HomeMy WebLinkAboutCARD METERING SYSTEMS 1G ZOOS,
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AGREEMENT TERMINATION
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Please complete this form when the attached agreement is no longer in effect.
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Return form to the Sr_ Deputy Clerk of the Council (M -30). C 116f%5 ;238 i RA e any
questions.
The agreement with lam'\ �1 LVIG'j at 1 , �(n�.., No. 1U "off ,5—OC)1
was completed on 1 1
p � I (j5 ,and final payment has been made.
Department: 1' ILC5 IA'
Signature: 'Ffx
Date: (-Qili1iLy
City of Santa Ana
Revised 8 -7 -03 Clerk of the Council
INSURANCE ON FILE
WORK lirA Y PROCEED
UNTilIl~SURANCE EXPIRES
J.f - d, fI-06
CLERK OF COUNCIL
DATE: /- 13-oS
C,: PR.li. THIS AGREEMENT made and entered into this r day of~, 2004 by
1..1>.~) and Card Metering Systems, Inc. a California Corporation (hereinafter "Consultant ), and the
City of Santa Ana, a charter city and municipal corporation organized and existing under the
Constitution and laws of the State of California (hereinafter "City").
N-2005-00l
CONSULTANT AGREEMENT
RECITALS
A. The City desires to retain a consultant having special skill and knowledge in the field of
management of self serve photocopiers, printers, coin operated mechanisms and debt
card controls.
B. Consultant represents that Consultant is able and willing to provide such services to the
City.
C. In undertaking the perfonnance of this Agreement, Consultant represents that it is
knowledgeable in its field and that any services perfonned by Consultant under this
Agreement will be perfonned in compliance with such standards as may reasonably be
expected from a professional consulting finn in the field.
NOW THEREFORE, in consideration of the mutual and respective promises, and subject to the
tenns and conditions hereinafter set forth, the parties agree as follows:
1.
SCOPE OF SERVICES
Consultant shall provide copier and micrographic printer service with debit card
technology at the McFadden Learning and Technology Center, as set forth in Exhibit A
("Facilities Management Agreement") to this Agreement.
2.
COMPENSATION
a. City agrees to pay, and Consultant agrees to accept as total payment for its services,
the rates and charges identified in Exhibit A. The total sum to be expended under this
Agreement shall not exceed $3,700.00, annually, during the tenn of this Agreement.
b. Payment by City shall be made within thirty (30) days following receipt of proper
invoice evidencing work perfonned, subject to City accounting procedures. Payment need not
be made for work which fails to meet the standards of perfonnance 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 tenninate on
December 31 2005, unless tenninated earlier in accordance with Section 12, below. The tenn of
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this Agreement may be extended for two additional one-year tenns upon a writing executed by
the Executive Director of the Parks, Recreation and Community Services Agency and the City
Attorney.
4.
INDEPENDENT CONTRACTOR
Consultant shall, during the entire tenn 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 perfonns 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 perfonnance of work under this Agreement, Consultant shall
maintain and shall require its subcontractors, if any, to obtain and maintain insurance as
described below:
a. Commercial General Liability Insurance. Consultant shall maintain commercial
general liability insurance naming the City, its officers, agents, volunteers, and employees as
additional insured(s) and shall include, but not be limited to protection against claims arising
from bodily and personal injury, including death resulting therefrom and damage to property,
resulting from any act or occurrence arising out of Consultant's operations in the perfonnance 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 fonn attached hereto as Exhibit B upon execution of this Agreement and shall
be approved in fonn by the City Attorney.
b. Business automobile liability insurance, or equivalent fonn, 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
perfonnance 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. The following requirements apply to the insurance to be provided by Consultant
pursuant to this section:
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(i)
Consultant shall maintain all insurance required above in full force and
effect for the entire period covered by this Agreement.
Certificates of insurance shall be furnished to the City upon execution of
this Agreement and shall be approved in fonn by the City Attorney.
Certificates and policies shall state that the policies shall not be canceled
or reduced in coverage or changed in any other material aspect without
thirty (30) days prior written notice to the City.
(ii)
(iii)
e. 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
tenninate this Agreement. Such tennination shall not effect Consultant's right to be paid for its
time and materials expended prior to notification oftennination. Consultant waives the right to
receive compensation and agrees to indemnify the City for any work perfonned 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 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.
7.
CONFIDENTIALITY
If Consultant receives from the City infonnation which due to the nature of such
infonnation is reasonably understood to be confidential and/or proprietary, Consultant agrees
that it shall not use or disclose such infonnation except in the perfonnance of this Agreement,
and further agrees to exercise the same degree of care it uses to protect its own infonnation of
like importance, but in no event less than reasonable care.
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 perfonnance 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:
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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:
Executive Director of Parks, Recreation and Community Services
City of Santa Ana
20 Civic Center Plaza (M-23)
P.O. Box 1988
Santa Ana, California 92702
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
To Consultant:
CMS, Inc.
1571 North E Street
San Bernardino, CA 92405
telefacsimile (909) 884-6058
Attn: Tamara Leslie
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 tenns of this Agreement and any attachments hereto, the
tenns 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 tenns or conditions of any purchase order or other instrument that are inconsistent
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with, or in addition to, that tenns 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 perfonned by City personnel or by other consultants retained by City.
12.
TERMINATION
This Agreement may be tenninated by the City upon thirty (30) days written notice of
tennination. In such event, Consultant shall be entitled to receive and the City shall pay Consultant
compensation for all services perfonned by Consultant prior to receipt of such notice of tennination.
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, tennination or
other employment related activities. Consultant affinns 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 has been executed and delivered in the State of California and the
validity, interpretation, perfonnance, and enforcement of any of the clauses of this Agreement
shall be detennined 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 tenn of this Agreement, maintain all necessary licenses,
pennits, 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 pennits, licenses,
approvals, waivers, and exemptions. Said inability shall be cause for tennination of this
Agreement.
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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 tenns of this Agreement, and shall
indemnify City fully, including reasonable costs and attorney's fees, for any injuries or damages to
City in the event that such authority or power is not, in fact, held by the signatory or is withdrawn.
b. All Exhibits referenced herein and attached hereto shall be incorporated as if fully set
forth in the body of this Agreement.
IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year
first above written.
ATTEST:
CITY OF SANTA ANA
~¿.:.. -J1 <f
pATRICIA E. H;A,.L Y
Clerk ofthe Council
~~
City Manager
APPROVED AS TO FORM:
JOSEPH W. FLETCHER
City Attorney
By:dtW-Æc~y
Laura Sheedy /
Assistant City Attorney..
CONSULTANT
Tax ID# g(P05$ ;J1C:>
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EXHIBIT A
FACILITIES MANAGEMENT AGREEMENT
CMS, Inc, will provide the following Facilities Management Cost-Per-Copy system to provide self-serve
photocopiers, micrographic reader printers, coin operated mechanisms and debit card controls, and printers to be
located at City of Santa Ana, McFadden Center, 2627 W. McFadden, Santa Ana, CA 9270 I.
EOUIPMENT
CMS will install, onerate, maintain and service the following enuinment as more fullv set forth below:
Item Description Location
I Sharp SF-7900, Coin Operated, ACT Debit Card add value reader, McFadden Center
SOO Sheet 8.Sxll, 2S0 Sheets 8.Sx14 Citv of Santa Ana
2 DigiNet Print Management Software on NT network with debit McFadden Center
card and HP Network Printers for printing from LAN City of Santa City of Santa Ana
Ana owned.
Debit Cards will sell for $1 and be encoded with $0.50 of value. The Debit Card price is $O.SO, including sales tax
computed to the nearest mil. The Debit Card is non-refundable. Replacement copies or prints will be issued as
refunds.
The branch libraries will sell pre-encoded debit cards for $3.50 including sales tax. The cards will have $3,00 in
value plus a SO.;-card charge. If a card is turned in towards a purchase, a credit for SO'; will be allowed. CMS will
sell the cards to the City of Santa Ana for the branch libraries and bill the City of Santa Ana for the cards delivered.
The Main Library will disperse the debit cards to the branches as needed. Debit card sales will be included in the
gross sales.
SUPPLIES
CMS provides 20 lb., long grain bond paper, no less than 86 bright and OEM toner. It is recognized that in an
emergency the City of Santa Ana may supply an inferior grade of paper without causing this contract to be breached.
VEND PRICES
Debit Card with coin on copiers, prints, and reader printers
CMS offers the following vend prices:
Debit Card core charge
Photocopies 8-1/2" x II" and 8-1/2" x 14"
Card
Computer Prints
SOø
ISØ Coin and ISØ Debit
IS'; per print, Debit Card only
Sales From Sales To Commissions/Charges
$0.00 $300.93 per month gross sales Customer guarantees a minimum $300.93 sales per
month in grOSS sales
$300.94 And above in net monthlv sales Customer earns 20.% above $300.94
MONTHLY COMMISSION and CHARGES
City of Santa Ana agrees to subsidize and guarantee the minimum average monthly revenue of $300.93 per month to
be computed on a quarterly basis. In the event the net quarterly revenue generated is less than $902.79 City of Santa
Ana will be charged the difference between $902.79 and the actual revenue collected. Commissions will be
computed monthly and paid quarterly, Any guaranteed amount owed during the quarter will be deducted from any
commissions earned during the quarter and a check issued for any commissions earned or an invoice issued for any
balance owed.
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TRAINING
CMS will provide all necessary Key Operator training for your City of Santa Ana staffs so that they will be able to
effectively operate all equipment provided.
SERVICE
CMS provides scheduled maintenance and emergency service Mondays through Fridays from 8:00 a.m. to 5:00
p.m.; Saturday and Sunday service from 9:00 a.m. to 3:00 p.m. Service calls are accepted seven days a week, 24
hours a day through one of several 800 service numbers. The lines are staffed Monday through Friday from 8:00
a.m. through 5:00 p.m. and through our voice maiVanswering system during after-hours, holidays and weekends,
Your service requests will be handled by our skilled factory trained technicians. Our technicians operate from our
fleet of electronic-dispatched fully stocked service vehicles that carry parts, supplies and paper necessary to operate
and maintain your Facilities Management Cost-per-Copy System. A parts storage locker will be installed in the
library (if space is available) that will enhance the service technician parts supply. Emergency Parts Orders are
available to augment the normal part's inventory.
Maintenance and service scheduling will be according to the factory recommendations for preventative maintenance
and "emergency service" will be on an "as-needed' basis. Our response time for hardware and copiers is eight
contiguous working hours. OUT service technicians or account representatives will collect the machines on a routine
basis.
KEY OPERATOR RESPONSIBILITIES
Staff will provide Key Operators and MIS Staff to operate the ITC Print Queue System and hardware installed by
CMS. The Key operators will do the following:
1. Load Paper
2. Clear Paper Jams
3. Replace Toner Cartridges when they run out of toner,
4. Reset the Print Queue Workstation if the station is not recognizing the print jobs.
5. Check and verify the Print Queue Workstations are logged onto the server.
6. Manually Print a "Test Page" to check that the printer is working and printing.
7. Notify CMS after verification that the problem is not Network related, or if it requires supplies, paper,
toner, debit cards or the machine will not take money.
Every time a Workstation Printer is reported "not working" a Key Operator or MIS Staff who has a working
knowledge of the network MUST determine if the problem is either NETWORK related or is a PRINT QUEUE
workstation problem.
NETWORK PROBLEMS ARE LIBRARY RESPONSIBILITY
Client is not logged on to the Network
Print Queue Workstation is not logged on to Network
Print server down or locked up due to bad data packets from Internet printing
Client workstation locked up due to corrupt data sending to print server
Client workstations with improper driver loaded
Client workstations with improper log on numbers
Client workstation dropping PCL code due to overloaded cache
Network losing printer address
PRINT OUEUE PROBLEMS ARE CMS RESPONSIBILITY
Printer does not deliver a "Test Page" when a manual test is started
Debit Card unit is jammed
Debit Card unit displays a "error code"
Hardware errors, FAT errors, GPF etc.
a.
b.
c.
d,
e.
f.
g.
h.
a.
b.
c.
d.
Key Operators or MIS Staff will immediately notify CMS of any problem requiring technical assistance that is
beyond Key Operator or MIS Staffresponsibilities identified above by calling our toll-free number, 800-527-3331.
In the event the Key Operator, MIS Staff or other authorized Library personnel call CMS for service and the
problem is found to be NETWORK related or a Key Operator responsibility a minimum service charge of $1 00 for
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the first hour and $69.00 for each hour thereafter will be charged to Library. [During the initial 30-day period after
installation all service charges will be waived,]
KEY OPERATOR BYPASSIREFUND COPIES
Each Key Operator outside the City of Santa Ana will be supplied with one 100 unit card for use in giving service
and bypass copies. Key Operator Cards will be replaced as needed. The City of Santa Ana will be issued ten 100-
unit debit cards for use in giving service and bypass copies.
STAFF BYPASS COPIES
The City of Santa Ana staff will be provided one 200-unit debit cards for making monthly staff copies in the
McFadden Center. Additional debit cards may be ordered from CMS at the rate of$6.60 for a 200-unit card or $3.30
for a IOO-unit card plus sales tax. Staff cards may be used on copiers, computers, micrographic reader printers, and
printers.
INSURANCE
CMS will provide a Certificate of Insurance to the City of Santa Ana Public. The amount of insurance will be
$1,000,000.00. Failure to maintain insurance is a breach of this agreement.
TERM OF AGREEMENT
1.. ..J~y of Santa Ana grants CMS the exclusive right to provide the equipment specified above for a period ending
2WC{' .~. fellf months after installation, after which it may be extended for additional 12-month periods with the
0J ' approval of both parties.
CANCELLATION
CITY OF SANTA ANA may cancel this agreement for cause if the vendor, CMS, defaults or violates the terms of
this agreement, unless it is out of the vendors control, by giving the vendor a written 30 day notice of intent to
cancel for cause.
Items that are considered "Cause" include: failure to replace any piece of equipment that has more than five (5)
failures for the same problem in any 30 day period, failure to respond to a service request within eight working
hours, failure to deliver paper, toner and other supplies within eight working hours or lapses in or cancellation of our
liability insurance.
Exceptions to "Cause" are elements that are out of the control of CMS or act of God. Such elements could include:
traffic or weather conditions or natural disasters that cause delays in travel or transportation, earthquakes, strike by
suppliers, out of stock conditions of suppliers or product unavailability from suppliers,
CITY OF SANTA ANA may cancel this agreement for non-funding on the part of the City of Santa Ana.
This agreement may be canceled with 30 day written notice mutually agreed upon by City of SANTA ANA and
CMS,
RE-OPENERS/ANNUAL REVIEW
This "Agreement" provides for an annual review of the copier vending operation provided to the CUSTOMER by
CMS. Items to come under review shall include, but not be limited to, performance of service responsiveness,
evaluation of the equipment as it pertains to meeting the needs of the CUSTOMER and suggestions that may
improve the overall operation of this enterprise.
This "Agreement" may also be "re-opened" for modification(s) during the "annual review" and at other times as
may be necessary, Any details contained within the "Agreement" are subject to modification at the annual review
meeting and shall become binding upon the written agreement of both parties. The scope of such items could
include, but are not limited to, changing the vend prices, term of agreement, changing or upgrading of equipment,
adding equipment, changing the commission plan, bypass copies, charges for bypass copies and so forth as long as it
can be cost-justified.
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EXHIBIT B
ADDITIONAL INSURED ENDORSEMENT
FOR COMMERCIAL GENERAL LIABILITY POLICY
Insurance Company
This endorsement modifies such insurance as is afforded by the provisions of Policy
# relating to the following:
I. The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701; its
officers, employees, agents, volunteers and representatives are named as additional insureds
("additional insureds") with regard to liability and defense of suits arising from the operations
and uses perfonned by or on behalf of the named insured.
2. With respect to claims arising out ofthe operations and uses perfonned 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 9270 I.
(Completion ofthe following, including countersignature, is required to make this endorsement
effective.)
Effective
Policy #
Issued to
, this endorsement fonn as a part of
Named Insured
Countersigned by
Authorized Representative
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OF 't'HI;: M'OVi Oe$CRlSED f'OLrt::rF.3 BE 0l"INCE;u.El:t BEfORe THE
e~MTlON OAT'Iii TIBt:;Ol", THe 1$$lJ1l'lO iNSUlteR wh.i. ENQEJ\VOR TO MAn.
30* nAYS ~t'tiEN NOTICE TO THE oeRTlliICA,TJ;' HOLDER NAMeD TO Tl'lt! Lt!!'T,
City of San~a Ana
:'~"~ of the City Council
~'.' Civil; CAnter Plaza (M...30)
Santa Ana, CA 92704
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_: ,/ Bl.IT FAlt.URE TO MAIL SUOH NOTIO& SHALl. IMPOse NO OeLK;ATION OR t.1A.8IUTY
ANY KIND UI"ON THE t~UR'EiR. ITS MENTS OR REPflE5fNTATIVE3.
I'!~CN'r^T1VE:
@ACORDCORPORATlON '988
ACORD 25 (2001108)
12/0702006 11:51
5205719667
KOTYLEAVIT
PAGE 03/05
IMPORTANT
IllM cerlifloate holder i. en ADDiTIONAL INSURED, the policy(les) must be endorsed. A statement
on thiS eertlftcete does not confer Mghls to the ceJ1ifieale holder In lieu of such endorsement(s).
II SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, eert.1oin pc:>lici.. may
roqui.... on endorsement. A .wemoot On this oortlficat. doeo nol confar ri!lhts to th. certificate
holder in lieu of!Uch endorsement(s).
DISClAIMER
Th. c.rti1ioate of Insurance on the rove.... $ide of thl. form does not conotitule . contram between
the issuing insurer(9), authoriZed representative or producer, and the certificate holder, nor does it
eflirmatlvely or negatively emend. extend or 8~r the coverage afforded by th~ polieits 1i8ted thefllQn.
Af'PR.G
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lb) Rented to, in the care, custody or
control of, or over which physical
control Is being exercised for any
purpose by you, any of your
"employees", "volunteer workers',
any partner or member Qf you are
a partnership or joint venture), or
any member (If you are e limited
Hebillty company).
b. Real Estate Manager
Any person (other than your "employee" or
"volunteer workerj, or any orgMizalion
whUe acting as your real estate manager.
c. Temporary CuStodians Of Your
Property
Any per.;on or ol1lanmon hailing proper
temporary custody of your property If you
die, but only:
l1) wtI1 respect to liability alising out of the
maintenance or use of that property; and
(:ll Until your legal representative has
been aPllOlnted.
d. t..egal Rep""sentative If You Die
Your legal representatiVe If you die, but
only with respect to duties as such. That
represemative wi. have aft your rights and
duties under this insurance.
e. Unnamed Subskllary
Any subsldiary and subsidiary thereof, of
yours which is a legany incoJllOl'lted entitY
of which you own a financial interest of
more than 50% of the voting stoe!< on the
effective date of Ihis coverage Part.
TIle insurance afforded herein for any
subsidiary nol shown in the Oeclarations
as a named insured does not appty 10
Injury or damage with respect to which an
insured under this insurance is also an
insured under another policy or would be
an Insured under such policy but for its
termination or upon the exhaustion of its
"milS of Insurance.
3. Newly Acquired Or Fonned Organization
Any organization you newly acquire or form,
other than a partnership, joint venture or
limited liability company, and over which you
maintain ~nanclal interest of more than 50% of
the voting stock, will quality as a Named
Insured if there is no other similar insurance
ave;lable to that organization. However.
a. Coverage under this provision is afforded
only until the 160th day after you acquire
or form the organization or the end of the
policy period, whichever is earlier; and
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PAGE 04/06
KOTVLEAVIT
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BUSINESS UABIUTY COVERAGE FORM
b. Coverage under this provision does not
. apply to:
(1) "BodUy injOry" or "property damage"
thai occurred; or
(21 "Personal and advertising injury"
arising oul of an olfense committed
befOl" you acqUired or fonned the
organi2;slion.
4. Operator Of Mobile Equipment
wtI1 respect to "mobile equipment" regiStered in
your name under any motor vehicle registrali<ln
laW, any person Is an insUred whue driving such
equipment along a publiC highway with your
pe..lwiDn. Any other person or organization .
responsillle for the conduct of .such persOI1 Is
alsO an Insured, but only with respect to r..billty
erising out of the operation of the equipment and
only if no o\hel' insurance of any k.iIld io avaHable
to that pelOOn or OIganizalion for thio Iiablrrty.
However, no person or organization is an insured
with respaclto:
a. "Bodny injury" to a co-"employee' of the
person driving the equipment; or
b. "Property damage" to property owned by.
rented to. in the chaI1le of or occupied by
you or the employer of any person who is
an insured under this provision.
6. Operator of NOIlowned Watercraft
\Mtl1 respect to waterore1l you do not own that
is leSS than 51 teellong and is not being used
to carry persons for a chal'lle, any person is an
insured while operating such watercra1l wtth
your permiSSiOn Any other person or
organization responsible for the conduct of
such person is alSO an insured, but only with
respect to liability a""iog out of the operation
of the watercraft, and only if no other
insurance of any kind is availabie 10 that.
person or organization for thiS liability.
However, no pemon or organization is an
Insured with respect to: .
a. "Bodily injury" to a co."employee" of the
person operating the watercraft; or
b. "Property damage" 10 property owned by,
rented to, in the charge 01 Of occupied by
you or the employer of any person whO is
an insured under this provision,
6. Additional Insureds When Required By
Written Contract, Written Agreement Or
Permit
Tl]<ljl"t~9!1(1Ii'lor organiZation(s) identified in
Paragrsphs a. through f. below are additionel
Insureds when you have agreed. in a written
,_or'"c:y
Page 11 of 24
:2/~7/~0e6 11:51
520571 %67
KOTVLEAVIT
PAGE 05/05
:Si.lSINESS UABILITY COVERAGE FORM
contract. WI'iIIen agreement or because of a
pennit issued by a state or pofltical
. subdivision, that such perSOn or organiZation
be added as .n additional insured on your
~oficy. provided tI'Ie in"ry Of damage occurs
subsequent 10 tI'Ie execution of the contract or
agreement, or tI'Ie issuance of tI'Ie permit.
A person or organiZatiOn is an additional
InSUred under this provision only for that
periOd of time required by the contract,
agreemelll or pennit.
However, no such person or organiLalion is an
additional insured under tI'Iis provision if such
pelSOI1 or organiLalion is included as an
.,lditional insured by an endorsement isSuM
by us and made a part of tI'Iis Coverage Part,
indUdinll all persons or organizations added
as additional Insureds under the specific
additional insured coverage granl!l in Section
F. - Optional AddiIionallnsura<l Coverages.
a. Vendors
Arty peISll11(s) or 04ga1oi<.at1On(S) (reIe!red 10
beIDw as vendor). but only wilh respect 10
"bodily in)lry" Of "Plopert'i damage" arising
out of ~r products' WhIclIlIf'Il disUi\lWld
Of sold .in 1he regular ~ of 1he veOOol's
bUsiI1e5S and only if 1l1iS C01/l!tlIge Part
provi:leS coverage b "bodIy il)..ly" or
'p,opert) damage' inducIed wllhin 1he
'produc\s-COf11lleted Ul*aIionS ha%.llId".
(1) The insurance afforded to the vendOr
is subjeCllO the following additional
exclusions:
This Insurance does not apply to:
(a) "B<xtily injury' or 'property
aamage' for which the 'oIendor is
obligated to pay damages by
reason of tM assumption of
Damlny in a contract or agreement.
this exclusion dOes IlOl apply to
labilay for damages that the
vendor woulcl have in Ille abSence
of the contract Of agreement;
(bl Any eJ(I)I'eSS warranty
unauthoriZed by you;
(e) Any physical or chemical ohange
in the product made intentionally
by the vendor.
(d) RepaCl<agIng. exuept when
unpacKed solely lor the purpose of
inspection, demonstration. testing,
or the sullSllMlOn of parts u~
instructions from the manufaelurer,
anO then repacl<aged in the
onginal container;
Ie) Any failure to make such
inspections, adjustments, tests or
serviCing as 111. vendor has
agree<! to make or normally
undertakes to make in the usual
course of bUSiness. in connection
with the distMbulion or sale of the
products;
If) DemonstratiOn, instanation,
servicing or repair operations,
except such operations performed
at the vendo(s premse5 in
connection with the sale of the
prOOuct;
(g) ProdlJcls which, after distribution
or sale by you, have been labeled
or relabeled or used as a
container, part or ingredient of any
other thing or substance by or for
the vendor; or
(h) "Bodily ;njJt;'" or "property
damage" arising out of the sole
negligence of t\1e vendor for its
own acts or omissions or those of
its employeeS or anyone else
acting on its behaif. HoweVer. this
exclusion :leeS no! apply ro:
(i) The exceptioI1s contained i1
subparagraphs (<I) orlfl; or
(n) Sud1 inspections. adjlstmenlS,
tests or seMdn!l as the vendor
has agreed In make or normally
undellakeS In make in the usual
COUfSll of bUSineSS, in
connection ....... the distribution
or sale aftheproduClS.
(2) This insurance does not apply \0 any
insured person or organizallon from
..tlOm you have acquired such products.
or any ingre<flent. part or contliner,
en1I!<1ng Into, 8WJH ifJlInying or
containing such produclS.
b. Lessors Of Equipment
(1) Any person or organization frOm
whom you lease equipment; but only
with respect to their liabilly for "bodily
injUry", "pmperty damage" or
"personal and advertising injulY"
caused, in whole Of in part. by your
maintenance, operation or use of
equipment leased to you by such
p~~~n ~r organization.
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If more than one ~mit of insurance under this
poley and any endorsements attacl1ed theretO
appHes to any Claim or "suit", ll1e most we will pay
under this policy and the endotSeltl!!nts is the
single highest limit of liab'-liIy of all coverages
applicable to sucl1 claim Qf "sulf'. However, this
paragraph does not apply to the Medical Expenses
Iimil set forth In Paragraph 3. alloW.
The umts of lnsuranOe of this ~ Part apflIy
sep8lalely to eatf1 COI1Sl!aIfi\Il! amual period and to
any l"ellIlIinQ;I period of _1Ilan 12 moltlhs. slal1ing
will the begiMIng of \I1e poicy period shown In the
DeClarations, unless the policy period is el(Iended
aIer tssuance for an addiIIonal period of leSS 1Ilan 12
rnonlhs. In thIll case, Ille ..ckIIb IaI period wi! be
de$med part ofllle Ia9t P,.....lll period for purposes
ofu..o..lIliling the I.ltr01S ofinsumnOe-
E. UABIUTY AND MEDICAL exPENSES
GENERAL CONDIl10NS
1. Bankruptcy
Bankruptcy or insoMlncy of the insured or of
the Insured's esla1e will not relieve US 01 our
obligations under1l1is CovenIge Part.
2. Dutle$ 111 TIle Event Of Oc:c1llTellCe,
Offense. Claim at Suil
a. Notice Of Occumnce at Offi!nse
You 0/' any addi!iollQl ilsured must see 10
a that we are notified as soon as
ptilcticable of an "ocanrence" or an
offense whicll may resuft in a claim. To
the elCIent possible, notice should indude:
(1) How, wlteO.aI1Cl whet'e tile "occwrence"
or oMlnse 1ll<lIc plaCe;
(2) 1l1e names and addresses of any
Injured pel'SOns.and wilne5Ses; and
(S) ilIe nature and location of any injul)'
Or damage arising out of the
.occurrenw" or offense.
b. Notice Of Claim
If a Claim is made or 'suit." is brought
against any insured, you or any additional
insured must:
(1) Immedia1e1y record the speeifics oflhe
claim or "sulf' and the dale receiVed;
and
(2) Notify us as soon as practicable.
You or any add.lonal ilsured must see 10
a that we receive a w1itten notice of the
claim or "suil" as soon as practicable.
c. AsSistance And cooperation ot.i'P"
Insured
You and any other involved insured must:
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PAGE 06/06
BUSINESS UABUJTY COVERAGE FORM
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(1) Immediately send us copies of any
demands, notices, summonses or
legal papen; received in connection
with the Claim or "suU";
(2) Authorize US to Obtain records and
other inf<>lTTlation;
(3) Cooperate with us in the investigation,
seuklmenl of the claim or defense
against the "suil"; and
(4) Assist us, upon our request, In the
enfon:ernent of any light against any
person or. organil:ation that may be
liable 10 the insured because of injUry
or damage to whioh this ilsurance
may alSO JlPIlIY.
d. Obligations At The lnSureers Own Cost
No ins&nd will, elCt:epI: 1111hallnsured's own
cost. IIllluntalIly make a pa~ assume
any obligation, or IncUr any expenoe, other
than 10rirst aid, .wlhOut our consent
e. Additional Insured's OCher insUJllllce
If we cowr a Claim 0/' "suit" under this
Coverage Part that may also be oavered
by other inSurance available 10 an
additional inSured, such acIditiOnal insured
must submit such efaim or "suit" to Ille
other insurer forderense and indemniy
Howewr. this proyision ~oes not apply 10
the extent that you have agreed in a
wrIlIen contract, wrIlIen agreement or
permit thai !hi!! insurance is pIImary and
non-conllibutOlY with the additional
insUred's own insurance.
f. Knowledge Of An occurrence, Olfense,
Claim Or Suit
Paragraphs a. and b. apply to you or to
any addltlonal insured only when sUCh
.occurrence", offense, Claim or "suit" is
known to:
(1) You or any additional insured that is
an Individual;
(2) Any partner, if you or an additional
inSured is jl pertnership;
(3) Any manager, If you or an additional
Insured is a limited liabllily company;
(4) Any "executive ofIicer" or inSurance
manager, if you or an additional
insured is a corporation;
(5) Any trustee, if you or an addttional
',"_, ,~'dQ~~fd is B trust; or
.(&)- Any elected or appointed ollicial, if you
or an addUlonal insured is a political
~ullclMsion or public entity.
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Page 15 of 24
~lW". CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDNYYY)
12/15/2004
PRODUCER (520)571-1900 FAX (520)571-9667 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Koty-leavitt Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTENO OR
6992 E. Broadway Blvd ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Tucson, AZ 85710-2803
INSURERS AFFORDING COVERAGE NAIC#
INSURED Card Metered Systems Inc INSURER A: ACE American Insurance Company
DBA: CMS dba INSURER B:
1104 N Anita Ave INSURER c:
Tucson, AZ 85705-7518 INSURER D:
INSURER E:
COVFRA¡;E'"
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 MAV HAVE BEEN REDUCED BY PAID CLAIMS.
INSR DD' TYPE OF INSURANCE POLICY NUMBER PR...L.~S~ EFFECTIVE POLICY EXPIRATION LIMITS
GENERAL. LIABILITY EACH OCCURRENCE $
r- DAMAGE 19r:;~ENTED .,,\
COMMERCIAL GENERAL LIABILITY $
I CLAIMS MADE D OCCUR MED EXP (Anyone person) $
PERSONAL & ADV INJURY $
r-
GENERAL AGGREGATE $
r-
GEN'l AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPfOP AGG $
h ,n:RO- n,
POLICY JECT lOC
~TOMOBILE UABILITY COMBINED SINGLE LIMIT .
ANY AUTO (Eaaccident)
r-
ALL OWNED AUTOS BODILY INJURY
r- $
SCHEDULED AUTOS (Per person)
f-
HIRED AUTOS BODILY INJURY
r- .
NON-OWNED AUTOS (Per accident)
r-
f-- PROPERTY DAMAGE $
(Peracddent)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
R ANY AUTO -/8:3 II 2 OTHER THAN EAACC '
"-- AUTO ONLY: AGG $
,
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $
0 OCCUR D CLAIMS MADE AGGREGATE $
$
R ~EDUCTrBLE $
RETENTION $ $
WORKERS COMPENSATION AND I T'X~~T~,Ir¥s I 10J~-
EMPLOYERS' LIABILITY
ANY PROPRIETORfPARTNERfEXECUTIVE E.L. EACH ACCIDENT $
OFFlr.ERfMEMBER EXCUJDED? E.L. DISEASE - EA EMPLOYE .
If yes, describe under
SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $
p~THr. CRl139400 04/28/2004 04/28/2005 $1,000,000 Wrongful Act
ro ess;onal Liabil ity
A $1,000,000 Aggregate
$10,000 Retention
l...ESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS attached.
certificate holder is named as Additional Insured per form PF8X31c (10/99)
This certificate is subject to all policy terms, conditions, exclusions, forms & endorsements
City of Santa Ana
Attn: Clerk of the City
20 Civic Center Plaza
Santa Ana, CA 92702
Counci 1
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
ACORD 25 (2001/08)
OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
D REPRESENTATIVE
@ACORD CORPORATION 1988
. .
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---- - ---- - - ---- ---------.--------..---.
ADDITIONAL INSURED ENDORSEMENT- NON AFFILIATED ENTITY
- --------------------,
-----------
-------
------------------- ~
~-~~---------~~'--'~--rËñdori;ment Number ----1'
-~-- ..H' -- -- ---_!
I;.' Effective Date of Endorsement ¡ , i I
4/2~/2!1QL_____! 12/1/04 ' ; . .
----------=-~.:-::-~--~-=-=====:::........-.-- -----_==-=::,::,,:=--"-j I
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--"---------------'---------
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IINamea-¡ñiurecr ----m__~~-_~~._--~--_.._~,,_.
, Card Metered Systems, Inc.
.-.....- --- - ---
! Policy Number Policy Period
i~~RL_l~9~0. - _.__._._=c:==_~2!!/2004_=--=~=-c-=
i Issued By (Name of Insurance Company)
L____~~~_~~eri~~_!~~~~~,=--~~~~~~X._-
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Insert the policy number. The remainder ot the information is to be compteted only when this endorsement is issued subsequent to the preparation of tl1e policy.
------ ---------------.
- --------------
-------
- ______n______------
-- "--.---------"--.----------
The following Special Conditions apply to your policy:
SECTION 1- DEFINITIONS, has been arnended to include the following:
r
r Additional Insured means any person or organization:
r
(1) which is not owned or controlled by any insured; and
(2) which does not own or control any insured; and
(3) which is not affiliated with any insured through common ownership or control; and
(4) in which no director, officer, partner nor principal stockholder is an insured otherwise covered under
this policy -
¡ ;
i
, i as scheduled herein.
The coverage afforded to the additional insured applies solely to liability arising out of wrongful act(s)
, of insured(s) in their perfonnance of or failure to perfonn professional services on behalf of the Named
: Insured.
i SCHEDULE OF ADDITIONAL INSUREDS
:
City of Santa Ana
20 Civic Center Plaza
Santa Ana. CA 92702
~
¿ /z.
Nothing contained herein shall be construed as increasing the limits of liability available to pay any
claims(s).
, All other terms and conditions of this policy remain unchanged. This end rsement is a part of your
Policy and takes effect on the effective date of your policy, unless an er elle iv~date is indicated on
this endorsement.
PF 8X31c (10/99)
_____n--_--__-
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CERTHOLDER COPY
STATE
P.O. BOX 420807, SAN FRANCISCO, CA 94142-0807
COMPENSATION
INSURANCE
FU N C CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
ISSUE DATE, 10-13-2004
GROUP: 000560
POLICY NUMBER: 364-2004
CERTIFICATE ID: 19
CERTIFICATE EXPIRES: 10-01-2005
10-01-2004/10-01-2005
CITY OF SANTA ANA
CLERK OF THE CITY COUNCIL
20 CIVIC CENTER PLAZA (M-30)
SANTA ANA CA 92704
This is to certify that we have issued a valid Worker's Compensation insurance policy in a form approved by the California
Insurance Commissioner to the employer named below for the policy period indicated.
This policy is not subject to cancellation by the Fund except upon 10 days advance written notice to the employer.
We will also give you 10 days advance notice should this policy be cancelled prior to its normal expiration.
This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the
policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with
respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy
described herein is subject to all the terms, exclusions, and conditions, of such policy.
~
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AUTHORIZED REPRESENTATIVE
PRESIDENT
EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS, $1,000,000 PER OCCURRENCE.
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EMPLOYER
CARD METER SYSTEMS INC
1104 NORTH ANITA
TUCSON AZ 85705
SCIF 10262E
[TB,SJ)
PRINTED: 10-13-2004
PAGE 1 OF1
Accept this certificate only if you see a faint watermark that reads "OFFICIAL STATE FUND DOCUMENT"
0~/05/2005 15:50 7145714209
MAY-02-20C5 MON 08:35 AM APS AFFILIATES
PARKS AND RECREATION
FAX NO, 9098857572
PAGE 02
r, Ui
u__..._.__'.-
ACORP"CERTIFICATE OF LIABILITY INSURANCE l .~~;:izO~~'
.AODUd."C.5lii)5fi: 1900 F"'" (.20).7I='9667 THIS ceFtTIFle"'TE IS l~$UED AS" M"'TTl'R Of 1l\~ORM"TION
Koty-I.j;:l.vi t~ insur.n," All"ncy, Inc. OOlL Y AND CONF~1l.S NO RIGHTS UPClII TIl~ C~RlIFIC"U,
HOLrli!R. THill CERTIFICATE DD~g NOT AMEND, e. r~NP OR
~99.1 E. I\ro.d...y Plvd "'Lr!".!..THeCO'yW~~,DEDI!'{_:nit:POI.!"'ES6fi~OW.
In.oon, AZ 3571Q-28D)
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OIlA.. 0.\$ db..
110+ N Anlt. Ava
Tacoon, Al 8570,-7518 . \
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ert11'1tat& f'l_lldQr is na,NIfllli as Additional In~ured,
.!NllrR-PIlOF o472iizoo~
04/11/2006
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P,L.OI51rASIi."lJlll;YLlpM1' I
$1,000,000 Wrongful Act
$l,OOO,QOO A9Qregata
$10,000 R.ten\lon
, ,------
~it~ of Santa Ana
Mtn, (larl. of tile City Council
Zo C;v,c Centar I'l,~a
Santa ^"a. CA gZ70Z
tOt'nl5o, condH,itlnJ, e)(C'U~iI)115. foMft,'i II I!ndors.&IMI="t~
C~Nr;F.LL.ATION
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h;S c"r\iflc'l. is SQb:l"~\ 10 B11 policy
IEwll1Ji !ImoDf.!L----
-...--
lMCORD C::ORPOflA.TION n..
._~
ACORD 10 (2001/001
...'~"....,_. .,.. ..." . ...:.,...".._ ... __.._' _. ____ __.,. __..._.--,,-..-... ~.._. "..",--","'.w","'LC,. ,.""",,,,..,.,
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PRODUCER (S20)571-1900
Koty-Leavitt Insurance
6992 E. Broadway Blvd
Tucson, AZ 8S710-2803
FAX (S20)S71-9667
Agency, Inc.
DATE (MMIDDIYYYY)
07/01/200S
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.
I
-. AmBLt
CERTIFICATE OF LIABILITY INSURANCE
INSURED
Card Metered Systems Inc
DBA: CMS dba
1104 N Anita Ave
Tucson, A2 8S70S-7S18
t.J - J.1J05 -OtJ I
INSURERS AFFORDING COVERAGE
INSURER A- Hartford Casualty Insurance
INSURER B:
INSURER c:
INSURER 0:
INSURER E:
Co
NAIC#
29424
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEO 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.
INSR DO'
TYPE OF INSURANCE
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
I CLAIMS MADE 0 OCCUR
POLICY NUMBER
POLICY EFFECTIVE
P2~lCY EXPIRATION UMfTS
07/01/2006 EACH OCCURRENCE , 1,000,00C
DAMAGE TO RENTED , 300 ,OO[
MED EXP (Anyone person) , 10,000
PERSONAL & ADV INJURY , 1,000,000
GENERAL AGGREGATE , 2,000,000
PRODUCTS. COMP/OP AGG , 2,000,000
S9SBABX2462 07/01/200S
A
-
-
GEN'L AGGREGATE LIMIT APPLIES PER:
---, nPRO- n
I POLICY JECT LOC
AUTOMOBIL.E LIABILITY
~
X ANY AUTO
-'-'--
ALL OWNED AUTOS
-
SCHEDULED AUTOS
-
HIRED AUTOS
S9UECTM74330 07/01/200S
.
07/01/2006
COMBINED SINGLE LIMIT
(Eaaccident)
,
1,000,000
BODILY INJURY
{Per person)
,
A
-
f--
f--
NON-OWNED AUTOS
BODILY INJURY
(Peracddent)
,
PROPERTY DAMAGE
(Per accident)
,
EXCESS/UMBRELLA LIABILITY
~ OCCUR D CLAIMS MADE
I DEDUCTIBLE
I RETENTION $
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
If yes, desClibe under
SPECIAL PROVISIONS below
OTHER
EACH OCCURRENCE
AGGREGATE
,
EA ACC $
,
,
,
,
,
,
AGG
~~GE UABIUTY
I ANY AUTO
AUTO ONLY - EA ACCIDENT
OTHER THAN
AUTO ONL yo
.., '"
"1'1'RO'!" ,>
-f} f o_.~~.
----r...-y. j" ." ---/'-'
;-\'''''''\
~,t.) l,-),-,l"
t..S .
--
-
I.we STATU- IOJb'-
E.L. EACH ACCIDENT $
E.L DISEASE. EA EMPLOYEE $
E.L DISEASE - POLICY LIMIT $
, '
DESCRIPTION OF OPERATIONS J LOCATIONS J VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT J SPECIAL PROVISIONS
e: Copy Machines at Santa Ana Public Library
he City of Santa Ana its officers, employees, agents and volunteers are named as Additional Insured
or General Liability.
Statutory non-payment
his certificate is subject to all policy terms, conditions, exclusions, forms & endorsements
U^,neD
, 'Tlml
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
30* DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE ~.
Jeanne Glessner/JG ~ WL. "L'
@ACORDCORPORATION 1988
City of Santa Ana
Clerk of the City Council
20 Civic Center Plaza eM-30)
Santa Ana, CA 92704
ACORD 25 (2001/08)
CERTHO~OER COPY
S.J
STATE
COMPENSATION
INSURANCE
FUND
P.O, BOX 420807, SAN FRANCISCQ,CA 94142-0807
CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
ISSUE DATE: 10-01-2005
GROUP: 000560
POLICY NUMBER: 0000371-2005
CERTIFICATE ID: 20
CERTIFICATE EXPIRES: 10-01-2006
10-01-2005/10-01-2006
CITY OF SANTA ANA
CLERK OF THE CITY COUNCIL
20 CIVIC CENTER PLAZA (M-30)
SANTA ANA CA 92704
S.J
This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the
California Insurance Commissioner to the employer named below for the policy period indicated.
This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer.
We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration.
This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded
by the policy listed herein. Notwithstanding any requirement. term or condition of any contract or other document
with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance
afforded by the policy described herein is subject to all the terms. exclusions, and conditions. of such policy.
~
~~c.
~
AUTHORIZED REPRESENTATIVE
EMPLOYER'S LIABI~ITY LIMIT INCLUDING DEFENSE COSTS:
PRESIDENT
$1,000,000 PER OCCURRENCE.
ENDORSEMENT #2085 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 10-01-2005 IS
ATTACHED TO AND FORMS A PART OF THIS PD~ICY.
EMPLOYER
CARD METER SYSTEMS INC DBA: C M S INC S.J
1104 N ANITA AVE
TUCSON AZ 85705
M0408
PRINTED
09-17-2005
(AEV.2.051
CERTHQLDER COPY
Su
STATE
COMPENSATION
INSURANCE
FUND
P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807
CERTIFiCATE OF WORKERS' COMPENSATION INSURANCE
ISSUE DATE: 10-01-2007
GROUP: 000560
POLICY NUMBER: 0000371 -2007
CERTIFICATE 10: 20
CERTIFICATE EXPIRES: 10-01-2008
10-01-2007/10-01-2008
CITY OF SANTA ANA
CLE~ OF THE CITY COUNCIL
20 CIVIC CENTER PLAZA (M-30)
SANT A N4A CA 127~
S,",
This IS to certlfv thllt we hllve Issued a valid Workers' Compensation Insurance policy In a form approved by the
ClIl,fornl. Insurllnce CommiSSioner to the employer named below for the policy period indicated.
ThiS poilCV IS not subject to cancellation by the Fund except upon 30 days advance written notice to the employer.
We Woll .Iso give you 30 days advance notice should this policy be cancelled prior to its normal expiration.
This certificate of Insurance is not an Insurance policy and does not amend. extend or alter the coverage afforded
by the poliEy listed herein. Notwithstanding any requirement. term or condition of any contract or other document
wIth respect to which this certificate of insurance may be issued or to which it may pertain. the insurance
afforded by the policy described herein IS subject to all the terms. exclusions. and conditions. of such policy.
~ ~(~~-~
~THORIZEO REPRESENT A TI
EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS:
PRESIDENT
$1,000,000 PER OCCURRENCE.
ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 10-01-2005 IS
ATTACHED TO AND FORMS A PART OF THIS POLICY.
EMPLOYER
CARD METER SYSTEMS INC DBA: C M S INC S.J
1104 N ANITA AVE
TUCSON AZ 85705
M0408
PRINTED
09-17-2007
(REV.2-05)
CERTHOLDER COpy
S.J
STATE
COMPENSATION
INSUFlANCE
FUND
P.o. BOX 420807, SAN FRANCISCO,CA 94142-0807
A. ;;)UL'i-f -,;)!;;L
CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
ISSUE DATE: 10-01-2008
GROUP: 000560
POLICY NUMBER; 0000371-2008
CERTIFICATE 10: 20
CERTIFICATE EXPIRES: 10-01-2009
10-01-2008/10-01-2009
CITY OF SANTA ANA
CLERK OF THE CITY COUNCIL
20 CIVIC CENTER PLAZA (M-30)
SANTA ANA CA 92704
S.J
This is to certify that We have issued a valid Workers' Compensation insurance pOlicy in a form approved by the
California Insurance Commissioner to the employer named below for the policy period indicated.
This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer.
We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration.
This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded
by the policy listed herein. Notwithstanding any requirement term or condition of any contract or other document
with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance
afforded by the policy described herein is subject to all the terms, exclusions, and conditions. of such policy.
d::REPRESENTATI
EMPLOYER'S LIABILITY LIMIT
~~
PRESIDENT
INCLUDING DEFENSE COSTS: $1.000,000 PER OCCURRENCE.
ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 10-01-2005 IS
ATTACHED TO AND FORMS A PART OF THIS POLICY.
-
-
-
EMPLOYER
CARD METER SYSTEMS INC DBA: C M S INC S.J
PO BOX 8344
TUCSON AZ 85738
(REV.2-0S)
PRINTED
09-17-2008
M0408