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HomeMy WebLinkAboutSUPER ANTOJITOS (3) - 201744 City of Santa Ana Clerk of the Council 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TERMINATION FORM Please complete this form in its entirety when the attached agreement and all amendments (if any) are no longer in effect.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. Is the agreement(s) a permanent record? Yes No Return form to the Clerk of the Council Office (M-30). Call 647-1520 it you have any questions. The agreement with N-2017-229 No. was completed on (List all amendments. Use space below if needed.) Revised: 10-18-16 COTC Office Use Only F THE COUNCIL 3 2121 PM.:28- -1 and final payment has been made. Department: mCo--�,lrl Phone/Ext.: `tpZ�q Signature: Date: INSURANCE)NOTT ON FILE WORK MAY NOT. PROCEED CLERK OF COUNCIL DATE. //-'-/J 0:PRCS(,) CATERING SERVICES AGREEMENT N-2017-229 Silvia Cuevas THIS AGREEMENT is made and entered into this 2"d day of November, 2017, by and between Super Antojitos ("Provider") 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 service provider having special skills, resources and knowledge to provide food catering for the 2017 Fiestas Patrias Parade State Representative Dinner event. B. Provider represents that Provider is able and willing to provide such services to the City. C. In undertaking the performance of this Agreement, Provider represents that it is knowledgeable in the field and that any services performed by Provider under this Agreement will, be performed in compliance with such standards as may reasonably be expected. NOW THEREFORE, in consideration of the mutual and respective promises, and subject to the terns and conditions hereinafter set forth, the parties agree as follows: SCOPE OF SERVICES Provider shall perform those services as set forth in Exhibit A to this Agreement. COMPENSATION a. City agrees to pay, and Consultant agrees to accept as total payment for its services, the rates and charges identified in Exhibit A. Total cost to be $9.50 per person. Total guest count to be provided to vendor prior to event. The total sum to be expended under this Agreement shall not exceed Nine Hundred Fifty Dollars ($950.00) during the term of this Agreement. Payment by City shall be made within thirty (30) days following Rill execution of this agreement, 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 stated above and ternlinate on November 4th, 2017 unless terminated earlier in accordance with Section 11, below. Page t of 7 4. INDEPENDENT CONTRACTOR Provider shall, during the entire tenn 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 manner in which Provider performs the services which are the subject matter of this Agreement; however, the services to be provided by Provider shall be provided in a manner consistent with all applicable standards and regulations governing such services. Provider 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. Provider is not an agent, representative or employee of City and Provider shall have no authority to act on behalf of the City. INSURANCE Prior to undertaking performance of work under this Agreement, Provider shall maintain and shall require its subcontractors, if any, to obtain and maintain insurance as described below: a. Commercial General Liability Insurance. Provider 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 Provider's negligent 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 and $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 insured 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 California State law, Consultant, if Provider 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, Provider 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 Provider pursuant to this section: (i) Provider shall maintain all insurance required above in full force and effect for the entire period covered by this Agreement. Page 2 of 7 (ii) Certificates of insurance shall be furnished to the City upon execution of this Agreement and shall be approved in form 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. e. If Provider 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 Provider's right to be paid for its time and materials expended prior to notification of termination. Provider 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 Provider agrees to and shall defend, indemnify 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 Provider 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 Provider 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 terns of, or effects arising from this Agreement. 7. CONFLICT OF INTEREST Provider 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. 8. 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: Page 3 of 7 To City: Clerk of the 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 copy to: Executive Director of Parks, Recreation and Community Services City of Santa Ana 26 Civic Center Plaza (M-23) P.O. Box 1988 Santa Ana, California 92702 Fax (714) 571-4211 To Provider: Super Antojitos 1702 North Bristol Santa Ana, CA 92703 Phone: (714) 835-3619 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. 9. EXCLUSIVITY AND AMENDMENT This Agreement represents the complete and exclusive statement between the City and Provider regarding the subject matter herein, 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 Provider. 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 Provider 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 is not embodied herein. 10. ASSIGNMENTS The experience, knowledge, capability and reputation of Provider were a substantial inducement for City to enter into this Agreement. Therefore, Provider 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. Page 4 of 7 11. TERMINATION This Agreement may be terminated by the City at any time upon written or verbal notice of termination. In such event, Provider shall be entitled to receive, and City shall pay Provider, compensation for all services rendered prior to the effective date of termination. 12. NON DISCRIMINATION Provider 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, teaching, training, utilization, promotion, termination or other employment related activities, or in any activities under this Agreement. Provider affinus that it is an equal opportunity employer and shall comply with all applicable federal, state and local laws and regulations. 13. 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. 14. LICENSES Provider shall, throughout the tern 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. 15. SEVERABILITY In the event that one or more of the phrases, sentences, clauses, paragraphs or sections contained in this Agreement shall be declared invalid or unenforceable by valid judgment or decree of a court of competent jurisdiction, such invalidity or unenforceability shall not affect any of the remaining phrases, sentences, clauses, paragraphs or sections of this Agreement, which shall be interpreted to carry out the intent of the parties hereunder. 16. EXHIBITS All Exhibits referenced herein and attached hereto shall be incorporated as if fully set forth in the body of this Agreement. 17. AUTHORITY The person(s) executing this Agreement on behalf of the parties hereto warrant that they are duly authorized to execute this Agreement on behalf of said parties and that be so executing this Agreement, the parties hereto are formally bound to the provisions of this Agreement. Page 5 of 7 N-2017-229 IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first above written. ATTEST: D. ' /�—Clerk of the Council APPROVED AS TO FORM: SONIA R. CARVALHO City Attorney By: F44�A— JOVN FUNK NK Assistant City Attorney RECOMMENDED FOR APPROVAL: GERARDO MQUET Executive'Director of Parks, Recreation and Community Services Agency CITY OF SANTA ANA um; RAUL GODINE CITY MANAGER PROVIDER: e W� SUPER ANTOJITOS Tax ID: Page 6 of 7 EXHIBIT A Page 7 of 7 Exhibit SUPER ANTOJITOS 1702 N. BRISTOL SANTA ANA CA 92703 714 535-3619 QUOTE CITY OF SANTA ANA 100 PEOPLE Purpose of expense: CATERING FOR PARADE PARTIOPANTS NOV 4, 2017 100 PLATES $9.50 $950.00 100 CUPS CONTAINER RICE CONTAINER BEANS CONTAINER ORDER OFCFUPS 2 CONTAINERS ORDER OF SALSA FAJITAS CHICKEN _ AGUAS T'AMARINDO, LEMON, HORCHATA TAX INCLUDED 10.00 I GRAND TOTAL 1$950.00 0912W209 MIUM190 RW 9rfli I I a9 MI0699199 TEPA INSURANCE SERVICES INC - 001 2509 W MCFADDEN AVE STE G SANTA ANA, CA 92704 (714)835-5159 Named Insured VICTOR J SANDOVALLOPEZ 2132 S ROSS ST SANTA ANA, CA 92707-2717 undefW,irten By: Alliance United Insurance Services, LLC Al P,O. Box 6060, Camarillo, CA 93011 -6060 Ph:(866) 530.5500 Fax:(866) 530.2500 Alliance United Inswanw fampany Lic It OC17987 www.allianceunited.com REWRITE DECLARATIONS PAGE Online Auto Rewrite of Cancel - Producer Payment Policy Number: Effective Date: Expiration Date: VEHICLE INFORMATION MIL3689190 5 09/22/2017 12:31 PM PT 03/22/2018 12:01 AM PT Veh # Year Make Model VIN mileafle Use Symbol Driver 1 2006 CHEV EXPRESS G3500 1GAHGSSU061270014 16500 Pleasure W-15-15 1 COVERAGE AND PREMIUM INFORMATION BI $15,000 Each Person / $30,000 Each Accident $107,75 PD $10,000 Each Accident $111.59 Total Vehicle Premium: $it 9.34 Rewrite Fee $10.40 Anti -Fraud Feels) $0 87 Total Premium and Fees $230.61 DRIVER INFORMATION Driv Name Gender Marital DOB Yrs Lic Relation License # Points 1 VICTOR J SANDOVALLOPEZ M M 07/XX/1979 22 Self XXXX5004 1 2 MADE JESUS SANDOVAL F M 04/XX11980 21 Spouse XXXX5894 0 EXCLUDED DRIVER INFORMATION Name Bancor Marital Q Relation JACOB SANDOVAL M S 10/XX/1988 SON DAVID SANDOVAL M S 03/XX/1989 BROTH DRIVING RECORD Drbv# Description Date Points 1 22102 Turning/Turn Signals 03/31/2016 1 1 5201 Registration 03/31/2016 0 OISCOUNTSISURCHARGES Description Veh #1 Multi-Car/Driver Discount X Good Driver Discount „t `I X Anti -Fraud Fee �f✓� b 7 X �Aevas POLICY AND ENDORSEMENTS AG 21 07/15 Gold Policy MI 01 07/14 Information Regarding Prom Discount MI 02 07/14 Auto Body Consumer Bill of Rights MI 05 07/14 Named Driver Exclusion MI 07 07114 Deletion of UninsuredlUnderinsured BI Cov MI 08 07114 Deletion of Uninsured Motorist Prop Dam Cov, Policy Policy Policy Policy Policy Policy INSURED COPY 09/2W2017 0 MIL3689190 - VICTOR J SANDOVALLOPPZ - ID Cards California Insurance ID Card If You Are In An Accident Alliance United Insurance Company PO BOX 6042 Camarillo, CA 93011.6042 1. Do not leave the scene. NAIC # 10920 2. Call the police to report the accident. Policy Number Effective Date Expiration Data MIL3689190 09/22/2017 03/22/2018 3, Cell Alliance United Insurance Company at (800) 508.5833, (lo card valid only If policy is io-force) 4. Do not admit fault. Do not discuss the accident with anyone except Named Insured: Named Drivers: the police and your Alliance United Insurance Company representative, VICTOR J SANDOVALLOPEZ -VICTOR J SANDOVALLOPEZ 2132 S ROSS ST -MADE JESUS SANDOVAL 5. Exchange information with the other driver, Ask for the following: SANTA ANA, CA 92707-2717 . Name, address, driver's license number, and phone numbers of other drivers and witnesses, . Year, make, model, and license plate number of all vehicles involved. Broker: . Name of Insurance Company and policy number of other TEPA INSURANCE SERVICES INC - 001 drivers. Phone: (714)835-5159 Vehicle Information: Year Make Model VIN # 2006 CHEV EXPRESS G3500 1 GAHG35U061270014 91? AC RO V - °"T1 1..,..- CERTIFICATE OF LIABILITY INSURANCE 1/0/20'"""' 11; 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 INSURE R(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) 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 CONTACT NAME: QUYEN HOANG PARKSIDE INSURANCE SERVICES,-- 16511 Brookhurst St Fountain Valley CA 92708 INSURED - -- - ELIZALDE, GUILLERMO DBA: SUPER ANTOJITOS EXPRESS 1702 N BRISTOL ST STE D SANTA ANA CA 92706 PHONE FAX (A/C, NO, EXT): 714-705-9453 (A/C, NO): 714-839-7381 E-MAIL ADDRESS: parksideins@gmail.com INSURER(S)AFFORDING COVERAGE INSURERA: EMPLOYERS PREFERRED INSURANCE CO INSURERB: INSURER C: INSURER D: INSURERS INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO TH E INSURED NAME ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUB] ECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDTL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD Vivo(MM/DD/YVYV) (MM/DD/VYYV) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS -MADE OCCUR DAMAGETO RENTED $ PREMISES (Ea Occurrence) MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ POLICY PROJECT LOC PRODUCTS - COMP/OPAGG $ OTHER: $ AUTOMOBILE LIABILITY \e6 COMBINED SINGLE LIMIT $ (Ea accident) ANYAUTO BODILY INJURY (Per person) $ OWNEDAUTOS SCHEDULED.(t, �e,�e V� G e �` V - ONLY AUTOS BODILY INJURY (Per accident) $ HIREDAUTOS NON -OWNED PROPERTY DAMAGES ONLY AUTOSONLY lC^1 (Peraccident) ��; /^ �iJ $ UMBRELLA LIAB OCCUR Q EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION ��-- - - ^ -.-PER �— OTHER $ AND EMPLOYERS'LIABILITY STATUTE ANY PROPRIETOR/PARTNER/ Y/N E.L. EACH ACCIDENT $ 1,000,0001 EXECUTIVE OFFICER/MEMBER N/A EIG229134900 11/01/2017 11/01/2018 A EXCLUDED? (Mandatory in NFN _Y ELDISEASE EAEMPLOYEE. $ 1,000,0001 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASEPOLICYLIMIT $ 1,000,0001 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) Certificate holder, its officers, agents and employees are named as Additional Insured. Should any of the above described policies be cancelled before the expiration date thereof, the issuing insurer will endeavor to mail 30 days written notice to the additional interest named below, but failure to mail such notice shall impose no obligation or liability of any kind upon the insurer, its agents or representatives. 10 day notice of cancellation for nonpayment. CERTIFICATE HOLDER CANCELLATION CITY OF SANTA ANA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION ATT: PRCSA DATE THEREOF NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 20 CIVIC CENTER PLAZA M-23 AL(4.R5WgNTATIVE __.--- _ SANTAANA -.--- -.._- --- CA 92701 ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All Rights Reserved 31-1769 11-15 The ACORD name and logo are registered marks of ACORD ADDITIONAL.INSURED ENDORStMENT insurance Company Ly NtPir—S TVs vYa-Hnf This endorsement modifies such insurance as is afforded by the provisions of Policy # 60 q q Z 4Y d !;Z relating to the following: 1. 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 benefitr of the additional insureds. 3. 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. 4. 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 %!5 /Tp % 'q- this endorsement form as part of Policy # o Let p 6 Y � E Issuedtoyoe-r d4 .$ f-X•r• r-SS Name I ured e Countersigned by a eJaS� P�' ./'7 CCOR,0 DATE,(MM/DD/YYYN) !�..-•' CERTIFICATE OF LIABILITY INSURANCE11102/2017 -- TI THIS GERTIFIGATE IS LfiSLLEDASRMATTBR pF:-tNFSJRMA'CLON.ONb15AMD,GDNEER6,WP=RtGHT$:URPNTIAESkERTIPIGATE;HOLDER.;THI$:CfftTIFIG/nTE DDES'NDTAFFIRMATIVELY DRi'NRGATIkELY .AMEAI➢,EXT,E-N :ORAVTERTIRE CAVERAG%RPFORDB98Y THilA91iDIE&'BBLQW,THIS.CERTMICATE OFiINSURANCEIDDES NOT+CONSYITOTE A CONT.RAC'rBBTW.HBNTHEIS$UINGTNSURER(&). ;AUTHORIZEDREPRE8ENTATIVESORPRODUCER,AND+THE•CERTIEICA'Me lOLD%R. tIMR,ORTANtT:+.IfShenartlFlcate4lpldar IeanAPPITIEINA4.IN811REA.dhelppllayjfe5)muaYhaveADDITIONALYINSURED proviplonpnr 6e endarsad.lf$U9RD.GATtON tS WAIVED,,Wbjecttn,Ihe:termsand +e9MIt190b of`theA statemenCon thisvaftlficate;dflp9 notconia"ighwo the contif make holderip.lieu 'afqucb erldamemeR((s). PRODUCER :CONTACTWiEa_.. _...._....... _. dyfti / 9�r), /7 _ 92 NAME: Wend Iy MLIGOZ _.... PAY .2441N-TwxtG `) A Ave Ste EP V� / s (�" (HDNNp EXT)714+550-11 DO f !C,f10)' 714,550-717.0 ..... E-MAIL _Santa Arta CA W70548E1 ADDRESS WRIU11.04farmef83gent,com IN$URER(9)ARPORDFNG:GAVERAGE NAIG# INSURED TNSURERA Tfwak?1geUfaRCe.EXDh>agge 21709 INSURERO Faf nerS InBUranoo Exchange _ 21052 #EU7A9„PE, #�UILLERML) -- - -.__ __. INSURERC MId:OogtUry InBLrance ("ornpony 21687 fl®A'S�iUP6R�.NT.t�JISY115;E�YIRk2E$_�u — 1702 �N;BRISTQVST I NaWRERD STEAD _..._ SANTA ANA .CA 92706 INSURERS:...- .............. _.... _ . _ ....................... . IN$41RER_F: .COVERAGES GERTIFIGATE`NUMBkR: ieEVISION:NUNI%ER: Tkl(S115 TppER@IPY TPWT'1'Hk'POL{CIEs OF IN$WRANGE LISTBp BEEOWHAVE BEEN IRSURp TOTWE INSURED NAMEA90YERORVHE POLICY RERIDD INDICAIIED;NOTWITHSTANDING ANY $kQUIREMENiLtfERM QRSQMDdP[DRA4F'ANY,CQNS{(ACT!Qfr'(dFiFtORIpflCA1M@NP W4'6INiRESGECTTOeWHICH.l1H13CERITIF1CATE MAY BE IS5UED: QR MAY PERTAIN, THE IYSURANGE`APPORUED DYTHE POLICIES OF SUGPI POLICIES UMplS£H¢WNMWHAVEAftEN REDUCED,BYPAIDOLNIMS, TBR TIMPEOFINSURANCE AINSPL VIVOP.OUCY NUMBER RGLICYEPF POLICY EXP MY3S (MM/DD/:YYYY) (MMIND)YXYHi) EACH `X CQMMERCIALGENERALk1A%IGfPY EACH:OCGURRBNCE $ 1;000;0.00 C1.AIMS;MAQE X OCCUR DAMAGE TOREaNTBD PREMISES(Ea DawreRve) $ 2$D;00➢ A Y IN Q05415467 4BNR.AGGREGAI'E LIM4b-APRUIES.PER: X IPOWCY ;PROJECT LOC OTHER: AUTONE0816ELIABILLWY rMEDEXR(Anyonepersoo) s 5;DO0 11101/2017 1'I70;1/2O1B .PERSONAL&AITV:INJURY $ 1 gpDlppp ._... ANYAUTO rOWN&DAUTOS 'SCHEDUHID ONLY AUTOS 'HIRED AUTOS INON,QWNRD 6 " "p ONLY AUTOSMNLN 4y .UMPRO LIAR OCCUR ... ......... ___-..__ .,,y / �. EXCE'SSLiAB CIAIMS114Af7E DED RETENnOn$ WORKERS.CDMPENSAMON __._.... ANY PROPRIETORY PARTNI BXE4U2'IR ,(MandaWryi REH -11y7D.WR®©F eugjty GfSCRJ HS OPE TIONSbalow rlilEStRI%IlQN;pF rOPERATIONS:bafpw xfN N/A GENERAL AGGREOAIiE_ $ 2,0Op rlpo IRRODUCTS COMP/OPAGG $ 2,000„000 COMBINEDSINGLE LIMIT _B (EaecLiflw@) ,0DIEVIINjURYRPw,Penm) '$ BODICV INIURY(Paraer,I:denG)� PROREWY DAMAGE (Perecndent) $ EACNIOCCWRRENGE $ AOPR£CrvATk $ 8 PER OTHER S:FATUTE 6L.EAGHACCID'BNIT $ EiL OPSEASE EAEMPLQYEE $ RIL 01IPOLOYIL'IMIT : DESCRI.BRI$ ICLS , A NTAGANA,CV927{'EE(AGGRO LDI tAdtllYipndlRartretksSChedule,+>may beaHaahadR:mprasRaca lssapUiFed% SI,702 N'&RtSTiSOL ST mTANTA ANA CA�82708 CBRTIPICATE;NIpUDER .CANCELLATION _ THELOITYOFSAN,TAANA SHOULD ANY PTTN PfCZfDATE THEREOF, NTpHTE'CEEBOWV1£LDDaEESDELIVERED :(INCAIEGSCBOEBG➢AAPICE'WITH THEAEDTLHICEYB'XRRRAIRYAIT$ItAONNS zo clutQ rt:ENmEre PLAZA k1�3rE�TI}��ESENTATJVE SANTAANA :CA ,927D1_. _.... _. _.. AC0RD25 (2015/03) algW2015 ACORDCO:RPORATON.. AII.RightsReserved 31 1769 11-15 The ACORD nome;andlogo are;reg�isReredvarks DfAMIRD