HomeMy WebLinkAboutK & A ENTERPRISES, INC. 1AAGREEMENT TERMINATION
Please complete this form when the attached agreement is no longer in effect
Return form to the Sr. Deputy Clerk of the Council (M-30). Call 647-52" u GONCIL
questions.
The agreement with
14
61t�s QS
AD03 -144-01 c 0
was completed on
and final payment has been made.
Department:
Signature:
Date:
City of Santa Ana
Revised 8-7-03 Clerk of the Council
4- acr 3 - / ,VV -01
INSURANtiE NOT ON FILE
WORK MAY NOT PROCEED
CLERK OF COUNCIL
DATE: fie- �v'a`P FIRST AMENDMENT TO
CONSULTANT AGREEMENT
C•. PBA
THIS FIRST AMENDMENT TO CONSULTANT AGREEMENT, is entered
into on N[ 4V ,X,� , 2004, by and between K & A Enterprises, Inc. ,
d.b.a. All Signs America, a California corporation ("Consultant') and the City of Santa
Ana, a charter city and municipal corporation of the State of California ("City").
Recitals:
A. The parties entered into Agreement #A-2003-144, dated July 7, 2003, (hereinafter
"said Agreement") by which Consultant has provided fabrication and installation of
bronze plaques to designate historical properties.
B. Since the inception of said Agreement, the cost of fabricating the plaques has
increased.
C. In accordance with the terms and conditions of said Agreement, the parties wish to
amend said Agreement to increase compensation paid per plaque to provide for the
increased per plaque fabrication cost.
Wherefore, in consideration of the covenants contained in said Agreement, and subject
to all the terms and conditions of said Agreement, except those amended in this First
Amendment to Consultant Agreement, the parties agree as follows:
That portion of Exhibit A identified as the PROPOSED FEE SCHEDULE FOR ALL
SIGNS AMERICA, shall be replaced with a new Proposed Fee Schedule, attached
hereto as Exhibit A-1, and incorporated by this reference. Said schedule sets forth the
price City shall pay for each plaque fabricated and installed by Consultant.
2. Except as amended hereinabove, all terms and conditions of said Agreement shall
remain in full force and effect.
IN WITNESS WHEREOF, the parties hereto have executed this First Amendment to
Consultant Agreement on the date and year first written above.
ATTEST:
P"ATRICIA E. HEALY
Clerk of the Council
APPROVED AS TO FORM:
JOSEPH W.FLETCHER
City Attorney
By: i n.
Laura Sheedy
Assistant City Attorney
APPROVED AS TO CONTENT:
/j A
' 4
Executive Director
Planning and Building
CITY OF SANTA ANA
A2
DAVID N. kEAM
City Manager
CONSULTANT
President
PROPOSED FEE SCHEDULE
FOR ALL SIGNS AMERICA
Order Quanity
Item
10
25
50
8"x10" Marker
Per unit cost
$
252.26
$
240.66
$ 225.36
Total cost per order
$
2,622.60
$
6,016.51
$ 11.267.83
Total cost for 45 markers
$ 11,351.70
$10,829.72
$10,141.04
Cx5" Marker
Per unit cost
$
114.86
$
109.85
$ 102.88
Total cost per order
$
1,148.60
$
2,746.16
$ 5,143.91
Total cost for 172 markers
$ 19,755.92
$ 18,893.60
$ 17.695.06
Sales Tax @ 7.75%
$
2,410.84
$
2,303.56
$ 2,157.30
Installation Cost per Unit
Installation on building
$
45.00
$
41.86
$ 39.13
Installation in sidewalk
$
200.00
$
186.05
$ 173.91
Personnel/Administrative Costs
$
-
$
-
$ -
Terms:
50% down payment on marker cost
Balance net 30
ExHIBIT A 1
• ' ` ^w;r ct.Xw "r: lj tU'LL i_J rr.Lu. ,-.
BLP Bronze InternakLional
260 Bartley Drive
Toronto, Ontario M4A IG5
Ph: 800-567-8383
Fax: 800-246-6326
May 17, 2004
Mr. Alan Gale
All Signs America
15481 Red Hill Ave. Suite B
Tustin CA 92780
Ph: 714-258-3600
Fax:714.258-9029
Dear Alan,
Thank you so much for the order fos the historical plaques for the City of
Santa Ana. Since the job was originally bid over one year ago, we were
unable to hoid the price for that length of time. Both bronze ingots and cur
labor costs have increased significantly since then.
The bid on yc ur 8 x 10 inch plaques was S204.26 each plus freight nine
months ago. The current cost of these plaques is $246.26 each, plus
freight.
The bid on your 4 x 5 inch plaques was $80.76 each plus freight twelve
months ago. The current cost of these plaques is $111.86 each, plus
freight.
We have also instituted an additional 10% meta! surcharge to cover the
56% increase in he cost of bronze that has occurred in the last 2 months.
I am not gong to add that surcharge to this job in the hopes that your
customer win be able to accept our new prices. I am so sorry that we had
to do this but long te, m bids are a difficult situation for all of us.
I have the H(,we-Waffle House plaque in production and it will be ready in
about two we Mks or sooner, if needed. I will wait to hear from you on the
others. They can be produced quite quickly if you give us the go-ahead.
Yours truly,
Linda Krabill
U.S. Marketing k anager
Architectural Bronze Division
BLP Bronze International
** TOTAL PAGE.01 r*
SENTRY INSURANCE A MUTUAL COMPANY
STEVENS POINT, WISCONSIN
(A PARTICIPATING MUTUAL COMPANY)
A MEMBER OF THE SENTRY FAMILY OF INSURANCE COMPANIES
F *zMW W3i=I=IZEd']-1Z141d
ACCOUNT NUMBER 49-39070
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.
Name and Address of Name and Address
Certificate Holder of the Insured
THE CITY OF SANTA ANA K & A ENTERPRISES INC DBA
ITS OFFICERS, EMPLOYEES, ALL SIGNS AMERICA
AGENTS, VOLUNTEERS & 15481 REDHILL AVE STE A&B
RESPRESENTATIVES TUSTIN, CA 92780
20 CIVIC CENTER PLAZA
SANTA ANA, CA 92701 A- L1
This certificate is issued on 09-23-2003 and is effective until 09-23-2004.
It certifies that policies of insurance listed below have been issued to
the insured named above. 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. Limits shown may have been reduced by paid
claims.
Coverage Provided
Businessowners Liability
. Includes:
Bodily Injury
Property Damage
Personal Injury
Advertising Injury
Hired and Non -Owned
Workers' Compensation and
Employer's Liability
oes Not Include:
-Pers/Adv Injury
49-39070-01 Each Occurrence 4 500
Medical Expense I 10
Fire Damage t 250
General Aggregate t 11500
Products Aggregate t 1,500
49-39070-02 Statutory
Each Accident
4
500
Each Disease/Employee
t
500
Each Disease/Policy
t
500
49-39070-03 Each Occurrence
t
1,000
General Aggregate
t
11000
Products Aggregate
i
1,000
If any of the listed policies are cancelled prior to their normal
expiration date, the insurer will send notice to the certificate
holder 30 days in advance.
80-C1035 (MECH)
ALL 49-39070 31-040406
05-28-2004
PAGE 1
(0007)
egy�
011IHORG 04634
SENTRY INSURANCE A MUTUAL COMPANY SENTRY'S BUSINESSOWNERS
STEVENS POINT, WISCONSIN POLICY
(A PARTICIPATING MUTUAL COMPANY)
A MEMBER OF THE SENTRY FAMILY OF INSURANCE COMPANIES
POLICY NUMBER 49-39070-01
NAME INSURED: K & A ENTERPRISES INC DBA
ADDITIONAL INSURED
SCHEDULE
The following information is required to complete the accompanying
additional insured endorsement which forms a part of the Named Insured's
BUSINESSOWNERS POLICY.
419�1t�[�1:LI�
THE CITY OF SANTA ANA
ITS OFFICERS, EMPLOYEES,
AGENTS, VOLUNTEERS &
RESPRESENTATIVES
20 CIVIC CENTER PLAZA
SANTA ANA, CA 92701
BP 70 23 02 97
EFFECTIVE
FROM SEPTEMBER 23, 2003
TO SEPTEMBER 23, 2004
BP 89 05 01 87 (MECH)
ALL 49-39070-01 00 031
05-28-2004
(000 0007)
01i160NG 04640
ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS
This endorsement modifies insurance provided under the following:
BUSINESSOWNERS POLICY
The information required to complete this endorsement is shown in the Declarations.
The following is added to Paragraph C. WHO IS AN INSURED in the Businessowners Liability Coverage Form:
4. The person or organization shown in the Schedule, but only with respect to liability arising
from "your work' for that insured by you or for you.
BP70230297
0171ROY4
Aq POLICY
SENTRY'S BUSINESSOWNERS
(A PARTICIPATING MUTUAL COMPANY)
A MEMBER OF THE SENTRY FAMILY OF INSURANCE COMPANIES
NAME INSURED: VARITEK INC
ADDITIONAL INSURED
SCHEDULE
POLICY NUMBER 49-07795-07
The following information is required to complete the accompanying
additional insured endorsement which forms a part of the Named Insured's
BUSINESSOWNERS POLICY.
ADDITIONAL
CITY OF SANTA ANA ITS OFFICERS BP 70 23 07 02
AGENTS AND EMPLOYEES
2 CIVIC CENTER PLZ
SANTA ANA, CA 92701
BP 89 05 01 87 (MECH)
VAR 49-07795-07 00 041
05-05-2004
(000 0031)
EFFECTIVE
FROM JUNE O1, 2004
TO JUNE O1, 2005
0 3 6 5 6
o. woAG
ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS
This endorsement modifies Insurance provided under the following:
BUSINESSOWNERS COVERAGE FORM
The information required to complete this endorsement Is shown In the Declarations.
The following is added to Paragraph C. WHO IS AN INSURED in Section II - Liability
4. The person or organization shown In the Schedule, but only with respect to liability arising
from your ongoing operations performed for that Insured.
BP 70 23 07 02
01TIT3XI
__
06/17/2004 15:28 FAX 715 346 8069 SENTRY C/L 2 002
CY4
SENTRY INSURANCE A MUTUAL COMPANY SENTRY'S BUSINESSOWNERS
AEPARTICOIPATINGIMUTUALNCOMPANYI POLICY
MEMBER OF THE SENTRY FAMILY OF INSURANCE COMPANIES
POLICY NUMBER 49-39070-01
NAME INSURED, K & A ENTERPRISES INC DBA
ADDITIONAL INSURED
SCHEDULE
THE FOLLOWING INFORMATION 15 REQUIRED TO COMPLETE THE ACCOMPANYING
ADDITIONALNERINSUREDIESS Y ORSEMENT WHICH FORMS A PART OF THE NAMED INSURED'S
ADDITIONAL
ENDORSEMENT EFFECTIVE
INSUED
THE CITY OF SANTA ANA BP 70 23 02 97 FROM SEPTEMBER 23, 2003
ITS OFFICERS, EMPLOYEES, TO SEPTEMBER 23, 2004
RESPRES°ENTATIIVESRS &
20 CIVIC CENTER PLAZA
SANTA ANA, CA 92701
FOR ENSEESOVERT TEXT,
y
BP 89 05 01 67 (MECH)
ALL 49-39070-01 00 031
06-11-2004
(000 0007)
06/17/2004 15:2 FFA% 715 046 8069 SENTRY C/L fij003
COMET DOCUMENT INQUIRY ACCOUNT
AD02TZONAL INSURED - OWNERS, LESSEES OR CONTRACTORS
THIS ENDORSEMENT MODIFIES INSURANCE UNDER THE FOLLOWING:
BUSINESSOWNERS POLICY
THE INFORMATION REQUIRED TO COMPLETE THIS LNDORSEMKNI IS SHOWN IN THE
DECLARATIONS -
THE FOLLOWING IS ADDED TO PARAGRAPH C- WHO IS AN INSURED IN THE
HUSTNESSOWNERS LIABILITY COVERAGE FORM!
q. 7-HE PERSON OR oRGAMIZATION SHOWN IN THE SCHEDULE, BUT ONLY WITH
RESPECT TO LIABILITY ARISING FROM YOUR ONGOING OPERATIONS
PERFORMED FOR THAT INSURED.
HP 70 23 02 97
lsaa7,516
COM CO-'M110CS-03 00 721
03-OB-OI
PAGE OOL
06/17/2004 15:29 FAX 715 346 8069 SENTRY C/L
U 004
PRIMARY/NONCONTRIBUTORY INSURANCE
THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING:
BUSINESSOWNERS LIABILITY COVERAGE FORM
WHEN REQUIRED BY WRITTEN CONTRACT AGREEMENT OR PERMIT, THE INSURANCE
PROVIDED TO THE ADDITIONAL INSUREb NAMED BELOW IS PRIMARY TO AND
NONCONTRIBUTORY WITH ANY VALID AND COLLECTIBLE INSURANCE AVAILABLE TO THE
ADDITIONAL INSURED.
ADDITIONAL INSURED: THE CITY OF SANTA ANA
ITS OFFICERS, EMPLOYEES, AGENTS,
20LCIIVICRCENTERPPLAZATATIVES
CERTA0007` CA 92701
BP 70 45 08 09
ALL 1-039070-01 00 031 G%% ^� " �(D
PAGE 007
\ Q9/28/2005 11:22 7142589029 ALL SIGNS AMERICA PAGE 02
A- 200IS- 14A
A-em - 1AA-0I
SENTRY INSURANCE A MUTUAL COMPANY d}. 2UO3— 140'01—
STEVENS POINT, WISCONSIN
(A PARTICIPATING MUTUAL COMPANY)
A MEMBER OF THE SENTRY FAMILY OF INSURANCE COMPANIES
CERTIFICATE OF INSURANCE ACCCUNT NUMBER 49-39070
This certiticate is issued as a matter of information only and confers no
rights upon the certificate holder. Th1s certificate does not amend, extenu
ur alter the coverage afforded by the policies below -
Name and Address of Name and Address
Ce-tiftcate Holder of the Insured
THE CITY OF SANTA ANA R i A ENTERPRISES INC ONA
AGENTTS SFIVOLUNTEERSO6EcS 154011REUHILLRAVE STE Aae
REESPRESCNTATIVES TUSTIN, CA 92700
20 CIVIC CENTER PLL
SANTA ANA, CA 92701
This certificate is issued on 09-23-2005 and is effective until 09-2'-2006.
It certifies that Pollcias of insurance listed below have been issued to
the insurtd named above. Notwithstanding any requirement, term or
condition of .ny 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. limits shown ■oY hove been reduced by Paid
claims.
Coverage Provided Policy Number
All Limits in Thousands
Businessowners Liability 49-59070-91
Each Occurrence
i
Soo
Modica] Expense
a
10
Includes: Bodily Injury
Demose to Premises
a
250
Property Damage
General Aggregate
a
1.500
Personal Injury
Products Aggregate
0
11500
Advertisingp In�ury
Hired and Nvn- caned
Workers' Compensation and 49-39070-02
Statutory
Employer's Liability
Each Accident
F
500
Each Disease/Employee
a
500
Each Disease/Policy
S
500
Umbrella Liability 49-39070-03
Each Occurrence
f
11000
Does Not Include:
General Aygrepste
s
1,000
-Pers/Ado Injury
Products Aggregate
0
1,000
:N11PROV> lj AS ''rO FORM
- - Omura Stitt S dy
�,,,is[ant City ttorney
60-CIO35 (SFA)
ALL 49-39070 51-040416 onuw.
10-29-200S
PAGE 1
(OD07)
10/20/2005 11:22 7142589029 ALL SIGNS AMERICA PAGE 03
CERTIFICATE OF INSURANCE - (CONT) ACCOUNT NUMBER 49-39070
Coverag■ Prowidad Policy Number All Limits in Thousands
Businessowners Liability 49-39070-OL Emcn Occurrence a Soo
Medical Expanse 0 10
Includes: Bodily Injury Damage to Preminax a 250
Property Damage General Apgragato # 11500
Parsonal Injury Products Aggroasto 9 11500
Adrertisiny Injury
Hirad and Non- "nod
Workers' Compensation and
49-39070-02 Statutory
Employer's Liability
Each Accident
1
Soo
Eacii Disease/Employaa
f
500
Each Diseasa/Policy
a
Soo
Umbrella Liability
49-39010-03 Each Occurrence
8
1,000
Ones Not Include;
General Ayy grapate
a
1,000
-Pars/Adv Injury
Products Aggragate
a
1,000
If any of the listed policies
are cancelled prior to their normal
txpiration date, the insurer
will send notice to the certificate
holder 30 days in advance.
. 'f:C)VE0 AS TO FORM
/,S:1�
'S She y
.,.:.yen[ City Attorney
80-CID55 1SFA)
ALL 49-39070 31-040416
10-to-2005
PAGE 2
(0007)
I. /28/2005 11:22 7142589029 ALL SIGNS AMERICA PAGE 04
,X1 SET yEq�{s NP$Q�jI [�W A MUTUAL cpN
(A�PARTIIICIPATfNGIMUTUALNCpMPAMT)Y SENTRY'S BUS H YSOMNERS
A MEMBER OF THE SENT Y FAMILY OF INSURANCE COMPANIES
POLICY NUMBER 49-39070-01
NAME INSURED[ K B A ENTERPRISES INC DBA
AODITIONEALDUIESUREO
The following information is required to complete the 8ccom0enying
edditiorel insured endorsement which forms a Dart of the Newed Insured's
BLIS114ESSOWNLRS POLICY.
ADDITICNAL
IMFURFO FN[7DR5FMFNT EEPpFFEFFCCEETIVE
IITHEEg ppCFITY((�� F SAENETA1, ANA BP 70 23 07 02 FROOM SEPTEMBER 23, 2005
AGENTS�i(t LRUATEER 0YEE5, T
RE SS PPREESENrrrrrAT1VEEEESS 66
20 C'IVIC CENTER PLZ
SANiA ANA, C'A 92701
�Uvcil
As 'gip 1�p�M
r
wa S' itt She
y
City Attorney
BP 09 05 01 07 (MECH)
All 49-39070-01 00 051
10-2B-2005
(009 0007)
SENTRY INSURANCE A MUTUAL COMPANY
STEVENS POINT, WISCONSIN
(A PARTICIPATING MUTUAL COMPANY)
A MEMBER OF THE SENTRY FAMILY OF INSURANCE COMPANIES
CERTIFICATE OF INSURANCE
ACCOUNT NUMBER 49-39070
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.
Name and Address of
Name and Address
Certificate Holder
of the Insured
VV
THE CITY OF SANTA ANA
K & A ENTERPRISES
INC DBA
ITS OFFICERS, EMPLOYEES,
ALL SIGNS AMERICA
t- oc3-Yl- y
AGENTS, VOLUNTEERS &
15481 REDHILL AVE
STE A&B
RESPRESENTATIVES
TUSTIN, CA 92780
20 CIVIC CENTER PLAZA
SANTA ANA, CA 92701
This certificate is issued on 09-23-2004 and is effective until 09-23-2005.
It certifies that policies of insurance listed below have been issued to
the insured named above. 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. Limits shown may have been reduced by paid
claims.
Coveraoe Provided
Policy Number All Limits in Thousands
Businessowners Liability
Includes: Bodily Injury
Property Damage
Personal Injury
Advertising Injury
Hired and Non -Owned
Workers' Compensation and
Employer's Liability
Umbrella Liability
Bpes Not Include:
-Pers/Adv Injury
If any of the listed policies
expiration date, the insurer
holder 30 days in advance.
• 80-C1035 (MECH)
ALL 49-39070 31-040416
06-27-2005
PAGE 1
(0007)
49-39070-01 Each Occurrence
$
500
Medical Expense
$
10
Damage to Premises
$
250
General Aggregate
$
11500
Products Aggregate
$
1,500
49-39070-02 Statutory
Each Accident
$
500
Each Disease/Employee
$
500
Each Disease/Policy
$
500
49-39070-03 Each Occurrence
General Aggregate
Products Aggregate
are cancelled prior to their normal
will send notice to the certificate
1,000
1,000
1,000
.M.oac 02391
j SENTRY INSURANCE A MUTUAL COMPANY
STEVENS POINT, WISCONSIN
(A PARTICIPATING MUTUAL COMPANY)
A MEMBER OF THE SENTRY FAMILY OF
[1
'0
SENTRY'S BUSINESSOWNERS
POLICY
INSURANCE COMPANIES
POLICY NUMBER 49-39070-01
NAME INSURED: K 8 A ENTERPRISES INC DBA
ADDITIONAL INSURED
SCHEDULE
The following information is required to complete the accompanying
additional insured endorsement which forms a part of the Named Insured's
BUSINESSOWNERS POLICY.
ADDITIONAL
INSURED
THE CITY OF SANTA ANA
ITS OFFICERS, EMPLOYEES,
AGENTS, VOLUNTEERS &
RESPRESENTATIVES
20 CIVIC CENTER PLAZA
SANTA ANA, CA 92701
BP 89 05 01 87 (MECH)
ALL 49-39070-01 00 041
06-27-2005
(000 0007)
ENDORSEMENT
BP 70 23 07 02
F ND RS 1ENT TEXT
S
EFFECTIVE
FROM SEPTEMBER 23, 2004
TO SEPTEMBER 23, 2005
O1i 190flf
02397
SENTRY INSURANCE A MUTUAL COMPANY
STEVENS POINT, WISCONSIN
(A PARTICIPATING MUTUAL COMPANY)
A MEMBER OF THE SENTRY FAMILY OF INSURANCE COMPANIES
0 CERTIFICATE OF INSURANCE ACCOUNT NUMBER 49-39070
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.
Name and Address of
Certificate Holder
THE CITY OF SANTA ANA
ITS OFFICERS, EMPLOYEES,
AGENTS, VOLUNTEERS &
RESPRESENTATIVES
20 CIVIC CENTER PLZ
SANTA ANA, CA 92701
Name and Address
of the Insured
K & A ENTERPRISES
ALL SIGNS AMERICA
15481 REDHILL AVE
TUSTIN, CA 92780
INC DBA
STE A&B
This certificate is issued on 01-09-2006 and is effective until 09-23-2006.
It certifies that policies of insurance listed below have been issued to
the insured named above. 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. Limits shown may have been reduced by paid
claims.
Coverage Provided
Businessowners Liabilit
Includes: Bodily Injury
Property Damage
Personal Injury
Advertising Injury
Workers' Compensation and
Employer's Liability
Umbrella Liability
Does Not Include:
-Pers/Adv Injury
Policy Number All Limits in Thousands
49-39070-01 Each Occurrence
Medical Expense
Damage to Premises
General Aggregate
Products Aggregate
49-39070-02 Statutory
Each Accident
Each Disease/Employee
Each Disease/Policy
49-39070-03 Each Occurrence
General Aggregate
Products Aggregate
If any of the listed policies are cancelled prior to their normal
expiration date, the insurer will send notice to the certificate
holder 30 days in advance.
0 80-C1035 (MECH)
500
10
250
1,500
1,500
500
500
500
1,000
1,000
1,000
ALL 49-39070 31-040416
12-12-2005
PAGE 1
(0007)
o11111o1�1 02509
SENTRY INSURANCE A MUTUAL COMPANY
STEVENS POINT, WISCONSIN
(A PARTICIPATING MUTUAL COMPANY)
A MEMBER OF THE SENTRY FAMILY OF INSURANCE COMPANIES
TERMINATION OF CERTIFICATE ACCOUNT NUMBER 49-39070
Name and Address of
Certificate Holder
THE CITY OF SANTA ANA
ITS OFFICERS, EMPLOYEES,
AGENTS, VOLUNTEERS &
RESPRESENTATIVES
20 CIVIC CENTER PLZ
SANTA ANA, CA 92701
Name and Address
of the Insured
K & A ENTERPRISES
ALL SIGNS AMERICA
15481 REDHILL AVE
TUSTIN, CA 92780
INC DBA
STE A&B
You are hereby notified of the termination of the certificate of insurance
issued to you under the policy or policies herein described. This
certificate will terminate at 12:01 A.M. standard time at the insured's
mailing address, effective on the date shown below.
Termination Date 11-21-2005
Type of Insurance
Businessowners Liability
Umbrella Liability
Workers' Compensation
�A replacement certificate is attached.
0 80-1020 (MECH)
ALL 49-39070 31-040416
12-12-2005
PAGE 1
(0007)
Policy Number
49-39070-01
49-39070-03
49-39070-02
aA 02510
SENTRY INSURANCE A MUTUAL COMPANY
STEVENS POINT, WISCONSIN
(A PARTICIPATING MUTUAL COMPANY)
IWIPW A MEMBER OF THE SENTRY FAMILY OF INSURANCE COMPANIES
. TERMINATION OF CERTIFICATE ACCOUNT NUMBER 49-39070
Name and Address of
Certificate Holder
THE CITY OF SANTA ANA
ITS OFFICERS, EMPLOYEES,
AGENTS, VOLUNTEERS &
RESPRESENTATIVES
20 CIVIC CENTER PLZ
SANTA ANA, CA 92701
You are hereby notified of the
issued to you under the policy
certificate will terminate at
mailing address, effective on
Name and Address
of the Insured
K & A ENTERPRISES
ALL SIGNS AMERICA
15481 REDHILL AVE
TUSTIN, CA 92780
INC DBA
STE A&B
termination of the certificate of insurance
or policies herein described. This
12:01 A.M. standard time at the insured's
the date shown below.
Termination Date 01-09-2006
Type of Insurance Policy Number
Businessowners Liability 49-39070-01
Automobile Liability 49-39070-06
Umbrella Liability 49-39070-03
Workers' Compensation 49-39070-02
A replacement certificate is attached.
c A-t�� eb
0 80-1020 (MECH)
ALL 49-39070 31-040416
12-12-2005
PAGE 1
(0007)
02511
SENTRY INSURANCE A MUTUAL COMPANY SENTRY'S BUSINESSOWNERS
STEVENS POINT, WISCONSIN POLICY
(A PARTICIPATING MUTUAL COMPANY)
A MEMBER OF THE SENTRY FAMILY OF INSURANCE COMPANIES
•
POLICY NUMBER 49-39070-01
NAME INSURED: K 8 A ENTERPRISES INC DBA
ADDITIONAL INSURED
SCHEDULE
The following information is required to complete the accompanying
additional insured endorsement which forms a part of the Named Insured's
BUSINESSOWNERS POLICY.
ADDITIONAL
INSURED
THE CITY OF SANTA ANA
ITS OFFICERS, EMPLOYEES,
AGENTS, VOLUNTEERS 8
RESPRESENTATIVES
20 CIVIC CENTER PLZ
SANTA ANA, CA 92701
C�
0 BP 89 05 01 87 (MECH)
ALL 49-39070-01 00 051
10-28-2005
(000 0007)
ENDORSEMENT
BP 70 23 07 02
FOR ENDORSEMENT TEXT,
SEE OVER.
EFFECTIVE
FROM SEPTEMBER 23, 2005
TO SEPTEMBER 23, 2006
.11,11.11, 00235
ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS
This endorsement modifies insurance provided under the following:
BUSINESSOWNERS COVERAGE FORM
The information required to complete this endorsement is shown in the Declarations.
The following is added to Paragraph C. WHO IS AN INSURED in Section II - Liability
4. The person or organization shown in the Schedule, but only with respect to liability arising
from your ongoing operations performed for that insured.
BP 70 23 07 02
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