HomeMy WebLinkAboutI.C.E. BUILDERS, INC. 1 - 2003INSURANCE ON FILE N-2003-098
WORK MAY PROCEED
UNTIL INSURANCE E)<PIRES
hl NCIL/{ Oy
DAZE' 1 n - fin-�3
CONSULTANT AGREEMENT
G LLA� THIS AGREEMENT, made and entered into this X day of 2003 by
(J;• and between I.C.E.Builders, Inc., a California corporation (hereinafter "C ultant' , and the
City of Santa Ana, a charter city and municipal corporation organized an existing under the
Constitution and laws of the State of California (hereinafter "City").
RECITALS
A. The City desires to retain a consultant having special skill and knowledge in the field of
construction.
B. Consultant represents that Consultant is able and willing to provide such services to the
City.
C. In undertaking the performance of this Agreement, Consultant represents that it is
knowledgeable in its field and that any services performed by Consultant under this
Agreement will be performed in compliance with such standards as may reasonably be
expected from a professional 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:
SCOPE OF SERVICES
This is an agreement for on -call services, as needed basis for minor building renovations.
Consultant shall be informed by the City of each pending project. Consultant shall reply, in
writing, within five working days with a formal bid. The bid proposal shall include
compensation requirements and time frame as to when the project shall be completed. The City
may accept, reject or negotiate with Consultant regarding said proposal. Consultant shall
perform said services only after receiving written notice, executed by the Executive Director of
the Community Development Agency.
Consultant is hereby authorized to perform those services set forth in its Proposal dated August
19, 2003, for the removal and replacement of an existing ceiling, attached hereto as Exhibit A.
2. COMPENSATION
a. City agrees to pay, and Consultant agrees to accept as total payment for its services,
the rates and charges identified in each accepted Proposal. The total sum to be expended under
this Agreement, shall not exceed S 9,000.00 during the term of this Agreement.
b. Payment by City shall be made within thirty (30) 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 commence on the date first written above 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 Community
Development Agency and the City Attorney.
4. INDEPENDENT CONTRACTOR
Consultant 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
Consultant performs the services which are the subject matter of this Agreement; however, the
services to be provided by Consultant shall be provided in a manner consistent with all
applicable standards and regulations governing such services. Consultant 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.
5. INSURANCE
Prior to undertaking performance of work under this Agreement, Consultant shall
maintain and shall require its subcontractors, if any, to obtain and maintain insurance as
described below:
a. Commercial General Liability Insurance. Consultant shall maintain commercial
general liability insurance naming the City, its officers, agents, volunteers, and employees as
additional insured(s) and 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 Consultant's 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. Consultant shall supply City with a fully executed additional insured endorsement in
substantially the form attached hereto as Exhibit B upon execution of this Agreement and shall
be approved in form by the City Attorney.
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 the provisions of Section 3300
of the Labor Code, Consultant, if Consultant 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, Consultant agrees to obtain and maintain any
employer's liability insurance with limits not less than $1,000,000 per accident.
d. Reserved.
e. The following requirements apply to the insurance to be provided by Consultant
pursuant to this section:
(i) Consultant shall maintain all insurance required above in full force and
effect for the entire period covered by this Agreement.
(ii) Certificates of insurance shall be furnished to the City upon execution of
this Agreement and shall be approved in form by the City Attorney.
(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.
f If Consultant 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 forthwith
terminate this Agreement. Such termination shall not affect Consultant's right to be paid for its
time and materials expended prior to notification of termination. Consultant 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
Consultant agrees to and shall 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 health, and claims for property damage, which may arise from the
direct or indirect operations of the Consultant 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 Consultant 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 terms of, or
effects arising from this Agreement. City may make all reasonable decisions with respect to its
representation in any legal proceeding.
7. CONFIDENTIALITY
If Consultant receives from the City information which due to the nature of such
information is reasonably understood to be confidential and/or proprietary, Consultant 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 Consultant disclosed in a publicly available source; (c) is in rightful
possession of the Consultant without an obligation of confidentiality; (d) is required to be
disclosed by operation of law; or (e) is independently developed by the Consultant without
reference to information disclosed by the City.
8. CONFLICT OF INTEREST CLAUSE
Consultant 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.
9. 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 telefacsimile 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
telefacsimile (714) 647-6956
With courtesy copies to:
and,
Executive Director of Community Development Agency
City of Santa Ana
20 Civic Center Plaza (M-25)
P.O. Box 1988
Santa Ana, California 92702
telefacsimile (714) 647-6549
City Attorney
City of Santa Ana
20 Civic Center Plaza (M-29)
P.O. Box 1988
Santa Ana, California 92702
telefacsimile (714) 647-6515
To Consultant:
I.C.E. Builders, Inc.
421 East Cerritos Avenue
Anaheim, California 92805
Telefacsimile (714) 491-7743
A party may change its address by giving notice in writing to the other party. Thereafter,
any notice, tender, demand, delivery, or other communication shall be addressed and transmitted
to the new address. If sent by mail, any notice, tender, demand, delivery, or other
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 telefacsimile, any notice, tender, demand, delivery, or
other 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.
10. EXCLUSIVITY AND AMENDMENT
This Agreement represents the complete and exclusive statement between the City and
Consultant, 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 Consultant. The parties
agree that any terms or conditions of any purchase order or other instrument that are inconsistent
with, or in addition to, that terms and conditions hereof, shall not bind or obligate Consultant nor
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.
11. ASSIGNMENT
Inasmuch as this Agreement is intended to secure the specialized services of Consultant,
Consultant 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 consultants retained by City.
12. TERMINATION
This Agreement may be terminated by the City upon thirty (30) days written notice of
termination. In such event, Consultant shall be entitled to receive and the City shall pay Consultant
compensation for all services performed by Consultant 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 Consultant 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 Consultant 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.
13. DISCRIMINATION
Consultant 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, training, utilization, promotion, termination or
other employment related activities. Consultant affirms that it is an equal opportunity employer
and shall comply with all applicable federal, state and local laws and regulations.
14. JURISDICTION - VENUE
This Agreement and all questions relating to its validity, interpretation, performance, and
enforcement shall be governed and construed in accordance with the laws of the State of
California. 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.
15. PROFESSIONAL LICENSES
Consultant 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. Consultant shall notify the City
immediately and in writing of her inability to obtain or maintain such permits, licenses,
approvals, waivers, and exemptions. Said inability shall be cause for termination of this
Agreement.
16. COMPLIANCE WITH GOVERNMENTAL REQUIREMENTS
Consultant shall carry out all services pursuant to this Agreement in substantial conformity
with all applicable laws, ordinances, statutes, codes, rules, regulations, orders, and decrees of the
United States, the State of California, the County of Orange, the City and of any other political
subdivision, agency or instrumentality exercising jurisdiction over the City, including all applicable
federal, state and local occupation, safety and health laws, rules and regulations and standards,
applicable state and federal labor standards, prevailing wage requirements, the City zoning and
development standards, City permits and approvals, building, plumbing, mechanical and electrical
codes, as they may apply, and all other provisions of the City and its Municipal Code (as it may
apply), and all applicable disabled and handicapped access requirements, including, without
limitation, the Americans With Disability Act, 42 U.S.C. §12101 et seq., Government Code § 4450
et seq., and the Unruh Civil Rights Act, Civil Code §51 et seq.
17. MISCELLANEOUS PROVISIONS
a. Each undersigned represents and warrants that its signature hereinbelow 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.
b. 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:
PATTICIA E. HEALY
Clerk of the Council
APPROVED AS TO FORM:
JOSEPH W.FLETCHER
City Attorney
Assistant City Attorney
RECOMMENDED FOR APPROVAL:
J P. REEKSTIN
E cutive Director of the
Community Development Agency
CITY OF SANTA ANA
,C
DAVID N. REAM
City Manager
CON ULTANT
DAN ROSA
Partner
Tax ID#
I.C.E. Builders, Inc.
To: The Depot at Santa Ana Project: Transportes InterCalifomias
City of Santa Ana New Acoustical Ceiling
1000 East Santa Ana Blvd. Suite 108
Santa Ana, California 92701
Attn: Carolyn Fullerton Fax No. 714/565-2693
Remove existing ceiling tiles and replace with new
2'x2' Ceiling Grid and Tile.
Approximately 80 Square Feet.
All work to be performed after 10 PM
Total Lump Sum Price
GENERAL CONTRACTOR
OWNER
Inc.
Daniel Rosa
Senior Project Manager
The Depot at Santa Ana
PROPOSAL
Date 8/19/2003
$863.00
Date: 8/192003
[ ] ACCEPT (signature)
[ ] DO NOT ACCEPT by:
[ j Title: Date:
I.C.E. Builders, Inc. 421 E. Cerritos Avenue Anaheim, Ca. 92805. 7141491-1317 Fax 714/491-7743
EXHIBIT A
EXHIBIT B
ADDITIONAL INSURED ENDORSEMENT
FOR COMMERCIAL GENERAL LIABILITY POLICY
Insurance Company
This endorsement modifies such insurance as is afforded by the provisions of Policy
# relating to the following:
I. The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701; its
officers, employees, agents, volunteers and representatives 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 benefit 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 to 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 Clerk of the Council, 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
Policy #
Issued to
this endorsement form as a part of
Named Insured
Countersigned by
Authorized Representative
OGT.19'2003 16:09 2706518127 PEDIGO LEESEN� #2953 P.002/007
A /iDii I Ikm""INITIT)
,N C
IMMUCER (270)651-8037 FAX (270)651-9127 I THIS CERTIFICATE IS ISSUED AS A MATTER OF
Pedigo-Lessenberry Ins. Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CC
103 Pin Oak lane HOLDER. THIS CERTIFICATE DOES NOT ANEMIC
P. 0. Sox 1999
Glasgow, KY 42142-1999
421 East Cerritos Ave.
Anaheim, CA 92905
INSURERS AFFORDING COVERAGE
Y+NJPERA St. Paul Fire a Mari
WAVA?R C
INSURER C.
NAIC N
THE POLICIES OF INSURANCE LISTED BELOW NAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTVAT14STANN M
ANY RECUIRVAENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE_ AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY NAVE BEEN REDUCED BY PAID CLANS.
TYIE W IMANtANIM
POLICY NUMBER
Y
PM EAP
��
GENEPAL LWIRM
KKO4100965
10/01/2003
10/01/Z004
a 1,000,0
X 0-0-M +CMB4NERALLIANUTY
oEAAaaHA+%clmREw.e
RFMTED
6 300.0
r,UNMS MAOF Qac"
Iwww,e...........
J�EM�
LIED EIIPIMrnnwllLIFLA)
a 10,00(
A
PERSONALaAOYBUIJRY
a 11000.00C
G.WfI LAGGREGATE
a 2,000,00
GENI. ACCRCGAT(ppLRpSApp.T. APPLIES PER,
PRODUCTS - cOMP/oP AGG
a 2 0pQ Q
POLICY X JECT LOC
AIlTOMOBILC
X
LAAMILM
ANYAVTO
KKO4100%5
20/01/2003
10/01/2004
COMlINEO SRI" LSAT
Ite eoGALM)
a 1,000,0040
somyM MY
IFM IAwTPPI
a
A
AU.ONYIBDAUTOO
BCHEOJLED AGTOB
RPMDAUTOS
NONAWNEO AUTOb
%
X
BODILY INJURY
IPM aeelaaMl
T
Hired Physical Dmgf
00 DED, COMPREHENSIVE
$SOO DED. COLLISION
%
L•ROW'.RTY OALNCE
(per eNUI
GARAGE LNBRJTY
AUTOONLY-FAACGMFNT
a
OTHER THAN FA ACC
AUTOO,0.Y• A00
a
ANYAUTO
a
ERCEianJNsIELIa IJArm
o cw �CIJUMSWOE
KK04100967
10/01/2003
10/4VZO04
EAr." wxIoARENcE
a 2S 000 0
AGGREGAT4
a 25.000.0
B
a
DEOVCTYJ45
a
f
RETENTmN a
rRxWERBcaepMeAmHAND
WVK4100442
10/01/2003
10/01/2004
X L^yTU• "•
A
ANY
ANY PPOPPHiTORPARTrA:WE)ECUTNB
"0II7'LMftMAA
OFPICFRIMEMBER EXCLUDEDT
R yL�fA, AwPM u 10
lMff;LII PROVrs10N6 BTIPN
Ei..EIY'FIACCIDFNT
a 1 1 000
E.L. mSEABE-EA F.MPLO
a 1 OOO
E.L OISEA6E•fOUCr LnaT
i 1 000
DIRER
0FnIHRA1TONs /COGTpMCJU IERCWBIONB ADDED BL'�/tlOASs ar/ nam /( as A
ty of Santa Ana, its off cars, agents 6 emp oyxs are nalEed as Additional Insureds per endorsement
attached.
City of Santa Ana, California
20 Civic Center Plaxa
Santa Ana, CA 92701
CHM0 ANY W THE ABOVE DEBCNBED PCLICM.B BE CANCELLLO BEPORF. THE
CRPmATION DATE TIEREDF. THE R4!"S P+BURER WILL 11800601L06 MAa
30 DAYaTTmTTaw MOT6ETor"EcmrwATEmxDERNAMEDTo TRELEFT,
KKYIOON090SIYIOYmO(XX
ACORD2512001N8) 11
A. e' �:U i� z✓a ..:'s • AOMIDR Inc.
;Ip� iJa 1UPiltCv
CORPORATION 1986
ocT.14•2003
EXRMITl3
' r r )t! • t )L r a rlr • u!
1291
Insrtunce Company St. Paul Fire a marine .Insurance Company
This endorsement toodifies such insurance as is alrorded by the provisions of Policy
T KK04100965 relating to the following:
1. The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701; its
officers, employees, agents, volunteers and,.,. entadves 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 benefit 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 am so included.
4. Wad} respect to the additional insureds, this insurance shall not be cancelled, or
ntamrially reduced in covcrsge or limits except after thirty (30) days written notice has been
given to the Ciryof Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701.
(Completion of the following, including coumtersignamre, is requited to make this endorsement
effective.)
Effective 10-1-03 this endocsement form as a part of
PolicyR NK04100965
Issaedtc I.C.E. Builders. Inc.'
Countersigned by _ � �r/
Authorized Rdpas anacive
,cV
ocT.14'2003 16:10 2706516127 PEDIGO LE55ENBERRY #2953 P.003/007
IMPORTANT
If the certificate holder Is an ADDITIONAL INSURED, the pollcy(ies) must be endamad- A statement
on this certificate does not confer rights to the certificate holder In Neu of such endorsement(s).
If SUBROGATION IS WANED, 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 Neu of such ardorsemend(s).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract bebveen
the Issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or nsgativey amend, etdend or alter the coverege afforded by the policies listed thereon.
10/26/2004 TUE 10.50 FAX 714+565 4020 CITY OF SANTA ANA i 4 CITY ATTORNEY
UL.1'C''CYXJ�, 11•J7 rmul'I-rCUlNau Lr—'a-1 DCRiCI CfYJ OJL O1C1 IU•lll�!JOJC07J
C &D CERTIFICATE OF LIABILITY
FR9OLIGER (�Z70)651-61f37 FAX
Pedigo-Lessenb•rry Ins. Agency,
103 Pin Oak Lane
P. 0. Box 1699
Glasgow. KY 42142-1699
INSURED I - Buyers, Inc.
421 E. Cerritos Ave.
Anaheim, CA 92905 -Z
f _nv�C A ncY
Inc.
2 002/006
r.C• o
INSURANCEI-1nSffl2e"I
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR
A_Uft THE CM11RAGE AFFORDED BY THE P = BELM
INSURERS AFFORDING COVERAGE
NAIL 8
INSURER.: Travelers Property Casualty Co.
of Amarica
INSURER 0.
INSURER C.
INSURER D,
bigURlR IL
THE POLICIES OF INSURANCE LISTED KLOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITi4STANDINC
ANY REOUIREMENT. TERM OR CONDITION OR ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WftlCH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN Is SueJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS $MOWN MAY HAVE BEEN REDUCED BY PAID CLAW
TTKOPINSURANCE POLICYNIJMBER PauCT E UCY UNITS
GENERALuAOIuTY
VTC23CO S71SR96-1
10/01/2004
10/01/2005
EACH OCCURRENCE
1 1 000,0000MM
rA
INCIAL GENERAL LIABII.nm
OAIWL FTORENTED300
OOOGI�pmCLAIM
ISMADE CX OCCUR
1ME0 EV (ARV wo permnl
! S 0
P19R3ONAL AADW "URV
s 1 000 00
MWEAAL AGGREGATE
s 2,000,00
Uk:WLACGAEGLTELIAIrAPPLIri8PON,
NNGWCTS-COMPIOPAOG
s 1.000.00
POLICY M 2"t LOC
AVTQR=LELIA®LnY
X ANY AUTO
VTJCAP S786897-3
W01/20D4
10/01/2005
Ir aED SINGLE LIMIT
IE2 eoaAerY)
1
1 f 000 , 00
ODDILY altmr
(Per pereen)
A
ALL O"ED AUTOS
SCHEDULED AU705
X HIRED W705
X NON DAUTOS
BODILY WARY
(pW*W15@Po1
S
PROPERTY DAMAGE
1
GARAO9 UANUTY
AUTO ONLY -EA ACCIDENT
OTHER TMAN U ACC
AUTO ONL" • AGO
S
ANY AM
s
INCEsau«aRILLaLUISL,.T
VTSM7CUP S7661198-5
10/01/2004
10/01/Z005
EAc►Ioccuiilium E
M 10 000.00
X OCCLM CLA1114 MADE
AGGREGATE
1 1000000O
s
A
DEDUCTOLE
s
RETENTION 1
A
rJORKIMSCOMPD"T10NAM
iYMLOYERS LUUNLITr
ANY PROPRr-YOIwARTNFplhMCLRNG
OFFICERO MLHIIIF•A EXCLUOEI"
SPECIAL PROnSIONSbola.
VTC23-LIB 445ON63-5
10/01/2004
10/01/ZOOS
r
E L. EACH ACCIDENT
S 1, 00D D00
C L 018EASE - CA EMPLOYEE
1 1,000.00
E L DISEASE -POLICY LIMIT
1 11000 00
OTMA
DesLa113IFTION OR OPERATION(I I LOCATIONS I VERJU-3! ERCUJ=kfi ADDED MY [tA010ABENENT I SPECIAL PRIWINONS
7ank>et Additional insureds *Ml y to General Liability and Autowbile Liability if required by Contract
er forms CGTAXXCI0/02) and CLT UC10/02).
City of Santa Ana
20 Civic Center Plaza
Santa Ana, CA 92702
ACORD 25 12001011
EMQULD ANY OP YNE ABOVE DESCAIB110 POLICIGI K CA110E1.1.0 OCKME THE
UPIRATN)N DATE THERSOP, TN[ ISSUINCI aSYRE1%WILL WA*xm= NNL
30 CATS WRITTEN NOTICE TO THE CgpTVICATE HOLDER NA w TO THE LEFT,
Ux>ulow Ux
Agency. Inc,
INSLIRAiMRD CORPORATION 1988
10/26/2004 TUE 10:51 FAX 714+565 4020 CITY OF SANTA ANA 444 CITY ATTORNEY Z 003/006
,r '-r�-CVJt94 ii;,L9 tKLA'I%r'CV1UU L1;-55CN=KKT e(u 631 tildf IU:1f145C by3 V -5-1b _
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the pollcy(ies) must be endorsed. A statement
on this cenlficate does not confer rights to the certificate holder in lieu of such endorsement(s),
If SUBROGATION iS WAIVED, subject to the leans and conditions or the policy. cerlain policies may
require an endorsernent. A statement on [his certificale does not conrer rights to the certificate
holder in lieu of such endorsemenl(s).
DISCLAIMER
The Cenificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representauwe or producer, and the certificate holder, nor does It
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
ACORO 26 po01101I
10/26/2004 TUE 10:51 FAX 714+565 4020 CITY OF SANTA ANA 444 CITY ATTORNEY Z 004/006
Ul.l'�'�UrJ`1 L1; 119 rKLM'1;rr.UvAJ Lr==1-q=KK1 cto 0?1 tl191 IU:111'ir."b
COMMERCIAL GENERAL LIABILITY
THiS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
BLANKET ADDITIONAL INSURED
(CONTRACTORS)
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIASiLITY COVERAGE PART
WN4 IS AN INSURED - (Section 11) is amended to include:
a) :any person or organization you are required to include as an additional
insured on this palicy by a written contract or written agreement signed
and executed by you prior to the loss for which coverage is sought; and
b) any person or organization who is the owner or property manager of a
mall while you arc required to add a tenant of such mall as an additional
insured on this policy by u written contract or written agreement signed
and executed by you prior to the loss for which coverage is sought.
The person or organization. does not qualify as an additional insured with respect
to the independent acts or omissions of such person or organization. The person
or organization is only an additional insured with respect to liability caused by
"your work" for the additional insured specified in paragraph (a) above.
2. The insurance provided to the additional insured is limited as follows:
a) in the event that the limits of liability stated in the policy exceed the limits
of liability required by a written contract or written agreement signed and
executed by you prior to the loss for which coverage is sought, the
insurance provided by this endorsement shall be limited to the Iirnits of
liability required by such contract or agreement. This endorsement shall
not increase the limits stated in Section Ill, - LWITS OF INSURANCE.
b) The insurance provided to the additional insured does not apply to "bodily
injury", "property damage", "personal injury" or "advertising injury"
arising out of an architect's, engineer's or surveyor's rcnduring of or failure
to reader any professional services inchiding-
i_ The preparing, approving or failing to prepare or approve maps,
shop drawings, opinions, reports, surveys, field orders, change
orders, or drawings and specifications; and
1I. Supervisory or inspection activities performed as part of any
related architectural or engineering activities.
C) This insurance does not apply to "bodily injury" or "property damage"
caused by "your work" included in the "products -completed operations
hazard" unless you are required to provide such coverage for the
additional Insured by a written contract or written agreement signed and
executed by 'you prior to the loss for which coverage is sought and then
unly for the period of time required by such contract or agreement and in
no event beyond the expiration date of the policy.
CG TH xx 10 02 Copyrichr. The Trsuvclers IAP4Q6V;A, z TO FOR4ase 1 of 2
LA4
Laura Stitt heedy
Ascictant City Attorney
10/26/2004 TUE 10:51 FAX 714+565 4020 CITY OF SANTA ANA 444 CITY ATTORNEY 2 005/006
OCT-25-2004 11:40 FREMPEDIGO LESSEhBERRY 270 651 8127 TO:17145652697 P.3'6
COMMERCIAL GENERAL LbkfflUn
3. Subpart (1)(a) of the Pollution exclusion under Paragraph 2., Exclusions of Bodily
Injury and Property Damage Liability Coverage (Sectioq Y - Coverages) does not
apply to you if the "bodily injury" or "property damage" arises out of "your work"
performed on premises which are owned or rented by the additional insured at the
time "your work" is performed.
4. Any coverage provided by this endorsement to an additional insured shall be
excess over any other valid and collectible insurance available to the additional
insured whether primary, excess, contingent or on any other basis unless a written
contract or written agreement signed and executed by you prior to th.e loss for
which eovnragc is sought specifically requires that this insurance apply on a
primary or non-contributory basis. When this insurance is primary and there is
other insurance available to the additional insured from any source, we will share
with that other insurance by the method described in the policy.
5. As a condition of coverage, each additional insured must:
a_) Give us prompt written notice of any "occurrence" or offense which may
result in a claim and Prompt written notice of "suit".
b.) Immediatdy forward all legal papers to us. cooperate in the investigation
or settlement of the claim or defense against the "suit," and otherwise:
comply with policy conditions,
c,) Tender the dcfcnse and indemnity of any claim or "suit" to any other
insurer which also insures against a loss we cover under this endorsement.
This includes, but is not limited to, any insurer which Iles issued a policy
of insurance in which the additional insured qualifies as an insured. For
Purposes of this requirement, the term "insures against" refers to any self-
insurance and to any insurer which issued a policy of insurance that may
provide coverage for the loss, regardless of whether the additional insured
has actually requested that the insurer provide the additional insured witb
a defense and/or indemnity under that policy of insurance.
d.) Agree to make available any other insumnec that the additional insured
has for a loss we cover under this endorsement.
CC; T8 xx 10 02 Copyright, The Trawelerfi Indenmiry Company, 2002 Page 2 of 2
10/26/2004 TUE 10:52 FAX 714+565 4020 CITY OF SANTA ANA 444 CITY ATTORNEY a 006/006
11:ti1g rKUi'i:rrWLW 4t57tMrKK7 1;:({7 10?1 1J1Cr IU:1 rl'b
COMMERCIAL AUTO
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
ADDITIONAL INSURED
This endorsement modifies insurance provided under the following.
BUSINtSS AUTO COVERAGE FORM
Paragraph e. of the WHO IS AN INSLWD provision includes the person or organization
indicated below, but only for his, her or its liability because of acts or omissions of an
"insured" under paragraphs a. or b. of that provision, subject to the following additional
provisions:
1. No liability is assumed by that person or organization for the payment of any
premiums stated in the policy or cased under the policy.
2. In the event of cancellation of the policy, written notice of cancellation will be mailed
by us to that person or organization.
I Any coverage provided by this endorsement to an additional insured shall be excess
over any other valid and collectible insurance available to the additional inmved whether
Primary, excess, contingent or on any other basis unless a written contract or written
agreement signed and executed by you prior to the loss forwhicb coverage is sought
specifically requires that this insurance apply on a primary or non-contributory basis.
When this insurance is primary, and thcrc is other insurance available to the additional
insured from any source, we will share with that other insurance by the method described
in this policy.
Person or Organization.
Any person or orgauizetiun you are requhtd to include U an additional inm=d on this policy by a writren
mnnaet of writum agreement Sip d cad executed by you prior to the loss for wbiicb coverage is sought.
APP-ROVED AS TO FORM
Laura S �` Sheedy
Assistant ity Attorney
CO Tfi XX 10 02 Copyright, The Travelers Indemnity Company, 2002 Page 1 of 1
Feb
28
06
11:42a
Tllagl
Feb
23
06
09:51a
T11agl
-081 ti'2
.c
11.1 -O5 •131.1
ACOAQ CERTIFICATE OF LIABILITY INSURANCE 91/09//200
rxVNuceA (270)651- 817 AJI ( 0)651-8127
THIS CERTIFICATE IB ISSUED AS AMATTER OF INFORMATION
Pedigo-Lessenberry Ins. Agency, Inc.
ONLY AND eOHpEAa NO RIGHTS UPON 111E CERTIFICATE
HCLOM INKS CERTIPTCATE DOES NOT AMEND%TEND OR
103 Pin Oak Lane
TER COV EAFFORD Y FOCIICIESS
P. 0. Box 1899
Glasgow, XY 01.42-1899
INSURERS AFFORDING COVERAGE
NAIC9
uisc+- Foi-L . SD, lders, Inc. —J —'
w;JERA TraVeiers Property Cana ty o•
f America
421 E. Cerritos A".
�NwuenN
Anaheim, CA 92805
ienuArxt _ .,_
PEn100 JCATf.MAYTED. NO ISSUED PPl01N0
THE POLICIES OF INSURANCE LISTED BELOW AVE BEENISSUEDAOTOR TO THE INSURED NANW ABOVE FORTHE POLICY THIS
TO WHILH.EX CERTFEXCLUSIONS COBEISSUEDOA
DOCUMENT19SUBJECT TO
ANY NERTA[kT tITERMGB ;%FFORON OF PNY GONCIES OR DESCRIBED
YAYNEATAWTHEINBVRPNCE SHOWN MAY AVEESENREW EDByPAOCILAIN 198UBJECT TOALL THE TERMS, SxCLU3r1N9 ANDCONOITxiN9OF SUCH
POLICIES AGGREGATE LN1R3 SHOWN NL4Y HAVE 86CN REpULEO BY PAID CWL6.
K R
nrtcFadWRA N,
rotln "WER
Y W
awn
I
i
a..LUw[m VT
X C01AtSYCIA[YLiwFRPLlYDL11Y
3-CO-57868961-TIL-0S
10/01/2005
10 006
ma,000YNRN+CL
f 1,000,00
E 3110•
DLxYCE TD NfNTED
MpO EN'IPnyrNPYwM
% 5 00
CwmSI.u.D[ �Of.4Ult
IVIIHO M&MVINYJRY
1 1 000_
.5
A i
I1
OENERALAnKCAW
t 2 000 00
--GENL NDTSfG'.m I,MD ^n•uE6 PEx
fwoxjcis-C 10V NOC
S 7,.000 00
-
WVC'T TS FI LOC
A
wfOneNtEUAmm
uLDA++FDawa
SCNfn4lT0AUlU5
K j NON LVdNCOAUI05
"1
I-CAP-578689711-TIL-05
AT11�T 1
'i' `fL/`r L
_ L:lGtO
10/01/2005
M1 .Ri
f\t) 1 .)
�•1 -L�
10/01,12006
f /1 �`''i
l'V
�
DaNaINED MxuuPm
J.eeclAV
E
1,000 O
BDDvrmnl RY
r
l
_
'MKiu YJOAY
Pn NMM)
PnOKRTY G1ALOf
ln.AceAy
S
t
—.•
GPMGE INNO�'
Aj. ISMI
1 L
�
AuTOON1.1-III Cm£N!
f-
M„l9.uW J !'l1CC
PDO
L
iNIfOONLY'
1,yrynU1D
1
I--fNRLbYNNRa.w varxm
A DccuA Cw-YS.MDE
J-CUP-47861984-TIL-OS
I016172005
10/O1/2008
lAnloccYxrina
s 30.000,0
P;'ZTE
E 10 000.00
t
A
� '
t
CfDU ukc
S
nE1ONlIDY 5
wDRNaacamrcNnnmlaxo
ev0'varEm' wsluvY
VTC23-UB-4490Si3-5-05
f L EAOnAC0IIII
a 1,000 00
A
nCHLR�MBIeFRPLCLWEOCUtIL(
_
Ct. d1FASF. FAEunDY
5 1.000.00
Et VgfAAE. POMo-'I
S 11000.00
§LECl.:�yFWLLNn9 Y,a.
_
mNlA
awpRelity and Auto
YF1cArrNK of n noxslLqcAErorniv011cLwly to Genera
tanker Ad�it�enal Insureds apply to General Ifaail Sty and Auto ability per form nunhars CLTenn
VS/O9) and CA2045 (00") attached, Certificate holder will qualify as SIR Additional Insured if
ewuired in a written contract with our insured.
zNauw NNOFT,e AaDNt oexmAwNDuolsreaNCEtupsNEwE TxF
EARRLna PLIE f WNLUr. 1XE I391N6 NEJR[AX1L EINMANNRNNAIL
IO CAYLeiu1EEN NOnCa EO TM CEnnKAlt NotmINAYW IOTNELlPT,
City Of Santa Ana K*NW 8Iaa81NIRBg1Xd%R8MXX
20 Civic 8N
Center Plata W0fY1SD f0BWSDYYIRXxwm XXXX
Santa Ana. CA 92701 PI^1 pmo A,Tc
P931004-MININSHIRY IMI CORPORATION 1968
A9au:y. IM.
p.2
Feb 28 06 11:42a Tllagl
Feb 23 06 09:52a Tllagl
IMPORTANT
P.3
.719 ']IJS 0 ?1 M1 c. b
If the colificale holder is an ADDITIONAL INSURED, the poficy(ies) must be endoraed. A statement
on this cenRcata does not confer fights to the rxadhcale hsldei in lieu of with eedomemenl(s)
If SUBROGATION IS WAIVED. s*wl to the farms and cnMeiuna of the poliq, certain pmicbs may
requite an endorserrrent. A slatamwd on this certificate does not confer rights to the Cgrtiaeale
holder m lien of such endorsement(s).
015CLAIMER
The Cenificale of Insurance on the reverse side of this form does not moslkile, a contract helwa in
Me issuing imurer(s), aumodzed representative or promm. and the anifew holder. nor d000 it
ati matively or negat"y amend, extend or altar the coverage afforeed by the policies Wed thereon.
ACDR61a (20e1104f
.-..,ale It Clty' Auo, ,,,v
Feb 28 06 11:42a Tllagl
Feb.23 06 09:52a Tllagl
?'Jt10E PS, .11C .FI BCa V'ae
CUhrytERClrt GCN-R:\L UA131LITY
HIS ENDORSEMENT CHANGES i HE POLICY. PLEASE READ IT CAREFULLY
BLANKET ADDITIONAL INSURED
(CONTRACTORS)
This endorsement modifies insurance provided under the toilovmxl:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
wHO IS AN INSURED - (Section If) is amended to include any person or
organization that you agree in a'wriltert contract requiring insurance' to include
as an additional insured on this Coverage Part, but:
a) Only with respect to liability for "bodily injury", "property damage" or
'personal m)ury and
b) If, and only to the extent that, the injury or damage is caused by acts or
omissions of you or your subcontractor in the performance of 'your work'
to which the "written Contract requiring insurance" applies The person or
organization does not qualify as an additional insured with respect to the
independent acts or omissions of such person ororganizal on.
2. WHO IS AN INSURED - (Section If) is also amended to include any person or
_ organization that is the owner or property manager of a mall while you are
--- ` " required in a "w(itten contract requiring insurance" to include a tenant of such
mall as an additional insured an this Coverage Part, but:
a) Only with respect to liability for "bodily injury'. "properly damage' or
"personal injury and
b) If, and only to the extent that, the injury or damage is caused by acts or
omissoria of you or your subcontractor in the performance of "your work"
to which the "written contract requiring insurance" applies. The person or
organization does not qualify as an additional Insured with respect to the
independent acts or omissions of such person or organization.
3. The insurance provided to the additional insured by this endorsement, whether
under paragraph 1, or paragraph 2. above, is limited as follows:
a) In the event that the Limits of Insurance of this Coverage Part shown fn
the Declarations exceed the limits of liability required by the `Written
contract requiring insurance", the insurance provided to the additional
insured shall be limited to the limits of liability required by that "written
contract requiring insurance'•. This endorsement shall not increase the
limits of insurance described in Section M - Umits Of Insurance.
b) The Insurance provided to the additional insured does not apply to "bodily
injury". "property damage' or "personal injury" arising out of the rendering
CG Ts an 03 us Copyrighl. The Traveien Indefnniry Company, _'aoz Page 1 ur i
- ,air:❑L' t:ily Attu-.:ey
to . 4
Feb 28 06 11:43a Tllagl
Feb 23 06 09:52a T11ag1
eU LU6n5. :NC
CObssIMIALGEMf RAL LIABILITY
of, or failure to render, any professional architectural, engineering or
surveying services, including:
i. The preparing, approving, or failing to prepare or approve. maps,
shop drawings opinions, reports, surveys. Mold orders or change
orders. or the preparing, approving, or failing to prepare or
approve, drawings and specifications; and
if. Supervisory, inspection, architectural or engineering activities.
c) The insurance provided to the additional insured does not appfy to "bodily
injury" or "property damage" caused by'your work" and included in the
"products -completed operations hazard' unless the "written contract
requiring insurance' specifically requires you to provide such coverage for
that additirnal insured under paragraph 1, above, or for the tenant of such
mall under paragraph 2. above, and then the insurance provided to the
additional insured applies only to such'badily injury" or'properiy
damage' that occurs before the end of the period of time for which the
'wrihen contract requiring insurance' requires you to provide such
coverage or the end of the policy period, whichever is earlier.
4. The insurance provided to It additional' insured by Inls endorsement is excess
over any valid and eotleclible'ather insurance". whether primary. excess,
contingent or on any other basis, that is available to the additional insured for a
loss we cover under this endorsement However, if the "written contract requiring
insurance" specifically requires that this insurance apply on a pr6nary basis or a
primary and non-contributory basis, this insurance Is primary to "other insurance'
available to the additional insured which covers that person or organization as a
named insured for such loss, and we will not share with that "other Insurance'.
But Me insurance provided to the additional insured by this endorsement still is
excess over any valid and collectible "other tflsuraflce", whether primary, excess,
contingent or on any other basis, that is available to the additional iosumd when
that person or organization is an additional insured under such 'other insurance".
5. As a condition of coverage provided to the additional insured by this
endorsement.
a) The additional insured most give us written notice as soon as practicable
of on "occurrence" or an offense which may resuff in a claim. To Inv
extent possible, such notice should include.
i- How, when and where the `occurrence" or offense took place;
it. The names and addresses of any injured persons and witnesses:
and
Id. The nature and location of any it ar damage arising out of the
"occurrence" nr offense.
b) It a claim is made or "suit' Is brought against the addidOnal insured, the
additional insured must:
CO Fs nn 43 0 r.opyrigln. Tile Travefen lndumn uy Company, 2002 Page 2 a l
Feb 28 06 11:43a T11ag1
Feb 23 06 09:52a T11as1
P.6
P.5
COMMERCIAL GENPRA I. LfABILITY
I. Immediately record (Ile specifics of the claim or "suit" and the date
received: and
ii, Notify us as soon as practicable.
The additional insured must see to It that vie receive writter notice of the
claim or "suit' as scan as practicable
c) The additional insured must immediately Send us copies of aV legal
papers received in connection erilh the daim or "suit". cooperate with us
in the investigation or settlement of the claim or defense against the "suit",
arid otherwise comply with all policy conditions.
d) The adddonal insured must tender the defense and indemnity of any
Balm or "suit" to any provider of "other insurance" which would cover the
additional insured for a loss we cover under tilts endorsement. However,
this condition does not affect whether the insurance provided to the
additional insured by this endorsement is primary to "other insurance`
available to the additional insured which corers that person or
organization as a named insured as described in paragraph d. above_
5. The io0owing derrration is added to SECTION V-- DEFINITIONS.
'Written contract requiring insurance' means that part of any mitten contract or
agreement under vihich you are requited to include a person or organization as
an additional inured on this Coverage Pan, provloed that the "bodily injury" and
"property damage" occurs and the "personal injury' is caused 0 an offense
committed:
a, After the signing and execution of the contract or agreement by you;
b. While that part of the contract or agreement Is in effect; and
C. Before the end of the policy period.
CG Tli m 08 05 Copyright, The Trarefms Indemnify Compm y. 7002 Page 3 of 3
rA.o:=ti:dl lit}AtS�'=:-.JA'
Feb 28 06 11:43a T11ag1
P.6
Feb 23 06 09:53a Tllagl
C. c EUILrE148, i,+C .-.< Uas 1J
COMMERCIAL AUTO
PC'.?cy vUMBER: ISSUE UATEr -
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE REAR (T CAREFULLY,
DESIGNATED INSURED
This andorsement mcdMes InauraW9 provided under Ills roltowmg:
BUSINESS AUTO COVERAGE FORM
GARAGE COVERAGE FORM
MOTOR CARRIER COVERAGE FORM
TRUCKERS COVERAGE FORM
With respaCt ro ooveriga prvoidgd by d:fs siMorsament. the pravlsiwls of the Coverage Farm apply uM9a6 mvdl-
had by this endorsement
This andersament iderrifi¢s presents) or organ'rradon(s) who are "insureds" under the irlhd to An Insured Prom•
sion of dw Coverage Fam. This endorsement does not alter coverage provided in the Coverage Pam_
SCHEDULE
Name of Persorys) or OrgaNaatton(s)!
"Any person or organization that you are required to include as an additional
insured on this 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 to effect during the policy period."
tlf no entry apWm above, Information m"imd fo cvnplcta Ihis endorsement will he shown in On Declarations
as Appheaoie» dre apdoreertent)
EaM person or arganUadon sham In am 5011WUle 46 an -WAuW for 4abifly CCV9Ia0e, U iney, to the sled
that person a organization qualities as an insured" under the Who le An Ineued PmAsian cpalNned 0 Section
it of the Caveraee Form,
CA a 44 92 99 Copynght inswahce Samtese OWA. lbw, INS Page I of 1
1 __
P.7
M � 6