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HomeMy WebLinkAboutWATERS & FAUBEL 2 -2005 . INSURANCE VI~ riLl WORi\ W,y rROCEED UNTIL INSURANCE EXPIRES -""7_1-05 CW:K OF COUNCil DATE, a~lh-05 A-2005-050 CONSULTANT AGREEMENT (} tCl1U) (ft~~ THIS AGREEMENT made and entered into this 1st day of March, 2005 by and between Waters & Faubel, 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"). RECITALS A. The City desires to retain a consultant having special skill and knowledge in the field of media relations and consulting 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 provide public affairs and media relations consultant services related to the City's efforts to ensure the Fourth District Court of Appeals remains in Santa Ana. 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. City shall pay to Consultant, in advance, a monthly retainer of $5,000.00, to cover the costs of all services performed by Consultant. City shall reimburse Consultant for necessary and reasonable costs and expenses incurred on its behalf in connection with services provided hereunder. Consultant shall not charge for local telephone, mileage or incidental postage. b. Consultant, with City's prior approval, may hire, retain, or subcontract such media production houses, research consultants and other professional firms as may be required. The costs and fees for such services shall be approved in advance by City, and will be assessed a 15% commission to Consultant. c. The total sum to be expended under this Agreement shall not exceed $10,000.00 during the term of this Agreement. d. Consultant shall monthly submit a bill with invoice or other documentation evidencing services provided during the prior month. 3. REPRESENTATIVES Consultant has designated Roger Faubel as the key contact with the City. Any change in this key contace will be communicated in writing to the City. 4. WORK PRODUCT Any and all information, reports and other data resulting from this Agreement shall be the sole property of the City, and the City shall have the right to use such materials for any purpose whatsoever. The Consultant may retain for its own internal use, copies of such materials. 5. TERM This Agreement shall commence on the date first written above and terminate on April 30,2005, unless terminated earlier in accordance with Section 12, below. The term of this Agreement may be extended upon a writing executed by the City Manager and the City Attorney. 6. 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. 7. INSURANCE Prior to undertaking performance of work under this Agreement, Consultant shall maintain and shall require its subcontractors, if any, to obtain and maintain insurance as described below: a. Commercial General Liability Insurance. Consultant shall maintain commercial general liability insurance naming the City, its officers, employees, agents, volunteers and representatives as additional insured(s) and shall include, but not be limited to protection against claims arising from bodily and personal injury, including death resulting therefrom and damage to property, resulting from any act or occurrence arising out of Consultant's operations in the performance of this Agreement, including, without limitation, acts involving vehicles. The amounts of insurance shall be not less than the following: single limit coverage applying to 2 bodily and personal injury, including death resulting therefrom, and property damage, in the total amount of $1 ,000,000 per occurrence. Consultant shall supply City with a fully executed additional insured endorsement in substantially the form attached hereto as Exhibit B upon execution of this Agreement and shall be approved in form by the City Attorney. b. Worker's Compensation Insurance. In accordance with the provisions of Section 3300 of the Labor Code, Consultant, if Consultant has any employees, is required to be insured against liability for worker's compensation or to undertake self-insurance. Prior to commencing the performance of the work under this Agreement, Consultant agrees to obtain and maintain any employer's liability insurance with limits not less than $1,000,000 per accident. 8. INDEMNIFICATION Consultant shall indemnify and hold City harmless from and against any and all claims that may at any time be made against the City as a result of statements made or materials produced by Consultant except to the extent that such claims result from the negligence of the City. Consultant shall submit all proposed statements or materials to City for approval prior to the publication of such statements and materials. City shall indemnify and hold Consultant harmless from and against any and all claims that may at any time be made against Consultant as a result of statements made or materials produced by Consultant and approved by the City except to the extent that such claims result from the negligence of the Consultant. 7. CONFIDENTIALITY If Consultant receives from the City information which due to the nature of such information is reasonably understood to be confidential andlor 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 oflaw; or (e) is independently developed by the Consultant without reference to information disclosed by the City. 8. CONFLICT OF INTEREST CLAUSE Consultant covenants that it presently has no interests and shall not have interests, direct or indirect, which would conflict in any manner with performance of services specified under this Agreement. 3 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: Cit Manager City of Santa Ana 20 Civic Center Plaza (M-31) P.O. Box 1988 Santa Ana, California 92702 telefacsimile (714) 647-6954 To Consultant: Waters & Faubel 25 Orchard Lake Forest, California 92630 Telefacsimile (949) 768-1601 Attn: Roger Faubel 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. This Agreement may not be modified except by written instrument signed by the City and by an authorized representative of Consultant. 4 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 either party upon thirty (30) days written notice of termination. In such event, Consultant shall be entitled to receive and the City shall pay Consultant compensation for all services performed by Consultant prior to receipt of such notice of termination, subject to the following conditions: a. As a condition of such payment, the City Manager 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 thereoffor such purposes as the City deems appropriate. 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. II II II II 5 IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first above written. ATTEST: ,. :rj . J /, ~::'L,-<-~___dc--:-L,< PATRICIA E. HEALY U Clerk of the Council CITY OF/SALjNTA ~A / " / /) (~PL' /// v'~" DAVIDN.REAM City Manager APPROVED AS TO FORM: JOSEPH W. FLETCHER City Attorney /\j I! . ~~~~s~~~~{,. ' ; 1,(7..C J/ Assistant City Attorney /p ~ , Tax ID# 6 EXHIBIT A Waters & Faubel Client Rate Sheet Principals $1 95/hour Senior Vice President $170/hour Vice President $150/hour Account Manager $130/hour Senior Account Executive $11 51hour Account ExecutivelAccount Coordinator $95/hour Administrative $75/hour 7 ,.OoUCER (714)53~-~OB6 Bannister , ~5oeiates L1c~se '0691071 30S 17th 51;r..t Huntington Baach, CA 9Z641-4ZD9 1..Ul<EO Roger "auo., PUD!'C Anall"S ;tIC. a t:A O;lrp dba: Waters & Faubel ,4- \~~,I;_I"C Z5 Orchard , ~ ~ lak~ ~orQ;t, CA '2&10 nO' UAIIlUT't ~PlffAlJrn P<:"~1ltU l.IAllIU'n' :!l ODCUS 0 Dl.ioIMS_' Tl DlOUC'TleL! "H 1lrn>rJ10N . WCru<ERs coMIIIAI!JATIOIl ANti tllP\.OW\I' \WIIUI'l' ,,~ P~QPfU!TOPWARTN~UTM; QFFICI!WiMlli~ I9Ct~lJO&O"l' If...,~'''''l.,,,,. jpEClAt fIIRDVIll0N8 hetl'W ~~~Qssiona' Liabilit~ B I ::r;m;>~l)t;.1 1.:: E.\.iAQi~OI!'T . 1\.OillWIi'io\-'~ . e:.l.OI~."OUCYLlUlT I $1.000,000 deh c:laim 51,000,000 .nnuiLl illllragate ' inCluding claims exDanse lIjI3CJWIlllIIo.QPI...11D..../LC1:41\.DLl.,V~/IXCI~_APPEP1!~~I.I'IlCIol.,,~ 10~.ay notica of canCallat10n TOr nOft-payment,tnl, notice Wlll be 5en~ in tha Ivent of companY alec~1on The City uf Santa Ana, its off1eer~. alllftts. Peprl!lSantatives. voluntalr$ and emplOyaas are named as additional insureU as r.sp.cts &.n.r.l liability. Primary Mlrcling includlld pl!r IIllner'al l1abil h:y cOV1lragl! form 952001 049 ..ivsr af 5ubrDgation ~doremen~ applies 10 be iS5~l!d by the carrier. A A i"l I ! I: I ! .: ~7/071?004 10:34 FAk 714 53S 4054 Bannistlr & Assoc. Ins. III 002/003 ACQRQ. I g~TB 1~"'1J/nYT) i' 07101/2004 THIS CERTIFICATE IS ISSUED AI A M"nER Of'1"FORMATION , ONLY AND CDNFl!1UI NO RIGHTS UPON THE CIIRTII'ICATE I t1ClJ.~.ER, TH~_C~RllFlllA11I DCE_O NOT AMIND, EXTEliIl OR "Ln'ftTt1~CUVI!!IUUa~ ,~, I .I!!L.OVY. CERTIFICATE OF LIABILITY INSURANCE FAX (714) S3f -4054 InsurancB AgBney, Inc. , INlIUFIIiRS AFI'ORCINIll COvE~GE ,..--.. Maryland t:a5walt'lt' ConIlilny I>lGUrlli~.' Philadl!lDhia ;tnllllrarlCe 'ConirIanies loaUI<ER Co :,. INSUIIIR 0; IhISU<Gll., NAIC # ," I 1 , I , I , TH! ~OUCIEs OF INSURANCE LISTED BELOW HAVli a~s.lSSulC'rO T>-tE INsUMD NAMED ABOV! FOIt THI! POLIcY "'RJOC INDICATI!!. NO'TWffilSTANDlt+ ANY REQUIRliMiNT, nlUol gRCONPITlON OF AN'( CONTAACT ~ OTH!~ DDClJMINTWTTH RESPIC'!' TO wHICH THIS ceRTIFICAT~ MAn" ISSUED OR MAY "EIlTAIN. THi INSURANCE ""FORDED BV THI POLlClES DESC~laEC HiRElN IQSUIl.J!CT TeAU. THIITERMll. Sl<Cl.USION.ll AND CONClflON.lI OF SUCH I'pLtCIES, AOGltiOATe UMIT1I8HOWN w.... MIIIV! B~!!N REOUCEO B" PAlD~CLAlM/l. = 1'YJIW,o.tMJUMNCOe; f:lgU~NUIIBeR. ~EF ~ Ut.R11i SEIlDw..IABlU'T'I' PPS 33413221 07/0 2004 0710112005 ~.~..E"CEI K ClCIoAME~'A1. QINS"AI. ~IMIU"" TO oS ICI.OI,.,.~g.OOOC<llJ~ ..!O!.ia',....".p....'J . PER9ONALI.M1IlfIL/I,IlIY .s lIIN1iR&l..AGGIlSGATE 5 Pl<OOUl:Tl. ctlo\I'IllPOGCl I - GiN'L""'/<E<lAT! lI"'T""~ ..., ~' 'cI,';r"'i~:er I I Igo 0llTIIII0IIl\Iu.L.... """ANY-""'O = AI..OW";OAUTOli h:;- .a~UL.eD"UTC8 X .....~D lIIUTOO X NON_OWNS] AJJrQS ..;..;.. - ~~ ~ !xclu~ Z .000 . 0JlDl 2 ODO.~ PI'S U41UU 07/01/Z004 07/01{2oo5 COMIINED I-..E liMIT Iii.",.,.",) 1 000 oilll IOOILY INJlnlY (PGirp.l'lcnl I I ~ . , I I " ii, , , , . I . 2.000.000 I Z ooo.oliO I I soal.YI...._ ll'Wt09'''''1 l?Ia~'y/P /I """"...'tYOAMME (l'or_) , AUTO C1M.T' -" ACOIDIIm' eA_ . ru~ """ PPS U4UZ:Zl 07/01/2004 117101/Z00S IACH O__C11 .aO_TE PHSPG&0366 07/:Zl/Z003 07/21/~004 , j Mn,n".. " .__u : 1 , City 01' Santa Ana Public: Wgrks ^,In~y "-36 1'0 BOll: l!lU Santll Ana. CA 92702 IHOUla.NYOn..u..M'...CIIlMII....IC'U..lWIClW.SDl__ I I .-mNDA....THlIIWlI', TIIII..IIINn....om....L .....rll1llX-. i: ...1L ;,lTOIMtlTeJlNClTICITO TIlE_IEAT! HOLaU ,.....,.lllTlll!LDT. ...."..'nr:cr~"(Mr-nu~-""'"<<U AllTHOIlI_.Jl"~'R\I! // lCIIXXXXX!' ( 7:. .<... r.~ ':';"'. .-' I -mOJ, .'10:11 tODZ-ZI-AoN I epg-, vOO/EOO'd 91Z-1 Oc/Oll~004 10:34 FAX 714 ~36 4054 Banh1$ter a A,,"", Ins. IIIl QQ~/OV' ! I Ii I 1 I THIS ENCO~S~ ..!NT CHANGES THE POLICY. PLbrdlE READ IT CAREFULLY. eG l!O 10 O:B7 ADDITIONAl., INSURED-OWNERS, LES5EI!5 OR CONT~CTOR$- SCHEDULED PERSON OR ORGANIZATION: : J, ; ~ Thl' Inde/Hmant rnQQlfl.,., Inl>urence prcVI~Bcl UMds.ths followin~: COMMI:RCJAl.I3ENI!RAL L1A611.1TY COVERAGE PART Tl1J1 .OOolumsn! ghlll1ges tk1IlIJI.lUI;iY o1Tollllvlt on tie In~pUQn dm&! of tI1l1o p<:lllcy \Jtlles:s IlMlIlllf dlll$ i$ Indlllllte4 b.low. n~orsement effeolivll , , , N""'ad In8u~ Wilt.:. PPS334132~1 Y --i...,tncrlzo ~nlan"'l scH!DULE N..". of P"rsllln or Ql'9lnlzaclol1: city of Santa Ana, its aft1cQ~, ~gentB, representatives, VgJ.nt~il~~ (lflWBrlWti~"h~-?b~lfl/i.llllllloA- 'equ~N&'~ thle 811dotllltl'Tlenl WIll bll showl1 in the tlGl~ as 1PP1ir:zblw 1lI1hl$ end<JrsemWlq WHO Is AN INSU~;O (SdClll II) Is sm.ndld to fnaulll II In InluriClll1e plII'SOIl or organiZBtIcn shown In Ihe Schedul., bLJI O~ I~ with re~pect 10 IlIabalty nlng out at YOLJr Oh;oln!lllllA~tIonD pllrformlld !'or lhllt in,ulld. 1 , I' Ii , ! ! ;% ,2/3 1 I I' I' Cl.i1i7(1ogTJ CG 0ICI10lnrT C~lI)'IIgh~ rlll,"~"llAMag CIIkle, In...llJll~ f'lplOr, I €~,-~ ~OO/~OO'd 9LI-1 _OOJj W'IO: II P001-II-AON 11/18/200' 1105 FAX 714 538 4054 Bannister & Assoc, Ins, ~ 002/002 Witl1 rllipllct tc "mobile equipment" to which this insurance Ilp~lies: a. When thi!! Coveraglil Part Is certified as proof of li~e"'cial res;>o"sibility und.r the provisions of any motor vehlcl. fI- nancial responllibility law. the insurance provldsd by the Coverage Part for Bodily Injury Liability or Pfo~erty Damage Li- ebility will comply with tI1lil provisions of the iaw to the utsnt of the coverage and limits of insurance rsquired by that law. b, We will provide any liability, uninsurlld motorl5ts. und9rlnsured motori.ts, no- fault or other coverages rllqJirM by any motor vehicle insurance law. We will provide ths required iimits for those coverages. 5, Other InsLlr.-,ce If othllr valid and collectible insuranc& is avail- able to the insured for a 10&& we cover u"der Coverages It. or B of this Covarage Part. our oblillations are Iimitlld as follow.: a. Pr lmery lneurlllCe Thle insurence is pfimafy except when b. below applies, If this insurance is ~ri- mary. our obligatlone afe not affected LIl1less any of the other insurance is also primary. Then. we willlhare with all that othef inli\.lronce by the method described in c. below. b. Excus lnIur.,oe This insurance Is Ilxcess oller: (1) Any of the other Insurance, whether primery, e~cest. contin"ent or on any other b"i$: (a) Th.t i. Fire, ExteMed Coverage, Builder's Risk. Installation Aisk or similar coverage for "your wor1<"; (b) That Insures for direct phvsical loss to premisu rented to you or temporarily occupied by you with pefmilision gf thfil owner; Ic) That is insurance p\.lrch"ed by you to cover youf liability as a tenant for "property damage" to premius rented to you Of t.m- porarlly occu~i..d by you with pllrmlnion of Ihe owner; or (dl If the Joss arises out of tn. main- tenance or use of lircraft "IU- tos" or watercfaft to the extent not subject to Exclusion II. of SECTION I - COVERAGE A . BODIl.VIIIJURV AND PROPERTV DAMAGI: LlABlU1'r'. 12) Any other ;>fimary insur""ce avail- able to you coverinllll.bility for dam- SlOes arising out of the ~remises or operations for which you have been added as an additionsl insured bv i1ttachment of In endorsement ' When this insurance i.$ excess. W8 wil' have no duty Linder Coverages A or II to dllflnd the insurad against IlI1Y clsim or "suit" if any other insurer has I duty to defsnd the Insured against that cJ,lm or "suit", if ng other insurer defends, we will undertake to do so, but we will be entitled to the insured's rights against all those other insurefS, When this insurBnce is eXCllSs over other insurancll. Wll will pay oniy our share of the emount of the 101$, if any. that ",x- ceeds the sum of: (1 J The total amount that all such other insurance would pay for the 10sI in the absenc. of this insurance; end 121 The totai of ell deductible and SIli/- insured amounts under all that other insurance. We will share the remaining loss. if any, wa:h any othllr i~lurance thet is not de- sCfib.d in this Excesl Insurance provi- s;on and was not bought speCifically to apply In excess of the Limits of Insur- ance Shown in Ihe Declarations of this Coverage I"art c. Method Of Sh..ing If .11 of the other insurance ~efmjts con- tribution by equal shares. we wiil follow this method also. Under thTs .pprQach 8ilch inS1.XBr contributes equal .moLlnts \.lntil it has paid Its 8p~licable limit of in- surance or none 01 the loss remain.. whichever comes fin;!. If any of the othllr insurance does not permit contribution by equal shares. wa will contribute by limits, Under this methOd. each Insurer's share is based on the ratio of its .pplicabllllimit of in- surance to ths totsl applicable limits 01 insurance of all insurers. 6, Premium Audit /0'$5/.3 952001 Ed. 4-98 Ift!IIl.dM ~ ~ >:I1"'1IfqI .....11:89 Ol'lil'll!l, lfe., .....lt1 itl: prm:tAi:n oep,r'i~ lr..nral s.vfal~ Ofl~ 1",,-, ~6V7 Cq:7,'nf'll, lilili, ~.rW C.ully ~~, ., to IrZI,;~1 'tIll<'I:&nIlI revlflonl Plge 12 of 17 11/12/213134 12:133 NO. 6013 GlB02 CERTHOLDER COPY STATE P.O. BOX 420807, SAN FRAIIICISCQ, CA~4142-0807 (:OM~.N~nCN INSyflltANr;.. FU N D CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE. 11-12-2004 GROUP: POLICY NUMBER: U15an,2004 CERTIFICATE 10: 15 CERTIFICATE EXPIRES: 04-01-2005 "4-01-2004/04-01-2005 , I crn OF aAI'lTA AHA l'1lIILJ:C 11I01UG AGIlNCY PO BOX J.!i88 SAII'l'A AKA CA 9 2 7 02 , JOB: AT'l'!!l JOJ; ~A.RCO I .' Thi; is 10 certify that Wi have ilmIGd ; valid Wolle;r', Coml)tn..tien in$ur"'''''@ pcll")ll" a Ill"" app_ by tho Cllrrfomlo Insurance Commilllonerto tM empl0}'9' nMle\l ~iIO\Alforlh. pelloy p",lod Indleatlld, TIlls polley 10 not 9UIljll<ll tD canCOlI"'ticn bylhD I'und __pt upcn 30 day_ advsnce writlsn notice 10 the employ,,,. WQ Will also gll/e you 30 days advan"" noti"" ~hould tIli~ policy boI canCilllod prior to it.& normal @XJliratlon. 1l'lis C8ltifiCBl.. 01 insurance I. not an Insul1lnoo policy.n<l ~on not ""'en~, extend or eltet tile coverage alfiJrd.d by the polO)' netetl herein. Notwllll.tan<ling any requlremont. l$m1 0< condition of 8I1Y ccntr.ct or olher dOQumellt willi respect to which this <:ertltl~e of Insurance may be islUod Qr \Q whIch n mey pert.oln. the insll/'ance afforded by lh~ polioy d6llCribed herein is subjeollo alllha llloo., IlJlC"""iOllll. iln~ ~nditkm., !1Illuch policy. ~ ..&~ c. fJL Alft'KlRImo RlPRiSEHTATIV! III1tBl~T EMPLOYBR'8 LrABILITY LrH7T rHCLUDrKG DE~KNSE cosrS, $l,OOB,BBB PEa OCCUKaaNCZ. II;l'IDOUBJIBm 11500 - ROGIlIl l!'A1IIlIU., pas, se, TR - EXCLUDIlD. 2RDORS~~ '2065 ERrITLID CB~J:pJ:~a gOLDERS' NOTrCE EFFECTIVE 04-01"2004 rs ATTA(!IIIlD TO llIm l!'OIlXS A PUT Ol!' TRIa J;>OLICY, 1#-2/ "ty 'I , e~R ,I , ROGER i'ADIllIiL J'Ol!ILJ:C MtAUS Die DU., !fARM .. PADIlIIL 25 ORClUllU) WlD J'ORlllff C.A ~~nQ I Ii ~'il~;1"- 11/12/2~~4 12:~9 NO. 605 (t~~2 : . CERTHOLOER COPY STATE P,O. BOX 4201$07, SAN FRANCISCO, CA 94142-0SQ7 C:OMJI'I:N~TION I,",SU""Ne. FUN D CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATS: 11-12-2004 MOup: POLICY NUMBER: 1515671-200i CERTIFICATE ID: 15 CERTIFICATE EXPIRES: 04.01.~005 o,-o~-'oD'lo'-o~-'OD5 CI:r1' Of SJlJI1'A AHA PUMoIC IIOEOOl 1I.GllZlCl" 1f-36 PO BOX 1~88 BAlITA J\DIA CA U702 JOIi ~ A~'m': JOB PAKCQ I This is to ..rII"'II'4IWlI ~1I'" 1N~t\l. valid WorI<er, Compllnllllion inCuran09 polit;y in a form llPomed bytl1e Califomill InllUJ'M<e Comm"'-'Ionllr to Ill, ..,.p1OYllr namG<! ~Iow for lh9 polit;y period indlt:llted. ThiS pOliey is not stJbjar:tlo Cll_IJ$llon bythQ Fund QXc.pt upon 30 doyo odvlinCII wriltlin notice to the .mpley.,. , w. will also glve)'Oll 30 d'Y5ad""~ nolle>> S/lould Ihis policy b. canceUfOd p'iorto Itl; normal llXpilOlaon. This =1I~art.' of Insu...nce Is not an inouranCII policy and don not emend, extend or alter the coverllg. a1fordod by the policy listed herein. NOlWllhotanalng any 'equlremen~ term or condition at any contract or other doaument with respeollo which IhT. certilicate or Insurance mey b. iSSIJ<d or!o ....hich it ""'y pl!!rtein, the inSIJtllnce m'furded by lIle policy dHC/1bed herain i. subj.cllD .lIth. term..l'>llC!u'lon., .nd conditio"", of ~uch policy. ~ J~c.~ Al11"KORlZm lii~iiNT"'T'rV1 fIftE~DENT KKPLOfBR'S ~%AaI~rTY t!Mt~ !MCLDn!MG DB1ENSB ~bS~S. $1,000,000 ~~ OCC~~~. ENDORSEMENT '~600 - ROGER FAUB!!L. ~RS, se, rR . EXCLUDED. ERDORSEMBNT '~065 KNTITLBD CBRTI7ICAT2 HOLDERS' ROTICK 2FF2CTrvB 04-0l-~004 IS ArrACXED TO AND FOllKll A PART OP THIS POLICY. ~.u*; IMPI.OTOR !loon FAUBEL PUBLIC AJ'UIR!I IIIC DIA. WATERS . J'AUBIlr. 2! OIlCHAm> I.1oXI2 POUIl'%' CA g~ 630 ~~J:n..u.2004