HomeMy WebLinkAboutMGE UPS SYSTEMS , INC. 1A -2004
A-.J.co4-01'i-OI
INSURANCEN9 !
WORK MAY Nor pr~OCEED
CLERK OF COUNCIL
DATE: ~--1'5~5
AMENDMENT TO AGREEMENT
(): ;/Vi:; THIS AMENDMENT, made and entered into this~ day offe.~A2I{2005, by and between MGE UPS
{fi1 ; ;"':l Systems, Inc. a California Corporation ("Consultant") and the City of Santa Ana, a charter city and municipal
,{,h 'corporation duly organized and existing under the Constitution and laws of the State of California ("City"),
collectively referred to herein as "the Parties".
RECIIALS
A. The Parties entered into that certain agreement entitled "Consultant Agreement." dated February 2,
2004, hereinafter referred to as "said Agreement", for providing maintenance and repair of City power systems.
B. The Parties hereto now desire to amend the Term of said Agreement in order to provide continuous
uninterrupted service under said Agreement.
WHEREFORE, in consideration of the mutual and respective covenants and promises hereinafter
contained and made, and subject to all of the terms and conditions of said Agreement as hereby amended, the
parties hereto do hereby agree as follows:
I. Section 3, of said Agreement, pertaining to Term of said Agreement is hereby amended to extend the Term
of said Agreement until February 28,2006.
2. Except as hereinabove modified, the terms and conditions of said Agreement remain unchanged and in full
force and effect.
IN WITNESS WHEREOF, the parties hereto have executed this Amendment to said Agreement the date and
year first above written.
~
----
ATTEST:
PATRICIA E. HEALY
Clerk of the Council
APPROVED AS TO FORM:
JOSEPH W. FLETCHER
City Atlorn yO'
I
By: 't
Michael Vig iotta
Deputy City Attorney
\J
--.
RECOMMENDED FOR APPROVAL:
'::\~~'~~'J \..~
Francisco Gutierrez
Executive Director of the
Finance Agency
~~
(
Tax ID#
op - 2R I{pSce
ACORD", CERTIFICATE OF LIABILITY INSURANCE Page 1 of 3 I DATE
06/101200j
'ReDUCER 877-945-7378 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIACATE
willi. Ho~th America, Inc. - Regoional Ce~t Center HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
26 century Blvd. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
P. o. Box 305191
Nashville, TN 31230!51-91 INSURERS AFFORDING COVERAGE
"SUREO MGE UPS Sy.t~, xnc. lNSURER A: Federal :tnlluranc. company 20281-005
1660 scenic Avenue ,A--d.lJOl}- () 19 INSURER B: federal Iuurance Company 20:l81-0Dl
Costa M.... CA 92626
INSURER c; Continental. Insurance C~any 35289-001
INSURER D:
, INSURER E:
;OVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. N01WITHSTANDING
ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH rHIS 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,
~~: TYPE OFINSURA.NCE POLlCYNu......eER pOUCYEFFECilVE POLlCV EXPIRATION UMITS
~ ~NERALLlABILITY 35818134
X COMM"RCIAl..GENERALLIABlllTY
l CLAIMS MADE [i] OCCUR
-
~'lAGQRE~E ,UMIT AP~ PEFt
v I POL.ICY I I ~~RT I 1 L.OC
l ~OMiOBJLELtABIUT'"
~ ANY AUTO
f--- ALL OWNED AUTOS
f...----. SCHEDULED A\.JTOS
~ HIRED AUTOS
f---- NON-OWNED AUTOS
6/1/2004 6/1/2005 EACHOCCURAENCE $ 1 000 -"00
FJRE OAMAGE(Any an. fire) $ 1 000 000
"ED EXP (Anv Ollll o9l1lon) $ 10,000
PERSONAl & AnV INJURY $ 1 000 000
G ENeR~ AGGREGATE $ 2 000 000
PRODUCTS. COMPIOP AGG $ 2 000 000
73528020
6/1/200j
6/1/2005
COMBINED SINGLE LIMIT
tEa accident)
$
1,000,000
BODILY INJURY
tPerpilfllOl1)
$
nAGE UABIUTY
H PNY AUTO
rYav-~~LW //r
l/
BODILY INJURY
{PIil"accidgnlj
$
PROPEATYOAMAGE
(PlIraccidenl)
$
y
AUTOONLy-eA.A.CCIDENT $
EAACO S
OTHER THAN
AUTOCNLY:
""0 S
EXCESS L1ABIUTY
~~OCCUR 0 CLAIMS MADE
I DEDUCTIBLE
~ ~eTENTION 5
WORKERS COMPENSATION AND
EMPLOYERS'L.IABILITY
CUP20765j7265
6/11200j
6/1/2005
EACH OCCURFlENCE
AGGREGATE
2 nDO
2 000
000
000
--
$
$
$
I
$
l.:af' ST~!.'!:. I IOJ~'
~.L EACH ACC10ErlT $
EL. DISEASE. EA EMPLOyEE $
E.l. DISEASE - POLlCY LIMIT $
OTHER
IESCRIPTION OF OPE.RATIONSlLOCAnONSlVEHIC~ESJEXCLUSIONS ADOEO BY ENOORSEMENT/SPIiCIALPFlOVISIONS
~rs voros AND REPLACES PREVrOUSLY rSSUED CERTrvrCATE DATED. 6/1/200j wrTH rD: 4426163
~e city of Santa Ana, 20 Civic Centar Plaza, Santa Ana, California 92'01z Xt. officer.,
~loye.., agents, volunteers and representatives are included a8 additional insured under the
hove referenced Gensral Liability (for.m attached) and Automobile Liability Insurance polici.. and
he coverage afforded the addit~onal insurea \JS:Lder the.. .POl..:i~ieB shall b. primary and
~on- inattr#lnnA t"_", ....... ...x..........t-. ..h.t- - ""-1. Art,...... -from r.hoDo -,-.!~ ~- of MGE UPS
:ERTIFICATE HOLDER I X I ADDITIONAL INS"RED, INSURER LmER, CANCELLATION
City o~ Santa Ana
Building M4intenan~. Divi.ion
AttUI Mario Ghizzi
P.o. BOX 1988 M-ll
Santa Ana, CA 92702
SHOULO A.NY OFTHEABOVE DESCRIBED POLICIES BECANCEL.L.ED BEFORE THE EXPIRATION
DATE THEReOF, THE ISSUIN'Q INSUAER WILL ENDeAVOR TO MAIL. ~ DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, aUT FAILURE TO DO SO SHAU
IMPOSE NO OBLIGATION OR LlABIUTV OF ANY KINO UPON THE INSURER, ITS AOENTS OR
I R~__''''
AUT.;;")"Eoj!B R~
C..rt, 4459'558 IC>ACORD CORPORATION 1988
ICORD 25-5 (7197) Coll:1015672 Tp1.263777
,
WIUIS CERTIFICATE OF LIABILITY INSURANCEPali8 Z of 3 I DA.TE
06/10/2004
PRODUCER 877-945-7378 THIS CERTIACATE IS ISSUED AS A MAlTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
willis North ~ric.. J:nc. - ~.gion.l Cert Center HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
26 Century 'Blvd.. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
P. o. Box 305191
N...hv!ll., TN 372305191 INSURERS AFFORDING COVERAGE
NSURED MOB UPS sy.~ema, Inc. INSURER A:. 7ed.ral rnaurll.nce CODlPal1:i 2tJ281-00i5
1660 Scenic Avenue INSURER9: 1'8deral In.urana. CODq;lo&ny 20281-001
Costa Me.., CA 92626
INSURER C: Continent..l In.urance CorftPany 35289-001
INSURER 0:
, INSURER E:
)ESCRJPTIONOFOPERATION8I1..0CATIONSlVEHICL.UJEXCLUSIO~S ADDEg E1Y ENDQRSEMENTtSPECIAI. PROVISIONS
9yatems, ~DC. or its .uboontracto~B with respect to all operations of the insured but only with
~e.p.ct to all work perfor.msd by and on behalf of the named insured HQE UPS ~.tema, Xnc. for
~ertificat. under oontraot.
~.:tIl
Coll,10l5672 Tp1,Z63777 Cert,4459558
, '
Page 3 of 3
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the polley, certain policies may
require an endorsement. A statement on this certificate does not confer rights \0 the certificate
holder in lieu of such endorsement(s).
DISCLAIMER
The Certificate of Insurance on the reverse side of this lonn does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate hoider, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon,
3/Y
CORD25-S(7197)
Co~~,101567~ Tpl,263777 cert.4459558
---
.'
COMMERCIAL GENERAL LIABILITY
CG20101001
'POLICY NUMBER: 35818734
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - SCHEDULED PERSON OR
ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name of Person or Organization:
The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701: Its olficers, employees. agents, volun-
teers and representatives
(If no entry appears above. information required to complete this endorsemerlt will be shown in the Declaratiorls as
applicable to this endorsement.)
A. Section 11- Who Is An Insured is amended to irlclude as an irlsured the person or organization shown in the ~
operations pertormed for that insured.
B. With respect to the insurance afforded to these additional Insureds, the following exclusion is added:
2. Exclusions
This insurance does not apply to "bodily injury" or "property damage" occurrirlg after:
(1) All work, including materials, parts or equipmentlumished in connection with such work, on the project (other
than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the site of
the covered operations has been completed; or
(2) That portion of "your work" out of which the injury or damage arises has been put to its intended use by any
person or crganization other than anothElr contractor or subcontractor engaged in performing operations for a
principal as a part of the same project.
Re: The coverage afforded the additional insured under these policies shall be primary and non-contributory in-
surance to the extent that a claim arises Irom the negligence 01 MGE UPS Systems, inc. or its subcontractors with
respect to all operations of the insured but only with respect to all work performed by and on behalf of the named
insured MGE UPS Systems, Inc. lor certificate under contract
~.~ 7'lr
CG20101001
@ISO properties, Inc., 2000
Page 1 011
Cl
--
ADDITIONAL INSURED ENDORSEMENT
FOR COMMERCIAL GENERAL LIABILITY POLICY
Insurance Company: Willis North America, Inc.
This endorsement modifies such insurance as is afforded by the provisions of Policy
# 3581873 relating to the following:
1. The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701; its
officers, employees, agents, volunteers and representatives are named as additional insureds
("additional insureds") with regard to liability and defense of suits arising from the operations
and uses performed by or on behalf of the named insured.
2. With respect to claims arising out of the operations and uses performed by or on
behalf of the named insured, such insurance as is afforded by this policy is primary and is not
additional to or contributing with any other insurance carried by or for the benefit of the
additional insureds.
3. This insurance applies separately to each insured against whom claim is made or
suit is brought except with respect to the company's limits of liability. The inclusion of any
person or organization as an insured shall not affect any right which such person or organization
would have as a claimant if not so included.
~
4. With respect to the additional insureds, this insurance shall not be cancelled, or
materially reduced in coverage or limits except after thirty (30) days written notice has been
given to the City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701.
(Completion of the following, including countersignature, is required to make this endorsement
effective. )
Effective March 8, 2006, this endorsement form as a part of Policy # 35818734
Issued to the City of Santa Ana.
Countersigned by
MARSH
CERTIFICATE OF INSURANCE
CERTIFICATE NUMBER
NYC-002669902-01
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS
NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVIDED IN THE
POLICY THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE
AFFORDED BY THE POUCIES DESCRIBED HEREIN.
PRODUCER
. MARSH USA INC.
200 CLARENDON STREET
BOSTON, MA 02116
MGE UPS SYSTEMS, INC.
1660 SCENIC AVENUE
COSTA MESA, CA 92626
A - JOM-O/ 9
A - J.0611 -(jJ 9- 0/
-oJ..
- OJ
COMPANIES AFFORDING COVERAGE
99713-APCC--07/07
COMPANY
A VIGILANT INSURANCE COMPANY
INSURED
(,
f'
COMPANY
B GREAT NORTHERN INSURANCE COMPANY
I(
f(
COMPANY
C WAUSAU BUSINESS INSURANCE COMPANY
I
I
COMPANY
D NATIONAL UNION FIRE INS. CO. OF PITTSBURGH, PA
COVERAGES This certifICate supersedes and-replaces any previOlJs~yj~uedcediflcl1te_fo'r:thepolicy_pertod-noted below. 1
THIS 15 TO CERTIFY THAT POLICIES OF INSURANCE DESCRIBED HEREIN HAVE BEEN ISSUED TO THE INSURED NAMED HEREIN FOR THE POLlCY PERIOD INDICATED.
NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THE CERTIFICATE MAY BE ISSUED OR MAY
PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, CONDITIONS AND EXCLUSIONS OF SUCH POLICIES. AGGREGATE
LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
Cr~ I ~PE OF INSURANCE l
! GENERAL LIABILITY !
A ~MMERCIAL GENERAL LIABILITY 13531-48-45
~ CLAIMS MADE [I] OCCUR I
~ ,OWNER'S & CONTRACTOR'S PROT
~.sIF, .
, I
AUTOMOBILE LIABILITY
-,
B ~ ANY AUTO
l_ ALL OWNED AUTOS
~ SCHEDULED AUTOS
_ HIRED AUTOS
NON.OWNED AUTOS
X PHYSICAL DAMAGE
X OMP & COLL $1 ,000
C
WCK-Z91-439161-016
10/01/06
10/01/07
LIMITS
~~L AGGREGATE $ 4,000,000
PRODUCTS - COMPIOP AGG $ 4,000,000
PERSONA.~ & ADV INJURY $ 2,000,000
EACH OCCURRENCE $ 2,000,000
~.IRE DAMAGE (Anyone firtll $ 1,000,000
MED EXP (Anv one nersonl $ 10,000
COMBINED SINGLE LIMIT $ 1,000,000
.-
BODILY INJURY $
(per person)
BODILY INJURY $
(per accident)
PROPERTY DAMAGE $
AUTOONLY-EAACCIDENT i $
OTH~~ THAN ,AUTO ~.
EACH ~CIDENT $
AGGREGATE ! $
EACH OCCURRENCE $ 5,000,000
AGGREGATE ,$ 5,000,000
-
$
X ...v;!..';:,;?,I~TU- I OJ,\"
TORY L1MITS_
EL EACH ACCIDENT $ 1,000.000
EL DISEASE.POLlCY LIMIT ,$ 1,000,000
EL DISEASE-EACH EMPLOyEE $ 1,000,000
POliCY NUMBER
06/01/07
7320-34-35
106/01/07
I
I
07/01/07
GARAGE LIABILITY
-
_ ANY AUTO
-_.'
EXCESS LIABILITY
o ~ UMBRELLA FORM
: OTHER THAN UMBRELLA FORM
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
4485537
06/01/07
1
07/01/07
1 THE PROPRIETOR!
. PARTNERS/EXECUTIVE
i OFFICERS ARE:
IU'H<.
~INCL
I : EXCL
"
",..
,?O'vSD A TO FORM
- --, /' Lu
I _ 7:Y--. vFr Lef C (cfyI'-r ,'"'717 '
<..p;?)~ !" iCer ,y /C.vc> /r1b~v \
C oK {lUll;'';
DESCRIPTION OF OPERATIONS/LOCATIONSrvEHICLES/SPECIAL ITEMS
.-.-.
"~-1-'-'-"'i~;'-; :'l!,i~ S:.....;.;J/
1\ 3.,..~W,1L (:ity AttOf:1CY
CERTIFICATE HOLDER
CANCELLATION
City of Santa Ana
Attn: Clerk of the City Council
Civic Center Plaza, M-30 P.O. Box 1988
Santa Ana, CA 92702-1988
SHOULD ANY OF THE POLICIES DESCRIBED HEREIN BE CANCELLED BEFORE THE EXPIRATION D,l,TE THEREOF,
THE INSURER AFFORDING COVERAGE 'MLL ENDEAVOR TO MAIL ----30 DAYS WRITTEN NOTICE TO THE
CERTIFICATE HOLDER NAMED HEREI\I, BUT FAILURE TO MAIL SUCH NOTICE Sf-'ALL IMPOSE NO OBlIGAT100 OR
LIABILrTY OF ANY KINO UPOO THE INSURER AFFORDING COVERAGE. ITS AGENTS OR REPRESENTATIVES, OR THE
ISSUER OFTHIS CERTIFICATE
MARSH USA INC.
BY: Edward R Ford
MM1 (3102)
~7?~
VAUD AS OF: 06/27/07
MARSH
CERTIFICATE OF INSURANCE
CERTIFICATE NUMBeR
NYC-002667482-01
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS
NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVIDED IN THE
POLICY THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE
AFFORDED BY THE POUC1ES DESCRIBED HEREIN.
PRODUCER
. MARSH USA INC.
200 CLARENDON STREET
BOSTON, MA 02116
COMPANIES AFFORDING COVERAGE
--- -
99713-APCC--07/07
--.'--
INSURED
COMPANY
A VIGILANT INSURANCE COMPANY
MGE UPS SYSTEMS, INC.
1660 SCENIC AVENUE
COSTA MESA, CA 92626
COMPANY
B GREAT NORTHERN INSURANCE COMPANY
COMPANY
C WAUSAU BUSINESS INSURANCE COMPANY
-,-
COMPANY
D NATIONAL UNION FIRE INS. CO, OF PITTSBURGH, PA
COVERAGES This certificate supersedes and replaces any previOusly issued certificate for th~poHcy. period noted below ~ 1
THIS 15 TO CERTIFY THAT POLICIES OF INSURANCE DESCRIBED HEREIN HAVE BEEN ISSUED TO THE INSURED NAMED HEREIN FOR THE POLICY PERIOD INDICATED
NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THE CERTIFICATE MAY BE ISSUED OR MAY
PERTAIN, THE INSURANCE AFFORDED BY THE POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, CONDITIONS AND EXCLUSIONS OF SUCH POLICIES. AGGREGATE
LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
~' TYPE OF 'NSURANCE I------::'Cy NUMBER
I GENERAL UABlLITY I
A [Xl C~MMERCIALGENERAL_~IABILlTY 13531-48-45
= CLAIMS MADE [] OCCUR
,-_' OWNER'S & CONTRACTOR'S PROT i
~ $2MMSIR . _I
I' POLICY EFFECTIVE POLICY EXPIRATION
I DATE (MMIDDJYV) DATE (MMJDDIYY)
06/01/07
I
107/01/07
AUTOMOBILE L1ABfUTY
,
107/01/07
B ~,ANYAUTO
~ ALL OWNED AUTOS
SCHEDULED AUTOS
1. HIRED AUTOS
NON.OWNED AUTOS
X PHYSICAL DAMAGE
X OMP. & COLL $1 ,000
GARAGE LIABILITY
7320-34-35
06/01/07
-"!
R' ANY AUTO
r--
~CESS LIABILITY
o ~ UMBRELLA FORM
I OTHER THAN UMBRELLA FORM
I WORKERS COMPENSATION AND
! EMPLOYERS' LIABILITY
I'>
THE PROPRIETORJ IXlINCL
PARTNERSJEXECUTIVE I":'=---j
I OFFICERS ARE: ' EXCL
o,HO.
4485537
06/01107
07101/07
10/01/06
10/01/07
WCK-Z91-439161-016
LIMITS
t:NERAL AGGREGATE
, PR~QUCTS-CO~~OPAGG
PERSONAl & ADV INJURY
~
, $
$
-
4,000,000
4,000,000
,----'----
2,000,000
2,000,000
1,000,000
'--'---
10,000
1,000,000
._~
5,000,000
5,000,000
---~
1,000,000
1,000,000
1,OOe,Ooo
DESCRIPTION OF OPERATIONS/LOCATIONSfVEHICLESISPECIAL ITEMS
RE. MGE field engineers performing work on MGE equipment.
The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701, its officers, employees, agents, volunteers and representatives are included as
additional insured (except Workers Compensation) where required by written contract and allowed by law.
CERTIFICATE HOLDER
CANCELlATION
~q~_OCCURRENCE i $
FIRE g!'MAGE (Anyone fire) $
MED EXP IAnv one Derson\ $
COMBINED SINGLE lIMIT__L-_.
BODIL'( INJURY i $
(Per person) j $
80DIL Y INJURY
(Per accident) +---
PROPERTY D~MAGE -. I $
AUTOONLY_EAACCIDENT $
~~ THAN AUTO ONLY'
EACH ACCIDENT $
AGGREGATE ~ $
EACH OCCURRENCE ' $
,$
$
AGGREGATE
X TOR~~~I~S i I UE~-
EL EACH ACCIDENT 1$
EL DISEASE.POLlCY LIMIT $
EL DISEA;:;E-EACH EMPlOYEE: $
SHOULD ANY OF THE POLICIES DESCRIBED HEREIN BE CANCELLEO BEFORE THE EXPIRATION DATE THEREOF
THE INSURER AFFORDING COVERAGE WILL ENDEAVOR TO MAIL --3Q DAYS IIVftITTEN NOTICE TO THE
CERTIFICATE HOLDER NAMED HEREIN. BUT FAILURE TO MAIL SUCH NOTICE SHALL MPOSE NO OBLIGATION OR
City of Santa Ana
AUn: Clerk of the City Council
Civic Center Plaza, M-30 P.O. Box 1988
Santa Ana, CA 92702
liABILITY OF ANY KIND UPON THE INSURER AFFORDNG COVERAGE, ITS AGENTS OR REPRESENTATIVES, OR THE
ISSUER OFTHIS CERTIFICATE
MARSH USA INC.
BY: Edward R Ford
MM1 (3/02)
~7?~
VAUD AS OF: 06/27/07
COVERAGES This certificate supersedes a-nd replaces any previously issued certificate for the policy _ perlod noted below. 1
THIS IS TO CERTIFY THAT POLICIES OF INSURANCE DESCRIBED HEREIN HAVE BEEN ISSUED TO THE INSURED NAMED HEREIN FOR THE POLlCY PERIOD INDICATED.
NOT\",ITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THE CERTIFICATE MAY BE ISSUED OR MAY
PERTAIN. THE INsuRANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. CONDITIONS AND EXCLUSIONS OF SUCH POLICIES. AGGREGATE
LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
---- --- ~- -
co I
LTR \ TYPE OF INSURANCE I POUCY NUMBER
,
MARSH
PRODUCER
MARSH USA, INC.
200 CLARENDON STREET
BOSTON, MA 02116
99713-APCC--08-09
INSURED
MGE UPS SYSTEMS, INC.
ATTN: MICHAEL DENNIS
1660 SCENIC AVENUE
COSTA MESA, CA 92626
A- :2ODI-lgLj
A -:.LODLf-Ol'l
A- ~'1-olq_o I
-0:>'-
-03
/I
"
i'
"
GENERAL LIABILITY I
, '
A ~tx COMMERCIAL GENERAL lIABlLlTY ,1,7218693
f - CLAIMS MADE rx--I OCCUR
! OWNER'S & CONTRAcr;'s PROT I
c'
X IuMM.sIIL _ - 1
1-
~~OMOBILE liABILITY
B X ANY AUTO
c-j
IL J .ll.lL OWNED AUTOS
, I SCHEDULED AUTOS
!f- .J HIRED AUTOS
f------.j NON.OWNED AUTOS
L)( PHYSICAL DAMAGE
X COIM~P-&(;OLL$1,OOO--
I GARAGE liABILITY
l-
i _! ANY AUTO
1-
EXCESS LIABILITY
o IX II UMBRELLA FORM
I-
I OTHER THAN UMBRELLA FORM
WORKERS COMPENSATION AND
C I EMPLOYERS'lIAB1l1TY
B I THE PROPRIETOR'
I PARTNERSlEXECUT1VE
I OFFICERS ARE:
OTHER
I
T J_CAP_8199A41-4-TIL
\
I
I
I
1
I
I
19835472
,
,
\TC2H-UB-8196A02-A-08- TIA
Ixll'NCLJTRJ-UB-186K259-O-08-TIL
I EXC'
!
1
I
CERTIFICATE NUMBER
NYC-002667482-04
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONfERS
NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVIDED IN THE
POLICY, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE
AFFORDED BY THE POLICIES DESCRIBED HEREIN.
CERTIFICATE OF INSURANCE
1-
COMPANIES AFFORDING COVERAGE
--- --- -
-
COMPANY
I A AMERICAN HOME ASSURANCE CO.
-I---~ -- ----- --- --
COMPANY
~ B TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA
-------- - - -- -
COMPANY
Ie TRAVELERS INDEMNITY COMPANY OF AMERICA
-- -~ - - - - ~-~--
COMPANY
, D NATIONAL UNION FIRE INS. CO. OF PITTSBURGH, PA
--\PO~CY EFFECTIVE~OUCY EXPIRATI~J---
DATE (MM/DDNY) , DATE (MM/DDNYI I
I ~ENERAL AGGREGATE : $
101/01/09 PRODUCTS _ COMPIOP AG~ $
\ ~~ON~ & ADV INJU_RY \ $
I EACH OCCURRENC~ $
\ ~REDAMAGEIAnYOl1efi~ _
MED EXP IAnv one nersol11 1$
, !
I COMBINED SINGLE ',-IMIT i $
LIMITS
101/01108
4,000,Oil,tl
4,000,000
2,000,000
--'--
_ 2,OOO,OO~
1.000,000
-
10,000
1,000,000
- -
1
I
I
1
101/01108
I
101/01109
I~~DILY IN-JURY-
(Per person)
~-
$
-1'---
$
I
1 BODILY INJURY
IPeraccidentl
,
I
I
I
I
,
I
101/01109
i
! PROPERT'r' DAMAGE
1101101108
~!JTO. ONL~AACCIDENT \$ . -_--
tOTHER THAN AUTO ONJ:Y..:.- -- _ ---'-----'-.-
f-- EACH ACCIDENT +!- - ----
i AGGREGATE I $
I EACJ:i~CCURRENCE $ 5,000,000
1 'GGREGA~ - f ~- - 5,000,00~
LX 1_ T~-!ltMI~sl TO~~~-,->~---,-----,_,
,EL EACH ACCIDENT__~ L_2,QOO,OOO
IEL DISEASE-POLICY L1MIT~ L ,----.?,OOO,O~~
EL DISEASE-EACH EMPLOYEE'I $ 2,000,000
101/01108
01101108
I
I
I
101101/09
01101109
I
I
1
;
DESCRIPTION OF OPERATIONSllOCATIONSfVEHICLE5ISPECIAL ITEMS
RE. MGE field engineers performing work on MGE equipment.
The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701, its officers, employees, agents, volunteers and representatives are included as
additional insured (except Workers Compensation) where required by written contract and allowed by law.
CERTIFICATE HOLDER
City of Santa Ana
AUn Clerk of the City Council
Civic Center Plaza, M-30 P.O. Box 1988
Santa Ana, CA 92702
CANCELLATION
SHOULD ANY OF THE POLICIES DESCRIBED HEREN BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF
THE INSURER ,o.FFORDING COVERAGE INILL ENDEAVOR TO MAIL ~ DAYS WRITTEN NOTlCE TO THE
CERTIFICATE HOLDER NAMED HEREIN BUT FAILURE TO MAil SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
LIABILITY OF ANY KIND UPON THE INSURER AFFORDi'lG COVERAGE. ITS AGENTS OR REPRESENTATIVES. OR THE
ISSUER OF THIS CERTIFICATE
MARSH USA INC.
BY: Edward R Ford
MM1(3102)
~7<'.~
VAUD AS OF: 12131107