HomeMy WebLinkAboutCLINICAL LABORATORY OF SAN BERNARDINO 1 - 2003
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THIS AGREEMENT, made and entered into this ~ day of ()¿u?",,!?er , 2003 by
and between Clinical Laboratory of San Bernardino, 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").
A-2003-239
CONSUL T ANT AGREEMENT
RECITALS
A. The City desires to retain a consultant having special skill and knowledge in the field of
performing domestic water quality testing.
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 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.
COMPENSA nON
a. City agrees to pay, and Consultant agrees to accept as total payment for its services,
the rates and charges identified in Exhibit B. The sum to be expended under this Agreement is
$133,970.00, with a ten-percent (10%) contingency for a total amount which shall not exceed
$147,370.00 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 and the terms set
forth in Exhibit A and B. 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
December 31, 2005. This is a two-year agreement, with an option, exercisable by City, to extend
the agreement for an additional two year period at the same price identified in Section 2 above.
This Agreement, however, may be 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 Public Works 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, ajoint 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 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 $ I ,000,000 per occurrence. Consultant shall supply City with a fully executed
additional insured endorsement in substantially the form attached hereto as Exhibit C 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.
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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. INDEMNIFICA TION
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 I 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
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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, California 92702-1988
telefacsimile (714) 647-6956
With courtesy copies to:
Thorn Coughran, Water Resources Manager
Public Works Agency
City of Santa Ana
220 S Daisy Avenue, Bldg A, M-85
Santa Ana, California 92703
and
City Attorney
City of Santa Ana
20 Civic Center Plaza (M-29)
P.O. Box 1988
Santa Ana, California 92702
telefacsimile (714) 647-6515
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To Consultant:
Richard Kelso
Clinical Laboratory of San Bernardino
P.O. Box 329
San Bernardino, CA 92402
Telefacsimile (909) 825-7693
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, 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.
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
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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.
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.
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b. All Exhibits referenced herein and attached hereto shall be incorporated as if fully set
forth in the body of this Agreement.
c. City shall have the right to possession and use of all documents produced pursuant to
this Agreement.
IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year
first above written.
ATTEST: ~
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Co-, .. ~~ . .
PATRICIA E. HEALY 1)
Clerk of the Council
APPROVED AS TO FORM:
JOSEPH W. FLETCHER
City Attorney
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OVAL:
CONSULTANT
ûi,m/Jar-
RICHARD KELSO
(Title)~PiTbRY DIRF:c.7bR
Tax ID# Q5. .:hOY,-/'Rg
K:\WPDOCSIDOI7IPOO 11000 I 0657.DOC
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EXHIBIT A
SCOPE OF WORK
A.
SAMPLING
1.
BACTERIOLOGICAL QUALITY
a. Routine: Samples shall be collected by the Consultant, in
appropriate sterilized bottles to which a chlorine reducing agent has been
properly added, on a weekly basis at 50 designated sample points (Table
I).
Total coliform analyses are to conducted using either the multiple tube
fermentation method analyzing a minimum of IOO-ml of water either with
using 5-tube 20-ml portions or 10-tube 10-ml portions, the membrane
filter technique, the presence/absence (P-A) coliform test, or the minimal
medium (Coliform) test.
Reporting of positive samples shall be based on the presence or absence of
coliforms in each sample rather than an estimation of coliform density.
Upon detecting that either a routine or repeat sample is either total
coliform or fecal coliform positive, or a sample is invalidated due to
interference problems, the Consultant shall notify the City within twenty-
four hours. To complete the notification, consultant must contact a live
individual. Voice mail and faxed notifications will only be a secondary
means of notification. The appropriate contact person for the City is the
Water Quality Inspector at (714) 647-3341. When voice mail is used to
leave a message, the Consultant shall contact the City's Dispatch Office at
(714) 647-3380 between the hours of 7:00 a.m. and 3:30 p.m. If
notification is required during a weekend or holiday, the Water Quality
Inspector should be contacted at (714) 346-5579. In addition, a copy of
the City's Emergency Notification Plan (Attachment A) is attached.
In the event that the Consultant is unable to contact the City within 24
hours, the Consultant shall notify the Department of Health Services,
Drinking Water Field Operations Branch, Santa Ana District, at (714) 558-
4410.
Upon detecting that a routine or repeat sample is total coliform positive,
the Consultant shall perform a fecal coliform test.
The Consultant shall, within twenty-four hours after notifying the City that
a single routine sample is total coliform positive, collect three repeat
samples. One shall be from the same total coliform positive sample point.
The other two locations shall be determined by the City, one to be located
within five service connections upstream and the other within five service
connections downstream of the total coliform positive sample point.
If total coliforms are detected in any repeat sample, the Consultant must
within twenty-four hours, after notifying the City that a repeat sample is
total coliform positive sample, collect another set of repeat samples from
the same locations.
b. Water Mains or System Repairs: Samples shall be collected by the
City in appropriate sterilized bottles provided by the Consultant to which a
chlorine reducing agent had been properly added. Sampling may consist
of two samples per month and shall be picked up by the Consultant at the
City Yard Meter Shop within twelve hours of notification. The Consultant
shall notify the City of the results by fax within four hours of the
completion of the test.
c. Wells: Samples shall be collected by the City in appropriate
sterilized bottles provided by the Consultant to which a chlorine reducing
agent has been properly added. Sampling shall consist of twenty samples
per month and shall be picked up by the Consultant at the City Yard Meter
Shop within twelve hours of notification.
d. Customer Complaint: Samples shall be collected by the City in
appropriate sterilized bottles provided by the Consultant to which a
chlorine reducing agent has been properly added. Sampling may consist
of four samples per month and shall be picked up by the Consultant at the
City Yard Meter Shop within twelve hours of notification.
2.
HETEROTROPHIC PLATE COUNT
Samples shall be collected by the Consultant in appropriate sterilized bottles to
which a chlorine reducing agent has been added on a weekly basis at the same
time and at the same 50 designated sample points (Table I). Consultant shall use
the necessary dilutions to report the results at concentrations up to 500 colony
forming units per milliliter.
3.
TOTAL CHLORINE RESIDUAL
Samples shall be field analyzed by the Consultant on a weekly basis at the same
time and at the same 50 designated sample points (Table I). DPD method of
analysis and the reading shall be made by the means of a colorimeter. Color disc
is not acceptable. Results must be reported to O.Img/1. Colorimeter must be
calibrated per the manufacturers requirements.
4.
GENERAL PHYSICAL QUALITY
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a. Routine: the Consultant shall collect Samples in appropriate
sample bottles on a monthly basis at the 50 designated sample points
(Table I). The analysis shall consist of turbidity, odor, color, field pH,
and temperature.
b. Customer Complaint: Samples shall be collected by the City in
specially prepared sample bottles provided by the Consultant and may
consist of four samples per month and shall be picked up by the
Consultant at the City Yard Meter Shop within twelve hours of
notification. The analysis shall consist of turbidity, odor, and color.
5.
GENERAL MINERAL
Samples shall be collected by the City in specially prepared sample bottles
provided by the Consultant and may consist of twenty samples on a yearly basis
and shall be picked up the Consultant at the City Yard Meter Shop within twenty-
four hours of notification.
6.
INORGANICS
Samples shall be collected by the City in specially prepared sample bottles
provided by the Consultant and may consist of twenty samples on a yearly basis
and shall be picked up by the Consultant at the City Yard Meter Shop within
twenty-four hours of notification.
7.
TRIHALO METHANES
The City shall collect samples in specially designed sample vials containing a
chlorine reducing agent and sealed with TFE-faced septa and screw caps. It shall
consist of twelve samples on a quarterly basis beginning in February and shall be
picked up by the Consultant at the City Yard Meter Shop within twelve hours of
notification.
8.
HALOACETIC ACIDS
The City shall collect samples in specially designed sample vials containing
crystalline NH4CI, which converts free chlorine to a combined chlorine residual
and sealed with TFE-faced septa and screw caps. It shall consist of twelve
samples on a quarterly basis beginning in February and shall be picked up by the
Consultant at the City Yard Meter Shop within twelve hours of notification.
9.
NITRA TEINITRITE
Samples shall be collected by the City in specially prepared sample bottles and
shall consist of six nitrate samples on a monthly basis and an additional six
samples on a quarterly basis. Nitrite samples shall consist of nine samples on a
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B.
semi-annual basis. The Consultant shall pick up samples at the City Yard Meter
Shop within twelve hours of notification.
Upon detecting nitrate level above the MCL of 40 mgll as NO) is exceeded, the
Consultant shall notify the City within twenty-four hours. To complete the
notification consultant must contact a live individual. Voice mail and faxed
notifications will only be a secondary means of notification. The appropriate
contact person for the City is the Water Quality Inspector at (714) 647-3341.
When voice mail is used to leave a message, the Consultant shall contact the
City's Dispatch Office at (714) 647-3380 between the hours of 7:00 a.m. and 3:30
p.m. If notification is required during a weekend of holiday, the Water Quality
Inspector may be contacted at (714) 346-5579. In addition, a copy of the City's
Emergency Notification Plan (Attachment A) is attached.
In the event that the Consultant is unable to contact the City within 24 hours, the
Consultant shall notify the Department of Health Services, Drinking Water Field
Operations Branch, Santa Ana District, at (714) 558-4410.
REPORTING REQUIREMENTS
1.
Reports:
The Consultant shall provide the following information within seven days of the
completion of each analysis:
a.
Name of the laboratory and either the person responsible for performing
the analysis or the laboratory director.
b.
Date of report.
c.
The analytical method used.
d.
The name, date, and time of sampling and identification of the person who
collected the sample.
e.
Identification of the sample as a routine, repeat, replacement, or "other"
sample when appropriate.
2.
Chain of Custody:
The Consultant shall provide to the City chain of custody forms for each sample
collected by the City when the Consultant provides the necessary sample
container.
II
Clinical Laboratory of San Bernardino, Inc. ~
FEE PROPOSAL
1. BACTERIOLOGICAL QUALITY
a. Routine Total Coli forms 5,200 samples @ $ 7.50 ea= S 39,000.00
b. Water Mains 48 samples @ $ 7.50 ea= $ 360.00
c. Reservoirs 24 samples @ $ 7.50 ea= $ 180.00
d. Customer Complaint 100 samples @ $ 7.50 ea= S 750.00
2. HETEROTROPHIC PLATE COUNT
5,200 samples @ $ 5.00 ea= $ 26,000.00
5,200 samples @ S 5.00 ea= S 26,000.00
3. COMBINED CHLORINE RESIDUAL
5,200 samples @ S 1.50 ea= $ 7,800.00
4. GENERAL PHYSICAL QUALITY
a. Routine 1,200 samples @ S 6.00 ea= S 7,200.00
b. Customer Complaint 100 samples @ $ 6.00 ea= $ 600.00
5. GENERAL MINERAL
General Mineral 60 samples @ $ 100.00 ea= S 6,000.00
6. INORGANIC
Inorganic 40 samples @ S 120.00 ea= S 4,800.00
7. TOT AL TRIHALOMETHANE
Total Trihalomethane 96 samples @ $ 40.00 ea= S 3,840.00
8. HALOACETlC ACID
Haloacetic Acid 96 samples @ S 65.00 ea= S 6,240.00
9. NITRA TElNlTRITE
NitratelNitrite 260 samples @ S 20.00 ea= S 5,200.00
TOTAL S 133.970.00
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Post Office Box 329. San Bernardino, CA 92402' (909) 825.7693 . Fax (909) 825-7696 . ELAP Number 1088
EXHIBIT C
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 Community Redevelopment Agency, the City of Santa Ana, 20 Civic Center
Plaza, Santa Ana, California 9270 I; 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 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
12
03/1 g/2004
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OFFlCER_..XCWDED?
~ii~I:"~Vís:¡;;'s ,....
D I :::~mional
LiahiHt
,",O<:"""DNO"'o'" N L
'J'BD
02/01/04
E1?G0002395,.
02/01/04
02/01/05
$1,000,000
$10 000 Oed
I YEHIe""'XCLUSIONS A.DED .Y "IDO""""'" f ...tlAt. .R"VI"'..
CERTIFICATE HOlDER
'1'om D;i.x
Cil:y Yard
City of Sanl:ø Ana
220 S. Da1ay Av...
Santa Ana CA 92703
CANCEllATION
'l'OfItDIXX ...auLDA"""""""""" DO.e""D oOUCI"" ""","_D ._FO._Tt<. .XPI"'"".
DA.. Tt<....,., _I..."NO ""UReo WlLlE_ova.TO MOIL ;L DA.. """"".
..",eE TO"'" œ'TIF"AU HOLD" HA"'. '...... LOFT. allT ""LU" TO D" so Ott^"'
IMPO" ND oaL"A1TON "" Uo.'LlTY O. ... KIND 110O....., INSU"'.ITS AG""" 00
"""'HTA_.,
AU~""""'PR_._NT. .
~1i I?et""son
~
ClACORD CORPORATION 111'
ACORD 2$ (2001108)
Jun 21 05 11:15a
Public Works
7148473345
p.2
. JUN-02-2005 0<3:42 ~DREINl ~D CO
A'CDRD. CERTIFICATE OF LIABILITY INSURANCE
P.02/04
OP 10 DATE CMIWJlOInYJI
CLINI-l 06 02 05
THIS CERTIFICAlE IS ISSUED AS A MATTER OF INFORIWATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFIC~TE
HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR
ALTER nif! COVERAaE AFFORDED BY THE POliCIES BROW.
I'RODUCER
Andreini ~-Company-S_Coa8t Net
License 0208825
One "cArthur Place, SuLtc 100
South Coast Metro CA 92707
Phone:714-3~7-1~OO Vax:714-327.1499
INSUAEb
INSURERS AFFORDING COVERAGE
NAICIIl
Clinical Laboratories of
San Bernadino, Inc.
P.O. Box 329
San Barnadino CA 9A402
11'l3UIUi:RA; _~C... c..u.ny l:'clIipUr oC
IN6~A D: C_.l"......~ CU....l~.. ....._
INSUqERC Zenith Inaurance COGIpanL
INSU""'R c.
INS~1l E;
COVERAGES
THE POliCIES OF INSuRANCE 1I3TED lIELOW HJ\\I1;; 8EI;;I'llSSUED TO Tt<E INSURED NAMED IlBOIIE FOR THE POtICY P1iAIOO IIII00CA TED. NO'TWITHST ANDING
ANY AIlQVlAEMENT, TE~"" OR COIlIOITIOlII OF lltoN CONTRIoCT OR OTfER DOCUMENT WiTllIlESl'ECT TO WHICt1 THIS CEATIFIClITE ~AY BE 18SVEO OR
MAY I'ERTol\IN. THE INSURANCE ,t.FFORDE' 0 BY T...e PO~ICIES DESCAlKO HEREIN IS SUBJECT TO lOll niE TE RMS, UC~Ull'ONS AND CONDIT IONS OF SUCH
PO~ICIES. AGGREOATe liMIT!! SHOWN MAY HAVIi lIEEN REPUCEO 8'1' "AD CLAIMS,
~TR Nstet TTPIi OF INSUMNCE POLICY NlJI4ER ~n:lMMIOM'VI o".n; '.IIIDOm'I liMITS
~EftAL L1A8Illl'Y eACH DCCU~NC€ 11,000,000
B X 3MI4ERCIAl C;areRAlllA8ll1l'Y TCP2068975201 02/01/05 04101/0' ~=~s rs;, ~NI\CtI) 1500.000
- CIA\MSI\I~ ~ OCCUR,
- MEa EXP (Afty 0"<: ""raonl 110,000
PeRSON.Al. & AD\lINJUI'lY '1.000.000
- GENERAl. AGORE~Te $2.000 000
GI;N'lllOOREOol\TI: llrllT JllIPlIes peR, PReDUCTS . COll4p/oP AOG I Excluded
I POLICY n ~R@r n LOC
AUTOMOBILE U"SIUfY CO~llllliiD SINGLE LIMIT I 1,000,000
f-
A ANY "UTO BtJ'A2068975084 02/01/05 02/01/06 IE. Ice_II
I--
~ All OWNED AUTOS IIOOIL Y INJURY
5
SCHEDULEO AUTOS jP.. 'lflIllII/
>--
Jt HIRED AuTOS BooL Y INJURV
5
...!.. NON.OWNED ...uTOS (Plr'I_'.
-..
- APPROVED \.8 TO FO] M I"1I0l'EftTf OA......GI;; l
(Pe< _cad.nll
RRAIOE LIABILITY ,lPl~ ~ 1..~/13 AUTO OIllL Y . EA ACCIDENT S
ANY AUTO OTltER Tt<AN ""Ace I
, - T .~lITIl Jl: ift Sheedy IIUTO ONLY, AGO S
I!ICCESlI/UI\dIIIl:EUA UABILlTY Assista~ ity Attorney !;ACH OCCUIlIU:I\lCE S
tJ OCCUR 0 CLAII'.1SIMOE AGGREGII"1'E S
S
R OiitlUC'f'IIl.E S
RETENllOI'l S s'
WORKEllScolIII'l!NSAnON AND X lrr"~-"IM1TS,1 IU~~.
_LOYERS' UABIlITY
C AlIIV PROPRIETORlPAATHEIlIEXECUTIVE Z066924601 02/01/05 02/01/06 E l, EACt1I1CCIOENT S 1,000,000
OFFrcEAlMiMBE~ EllC. UDan E.L.. DlllE,o.Se . EA I:MP.OVEE , I, <!?o ,000
=~=XS~ON!l blllM' e l O~E. POLICY lll\llT 51 000,000
DTIlE"
D E&O/Profe8sioDal BBA27U70923 02/01/05 02/01/06 Bach Dce 1,000,000
Liability Oed. 50.000
OfSCIll'TlOH OfF OPDU.'nO~ I LOcAl1ONS IVI!ttICl.iE6 j elCCLII:!KlIIS ADDeo 8'1' IlNDOR5EIoENT I St'ECIAL I'RaIllliIOHS
City of Santa Ana is nsmed as additionAl insured. bu~ only as thei~ interest
may appear as :r:espects operations of the named insurad. Covarage i8 primary
and non-contributory,
CE~T'FJCAYE HOLDER
City of Santa Ana
Water Resource Div., .-82
TOIll\ Dix
220 S. Oaisy Avenue, Bldg. A
Santa Ana CA 94703
CANCELLATION
llHOUl.D IiIW Of' 'tNIi AlIOIIE DESCAlllPD POLIGI&311E CANCELLED 8!FORE TttE!:lU'IRIIllON
DATE TlifAIEOF. THE ISSUING INSURER WIll eN....\IOJl TO tMIL ~ OIlYS WAlTTE~
MOllCE TO TlIl! CElilTlflCil TE HOlDER NAl4ED TO TIlE LEFT, BUT FAILU~ TO DO so !IIIlU.l
IMI'OSE 1\10 DeLlCA TlON OllllABIUfY 01' A>I'I KINO UPON l'14E ~IliUR"1I. . rs AGENTS OR
ACORD 25 (2001108)
e ACORD CORPORATION ,,"
Jun 2105 11:15a
Public Works
7148473345
p.3
JUN-02-2005 09:42
ANDREINI AND CO
P.03/04
IMPORTANT
If the certificate hotder is an ADDITIONAL INSURED, the poliCY(leS) must be endorsed. A statement
on thiS certificate does not confer rights to the certificate holder in lieu of SLJ(;h endorsement(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may
require an endorsement. A statement on this certificate does not confer rights to the certifICate
holder in lieu of such endorsement(s).
DISCLAIMER
The CertifICate of Insurance on the reverse side of this form does not constitule a contract between
the issuing insurer(s), authorized representative or producer, and lhe certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage alforded by the policies listed thereon.
,\ ~ ,)ROV BD AS 'TO FORM
.___._ -:t-:~~ :2-) J
. ..luln Stitt Sheedy
" ..;."lddl City Attorney
ACORD 25 (2001108)
Jun 2105 11:15a
. JUN-02-2005 ag:42
Public Works
7148473345
~DREINJ AND CO
POLlCY NUMBER: TCP2068975201 COMMERCIAL GENERAL LIABILITY
INSURED: CLINICAllABORA TORIES OF SAN BERNARDINO. INC.
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS (FORM B)
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHt:.DULE
Nilme 0' Person or OrganlZlltlon:
city of Santa Ana
Water Resource blv., M..sf
If no entry appears above. information required to complete this endorsement will be sllown in the
Declarations as applicable to this endorsement.)
WHO IS AN INSURED (Section II) is amended to indUde as an imiured the person or
organization shown in the Schedule, but only with respect to liability arising out of "your work" fOf
that insured by or for ~OU.
PRIMARY WORDING
It is further agreed that such insurance as is afforded by this policy for the benefit of the additional
insureds shown above shan be Drimarv insurance, but only 85 respects to any claims, loss or
liability arising out of the named insureds operations. and any insurance maintained by the
additional insureds shall be non..contribumg.
Should any of the polic/fIS be cancelled before the expiration date thereof, the issuing
company will mall 11]0 days writt&n not#ee to the cerliflclIle holde,. ..,0 days notice to,
non-payment does apply.
CG 20 10 11 85 Copyrigh~ Insurance Services Office, Inc. 1984
A,PPROVED AS TO FORM
J438 ]>13
- ilLaura Stitt Sheedy
,~"istant City Attorney
p.4
P.04/04
TnHll P D1.d
;; ,"-
MEMORANDUM
~
~
-r cx-Z
To:
Connie Gee
Date:
November 16, 2005
Thomas L. Dix
From: Water Quality Inspector
Subject: AGREEMENT A-2003-239
Section I entitled GENERAL PROJECT DESCRIPTION of the Request for Proposal for
Consulting Services for Domestic Water Quality Testing dated October, 2003 states the
following:
The City of Santa Ana requests the services of an analytical laboratory to
provide timely, high-quality analytical analysis of the City's domestic
water system for the period from January I, 2004 through December 31,
2005. The City reserves the right, with Consultant approval, to
automatically extend the project for an additional two-year period from
January 1,2006 through December 31,2007.
As noted in this Section and per the attached letter of approval from the Consultant, we
will be extending the above-referenced Agreement for the additional two-year period
beginning January 1, 2006 through December 31, 2007 in an amount not to exceed
$150,000.
cc: Pat Healy, Clerk of the Council
Dina Melgar, Public Works Agency
I"] . / 1
':'0 ":..; :
Y:\Water Operations\Quality\Water Quality Sampling\Routine & Agreements\Dom Wtr Qual Testing\Request for Proposals\agreement A~2003.239
extension.doc
November 16,2005
._ . ' ~linical Laboratory of San Bernardino, Inc.
~
November 11, 2005
Thomas L. Dix
City of Santa Ana
Public Works Agency
220 S. Daisy Ave., M85
Santa Ana, CA 92702
Dear Mr. Dix:
I am writing in regard to the extension of our current contract for Domestic Water
Quality Testing for an additional two-year period from January 1,2006 through
December 31, 2007. Clinical Lab is pleased to agree to this extension under the current
terms and conditions. If you have any questions or need additional information, please
feel free to call or e-mail.ke1so@clinical-Iab.com.
Thank you for your business over the past years and if there is anything we can do to
improve our service to you, please do not hesitate to contact us.
SR;;J::J~
Richard Kelso
Laboratory Director
Post Office Box 329. San Bernardino, CA 92402 . (909) 825-7693 . Fax (909) 825-7696. ELAP Number 1088
From. Vicki Fagan, CISR At: Andreini & Company FaxlD: 650-378-4361 To: Attn: Jerry Feffries
Date: 8/1312007 11 :37 AM Page: 3 of 9
Au~ 0.7. .0:7 09: 36"
'Public .W6,.ks
7146'l733'1:5
p.2
,-
AcaRii -'''CERTIFICA TE OF LIABILITY IN 151J RANCE
OPID .l1\r.cl~flVD~
CtINI-1 . 05 3i 07
,~i:Ef.TU:ICATE IS ISSUED AS AMATTE.R OF LNFORMATION
(lNl Y .UO cONFERS NO RIGIfTS up'm THE.CERT1F1CATE
HOl[I:!R THIS CERTIFICATE! POES NOT AMEND. ~NO Oft
"'-'EI! "IIE: COVERAGE AFFORDED BVTlfE POI.ICIES BELOW.
r---~--
"~DUCE.~
And".in1 &. COlllpO"y-South Coast A-~-;>o3 ~
License 0206825
On. MacArthur Place. . Suite 100 A-.rooJ- 023'--OJ
S6nth Coasc. Meuo CA. 92707
~.l:IQD.e:: 714-327-~4CO PaxI:714.-32j''':'14,99.
lNSUm!C .
cYrni~al Laboratories of
. ..S\\Bf:e~;t:I1i!'-1:"d.iuo, l:l1e~
.P":O....BD'X-.3A9 _._.....' ~.. _
San BeD1a.~ciiuo Ch 9..l;;"!I!02 --.
., "'.....".
t~I~;URE :'tf A:~ORDING COVERAGE.
--r---~-'-
--- .It,~j"JFl:ER.,:, t~'"n:k;ttt cuualty ';myar
~E~~~~ ::~:3'enit:h rnsurance. Co an
l"fiJR..ER :: : I.,. :.:.... ~-= .
- -.i~~~d.~; ;:"'= . ..~k",,'::':!l.':c~~:..
; It.SJRE~" ,.~., ':""~"';
NAlC#
2042i(r'
COVERAGES
.~ ...~:..;. '.~":,,..'1...:
Tl1E POlICIES Of INSURANCEUSlED SELOW ~'.'E BEEN ISSUCDTO 'niE INSI.1AeO lIIJ'uEO ABO"'!: r:QR 11~ ''O.ICY PERIOD IND!CAlEO..IJCJJWJTHSrANOING
~'f REOLlrRlOMENT,'TERM.ciR CONDJnOP<l at" IWY CQNl'I'(p.C1"QROThEil OOcUAAENrWlnI RE.Sl'ECT1.'1 >N I ~11l'lilS.cEAnF"Ic.\TE Nl\VaE r85UEOtlR \
-.v PSRTAltl!; THE IIllSUP.ANCf AFfDRDCD BV THE POl.JCiESCESCRlQffi HEREIN IS SUBJEcT TC I,lL 1.., T;: thol;. en.USIONS. AND CONDITIONSOF' sue,",
PlJLlClE:>. AlOG~GA.TE lIU1TS SHOW.... "lAY HA.VE:BEEN REOUeetJ ~y PA.IOOAIM:s.
A X
"NPEOF INSURANCI;
G9lERAL..f..lA8l1..lTY
-=- .
X CCMuEAcw..G~I;Rf\t.UI',!llL.HY
= =:J CLAIMS AlJ.OE [!J OCCUR
POUC'V' HUMBER
'......L";'i~ill';'~
. !)ATlj~1MIQ.:!D
DATE IMMlDD
u"'"
LT.
'lCP2.068!f752()1
O:l/O:l. .C'
~I-l OCCURREN:CE
02/01./08 NU!Mt9Es[~~1
ME[]O:"'IAnyIJ"cp~n)
PERSOtw..& AnV INJURY'
G~ACGIlEC4'rE
PRODUCTS. COuPlQP AGG
Elu..l' Ben.
11,000,000
53.00.000
HO,OOO
'1.000,000
'2.0000.000
S Excluded.
J.,OOO,OOO
1"11,000,000
,
GEN'LAGGR~ElllMrrAi"~~;
ill'OLle!.Ll..~-r I !lOC
~I1TOMOEIIl.EUABIUrv
I-
ANY AUTO
:: All.OWNEOAlITOS
SCl-G)uLED AUTOS
'=-
~, HIRED IlUT(JS
. .~, ._ . .,~ .~~~'()W~EOAItI'O&
-.
A:
!
-I
BllA2n68975084
OllOl. 'C:
l:U"lEllNli1J~INt5Lt<\.ll\1t(
OaJOl/08 ,~.=,~)
BODIlV INJURY
,",,_I
I
I . -
AO~l~1!V Xl1:J lri~ii!ssV
,(pOO'lSI1!JS BlnBT
t:!ODll't UUJRY
",{f'ep:lcc!ihll)
GARAGEllABu.iTv '.
~""'uro
~~~~G; Up -.Ii
A
,t /. V .~ . P:"'~ (I AvroQNlY-e'AACCl<'f.N'r s
j/'/ ..'l OlliERT'!iAH '-lACC $
~, ~ r'>'T T !'\500Nl.~ AGG .
~:i-SY.-EL.. - '-!;ACHOCCUR....:a '5.000;000
O:!,IOl.O-; 02/01./08 'AGGllEG4TE 5-
/
--.
EXCESSJuUBRELL\ UABtUTY
/!J CCCUA. 0 t.t.A1MS!MDi! ctJp206B'g.753444
h 0€0u:;;n9Lt
!xl REreN'TlC)),j . SJ.D., DOc)
~ORl<f.RS tOM;>-';;NSATIOPllA}JO
EMPLOYERS' UABlLITY
B 1\NYPROPRrm>!ilPARTlII!;RIEXECUTlVE C06"6924302 0;1/01, O~
1_- .'P~"ICl>RtMC~&:Rexcl.Uoel7<' . - "- .... ;... i
:~~~v~li~~batIw .
A ;:::sro,- :Bl.."k&t Xcpmam20l Oi!.~~~ iJ 02/01/09
DESCRIPTIO," CFOPI!RAnoNS I lCCAilDfoIS/VEHlClESIEXCWSJONSAOOED8Y ENDORSEMENT. ~Pf{;II, . f fi:JI'ISIOOS
CQ.rtificate Kolder is additional insu~ed as respe;,c te :0 l~eDera.l !.ii!.bilit:.y
per ~itteD cQatxacc per attached S-17957-G99
'the CANCELLATION .OOC,1Ce. herein is amended to read 10 :[ji:!I~ as respects any
cancellation due to non-pay.msnt of premium
$
.
,
. ~.~... '.,"
~ORYlIMIT!i-L Eli
e.LEAa-lACCfOENT ;~. DaD, 00.0
!:..l..OlSl:'ASE:&tI!MPl:Om 1~,'ODO. DOD
!.;.LOlSEASE"POlICrUUIT S 1, ODD. 000
02/01/08
Property
Special
111300a
C~TIACATE HOLDER C,:!I/CEI; ,=~!'H
CITYSAA. S~I;lULO,)II" 31'l'liE ABOVE l)e~RI~ f'0UCIE.$ Qe CANC&.Leo t1~.~l'Ji~t:ltPJRP.nON
[AfETHil~H.p, THEISSUlNGlNSURER:Wl\.LENOEAVORTOMAlt. ~ DA'rSrffiETTEN
"Ol1C~ - :1'.1 E I:EIl11F1CA"l'!: HOLDER /'lAMEOTO THE lEFT, 8lIr JO'AllURETO DOSOSI-IAI..1.
City of Santa Ana
Departmen t O:f J?ubJ.ic Worn
22D S. D~isGY ~Vg.
Santa Ana CA 92703
1"iUSt<.: I.) ) 11':iJ1.TION OftlJAEilLJTY ClF ANT I'iI~DUroN nil: rlllSlmER" m; AG~l'3 O-lt
f;:E:lR,E.';.t:J'(.l,/1''t$.
AI. T~' :oI':SRl<5EN'ATTVE
:~',J~:
--.1.:..--
ACORD 25 (2001/0B)
GO'd
9 L: L L
LOOG 6 :nv
,1,9 LV9 VIL
5L,9-LU9-vLL:xe, AllV All3 VNV V1NVS
01' II [nHllL002-60-9n~ 00'1/0'100 x~
:,/
200 'd
.From: Vicki Fagan, CISR At: Andreini & Company FaxfD: 650-378-4361 To: Attn: Jerry Feffries
Date: 8/1312007 11:37 AM Page: 4 af9
'Au.g 07 ,07 OS: 36..
PUb 1 i c Works
7146473345
".3
IMPORTAN'l
If the certificate holder is an ADDITIONAL INSURED, the ;,<) it.y(ies) must be endorsed. A statement
on this certificate does not confer lights to the certjfl~'te I" det in lieu of such endorsemenl(s).
If SUBROGATION IS WANED, subject to the terms "nel 'crditions of the policy, certain polic/as may
require an endorsement A statement on this certificate dllH not confer rights to the certJficate
holder in lieu of such endorsement(s).
DISClAIMER
The Certiflc'ale of insure.nc"e on the reverse 'side Oflhis -Ie. 'm d::les nQt cOflstit!,Jfe a,'contr~ct between
the issuing insurer(s), authorized representative or .,,'OdL :H. lnd the certificate holder. nor does It
affirmatively or neganvely amend, extend or alter the CCI' :~cg" afforded by the policies listed thereon,
)'0#
p,'S 'to
C\.'j'.!JI.J('';;) 1\;$, V V))cj ~
;\5' r~:...e'f
~ ,../ S\\t\ ~\\O<(O!
---- 0\'1
...,..-/ \.';:"0.\.
,'.':>
ACORD 25 (2DOlm",
oO'd
9 L: L I lOO~ 6 gnv
SISq nq DII
SISS-l&S-Dll:xej AIIV A11J VNV V1NVS
n I ; II (nH I)) nn?-hn-gnH .. II /...n x~
>00 'd
From: Vicki Fagan, CISR At: Andreini & Company FaxlD: 650-378-4361 To: Attn Jerry Feffries
,A~~ 07,07 09:368
Pub 1 i c Works
.'
C"NA
Date: 8/1312007 11:37 AM Page: 5 of 9
7146473345
G.17S57-G99
(Ed,10/01)
IMPORTANT: THIS ENDORSEMENT CONTAINS OUT/Po:,; '(I-fAT APPLY TO THE ADDITIONAL
INSURED IN THE EVENT OF OCCURRENCE, OFFI::NSI:, ':LAlM OR SUIT. SEE PARAGRAPH
C.t. OF THIS ENDORSEMENT FOR THESE DUTIES,
ALSO, THIS ENDORSEMENT CHANGES THE CONTR,I,e tUAl LIABILITY COVERAGE WITH
RESPECTS TO THE "BODILY INJURY" OR .PROPERTY I)AMAGE" ARISING OUT OF THE
"PRODUCTS-COMPLETED OPERATIONS HAZAI~D." f,;"e PARAGRAPH B.3.. OF THIS
ENDORSEMENT FOR THIS COVERAGE CHANGE.
THIS ENDORSEME:NT CHANGES THE POUGY. 1'1. E,\SE READ IT CAREFULLY.
CONTRACTOR'S SCHEDULED AND BI.AJ~IKI:r ADDITIONAL INSURED
ENDORSEMENT WITH LIMITED PRODUl;n;- C:OMPLETED OPERATIONS
COVERAm:;
This endor,*,mant modUles insuranes provided under lhe followin[l:
COMMERCIAL GENERAL LIABILITY COVERAGE PAR,
SCHEDULE
Name of PerSIlII Dr Orgini2atian, 0."111/' Iuad Pro/eel:
(CoVllJ'llge under Ihls endorsement is notaffecled by an entry,~ '",:/.<e,I!lll1ry In Illo Scheduleabova.)
m A.
i
m
~
~
I
Ii
i
.
=
..
;;;;
at S.
'"
~
iii
~
!i
;;
..
i.
-
WHO IS AN INSURED (SecIIon II) is amended to
inclUde as an Insured any poraon or organization,
including any person or organization shown In the
schedule above, (callad acfdlUonallnsuradj whom you
ara required 10 add lIS an eddlllonallnsured on thl,
policy under a wrlllen contract or written egreemen~
but the wrlllen contract orwril1en agreement musl be;
1. Ourrantly In effect or becOming 'affective during the
lerrn of this policy; and
2, Executed prior 10 the "bodily injury; 'proparty
damage," or 'psrBonaland adVarllslng InjUlY,"
The inslJ/ance provided to the additional insurad is
IIm~ed lIS faDows:
1. That. pelBDn or or9llnizetion Is an additional
insured safely for liabUlly due 10 your negligence
IlIld speclfically resuJiing !rom "your work" lor the
addtllonal insured wIllch is the robJact 01 the
writtan conlra~1 or wriffan agrsement. No
coverage applies to liability resulting trom the sole
negligence 01 1I1e addltlDnal insured,
2, The Umfls of Insuranoe applicable 10 me
addillonel Insured are those specified In tha
written oonl",cl or Writlen agreemsnt or intha
G-17!l57 -G99
rEd. 10101\
~O.d
9L;lL LOOl 6 ~nw
51,9 LP9 VII
VOO .d
J.:I~ratlons of this polley, whichever is lass,
IIi"M Umfts of Insumnm are Inclusive of, and nol
n Hcdltion to, the Limits ollnsurancs shown in tha
D. :laralla"s,
3. 'fiB covemge provIded 10 lhe additional Insured
il!' this endorsement and paragraph f. of 1I1e
:1'1' Ir IlIon of 'inslJJ9d contraot" under
oe FiNITlONS (SecIEan V) do not apply 10 "bodily
Ini"rl" or'''property damage' arisIng oul oflhe
'~r ,iiuc!s-compISlIKl oPlllallons hSZ!llll" unless
reo ulred by the wrl/tan _tract or written
"i)"BOment, Whan coverage does apply 10 "bodily .
Inlllr I" or "property damage" arising out 01 Ihe
'~fltlucts-complellld oparations hazard" such
Cl)' 'Hage wRl not apply beYOnd:
a "The pariod of time raqUlred by the written
,onlrect or wrftIen agreement: or
n., 5 years irom 11>9 compJellon 01 'your work' on
!he project which Is /he sUbjecl ollha writtan
,ontract or written a9'eemen~
~^ t ir 119ver is less.
4. Tn a In5~rance prolllded to the acfdlllonel ineured
.;I)~, not apply 10 "bodilY In/ury: "Property
Page 1 012
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.From: Vicki Fagan, CISR At: Andreini & Company FaxlD: 650-378-4361 To: Attn Jerry Feffries
flu.l: .'07.07 OS: 37a
Public Works
"
.
damage,' or "personal and advertising injury'
arising oll! of an arohltetl's, engineer's, or
sUlveyor's ..~dering of or faUura to render eny
preiSsslonal ..lVi""s including:
a. The preparing, approving, or failing to prepare
or approve maps, Shop drawings, opinions,
mporls, surveys, Reid ordem, change orders
or drawings and specifications; and
b. SupervisolY. or inspection eelivitias performed
as part 01 any related archilectJJral or
engineering aclivitiils.
C. /Is respllds /he covoraga provided undor this
endolSemen~ SECTION IV - COMMEIlCIAL
GENERAL lIABILITY CONDmONS ere amended ..
follows; . .
1. The following Is added to the Duties In The Event
of Occurrence, Offense, Claim or Sull Condition:
e. An addltlonallnsur9Cl under lhis endorsament
will as soon as pnu;!ICable;
(1) Give written notice of an oecurmnee or an
offense 10 us which may fesullln a claim
or usuir under this insurance;
(2) Tender the defense and indemnify of any
claim or "suit' to us for a loss We cover
Under Ihie Coverage Pari;
(3) Tender tha defanse and indamnlty 01 any
dalm or 'suK' to any athef Insurer whIch
also has insurance lor a loss we cover
under this Coverage Part; and
(4) Agree to make available any other
insuran"" Which lh.. additional insured
haa lor a loss wa cover under this
Cov.rage Part.
f. We have no duly 10 dafsnd ot indamnlfy an
additional insured under this endOlsement
until we tolCBlve wrlttan notice of a clalm or
"Suil" from lbo additional Insurod.
2. Paragraph 4.b. of tho Other Insuranco Cat1r.lltion is
deleted and replaced with the following;
G.17957-GB9
(Ed. 10/01)
50 'd
91;ll LOO~ 6 anv
5159 LP~ VI!
5DD.d
Date: 8/1312007 11:37 AM Page: 6of9
7146473345
".5
l:i-lIl1l1f-ti~~
(Ed. 10101)
4. Olhar t/b ~J -0 Jf-
b. Excess Insurance
IS nsutanee is excess ovor any other
Insumnce naming the addi~ona1 Insured
.. on Insured whlJ1her primary, excess,
oontlngent or on any other basis unlBSQ e
wrillen comracl or written agresment
spac/flcally requires that thle !nsuranca be
either primary Dr pnmBJy and
nonconhlbullng to the edditional Insur&d's
own coverage. This insurance Is excess
over any other Insuranca to which !he
addltionallnourod has boen added as an
additionallnsurad by endorsamenl.
When Ihls insurance is eX<:e5s, We will
nave no dUlY under CllVllrages A or B to
delend the edd1fJonallnsured against any
'sull" II any olher lnlllJrer has a duty to
defend the additional in.urad .g.rnslthal
'suit' il no other insurer defends, we will
underlako 10 do so, bul we Will be entitlad
to tho additional msurad's rigl11s againsl
ell lho5ll other Insurets.
When this insurancals axoass ovar other
insurance, we will pay only our .hars of
the amount of the loss, II any, that
exceeds the .um of:
(1) The tolal amount lhat all such olhor
Insurance wouid pay for tho loss tn
the absence of this Insurance; and
(2) The lotal of all daducllble and sol'-
insured amounts undar all that other
Insurance.
We will share lhe 18malning loss, If any,
wilh any CIlher Insurance that is nol
de.cribed In lf11s Excess Insul1lnce
prOVision and was nol bOU{lhl spacifically
to appiy in excess . of tha Llmlls 01
InsWaIlCll shown In the Declarations 01
this Covorege Part.
- tJd pn~
~
A.Pl'ROVED
S"ect.'
S -n 1.1.'-' J ,
Laura ;'t Attorr~e'/
. tant L-l Y
AS'61S
Paga2 01 2
SI59-L~9-~IL:xej AI1V A1IJ VNV V1NVS
01 'II (nHI)}nn~-hn-qnH OWII/040n "M
OP ID VJ DATE (MMlDDIYYYY)
CLINI-1'&1 05/31/07
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
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
~CORD,.
CERTIFICATE OF LIABILITY INSURANCE
PRODUCER J
Andreini & Company-South Coast
License 0208825
One MacArthur Place,
South Coast Metro CA
Phone: 714-327-1400
-- .'_., , .- -,
INSURED
Suite 100
92707 '
!,a~~?14 ~327_~14!_9___ IINS.'-IRER~ AFFORDING ~OVE~GE '._.
~URER A. American Casual ty Company of
A - ~C03 -~ ;;WRE; B -. Zeni th Insur~nce Company
A ....1cC)j -.;lj9~~U!,ER~_='-==--=- ==-=-=-_
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY 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 PAID CLAIMS,
"" ---."~- -~- POL'IC"y' NUMB-ER ~ ---I POLICY EFFECTIVE" rpQ[iCv EXPIRATION I
TYPE OF INSURANCE ' DATE (MMIDDIYY DATE (MMIDDIYY)
GENERAL LIABILITY I
A X! X! COMMERCIAL GENERAL LIABILITY TCP2068975201 02/01/07 02/01/08
, ,. 'CLAIMS MADE [}c' OCCUR
Clinical Laboratories of
San Bernardino, Inc.
P.O. Box 329
San Bernardino CA 92402
INSURER D
1-----'---, ,-- ---
INSURER E:
COVERAGES
L TR INSR
A
I I
l GEN'L AGGREGI\TE LIMIT APPLIES PER II
Ix ! POLICY i j~c?T LOC !
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
X HIRED AUTOS
X , NON.OWNED AUTOS
BUA2068975084
02/01/07
02/01/08
GARAGE LIABILITY
ANY AUTO
A
EXCESS/UMBRELLA LIABILITY
X OCCUR I l CLAIMS MADE
CUP20689753444
02/01/07
02/01/08
, DEDUCTIBLE
RETENTION
s10,OOO
B
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER F'XCLUDED?
If yes, describe under
SPECIAL PROVISIONS below
OTHER
C066924302
02/01/07
02/01/08
A
Property Blanket
02/01/07
02/01/08
CERTIFICATE HOLDER
CANCELLATION
NAIC#
20427
I--=----=-
LIMITS
: EACH OCCURRENCE
'~DAI\lI)l;GE I U Keo N I eo LJ --
P~MISESLEa occurence)
~~ED _E,XP (Anyone PersCln)
PERSONAL & ADV INJURY
---- ---- --- --
GENERAL AGGREGATE
r:RO~UCT~:_C~~~OP~GG
Emp Ben.
sl,OOO,OOO
$100,000
s10,OOO
s1,OOO,OOO
1$2,000,000
~----
s Excluded
~---~,._._-
1,000,000
COMBINED SINGLE LIMIT
(Ea aCCIdent)
sl, 000, 000
BODIL Y INJURY
(Per person)
s
BODIL Y INJURY
{Per accldenU
$
PROPERTY DAMAGE
(Per aCCIdent)
, $
,
I
AUTO ONL Y . EA ACCIDENT'S
EA ACC r-S--
A-GG 1$
,
OTHER THAN
AUTO ONLY
I EACH OCCURREN~E
r
f AGGREGAT~_
s5,OOO,OOO
1$-'-.'--
.f-- ----
i
i
1--
~ i TQR'y LIMITS ER
IE L. EACH ACCID.ENT_. __ ~ 000 ! 000
EL.DiSEASE.I=AEMPLOYEE' $ 1, 000, 000
~--- --
" E L. DISEASE. POLICY LIMIT S 1, 000 , 000
Property
S ecial
1113000
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAlL 30 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES,
AUTHORIZED REPRESENTATIVE
CITYSAA
City of Santa Ana
Department Of Public Works
220 S. Daisey Ave.
Santa Ana CA 92703
~~
ACORD 25 (2001/08)
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may
require an endorsement. A statement on this certificate does not confer rights to the certificate
holder in lieu of such endorsement(s).
DISCLAIMER
The Certificate of insurance on the reverse side of this farm does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
f1i5 zf{
ACORD 25 (2001/08)
damage," or "personal and advertising injury"
arising out of an architect's, engineer's, or
surveyor's rendering of or failure to render any
professional services including:
B. The preparing, approving, or failing to prepare
or approve maps, shop drawings, opinions,
reports, surveys, field orders, change orders
or drawings and specifications; and
b. Supervisory, or inspection activities performed
as part of any related architectural or
engineering activities.
C. As respects the coverage provided under this
endorsement, SECTION IV - COMMERCIAL
GENERAL LIABILITY CONDITIONS are amended as
follows:
1. The following is added to the Duties In The Event
of Occurrence, Offense, Claim or Suit Condition:
e. An additional insured under this endorsement
will as soon as practicable:
(1) Give written notice of an occurrence or an
offense to us which may result in a claim
or "suit" under this insurance;
(2) Tender the defense and indemnity of any
claim or "suit" to us for a loss we cover
under this Coverage Part;
(3) Tender the defense and indemnity of any
claim or "suit" to any other insurer which
also has insurance for a loss we cover
under this Coverage Part; and
(4) Agree to make available any other
insurance which the additional insured
has for a loss we cover under this
Coverage Part.
f. We have no duty to defend or indemnify an
additional insured under this endorsement
until we receive written notice of a claim or
"suit" from the additional insured.
2. Paragraph 4.b. of the Other Insurance Condition is
deleted and replaced with the following:
\.:l-1/l:Io/-l.:il:ll:i
(Ed. 10101)
4. Other Insurance
b. Excess Insurance
This insurance is excess over any other
Insurance naming the additional Insured
as an insured whether primary, excess,
contingent or on any other basis unless a
written contract or written agreement
specifically requires that this insurance be
either primary or primary and
noncontributing to the additional insured's
own coverage. This insurance is excess
over any other insurance to which the
additional insured has been added as an
additional insured by endorsement.
When this insurance is excess, we will
have no duty under Coverages A or B to
defend the additional insured against any
"suit" if any other insurer has a duty to
defend the additional insured against that
"suit." If no other insurer defends, we will
undertake to do so, but we will be entitled
to the additional insured's rights against
all those other insurers.
When this insurance is excess over other
insurance, we will pay only our share of
the amount of the loss, if any, that
exceeds the sum of:
(1) The total amount that all such other
insurance would pay for the loss in
the absence of this insurance; and
(2) The total of all deductible and self-
insured amounts under all that other
insurance.
We will share the remaining loss, if any,
with any other insurance that is not
described in this Excess Insurance
provision and was not bought specifically
to apply in excess of the Limits of
Insurance shown in the Declarations of
this Coverage Part.
jS5 1/r
G-17957 -G99
(Ed. 10/01)
Page 2 of 2
~AfA
G-17957 -G99
(Ed. 10101)
.. I '..
IMPORTANT: THIS ENDORSEMENT CONTAINS DUTIES THAT APPLY TO THE ADDITIONAL
INSURED IN THE EVENT OF OCCURRENCE, OFFENSE, CLAIM OR SUIT. SEE PARAGRAPH
C.1. OF THIS ENDORSEMENT FOR THESE DUTIES.
ALSO, THIS ENDORSEMENT CHANGES THE CONTRACTUAL LIABILITY COVERAGE WITH
RESPECTS TO THE "BODIL Y INJURY" OR "PROPERTY DAMAGE" ARISING OUT OF THE
"PRODUCTS-COMPLETED OPERATIONS HAZARD." SEE PARAGRAPH B.3. OF THIS
ENDORSEMENT FOR THIS COVERAGE CHANGE.
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CONTRACTOR'S SCHEDULED AND BLANKET ADDITIONAL INSURED
ENDORSEMENT WITH LIMITED PRODUCTS - COMPLETED OPERATIONS
COVERAGE
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Designated Project:
Name of Person or Organization:
gj
"'
~
"'
i
ED
ED
l<l
I
~
(Coverage under this endorsement is not affected by an entry or lack of entry in the Schedule above.)
A. WHO IS AN INSURED (Section II) is amended to Declarations of this policy, whichever is less.
include as an insured any person or organization, These Limits of Insurance are inclusive of, and not
including any person or organization shown in the in addition to, the Limits of Insurance shown in the
schedule above, (called additional insured) whom you Declarations.
are required to add as an additional insured on this 3. The coverage provided to the additional insured
policy under a written contract or written agreement; by this endorsement and paragraph f. of the
but the written contract or written agreement must be: definition of "insured contract" under
1. Currently in effect or becoming effective during the DEFINITIONS (Section V) do not apply to "bodily
term of this policy; and injury" or "property damage" arising out of the
"products-completed operations hazard" unless
2. Executed prior to the "bodily injury," "property required by the written contract or written
damage," or "personal and advertiSing injury," agreement. When coverage does apply to "bodily
B. The insurance provided to the additional insured is !,njuryd" or "proP1ertyd damage:' arisinhg oudt" of theh
limited as follows: pro ucts-comp ete operations azar suc
coverage will not apply beyond:
1. That person or organization is an additional
insured solely for liability due to your negligence a. The period of time required by the written
and specifically resulting from "your work" for the contract or written agreement; or
additional insured which is the subject of the b. 5 years from the completion of "your work" on
written contract or written agreement. No the project which is the subject of the written
coverage applies to liability resulting from the sole contract or written agreement,
negligence of the additional insured.
whichever is less.
2. The Limits of Insurance applicable to the
additional insured are those specified in the 4. The insurance provided to the additional insured
written contract or written agreement or in the does not apply to "bodily injury,' "property
--
;;;;
=
-
iiii
-
-
-
-
==
==
=
G-17957-G99
(Ed. 10/01)
~3/1
Page 1 of 2
Apr
01 08 03:3Sp
. ......v.. ......,LoI,- "'L r'\!1Ultlllll... co
1\ - ~oo3 - ;;1'Yf
Public Works
t-axlU h~O-JiB-l\361 To Thom;r!o;u A _.20o:3-.;L.3l1--DI
A -;;w:57 - .;:). '+10
7146473345 p.2
Date 4/1/:'008 1113AM Page "~'4
CERTIFICATE OF LIABILITY INSURANCE OP 10 N~ OAT!: (MMIOOJVY'('()
ACORD. CLINr-l 04/01/08
PRODUCiOR THIS CERTIFICATE 1$ ISSUED AS A MATTER OF INFORMATION
Andraini & Company-south Coast ONl.V AND c;Ol'ff.e."~ /'10 ftlGHTS UPON THE CERTIFICATE'
License 0208825 HOLDER, THIS CERTifICATE DOES NOT AIlEND, EXTEND OR
One MacArthur Placer Suite 100 Al fER THE COVERAGE AFFOROED BY THE POLICIES BElOW.
South Coast Metro CA !il~701 1
Pbone:114-327-1400 l'ax;714-327-1499 INSURERS AFFOIWtNG COVERAGE l"^~
-- - -- ----t---
INSURED i I'<o;,;.,~ f.' ~ ~nclnr.uU&~tl'CDlllJ'antot 1_2042'
- --- ---
,"::;_'R~R <; CQnt~Mnh~_ Cu".U_y ~II~.~
Clini.cal Laboratories of -- I -
San Bernardino, Inc. r'JSI_I~e::; ,
-- - ---- - --
P.O. Box ~29 1 '''''.-l'<t:~ ,~, --j-
San Bernardino CA 92402 - - - -- - - -
'}.!;:[f;[
C;OVERAGE:S
'H~ ", 'c ,It ~ uF l.j~l'f;','\I"':!:: l ~,ft;l-' ,;~l'."" ""''It !3€EN I':;::;UF') In :'1-~ 't,~ '"'~, ,,"'I~," '.J.:' ,L ,~,q -HI::. . ")lIC', Fe;,', ~ '1.1' \.:A7E:) Nl.: 1!V1':'H>:1 ANC;lt,':'
'-,'1" <;'f' 1;,'~\'Il: "1 Er.'\1< ,'. ,X.C;!~,,..Y,: ,-," M..~' C,~I\<'R",:I G" ,;1"110" I)~': .'~':~I\l '," ~T-H'[ -,' t' "\',''1''.1-< :,"I~ ,-t~' F :,v,v B~ IS:::;I~" (.f<
.~~. "L 'H:. ~HI I:~S',-"'~<', , ~I F, :~'JEC ~\ ,_-<I POl-,"'IE:t' ,!~:iCillKt'[) f-:c'?' I', ,~ ~I f' E"I I. ~ THE TEI'~,I" L'C:II ']1; l' ;'," ~o.'iL;IT'Ot S:;)I' ~I,' "
.y, :'-c J..,:';;l<f'l.',r..- L'I_1 " ,/-I,.wr. M"" >-L="ff Bt_~N "~.J..,,,tD ~'. po>" " , ";,,,r..'
1<DDT
L TR Ir-.<;RO TYPE OF INSURANCE __ i POLlC" NU~Rf-R
T ~ENE~AlllAlltUTY I
A I X X +~::'t'l ,', ,I- --n";:'~lc' ....'11:' f" i TCA206aSn5ZQl
I j _.' ':U.IM:; 1.1!10f- X~ _" ...LJl !
i-
-----:-ptJllCY1iFJ'B:lWE"IPOUCY 1::xt'1f(A IIUN
~T&,,~Y~:"~j~DOrn)
1 '
02/01/08 02/01/09
I 'FNL' .,,~:=.Y,I[ _1"Ti~ llP;:UtS PEIi I
,){' ",: '" r~i2r r'll"':
~I.J:O~OeILE LIABILITY
I
-r-
02/01/08
LIMITS
':'''CHC:~Cll..P!:NL'I_ 1~1,OOO,OOO
ni',J'I:"'~~~tJ - :--- --
~RF.flS;:::~I,~l\O~~f~t~ -+ ~ 100,000__
~'EC'EXI-':"lvr:""r~"..:::. ifJ.O,ooo _
1 "'"(;"S"I-io" ~J.\':)V':--!,.':~, Til,ooo,ooa
'-:;- m:!-,.,ol.J "'::l:)[,JpTE : i 2, QPO, 000
S Zxc:l.uded.
- .--
1,000,000
111,000,000
-t-
BUA20S9975084
I C(','ilel~'t~: :;r.,;L~ LMII
02/01/09 I ,i-~~,CIU'":li:
i ~~'>:'~;:TS _~~"';"'=-'l.'_'"
Ben.
I ;'R:\P~r;-,; [11J\1AG[ I' ,
,"'~, ~\L 'U~Jt)
1 1
\ ,.1:1(.; U'lL' lOA "'C(IUl::~j~ ! f,
i ,_,,..E;; T-Jo,t. C,I'f-,::C $
'A'J~jor,I~~ -~~ 1$
:l.l~H '::U-.r,ENCS J 5,000,000
02/01/09 r:';R",.ATf - I:
r- - -t;-
L_~_ 0_
i ~
~ :;i~,~'~~;r'~ ,-R .: $-
o fll~'FA[~ -~... bM"; ""IZj;-
----t::.t C';..!-.:.'," .~";"_ll'" ::,I:r is
...
1_ j""""'-w
I " ;'-Il ~WI',[f.1-,'f'"
1,.<''';L-iL!::c''.'UT';'S
L~~ IIII.'['~' IT,',.,
I ~ '.j~,i,V\~,',l)"LI'CE
1
1
L~~A.RAGE lIABl.lTY
[.;r"".,,'
i
f-
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A
I E~CES$lUMBRELLA LlA8lllTV .
:~-.J '" -ll~ __I '.1 ,',;W., M4Dr
L
02/01/08
I CUP20...753444
x
j :'EL'_ :TI~'.~
Pf'1t""n,
$10,QOO
WURKERS COMPENSATION ANO
I EMPLOYERS' LI.ll6Ill'ry
..-", f-" !;:~'I' T"f-'-'PA,,:kl.i;iC,E,:;
~ L U :1:,ll ~.If1! ; E "L'X, (),
1,..,,_
"",".I",,,l"'LJ,,,.,!:'
, ~,;~E~T~,- ""<)VI~,li:r'L; t",lof.'
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i'lOI)JLi':r....!".
!(re.p",sc~~_
I ~~;';C-CI'~L~:~"
i--
i'
1
B ! Professional EEA276170923 02/01/Q81 02/0l/0Sl
Liability ("'0) I . __, __ _n I
IlESCRlPTIClN OF OPERATIONS.; LOCATIONS I VEHiCLES J EXCI USIONS. AOOEO BY ENtlORSE/.I:NT I SPECIAL PRC'JI'lIONS
+.REVrSES * REPLACES CERTIFICATE ORIGlNALL~ ISSUED 02/15/08**
Certificate Holder is additional insured as respects to General Liability
per written contract per attached G-l?957-G99.
The CANCELLATION notice herein is amended to ro~d 10 deY3 as ~espects any
cancellation due to non-payment o~ premiwm.
CERTIFICATE HOLDER
CANCELLATION
SI-'OULO AI\IY OF THl': JlI'lCiVE OESCRIRED POlICIES liE CANCELLED BeFORE TI4' EXPIRATION
CAYS WRITTEN
CITYSAA
claim/A;g
Deduct.
3,000,000
100,000
UATE THEREOF. THl<lss~r>;G 'NSUA.ER WLL ErmEAVOR TO MAil 30
.'lonCE TO THE CERTlFiCAll "'OL:JERNAMEO T01HE LEfT. BUT FAILURE TO 00 $0 SHAll
City of Santa Ana
Department Of Public Works
220 S. Daisey Ave.
Santa Ana CA 92703
IMPOSE NO 08UGATJON C,f'1lI118ILITV OF ANY KIND UPON THE INSURER, ITS AG<=NTS OR
ACORD 25 (20D1!1l8)
~(L//~
, , - . ," . ,
, , . ':-- >' ..,.,\. .. ;" , ,...
v
@ACORDCORpORA.TtoN1988
Apr
01 08 03:39p
__ ~ ~',"oC ,~,. n' '.... ell" ,.. <"0
Public Works
t-a}Clu bbO 378-4351 To' T~lcmil~ 0
7146473345 p.4
Date 4/11:200811 13AM Page a Of4
CERTHOLDER COpy
SG
STATE
COMPENSATION
INSURANCE
FUND
P.O. BOX 420807 SAN FRANCISCO,CA 94141 '0807
CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
ISSUE OATE~ 04~01.2003
GROup
POLO NUMBL'.' 1886779-2008
CER1IFICAT[ Ie: 4
CERTlfICA,E [X.'IRES, 02-01-2009
02;-01 -2008/0~~01-200S
CITV OF SANTA ANA
DEPARTMfNT OF PUBLIC WORKS
220 S DAISY AYE
SANTA ANA CA 92703-4334
SG
in.s i~ to certify thai we hive ISSUed .a vahd \tllorlo..ers' C;'JmDens.atl\ln jl'1s.urM'lce Dolt.y n iii for:n app:-oved hy tne
C.;:llforni& Insurance Commissioner :0 the employ~ named ba;oV\' fo~ the POlicy per'od .,jjcated.
T1W5. iJohcy IS nol st.bJElCI to c.:mC€llatI01 by the Fund e;':Cf-::n LlpOI" 10 d.ay~ ..dvOInce ~ntten notice to the ~molo'..er.
\Ne Will also Qlve .,OU 10 days advance '"Io1ice should thii JOlIc\' De canceli9d j1rior to Its norrn6! expilatlon.
Thl:<, :erti1icate- wI lllsural'K;e 15 nol an insur;ance DOliey and ODes 'lot OImend. extend or alter the coverage ahorded
by the poliq 'L;led herem. NctwilhStandin;t iilnV reqUirement, [arm 0: condition oT ..1"1\' c;antract or other do:=-ument
with rf'SDect to whlctl thiS certificate of i"surilnce m"y be ISSu.ed or to .,.,m'cll il may perl..1in, the insur;Y1ce
Jtlorde::l by IIII>' policy described !'-ereln IS :;...bJ6CI to all the terms. e)(clUSIOns, and conditions, of sueh pori.;v_
CJ:::-RePRCSENTAl1
EMPLOYER'S lIABILITY LIMIT
~~~
PRl:SiDtNT
INCLUDING DEFENSE COSTS
$1,000.000 PER OCCURRENCE
EMPI~OYE:rl
CLINICAL LABORATORIES Of SAN BERN AND/OR GEO
NQNITOR INC
PO BOX 329
SAN BERNARDINO CA 92402
lREV2-:l5i
~
iB15,NAJ
P_INTEO 04-01-2008
. 39 Pub1 ic Works
Apr O.~.,_~.~_ ,~~,~,,,,,,,,,f,--[) '-d.XIU bb<J.37B-4361 To"Thom;t<;[)
7146473345 p.3
Date 4/112008 11 13 AM PBgf.' 3 (,f 4
IMPORTANT
If the certificate holder is an ADDIT:ONAL INSUR!:::LJ the polll.:Y(le~) must be endorsed A statement
on thIS certificate does not confer rights to the cer1lflcate holder In Jjf'.J Of such endorsement(s).
If SUBROGA TION IS WAIVED, subject tv the cerrns af'l-d conditions OFthe Dolley, certain policies may
reowre an endorsement. A statement on 'hiS oertlficate does not conter fights to the certificate
nolde( In lieu Of such endorsementts)
DISCLAIMER
The Certificate of Insurance on the reverse srrlp of tnls form does no1 constitute a contract between
:he issuing Irsurer(s), authorized representative or prod!Jcer, ana the certificate holder, nor does it
aftlrmatiIJ8,'y or negatively alllcnd, extend or alt~1 ttn.:! coverage a"o'ded by the policies listed thereon
ACORD 25 (200f/OB)