HomeMy WebLinkAboutCTL ENVIRONMENTAL SERVICES, INC. 1-2003
e-:PÞ
ç:iwrL
INSURANCE lJ,OT ON FilE
WORI{ MAY Jim PHOGEED
CLERK OF COUNCIL
DATE: 1J-/;'3/D3 CONSULTANT AGREEMENT
TIllS AGREEMENT, made and entered into this 19th day of Þ.i.~r ,2003 by
and between CTL Environmental Services, a California corporation (hereinafter "Consultant"),
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 (hereinafter "City").
N-2003-150
RECITALS
A The City desires to retain a consuhant having special skill and knowledge in the field of
lead air and surface testing.
B. Consuhant represents that Consultant is able and willing to provide such services to the
City.
C. In undertaking the performance ofthis 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 consulting 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
Consultant shall perform those services as set forth in Exhibit A to this Agreement.
2.
COMPENSATION
a. City agrees to pay, and Consultant agrees to accept as total payment for its services,
the rates and charges identified in Exhibit A. The total sum to be expended under this
!\.g;-;:;:ment shall not exceed $1,000.00, annually, during the term ofthis 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 ofthis
Agreement may be extended upon a writing executed by the Chief of Police 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, employees, agents, volunteers and
representatives as additional insured(s) and shall include, but not be limited to protection against
claims arising from bodily and personal injury, including death resulting therefÌ'om and damage
to property, resulting fÌ'om any negligent 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 therefÌ'om, and property damage, in the total
amount of$I,OOO,Ooo 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. Professional liability (errors and omissions) insurance, with a combined single limit of
not less than $1,000,000 per claim.
2
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.
Certificates of insurance shall be furnished to the City upon execution of
this Agreement and shall be approved in form by the City Attorney.
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.
(ii)
(ill)
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 effect 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.
INDEMNIFICA nON
Consultant agrees to and shall indemnifY and hold harmless the City, its officers, agents,
employees, consultants, special counsel, and representatives fÌ'om liability: (I) 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 fÌ'om
negligent acts as a result of 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 I of this Agreement; and (2) fÌ'om any claim that personal injury,
damages, just compensation, restitution, judicial or equitable relief is due by reason of the terms
of or effects arising fÌ'om 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 fÌ'om this Agreement.
7.
CONFIDENTIALITY
If Consultant receives fÌ'om 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 ofthe 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 oflaw; 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.
WORK PRODUCT
All work product prepared by Consultant pursuant to this Agreement shall be the
property of the City. Consultant consents to the City's use thereoffor such purposes as the City
deems appropriate. Consultant shall submit all work product to City in hard copy and produced
in II form compatible with City's computer system, as agreed between the Project Manager and
Consultant
10.
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 telefacsirnile 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
telefacsirnile (714) 647-6956
With courtesy copies to:
Chief of Po lice
City of Santa Ana
60 Civic Center Plaza (M-97)
P.O. Box 1988
Santa Ana, California 92703
telefacsimile (714) 245-8007
and,
City Attorney
City of Santa Ana
4
20 Civic Center Plaza (M-29)
P.O. Box 1988
Santa Ana, California 92702
telefacsimile (714) 647-6515
To Consultant:
CTL Environmental Services
24404 S. Vermont Avenue, #307
Harbor City, California 90710
Telefacsirnile (310) 530-0792
Attn: Marie Tullai
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 fÌ'ames, weekends, federal,
state, County or City holidays shall be excluded.
11.
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, the 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.
12. 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
5
. .
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.
13.
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 fur 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 Consuhant 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 Consuhant 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.
14.
DISCRIMINATION
Consultant shall not discriminate because of race, color, creed, religion, sex, marital
status, sexual orientation, age, national origin, ancestry, or disability, as defmed 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.
15.
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 oftne 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.
16.
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.
6
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 attomey'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
fl1'st above written.
ATTEST:
CITY OF SANTA ANA
/'
/~~/
PATRICIAE.HEALY ~
Clerk of the Council '
"", / -)
\ /.. "" <.~.. -
,., ~.,....<:::- t ~
fDAVIDN.REAM
City Manager
APPROVED AS TO FORM:
/1
/ /
RECOMMENDED FOR APPROVAL:
CTL ENVIRONMENTAL SERVICES
(, 1: ~ \~ ~\J.
~
Chief of Police
~ -~
~~ ~ {~ f2.. S:::.t+,\-CK
Ðirecmr VICL ~1Þ~
Tax ID #
7
..'..
~'I
~
CTL Environmental Services
an lnc. 500 Company
October 21,2003
Via Fax (714) 245-8097
Mr. Kim Hagen
CITY OF SANTA ANA
RISK MANAGEMENT DIVISION
60 Civic Center Plaza
Post Office Box 1981
Santa Ana, CA 92702
RE:
LEAD AIR AND SURFACE TESTING
SANTA ANA POLICE DEPARTMENT
JOSEPH BOYD FIRE ARM TRAINING CENTER
CTL PROPOSAL #A-O23-8632 (revised)
Dear Mr. Hagen:
CTL is pleased to present the following proposal for the above-referenced project. CTL
understands the scope of work to include lead air and surface wipe sampling at the site
referenced at above.
SCOPE OF WORK
AIR MONITORING
CTL has developed a highly specialized and extensive program for environmental air
sampling and air sample analysis lead projects, CTL's procedures include Cal-DHS
Certified Lead Project Monitors.
0 Air SamDlin!.! Method - Low Flow: Samples obtained fÌ'om within the abatement work
area are collected using self-contained, battery powered low volume pumps, operating at
between one (1) and four (4) lpm. These samples are also obtained in accordance with 29
CFR 1926.1101, as above.
0 Calibration of EquiDment: Field calibration of sampling pumps is carried out at the
beginning and end of each sampling period. The pumps are checked with pre-calibration
rotometers. Rotometers are calibrated against an NBS traceable wet test meter and/or
against a bubble buret, on a semi-annual basis. Whenever the flow rate(s) at the
beginning and end of each sampling period differs by ten percent (10%) or less, then the
average flow rate is utilized. If the flow rate ever differs by greater than ten percent
(10%), then the sample is considered void and analytical results are not utilized by CTL.
24404 S. Vennonl Avenue, #307 . HarborCiIy, CA 90710 . TEL: (310) 530-5006 . FAX: (310) 530-0792
tEXH
". '.-.
City of Santa Ana
October 21, 2003
CTL Proposal #A-O23-8632
Page 2
0 Analysis of Samples - Air (Lead): Air samples are collected and analyzed in accordance
with NIOSH Method 7082. All samples are retained for a period of 30 days, unless
requested in writing to retain the samples for a longer period of time.
0 Analvsis of Samples - Surface Wipe (Lead): Surface wipe samples are collected using
HUD protocol and analyzed in accordance with NIOSH Method 3050/7420. All samples
are retained for a period of 30 days, unless requested in writing to retain the samples for a
longer period of time.
0 Analysis of Samples - Soil (Lead): Soil samples are collected using HUD protocol and
analyzed in accordance with EPA Method SW-846. All samples are retained for a period
of 30 days, unless requested in writing to retain the samples for a longer period of time.
CLOSE-OUT DOCUMENTATIONIFINAL REPORT FORMATS
CTL shall provide two (2) bound copies of the final close-out documentation within three
weeks of project completion to clearly summarize all project related activities and analytical
results, which incorporates the following:
. Analytical and Abatement Procedures/Summary of the Project
. Copies of All Air, Soil, and Surface Wipe Sampling Forms with their Analytical Results
FEE SCHEDULES
The following fee schedule is an estimate only. CTL will only invoice for the number of
samples analyzed.
Project Manager l@ 95.001hr $95.00
Technician 8 hours (à¿ $65.001hr $520.00
Clerical 2 ills (à¿ $501hr $100.00
Sample Analysis - Lead in Air (3-5 day 2 @ $15.00 each $30.00
turnaround)
Sample Analysis - Lead Surface Wipe (3-4 7 @ $15.00 each $105.00
day turnaround)
Estimated Project Total $850.00
'fl' cn Environmental Services
EXHIBIT B
ADDITIONAL INSlJßJm ENDORSEMENT
FOR ('~QMMTIRçrt\J!SÆNEML IÆðBUJ:I:LPOLTCY
Insurance Company
Gulf Underwriters Ins. Co.
Tills endorsemcnt modifies such insurance as is afforded by the provisions of Policy
# 1 .-- relating to the following:
I. Thc City of Santa An!!, 20 Civic Center Plaza, Santa Ana, California 92701; its
officers, employees. agents, volunteers and represerllatives arc named liS additional insureds
("additional insureds") wilh regard to liability and defcnsc of suits arising fÌ'om the operations
and uses performed by or on behalf of the named insured.
2. With respect to claims arising out ofthc opcrutions and tlscspcrformcd by or on
bchalfofthe named insured. such insurance as is afforded by this policy is primary and is not
uddit ional to or contributing with any other insurance canied by or for the benefit of the
additional insurcds.
3. l1IÌs insurance uppJies separately to each iJ1SUrcd against whom claim is nmde or
suit is brought except with respcct to the company's limits of liability. The inclusion of any
person or organi7.alion as an insured shall not affect any right which such pcrson or organization
would have as a claimant if not so included.
4. With respect to the additional insmeds, this insurance shall not be cancelled, or
materially reduced in coverage or lìmits except after thirty (30) days \\Titten notice has been
given to the City of Santa Ana, 20 Civic CcntcrPlaza, Santa Ana, California 92701.
(Completion ufthc following, including countersignature, is requircd to make this endorsement
effective.)
Eileçlivc
I'olìcy #
Issued to
November 7.5. 7.00:, . this endorsement form as a part of
GT1?R?R154
CTL Environmental Services
Named Insured
Countersi¡,'11cd by \\~ \\:. \. ~l'O (1 ( L
Authorized Representative
ACORa. CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDIYYYY)
I 2/20/2004
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
BC ENVIRONMENTAL INS. BROKERS INC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR
1037 SUNCAST LANE, SUITE 103 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
EL DORADO HILLS, CA 95762
(916) 939-1080 INSURERS AFFORDING COVERAGE NAIC#
INSURED CTL ENVIRONMENTAL SERVICES INSURER A GULF UNDERWRITERS INS. CO
INSURER B
24404 S. VERMONT AVENUE #307 INSURER C
HARBOR CITY, CA 90710 INSURER 0,
tJ- ~l/o.J -/60 INSURER E
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING
ANY REOUIREMENT, 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 HAVE BEEN REDUCED BY PAIDCLAIMS.
"OR DD'L POLICY EFFECTIVE POLICY EXPIRATION
LTR N"D E F RA POLICY NUMBER ATE MMlDDIYY DATE MMI DIYY
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE ~I OCCUR
X CONT. POLLUTION GU2828154
LIMITS
07/01/03
EACH OCCURRENCE $ 1,000 000
PREMISES E' oœoceoœ 50,000
MED EXP IAny 000 pe",") 5 000
07/01/04 PERSONAL & ADV INJURY $ 1,000 000
GENERAL AGGREGATE $ 2,000,000
PRODUCTS. COMP/OP AGG $ 2 000 000
A
LOC
ANYAUTO
ALL OWNED AUTOS
COMBINED SINGLE LIMIT
IEe,wdeot)
$INCL IN GL
A
SCHEDULED AUTOS
X HIRED AUTOS
X NON.OWNEDAUTOS
BODILY INJURY
IPecpec,,")
GU2828154
07/01/03
07/01/04
BODILY INJURY
IPe"œideot)
PROPERTY DAMAGE
(p""",ideot)
A
II
OTHER THAN
AUTO ONLY
GU2828155
07/01/03
07/01/04
AUTOONLY.EAACCIDENT $
EAACC $
AGG $
$
$
$
4 000,000
EACH OCCURRENCE
AGGREGATE
RETENTION
$ 10 000
$
E.L DISEASE - EA EMPLOYE'
E.L OISEASE. POLICY LIMIT $
LIMITS:
1,000,000 OCCURRENCE
2 000 000 AGGREGATE
WORKERS COMPENSAT!ONAND
EMPLOYERS' LIABILITY
A'" PROPR"'ORIP^""'ER,,XEcum,
o",c"""'.S'R "'c'""'"
Ify,",ds,enbs""d"
SPECIAL PROVISIONS bslow
OTHER
A PROF LIAB GU2828154 07/01/03 07/01/04
(CLAIMS - MADE)
DESCRIPTION OF OPERATIONS I LOCATIONS IVEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
THE CITY OF SANTA ANA, ITS OFFICERS, EMPLOYEES, AGENTS, VOLUNTEERS, AND
REPRESENTATIVES HAVE BEEN NAMED AS ADDITIONAL INSUREDS.
(ENDORSEMENT ATTACHED) PRIMARY AND NON-CONTRIBUTORY COVERAGE APPLIES.
CERTIFICATE HOLDER
CITY OF SANTA ANA
20 CIVIC CENTER PLAZA (M-30)
P.O. BOX 1988
SANTA ANA, CA 92702-1988
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIO
DATE THEREOF, THE ISSUING INSURER W1LL~D MAlLdL OAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BK1JfIlQ1RKWtJ1 :~
11JIffl!g" It - ROOXlK J>Ii\XIXOC JilOO!X1<IOfJI( 11m 1K1Ð1C IKS() ~ )it (-
1m{
AUTHORIZED REPRESENTATl1
ACORD25(2001/08)
@ACORDCORPORATION1988
~
ATTACHED TO AND ENDORSEMENT EFFECTIVE PROGRAM
FORMING A PART OF (Standard Time) INSURED ADMINISTRATOR
POLICY NUMBER MO. DAY YR. 12:01 NOON
GU2828154 02-20-04 I~I CTL Environmental Services
FREBERG
ENVIRONMENTAL, INC.
NO: 400000
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - DESIGNATED PERSON OR
ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name of Person or Organization:
The City of Santa Ana its officers. employees aQents, yolunteers and representatives
20 Civic Center Plaza (M-30)
Santa Ana. CA 92702-1988
RE: All California Operations
(If no entry appears above, information required to complete this endorsement will be shown in the Declarations as
applicable to this endorsement)
WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the
Schedule as an insured but only with respect to liability arising out of your operations or premises owned by or rented
to you.
PRIMARY INSURANCE: I
It is understood and aQreed that this insurance is primary and any other insurance maintained by the additional
insured shall be excess only and not contributinQ with this insurance.
f#3I\.VP/.2./.2.
CG 20 26 11 85
COPYRIGHT. INSURANCE SERVICES OFFICE INC 1984
CERTHOLDER COpy
STATE P.O. BOX 420807, SAN FRANCISCO, CA 94142-0807
COMPENSATION
INSURANCE
FU N C CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
ISSUE DATE: 01~16~2004
GROUP:
POLICY NUMBER: 1643437~2003
CERTIFICATE ID: 232
CERTIFICATE EXPIRES: 08-01-2004
08 - 01-2 003/ 08 -01-2004
CITY OF SANTA ANA
20 CIVIC CENTER PLAZA IM-30) PO BOX 1988
SANTA ANA CA 92702-1988
!J ~ ~O()3 - 150
This Is to certify that we have Issued a valid Worker's Compensation insurance policy in a form approved by the California
Insurance Commissioner to the employer named below for the policy period indicated.
This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer.
We will also give you 30 days advance notice should this policy be cancelled prior to Its normal expiration.
This certificate of insurance Is not an insurance policy and does not amend, extend or alter the coverage afforded by the
policies listed herein. Notwithstanding any requirement, term or condition of any contract or other document with
respect to which this certificate of insurance 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.
~
,&~
c
~
AUTHORIZEO REPRESENTATIVE
PRESIDENT
EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE.
ENDORSEMENT #1600 ~ STUART SALOT, PRES - EXCLUDED.
ENDORSEMENT #1600 - MARTHA SALOT, S,T - EXCLUDED.
ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 08-01-2002 IS
ATTACHED TO AND FORMS A PART OF THIS POLICY.
~i .
/'--,::::;+~y: L}
EMPLOYER
XEON, INC DBA: CTL ENVIRONMENTAL SERVICES
24404 VERMONT AVE STE 307
HARBOR CITY CA 90710
SCIF 1O262E
A"'pl Ih;, "rtifi,,","I,if,," "" l"c'wO<"m,~ tho< ",d, "OFFICIAL STATE FUND DOCUMENT'
¡,o'¡¡~i"E"d,O""'2004
PAGE 1 OF1
~......
.
zmq rell '6 AN - ')
)ITA ;~,r,Ii~
-'I !,JAIL
".11'1.;
City of Santa Ana
20 Civic Center Plaza (M-30)
P.O. Box 1988
Santa Ana, CA 92702-1988
l.'\~O
\:;,1 'd-vO' )
November 9,2004
RE: Endorsement
Insured: CTL Environmental Services
Carrier: Gulf Underwriters Insurance Company
Effective Date: 07-01-03 to 07-01-04
Please see the attached endorsement you requested from the above referenced insured.
This endorsement will supercede the one previously issued (which is now null and void).
Thank you for your assistance.
Sincerely,
I!. "'rJ~&..-
Kevin Woodwick
BC Environmental Insurance Brokers, Inc.
(916) 939-1080 - Ext. 204
(A~'" CoG",""'"
1 03 7 SUl1cast Lane, Suite 103
EI Dorado Hills, CA 9,,762
TeL: '116.93'1.1 aHa
EIX: 91{).939.1085
\Vel): \V\v\v.cnvironmcntalinsurance.com
-
.
.
ENDORSEMENT
This endorsement forms a part of the policy to which it is attached. Please read it carefully.
ADDITIONAL INSURED ENDORSEMENT - OWNERS, LESSEES OR
CONTRACTORS
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:
i:8J Commercial General Liability
i:8J Contractor's Pollution Liability
SCHEDULE:
Name of Person or Organization: Any person or organization that is an owner of Real Property or
Personal Property on which you are performing operations, or a contractor on whose behalf you are
performing operations, and only at the specific written request of such person or organization to you,
wherein such request is made prior to commencement of operations, and for which a certificate of
insurance naming such person or organization as an additional insured is on file with the Company.
(If no entry appears above, information required to complete this endorsement will be shown in the
Declarations as applicable to this endorsement.)
SECTION II - WHO IS AN INSURED is amended to include as an insured any person or organization for
whom you are performing operations when you and such person or organization have agreed in writing in a
contract or agreement that such person or organization be added as an additional insured on your policy.
Such person or organization is an additional insured only with respect to liability arising out of your ongoing
operations performed for that insured. A person's or organization's status as an insured under this
endorsement ends when your operations for that insured are completed.
APPROVED AS TO FORM
'.!?:~)/x;-
.
LaUL, :-), .:( .~~'J'>;Jy
ASslstant CIty Atlorne)
All other terms and conditions remain the same.
Page 1 of 1
GU-ESP-2010 (04-03)