HomeMy WebLinkAboutBAKER RESCUE SERVICES, INC. (2)N-2022-127
INSURANCE ON FILE
WORK MAY PROCEED
UNTIL INSURANCE EXPIRES
0%103/ ZZ
CLERK OF COUNCIL AGREEMENT WITH BAKER RESCUE SERVICES, INC.
DATE: TO PROVIDE ON -CALL CONFINED SPACE RESCUE STAND-BY SERVICES
O� pV4A(gr►anLOP VL)(DZ)2
THIS AGREEMENT is made and entered into this 21 st day of April 2022, by and between Baker
Rescue Services, Inc., ("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
o ("City").
RECITALS
A. The City desires to retain a contractor having special skill and knowledge in the field of
Z on -call Confined Space Rescue Stand-by Services for the Public Works Agency.
B. Contractor represents that Contractor is able and willing to provide such services to the
City.
C. In undertaking the performance of this Agreement, Contractor represents that it is
knowledgeable in its field and that any services performed by Contractor under this
Agreement will be performed in compliance with such standards as may reasonably be
expected from a professional contracting 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:
1. SCOPE OF SERVICES
Contractor shall perform the tasks and obligations including all labor, materials, tools,
equipment, and incidental customary work required to fully and adequately complete the services
described and set forth in Exhibit A, attached hereto and incorporated by reference.
2. COMPENSATION
a. City agrees to pay, and Contractor agrees to accept as total payment for its services
under this Agreement, the rates and charges identified in Exhibit B. The total amount
to be expended under the term of this Agreement shall not exceed Fifty Thousand
Dollars and Zero Cents ($50,000).
b. City shall compensate Contractor for any services provided under the terms of this
Agreement since April 1, 2022.
c. Payment by City shall be made within 45 days (forty-five) days following receipt of
proper invoice evidencing work performed, 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 continence on the date first written and terminate on March 31, 2024,
unless terminated earlier in accordance with Section 17, below.
4. PREVAILING WAGES
Contractor is aware of the requirements of California Labor Code Section 1720, et seq.,
and 1770, et seq., as well as California Code of Regulations, Title 8, Section 16000, et seq.,
("Prevailing Wage Laws"), which require the payment of prevailing wage rates and the
performance of other requirements on "public works" and "maintenance" projects. If the services
being performed are part of an applicable "public works" or "maintenance" project, as defined by
the Prevailing Wage Laws, and the total compensation is $1,000 or more, Contractor agrees to
fully comply with such Prevailing Wage Laws. Contractor shall defend, indemnify and hold the
City, its elected officials, officers, employees and agents free and harmless from any claim or
liability arising out of any failure or alleged failure to comply with the Prevailing Wage Laws.
5. 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.
6. OWNERSHIP OF MATERIALS
This Agreement creates a non-exclusive and perpetual license for City to copy, use,
modify, reuse, or sublicense any and all copyrights, designs, and other intellectual property
embodied in plans, specifications, studies, drawings, estimates, and other documents or works of
authorship fixed in any tangible medium of expression, including but not limited to, physical
drawings or data magnetically or otherwise recorded on computer diskettes, which are prepared or
caused to be prepared by Contractor under this Agreement ("Documents & Data"). Contractor
shall require all subcontractors to agree in writing that City is granted a non-exclusive and
perpetual license for any Documents & Data the subcontractor prepares under this Agreement.
Contractor represents and warrants that Contractor has the legal right to license any and all
Documents & Data. Contractor makes no such representation and warranty in regard to
Documents & Data which were provided to Contractor by the City. City shall not be limited in
any way in its use of the Documents and Data at any time, provided that any such use not within
the purposes intended by this Agreement shall be at City's sole risk.
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. Minimum Scope and Limit of Insurance
1. Commercial General Liability (CGL): Insurance Services Office
Form CG 00 01 covering CGL on an "occurrence" basis, including
products and completed operations, property damage, bodily injury
and personal & advertising injury with limits no less than
$1,000,000 per occurrence. If a general aggregate limit applies, either
the general aggregate limit shall apply separately to this
project/location (ISO CG 25 03 or 25 04) or the general aggregate
limit shall be twice the required occurrence limit.
2. Automobile Liability: ISO Form Number CA 00 01 covering any
auto (Code 1), or if Contractor has no owned autos, hired, (Code 8)
and non -owned autos (Code 9), with a limit no less than $1,000,000
per accident for bodily injury and property damage.
3. Workers' Compensation: as required by the State of California,
with Statutory Limits, and Employer's Liability Insurance with limit
of no less than $1,000,000 per accident for bodily injury or disease.
4. Professional Liability: 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 $2,000,000 per claim with $2,000,000 in the aggregate.
Broader Coverage: if the Contractor maintains broader coverage
and/or higher limits than the minimums shown above, the City
requires and shall be entitled to the broader coverage and/or the
higher limits maintained by the Contractor. Any available insurance
proceeds in excess of the specified minimum limits of insurance and
coverage shall be available to the City.
b. Other Insurance Provisions
1. Additional Insured Status: The City, its officers, officials,
employees, and volunteers are to be covered as additional insureds
on the CGL policy with respect to liability arising out of work or
operations performed by or on behalf of the Contractor including
materials, parts, or equipment furnished in connectionwith such
work or operations. General liability coverage can be provided in
the form of an endorsement to the Contractor's insurance (at least as
broad as ISO Form CG 20 10 11 85 or if notavailable, through the
addition of both CG 20 10, CG 20 26, CG 20 33, or CG 20 38; and
CG 2037 if a later edition is used).
2. Primary Coverage: For any claims related to this contract, the
Contractor's insurance coverage shall be primary coverage at least
as broad as ISO CG 20 01 04 13 as respects the City, its officers,
officials, employees, and volunteers. Any insurance or self-
insurance maintained by the City, its officers, officials, employees,
or volunteers shall be excess of the Contractor's insurance and shall
not contribute with it.
3. Notice of Cancellation: Each insurance policy required above shall
provide that coverage shall not be canceled, except with notice to
the City.
4. Waiver of Subrogation: Contractor hereby grants to City a waiver
of any right to subrogation that any insurer of said Contractor may
acquire against the City by virtue of the payment of any loss under
such insurance. Contractor agrees to obtain any endorsement that
may be necessary to affect this waiver of subrogation, but this
provision applies regardless of whether or not the City has received
a waiver of subrogation endorsement from the insurer.
Self -Insured Retentions: Self -insured retentions must be declared
to and approved by the City. The City may require theContractor to
purchase coverage with a lower retention or provide proof of ability
to pay losses and related investigations, claim administration, and
defense expenses within the retention. The policy language shall
provide, or be endorsed to provide, that the self -insured retention
may be satisfied by either the named insured or City.
6. Acceptability of Insurers: Insurance is to be placed with insurers
authorized to conduct business in the state with a current A.M.
Best's rating of no less than A:VII, unless otherwise acceptable to
the City.
7. Claims Made Policies (applicable only to professional liability):
The Retroactive Date must be shown, and must be before the
date of the contract or the beginning of contract work.
ii. Insurance must be maintained and evidence of insurance
must be provided for at least five (5) years after completion
of the contract of work.
iii. If coverage is canceled or non -renewed, and not replaced
with another claims -made policy form with a Retroactive
Date prior to the contract effective date, the Contractor must
purchase "extended reporting" coverage for a minimum of
five (5) years after completion of work.
Verification of Coverage: Contractor shall furnish the City with
original Certificates of Insurance including all required amendatory
endorsements (or copies of the applicable policy language effecting
coverage requiredby this clause) and a copy of the Declarations and
Endorsement Page of the CGL policy listing allpolicy endorsements
to City before work begins. However, failure to obtain the required
documents prior to the work beginning shall not waive the
Contractor's obligation to provide them.
The City reserves the right to require complete, certified copies of all
required insurance policies, including endorsements required by
these specifications, at any time.
Subcontractors: Contractor shall require and verify that all
subcontractors maintain insurance meeting all the requirements
stated herein, and Contractor shall ensure that City is an additional
insured on insurance required from subcontractors.
10. Special Risks or Circumstances: City reserves the right to modify
these requirements, including limits, based on the nature of therisk,
prior experience, insurer, coverage, or other special circumstances.
11. 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
without 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.
12. CONFLICT OF INTEREST CLAUSE
Contractor covenants that it presently has no interest and shall not have interests, direct or
indirect, which would conflict in any manner with performance of services specified under this
Agreement.
13. 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: Clerk of the City Council
City of Santa Ana
20 Civic Center Plaza (M-30)
P.O. Box 1988
Santa Ana, CA 92702-1988
Executive Director
Public Works Agency
City of Santa Ana
20 Civic Center Plaza (M-21)
P.O. Box 1988
Santa Ana, CA 92702
To Contractor: Baker Rescue Services, Inc.
19744 Beach Blvd. #366
Huntington Beach, CA 92648
Attn: David Baker
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
timeframes, weekends, federal, state, County or City holidays shall be excluded.
14. EXCLUSIVITY AND AMENDMENT
This Agreement represents the complete and exclusive statement between the City and
Contractor 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
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.
15. 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 Contractors retained by City.
16. WAIVER
No waiver of breach, failure of any condition, or any right or remedy contained in or
granted by the provisions of this Agreement shall be effective unless it is in writing and signed by
the party waiving the breach, failure, right or remedy. No waiver of any breach, failure or right, or
remedy shall be deemed a waiver of any other breach, failure, right or remedy, whether or not
similar, nor shall any waiver constitute a continuing waiver unless the writing so specifies.
17. 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 unless 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 which fails to meet the standard of
performance specified in the Recitals of this Agreement.
18. NON-DISCRIMINATION
Contractor shall not discriminate because of race, color, creed, religion, sex, marital status,
sexual orientation, gender identity, gender expression, gender, medical conditions, genetic
information, or military and veteran status, 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 any services provided under this
Agreement. Contractor affirms that it is an equal opportunity employer and shall comply with all
applicable federal, state and local laws and regulations.
19. 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.
20. 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.
21. MISCELLANEOUS PROVISIONS
a. Each undersigned represents and warrants that its signature herein below has the
power, authority and right to bind their respective parties 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.
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: CIITT�Y OF SANTA ANA
Daisy Gomez Kr st
Clerk of the Council City Manager
[signatures continued on next page/
APPROVED AS TO FORM
SONIA R. CARVALHO
City Attorney
Deputy City Attorney
FOR APPROVAL
Nabil Saba, P.E.
Executive Director,
Public Works Agency
CONTRACTOR
David Baker
President
1'*K4 : l I:j Y MAI
Exhibit A
Baker Rescue Services, Inc
City of Santa Ana Water Resources Division
220 S. Daisy Ave.
Santa Ana, CA 9271
Attention: Lauren Cortez
Re: 3 Man Rescue Team for Confined Space Entry
Dear Lauren,
Baker Rescue Services (BRS) is pleased to submit the following estimate to City of Santa
Ana Water Resources Division for certified stand by rescue services.
Scope of Work
BRS to provide City of Santa Ana employees with a three (3) man certified rescue team
while City of Santa Ana employees and/or their subcontractors are working inside
confined spaces. BRS will provide all necessary rescue personnel, equipment, and
materials to perform a rescue for any entrant who becomes unable to perform a self -
rescue or removal of themselves while in a confined space.
Company background
Members of BRS certified rescue team are comprised of all off -duty full time firefighters.
All BRS employees are professional rescue personnel that are members of various Urban
Search and Rescue Teams for the State of California, Government Agencies, and/or
FEMA. All BRS employees are certified through the State of California Fire Marshal's
Office as Confined Space Rescue Technician and Emergency Medical Technician.
Price
BRS is providing an hourly rate based on Prevailing Wage straight, overtime, and
double time rates. The price includes all necessary equipment. If you have any
questions, please do not hesitate to call me at the number below.
Baker Rescue Services, Inc
19744 Beach Blvd. #366
Huntington Beach, Ca 92648
Tel: (714) 493-4200
Exhibit B
Baker Rescue Services, Inc
Description
UOM
3-Man
Team
Straight time hours - Monday -Friday
HR
$290.00
Overtime hours — Any hours after eight
HR
8 Monday — Friday, and Saturday
$345.00
Double time hours — any hours worked
HR
after first eight (8) on Saturday, any
hours after twelve (12), all Sunday hours
$400.00
and Holidays.
Eight (8) hour workday on -Fri)
Da
$2,320.00
Mob/Demob
Job
$500.00
Total for 1-day job
I Job
$2 820.00
Baker Rescue Services, Inc
19744 Beach Blvd. #366
Huntington Beach, Ca 92648
Tel: (714) 493-4200
Tori Pierson oate.20 043713:16:3-0TN'
�►� o® CERTIFICATE OF LIABILITY INSURANCE
DATE(MMIDDMYY)
oa/zo/zoz2
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLYAND 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 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 Shelby Cecena AFIS
NAME:
James G Parker Insurance Assoc
PHONE (559) 58 -3323 FAX (559) 584-9313
A/C No EKt: AIC, No:
Become Ins Agency Lic#0554959
E-MAIL shelbyc@jgparkeccom
ADDRESS:
P O BOX 1129
INSURER(S) AFFORDING COVERAGE
NAIC#
INSURER A: Landmark American Ins Co
33138
Hanford CA 93232
INSURED
INSURER B: California Automobile Insurance
38342
Baker Rescue Services Inc
INSURER C: State Compensation Ins Fund
35076.
19744 Beach Blvd #366
INSURER D:
INSURER E :
Huntington Beach CA 92648-2988
INSURERF:
COVERAGES CERTIFICATE NUMBER: 21-22 Master GL/BA/EX/ REVISION NUMBER:
THIS IS TO CERTIFY THATTHE 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAYBE 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
ADOLSUBRPOLICY
INSD
MD
POLICY NUMBER
EFF
MWDD/YYYY
P E P
MMIDDIYYYY
LIMITS
MERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 1.000,000CLAIMS-MODE
�OCCUR
T
PREMISES Ea occurrence
$ 50,000
MED EXP(Any one person)
$ 5,000
I
PERSONAL aADV INJURY
$ 1,000.000
A
Y
LHC843766
08/03/2021
08/03/2022
GENL AGGREGATE LIMIT APPLIES PER:
GENERALAGGREGATE
$ 2,000,000
X POLICY JECPROT LOC
PRODUCTS - COMPIOP AGG
$ 2,000,000
OTHER:
CGL B Professional Lett
$ 2,01101
AUTOMOBILE
LIABILITY
EBMBNYL+PUINGLE LIMIT
Ea accident)
$ 1,000,000
X
BODILY INJURY (Per person)
$
ANYAUTO
B
OWNED F SCHEDULED
AUTOS ONLY AUTOS
Y
BA040000069059
08/03/2021
08/03/2022
BODILY INJURY (Per accident)
$
HIRED I I NON -OWNED
AUTOS ONLY ALMOS ONLY
PROPERTY DAMAGE
Per accitlent
$
Uninsured motorist
s 1.000,000
UMBRELLA LIAB
OCCUR
""""""""""""""'
EACH OCCURRENCE
$ 5,000,000
A
EXCESS LIAB
CLAIMS -MADE
LHA252201
08/03/2021
08/03/2022
AGGREGATE
$ 5,000,000
DED
I I RETENTION $
$
C
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETORIPXCLUD (EXECUTIVE 1
(Mandy, WMEMBEft EXCLUDED?
IMandatsc in NH))))
NIA
Y
1851446-2021
09/01/2021
09/01/2022
PER OTH-
X STATUTE ER
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYEE
$ 1,000,000
Dyes,RIPTIONribe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
$ 1,000,000
DESCRIPTION OF OPERATIONS LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required)
City of Santa Ana, officers, agents, employees, and volunteers are included as Additional Insured with respects to General Liability per attached form
RSG95001 0903 and Automobile Liability per attached form MCA8510 0817. Primary & Non-contributory is included with respects to General Liability per
attached form RSG54155 0816. Wavier of Subrogation Applies per form 10217 REV.7-2014.
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS.
Risk Management Division AUTHORIZED REPRESENTATIVE „ Wi Mo�gutnl OhYm
20 Civic Center Plaza, 4th flo .f 96,"•.q�&N®�,
Santa Ana CA 92701 (� D n -/pu � ^/ ✓� tL irwen
91988-2015ACORD ..__.._.._r_.._... _,,..a.._.._
ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
LANDMARK AMERICAN INSURANCE COMPANY
This Endorsement Changes The Policy. Please Read It Carefully.
PRIMARY AND NONCONTRIBUTORY -
OTHER INSURANCE CONDITION (SPECIFIC)
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE FORM
SCHEDULE
Name of Additional Insured
Any person or organization to whom or to which the Named Insured is obligated by virtue of a written contract or
by the issuance or existence of a written permit, to provide insurance such as is afforded by this policy.
The following is added to the Other Insurance Condition and supersedes any provision to the contrary:
Primary And Noncontributory Insurance
This insurance is primary to and will not seek contribution from any other insurance available to the additional
insured listed in the SCHEDULE above provided that:
(1) The additional insured is a Named Insured under such other insurance; and
(2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not
seek contribution from any other insurance available to the additional insured.
This endorsement effective 08/03/21
forms part of Policy Number LHC843766
issued to BAKER RESCUE SERVICES INC
by Landmark American Insurance Company
Endorsement No.: 15
RSG 54155 0816 Includes copyrighted material of Insurance Services Office, Inc.
with its permission.
y
I&CI F
Wi Menge MW
I2inef & Are Sr.
%au Pita.dn
�
Ruk Muu9ermndmral Aide
LANDMARK AMERICAN INSURANCE COMPANY
This Endorsement Changes The Policy. Please Read It Carefully.
ADDITIONAL INSURED
(BLANKET - PRIMARY)
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
WHO IS AN INSURED (Section II) is amended to include as an insured: any person, organization, trustee,
estate or Governmental entity to whom or to which you are obligated, by virtue of a written contract or by
the issuance or existence of a permit, to provide insurance such as is afforded by this policy, but only with
respect to operations performed by you or on your behalf or to facilities used by you and then only for the
limits of liability specified in such contract, but in no event for limits of liability in excess of the applicable
limits of liability of this policy; provided that such person, organization, trustee, estate or Governmental
entity shall be an Insured only with respect to occurrences taking place after such written contract has
been executed or such permit has been issued.
If you are required by a written contract to provide primary insurance this policy shall be primary as
respects your negligence and Section IV, Condition 4. Other Insurance does not apply, but only with
respect to coverage provided by this policy.
All other terms and conditions of this policy remain unchanged.
This endorsement effective 08/03/21
forms part of Policy Number LHC843766
issued to BAKER RESCUE SERVICES INC
by Landmark American Insurance Company
Endorsement No.: 01
RSG 95001 0903
1- Pit'
ReneLm4APPxa�Br.
1�LLt J ^Jnre P&rft
��� RukhU,uger,artClviralhtle
00
ENDORSEMENT AGREEMENT
BROKER COPY
WAIVER OF SUBROGATION
BLANKET BASIS
HOME OFFICE
SAN FRANCISCO EFFECTIVE SEPTEMBER 1, 2021 AT 12.01 A.M.
ALLEFFECTIVE DATESARE AND EXPIRING SEPTEMBER 1, 2022 AT 12.01 A.M.
AT 12:01 AM PACIFIC
STANDARD TIME OR THE
TIME INDICATED AT
PACIFIC STANDARD TIME
BAKER RESCUE SERVICES, INC
19744 BEACH BLVD # 366
HUNTINGTON BEACH, CA 92648
WE HAVE THE RIGHT TO RECOVER OUR PAYMENTS FROM ANYONE
LIABLE FOR AN INJURY COVERED BY THIS POLICY. WE WILL
NOT ENFORCE OUR RIGHT AGAINST THE PERSON OR
ORGANIZATION NAMED IN THE SCHEDULE.
THIS AGREEMENT APPLIES ONLY TO THE EXTENT THAT YOU
PERFORM WORK UNDER A WRITTEN CONTRACT THAT REQUIRES YOU
TO OBTAIN THIS AGREEMENT FROM US.
THE ADDITIONAL PREMIUM FOR THIS ENDORSEMENT SHALL BE
2.00% OF THE TOTAL POLICY PREMIUM.
SCHEDULE
PERSON OR ORGANIZATION JOB DESCRIPTION
ANY PERSON OR ORGANIZATION BLANKET WAIVER OF
FOR WHOM THE NAMED INSURED SUBROGATION
HAS AGREED BY WRITTEN
CONTRACT TO FURNISH THIS
WAIVER
1851446-21
RENEWAL
NE
7-42-16-60
PAGE 1 OF 1
NOTHING IN THIS ENDORSEMENT CONTAINED SHALL BE HELD TO VARY, ALTER, WAIVE
OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS
POLICY OTHER THAN AS STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE
HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR
LIMITATIONS OF THIS ENDORSEMENT.
Rb4Mo.gmineDiMdm ,.
COUNTERSIGNED AND ISSUED AT SAN FRANCISCO; SEPTEMBER 2, 2021
�� , / ,/�j � RukAlaeugemm[Umalhde w
2572
AUTHORIZED REPRESENT IVE PRESIDENT AND CEO
SCIF FORM 10217 (REV.7-2014) OLD DP 217
BA040000069059
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
Business Auto Broadening Endorsement
This endorsement modifies insurance provided under the fo I lowing:
BUSINESS AUTO COVERAGE FORM
I. NEWLY ACQUIRED OR FORMED ENTITY (BROAD FORM NAMED INSURED)
II. EMPLOYEES AS INSUREDS
III. AUTOMATIC ADDITIONAL INSURED
IV. EMPLOYEE HIRED AUTO LIABILITY
V. SUPPLEMENTARY PAYMENTS
VI. FELLOW EMPLOYEE COVERAGE
VII. ADDITIONAL TRANSPORTATION EXPENSE
VIII. HIRED AUTO PHYSICAL DAMAGE COVERAGE
IX. ACCIDENTAL AIRBAG DEPLOYMENT COVERAGE
X. LOAN/LEASE GAP COVERAGE
XI. GLASS REPAIR —DEDUCTIBLE WAIVER
XII. TWO OR MORE DEDUCTIBLES
XIII. AMENDED DUTIES IN EVENT OF ACCIDENT, CLAIM, SUIT OR LOSS
XIV. WAIVER OF SUBROGATION
XV. UNINTENTIONAL ERROR, OMISSION, OR FAILURE TO DISCLOSE HAZARDS
XVI. EMPLOYEE HIRED AUTO PHYSICAL DAMAGE
XVII. PRIMARY AND NONCONTRIBUTORY IF REQUIRED BY CONTRACT
XVIII. HIRED AUTO — COVERAGE TERRITORY
XIX. BODILY INJURY REDEFINED TO INCLUDE RESULTANT MENTAL ANGUISH
Copyright 2017 Mercury Insurance Services, LLC. All rights reserved. 11
RhkMergewd U.b:.-.
MCA85100817-CA Includes copyrighted material of Insurance Services Office, Inc., with its Permissio I R�& MPHars8e
FI 1
�m..dg�am�ia,ir
BA040000069059
BUSINESS AUTO COVERAGE FORM
NEWLY ACQUIRED OR FORMED ENTITY (Broad Form Named Insured)
SECTION 11 - LIABILITY COVERAGE, A. Coverage, 1. Who Is An Insured, the following is added:
d. Any business entity newly acquired or formed by you during the policy period
provided you own 50% or more of the business entity and the business entity is not
separately insured for Business Auto Coverage. Coverage is extended up to a
maximum of 180 days following acquisition or formation of the business entity.
Coverage under this provision is afforded only until the end of the policy period.
Coverage does not apply to an "accident" which occurred before you acquired or
formed the organization.
II. EMPLOYEES AS INSUREDS
SECTION II - LIABILITY COVERAGE, A. Coverage, 1. Who Is An Insured, the following is added:
e. Any "employee" of yours is an "insured" while using a covered "auto" you don't
own, hire or borrow in your business or your personal affairs.
III. AUTOMATIC ADDITIONAL INSURED
SECTION II - LIABILITY COVERAGE, A. Coverage, 1. Who Is An Insured, the following is added:
f. Any person or organization that you are required to include as additional insured
on the Coverage Form in a written contract or agreement that is signed and
executed by you before the "bodily injury" or "property damage" occurs and that is
in effect during the policy period is an "insured" for Liability Coverage, but only for
damages to which this insurance applies and only to the extent that person or
organization qualifies as an "insured" under the Who Is An Insured provision
contained in Section IL
IV. EMPLOYEE HIRED AUTO LIABILITY
SECTION II - LIABILITY COVERAGE, A. Coverage, 1. Who Is An Insured, the following is added:
g. An "employee" of yours is an "insured" while operating an "auto" hired or rented
under a contract or agreement in that "employee's" name, with your permission,
while performing duties related to the conduct of your business.
V. SUPPLEMENTARY PAYMENTS
SECTION II — LIABILITY COVERAGE, A. Coverage, 2. Coverage Extensions, a. Supplementary
Payments, Subparagraphs (2) and (4) are replaced by the following:
(2) Up to $3,000 for cost of bail bonds (including bonds for related traffic law
violations) required because of an "accident" we cover. We are not obligated to
furnish these bonds.
(4) All reasonable expenses incurred by the "insured" at our request, including
actual loss of earnings up to $500 a day because of time off from work.
Copyright 2017 Mercury Insurance Services, LLC. All rights reserved. ,
M^'b.
MCA85100817-CA Includes copyrighted material of Insurance Services Office, Inc., with its PermissiO 6MP Sr..
S
Ruk Mrregmm,UmralNae
BA040000069059
VI. FELLOW EMPLOYEE COVERAGE:
SECTION II — LIABILITY COVERAGE, B. Exclusions, 5. Fellow Employee
This exclusion does not apply if you have workers' compensation insurance in -force covering all of
your "employees". Coverage is excess over any other collectible insurance.
VII. ADDITIONAL TRANSPORTATION EXPENSE
SECTION III - PHYSICAL DAMAGE COVERAGE, A. Coverage, 4. Coverage Extensions, a. Transportation
Expenses, is replaced with the following:
We will pay up to $50 per day to a maximum of $1000 for temporary transportation
expense incurred by you because of the total theft of a covered "auto" of the private
passenger type. We will pay only for those covered "autos" for which you carry either
Comprehensive or Specified Causes of Loss Coverage. We will pay for temporary
transportation expenses incurred during the period beginning 48 hours after the theft and
ending, regardless of the policy's expiration, when the covered "auto" is returned to use or
we pay for its "loss". If your business shown in the Declarations is other than an auto
dealership, we will also pay up to $1,000 for reasonable and necessary costs incurred by
you to return a stolen covered auto from the place where it is recovered to its usual
garaging location.
Vill. HIRED AUTO PHYSICAL DAMAGE COVERAGE
SECTION III —PHYSICAL DAMAGE COVERAGE, A. Coverage, 4. Coverage Extensions, the following is
added:
If Liability Coverage is provided in this policy on a Symbol 1 or a Symbol 8 basis and
Comprehensive, Specified Causes of Loss, or Collision coverages are provided under
this coverage form for any "auto" you own, then the Physical Damage Coverages
provided are extended to "autos" you hire, subject to the following limit:
(1) The most we will pay for "loss" to any hired "auto" is $50,000 or Actual
Cash Value or Cost of Repair, whichever is less
(2) $500 deductible will apply to any loss under this coverage extension,
except that no deductible shall apply to "loss" caused by fire or lightning
Subject to the above limit and deductible we will provide coverage equal to the
broadest coverage applicable to any covered "auto" you own of similar size and
type. This coverage extension is excess coverage over any other collectible
insurance.
IX. ACCIDENTAL AIRBAG DEPLOYMENT COVERAGE
SECTION III - PHYSICAL DAMAGE COVERAGE, B. Exclusions, 3.a., is amended to add the following:
This exclusion does not apply to the accidental discharge of an airbag.
Copyright 2017 Mercury Insurance Services, I.I.C. All rights reserved. 11
NAM.V dDo
MCA85100817-CA Includes copyrighted material of Insurance Services Office, Inc., with its Permissio t,�b�`':= W�&A Sr.
00
Rek Mnugermrt Uairzl Pi tle
BA040000069059
X. LOAN/LEASE GAP COVERAGE
SECTION III - PHYSICAL DAMAGE COVERAGE C. Limit of Insurance, the following is added:
4. In the event of a "total loss" to a covered "auto" shown in the schedule or declarations for
which Collision and Comprehensive Coverage apply, we will pay any unpaid amount due on
the lease or loan for that covered "auto," less:
a. The amount paid under the Physical Damage Coverage Section of the
policy; and
b. Any:
(1) Overdue lease/loan payments at the time of the "loss";
(2) Financial penalties imposed under a lease for excessive use, abnormal wear
and tear or high mileage.
(3) Security deposits not returned by the lessor;
(4) Costs for extended warranties, Credit Life Insurance, Health, Accident or
Disability Insurance purchased with the loan or lease; and
(5) Carry-over balances from previous loans or leases.
The most we will pay under Auto Loan/Lease Gap Coverage for an insured auto is 25% of
the actual cash value of that insured auto at the time of the loss.
XI. GLASS REPAIR —DEDUCTIBLE WAIVER
SECTION III - PHYSICAL DAMAGE COVERAGE, D. Deductible, the following is added:
No deductible applies to glass damage if the glass is repaired rather than replaced.
XII. TWO OR MORE DEDUCTIBLES
SECTION III -PHYSICAL DAMAGE COVERAGE, D. Deductible, the following is added:
If two or more "company" policies or coverage forms apply to the same accident:
1. If the applicable Business Auto deductible is the smallest, it will be waived; or
2. If the applicable Business Auto deductible is not the smallest, it will be reduced by
the amount of the smallest deductible; or
3. If the loss involves two or more Business Auto coverage forms or policies the
smallest deductible will be waived.
For the purpose of this endorsement "company" means the company providing this
insurance and any of the affiliated members of the Mercury Insurance Group of companies.
XIII. AMENDED DUTIES IN EVENT OF ACCIDENT, CLAIM, SUIT OR LOSS
The requirement in SECTION IV, BUSINESS AUTO CONDITIONS, A. Loss Conditions, 2. Duties In The
Event Of Accident, Claim, Suit, Or Loss, a., In the event of "accident", you must notify us of an
"accident" applies only when the "accident" is known to:
(1) You, if you are an individual;
(2) A partner, if you are a partnership;
(3) A member, if you are a limited liability company; or
(4) An executive officer or insurance manager, if you are a corporation.
Copyright 2017 Mercury Insurance Services, LLC. All rights reserved.
MCA85100817-CA Includes copyrighted material of Insurance Services Office, Inc., with its Permissio ° Ihne &nwRur®Br.
d.' 7ou i�icwon
RakM gcvemvUmi Mde
BA040000069059
XIV. WAIVER OF SUBROGATION
SECTION IV - BUSINESS AUTO CONDITIONS, A. Loss Conditions, 5. Transfer of Rights Of Recovery
Against Others To Us, section is replaced by the following:
5. Transfer Of Rights Of Recovery Against Others To Us
We waive any right of recovery we may have against any person or organization to
the extent required of you by a written contract executed prior to any "accident" or
"loss", provided that the "accident" or "loss" arises out of the operations
contemplated by such contract. The waiver applies only to the person or
organization designated in such contract.
XV. UNINTENTIONAL ERROR, OMISSION, OR FAILURE TO DISCLOSE HAZARDS
SECTION IV - BUSINESS AUTO CONDITIONS, B. General Conditions, 2. Concealment,
Misrepresentation, or Fraud, the following is added:
Any unintentional omission of or error in information given by you, or unintentional failure
to disclose all exposures or hazards existing as of the effective date or at any time during
the policy period shall not invalidate or adversely affect the coverage for such exposure or
hazard or prejudice your rights under this insurance. However, you must report the
undisclosed exposure or hazard to us as soon as reasonably possible after its discovery.
This provision does not affect our right to collect additional premium or exercise our right
of cancellation or non -renewal.
XVI. EMPLOYEE HIRED AUTO PHYSICAL DAMAGE
SECTION IV — BUSINESS AUTO CONDITIONS, B. General Conditions, 5. Other Insurance, b. For Hired
Auto Physical Damage Coverage, is replaced by the following:
b. For Hired Auto Physical Damage Coverage, the following are deemed to be covered
"autos" you own:
1. Any covered "auto" you lease, hire, rent or borrow; and
2. Any covered "auto" hired or rented by your "employee" under a contract in
that individual "employee's" name, with your permission, while performing
duties related to the conduct of your business.
However, any "auto" that is leased, hired, rented or borrowed with a driver is not a covered
"auto".
XVII. PRIMARY AND NONCONTRIBUTORY IF REQUIRED BY CONTRACT
SECTION IV —BUSINESS AUTO CONDITIONS, B. General Conditions, 5. Other Insurance, the
following is added and supersedes any provision to the contrary:
e. This insurance is primary to and will not seek contribution from any other insurance
available to an additional insured under your policy provided that:
(1) The additional insured is a Named Insured under such other insurance; and
(2) You have agreed in writing in a contractor agreement that this insurance
would be primary and would not seek contribution from any other
insurance available to the additional insured.
Copyright 2017 Mercury Insurance Services, LLC. All rights reserved. Rli Ne geno Da
MCA85100817-CA Includes copyrighted material of Insurance services Office, Inc., with its Permissio lens f Am Br.
%au ;Pic+
rs�xm.,�sn�,ram�iux
BA040000069059
XVIII. HIRED AUTO -COVERAGE TERRITORY
SECTION IV - BUSINESS AUTO CONDITIONS, B. General Conditions, 7. Policy Period, Coverage
Territory, e. Anywhere in the world if:, is replaced by the following:
e. Anywhere in the world if:
(1) A covered "auto" is leased, hired, rented or borrowed without a driver for a
period of 30 days or less; and
(2) The "insured's" responsibility to pay damages is determined in a "suit" on
the merits, in the United States of America, the territories and possessions
of the United States of America, Puerto Rico, or Canada or in a settlement
we agree to.
XIX. BODILY INJURY REDEFINED TO INCLUDE RESULTANT MENTAL ANGUISH
SECTION V — DEFINITIONS, C. "Bodily Injury" is amended by adding the following:
"Bodily injury" also includes mental anguish but only when the mental anguish arises from
other bodily injury, sickness, or disease.
Copyright 2017 Mercury Insurance Services, LLC. All rights reserved. Rik Mo.ge DlWiion
MCA85100817-CA Includes copyrighted material of Insurance Services Office, Inc., with its Permissio 1 - Reow &Arne 8,:
'` Ji:l I� %u %!r ,a
rsmxn>a��e„�,umuiadr
CT u. COMMERCIAL LINES COMBINATION POLICY DECLARATIONS
Lot,
/ Landmark American Insurance Company
(A New Hampshire Stock Co.)
(hereinafter called "the Company")
EXECUTIVE OFFICES: 945 East Paces Ferry Road, Suite 1800, Atlanta, GA 30326-1160
Policy Number: LHC843766
Named Insured and Mailing Address:
BAKER RESCUE SERVICES INC
19744 BEACH BLVD
SUITE 366
HUNTINGTON BEACH, CA 92648
RENEWAL OF: LHC840822 00
Producer Name:
Policy Period: From: 8/3/2021 To: 8/3/2022 12:01 A.M. Standard Time at the Named Insured address as stated herein.
IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THIS POLICY, WE AGREE WITH YOU TO
PROVIDE THE INSURANCE AS STATED IN THIS POLICY.
THIS POLICY CONSISTS OF THE FOLLOWING COVERAGE PARTS FOR WHICH A PREMIUM IS INDICATED. THIS PREMIUM MAY
BE SUBJECT TO ADJUSTMENT.
Business Description: EMERGENCY FIRST AID RESCUE SERVICES
COVERAGE PARTS PREMIUM
Commercial General Liability
COMMERCIAL GENERAL LIABILITY COVERAGE FORM - $ Included
OCCURRENCE
Professional Liability
MEDICAL PROFESSIONAL LIABILITY COVERAGE PART CLAIMS $ Included
MADE AND REPORTED BASIS
Forms and Endorsements made a part of this policy at time of issue: Please see SCHEDULE OF ATTACHMENTS.
(Omits applicable forms and endorsements if shown in specific Coverage Form Declarations.)
THESE DECLARATIONS TOGETHER WITH THE COMMON POLICY CONDITIONS, COVERAGE FORM(S) AND ENDORSEMENTS, IF
ANY, ISSUED TO FORM A PART THEREOF, COMPLETE THE ABOVE NUMBERED POLICY
August 17, 2021 By: 4U
Date Authorized Representative
Declarations Page 1 of 2 SebldlD7k 235164 BlnderlDtt
RSG 50011 1020 w.tw tni.
°•tdD.ItJL Tau Pocumo
rusk M1laeu9eem+t Clmcal A l
DECLARATIONS
Policy Number:
LHC843766
IRG'iIYi361AIIWlt7_1Z[fl l
CGL and Professional Liability:
$ 2,000,000 Policy Aggregate Limit
Commercial General Liability
Effective Date: 8/3/2021
At 12:01 A.M. Standard Time
$ Included in Policy Aggregate General Aggregate Limit (Other than Products -Completed Operations)
$ 2,000,000 Products -Completed Operations Aggregate Limit
$ 1,000,000 Personal and Advertising Injury Limit
$ 1,000,000 Each Occurrence
$ 5,000 Medical Payments (Any One Person)
$ 50,000 Damage to Premises Rented to You
Professional Liability:
$ 1,000,000 Each Claim
$ Included in Policy Aggregate Aggregate
DEDUCTIBLE: $ 2,500 Each Claim
RETROACTIVE DATE: Coverage
Commercial General Liability N/A
Professional Liability 8/3/2011
THESE DECLARATIONS ARE PART OF THE COMMON POLICY DECLARATIONS CONTAINING THE NAME OF THE INSURED AND
NOTICE:
This is a claims -made and reported policy. Please read the policy carefully and discuss the coverage afforded by the policy
with your insurance agent or broker.
Dedaratiws Page 2& 2 SubldIDW: 235164 Rbl[Mv�ganrnl D"oiuon
1
lYL1.Jf i� %ati ;Dicwar
RSG 50011 1020
_ rsuxn,a,dae..a,ramwa„�
C �I LIABILITY
EXCESS
POLICY DECLARATIONS
945 E. Paces Ferry Rd.
Suite 1800
Atlanta, GA 30326
THIS POLICY IS ISSUED BY THE COMPANY DESIGNATED BELOW:
COMPANY NAME Landmark American Insurance Company
(A New Hampshire Stock Co.)
POLICY NUMBER: LHA252201
NEW:
❑
RENEWAL OF: LHA249939
ITEM 1
BAKER RESCUE SERVICES INC
NAMED
19744 BEACH BLVD., SUITE 366
INSURED
HUNTINGTON BEACH, CA 92648
AND
MAILING
ADDRESS
I
PRODUCER
CODE NO:
F— PRODUCER'S NAME AND ADDRESS
ITEM 2
COVERAGE: EXCESS
POLICY PERIOD
ITEM 3
FROM 8/3/2021 TO 8/3/2022
12:01 A.M. STANDARD TIME AT THE ADDRESS OF THE NAMED INSURED
LIMITS OF INSURANCE
ITEM
4
EACH OCCURRENCE
AGGREGATE WHERE APPLICABLE
LIMITS
$ 5,000,000
$ 5,000,000
AND
PREMIUM
REMIUM
$25,000.00
® FLAT
❑ AUDITABLE — SEE PREMIUM COMPUTATION ENDORSEMENT
ITEM 5 ENDORSEMENTS ATTACHED: Policy Jacket: RSG 31001 0507, Schedule of Underlying Insurance-RSG 30002 0803
SEE SCHEDULE OF POLICY ATTACHMENTS AND FORMS
RSG 30001 1117
Date Issued August 04 2021
Countersigned By Authorized Representative
JH
m ask Me gee Daa
y `r F 4A8v:
'tla�alajakwrs v Prpw®76,i P ,ow
V ftokManagennndmalhtle
POLICY NO.
ITEM 6.
Type of Policy
COMMERCIAL EXCESS LIABILITY POLICY
DECLARATIONS
SCHEDULE OF UNDERLYING INSURANCE
Insurer
Applicable Limit
GENERAL LIABILITY LANDMARK AMERICAN INSURANCE $1,000,000 EACH OCCURRENCE
COMPANY $2,000,000 GENERAL AGGREGATE
$2,000,000 PRODUCTS/COMPLETED OPS AGG
$1,000,000 PERSONAL/ADVERTISING INJURY
AUTO LIABILITY CALIFORNIA AUTOMOBILE
INSURANCE COMPANY
II�Y�1:7_P[y�1�1►17
PROFESSIONAL LANDMARK AMERICAN INSURANCE
LIABILITY COMPANY
GENERAL LIABILITY LANDMARK AMERICAN INSURANCE
COMPANY
RSG 30002 0803
$1,000,000 COMBINED SINGLE LIMIT
$1,000,000 EACH ACCIDENT
$1,000,000 DISEASE EACH EMPLOYEE
$1,000,000 DISEASE POLICY LIMIT
$2,000,000 COMBINED AGGREGATE
$1,000,000 EACH OCCURRENCE
$1,000,000 EACH OCCURRENCE
$2,000,000 PRODUCTS/COMPLETED OPS AGG
$1,000,000 PERSONAL/ADVERTISING INJURY
-" Fuk NNnagemm[QmalNtle
NOTICE OF COMPLIANCE
CITY STAFF: PRINT THIS PAGE AND INCLUDE WITH AGREEMENT TO THE CLERK OF THE COUNCIL
Contractor
Baker Rescue Services, Inc
Name:
Project
N-2022-127
Number:
Project
Bakers Rescue Services, Inc
Name:
The Certificate of Insurance (COI) submitted indicates that the coverages are in compliance with the
insurance requirements. No further action is required at this time.
The compliant coverage(s) are:
POLICY EXPIRATION
TYPE OF INSURANCE COI DATE FILE NAME
NUMBER DATE
CERT City of
Santa Ana with
AUTOMOBILE LIABILITY 032105570 08/03/2023 01/24/2023
new auto
policy.pdf
CERT City of
GENERAL LIABILITY LHC846774 08/03/2023 08/01/2022 Santa
Ana_Part1.pdf
CERT City of
WORKERS COMPENSATION AND
18514462022 09/01/2023 08/01/2022 Santa
EMPLOYERS' LIABILITY
Ana_Part1.pdf
Thank you,
City of Santa Ana
Risk Management Division
in partnership with
CTrax Plus Services Team
2/7/2023 2:09 PM
NOTICE OF COMPLIANCE
CITY STAFF: PRINT THIS PAGE AND INCLUDE WITH AGREEMENT TO THE CLERK OF THE COUNCIL
Contractor
Baker Rescue Services, Inc
Name:
Project
N-2022-127
Number:
Project Agreement With Baker Rescue Services, Inc. To Provide On-
Name: Call Confined Space Rescue Stand-By Services
The Certificate of Insurance (COI) submitted indicates that the coverages are in
compliance with the insurance requirements. No further action is required at this time.
The compliant coverage(s) are:
POLICY EXPIRATION
TYPE OF INSURANCE COI DATE FILE NAME
NUMBER DATE
ACORD
Form
AUTOMOBILE LIABILITY GMI060600 08/03/2024 08/03/2023
20230803-
145343.pdf
ACORD
Form
GENERAL LIABILITY LHC851049 08/03/2024 12/06/2023
20231206-
105532.pdf
WORKERS COMPENSATION AND City of Santa
18514462023 09/01/2024 08/30/2023
EMPLOYERS' LIABILITY Ana.pdf