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HomeMy WebLinkAboutRACE CENTRAL - 2017City of Santa A, Clerk of the Council coTc office Use only AGREEMENT TERMINATION FORM Please complete this form in its entirety when the attached agreement and all amendments (if any) are no longer in effect. Note: If your agreement is grant related, please ensure that all grant retention requirements have been satisfied prior to signing the termination form. CLERK [IF THE COUNCIL Is the agreement(s) a permanent record? Yes No WO 219-t P I�,.3:31 Return form to the Clerk of the Council Office (M-30). Call 647-1520 if you have any questions. The agreement with C (% Q G 1 1. 1i1 No. N-2017-183 was completed on IQi;1 I1-1 and final payment has been made. (List all amendments. Use space below if needed.) Department: J,,� �t ��.�,! Phone/Ext.: Signature: Date: Revised: 10-18-16 INSURANCE B91 ON FILE N-2017.183 WORK MAY 01 PROCEED CLERK OF COUNCIL AGREEMENT FOR RACE TIMING SERVICES DATE FOR (DOWNTOWN 5K RUN EVENT (2017) W10. z0i� THIS AGREEMENT is made and entered into this 16`" day of August, 2017 by and between Race Central ("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 ("City"). RECITALS A. The City desires to retain a Contractor having special skill and knowledge in the field of race timing services to provide such services for the City's Downtown Santa Ana (DTSA) 5K Run event to be held in the City on October 21, 2107 ("Event"). B. Contractor represents that it is able and willing to provide such services to the City. C. In undertaking the performance of this Agreement, Contractor represents that it is lrnowledgeable in its held and that any services performed by Contractor tinder this Agreement will be performed in compliance with such standards as may reasonably be expected from a professional consulting firm in the field. NOW THEREFORE, in consideration of the mutual and respective promises, and subject to the terms and conditions hereinafter set forth, the parties agree as follows: SCOPE OF SERVICES Contractor shall perform those services for the Event as set forth in Exhibit A to this Agreement. Contractor's proposal is incorporated by reference as though fully set forth herein. 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 $7,246.73 during the term of this Agreement. This amount is comprised of (1) the sum of $6,301.50 and. (2) a 15% contingency of up to $945.23 for additional services as may be performed by Contractor at the sole direction of the City. b. Payment by City shall be made within thirty days (30) days following receipt of proper invoice evidencing work performed, subject to City accounting procedures. Payment need not be made for work that 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 stated above and continue through October 31, 20 t7, unless terminated earlier in accordance with Section 13, below. A. 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. S. INSURANCE Prior to undertaking performance of work under this Agreement, Contractor shall maintain and shall require its subcontractors, if any, to obtain and maintain insurance as described below: a. Commercial General Liability Insurance. Contractor shall maintain commercial general liability insurance naming the City, its officers, employees, agents, volunteers and representatives as additional insured(s) and shall include, but not be limited to protection against claims arising from bodily and personal injury, including death resulting therefrom and damage to property, resulting from any act or occurrence arising out of Contractor's operations in . the performance of this Agreement, including, without limitation, acts involving vehicles. The amounts of insurance shall be not less than the following: single limit coverage applying to bodily and personal injury, including death resulting therefrom, and property damage, in the total amount of $1,000,000 per occurrence, with $2,000,000 in the aggregate. Such insurance shall (a) name the City, its officers, employees, agents, volunteers and representatives as additional insured(s); (b) be primary and not contributory 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 California 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. If Contractor is or employs a licensed professional such as an architect or engineer: Professional liability (errors and omissions) insurance, with a combined single limit of not less than $1,000,000 per claim with $2,000,000 in the aggregate. e. 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 by the City. (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. (iv) Contractor shall supply City with a fully executed additional insured endorsement, f. 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 terminate this Agreement. Such termination shall not affect 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, defend, and hold harmless the City, its officers, agents, employees, consultants, 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 death, and claims for property damage, which may arise from the negligent operations of the Contractor or its, subcontractors, agents, employees, or other persons acting on their behalf which relates to the services described in section I 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 torn 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. RECORDS Contractor shall keep records and invoices in connection with the work to be performed under this Agreement, Contractor shall maintain complete and accurate records with respect to the costs incurred under this Agreement and any services, expenditures, and disbursements charged to the City for a minimum period of three (3) years, or for any longer period required by law, from the date of final payment to Contractor under this Agreement. All such records and invoices shall be clearly identifiable. Contractor shall allow a representative of the City to examine, audit, and make transcripts or copies of such records and any other documents created pursuant to this Agreement during regular business hours. Contractor shall allow inspection of all work, data, documents, proceedings, and activities related to this Agreement for a period of three (3) years from the date of final payment to Contractor under this Agreement. 8. 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 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. 9. 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. 10. 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 fax or other telegraphic communication in the manner provided in this Section, to the following persons: To City: Cleric 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: To Contractor: Gerardo Mouet Executive Director Parks, Recreation, and City Attorney's Office Community Services Agency City of Santa Ana City of Santa Ana 20 Civic Center Plaza (M-29) 20 Civic Center Plaza M-23 P.O, Box 1988 P.O. Box 1988 Santa Ana, California 92702 Santa Ana, California 92702 Fax 714- 647-6515 Race Central 231 S. Olive Ave Rialto, CA 92376 4 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 fax, 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, 11. EXCLUSIVITY AND AMENDMENT This Agreement represents the complete and exclusive statement between the City and Contractor regarding the subject matter therein, 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 or 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. 12. 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 consultants retained by City. 13. 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 rmless 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 that fails to meet the standard. of performance specified in the Recitals of this Agreement. 14. NONDISCRIMINATION 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 or in connection with any activities under this Agreement. Contractor affirms that it is 5 an equal opportunity employer and shall comply with all applicable federal, state and local laws and regulations. 15. 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, 16. 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. 17. MISCELLANEOUS PROVISIONS a. Each undersigned represents and warrants that its signature herein below has the power, authority and right to bind their respective patties 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. IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first above written. ATTEST: CITY OF SANTA ANA �I I - 1 .t �Iaria U. Iluizar Qynthia -trz Ilerlc of the Council Interim City Manager [signatures continue on next page] 6 APPROVED AS TO FORM: SONIA R. CARVALHO City Attorney By: John V. Funk Assistant City Attorney RECOMMENDED FOR APPROVAL: Gerardo Mouet Executive Director, Parks, Recreation, and Community Services Agency EXHIBIT A SCOPE OF SERVICES VENDOR INFORMATION Name: Race Central Event: Downtown Santa Ana (DTSA) 5K Run SERVICE DATE(S): Saturday, October 21, 2017 COMPENSATION DUE TO THE VENDOR: NTE $7,246.73. This includes a 15% contingency DESCRIPTION: Race Central will be providing timing services at the City of Santa Ana's 2017 Downtown Santa Ana (DTSA) 5K Run event on October 21, 2017 from 6:00am to 10:00am BREAK DOWN OF SERVICES: Base Timing Services Cost and Inclussions" • $2,000 Base Timing Fee (Includes 1000 full color bibs w/QR code to brandable results and 2 — 20' inflatable arches) Chip Charges (2 chips per athlete suggested for mud run) • $1.00 Per Chip/Bib Prepared • $1.00 Per Registration Additional Costs • TRAVEL— Up to 100 miles each way (INCLUDED) • PACKET PICK UP DAY - $200 per staff/day if applicable • SAFETY PINS (ea. Box + 300 runners) $14.50/box (if applicable) Equipment & Staffing Include: • Brandable Online Registration & Results • Start/Finish line set up (4 Meters ea.) • 1 LED Clock, 1 Generator, LIVE SERVICES • Wireless card & 12 computer kiost for Registration/Results • Manual Stop Watches for back-up • 20' Inflatable Arch X 2 • 3 Staff Members: I Reg. Mgr., 1 Course Mgr., 1 Scorer EQUIPMENT & SERVICES PROVIDED BY EVENT • Tent for scouring to be place close to registration 2 charis inside scoring tent • 1 table inside scoring tent • 12 tables for registration/packet pick-up area 0 Power @ Finish Line & Registration DATE AC O CERTIFICATE OF LIABILITY INSURANCE 8/29(/2017 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 policyhes) must have ADDITIONAL INSURED provisions or 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 RITA M PRICE INSURANCE AGENCY INC. PO Box 189 Lake Arrowhead, CA 92352 CONTACT NAME. PHONEp _. lac mnr(909)336-6989 M ._ E-MAIL ADDRESS ._.._ INSU0.EP15 AFF00.01N0 COVERAGE NNCN 0544472 INSURER A. u son—Specia y Laurance o. INSURED Race Central LLU Judy Ikenberry tl'a-"JI �P Irl}".k INSURER B INSURER 229 S. Olive Avenue INSURER D. Rialto, CA 92376 INSURER _ 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. NSP LTR TYPE OF INSURANCE Ali w n SUER Vined POLICY NUMBER POLIO - MMIDD 10MMIDDPi LIMITS CONSIERCML GENERAL. LARLIM EACH CCCURRENOE 5 1,000,000 CLAIMS -MADE FxI OCCUR PREMISES la occurrence 5 / MEO EXP(Any one person) $ 0 / 'a' x HBD 10015218 029 01/27/2017 01/27/2018 PERSONAL 8 ADV INJURY $ / / UUU GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2, / POLICY E PRO ❑ ;_CC ECT PRODUCTS CCMPIOP AGO 7_17$ / / $ OTHER. AUTOMOBILE LIABILITY COMB Ea accibent v L $ BODILY INJURY (Per person) S ANYAUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY `, BODILY INJURY (Per accident) S PROPERTY DAMAGE$ (Per accident $ rr� 4/ UMBRELLA LAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS -MADE p1�� r X� C w AGGREGATE $ DED REfENTON 8 $ WORKERS COMPENSATIONS AND EMPLOYERS"LIABILITY YIN ANY PROPRIFfORRARINEWEIECti OFFICERNEMBER EXCIADEDP IMddedid In all /�. l 1 �T ER DIN STATUTE ER - E.L. EACH ACCIDENT $ E. L. DISEASEEAEMPLOYE S 't yes describe under DESCRIPTION OF OPERATIONS below EL DISEASE- POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS VEHICLES (ACORD 101. Additional Remarks Schedule, maybe attached if more space Is required) Certificate Holder is listed as additional insured: The City of Santa Ana, its officers, employees, agents, and representatives as additional insured. City of Santa Ana 20 Civic Plaza Santa Ana, CA 92701 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Tink] All nmhtc rr c r,ni ACORD25(2016/03) The ACORD name and logo are registered marks of ACORD ADDITIONAL INSURED ENDORSEMENT Insurance Company Q n swf ri a LLB-. This endorsement modifies such insurance as is afforded by the provisions of Policy # relating to the following: The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701; it officers, employees, agents and representative are named as additional insureds ("additional insureds") with regard to liability and defense of suits arising from the operations and uses performed by or on behalf of the named insured. 2. With respect to claims arising out of the operations and uses performed by or on behalf of the named insured, such insurance as is afforded by this policy is primary and is not additional to or contributing with any other insurance carried by or for the benefit of the additional insureds. This insurance applies separately to each insured against whom claim is made or suit is brought except with respect to the company's limits of liability. The inclusion of any person or organization as an insured shall not affect any right which such person or organization would have as a claimant if not so included. With respect the additional insureds, this insurance shall not be cancelled, or materially reduced in coverage or limits except after thirty (30) days written notice has been given to the City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701. (Completion of the following, including countersignature, is required to make this endorsement effective.) Effective 2 I this endorsement form as part of Policy# }� �/1 lucnG2\� aQ�° Issued to G�I (�1 Ongs�rr�,� Lu- Z Name Insured Countersigned by nsurance Agent Signature Q� Sent By: RACE CENTRAL; 909+874+2604; Sep-25-17 2:50PM; CERTHOLDER COPY Page 2/3 SP ISSUE DATE: 08-25-2017 P.O. BOX 8192, PLEASANTON, CA 94588 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE' CITY OF SANTA ANA PARKS RECREATION AND COMMUNITY SERVICES 20 CIVIC CENTER PLZ SANTA ANA CA 92701-4058 F71;7 GROUP POLICY NUMBER: 11102SS-2015'. CERTIFICATE ID, 10 CERTIFICATE EXPIRES: 12-01-2017 12-01-2016/12-01-2017 This is to certify that we have Issued a valid Workers' Compensation Insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 30 days advance written notice tp 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 doOment 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. Authorized Representative President and CEO UNLESS INDICATED OTHERWISE BY ENDORSEMENT, COVERAGE UNDER THIS POLICY EXCLUDES THE FOLLOWING: THOSE NAMED IN THE POLICY DECLARATIONS AS AN INDIVIDUAL EMPLOYER OR A HUSBAND AN6 WIFE EMPLOYER; EMPLOYEES COVERED ON A COMPREHENSIVE PERSONAL LIABILITY INSURANCE POLICY ALSO AFFpRDING CALIFORNIA WORKERS' COMPENSATION BENEFITS; EMPLOYEES EXCLUDED UNDER CALIFORNIA WORKERS' COMPENSATION LAW. _i EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS; $1,000,000 PER OCCURRENCE. ENDORSEMENT #0015 ENTITLED ADDITIONAL INSURED EMPLOYER EFFECTIVE 2017-09-25 15 ATTACHED TO AND FORMS A PART OF THIS POLICY. NAME OF ADDITIONAL INSURED; CITY OF SANTA ANA ENDORSEMENT N2085 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 12-01-1908 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. EMPLOYER IKENDCRRY, DENNIS AND IKENBERRY, JUDY 228 S OLIVE AVE RIALTO CA 02376 IREV.7-ie141 SP (NKH,CNI PRINTED : OB-25-2017 Sent By: RACE CENTRAL; 909+874+2604; Sep-25-17 4:30PM; Page 1/1 AUTOMOHME LIABILITY INSURANCE'; CALIFORNIA AUTOMOBILE LIAIILITY INSURANCI CARD IDENTIFICATION CARD .a� IDENTIFICATION Mercury Cnsuultp Company �„ 1C'lcrcnry Casualty Compmq, \\\\ lv HER IiItFNCfIVII Ii01RA11UNDAIE \ - 5< 12N620I6 12IUUR011 POW( NUINUER EPFEC'TIVI? eXl'IRA110NUA'I'ES. CCAWOK55 12AW2016 I2ttI6Rull )svr nico winpli.x RIW55, A16500.5 '1 Ilm inss.mnce n,lnpliea' winl ('V(' Rud755.A16500.5 nnx,d Incurod Nm and Insured RACE CENTRAL. I d.0 AND INI INI'fY TIMING I.LC RACF.Ch;N'CRAt. LLC AND INFINITY T1MIN(s 1.1,C vlfllfC'LE IUFNlll9('ATION NUMBER NUMBER )AJAYliAR MAKE Vlil il(BSW1 ' MAKP: 4S3HG6NMX76411965 1 909 SIIIiARU ' 5V4IK5!i2;K2JON tlau DODGE 10.5WIg5Y41KS525A1 20111 1' :. DELANItY'INS ACI{NCV INC' 12881 CA ' DELANEY INS AGENCY INC 72932 CA ACILNT'$PtWNIs NUMBER 90v-181-7/2. 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I d. ilii unpxly e.n7a s•„ "pent, Morcury Ur the police. „I. v 1 ' �Ic: I• (i �s., lmluullamly l'epon Ub Halms to Mercury l¢HA00)-500975,1, l II 1 n:dld [ vle,rui. mi rtnUu 5lg-,vti PI2aFa IuAs; ph"IUs If Imssiblordu. e5116 r„e ,l yL,.1o•d pi:,' ruv. Us/16 __-_____,,.___ MERCURY INSUR®NCETM A. IDENTIFICATION CARDS',%` YOUR NEW AUTOMOBILE IDENTIFICATION CARDS ARE ATTACHED'-. KLE,I' ONE CARD IN YOUR MOTOR VEI-IICI.,E WHILE IN OPERATION, --T ------ Meru�NCesuuh TCom eniti...______...._________,._________._______..__.. _ .. .... _ .. . _ ..... _.. CALIFORNIA AUTOMOBILE W ABILITY INSURANCE ION CALIFORIVIA AUTOMOBILEL1ABtL1TV INSllft.-1NCE��AA IDENTIFICATION CARD Y y P y AA Mercury Cusuolty Company EFfECTNEI EXPIRATION DATI'.S I'OLICY NUMBER EPPG(1TIVe:EXPIRATIONOATES 1'OLI('Y NUMUCR 12/0621111 CCA0003955 I21U612016 11106r1011 12f01i2U16 CCA0003RS5 '(ills insurance cmnplies wits ('VC A16055116500,5 This imumnce co1l)Pbc$ with C'vC' 916055.8165110-5 Namcd hlsomd :. Ninxd lnsmod ei ACL CENTRAL LLC AND INFINITY TIMING LLC; RACE CENTRAL 1,1& AND INFINITY TIMING I.LC YEAR MAKE vEIRCLEIDF.N'11TICA(ION NUMBER YLAK M1HkCEDD'.A HF.NZVp�I(WUroE CCXC5TI 8 Mx11R 2012 SUDAKII 454WX541D1C44027U3 DELANEY INS AGENCY INC 12882 CA DELANEY INS AGENCY INC 72982 CA ( DELANAGhNT'S I'NDNE IRINCY 1t 909-0tl1-1222 AGIiN'f'S PHONF. NUMBER 909-4tl1.7212 ' 2d HOUR CLAIMS: TO REPORT A CLAIM CALL YOUE AGENT,:' BROKER 2A HOUR CLAIMS: TO HEPOKI' A CLAIM C'ALLYOUR AGENT / BKUKEH� Or call loll fsue I-tlUU•507-3724 Or eaJl toil tmc I.R(MI-503A724 11IF. C'OVEC<AC:BS YD111V IIDEU IIX'1'11YS l'(DYACY MISE'fS THE : THE COV EICAGC PROVIDED BY THIS POLICY MEWS THE !b1pNlVER LIABILITYLIMITSHISF kiBl?11 BY LAW MINIMUM LIABILITY LIMITS pRESCRWED BYLAW III. YOU.IIAVE AN-ALCIDEN:.I'. IFYC�VEA ACL`IREIY� ' Notify the police Immediately. j S.''dY Oa•p,il ic,inunulhnhlt. • Writ I . I w mr Idd . (elaph m nunbc, �, dd c 1 ucnlxc Dumber: I Write down llamas, uddresves, lelDphmle "ambers, driver license mambos :w,l lic.rout pl to wimp r I I u0I cv 1. u)v dmd and f t murwo. and liccnaa plate 0umbrxs of all penrotu involved and Of wimessc9 I Elease unm any Oxmoge W other vehicles. Do not admit fault. Do not discuss the DeeWem with aOYuDe (ueept yom'