HomeMy WebLinkAboutBEAUCHAMP ENTERPRISES 1 - 2005City of Santa Ana
Clerk of the Council
AGREEMENT TERMINATION FORM
COTC Office Use Only
1:
r t I 2 2
Please complete this form when the attached agreement and all
amendments (if any) are no longer in effect.t g
;i
Return form to the Clerk of the Council Office (M -30). r iL
Call 647 -6520 if you have any questions.
The agreement with
No. A - C� (1) "'was completed on
Ktr� (List all amendments. Use space below if needed.)
N 22W T -106°V 0h)
Revised D &2370
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and final payment has been made.
Department:
Phone /Ext.:
Signature: II
Date:
A- 2005 -019
WURA;,,L ON FILL
WORK IJIAY PROCEED
UNTIL INSURANCE EXPIRES
0-11-05 CONSULTANT AGREEMENT
CLERK OF COUNCIL
DATE: 3-1(0-05
THIS AGREEMENT made and entered into this i M day of h Rr,, A,,V 2005 by
C and between Beauchamp Enterprises, Inc., a California corporation (hereinafteultant" ),
(S. fW 0) 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
A. The City desires to retain a consultant having special skill and knowledge in the field of
real estate and paralegal services.
B. Consultant represents that Consultant is able and willing to provide such services to the
City.
C. In undertaking the performance of this Agreement, Consultant represents that it is
knowledgeable in its field and that any services performed by Consultant under this
Agreement will be performed in compliance with such standards as may reasonably be
expected from a professional consulting firm in the field.
NOW THEREFORE, in consideration of the mutual and respective promises, and subject to the
terms and conditions hereinafter set forth, the parties agree as follows:
1. SCOPE OF SERVICES
Consultant shall perform the following services, inter alia:
♦ Organizing and maintaining case files, both paper and electronic;
♦ The coordination and support of condemnation and other litigation processes as
required
♦ Acting as liaison between the Public Works Agency, the Office of the City Attorney,
outside counsel, opposing counsel, appraisers, title companies, and property owners;
♦ Conducting legal research.
2. COMPENSATION
a. City agrees to pay, and Consultant agrees to accept as total payment for its services, an
hourly rate of $40.00 per hour.
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 shall continue until
otherwise terminated pursuant to Section 12 of this Agreement.
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. Business automobile liability insurance, or equivalent form, with a combined single
limit of not less than $1,000,000 per occurrence. Such insurance shall include coverage for
owned, hired and non -owned automobiles.
b. If Consultant is or employs a licensed professional such as an architect or engineer:
Professional liability (errors and omissions) insurance, with a combined single limit of not less
than $1,000,000 per claim.
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. The Consultant further agrees to indemnify, hold
harmless, and pay all costs for the defense of the City, including fees and costs for special
counsel to be selected by the City, regarding any action by a third party challenging the validity
of this Agreement, or asserting that personal injury, damages, just compensation, restitution,
judicial or equitable relief due to personal or property rights arises by reason of the terms of, or
effects arising from this Agreement. City may make all reasonable decisions with respect to its
representation in any legal proceeding.
7. CONFIDENTIALITY
If Consultant receives from the City information which due to the nature of such
information is reasonably understood to be confidential and/or proprietary, Consultant agrees
that it shall not use or disclose such information except in the performance of this Agreement,
and further agrees to exercise the same degree of care it uses to protect its own information of
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.
S. 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 copy to:
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: Rick Beauchamp
Beauchamp Enterprises, Inc.
2654 -C Andover Avenue
Fullerton, California 92831
A party may change its address by giving notice in writing to the other party. Thereafter,
any communication shall be addressed and transmitted to the new address. If sent by mail,
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, 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 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 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 its 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.
IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year
first above written.
ATTEST:
PATRICIA E. HEALY
Clerk of the Council
APPROVED AS TO FORM:
JOSEPH W.FLETCHER
City Attorney
By:
Jo doval
Sr. A stant City Attorney
FOR APPROVAL:
CITY OF SANTA ANA
DAVID N. REAM
City Manager
CONSULTANT
L
R. Bid UCHAMP
President /CEO
Tax ID# 75- 3075206
Progressve Casualty Insurance Company
PO Box 94739
Cleveland, 01144101
800- 4444487
Certificate of Insurance
Awagam3
Commercial Auto Insurance
Policy number: 01954225.4
February 15, 2005
Page 1 of 1
CertMrrots eeldv
Agent
CITY OF SANTA ANA
8 EAU CHAMP ENTERPRISES I
PROGRESSIVE
20 CIVIC CTR PLAZA
2654- CANDOV RAVE
PO BOX 94739
7TH FLOOR -0ECE CTYATTORNEY
EULLERTON, CA 92831
CLEVELAND, OH 44101
SANTA ANA, CA 92702
This document certifies that insurance policies identified below have been issued by the designated insurer to the
insured named above for the period(s) indicated. This Certificate is issued for information purposes only. It confers no
rights upon the certificate holder and does not change, after, modify, or extend the coverages afforded by the policies
listed below. The coverages afforded by the policies listed below are subject to all the terms, exclusions, limitations.
endorsements, and conditions of these policies.
.. ..... ,.. ........... ...........
_e . 2004. . _ . cY P
Policy Effective Date: Dec 19, 2004 Poli Ex iration Date: Jun 19, 2005
Insurance coverap(s) ............................
Bodily Injury/Property Da mage $1 000,000 Combined Single Limit
Employer's Non -Owned Auto BIPD $1,000,000 Combined Single Limit
HlredAuto Bodily Injury/Property Damage $1,000,000 Combined Single Limit
Description of LocationNehicles/5pecial Items
Scheduled autos only ..................... __.... __...
20006OD4 PICKUP 167GL22XM786987
Certificate number
04605ITY225
Please be advised that the certificate holder will not be notified in the event of a mid -term cancellation.
APPROVED AS TO FORM
Lama Stitt Sh, edy
ram 5241 00ra2) Assistant City Attorney
PROGRESSIVE COMMERCIAL
PO BOX 94739
CLEVELAND, OH 44101
BEAUCHAMP ENTERPRISES I
2654 -C ANDOVER AVE
FULLERTON, CA 92831
Additional insured endorsement
Name of Person or Organization
CITY OF SANTA ANA A
20 CIVIC CTR PL
SANTA ANA, CA 92705
PROGREJJ /UE®
COMMERaAL
Policy number: 01954225 -8
Underwritten by:
Progressive Casualty Insurance Co
Insured: BEAUCHAMP ENTERPRISES I
December 23, 2006
Policy Period: Dec 21, 2006 - Jun 21, 2007
Mailing Address
Progressive Casualty Insurance Co
PO Box 94739
Cleveland, OH 44101
800 - 895 -2886
For customer service, 24 hours a day,
7 days a week
The person or organization named above is an insured with respect to such liability coverage as is
afforded by the policy, but this insurance applies to said insured only as a person liable for the conduct
of another insured and then only to the extent of that liability. We also agree with you that insurance
provided by this endorsement will be primary for any power unit specifically described on the
Declarations Page.
Limit of Liability
Bodily Injury Not applicable
Property Damage Not applicable
Combined Liability $1,000,000 each accident
All other terms, limits and provisions of this policy remain unchanged.
This endorsement applies to Policy Number: 01954225 -8
Issued to (Name of Insured): BEAUCHAMP ENTERPRISES I
Effective date of endorsement: 12/21/2006 Policy expiration date: 06/21/2007
Form 1199 (07/04)
a i'k I
A - -dc5c5-c(`
PROGRESSIVE COMMERCIAL
PO BOX 94739
CLEVELAND, OH 44101
BEAUCHAMP ENTERPRISES I
2654-C ANDOVER AVE
FULLERTON, CA 92831
Additional insured endorsement
PR99REWYE
L7ir4s?"?u"z'
Policy number. D783b225-H
Rc —5P;e C, -- -4r„ � -q'r rs Co
21, 7^r7
Pcr.,,, a_,.A- ` -n 21. 2'.17 -
Mw7mg Address
Pr- = -n Ca -'*Y Ca
PO ern 94739
_0101 1
8DD- 895.2935
For cus Omer serr--, 24 hc-:5 a day,
Name of Person or Organization 7 dais a sek
CITY OF SANTA ANA A
20 CIVIC CTR PL
SANTA ANA, CA 92705
The person or organization named above is an insured with respect to such liabf!mr cr'ere^n as is
afforded by the policy, but this insurance applies to said insured only as a person liable I-, the ccnduct
of another insured and then only to the extent of that liability. We also agree :,! th you that i^ r:-arc=
provided by this endorsement will be primary for any power unit specifically described on the
Declarations Page.
Limit of Liability,
— -- Bodily Injury Not applicable
Property Damage Not applicable
Combined Liability $1,000,000 each accident
All other terms, limits and provisions of this policy remain urrchangec.
This endorsement applies to Policy Number: 01954225 -9
Issued to (Name of Insured): BEAUCHAMP ENTERPRISES I
Effective date of endorsement: 06121/2007 Policy expiration date: 12/21/2007
rpm 1198101,041
AP. ^R{3'iJ �S TO FORM
',I) Auoraey,
%� *`20GRESSIVE COMMERCIAL
PO BOX 94739 -
CLEVELAND, OH 44101 000057
Named insured ;'�:' : # -7-L:—'Z"1'
BEAUCHAMP ENTERPRISES I
2654 -C ANDOVER AVE
FULLERTON, CA 92831
Commercial Auto
Insurance Coverage Summary _ --
This is your revised Renewal
Declarations Page
Your coverage begins on December 21, 2007 at 12:01 a.m. This policy expires on tune 21, 20;8 at 12.0; _. �.
This coverage summary replaces your prior one. Your insurance policgr and any pc;i_;
your coverage. The policy limits shown for an auto may not be combined ,vRh ti�a li^ i °. t-a _a: -e
unless the policy contract allows the stacking of limits. The policy contract is fa r; 5912 ; ' T- -..� _ _ _ _- -_ .
Z435 (12/06), 4757 (03/05), 4852CA (10104), 4881 CA (12104), Z228 (07105), 1198 i,01 r+�, ' 3�0 01,-G3
The named insured organization type is a corporation.
Outline of coverage
- Description - -- -- -- - bmits
............................................................................ ....................... ........ ......... .... .... ... _
Liability To Others
Bodily Injury and Property Damage Liability $1,000,000 combined singe limr
.... .. ............. ............................... ................. -..... ...... ... .... . ........ ............. . .................. ..._.......... ...._. - . .... ._ ...
Uninsured /Underinsured Motorist Rejected -
........... ............. ................................. ....... ................. .........I.........._..._...... _ ......
..._........... . -. _ ... ...
Uninsured Motorist Property Damage Rejected -
_..._ .................................................................................. ...................... ......... .. ... .. .
Medical Payments $5,000 each person
............ . ...... ............... .............................. ..................... ............................. ...
.......
Comprehensive
See Schedule Of Covered Autos Limit of liability less deductb:a
............... .................. . .................. . ....... ................... .:........ .......... ...
.... . .
Collision
See Schedule Of Covered Autos Limit of liability less deduc ib'e
................................................................................. ............................... .
Hired Auto Liability To Others
Bodily Injury and Property Damage Liability $1,000,000 combined sing'a lira^
........ ............ ................_........................ ......_......__... ................._.._..........
Employer Nonowned Auto Liability To Others
Bodily Injury and Property Damage Liability $1,000,000 combined sing e'ir^t
Subtotal policy premium
................................................................................. ...............................
California Vehicle Assessment fee
................................................ ............................... . ....... . ...................
Fees
. .... ... ... . ............ ................ . ....... . ....... ......................... I ...... ................... ..... .
Total 6 month policy premium
Number of Employees (0 - 10)
Rated driver
......... ......... .. .................. ....... .................. ................. .._............. ...._ .........
1. RICHARD BEAUCHAMP
C�
Form 6489 CA (05/06)
�.� Lit _
Auto coverage schedule
1.
2000 Dodge Pickup
VIN: 1B7GL22X7YS786987
Liability
liability. MedPay ...................
. ...................
Premium
$457 $15
Comp Comp Collision Collism
Physical Damage
Y g
Deductible Premium Deductible Premium
....... I.....
Premium
... ................................. I.................
$1,000 $28 $1,000 $128
Premium discounts
Policy
•
Stated Amount.
Garaging Zip Co-
.................................. ........................................ .. ..............I...I............
01954225 -6 Paid in Full and Renewal
Additional Insured information
............................ ....................... .......... I .......................
....... .
1 . Additional insured CITY OF SANTA AMA A
20 CIVIC CTR PL SANTA Ai IR,
Company officers
President
Form 6489 CA (05106)
Secretary
z
' M
Hired Auto Coverage endorsement
Except as specifically modified in this endorsement, all provisions of the Comm_rca ' u c Poli,li, ac-c
We agree with you that the insurance provided under your Commercial Aut o Polio. �S mcdf -�Ec as
Additional definitions used in this endorsement
When used in this Endorsement, whether in the singular, plural, or possessive:
1. 'Hired auto' means an auto you lease, hire, rent or borrow. This does nct include an; auto vnu lease; hire,
rent or borrow from any of your employees, partners (if you are a partnership';, members Of�rou are a lirn4ed
liability (ompany) or member of their households.
2. 'Cost of hire' means the total amount paid by you for the hire of autos. incijdina c; arges for services
performed by motor carriers of property or passengers that are subject to tie comoulscr; re:a iram,er of an,
motor carrier laws or regulations.
Changes in Part I - Liability To Others
When used in Part I - Liability To Others, the definition of insured auto is amend _u tc a j�ed auto.
Other Insurance
The insurance provided by this Hired Auto Coverage Endorsement is excess o.er an, other ;aid and collectible
insurance, whether primary, excess, or contingent.
Premium agreement
The premium for this Hired Auto Coverage is based on the cost of 1 ',rs, ands sub -.- ' - 7.im cost e `� =r= as
listed below. We may audit the cost of hire and charge appropriately for additional premium f0r up to ,r&E (3) , ears
after the policy expiration.
Schedulle offiited Auto-Premium. BIRD tiabil"rty Coverage
...
................................................................. ............................
Rate per $100 Cost of hire $1.00
................................................................... ...............................
Minimum cost of hire $5,000.00
...
.... ..
............................................................ ......... ... ................ .
Minimum Premium $50.00
.................................................................... ............................... .
Estimated cost of hire $5,000.00
.................................................................. ...............................
Estimated premium $50.00
Form 1891 (09104)
PROGRESSIVE COMMERCIAL
PO BOX 94739
CLEVELAND, OIL 44101
Po icy ni.4m.ben OIS-34225-i
BEAUCHAMP ENTERPRISES I
2654-C ANDOVER AVE
FULLERTON, CA 92831
Maiiing Address
Additional insured endorsement
Name of Person or Organization
CITY OF SANTA ANA I A
20 CIVIC CTR PL
SANTA A NA*', CA 92 05
The person or organiza4ion named ab,).,e!s an
afforded by the policy, but this insurance applies to said insureri
of another insured and then on1v to the extent of thst ljabdit:. We F-�zc ac'-F;c- you
provided by this enclorsernertvAl be prilral. I I o I a"; P C
Declarations Page.
Limit of Liability
Bodily Injury "'ict applicatHI:
Property Damage
Combined Liability 1,0 0,nCC-,' eat accident
All other terms, limits and provisions of this policy remain unchangecl.
This endorsement applies to Polic.; t1urnberl 0, 954225-6
Issued to (Name of Insured): BEAUCH,= -,NIP ENTEPPMES I
Effective date of endorsernem 12121/20',0
PROGRESSIVE
PO BOX 94719
CLEVELAND, OH 44101
Named insured
BEAUCHAMP ENTERPRISES I
2654{ ANDOVER AVE
FULLERTON. CA 42831
PRWREWI/E
aDasbe GNU C"
)�tluu�tl�ulu r�lunl�r)rlr)u r�)Inu nll)ur�r��l utlrll
Commercial Auto
Insurance Coverage Summary
This is your revised Renewal
Declarations Page
policy number: 07954225.7
Underwritten by:
progressive Express Ins Company
May 30, 2008
Policy Penod: Jun 21, 2008 - Dec 21, 2008
Page I of 2
progressive.com
Online Service
Make payments, check billing activity, pnnt
policy documents of heck the status of a
dam.
500- 895.2886
For customer service and daims,eramce,
24 homy a day. 7 day; a week.
Your coverage begins on June 21, 2008 at 12.01 a.m. This policy expires or Oecemter 21, 208 at 12.01 a.m.
This coverage summary replaces your prior one. Your insurance policy and any policy endorsements conta n a full explanation of
your coverage The policy limits shown `or an auto may not be combined with the limits for the same coverage on another auto,
unless the Z435 (12(06)'x4757 (03105), s'acking limits. The
(12104),, Z228 (07/05), 11981(01104)51890 (02 /05) and 1 91 modified
(09104)forms
The named insured organization type is a corporation.
outline of coverage
Description ....... ...
Liability To Others
Bodily Iniury and Property Damage Liability
UninswedlUndeiinsured Motorist
Uninsured Motorist Property Damage
Medical Payments
Comprehensive
See Auto Coverage Schedule
Cal!ision
See Auto Coverage Schedule
Hired Auto Liability To Others
Bodily Injury and Property Damage Liability
Employer Nonowned Auto Liability To Others
Bodily Injury and Property Damage Liability
Subtotal policy premium. ....
Calttomia Vehicle Assessment Fee
Fees
Total 6 month policy premium
Number of Employees (0 - 1 U)
Rated driver
1. RICHARD BLAUCHAMP
form 6429 cr (05:06)
conhnaed
Dednrtible Premium
$421
$1,000,000 combined single limit
Rejected
Rejected
$5,000 each person
13
28
Limit of liability less deduc, ble ..
-
....... _.
117
Limit of liability less deduciible
50
$1,000,000 combined single limit
. ...
31
$1,000,000 combined single limit
$660.00
_, ... 0.90
2100
$685.90
conhnaed
Policy number. D 1954225 7
BEAUCHAMP ENTERPRISES I
P9ye 2 nt 2
Auto coverage schedule
Premium discounts
Poly ... ..
01954225-7 Paid in Full and Renewal
Additional Insured information
i Addrtionallnsured
CITY OF SA'NiA ANA A
2U CIVIC C1 PL SANTA ANA, CA 92705
Company officers ��
�rr
g. i i
President
form 6489 CA (05:D6)
Secretary
ft
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Stated Amount: $18,000
1.
2000 Dodge Pickup
Garaging Zip Code. 92831 Radius: 50
VIN. 197GL22X7YS785987
Liability
V Med P .... _.., ....__ ....
Iia6i10 a ............." .
Premium
$121 $13
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Camp P Deductible Prenxum ..._ _.. -- ��
Physical Damage
DeJura6le Premw!n -- — $579
Premium
$1,000 $28 $1,000 $117
Premium discounts
Poly ... ..
01954225-7 Paid in Full and Renewal
Additional Insured information
i Addrtionallnsured
CITY OF SA'NiA ANA A
2U CIVIC C1 PL SANTA ANA, CA 92705
Company officers ��
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President
form 6489 CA (05:D6)
Secretary
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PROGRESSIVE
PO BOX 94739
CLEVELAND, OH 44101
BEAUCHAMP ENTERPRISES I
2654 -C ANDOVER AVE
FULLERTON, CA 92831
Additional insured endorsement
Name of Person or Organization
CITY Of SANTA ANA .A
20 CIVIC CTR PL
PROGREII /bE`
Policy number: 01954225 -7
Underwritten by
Progressive Express Ins Company
Insured: BEAUCHAMP ENTERPRISES I
May 30, 2008
Policy Penod. Jun 21, 2008 - Dec 21, 2008
Mailing Address
Progressive Express Ins Company
PO Box 94739
Cleveland, OH 44101
800 - 895 -2886
For customer service, 24 hours a day,
7 days a week
SANTA ANA, CA 92705
The person or organization named above is an insured with respect to such liability coverage as is
afforded by the policy, but this insurance applies to said insured only as a person liable for the conduct
of another insured and then only to the extent of that liability. We also agree with you that insurance
provided by this endorsement will be primary for any power unit specifically described on the
Declarations Page.
Limit of Liability
Bodily Injury Not applicable
Property Damage Not applicable
Combined Liability $1,000,000 each accident
All other terms, limits and provisions of this policy remain unchanged.
This endorsement applies to Policy Number 01954225.7
Issued to (Name of Insured); BEAUCHAMP ENTERPRISES I
Effective date of endorsement: 06/21,2008 Policy expiration date 12/21/2008
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