID CLAIMS. I OR TYPE OFiNSURANCE City Of Santa Ana 20 CIVIC CENTER PLZ. POLICY NUMBER Mlo F eCY EXP OfYh1p Y, LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ]OCCUR GL1872136 12/01/2013 09/01/2014 EACH OCCURRENCE S 0 000 A 0 TO ELATE PREMISES fee Ocaurrec $10,000,000 MED EXP(Any one poman) $10 000 PERSONAL &ADV INJURY S10 ADO 000 J GENERAL AGGREGATE 310 000, 000 _ _ 0EN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS- COMPIOP AGO 910 000 000. S POLICY PR' IOC A AUTOMOBILE LIABILITY CA6506059 12/01/2013 3/01/2014 E4 eB idea nt51.GLE LIMIT 010,000,000 BODILY INJURY(Per pereum 'S X ANYAUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS NOILOWNED AUTOS BODILY INJURY (Parawldenq. S PROPERTTDAMAGE er eadidsn S S B X UMBRELLA LIAR I X .00CUR XYZ00032016370 2/01/2013 03/01/2014 EACH OCCURRENCE _35,.000. 09U AGGREGATE $5.,900.,000 ME"LIAO CLAIMSMADE DED RETENTIONS -. $ WORKERS COMPENSATION WCSTATU, OTH -I AND EMPLOYERS' LIABILITY YIN ANFIGERIMEMBEREARTNE O?ECUrIVE77 MIA EL. EACH ACCIDENT S E4 DISEASEEAEMPLOYE 3 ((Mandatary In NH) If yes ceramics under DESLtRIPTIONOF'OPERATIONSCeICry EL. DISEASE POLIOYUMIT ;S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remorlm Schedule. If more apace Is required) City. Of Santa Ana is included as an Additional Ip9eured on General Liability and Auto Liability as required by written contract. The above Ombrelle Policy XYZ00032016370 with All Ana was placed by March Canada Limited. Seabury & Smith, Inc. has only acted in the role. of a ooeultant to this placement, which is indicated here for your convenience A 1DPRO 3f g; r �`. A S TO FORM '6d t 111/ 1 Ki1.M I'T,..]. A Sl A lA L CERTIFICATE HOLDER Assistant tin, fr,..,,n., CANCELLATION m 1988-2010 ACORD CORPORATION.: All rights. reserved. ACORD 25 (2010/08) The ACORD name and logo are registered marks of ACORD DS$44221855 SHOULD ANY OF THE ABOVE. DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE. DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City Of Santa Ana 20 CIVIC CENTER PLZ. AUTHORIZED REPRESENTATIVE -SANTA ANA, CA 92701 m 1988-2010 ACORD CORPORATION.: All rights. reserved. ACORD 25 (2010/08) The ACORD name and logo are registered marks of ACORD DS$44221855 ACCW " CERTIFICATE OF LIABILITY INSURANCE DATE 1 /312001VYYY) 1!3(2014 THIS CERTIFICATE. IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES. NOT AFFIRMATIVELY OR NEGATIVELY AMEND, . EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies)must be endorsed. If SUBROGATION IS WAIVED; subject to the teems and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights 4o the certificate holder in lieu of such endorsement(s). PRODUCER -- -- - CONTACT POLICY EXP _. MooryYYY NAME; MARSH USA INC, 6500 SMERIDAN DRIVE, SUITE 114 WILLIAMSVILLE, NY acmExt: 1-666 - 016 -0088 Np. 410- 349 -4584 EMAIL _ -- ADDRESS; INSURER (S) AFFORDING COVERAGE NAIC N `U. &:A. 14221 ©/1-,// -0O INSURER N. EACH OCCURRENCE /" W J IN RED' Dynamex- Operations West, LLC 2051Raymor Ave, Unit A Fullerton, CA 92833 INSURER B:. INSURER C: •- -- INaea D: LIBERTY MUTUAL FIRE INSURANCE CO. w — 23035 WSuSURER e: DAMAGE TG :NED PREMISES. Me occurrence) $ INSURER F: MEOE-XP(Any One parson) $ COVERAGES CERTIFICATE NUMBER: 13114.252 -WC REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE. LISTED BELOW HAVE SEEN 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 TERM$, EXCLUSIONS AND CONDITIONS OF 'SUCH POU014B.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INUR LTR - - TYPE OF INSURANCE APOL INSR short WVD POLICY NUMBER. POLICY EFF MMOD POLICY EXP _. MooryYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR DAMAGE TG :NED PREMISES. Me occurrence) $ MEOE-XP(Any One parson) $ PERSONAL SAOV INJURY $ GENERAL AGGREGATE $ GEN' {AGGRBGATELIkUT APPLIES PER PRODUCTS' - COMP /OP AGG. $ $- oUCY PRO- LOO aurDMOaILELlaeluTY [IITP12� ? COMBINED LIMIT ES accident) $� BOOILY INJURY (Per parson) $ ANYAUTO ALLOWNRD SCHEDULED AUTOS AUTOS NON -OWNED HIREDAUTG$ AUTOS I UTB . stout - Od 'ltt. �)4G y itY A ttD "B - -^" `" w BODILY INJURY (Per accident) $. J?ROPERTYDAMAGE Per accident $ L_JUMBIIELLAIIA8 OCCUR EACH OCCURRENCE ,$ AGGREGATE $ 6KORSS LIAD I ICIAIMS-MADE OLD I I RETENTION $ 1 $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN x WCSTATU- TORYLIMITS 0TH - ER E,L EACH ACCIDENT $1.,000,000 ANYPROPRIETDRIPARTNEWEXECUTtVE NQ OFF10FRIMEMBER EXCLUDED! (Mdndatpryin NH) It yea; describe antler DESCRIPTIONOFOPERATIONSbaloiv NIA W(� -BAD- 1%0641- 013 11130/2013 09I3O/2014. E.L. DISEASE - IEMPLOYEE :$1,000,000 - E.L. DISEASE - POLICY LIMIT $1,000;000 DESCRIPTION OF OPERATIONS I LOCATIONS .I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) Evidence of coverage. CERTIFICATE HOLDER CANCELLATION na SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED' BEFORE Plaza THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. F AUTHORIZED REPRESENTATIVE y� - @1988.2010 ACORD CORPORATION. All rights. reserved. ACORD 25;(2010/05) The ACORD name and logo are registered marks of ACORD ATTACHMENT A FEES FOR PRESORT SERVICES 1. Location. Unless you tell us otherwise in writing, we will pick up your mail at the following location(s): City of Santa Ana 20 Civic Center Plaza Santa Ana, CA 92701 2. First Class Letters and Postcards 2.1 Postage — Metered Letters. Customer shall meter all First Class letter mail at the then current Mixed AADC Rate. At the time of this Agreement, the Mixed AADC rate for First -Class letter mail meeting automation requirements pursuant to the USPS Domestic Mail Manual ( "DMM" ®) regulations is: $0.405 per piece of 1 ounce mail. $0.405 per piece of 2 ounce mail. $0.655 per piece of 3 ounce mail. Customer shall reimburse PBPS for all postage metered by PBPS on behalf of Customer. 2.2 Postage — Metered Postcards. Customer shall meter all First Class postcard mail at the then current Presort Rate. At the time of this Agreement, the Presort rate for First -Class postcard mail meeting automation requirements pursuant to the USPS Domestic Mail Manual ( "DMM" ®) regulations is $0.281 per piece. Because PBPS, as the presenter, must pay the USPS for permit postage, Customer shall establish a Postage Deposit or otherwise pay for such postage in advance as provided below. 2.3 Postage — Permit Letters. PBPS will submit Customer's First Class permit indicia letter mail meeting automation requirements pursuant to the USPS DMM regulations at the then current Mixed AADC rate. At the time of this Agreement, the Mixed AADC rate for First -Class letter mail meeting automation requirements pursuant to the USPS Domestic Mail Manual ( "DMM" 4) regulations is: $0.405 per piece of 1 ounce mail. $0.405 per piece of 2 ounce mail. $0.655 per piece of 3 ounce mail. Because PBPS, as the presenter, must pay the USPS for permit postage, Customer shall establish a Postage Deposit or otherwise pay for such postage in advance as provided below. 2.4 Postage — Permit Postcards. PBPS will submit Customer's First Class permit indicia postcard mail meeting automation requirements pursuant to the USPS DMM regulations at the then current Presort rate. At the time of this Agreement, the Presort rate for First -Class postcard mail meeting automation requirements pursuant to the USPS Domestic Mail Manual ( "DMM" ®) regulations is $0.281 per piece. Because PBPS, as the presenter, must pay the USPS for permit postage, Customer shall establish a Postage Deposit or otherwise pay for such postage in advance as provided below. 2.5 Presort Fee. Customer shall pay the following presort fees: • $0.019 per piece of First Class letter mail metered at the Mixed AADC rate • $0.022 per piece of First Class permit letter mail submitted at the Mixed AADC rate • $0.00 per piece for First Class postcard mail metered or submitted at the Presort rate • $0.05 per piece for non- automation compatible First Class letter mail over 2 ounces 2.6 Exception Handling Fee. Mail that is rejected by the MLOCRs ( "Machine Rejected Mail" or "MRM ") and mail that fails Delivery Point Validation ( "DPV ") will be charged the above Presort Fee plus an Exception Handling Fee. The Exception Handling Fee will be applied to a percentage of Customer's mail, regardless of the actual number of pieces of Exception Mail, based upon a testing of your mail. Such percentage may be adjusted by PBPS, in its reasonable discretion, in the event that the readability or accuracy of Customer's mail materially changes, following additional testing and advance notice to you. While PBPS will make reasonable efforts to process MRM /DPV mail the same day, such mail may be delayed because of the extra handling necessary to meet USPS preparation requirements. PBPS may re -date and submit such delayed mail the following business day. Page 2 of 3 Proprietary and Confidential PBPS Contract Management - Rev Nov 2012 ATTACHMENT A (continued) FEES FOR PRESORT SERVICES • The MRM fee of $0.00 per piece will be applied to 0 percent of the letter mail. • The MRM fee of $0.00 per piece will be applied to 0 percent of the postcard mail. • The DPV fee of $0.00 per piece will be applied to 0 percent of the letter mail • The DPV fee of $0.03 per piece will be applied to 2_7 percent of the postcard mail 3. Metering Fee. In the event that PBPS meters any mail on behalf of Customer, in addition to the postage expense, Customer will pay PBPS a fee of $0.02 per piece of letter or postcard mail that is metered. 4. Quality Control and Error Correction. To maintain quality control of the mail processed, PBPS will periodically inspect Customer's mail for compliance with quality standards. Mail not in compliance will be corrected or returned to Customer as determined by PBPS. Additionally, Customer will pay the following charges for error correction: $25.00 per hour for screening mail, plus $0.02 per piece corrected plus applicable postage. 5. Quantity of Mail. Customer will provide approximately 1,445 pieces of mail per day, for an average of 30,345 pieces of mail per month (assuming a 21- business day month), for pick up and processing by PBPS, but not less than all of the presort compatible mail produced at the facility. 6. Transportation. For the mail transportation services described in the Agreement, Customer shall pay PBPS a transportation fee of $N /A. 7. Fuel Surcharge. In addition to the transportation fee set forth above, Customer shall pay PBPS a fee of $N /A per mail pick up on account of fuel costs associated with performing the services described in this Agreement. 8. Minimum Weekly Fee. For services specified in this Agreement, Customer shall pay not less than an aggregate minimum weekly fee of $N /A. If the fees for services specified in this Agreement are less than such minimum weekly fee, then PBPS will charge Customer an amount sufficient to satisfy such weekly minimum fee. 9. Postage Deposit. If Customer uses Permit mail or regularly requires PBPS to meter mail on Customer's behalf, Customer shall deposit in advance with PBPS the initial sum of $5,000.00. The amount to be deposited may be changed by PBPS on a periodic basis (but not more frequently than quarterly) based upon changes in Customer's volume, postage usage, service fees, payment history or services utilized. Customer will be notified in advance, in writing, if the deposit amount is changed. PBPS shall retain any and all interest income earned on the deposit amount. Upon the termination of this Agreement, PBPS shall return the deposit to Customer after all Fees for services and postage have been paid to PBPS by the Customer. IF CUSTOMER FAILS TO MAINTAIN THE DEPOSIT AT THE THEN - APPLICABLE LEVEL(S), PBPS MAY IMMEDIATELY SUSPEND ITS PERFORMANCE UNDER THE AGREEMENT AND WILL, AT CUSTOMER'S OPTION, EITHER: (i) HOLD CUSTOMER'S MAIL UNTIL THE DEPOSIT IS RECEIVED OR (ii) RETURN THE MAIL TO CUSTOMER. Page 3 of 3 Proprietary and Confidential PBPS Contract Management - Rev Nov 2012 Ac"OR� CERTIFICATE OF LIABILITY INSURANCE DATD/YYYI� CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, 9 /17/2 9/17/2012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(ies) must be endorsed. 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). PRODUCER CONTACT NAME: MARSH USA INC. 6500 SHERIDAN DRIVE, SUITE 114 WILLIAMSVILLE, NY PHONE 1 -866 616 -0088 Arc, No, Ext : FAX 416 - 349 -4564 ac, No EMAIL ADDRESS: U.S.A. 14221 INSURERS AFFORDING COVERAGE NAIC # INSURER A: LIBERTY MUTUAL FIRE INSURANCE COMPANY 23035 INSURED Dynamex Operations West, Inc. INSURER B: INSURER C: DAMAGE TO RENTED PREMISES Ea occurrence 2051 Raymer Avenue INSURER D: $ Unit A Fullerton, CA U.S.A. 98233 INSURER E: $ INSURER F: GEN'L AGGREGATE LIMIT APPLIES PER: COVERAGES CERTIFICATE NUMBER: 1016 -WC DYNA 12 -13 REVISION NUMBER: THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSR SUER WVD POLICY NUMBER POLICY EFF MM/DD POLICY EXP MMIDD LIMITS GENERAL LIABILITY EACH OCCURRENCE ❑ COMMERCIAL GENERAL LIABILITY ❑ ❑ CLAIMS -MADE ❑ OCCUR ❑ ❑ DAMAGE TO RENTED PREMISES Ea occurrence $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ ❑ POLICY ❑ PRO- ❑ LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ❑ ANY AUTO BODILY INJURY (Per person) $ ❑ALL OWNED SCHEDULED AUTOS ❑ AUTOS BODILY INJURY (Per accident) $ NON -OWNED ❑ HIRED AUTOS ❑ AUTOS PROPERTY DAMAGE Per accident $ ❑ ❑ $ ❑ UMBRELLA LIAB ❑ OCCUR EACH OCCURRENCE $ ❑ EXCESS LIAB ❑ CLAIMS -MADE AGGREGATE $ ❑ DIED ❑ RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ® WC STATU- TORY LIMITS ❑ OTH- ER ANY PROPRIETOR/PARTNER/EXECUTIVE NO OFFICER/MEMBEREXCLUDED7 (Mandatory IN NH) If yes, describe under NIA Y WA2 -B7D- 170841 -012 07/01/2012 07/01/2013 E.L. EACH ACCIDENT $1'000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 E.L. DISEASE - POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more 7V r�g@��I h AS T O FORM EVIDENCE OF US WORKERS COMPENSATION & EMPLOYERS LIABILITY COVERAGE.V Y C A //�qn 0 -- / Laura Stitt S edy CERTIFICATE HOLDER CANCELLATION Assistant City Attorney Pitney Bowes Presort Services, Inc. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE A Pitney Bowes Company THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 101101 Street ACCORDANCE WITH THE POLICY PROVISIONS. Omaha, NE AUTHORIZED REPRESENTATIVE U.S.A. 68127 I ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD t`l - ab l I- I) I- 00 1 Ac"Rf> CERTIFICATE OF LIABILITY INSURANCE DATE IMM /DD YY) it 11/01/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. 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). PRODUCER CONTACT NAME: Marsh USA Inc., Multinational Incoming Unit a service of Seabury and Smith, Inc. PHONE FAX EMAILo Est: - - AIC, No: Lp�3] =3g LIMITS 9830 Colonnade Boulevard, Suite 900 ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC It PO Box 659520 San Antonio, TX 78265 -9520 INSURER A: NAT'L UNION FIRE INS CO of PA 12/01/2013 INSURED INSURER B: AllianZ Global Risks US Ins Cc DAMAGE TORENTED INSURER C: Dynamex Operations West, Inc. INSURER D: 2051 Raymer Ave, Unit A Fullerton, CA 92833 INSURER E: $10,000,000 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE DL INSR SUER WVD POLICYNUMBER POLICY EFF MMIDDIYYYY POLICY EXP MMIDDIYYYV LIMITS A GENERAL LIABILITY GL1872136 12/01/2012 12/01/2013 EACH OCCURRENCE $10,000,000 DAMAGE TORENTED g COMMERCIAL GENERAL LIABILITY PREMISES Edoecurrence $10,000,000 CLAIMS -MADE OCCUR MEDEXP(Anyoneperson) $10 000 PERSONAL& ADV INJURY $10,000,000 GENERAL AGGREGATE $10,000,000 GEN'L AGGREGATE LIMIT APPLIES PERK PRODUCTS - COMPIOP AGO $10,000,000 $ POLICY JEO Fj LOC A AUTOMOBILE LIABILITY CA6506059 12/01/2012 12/01/2013 CEOMaBIINdEEDtSINGLE LIMIT $10,000,000 BODILY INJURY (Per person) S `X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ NON -OWNED HIRED AUTOS AUTOS B X UMBRELLA LIAB X OCCUR XYZ00032016370 12/01/2012 12/01/2013 EACH OCCURRENCE $5,000,000 AGGREGATE s5,000,000 EXCESS LIAB CLAIMS -MADE DIED RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN WC STAIN OTH- TORY LIMITS ER ANY PROPRIETORIPARTNEWEXECUTIVE E.L. EACH ACCIDENT $ ' OFFICERIMEMBER EXCLUDED? ❑ NIA (Mandatory in NH) E.L. DISEASE EA EMPLOYE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) City Of Santa Ana is included as an Additional Insured on General Liability and Auto Liability as required by written contract. The above Umbrella policy XYZ00032016370 with Allianz was placed by Marsh Canada Limited. Seabury c Smith, Inc. has only acted in the role of a consultant to this placement, which is indicated here for your convenience. APPROVED AS TO FORM CERTIFICATE HOLDER CANCELLATION Laura Stitt Sh dY. Assistant City t%OTI10Y SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City Of Santa Ana 20 CIVIC CENTER PLZ AUTHORIZED REPRESENTATIVE _ SANTA ANA, CA 92701 © 1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 26 (2010/05) The ACORD name and logo are registered marks of ACORD AC °RO CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDO /YYYY) 10/31/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. 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). PRODUCER CONTACT POLICY EFF MMIDD /YYYY) NAME: MARSH USA INC. 6500 SHERIDAN DRIVE, SUITE 114 WILLIAMSVILLE, NY PAIL, No Ezt : 1 -866- 616 -0088 Fn c No 416- 349 -4564 EMAIL ADDRESS: U.S.A. 14221 INSURER (S) AFFORDING COVERAGE NAIC k INSURER A: EACH OCCURRENCE INSURED Dynamex Operations West, Inc. INSURER B: 2051 Raymer Ave, Unit A INSURER C: INSURER D: LIBERTY MUTUAL FIRE INSURANCE CO. 23035 Fullerton, CA 92833 INSURER E: INSURER F: CLAIMS -MADE F-1 OCCUR COVERAGES CERTIFICATE NUMBER: 13113- 1422 -DY -WC REVISION NUMBER: THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR LTR TYPE OF INSURANCE ADDL INSR SUBR Me POLICY NUMBER POLICY EFF MMIDD /YYYY) POLICY EXP MMIDDM'YV LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence) $ CLAIMS -MADE F-1 OCCUR MED EXP (Any one person) $ PERSONAL S ADV INJURY $ GENERAL AGGREGATE $ APPLIES PER PRODUCTS- COMP /OP AGG $ GEN'LAGGREGATELIMIT POLICY PRO - JET LOC $ MOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident) $ BODILY INJURY (Par person) $ NY AUTO FAUTOS LL OWNED SCHEDULED AUTOS BODILY INJURY (Per accident) $ NON -OWNED IREDAUTOS AUTOS PROPERTY DAMAGE (Per accident ) $ $ UMBRELLAUAB OCCUR EACH OCCURRENCE $ AGGREGATE $ E %CESS LIAR CLAIMS -MADE DEG RETENTION $ $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN X WC STATU- TORY LIMITS OTH- ER ANY PROPRIETOR/PARTNEWEXECUTIVE OFFICEMMEMBER EXCLUDED? NO (Mandatory in NH) If yes, describe under N/A WA2 -B7D- 170841- 012 07/01/2012 11/30/2013 E .L. EACH ACCIDENT $1,000,000 E. L. DISEASE - EA EMPLOYEE $1,000,000 EL .DISEASE - POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more apace is required) Evidence of coverage. APPROVED AS TO FORM L CERTIFICATE HOLDER' 20 Civic Center Plaza Santa Ana, CA U.S.A. 92701 ACORD 25 (2010/05) r o e Cr:�t Assistant City CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. The ACORD name and logo are registered marks of ACORD All rights reserved. N 2011 -111 • -00 I iR �7`4�- DATE IMMIDOn'VYY) THIS CERTIFICATE 19 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES -NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW THIS CERTIEI /ATE OF INSURANCE DOES' NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE bR'+2001J4`ER AND TtllE` 6ER7(Flf.`ATE HOLDER. IMPORTANT: time CIRRUCa{a'hdlderls an `ADDITIONAL INSURED, the policy(los) must pe eudorano. If SUBROGATION IS WAIVED,. subject to the temTs 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 Nett of such endorsement s . PRODUCER NAN' 'NaYeh USA InC., Mellt inat Tonal TnCPming Unit 'PHOONE a aecvice of Seabuey and Smith: inc. 9x730 Colonnade SoulFvud, Suite 400 5 insl �Q• � INSURER s AFFOROIND COV@RACE ... _.._._.__..L.l._._.._._.._...._ ....._._......— .__.__.:.. NAILI PO Box 5ry9520 San Antonio, T:S 76 26 5-9520 INSUItERA NAP'L UNSON FTRB IN CO DE RA INSURED INSURERe: Allianx G10ba1 Rtsks US Ina Cc E P PR?dl`u.R$1E�24GV6A.IN£i CYnamex Operations Went, LAC. INSURER qL 2051 Raymer .Ave, Uni: A --..�. ........,..._.... _ _ _- Fu.tlantan, CA 92337 9: _..._.. INSURER .RaR 0: ME_D IXPIAnyone yelsonl INSURER E: INSURER R: COVERAGE$ CERTIFICATE NIIMRRRt OevlelnAt M"..M.n. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED BOVE 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 POUCHES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURRNDf. POLICY NUMBER Ii�IGYT"P...�m LIMITS A OVOC.RAL LIVABILITY oa1e72176 n3re1/2014 PACHOCCLRRENDE 5 insl �Q• � 1.6_0NMEACI&OSM RAt UAWLnY E P PR?dl`u.R$1E�24GV6A.IN£i "" � elf GLAIMS-MADE 1�,�OCCUR I ME_D IXPIAnyone yelsonl +'i.D.QD. _..... �¢�qq� .. , PERSONALS ADV INJURY �1Q +Qp9..e�� -.. U00 OWI, AGGREGATE til LIMIT APPLIES PEA: _PRODUCTS -GOMII AGO _ Lq og 00;¢� POLICY PRO. LCC g A AUTOMDRILE LABILITY _ CA6S06¢i4 43/01 /'LOti U0 V401'> 1 ' .SBBODILY ANY AUTO I IIN,jUR_Y_— (Per Oaec.ot.i.ccb_Onl ,., ON@ SCHEDULED OLY N--ALL PelA S AUTOS . HIREDAUYOS NON-CEO ...__ AUTOS 5 E '. X UTABRELLA tIAe X OCCUR %Y'b 'U32tJ,6 03/01/2014 ) /Ot!20'l1 EACHOCCURRENCE ..v..._..a�,. EXCESS LIAtl _ _ CLAIM9.MAD„E ACR3ihTE 95y000, 0(.lU 0 9 1 RET ANTI N .._. ...— s I' NOAXERSCOMPENSATION p AND WRLOYRR5 LIAOILITY YIN ._..iCRYJdhi¢S. _._. i.. JIM ANY PROPRIETOR/PARTNENEXEC UTIVE E.L EACH ACCIDENT $ OFFICERIMEMSER EXCLUDED) (M(e,da9R[y10 NH) If Yyes, deltitre uTler NIA EL_016EASE- EAEMPLOYE: a DESCRIPTION OP OPERATIONS W. E.L OISFASE- POLICY LIMIT. S DESCRIPTION OF OPERATION$ I LOCATIONS I VEHICLES (Atlach ACORD 101, Addlaonul Remxd<a S,,IePes , Amore s e,.lP M41,ed) - - Lty of San4a NIA tv LD IUNdJ a A Aldl 1ueaL Ln(, ed a ee9Cdl 1a .i: Cy and ACt ,iabLLUy as =A „virnd ny NzItten ont a" Y h L lh. uoue )-It ul.la p Ii 3tl C32019707 1 Y ALLim" e" N Y%! p1 Cctl V Dn .unada i ni'ed. eb e' c 4 h L'r n o.vy axed A the -a12 oP .unt..ILan e tF_s PiaaemwL, wnioa L.5 ind:Coteo ap IIvAO for Ir cr Lan -ae y vAn � 1� 1. = cY � . trey - t:AN4cl,LAIIVR - k+t `J � t SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED SEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, Ctt'rr OE Santa Ana AUTHORDED REPRESENTATIVE SAN AV�AiNA, CA 701 L 0�i4c Ay/7f.0 }/ 0 01905 -2010 ACOROCORPORATION. All fights reserved. ALJ VRL/ za lzO7meo) The ACORD name and logo are registered marks of ACORD D54457.29752 A I N -2o11- ]II -uu A� °P CERTIFICATE OF LIABILITY INSURANCE DAT2320 DM Y) 6vzalz9ls THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. 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). PRODUCER Marsh USA Inc, Multinational Incoming Unit, a service of Seabury and Smith, Inc. CONTACT NAME: PHONE AIG Np: E -MAIL ADDRESS: 9830 Colonnade Boulevard, Suite 400 PO Box 669520 INSURERS AFFORDING COVERAGE NAIC # San Antonio, TX 78265 -9520 INSURER A: National Union Fire Insurance Co, of PA 19445 CN103820276- Pal- 5MGL -15 -16 INSURED Dynamex Operations West, LLC INSURER B : AIIIanz Global Risks US Insurance Company 35300 INSURER C 2051 Raymer Avenue, Unit A Fullerton, CA 98233 INSURER D E DAMA TO RENTED PREMISES Ea occurrence) INSURER E MED EXP (Any one person) $ 10,000 INSURER F $ 10,000,000 COVERAGES CERTIFICATE NUMBER: HOU- 002363634 -03 REVISION NUMBER:2 THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF MM /DD/YYYY POLICY EXP MM /DDIYYYY LIMITS A GENERAL LIABILITY of Marsh USA Inc. GL1872136 03/01/2015 03/0112016 EACH OCCURRENCE $ 10,000,000 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE M OCCUR E DAMA TO RENTED PREMISES Ea occurrence) $ 10000,000 MED EXP (Any one person) $ 10,000 PERSONAL &ADV INJURY $ 10,000,000 GENERAL AGGREGATE $ 10,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 10,000,000 X POLICY PRO- LOC ,JECT 1-1 $ A AUTOMOBILE LIABILITY CA6506059 0310112015 03101/2016 COMBINED SINGLE LIMIT Ea accident 1Q000,000 BODILY INJURY (Per parson) $ X ANYAUTO ALL OWNED SCHEDULED AUTOS AUTOS (Per BODILY INJURY Per accident $ NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE Per ac (dent $ B X UMBRELLA LAB X OCCUR XYZ 0005798 0336 03/0112015 03101/2016 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 EXCESS LIAB CLAIMS -MADE OED RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY YIN OFFICER/MEMBER EXCLUDED ?ECUTIVE� N/A V T E. L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ (Mandatory in NH) If yes describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) R City Of Santa Ana is included as an Additional Insured on General Liability and Auto Liability as required by written contract, Y�pV Y fey A55,Stiart CERTIFICATE HOLDER CANCELLATION City Of Santa Ana 20 CIVIC CENTER PLZ i l) J :S tli1V '�):+ 11 T «J �� SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN SANTA ANA, CA 92701 ACCORDANCE WITH THE POLICY PROVISIONS. [7 % (� t466 7 z �j 4�I sot AUTHORIZED REPRESENTATIVE •t of Marsh USA Inc. ACORD 25 (2010105) © 1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AC 0 "i AGENCY CUSTOMER ID: CN103820276 LOC #: San Antonio ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY Marsh USA Inc„ Multinational Incoming NAMED INSURED Dynamex Operations West, LLC 2051 Raymer Avenue, Unit A Fullerton, CA 98233 POLICY NUMBER CARRIER NAIO CODE EFFECTIVE DATE: AUDI I IUINAL KCIVIAKKJ THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance The above Umbrella policy XYZ00032097677 with Allianz was placed by Marsh Canada Limited. Seabury & Smith, Inc. has only acted in the role of a consudamto this placement, which is indicated hereforyour convenience. S® X00 �Vz CK e ,o an pity pxtoy � y ACORD 101 (2008101) ©2008 ACORD CORPORATION. All riahts raenrvad The ACORD name and logo are registered marks of ACORD '" CERTIFICATE OF LIABILITY INSURANCE DAT9 Y) CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, /30/2 14 9130/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. 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). PRODUCER CONTACT GENERAL LIABILITY NAME: MARSH USA INC. 6500 SHERIDAN DRIVE, SUITE 114 WILLIAMSVILLE, NY AlcrvNO Ext): 1 -886- 618 -0088 ac, No): 416- 349 -4564 EMAIL ADDRESS: U.S.A. 14221 INSURERS AFFORDING COVERAGE NAIC# INSURER A: INSURED Dynamex Operations West, LLC INSURER B: COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence 2051 Raynner Ave, Unit INSURER C: CLAIMS -MADE F1 OCCUR INSURER o: LIBERTY MUTUAL FIRE INSURANCE CO. 23035 Fullerton, CA 92833 NSURER E: INSURER F: $ COVERAGES CERTIFICATE NUMBER: 14115.596•WC REVISION NUMBER: THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSR sues MID POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MMIDDIYYVY LIMITS J GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $ CLAIMS -MADE F1 OCCUR MED ERE (Any one person) $ PERSONAL &ACV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMPIOP AGG $ POLICY PRO - LOG S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT COMB $ BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS " BODILY INJURY (Par accident) $ NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE Per accident $ UMBRELLALIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB Ld CLAIMS -MADE ICED I I RETENTION$ $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN X` STATU" TOR WC Y LIMITS OTH- ER ANY PROPRIETORIPARTNERIEXECUTIVE NO OFFICERIMEMBER EXCLUDED? (Mandatory in NH) If yes, describe under NIA WA2 -B7D- 170841- 014 09/30/2014 09/30/2015 E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,009 E.L. DISEASE - POLICY LIMIT $1,000,090 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Evidence of coverage. CERTIFICATE HOLDER CANCELLATION City Of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 20 Civic Center Plaza THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Santa Ana, CA ACCORDANCE WITH THE POLICY PROVISIONS. U.S.A. 92701 AUTHORIZED REPRESENTATIVE J i lA © 1988.2010 ACORD CORPORAiILiAk^AlIN § htbMserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD Rp'F',QV r+t""r AlMa 1 tS?T KneY. Ptasistatl �l' ENDORSEMENT Attached to Certificate This Endorsement is the equivalent of the CG 2010 10 01 and the CG 2037 10 01 POLICY NO. GL 1872136 Commercial General Liability CERTIFICATE HOLDER City Of Santa Ana 20 CIVIC CENTER PLZ SANTA ANA, CA 92701 (Marsh No. 587) Additional Insured — Owners, Lessees or Contractors (Form B) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE ADDITIONAL INSUREDS City Of Santa Ana. "THE INSURANCE AFFORDED BY THIS POLICY FOR THE ADDITIONAL INSURED(S) IS PRIMARY INSURANCE AND ANY OTHER INSURANCE MAINTAINED BY OR AVAILABLE TO THE ADDITIONAL INSURED(S) IS NON - CONTRIBUTING." All other terms and conditions remain unchanged. National Union Fire Insurance Company of Pittsburgh Authorized Representative Dated this May 22, 2015 ss 5 t City p or A r e4 POLICY NUMBER: GL 1872136 COMMERCIAL GENERAL LIABILITY CG 20 37 10 01 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Additional Insured Person(s) Or Organization (s): Location And Description Of Completed Operations 587 City Of Santa Ana All Locations Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II — Who Is An Insured is amended to include as an insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the schedule of this endorsement performed for that insured and included in the "products- completed operations hazard ". National Union Fire Insurance Company of Pittsburgh Authorized Representative Dated this May 22, 2015 To polo LISA r STORct< Assistant City Attorney