HomeMy WebLinkAboutFETTERS, PAUL 1City of Santa Ana
- Clerk of the Council
AGREEMENT TERMINATION FORM
Please complete this form when the attached agreement and alf
amendments (if any) are no longer in effect.
Return form to the Clerk of the Council Office (M-30).
Call 647-6520 if you have any questions.
The agreement with Paul Fetters dba The Training Spot
COTC Office Use Only
7015 SPAY -11 P9 -�: 19
S lr;A,
K' in LSa friY:i)
No. N-2002-150 was completed on 04/30/2015 and final payment has been made.
(List all amendments. Use space below if needed.)
N-2002-150-01 Department: Police Department
N-2002-150-02
N-2002-150-03 Phone/Ext.: (714)245-8004
Signature:
Dater 4/30/2015
Revised 08-2310
1N!W,4WN�E 1101 ON ; ILE
WORK NIAY NOT PROCEED
CLERK OF COUNCIL
DATE: �) 4-o Z
CONSULTANT AGREEMENT
N-2002-150
03
THIS AGREEMENT, made and entered into this q i� day of �R , 2002
(, by and between Paul Fetters, (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").
RECITALS
UJ
A.
The City desires to retain a consultant having special skill and knowledge in the field of
o W
health and fitness to provide classes for law enforcement personnel.
W
a: Cj V
o z
Cy
z
0 �� '
(D �
B.
Consultant represents that Consultant is able and willing to provide such services to the
W �
U ¢ V) r('1
z
i
W �O
O
City.
City.
UJ
J ¢
C.
In undertaking the performance of this Agreement, Consultant represents that it is
z
L> o
kn l d bl f I d h
V w e gea emits ie an t at 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 teach health and fitness classes for law enforcement personnel at the
Santa Ana Police Department Training Center. Said classes shall be held in a lecture format to
discuss and explore the benefits of nutrition and exercise. Prior to commencement of any such
class, Consultant shall obtain approval of his curriculum from the Santa Ana Police Department.
2. COMPENSATION
a. City agrees to pay, and Consultant agrees to accept as total payment for its services,
$50.00 per hour. The total sum to be expended under this Agreement, shall not exceed $
3,000.00 during the term of this Agreement.
b. Payment by City shall be made within thirty (30) days following receipt of proper
invoice evidencing work performed, subject to City accounting procedures. Payment need not
be made for work which fails to meet the standards of performance set forth in the Recitals
which may reasonably be expected by City.
3. TERM
This Agreement shall commence on the date first written above and terminate on June 30,
2003, unless terminated earlier in accordance with Section 12, below. The term of this
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 therefrom and damage
to property, resulting from any act or occurrence arising out of Consultant's operations in the
performance of this Agreement, including, without limitation, acts involving vehicles. The
amounts of insurance shall be not less than the following: single limit coverage applying to
bodily and personal injury, including death resulting therefrom, and property damage, in the total
amount of $1,000,000 per occurrence. Consultant shall supply City with a fully executed
additional insured endorsement in substantially the form attached hereto as Exhibit A upon
execution of this Agreement and shall be approved in form by the City Attorney.
b. 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.
c. 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.
d. 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. INDEMNIFICATION
Consultant agrees to and shall indemnify and hold harmless the City, its officers, agents,
employees, consultants, special counsel, and representatives from liability: (1) for personal
injury, damages, just compensation, restitution, judicial or equitable relief arising out of claims
for personal injury, including health, and claims for property damage, which may arise from the
direct or indirect operations of the Consultant or its contractors, subcontractors, agents,
employees, or other persons acting on their behalf which relates to the services described in
section 1 of this Agreement; and (2) from any claim that personal injury, damages, just
compensation, restitution, judicial or equitable relief is due by reason of the terms of or effects
arising from this Agreement. This indemnity and hold harmless agreement applies to all claims
for damages, just compensation, restitution, judicial or equitable relief suffered, or alleged to
have been suffered, by reason of the events referred to in this Section or by reason of the terms
of, or effects, arising from this Agreement.
7. CONFIDENTIALITY
If Consultant receives from the City information which due to the nature of such
information is reasonably understood to be confidential and/or proprietary, Consultant agrees
that it shall not use or disclose such information except in the performance of this Agreement,
and further agrees to exercise the same degree of care it uses to protect its own information of
like importance, but in no event less than reasonable care. "Confidential Information" shall
include all nonpublic information. Confidential information includes not only written
information, but also information transferred orally, visually, electronically, or by other means.
Confidential information disclosed to either party by any subsidiary and/or agent of the other
party is covered by this Agreement. The foregoing obligations of non-use and nondisclosure
shall not apply to any information that (a) has been disclosed in publicly available sources; (b) is,
through no fault of the Consultant disclosed in a publicly available source; (c) is in rightful
possession of the Consultant without an obligation of confidentiality; (d) is required to be
disclosed by operation of law; or (e) is independently developed by the Consultant without
reference to information disclosed by the City.
8. CONFLICT OF INTEREST CLAUSE
Consultant covenants that it presently has no interests and shall not have interests, direct
or indirect, which would conflict in any manner with performance of services specified under
this Agreement.
9. NOTICE
Any notice, tender, demand, delivery, or other communication pursuant to this
Agreement shall be in writing and shall be deemed to be properly given if delivered in person or
mailed by first class or certified mail, postage prepaid, or sent by telefacsimile or other
telegraphic communication in the manner provided in this Section, to the following persons:
To City:
Clerk of the City Council
City of Santa Ana
20 Civic Center Plaza (M-30)
P.O. Box 1988
Santa Ana, CA 92702-1988
telefacsimile (714) 647-6956
With courtesy copies to:
and,
Chief of Police
City of Santa Ana
60 Civic Center Plaza (M-97)
P.O. Box 1988
Santa Ana, California 92702
telefacsimile (714) 245-8001
City Attorney
City of Santa Ana
20 Civic Center Plaza (M-29)
P.O. Box 1988
Santa Ana, California 92702
telefacsimile (714) 647-6515
To Consultant:
Paul Fetters
16942 Gothard Street, Suite #F
Huntington Beach, California 92648
Telefacsimile (714) 847-8028
4
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
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.
b. All Exhibits referenced herein and attached hereto shall be incorporated as if fully set
forth in the body of this Agreement.
CJ
E
IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year
first above written.
ATTEST:
*ATR CIA E. HEAL
Clerk of the Council
APPROVED AS TO FORM:
JOSEPH W.FLETCHER
City Attorney
r
Lauea Sheedy
Assistant City Attorney
APPROVED AS TO CONTENT:
PAUL M. WALTERS
Chief of Police
CITY OF SANTA ANA
DAVID N. REAM
City Manager
CONSULTANT
PAUL FETTERS
L61- L (- ;;,- 3tf 9
Employer ID # or Individual SS #
EXHIBIT A
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:
1. The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701; its
officers, employees, agents, volunteers and representatives are named as additional insureds
("additional insureds") with regard to liability and defense of suits arising from the operations
and uses performed by or on behalf of the named insured.
2. With respect to claims arising out of the operations and uses performed by or on
behalf of the named insured, such insurance as is afforded by this policy is primary and is not
additional to or contributing with any other insurance carried by or for the benefit of the
additional insureds.
3. This insurance applies separately to each insured against whom claim is made or
suit is brought except with respect to the company's limits of liability. The inclusion of any
person or organization as an insured shall not affect any right which such person or organization
would have as a claimant if not so included.
4. With respect to the additional insureds, this insurance shall not be cancelled, or
materially reduced in coverage or limits except after thirty (30) days written notice has been
given to the 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 , this endorsement form as a part of
Policy #
Issued to
Named Insured
Countersigned by
Authorized Representative
Oct 21 02 09:43a
FITNESS and WELLNESS
8585190822
P.3
AaORDL CERTIFICATE OF LIABILITY INISURANC OP1D g�DATE�21,/n(
) 7212 0 2
Fitness & Wellness Insurance THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS END OR
380 Stevens Ave., First Floor ALTERTHE COVERAGEEAFFORDED TE DOES By �NpOLIC ES BELOW.
Solana Beach CA 92075
Phone:800-395-8075 Pax:858-519-0822 INSURERS AFFORDING COVERAGE
INSURED -
INWRERA: Specialty National Insurance
Paul H. Fetters 0072120 INSURER B:
Eff:05-31-02 The training Spot INSURER C:
7602 Ontario Drive
Huntington Beach CA 92648 FR D:
INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT. TERM OR CON=10N OF ANY CONTRACT OR OTHER DOCUMENT tYITH RESPECT TO ICH THIS CERTIFICATE MAY Be ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERA4S, EXCLUSIONS AND CCMICITS LI OF SCICH
POUGES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
i
LTR TYPE OF INSURANCE DATE M
POUCYNUMBER DATE MwD LIMITS
GENERAL LIABILITY EACH OCCURRENCE F3O
A% coaL LIABILL GENERAL LIABILITY 0,000
3XZ126451-01 05/31/02 05/31/03 F:tEDAMAGE(Anyw,er-e) 000
CLAIMS MADE X U OCCUR 1
A LXJ Kisc Professional
GEN'L AGGREGATE LIMIT APPLIES PERPRO.a:
POLICY 1 JECT n LOC
AUTOMMLE LIABLITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
GARAGE LIABILITY
I ANY AUTO
EXCESS UAB1LrtY
OCCUR 1:1 CLAIMS MADE
DEDUCTIBLE
RETENTION E
WORKERS COMPENS,ATWN AND
EMPLOYERS LIABILITY
A ISexual Abuse
APPROVES AS TO
Laura Sheedy I
Deputy City Aitorncy
MED ow {Any one person) $2,500
F
RSONAL 6 ADV INJURY S1,,000,000
NERAL AGGREGATE S3,000,000
PRODUCTS - COMP1OP AGG , $1,0()0,000
COMBINED SINGLE UNIT
{Ea saiOeM)
� $
— --t$
SOMY INJURY
(Per
Person)
ILY INjuRy
±
(Per &&MkI4.)
PROPERTY D MAGE
S
(Per wMent)
AUTO ONLY- EA ACCIDENT S
OTHER THAN EA s
AUTO ONLY: AGG S
EACH OCCURRENCE
i
RM AGGREGATE
i
a
3
S
E.L EACH SACCIDEItMLDEEAT S
ELDISEASE - POLICY LIMIT 4
-••,•••• •••••y ADDED BY ENOpRSENIBITISPEGAL PROyIgIpNS
*It's Officers, Employees, Agents, Volunteers and representatives are named
as additional insureds with regard to liability and defence of suits arising
'from the operations and uses performed by or on behalf of the named insured
CERTIFICATE HOLDER Y I Aomew, INSURED• MURM LETTER:
SANANAT
The City of Santa Ana*
Lieutenant 3eff Owens
20 Civic Center plaza
Santa Ana CA 92701
200,000
300,000
CANCELLATION
SHOULD ANY OF Tie ABOVE OESCWSED pOUC $ SE AFI I M BEFORETHE E1(PWA.M
DATE TTiEMM THE iSSLANG INSURER WILL ENDEAVOR TO MAK. A-IZ DAYS MR ITTI EN
NOTJCE TO THE CERTIRCATE HOLDER NAMED To THE LEFT, WT FAujAW TO DO B0 SMALL
MKWE NO 09UGATM OR UABLITY OF ANY KWD UPON THE BISWWK ITS AGEMTTI OR
RlPRIERMpTATMES.
Oct 21 02 09:43a
FITNESS and WELLNESS
8585190822
Murria & Frick/Fitness and Wellness insurance Agency
ADDITIONAL INSURED ENDORSEMENT
FOR COMMERCIAL GENERAL LIABILITY POLICY
Insurance Company Specialty National
This endorsement modifies such insurance as is afforded by the provisions of Policy
# 3XZ 126451-01 relating to the following:
1. The City of Santa Ana, 20 Civic Center PIaza, Santa Ana, California 92701; its
officers, employees, agents, volunteers and representatives are named as additional insureds
("additional insureds") with regard to liability and defense of suits arising from the operations
and uses performed by or on behalf of the named insured.
2. With respect to claims arising out of the operations and uses performed by or on
behalf of the named insured, such insurance as is afforded by this policy is primary and is not
additional to or contributing with any other insurance carried by or for the benefit of the
additional insureds.
3. This insurance applies separately to each insured against whom claim is made or
suit is brought except with respect to the company's limits of liability The inclusion of any
person or organization as an insured shall not affect any right which such person or organization
would have as a claimant if not so included.
4. With respect to the additional insureds, this insurance shall not be cancelled, or
materially reduced in coverage or limits except after thirty (30) days written notice has been
given to the 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: 10-21-02, this endorsement form as a part of Policy # 3XZ126451-01
Issued to: Paul Fetters
Named Insured
Countersigned byA tho�•
ri Representative
APPROVED AS TO FORM
'r
l
U I,ra Sheedyu= I�XX
G)-11Uty Clty Attomov
380 Stevens Avenue, First Floor - Solana Beach - CA 92075-2097
(800) 395-8075 - Fax (858) 259-6069 - License OD28716
p.2
•
MAYOR
Miguel A. Pulido
MAYOR PRO TEM
Brett E. Franklin
COUNCILMEMBERS
Claudia C. Alvarez
Lisa Bist
Alberta D. Christy
Mike Garcia
Jose Solorio
September 3, 2003
ta
)'acation Zst
CITY OF SANTA ANA
OFFICE OF THE CITY ATTORNEY
20 CIVIC CENTER PLAZA M-29 • P.O. BOX 1988
SANTA ANA, CALIFORNIA 92702
(714) 647-5201 • Fax (714) 647-6515 O
Paul Fetters
7602 Ontario Drive
Huntington Beach, California 92648
Dear Mr. Fetters
CITY MANAGER
David N. Ream
CITY ATTORNEY
Joseph W. Fletcher
CLERK OF THE COUNCIL
Patricia E. Healy
Pursuant to Consultant Agreement #N2002-150, which you entered with the City of
Santa Ana, dated October 4, 2002, Section 3 — "Term", the time period of said
Agreement is hereby extended from June 30, 2003, until June 30, 2004. The insurance
certificates and Additional Insured Endorsement are required to be extended and/or
renewed to cover this extension. All other terms and conditions of said Agreement
remain unchanged and in full force and effect.
If you have any questions in this regard, please feel free to contact Detention Training
Supervisor, Christina Williams at (714) 245-8053
Sincerely
PAUL M. WALTERS
Chief of Police
Cc: Clerk of the Council
APPROVED AS TO FORM
JOSEPH W.FLETCHER
By r_c
Laura Sheedy
Assistant City Attorney
C.S 679
ACaRD CERTIFICA OF LIABILITY INSURAN46 OP ID
DATE(MM/DD/YYYY)
0072120
07/22/03
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIO
Fitness & Wellness Insurance
'ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Agency
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
380 Stevens Ave . , First Floor
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW
Solana Beach CA 92075
Phone: 800-395-8075 Fax: 858-519-0822
INSURERS AFFORDING COVERAGE NAIC #
INSURED
INSURER A: Steadfast Insurance
INSURER B:
0072120 Paul H. Fetters
dba: The Training Spot
7602 Ontario Drive
Huntington Beach CA 92648
INSURER C: (ICZ S
INSURER D:
INSURER E:
PREMISES(Eaoccurence) $100,000
C VERAGES
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.
LTR
INSR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE MM/DD/YY
POLICY EXPIRATION
DATE MM/DD/YY
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE $ 1,000,000
A
X
%COMMERCIAL GENERAL LIABILITY
CLAIMS MADE �OCCUR
EOL5281395-00
05/31/03
05/31/04
PREMISES(Eaoccurence) $100,000
MED EXP (Any one person) $2,500
PERSONAL &ADV INJURY $1,000,000
A
Sa.Professional
GENERAL AGGREGATE $3,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG $ INCLUDED
PRO-
X I POLICYLI JECT LOC
AUTOMOBILE
LIABILITY
ANYAUTO
COMBINED SINGLE LIMIT
(Ea accident) $
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY $
(Per person)
HIRED AUTOS
NON -OWNED AUTOS
BODILY INJURY
(Per accident) $
PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT $
OTHER THAN EA ACC $
ANY AUTO
AUTO ONLY: AGG $
EXCESS/UMBRELLA LIABILITY
OCCUR El CLAIMS MADE
PP j e (. LD
A,, I. l
�
EACH OCCURRENCE $
AGGREGATE $
$
DEDUCTIBLE$
RETENTION $
$
-
TORY LCSTIMITS I I ER
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
,U ; Ci SI1Cc`iI `,!
T-7
I)ehtlty i.'tty A.I I
(lt'IIuV
E.L. EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED?
If yes, describe under
E.L. DISEASE- EA EMPLOYEE $
E.L. DISEASE - POLICY LIMIT $
SPECIAL PROVISIONS below
OTHER
A
Sexual Abuse
EOL5281395-00
Occ. 100,000
Agg. 300,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
*It's Officers, Employees, Agents, Volunteers and representatives are named
as additional insureds with regard to liability and defence of suits arising
from the operations and uses performed by or on behalf of the named insured
CEIR I IFICA I C MULUCK CANCELLATION
SANANAT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIO
DATE THEREOF, THE ISSUING INSURER`ILL40FAIJIMMMAIL 30 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
The City of Santa Ana* R
20 Civic Center Plaza
Santa Ana CA 92701 AUTHORIZED REPRESENTATIVE
Jeffrev E. Frick
ACORD CERTIFICAJ& OF LIABILITY INSURAN& OP ID
DATE(MM/DD/YYYY)
0072120
07/22/03
PRODUCER
Fitness & Wellness Insurance
. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIO
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Agency
380 Stevens Ave., First Floor
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW
Solana Beach CA 92075
LIMITS
Phone: 800-395-8075 Fax: 858-519-0822
INSURERS AFFORDING COVERAGE NAIC #
INSURED
INSURER A: Steadfast Insurance
INSURER B:
0072120 Paul H. Fetters
dba• The Training Spot
7602 Ontario Drive
Huntington Beach CA 92648
INSURER C:
INSURER D:
INSURER E:
X CO, CIALGENERALLIABILITY
CLAIMS MADE 7 OCCUR
COVERAGES
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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
IN511
LTR
)U
NSR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE MM/DD/YY
POLICY EXPIRATION
DATE MM/DD/YY
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE $1,000,000
A
X
X CO, CIALGENERALLIABILITY
CLAIMS MADE 7 OCCUR
EOL5281395-00
05/31/03
05/31/04
PREMISES (Eaoccurence) $ 100,000
MED EXP (Any one person) $ 2,500
A
X Misc.Professional
PERSONALBADVINJURY $1,000,000
GENERAL AGGREGATE $ 3,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OPAGG $ INCLUDED
X POLICY PRO- LOC
JECT
AUTOMOBILE
LIABILITY
ANY AUTO
COMBINED SINGLE LIMIT
(Ea accident) $
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY $
(Per person)
HIRED AUTOS
NON -OWNED AUTOS
BODILY INJURY $
(Per accident)
PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT $
ANY AUTO
OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESWUMBRELLA LIABILITY
OCCUR CLAIMS MADE
EACH OCCURRENCE $
AGGREGATE $
DEDUCTIBLE
RETENTION $
$
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
TORY LIMITS ER
E.L. EACH ACCIDENT $
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
If yes, describe under
E.L. DISEASE- EA EMPLOYEE $
E.L. DISEASE - POLICY LIMIT $
SPECIAL PROVISIONS below
OTHER
A
Sexual Abuse
EOL5281395-00
Occ. 100,000
Agg. 300,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS
*It's Officers, Employees, Agents, Volunteers and representatives are named
as additional insureds with regard to liability and defence of suits arising
from the operations and uses performed by or on behalf of the named insured
ULK 1 IF ICA I C r7ULLJCK CANCELLATION
SANANAT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATII
DATE THEREOF, THE ISSUING INSURER WILL MAIL 30 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
The City of Santa Ana*
20 Civic Center Plaza
Santa Ana CA 92701 AUTHORIZED REPRESENTATIVE
ORD 25
0
EXHIBIT B
ADDITIONAL MSU"Q ENDORSEMENT
FOR COMMERCIAL GENERAL LIABILITY POLICY
Insurance Company 1aA�� K5 wrfy , C t
This endorsement modifies such insurance as is afforded by the provisions of Policy
# C-0 5Z$1VV5j-00 relating to the following:
1. The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701; its
officers, employees, agents, volunteers and representatives are named as additional insureds
("additional insureds") with regard to liability and defense of suits arising from the operations
and uses performed by or on behalf of the named insured.
2. With respect to claims arising out of the operations and uses performed by or on
behalf of the named insured, such insurance as is afforded by this policy is primary and is not
additional to or contributing with any other insurance carried by or for the benefit of the
additional insureds.
3. This insurance applies separately to each insured against whom claim is made or
suit is brought except with respect to the company's limits of liability. The inclusion of any
person or organization as an insured shall not affect any right which such person or organization
would have as a claimant if not so included.
4. With respect to the additional insureds, this insurance shall not be cancelled, or
materially reduced in coverage or limits except after thirty (30) days written notice has been
given to the 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 513 i 103 , this endorsement form as a part of
Policy # Z - O 0
Issued to l er5
Named Insured
Countersigned by
Representative
1' OVED ,1,
'heedy �
10 city . .
0 It 06/03/2004 15:59 8585190822 FITNESS AND WELLNESS PAGE 02/03
ACORD DATE (MM/DDNYYY)
,A CERTIFICATE OF LIABILITY INSURANCE JUN 304
PRODUCER THIS CERTIFICATE 13 ISSUED AS A MATTER OF INFORMATION
FITNESS AND 1 (ELLNESS INSURANCE AGENCY ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
380 STEVENS J VENUE, SUITE 206 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
SOLANA BEAC i CA 92075 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE NAIC #
— - Agency, Lie#: OD28716
INSURED INSURER A: ZURICH AMERICAN INSURANCE CO.
PAUL H. F 'TIERS INSURER 8: - -- _._
DBA THE' RAINING SPOT
7602 ONTj RIO DRIVE INSURER C,
HUNTINGI ON BEACH CA 92648 INSURER D; –
INSURER E:
COVERAGES
THE POLICIES OF ISURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POI.ICYPERIOD INDICATED, NOTWITHSTANDING
ANY REQUIREMENT TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHfCH 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. AGGREG TE LIMITS SHOWN MAY HAVE BEEN REDUCF13 BY PAID CLAIMS.
MSR ADDIL TYPE( r INSURANCE I POLICY NUMDr;R POLICY EFFECTIVE POUCYEXPIRATION LIMITS
INS DATE (MMIDW"l 0
DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT
FAILLIRETO DO BO $HALL IMPOSE NO OBLIGATION OR LIABILIYYOF ANY KIND UPON THE
20 CIVIC C ENTER PLAZA
GENERAI LIABILITY EOL901232MO
MAY 3104
MAY 3105
EACH OCCURRENCE
1,000,000
$ 100,000
X COI MERCIAL GENERAL UABILITY
_ .
lCLAIMS MADE OCCUR
DAMAGE TO RENTEp
.P_RF.WC.F6 (EA.occum
MED. EXP (Any one person)
$ 2,500
$ 1,000,000
A
PERSONAL &ADV INJURY
$ 3,000,0_0_0
GENERAL AGGREGATE
GEN'L AG ;REGATE LIMIT APPLIES PERI
...X
PRODUCTS•COMPIOP AGG.
$ 3,000,000
I POL :Y f7 PROJECT LOC
AUTOMO
ILE LIABILITY I
AN) AUTO I
COMBINED SINGLE LIMIT
(Fa owdem)
$
ALL )WNEO AUTOS
BODILY INJURY
—
SO 17ULED AUTOS
(Per person)
S
HIR D AUTOS
NOI -OWNED AUTOS
BODILY INJURY
(Per soCldent)
$
PROPERTY DAMAGE
Peretddem
GARAGE AABILtTY
AUTO ONLY - EA ACCIDENT
—
OTHER THAN EA ACC
AN, AUTO
$
AUTO QNLY:
$
EXCESS, UMBRELLA LFABILITY
EACH OCCURRENCE
$
00, UR �. —1 CLAIMS MAGE
.$ _---
AGGREGATE --
`
DE( JCTISLE
RE' SNTION $
_......—.
Is
WORKERS COZY 'IRNSATION AND
EMPLOYERS' LI YBILITY
ANY PR0PRIWMF 'ARTNEIWXCurnE
iRL'
�' ` KiJ..
/
1
WC STATU-
UMD:S OTHER
-
E.L. EACH ACCIDENT
S
E.L. DISEASE•EA EMPLOYEE
OPPICERIMFMOEF EXCLUDED?
$
-
lfyff, fAfarlhf um it
SPECIAL PROVIS14 43 bolew
-
E.L. DISEASE -POLICY LIMIT
$
OTHER:
DESCRIPTION )F OPERATIONSILOCATIONSIVEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS
THE CITY OF S 1NTA ANA, 20 CIVIC CENTER PLAZA, SANTA ANA, CALIFORNIA 92701. ITS OFFICERS, EMPLOYEES, AGENTS, VOLUNTEERS
AND REPRESE dTATIVES ARE NAMED AS ADDITIONAL INSUREDS WITH REGARD TO LIABILITY AND DEFENSE OF SUITS ARISING FROM
THE OPERATIC NS AND USSES PERFORMED BY OR ON BEHALF OF THE NAMED INSURED.
mmnrlvrAr 1^1 nam
ACORD 25 (Z( )1108)
Certlfic2te # 3037
OD28716 V ACORD CORPORATION 1988
r1)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENOEAVQR TO MAIL SO
CITY OF S ►NTA ANA
DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT
FAILLIRETO DO BO $HALL IMPOSE NO OBLIGATION OR LIABILIYYOF ANY KIND UPON THE
20 CIVIC C ENTER PLAZA
INSURER, ITS AGENTS OR REPRESENTATIVES,
SANTA AF 4, CA 92701
AUTHORIZED REPRESENTATIVE erl
Attention:
Jeffrey E. Frick, CEO
ACORD 25 (Z( )1108)
Certlfic2te # 3037
OD28716 V ACORD CORPORATION 1988
r1)
06/03/2004 15:59 8585190822 FITNESS AND WELLNESS PAGE 03/03
D,ATI .: June 3, 2004
POLI ;Y NUMBER: EOL9012328-00
INSU ZED NAME: Paul H. Fetters
TH] S ENDORSEMENT CHANGES THE ]POLICY. PLEASE READ IT CAREFULLY
1 CG 20 10 11. 85
A )DITIONAL INSURED --OWNERS, LESSEES OR CONTRACTORS (FORM B)
This ei 3orsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name � f Person or Organization: City of Santa Ana
20 Civic Center Plaza
Santa. Ana, CA 92701
(If no E atry appears above, information required to complete this endorsement will be shown in the Declarations as
applicr -ilc to this endorsement,)
WHO 3 AN INSURED (Section II) is amended to include as an insured the person or organization shown in the
Schede le, but only with respect to liability arising out of "your work" for that insured by or for you.
Primas • Insurance it is agreed that such insurance as is afforded by this policy for the benefit of the additional
insure( shown shall be primary insurance, and any other insurance maintained by the additional insured(s) shall be
excess and non-contributory, but only as respects any claim, loss or liability arising out of the operations of the
named nsured(s) or its subcontractors, and only if such claim, loss or liability is determined to be soley the
negli.gE -.ice or responsibility of the named insured.
Notice )f Cancellation or Non -renewal it is agreed that the company will provide the additional insured shown
below lith 30 days notice of cancellation of this policy in the evert of cancellation due to company election only.
Hold F arnticss Clause it is agreed that such insurance as is a.ffo.rded by this policy for the benefit of the additional
insures shown below shall indemnify and hold harmless the additional insured, but only as respects any claim, loss
or liab: ity arising out of the operations of named insured(s) or its sub -contractors.
Severa iility of Interest as is afforded by this policy for the benefit of the additional insured shown below shall apply
separai ,ly to each additional insured against whom a claim is made or suit is brought, except with respects to the
limits ; f insurance under this policy.
WAIVER OF SUBROGATION
It is agreed that we waive any right of recovery we may have against the person
or organization shown in the schedule because of payment we make for injury or
damage arising out of "your work" done under a contract with that person or
organization. The waiver applies only to the person or organization shown in.
the schedule.
SCHEDULE
NAME OF PERSON OR ORGANIZATION
FROM FITNESS AND WELLNESS INSURANCE %N)JUN 20 2005 12: 01/ST.12:00/No.6820420804 P 1
ACORD CERTIFICATE OF LIABILITY INSURANCE
DATE (Tf012008 )
0812012008noo6
TM.
IYPE OF INSURANCE
DDNERALLIAIRIm
X� COMMERGAL GENERAL LW&LItY
PRODUC ER Ph": ISM) M-5075 Pee IMel E1M )SM
FITNESS AND WELLNESS INSURANCE AGENCY
380 STEVFNS AVENUE, SUITE 200
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE GElTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
SOLANA BEACH CA 92076R
Tilt
owAATE Tonamo s 100,000
PREMIEEE bRca..w —
INSURERS AFFORDING COVERAGE MAIC #
Ammi LION: 0D28718 _
VISUREDINSURER
PAULH, FETTERS NI - P00d— 15 L
DEBAIHETRAINING SPOT �OZ
78Q2 OITA=DRIVE
HLJINT14GTON BEACH CA 9268
A: Zurich Mxrban hlsuranee _
INSURER B:
JeFrickk,,
INSURER C:
INSURER D:
A
INSURER E:
G CFRPAIEB
THE POIIQI$ OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTVIITNSTANORG
ANY REG UNEMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH TAB CERTIFICATE MAY DE ISSUED OR
MAY PERTAN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES_ AWREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
IWR'
LTR
MBR
IYPE OF INSURANCE
DDNERALLIAIRIm
X� COMMERGAL GENERAL LW&LItY
POLICY HUASER
EOL9012328-01
M Yffm` a
CATRImplYm
06131106
ralcY MI Ttn,
06!31/08
LIMITS
EACH OCCURRENCE i 1,000,000
owAATE Tonamo s 100,000
PREMIEEE bRca..w —
MED. EXP (Any" WB l E _ 2,666
SANTA ANA, CA 92701
AUTHOMMO REPRESENTATIVE /
,CCEO
MAIMS MADE n OCCUR
JeFrickk,,
PERSONAL 4 ADV INJURY s 1,000,000
A
GENERAL AGGREGATE 3 3,060,000
GFrv'L AODREOATE LIMIT APPLIES PER:
PRODUCTS-OOM=AGG i 3,000,000
X POLICY JPERm LOC
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT E
IF.B iCOiNBnq
ANY AUTO
ALL OWNED AUTOS
BODILY INJURY
(PN Batson) i
SCHEDULED AUTOS
BODILY INJURY i
(Be Rwid.Rq ..
HREDAUTOG
NON -OWNED AUTOS
PROPERTY DAMAGE E
(PN occident
GARAGE LIAyUTY
AUTO ONLY• EA ACCIDENT i
OTHER THAN FA ACC i
AUTO ONLY: AGO S
ANY AUTO
E)CESS( UMBRELLA LIABILITY
FACHOCCURRENCE E
AGGREGATE
.._� OCCUR F, CLAIMS MADE
DEDuDEDUCTIBLEORNI
APPROV
i. )
I ,1k i'rJ F
i
s
RETENTION S
—
WnRHERarLIABILBATIDN AND
EMPLOYER%LI1IBILITY
RIYPIIYAIINRI.'ARTNEI..FGURW
PgICB.MMBBR lYBLWYRT
..IIA
AsbiSt$
7 SL L SIi C�(jV
L (..TLB �?ItOT;��
Y,CyUMIT GSR
@
E.L. EACH ACCIDENT i
E,L.CISEASE-EAEMPLOYEE E
E1. WASE -POLICY LIMIT E
im AAMmRunr
TIaA4 MRWlglibnw
OTHER:
DESCRM'TI7N OF OPERATIONSILOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS
THE CITY OF SANTA ANA. 20 CMC CENTER PLAZA, SANTA ANA, CALIFORNIA 92701. ITS OFFICERS. EMPLOYEES, AGENTS, VOLUNTEERS
AND REPRESENTATIVES ARE NAMED AS ADDITIONAL INSUREDS WITH REGARD TO LIABILITY AND DEFENSE OF SUITS ARISING FROM THE
OPERATIONS AND USSES PERFORMED BY OR ON BEHALF OF THE NAMED INSURED.
ERTIFICATE HOLDER CANCELLATION
C
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLEO BEFORETHE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS
WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO
CITY OF SANTA ANA
DO SO SMALL IMPOSE NO OBLKIATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS
20 CMC CENTER PLAZA
AGENTS OR REPRESENTAnVES.
SANTA ANA, CA 92701
AUTHOMMO REPRESENTATIVE /
,CCEO
AltenOon: CHRIS WO.LIAMS
JeFrickk,,
ACORD 26(2001/09) Certificate# 22764 W ACORD CDRPURAINUR Teen
I
FROM FITNESS AND WELLNESS INSURANCE (MON) JUN 20 2005 12:021T.'2:00/No.6820420804 P 2
POLICY NUMBER: EOL9012328-01 COMMERCIAL GENERAL LIABILITY
'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
SCHEDULE
Name of Person or Organization; CITY OF SANTA ANA
20 CIVIC CENTER PLAZA
SANTA ANA, CA 92701
(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 ll) is amended to include as an insured the person or organization
shown in the Schedule, but only with respect to liability arising out of "your work' for that insured by
or for you
10 r—ORAQ
CG 20 10 1185 Copyright. Insurance Services Office, Inc., 1984
Certificate 0 22764
FROM FITNESS AND WELLNESS INSURANCE (MON)JUN 20 2005 12:02/ST.12:00/No•6820420804vP
ADDITIONAL INSURED ENDORSEMENT
U
InsurenceCompany Z-LtguA �M I��i iNSUIt?A✓JC [�.
This andorsement modifies such insurance as is afforded by the provisions of Policy
# EDOG3390 -vii relating to the following:
Cine* 3lpgs
1. The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, Califomla
92701; ft officers, employees, agents, volunteers and representatives are named as
additional insureds ("additional insureds') with regard to Nability and defense of suits
arising from the operations and uses performed by or on behalf of the named insured.
2. With respect to ciafms arising out of the operations and uses performed by
or on behalf of the named insured, such insurance as is affordad 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 "I 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 Canter Plaza, Santa Ana,
California 92701.
(Completion of the following, inotuding c:ounterslgnature. Is required to make this
endorsement affective.)
Effective Vh%-i -3t; 2ppy5 -1 P01 31, this endorsement form as a part of
Policy# tMtF10la3;-e—oW G t�►�Tax 3r�g�
Issued to
Countersigned by_...__
Representative
'.crura Slit: Sl:�cdy .
45���'uult C7tm ,'FCnr-,rr