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7.3.2 The Vendor will be required to provide the following insurance documents that <br />contain specific modifications before any work can commence: <br />a. Complete and provide an Additional Insured Endorsement form. <br />(1) See Appendix C for City's preferred Additional Insured Endorsement <br />form. <br />b. Complete with modifications and provide a Certificate of Insurance form. <br />(1) Include in the "Certificate Holder" block (left bottom corner) the statement: <br />CITY OF SANTA ANA, ITS OFFICERS, AGENTS AND EMPLOYEES <br />P.O. BOX 1988 <br />SANTA ANA, CA 92702 <br />(2) Modify the "Cancellation" block to read: <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVO <br />T$MAIL *30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED <br />TO THE LEFT, BUT FAILURE II T TRE TO MAIL A I S G14 NOTICE CU n I I IAiIDOSE NO <br />OBLIGATION O LIABILITY OF ATV VATA PON T -14E COMPANY, ITQ A!LATTC <br />OR <br />REPR SENT A TIVES <br />(3) See Appendix C for sample of a properly completed Certificate of Liability <br />Insurance form. <br />c. Insurance companies may be California admitted or non -admitted carriers. If <br />non -admitted, they need to be licensed to do business in California and proof <br />may be required. <br />d. Vendors who self -insure Workers' Compensation must submit a copy of their <br />Certificate to Consent to Self -Insure from the State of California and provide <br />third party administration information, if applicable. <br />(1) See Appendix C for sample of a proof of Workers' Compensation <br />Insurance form. <br />7.4 Invoices <br />Invoices, submitted in duplicate, shall be mailed to: <br />City of Santa Ana <br />Information Services (M-12) <br />P.O. Box 1988 <br />Santa Ana, CA 92702 <br />The Agreement number must appear on all invoices. <br />City of Santa Ana Page 15 of 39 <br />Exhibit A <br />