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<br />Mar-ZB-DZ 1D:17a. From-ROBERT F DRIVER <br /> <br />+949-ZS 1-166, <br /> <br />T-614 P DDI/DDZ HBI <br /> <br />VENDORS/CONTRACTORS GENERAL LIABILITY REQUEST TO BIND COVF.:RAGE <br /> <br />Contrae/ors Program _ Complete top see/Ion and retum to R. F. Driver to Bind. <br />Attelltion: Monique Navarro, Account Administrator <br /> <br />(COVERAGE NOT IN FORCE lJNTn. BINDER RECEIVED FROM: COMPANY) <br />Date:2t~~ <br /> <br />Public Entity: City of Santa Ana <br /> <br />(714) 647-5311 <br /> <br />Fax: <br /> <br />Vendor I Contractor: <br /> <br />Secure Investigations, Inc. & Associates <br /> <br />Vendor 1 Contractor Mailing Address: <br /> <br />2021 E. 4th Street, Suite 200 <br />Santa Ana, CA 92705 <br /> <br />Cemtac\: Rosa Flores <br /> <br />Descnption of Contract: <br /> <br />Surveillance, inves tigat~.ct Value: <br /> <br />$9,000 <br /> <br />Scopc of Work: <br /> <br />Surveillance, investigations <br /> <br />Tenn of Contract: From 3/25/02 To: 6/30/02 Hazard: <br /> <br />I <br /> <br />Rate: $359.77 <br /> <br />Plcase bmd !he above account effective .-2-1 ~--.!!!:.... <br /> <br />Total Policy Premiu m: <br /> <br />State Tax (3%): <br />StampiDg Fee (.25%): <br />Certificate Fee: <br />Total AlPount: <br /> <br />$ 300.00 <br />5 9.00 <br />5 0.77 <br />$ 550 <br />$ 359.77 <br /> <br />__........__......__.___......_____..... ._....__.._.M_ <br /> <br />.....-.---....-.,-.--....-..-..'..--- ....-.--.--.... <br /> <br />~~~~/ <br /> <br />Robert F. Driver Ph: (949) 756-0271 <br />P.O. Bol<. 6450 Fax: (949) 756-2713 <br />Newport Beach, CA 92660 <br />License #OC36861 <br /> <br />BINDER ACKNOWLEDGEMENT <br /> <br />Dale: (23...1;:)..<;;;1 ck:r <br /> <br />Contractor is Bound Effecrive:03 f2~ I~'ulcrum Insurance Company. <br />Master Policy Number: CP-1002566 <br /> <br />COVERAGE IN FORCE FOR NAMED CONTRACT ONLY, <br />Public Entity i, Namcd as AdditIonal Insured: <br /> <br />gv.... '/- }- <br /> <br />Q er- "7 <br /> <br />Au!horized Representative <br />R.E. Chaix & Associates Insurance Broken, Inc. <br />L icensc #0726213 <br /> <br />Sample ur Policy i> au file witlt the Public Entity and c8n be provided UpOD re<ptt'PROVED AS TO F <br /> <br />,.....','~___~"" ~~ ""n"" ORM <br /> <br /> <br />1.nura Sheedy ~ <br />I),pl.!) Ci,y'Allorney <br />