Loading...
HomeMy WebLinkAboutBAINBRIDGE GROUP, INC. 1A-2003 INSURANCE ON FILE WORK MAY PROCEED UNTIL I SUR CE EXPIRES J 0 (Ow CLERK OF 90U~IL DATE: I F;J./f (ð3 A: ) FIRST AMENDMENT TO CONSULTANT AGREEMENT ß' C-1> WékJj V' t1' bl f7yJ , . . I N- Gðö2 -Ohe-I THIS FIRST AMENDMENT TO AGREEMENT is entered into on the I :;1- day of . Tu Iv , 2003 by and between the Bainbridge Group, Inc. ("Consultant") and the Ci~a, a charter city and municipal corporation, organized and existing under the Constitution and laws of the State of California ("City"). Recitals: A. City and Consultant entered into a Consultant Agreement, dated July 23,2002, (hereinafter "said Agreement") by which Consultant has provided asbestos, hazardous and microbial consulting services. B. In accordance with the terms and conditions of said Agreement, the parties wish to extend the term of said Agreement, amend the Scope of Services and increase compensation to pay for services during the extended term. Wherefore, in consideration of the covenants contained in said Agreement, and subject to all the terms and conditions of said Agreement, except those amended in this First Amendment to Consultant Agreement, the parties agree as follows: 1. Section 1, SCOPE OF SERVICES, shall be amended to read as follows: "Consultant shall perform those services as set forth in Exhibit A-I to this Amendment." 2. Section 2.a., COMPENSATION, shall be amended to read as follows: "City agrees to pay, and Consultant agrees to accept as total payment for its services, the rates and charges identified in Exhibit A-I, attached hereto. The total sum to be expended under said Agreement, shall not exceed $10,000.00, annually. The total sum to be expended under this Agreement shall not exceed $20,000.00 during the term of this Agreement." 3. Section 3, TERM, shall be amended to read as follows: "This Agreement shall commence on the July 23, 2002 and terminate on June 30, 2004, unless terminated earlier in accordance with Section 12, below. The term of this Agreement may be extended upon a writing executed by the Executive Director of the Community Development Agency and the City Attorney." , . . , IN WITNESS WHEREOF, the parties hereto have executed this First. Amendment to Consultant Agreement on the date and year first written above. ATTEST: ~~ ,/"'. -I. '- PATRICIA E. HEA Clerk of the Council CITY OF SANTA ANA APPROVED AS TO FORM: JOSEPH W. FLETCHER City Attorney By: Tfi4~ c>. jJ~; ./~? Lalffa Sheedy / Assistant City Attorney APPROVED AS TO CONTENT: CONSUL T ANT JOHN ~ß~KSTm Execut ve Director ~9 HENRY A\ MORENO Principal- Project Manager .. , 136/135/213,133 11: 6e , . '1'he Bfiinbridge Group, Inc. . Ú1~ iri)~et'1tai Consultants 25~2 (~~,ambeIt Road' 1u.~riì1~, Califoqú 92780 (71-4,) ~~;3-4005 lax (714) 573-4097 ,...,................. ~ -- 7145734097 PAGE 132 13AINJJRIIJG E May 28, 2003 , Mr. Terry Gilbreth Housing ProQrams Analyst , Community ðevelopment J\gency-City of Santa Ana 20 Civic Center Plaza. M-37 Santa Ana, Califomia 9270~ RE:, Asbestos, Lead, Haz,¡rdous and Microbial Consulting Services - , CompaFlY QualificatìoFls/Proposal for the Community Development , Commission-City of $an~ Ana, California. . Dear MI'. Gilbreth: We are pleased to submit our fee proposal and qualifications in response ,10 the' Community Development Commission-City of Santa Ana. The 3ainbridge Group, Inc. has performed these services for government agencies throughout Southern California for the past ten years. The Bainbridge Group has diligently assisted these clients by performing asbestos and lead paint and other hazardous material surveys, design ,of specifications for abatement and has provided clearance/monitoring serVices of abatement in support of the various housing and facility environmental programs. In addition, The Bainbridge Group provides mold/microbial investigation/testing and remediation consulting services for residential and commercial properties. The Bainbridge Group performs survey/testing, abatement specifications, bidding assistance, and air clearance and monitoring in accordance with the requirements of the Community Development Commission-City of Santa Ana standards, as well as HUD, OSHA, . AHERA standards and other government requirements therein~ COf\JIPANY QUALIFICATIONS: Th~ Bainbrid!¡le Group, Inc. is a mecium size, minority owned and managed business (MBElDBE) with a diversified staff of experienced management and technical professionals with collective backgrounds in asbestos and hazardous material industrial hygiene. SpecificaUy I these personnel have extensive and pertinent experien08 in a~bestOs. lead, and hazardous material related inspections, design of abatement specifications, working drawings, abatement oversight (monitoring), project support and management. ' Generally, our consulting service capabilities include the following: I . I J '~surveys, Testing & Evaluations , Cost Estimates & Working Drawings/Bidding Consulting , Project Abatement SpecifiÒ8tions - ' . Aenovation/l)emolition Defign . . AHERA an~ Operations & Maintenance f'rograms . ConstructioJ1/Abatement Admini~tiQn. & MQnitoring EXH¡ .' . \ k 13&/135/2003 11:013 , .' , . . - 71457341397 PAGE 133 CDC Santa An, - Co. QualifioatiOns ~he Balnbridg, Group, Inc. . . ,.. ~ ~ OS/28/03 Page2 - . ead-8 sed aint: XRF/Ni on Lead TestiflQ EP A Tille X Real Es~te Disclosure Assessments Construction Assesslflent Surveys & Testing Cost E,timates & WO(kin~ Drawing, Abatef119nt Design SReCiflcations Constrllction/ AbatemEV'lt Admìnistratic>n & Monitoring vi nmen I sment ecfati Servi s: Phase nvironmentfl Site Assessments . Indoor .ir Qualíty/MolCil/Fungi Microbial Testing & Monitoring ',Our company's experience and proximity to the City of Santa Ana housing prOjects will further allow for a quick-response service commitment to fit the best interest of the COCo , INSURANCE: . '. . . . The Bainbridge Group provides A-rated professional liability coverage for up to $1,000,000.00 occurrence and general liability coverage for up to $6.000.000.00 by American Safety Casualty Insurance Company. Per your request Attached please find our rates. Please feel free to contact me at (714) 247-0024. Respectfully Submitted, THÈBAINBRIDGE GROUP, INC. reno, DHS, CAC, REA ject Manager Attachments . HAMlsih City of Santa Ana\CDC QuaIs 2003 The -"lnbridge GICIUP. Inq, Aevi5ed J~ 5. 2003 0&/05/2~f33 11:0e , . 7145734097 PAGE 84 toc Santa An~ - Co, Qualifications ,The' 8ainbridg. Group, Inc. . - OS/28103 Page3 - ~ ,.. The Bainbrl,ge Group, IfIC. General RItes Professíonal f;taff/Support ftaft and Matetial/Sample Fee Schedute Asbestos ~nsulting S9fVlces: (J)Rate 7~.OO/hr. 63,00Itir. 54.00lhr. 48.00lhr. 28.00Ihr. 390.00/shift (includeS max. 5 pcm's) 9.00leach (24-hour ~nalysis) 9.00/each (24-hour analysis) cost + 15%/each (8-hour analysis) Air Sarj,ples .. Phase Contrast Microscopy cost + 15c/oleach , ' (a-hour analysis) .Air Samples - Transmission Electron Microscopy cost + , ' . 15o/cJeach (24-hour analysis) Air Samples - Transmission Electron Microscopy cost + " , 15°lc/each (a-hour analysis) Cl8sslfioati~n Principal , Senior Proj~ Manager , Certified As~stos Consultent (CAC) - PM Certified Site Surveillance Technician (CSST) , Clerical a-Hour $hitt -\batement Mo.wtoring Bulk Sample "nslysis Air Samples.. Phase Contrest Microscopy , ,Bulk Sample Analysis 'Lead Consulting Services: Paint InspectionfTesting (2 bedroom) Paint InspectionlTesting (3 bedroom) ,Risk Assessment XRF Testing, Wipe Sampling & Report (2 bedroom) AiskAssessment XAF Testing, ',Wipe Sampling & Report (3 bedroom) ($)Rate 300.00/1 house 400.00/1 'house 250.00/1 house 350.00/1 house CI~rance testing, Sampling & Report (2 bedroom) , Clearance testing, Sampling & Report (3 bedroom) 250.00/1 house 300.00/1 house -" The ~ Group, InQ, ReviI8d ""'" S. 2DO3 . ," '136/135/213133 11:66 ... '. 71457341397 PAGE 135 COC Santa An, - Co. Qualifications The Bàinbrídg, Group, Inc. ~ - - - Ø5/28/03 Pagø4 , The Bainbritlge Group, I"c. General "ates lAC - MicroQial Consulting Services Professional Staff/Support ttnd Material/Semple Fee Schedule ~ $tatfing; Staff Qlpssifìc\tion Certified Industrial Hygienist «()IH) Senior Project tJlanager (IH) Project Manacler (lH) AssOciate Tec"nician (IH) ,CI ¡ rìcal/Admin. (t\ Rate 12~.OO/hr. 9Ð.OOlhr. 7fi.OO/hr. 60.00Ihr. 4O.00/hr. '~Cóm~ined ,ervices: Service Type Inspection & f)cope of WorJc (1 Apt. Unit) , Post Abatement Clearance (1 Apt. Unit) ($) Rete 325.00.each 595.00 each " . Microbiologv/Bioaero8ol Analysis: , Cult~mÞle Air Samcles (Andersen. SAS. RCS) Fungi Bacteria' ($) Rat~ 55.00/each 45.00/eaCh ($) Rate 55.00/eaCh 65.00/eaCh 45.00/each 65.00/each 50. DO/each , Culturable S m Ie u bulk swab other Fungi' ,uantitative, 1 medium (MEA) , , Fur1gi Quantitative, 3 media (MEA, cellulose, DG18) Bacteria, 1 medium (TSA blOOd) Baoteria, 3 media (1SA blood. CAN, MacConkey) E.'.coli/coliform, presence/absence (MUG) Non-Culturable Air Samples (Zefan) Non-viable spore trap slide ZefQn Air-O-Cell Cassettes is) Rate" 55.00/each 1'o.OO/each Surfacê Samoles (tape lifts. bulk. swab. other) SUrface samples. dìrect examination ($) Rate- 40.00/each '. Normal rates for 3 to 5 working days. , Same day rush analysis fees sad 50% Cult1Jrable samples require incubation time, therefore rush services will not apply. ,- The ~nbrtdge GIoup, 'no. Revised .IL'1IJ 5, 2003 .n.. .. -1--'."-' .,.-. , ~~ ~...............'............. " I 0 """ WOO P.U06 I ACORD '" . ':! - 7" CE~TIFICA Tß OF LIAQULITY IN$URANCE I DAW toIIIIIDOtm'Y) '" 03127/2003 PflOOUC:Ðt " . THIS 9ERTlFlCATElS ISfUEDAS A MÞ:m~OF IN...~!l°N BC Em IRPNMENT¥ INS - BROf\PRS INC ONLY AND CONFa:iO RIGHTS UPoN TJfE CEIITlACATE 1 HOlDJR. ntlS CERTJATE DOES NOT ~MEND. ~END OR 1037 ~ UNÇAST ~E, SUITE'103 AlTEIl THE COVERAG AFFORDEDBY Ttte POUCI 'BELOW. EL DOE ADp HILL~, CA 9576~ ~ . ! (916) 93~-1080 I NS UREf{S A FFO ROt NGCQVERA G E T!fA1CIJ ! JH$URED T~ BAIN~RIDGE GRO'ifP, INC. II'1SURERAì GULF UNDE~WRITERS I~S. t' I IIfSUREAe¡' GREENWICH', INSURANCE" ~ , I I 2~Z2 CHAlfBERS ROAD II'I$URER c\ ' I I TqS:l'IN, ÇA 92780-u INSUFŒ1'I Q¡ ' . .. i 'I IIt."URER It I COVERAG ::S' ~ ' " .. I THE POUC /ES.'óF 1NS\JfWICI USTED eaOVVHAye SEEN ISSUED TO_~ INSURED 1WÆO ABaJE FOR THe Pd JCY PeRIOD IÐICAteO. NO'I'WITHSTANOING I I Am RE- ' , TERM ~ CONQITION OF A)ff CONTRACT OR O'rHER DOClHENT W 'T1i RESPECT TO \MilCH 1H1S ŒR11FICA~ MAV Be ISSUED OR MAY PERT ~ ~ AFFOADEO 8Y'n1E POùC1ES CESCAJeED HERe"" IS SuBJECT TO All. 1HE TERMS. EXCWSIONS AND CONOfTJONS OF SUCH POLICIES ,GATE It,trTfSHOWNMAVttAveêefNREDUCED8VPAIOClAM$. I":' ~ ~ER POU:T eFFt;I:11VE rou:-r EJIPIRA'T1OII LIIIITS DATE DATE I .... """'U48IUTV EACtt OCCURRENCE ,1,000,000 Ix . CC8'M~CIAL ~ LlA8lLITV PREMISES 1& 0CI:1ftIIœ S - O&.AINSMAOe (!] ca:uR M6) EXPIoUY- peooø) s 5,000 A ,_POLLUTION GU2839947 01/10/03 01/10/06 ~.AOYrNJURV ,l,UUU,OOO ARTL"TTY GaEfW. AGOftECllTë t2,OOOFUUU ! .! I'I\.AGOReGIITeLlllllt'nPER: PIIOOUCTS. COMIl'IOI'.tGG S2,00OFOOO I 1 POUO"fI ~' I.CM: I ~ COIo1I11HEÐ SINGLE UMIT sINC.IN GL MY AU'1'\:) ~ aecio.nO j i- ÞoU ~EO AVTOS eooa. v I NJIJRV I I i- (Per pct:OII) S ::oIEOULED AUTœ IA i HlReo AUTOS ~U2839947 01/10/03 01/10/06 I 80011. Y II'UIJftY (!'a-II ,$ ~AU~ I - I - I'ROf'SOY o-.III.-œ 5 , Ch'aecIIIo<oO I ~ IItAÇ£ LlA81JTY AUTOONI. V . EA ACCIO9IT S I FoRM ! I>H'f AUTO APPROVE D AS TO OTHER r.- SA.a: s - AUTOONI. 'I" I .IGG $ ! rta.1A \JA8LIT"I' /ftA J ø .J -..-- ~~ $ - )OCCUR 0 CLAtIlSltlAÞE - - AGGReGATe S - Y , : - ~:= ~ She.e( $ Deputy Clt Attorney $ ¡ - s s 0 walt TJOHUIO I=~I Icn~ , I ~ E.L. ~H -.cQIOEtfT - , I - - EL. DISEMe. EA EMPLO't'EE $ If,.,..,., :ttt.",,- EL DI$GUE . PCuC'l' UMII' s CMSIOHS w" A ontER PROFESS. ~U7, -z1 U1/10/0::S 01/10/0& ~l, 000, OOO/~, ,000,000 LIA ~-CLAIMS KADE .. B 'PRO PERTr /EQUI PMT 2529340 02/01/03 02/01/04 DESCItIPT1OM: F OPERATION SI'UX:A ~ ICI.Ø EXCLUSIOH$\DD£D8Y ÐI DOft$EMfN1f 5PEc~ 0\1l$IOII$ THE C TY OF SANTA ANA ' THE COMMUNITY REDEVELOPMENT AGENCY OF THE CITY OF SANTA ANA, 20 CIVIC CENTER PLAZA, SANTA ANA, CA 92701 SHALL BE NAMED AS ADDIT ONAL INSURED WITH RESEPCT TO GENERAL LIABILITY. PRIMARY & \ NON-C )NTRIBUTORY INSURANCE APPLIES. ""10 DAY NOTICE OF CANCELLATION OF NON-P YdNT. CERllFtC TE HOLDER CANCELLATION ---- -..-".-- -,' .. ,-' ,-.. -'.., ,.. $MOULD IU(y OF THe AeO\l£ DESCMIEO PCI.JC\E.S 8E c:AJIICEUÆØ BEFORE 1'H£ EXP1M'tJOf ttECltYf.OFS~TAJ.NA .. OATE~eoF.111£ISSUII'IG~W1U.eN~~L 30; DAVSWRITl'EH 1~ C:rVI(: CE:NTER PJ4Z'A M-26 ,¡on:¡;; tP THE ŒlmRCA n; HO~ED TO THE LEFT,'~ sfNTA AN~, CA 927f1 ~ 'i ~.... .... ;' '.. A.a" -- AUTHORtfD REI'ReseNTATIIIE 2 ,.,..~ ~- '" I ÁCORtlZ5 ~'lCI8j ,. , '0; ,~ '.' ~AqoRDCORPpRA110N9a8 - - .- - I " - - - ,- - '-, - - -- -- -..-..-....-.....- V I V «]v" IlJO1J t".UUI "OLlCY NVM8ER . GU283~47 P9L1CY CHANG - 5 EFFECTIVE . 03127/03 COM ANY ;f :-: Gulf 4nderwriters Irsurance Company - . AVTHORIZED RiPRESENTATI .; u -\ - ~ - ;~ ij NAMES INSU$eo Thf Bainoodge G~UPI Inc: Freberg Environmental Inc:. 1451 Lañmer Sf. Suite 200 Denver, CO 8020:l ENDORSEMENT This endorsement forms a part of the policy to Which it is attached. Please read it carefully. :.. ..'..:; ,~....', :' ',':.¡" . ':" " ..:: ',~.~:':,.', ... ~-:':.' ::~.> '~~:Ý~~>~;~~'¡::'::';'.'._~'~~~.~~:.~..:.~.~.",:;: , .. ."~ DO' "1NSfJRED ENOO..RSEM He .t;:eìf<;:",""" '.. ,'. ,:~~~~ ~~L. ..': "', :" ":~:i~;....,~7':.........(...H.' :;""I~"=::;~~:;;~~/:' , ',:' ~',,-:,:~':". ,"-',:': ,'~:' , . ;CÐ':'4::~~mRS::'~=~~_':':"~"~~.!~'.t1~~':";...~~~'I..:""~~;;~"';'..:3~ ":'~:. "',':,'.",,",: ,,'J~'.:":' - "'.' '::-:' N:' '1':.~~~',~~:";:'~¡:~~~~~~:.;;..L~',,;~: ~;,:'~~),~~~~~¡:i.:,~'~:~Ë In consideration of the premium charged, and notwithstanding anything contained in this policy to the contrary, it is hereby agreed that this endorsement applies to the following designated coverage parts only: - x X Commercial General Uability , Contractors Pollution Uabifity Site Specific Third Party Pollution Liabifrty Onsite Cleanup Coverage ' SCHEDULE: Name of Person or Organization: City of Santa Ana 20 Civic Center Plaza M-2G Sant Ana, CA 92701 (If no entry appears above, ¡n(oonation required to complete this endorsement will be shown in the Dèclarations as applicable to this endOrsement.) . SECTION II - WHO IS AN INSURED is amended to include as an insured the person or organization (called &addltional insured") shown in the Schedule, but only with respect to liability arising out of your ongoing operations performed (or that additional insured. ,--~- APPROVED AS TO FoRM _1JI\4~it Laurà Sh(tedy- '".. ---- ",})QPuty ~hy~ttsìiiëY .. , , ", ..- , --- ----.. ,---------.- .. .. ... .. r All other te~and conditions remain the sam" fu-eSP-2f1 0 (09-02) -~--~,~-~~~----.--- V IV ".xl I VV" t'.uoo , $lOUCY N ' MBER . GU283'947 PtLiCY CHANGijS 'EFFECTIVE; 03127/03 >~ NAMES INSU. D Th~ Bainbridge Gjpup, Inc, ': .... - . , COMpANY " ;, Gulf Underwriters InJ;urance Col1)an J\fJTHORIZED Rf,PRESENTATIVE Freberg EnviJonÎTIentallnc. f 1451 Larimf!JSt. Suite 200 Denver. - 0 80202 E~DORSEMEtff This ,ndorsement fotynS a part of the policy to which ft is attached, Please read it carefuUy. .' "': ".' ",;:~, ',;' :~: ,', ".' :';"""":~~',-;,'::'~~~:"'.',::=~'::r, ..::~::...'. ,1;~"';';'~ '.:C:C :~,. " , .'..: h" NÐ~.....CÉ;9F eANCEL(A11ON=.:r9.:I; g9.~GNAtE9~:nss:~,~'~~S~':~ ~~1;: :,:.~,~' ',:. ' :::~ '..: .~," :":,~'-':'~: :',' " " "',", ~:-::, ",:':,,~::':~~:~~',,~;~.'..~,¡..~,;,'~~::~::'~::;:~ ,,:"~~",:,,~",:',,~:~~ SCHEDULE: Name of Person(s) or Organization(s): City of Santa Ana 20 Civic Center Plaza M-26 Santcl Ana, CA 92701 In consideration of the premium charged. and notwithstanding anything contained in the policy to the contrary, it is hereby agreed if we decide to Cancel this policy on~or before the expiration date of the Coverage Form, we will mail or derJVerto the person(s) or organization(s) shown in the Schedule, written . notice of cancellation not less than 30 days prior to cancellation. This Wl11 not apply to non-payment of premium. . APPROVED AS TO FORM n~.~___- ~- çjq La~ra Sheedy -~.-,----DeputyÇjty AHonley . . -- --~-- .. '" ,.. ". "! ~ .... '" " fU-ESP-4101 (06-02) All other term, and conditions remain the sam,. page 1 of 1 " ----,...-, .---- .. ' - , -- _.__.._...~.....- \J 10 ,,'^' IU~ t'.uœ , PO "ICY CHANGE~ EFf!,ECTIVE 03~7/O3 COMPANY ; ¡; Gulf Und',rwriters Insurqrce Company' AUTHORIfEO REPRES¥ A TIVE Freberg E; 1vironmental IItc. 1451 tamper St. Suite 21jo Denver, . 80202' i " ,!!' " " THI~ ENDORSEMfNT CHANGES THE POLICY. rLEASE READ IT CAREFULLY. PRI¥ARY AND N~-CONTRIBUT~RY INSURANqE This endoIJement modifi~ insurance provided under the ~pllowing: COM~,ERCIAL GENIJRAL LIABILITY COVERAGE PART SCHEDULE t. am, and Address of Person or Organization (Additionallnsur:ed): , City f S,ota Ana ' , 20 C c 'tenter PI~ M-26 Sa Ana. CA 92701 2. dditional Premium: Appfied This nsurance is pñmarywith respect to the coverage afforded to the Additional Insured shown in the Schedule abo by the following endorsement: GlJ-ESP-201 0 (09-02). Any ther insul';lnce which the Additional Insured may have is excess and non-contributory. ALL THER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED, 41912003 DATE ,-- ,-". ,- '~"'--- .. - , '" I'" ~ APPROVED AS "TO FoRM 1- :&fh¿ d "1 Laúra Sheedy, Deputy City Attorney #1~ G -~.1290 (O'~O1) .. r "----, stATE , COM"""SATION FuÑë œRTHO~DER COpy \ ' P'.O.80X 807, SAN Í"AANCfSCO,CA 94142-0$07 CERTIFICA'l'EOFWORKERS'COMPENSA TIOI'Ji INSURANCE ISSUE DATe: 03-01-2004 GROUP: POLICY NUMBER: 1466943-2004 CERTIFICATe 10: 14 CERTIFICATE EXPIRes: Q3-01-2ooS 03"'01 w2004~".O1'2QO!1. ,J08: ASBESTOS CONSULTiNG: SERVICES THE CITY OF SANTA ANA 20 ClVIC.CENTER SANTA ANA CA 927°1 N-).oo,J..- 0'(, f IJ - ~oo;}..':'()fø f-:-l This is to certi1y that we have issued a valid Workers' Compensation insurance policy in a form approved by the Califormà"~'fance Commissioner to the employer named below for lI1e i'olj~y period Indicated, This policy is not subject to cancellation by the Fund/except upon 30 days' advãhce W1'Itten' not¡~ to the employer, We will also give you30doVS'.adv¡mce notice should this POlicy be cancelled prior to its normal expiration, This certificate~of;'ir\$Ur,¡qc<I¡$ net"" insùrance policy and does not ame~d, exle~d or alter the øoverage afforded by the pollcies!!$ted herêin,'NQlwiths , ¡my requirement, term. or 6oriditio~ Of any co~lract or other document will1 resþ..ØI to'wmøh lI1iscertificate qof\Ce'måyb.. issued or may pertain, the insurance offordeci by the pOlicies desØril?ed herein is subject to jarms, "xcluSions and conditions Of such policies, ~ jj~ t!. ~ AUTHORIZED RePReSENT A TIVE PRESIDENT EMP~OYP'S LIABI~ITY LIMIT INCLUDING DEFENSE COSTS: $1,000,OOÐ,QO OCCURRENCE, EIllQORSEMÉNT . #2085' ENTITLED CERTIFICATEHlltDtRS' NOnCE EFFEctIVE 0i-01-2004 IS FOIÚIS A PART OF THIS POLICY; L.EGAL NAME PRINTED: . :' . . .. , : AND PO408