HomeMy WebLinkAboutUnited Storm WaterAGREEMENT TERMINATION
Please complete this form when the attached agreement is no IongeYYh CHY.ct,~ ~
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and final payment has been made.
Department
Signature:
Date:
Revised 08-28-06
City of Santa Ana
Clerk of the Council
INSURANCE NOT ON f:H.l
WORK MAY I'LQI PROCEED
CLERK OF COUNCIL
DATE: u:v/7-C;5
A-2005-124
CONSULTANT AGREEMENT
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THIS AGREEMENT, made and entered into this 6th day of June, 2005 by and between
United Storm Water, Inc., a California corporation (hereinafter "Consultant"), and the City of
Santa Ana, a charter city and municipal corporation organized and existing under the
Constitution and laws of the State of California (hereinafter "City").
RECITALS
A. The City desires to retain a consultant having special skill and knowledge in the field of
catch basin inspection and cleaning, for the purpose of meeting National Pollution
Discharge Elimination System (NPDES) permit requirements.
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 those services as set forth in Exhibit A to this Agreement.
2. COMPENSATION
a. City agrees to pay, and Consultant agrees to accept as total payment for its services,
the rates and charges identified in Exhibit B. The parties anticipate that additional services may
be required, and will be charged at the rates and charges listed. The total sum to be expended
under this Agreement, shall not exceed $125,000.00 during the term of this Agreement.
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 terminate on May 31,
2006 unless terminated earlier in accordance with Section 12, below. The term of this
Agreement may be extended upon a writing executed by the Executive Director of Public Works
and the City Attorney.
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. 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 protection against claims arising from
bodily 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. The
amounts of insurance shall be not less than the following: single limit coverage applying to
bodily and personal injury, including death resulting therefrom, and property damage, in the total
amount of $1 ,000,000 per occurrence. Consultant shall supply City with a fully executed
additional insured endorsement in substantially the form attached hereto as Exhibit C upon
execution of this Agreement and shall be approved in form by the City Attorney.
b. 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.
c. Worker's Compensation Insurance. In accordance with the provisions of Section 3300
of the Labor Code, Consultant, if Consultant has any employees, is required to be insured against
liability for worker's compensation or to undertake self-insurance. Prior to commencing the
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.
d. The following requirements apply to the insurance to be provided by Consultant
pursuant to this section:
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(i) Consultant shall maintain all insurance required above in full force and
effect for the entire period covered by this Agreement.
(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.
e. If Consultant fails or refuses to produce or maintain the insurance required by this
section or fails or refuses to furnish the City with required proof that insurance has been procured
and is in force and paid for, the City shall have the right, at the City's election, to forthwith
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. INDEMNIFICA TION
Consultant agrees to and shall indemnify and hold harmless the City, its officers, agents,
employees, consultants, special counsel, and representatives from liability for bodily injury or
property damages arising out of claims for bodily injury, including death, and claims for property
damage, which may arise from the negligent performance of 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. The Consultant
further agrees to indemnify, hold harmless, and pay costs for the defense of the City, regarding
any such action by a third party, or asserting that bodily injury or property damages arises by
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.
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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.
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 copies to:
Public Works Agency - Design Engineering
City of Santa Ana
20 Civic Center Plaza (M-36)
P.O. Box 1988
Santa Ana, California 92702
telefacsimile (714) 647-5640
and
City Attorney
City of Santa Ana
20 Civic Center Plaza (M-29)
P.O. Box 1988
Santa Ana, California 92702
telefacsimile (714) 647-6515
To Consultant:
United Storm Water, Inc.
14000 E. Valley Boulevard
City ofIndustry, California 91746
telefacsimile (626) 961-3166
Attn: Paul Corn
A party may change its address by giving notice in writing to the other party. Thereafter,
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
4
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 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. 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.
5
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 her inability to obtain or maintain such permits, licenses,
approvals, waivers, and exemptions. Said inability shall be cause for termination of this
Agreement.
16. COMPLIANCE WITH GOVERNMENTAL REQUIREMENTS
Contractor shall carry out all services pursuant to this Agreement in substantial
conformity with all applicable laws, ordinances, statutes, codes, rules, regulations, orders, and
decrees of the United States, the State of California, the County of Orange, the City, and of any
other political subdivision, agency, or instrumentality exercising jurisdiction over the City,
including all applicable federal, state, and local occupation, safety and health laws, rules,
regulations and standards, applicable state and Federal labor standards, prevailing wage
requirements, the City zoning and development standards, City permits and approvals, building,
plumbing, mechanical and electrical codes, as they may apply, and all other provisions of the
City and its Municipal Code (as they may apply), and all applicable disabled and handicapped
access requirements, including, without the limitation, the Americans With Disability Act,
42 U.S.C. S 12101 et seq., Government Code S 4450 et seq., and the Unruh Civil Rights Act,
Civil Code S 51 et seq.
17. 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.
6
IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year
first above written.
ATTEST:
CITY OF SANTA ANA
PATRICIA E. HEALY
Clerk of the Council
aA2r:L-
DAVIDN. REAM
City Manager
APPROVED AS TO FORM:
JOSEPH W. FLETCHER
City Attorney
By: 'U { I /1 (" _h 1.."_ ; \ \/" .
Laura Sheedy
Assistant City Attorney
I
CONSULTANT
~~~
PAUL CORN
Director of Operations
Tax ID#
\ -
7
EXHIBIT C
ADDITIONAL INSURED ENDORSEMENT
FOR COMMERCIAL GENERAL LIABILITY POLICY
Insurance Company
This endorsement modifies such insurance as is afforded by the provisions of Policy
# relating to the following:
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
effecti ve.)
Effective
Policy #
Issued to
, this endorsement form as a part of
Named Insured
Countersigned by
Authorized Representative
8
CONSENT CALENDAR
Motion: Approve staff recommendations on the following Consent Calendar
items.
MOTION: Bist
SECOND: Solorio
VOTE:
AYES:
Alvarez, Bustamante, Pulido, Bist, Christy,
Garcia, Solorio (7)
NOES: None (0)
ABSTAIN: None (0)
ABSENT: None (0)
ADMINISTRATIVE MATTERS
MINUTES
Motion: Approve minutes. (Items 10.A. through B.)
10.A. ADJOURNED REGULAR MEETING OF MAY 16, 2005
(Councilmember Christy abstained on this item)
10.8. REGULAR MEETING OF MAY 16, 2005
(Councilmember Christy abstained on this item)
ORDINANCES SECOND READING
11.A. PROPOSED AMENDMENTS TO CLASSIFICATION AND
COMPENSATION PLANS, ANNUAL BUDGET, AND SANTA ANA
MUNICIPAL CODE
Placed on first reading at the May 16, 2005 Council Meeting and approved
by a 6-0 vote (Christy absent)
Published in the Orange County Reporter on May 20, 2005
Motion: Place ordinance on second reading and adopt.
CITY COUNCIL MINUTES
3
JUNE 6, 2005
CONSENT CALENDAR
25.H. AGMTS 2005-119 AND 2005-129 - RAPID RESPONSE MARKETING
SERVICES - With O'Reilly & Associates in an amount not to exceed
$15,000 and HR Management Services in an amount not to exceed
$20,000 - Community Development Agency
25.1. AGMT 2005-120 - JOB SEARCH SYSTEMS SUBSCRIPTION - With
Geographic Solutions in an amount not to exceed $39,000 - Community
Development Agency
25.J. AGMT 2005-121 - "SANTA ANA PAINT DAY" PROGRAM - With Paint
Your Heart Out Inc., in an amount not to exceed $92,000 - Community
Development Agency
25.K. AGMT 2005-122 DOCUMENT MANAGEMENT SYSTEM
MAINTENANCE AND EXPANSION - With Compulink Management
Center, Inc. to implement a document management system in the Public
Works Agency in an amount not to exceed $145,000, and for maintenance
of the City's Laserfiche system in an amount not to exceed $48,000 with a
provision for two one-year renewals not to increase by more than 5%
annually - Finance and Management Services Agency
25.L. AGMT 2005-123 - MEMORANDUM OF UNDERSTANDING - Execute an
agreement with the Fire Management Association for wages, hours and
other terms and conditions of employment - Personnel Services Agency
25.M. AGMT 2005-124 - CATCH BASIN CLEANING SERVICES - Execute an
agreement with United Storm Water, Inc for an amount not to exceed
$125,000 - Public Works Agency
25.N. AGMT 2005-125 - OFFICE SPACE RENTAL - Execute a month-to-month
agreement at a not-exceed rate of $3,900 per month - Fire Department
CONDITIONAL USE PERMIT I VARIANCES
31.A. CONDITIONAL USE PERMIT NO. 2005-08 AND VARIANCE NO. 2005-
04 -100 WEST MACARTHUR BOULEVARD
Filed by David Shamtoub to allow a car wash and after hours operation of
a service station and a variance to reduce the required landscape
setbacks for a Mobil Service station in the Arterial Commercial (C5) zoning
district at 100 West MacArthur Boulevard
Motion: Receive and file the staff report
1. Denying Conditional Use Permit No. 2005-08 (a) to allow a car
wash.
CITY COUNCIL MINUTES
10
JUNE 6, 2005
To:
Company:
From:
Subject:
Remarks:
CITY OF SANTA ANA
Public Works Agency
Development Engineering
P.O. Box 1988, M-93
Santa Ana, California 92702
. TRANSMITTAL
~ { JIV\
p.-os. ~
Date:
Fax Number
Phone Number
Attached Pages
~OG PA~o
Phone Number
(714) 647-
(714) 647-5823
Fax Number
~( M ~ LATLH- &AS-u'J LLeAV\Ji"'-J0
G') ,'l.J'Te-A ~ N f2L~ f:i"'t--j~
r::;-~ '1 C) LJ f?- s { (C ^-.J ATV R-.o-
SENDER'S NAME
ACORD.. CERTIFICATE OF LIABILITY INSURANCE OP 10 7~ DATE (MM/DDIYYYY)
UNITE-7 06/13/05
I-RODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Acordia of California (soc) ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Ins Services, Inc. Lic#0352275 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
15303 Ventura Blvd., 7th Floor ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Sherman Oaks CA 91403-3197
Phone: 818-464-9300 Fax:818-464-9398 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: Zurich American Ins. Grp.
INSURER B: State Compensation Ins.
United Storm Water, Inc. INSURER C: Steadfast Insurance Co
Attn.: Paul Corn
14000 E. Valley Blvd. INSURER 0:
City of Industry, CA 91746 INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR NSR[ TYPE OF INSURANCE POLICY NUMBER DATE (MM/DD~ll: I p~kfl(MM/DDNY1' LIMITS
GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
f-- 11/16/04 11/16/05 PREMISES (E~~~~~nce)
A X X COMMERCIAL GENERAL LIABILITY GL0525843202 $50,000
I-- ~ CLAIMS MADE ~ OCCUR
MED EXP (Anyone person) $ 5,000
f-- $1,000,000
X CG-20-37-10-01 PERSONAL & ADV INJURY
I--
GENERAL AGGREGATE $1,000,000
f-- $1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS. COM PlOP AGG
n .nPRO- n
POLICY JECT LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000
-
A X ~ ANY AUTO BAP525843302 11/16/04 11/16/05 (Ea accident)
ALL OWNED AUTOS BODILY INJURY
- $
SCHEDULED AUTOS (Per person)
- i\..i'iIROVl AS FORM
~ HIRED AUTOS U 1'0 BODILY INJURY
$
X NON-OWNED AUTOS (Per accident)
- . .//(j.
~ MCS-90 ~: /~') PROPERTY DAMAGE
,~" .I " I ,j $
X CA9948 /' -<. (Per accident)
v
GARAGE LIABILITY ""L<U, Q ."" II ,jl<\2:: AUTO ONLY - EA ACCIDENT $
=l ANY AUTO i\:,>tsra 'H City Atfop' 'Y
,. . . EA ACC $
OTHER THAN
AUTO ONLY: AGG $
EXCESs/UMBRELLA LIABILITY EACH OCCURRENCE $4,000,000
A X tJ OCCUR D CLAIMS MADE SE0525843802 11/16/04 11/16/05 AGGREGATE $4,000,000
$
~ DEDUCTIBLE $
X RETENTION $10,000 $
WORKERS COMPENSATION AND X ITO'~Y:;LI~:i'S I IOJ~'
B EMPLOYERS' LIABILITY 157136405 01/01/05 01/01/06 $1,000,000
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT
OFFICER/MEMBER EXCLUDED? EVIDENCE ONLY E.L. DISEASE. EA EMPLOYEE $1,000,000
If yes, describe under E. L. DISEASE. POLICY LIMIT $1,000,000
SPECIAL PROVISIONS below
OTHER
C PROF LIABILITY/ PEC525842902 11/16/04 11/16/05 TOTAL LIM $1,000,000
E&O (CLAIMS MADE) POLLUTION LIAB (oee FORM) ANN AGG $25,000 DED
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
WAIVER OF SUBROGATION APPLIES. RE: FOR CATCH BASIN CLEANING SERVICES. CLERK
OF THE CITY COUNCIL, CITY OF SANTA ANA IS NAMED AS ADDITIONAL INSURED AS
RESPECTS ALL OPERATIONS AS PER ATTACHED CG 20 01 10 01, FORM MCS-90, FORM
MCP-65, FORM CA 9948.
*EXCEPT 10 DAYS NOTICE FOR NON-PAYMENT OF PREMIUM.
CERTIFICATE HOLDER
CANCELLATION
CCCCCCC
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL !::Il!l!!....ell 18 MAIL *30 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Ii'''T r"Ib.URi: TQ llilllilllll"b.1.
Clerk of the City Council
City of Santa Ana
20 Civic Center Plaza (M-30)
P.O. Box 1988
Santa Ana, CA 92702-1988
Ir~POiE: tl9 29b.1~"Tlgtl OR ~1"&lbl~' sr -.If: lUll _. _ . .._ IfJ8ijR,CR,ITB -,81SJJ18 8A
ACORD 25 (2001/08)
@ACORDCORPORATION 1988
, .
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 policy, certain policies may
require an endorsement. A statement on this certificate does not confer rights to the certificate
holder in lieu of such endorsement(s),
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon,
APPROVED /\S TO r ORM
~
.~;C ., / /
."J )"'-:',,/1
L1lura Stitt <::!,,~:-.._._-_._-
~... iJ'-I"-'vU:/
'",i~;taut City AnCf[j,'\
ACORD 25 (2001/08)
, .
POLICY NUMBER:
COMMERCIAL GENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - COMPLETED OPERATIONS
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name of Person or Organization:
"Any person or organization for whom you are performing operations when you and such person or
organizations have agreed in writing in a contract our agreement, prior to the performance of these
operations, that such person or organization be added as an additional insured on your policy".
Location and Description of Completed Organizations:
See Above
Additional Premium:
(If no entry appears above, information required to complete this endorsement will be shown in the
Declarations as applicable to this endorsement,)
Section II - Who Is An Insured is amended to include as an Insured the person or organization shown in
the Schedule, but only with respect to liability arising out of "your work" at the location designated and
described in the schedule of this endorsement performed for that Insured and included in the "products-
completed operations hazard".
APPROVEU i\S ;') r,(}Rl\1
~-->/l'-' /
~.7;' , ' '
;;/ -/)..) ,:". ,~/~ ...=-----^
- Laura Stit! "
'Assistan t CI: \ /',., .
CG 20 37 10 01
Copyright, ISO Properties, Inc., 2000
Page 1 of 1
COMMERCIAL GENERAL LIABILITY
CG 20 3310 01
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - AUTOMATIC STATUS WHEN
REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
A. Section II - Who Is An Insured is amended to
include as an insured any person or organization
for whom you are performing operations when you
and such person or organization have agreed in
writing in a contract or agreement that such per-
son or organization be added as an additional in-
sured on your policy. Such person or organization
is an additional insured only with respect to liability
arising out of your ongoing operations performed
for that insured. A person-s or organization-s
status as an insured under this endorsement ends
when your operations for that insured are com-
pleted.
B. With respect to the insurance afforded to these
additional insureds, the following additional exclu-
sions apply:
2. Exclusions
This insurance does not apply to:
a. "Bodily injury", "property damage" or "per-
sonal and advertising injury" arising out of
the rendering of, or the failure to render,
any professional architectural, engineering
or surveying services, including:
(1) The preparing, approving, or failing to
prepare or approve, maps, shop draw-
Ings. opinions, reports, surveys, field
orders, change orders or drawings and
specifications; and
(2) Supervisory, inspection, architectural or
engineering activities.
b. "Bodily injury" or "property damage" occur-
ring after:
(1) All work, including materials, parts or
equipment furnished in connection with
such work, on the project (other than
service, maintenance or repairs) to be
performed by or on behalf of the addi-
tional insured(s) at the site of the cov-
ered 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 or-
ganization other than another contractor
or subcontractor engaged in performing
operations for a principal as a part of the
same project.
APPROVED AS TO FORM
'.<>, ,I
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Laura SllU ShcCd::'--'----
As~js!anf Citv !\rtil,I'J.\
CG 20 33 10 01
@ ISO Properties, Inc., 2000
Page 1 of 1
AGENT COPY
POLICY NUMBER: BAP :J258433-02
COMMERCIAL AUTO
CA 20 01 1001
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
LESSOR - ADDITIONAL INSURED AND LOSS PAYEE
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
BUSINESS AUTO PHYSICAL DAMAGE COVERAGE FORM
GARAGE COVERAGE FORM
MOTOR CARRIER COVERAGE FORM
TRUCKERS COVERAGE FORM
With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modi-
fied by the endorsement.
This endorsement changes the policy effective on the inception date of the policy unless another date is indicated
below.
Endorsement Effective:
Countersigned By:
Named Insured:
(Authorized Representative)
SCHEDULE
Insurance Company ZURICH AMERICAN INSURANCE COMPANY
Policy Number BAP 5258433-02
Effective Date 11-16-04
Expiration Date 11-16-05
Named Insured UNITED SruIDRMWATER, INC.
Address 14000 EAST VALLEY BOULEVARD
CITY OF INDUSTRY CA 91746
Additional Insured AS REQUIRED BY THOSE ENTITIES WITH
(Lessor) WHOM THE NAMED INSURED EXECUTES A
Address WRITTEN CONTRACT.
CITY OF INDUSTRY,CA 91746
Designation or ANY LEASED VEHICLE
Description
of "Leased Autos.
CoveraQes Limit Of Insurance
Liabilitv 1 000,000 Each .Accident"
personallnlury
Protection or equivalent
no-fault coveraaeY
Comprehensive ACTUAL CASH VALUE OR COST OF REPAIR WHICHEVER IS LESS;
MINUS: 3,000 For Each Covered "Leased Auto.
Collision ACTUAL CASH VALUE OR COST OF REPAIR WHICHEVER IS LESS;
MINUS: 3.000 For Each Covered "Leased Auto.
Specified Causes of Loss ACTUAL CASH VALUE OR COST OF REPAIR WHICHEVER IS LESS;
MINUS: For Each Covered "Leased Auto.
(If no entry appears above, information required to complete this endorsement will be shown in the Declarations
as applicable to this endorsement.)
APPROVED i\S i'O j"UJ~.\j
>,:~,/
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Laura SUtr ~..;t-~::,(>J.'I
CA 20 01 1001
As,istall! Citv'\iicr',@ ISO Properties, Inc., 2000
Page 1 of 2
AtENT copy
A, Coverage
1. Any "leased auto. designated or described in
the Schedule will be considered a covered
"auto. you own and not a covered "auto. you
hire or borrow. For a covered .auto. that is a
"leased auto. Who Is An Insured is changed to
include as an "insured" the lessor named in the
Schedule.
2. The coverages provided under this endorse-
ment apply to any "leased auto. described in
the Schedule until the expiration date shown in
the Schedule, or when the lessor or his or her
agent takes possession of the "leased auto",
whichever occurs first.
B. Loss Payable Clause
1. We will pay, as interest may appear, you and
the lessor named in this endorsement for "loss.
to a "leased auto.,
2. The insurance covers the interest of the lessor
unless the "loss. results from fraudulent acts or
omissions on your part.
3. If we make any payment to the lessor, we will
obtain his or her rights against any other party.
i\PPROV FLi)' /",'" '( ,
~ ~) i ) l-()i<.
C. Cancellation
1. If we cancel the policy, we will mail notice to the
lessor in accordance with the Cancellation
Common Policy Condition.
2. If you cancel the policy, we will mail notice to
the lessor.
3. Cancellation ends this agreement.
D. The lessor is not liable for payment of your premi-
ums.
E. Additional Definition
As used in this endorsement:
"Leased auto" means an "auto" leased or rented to
you, including any substitute, replacement or extra
'auto" needed to meet seasonal or other needs,
under a leasing or rental agreement that requires
you to provide direct primary insurance for the les-
sor,
~~ I /
------L~,:) \.' ~
Laura \i.jt! ShccJ\.-~---.__.H'.
l\'-':Jl:)ldllf (~!l~'\lI')i":],_\
Page 2 of 2
@ ISO Properties, Inc., 2000
ACE"''' CDPY
CA 20 01 1001
o
~ DATi; FlpPsVED BY l?J>l,V: :':. '
nMY
~~
A PlJbn~ SeNice Agency
CERTIFICATE OF INSURANCE
Motor Carriers of Property .
,":~i ;~FiciBRII!R.'(eA)'f ~{(if
CAj:1024
lI-lSU~ER ilNSURANCE COMPANY) NAIC # 5 Sta.tus:
[NAME, ADDRESS, J..ND P~ONE HJ 16 35
ZORICH AMERICAN I:NS. COMPANY OTH!:R # lXJ Ucensecl to write insuranoe In the State of California
801 N'_ BRAND BLVD.. , il?H (Admitted InSl.Jrer)
GLENDp,E, CA 91203 0 NonadmittEld Insurer subject to Section 1763 'of the.
California Insurance Code.
D Charitable Risk Pool BlJl'lpl.US IJNE BROKER NAME
NAME OF INSUACR'S AlJ1HORIZEO.AEPflESENTATll/.e ALEXLIO'
INSURED (MOTOR CARFlII:R t>!AME AND ADDRESS) Flied with the:
I
UNITIID STORM WATER, INC. California D.epartment.of Motor Vehicle~
Motor Carrier Permit Branch
.ATTN': JAMF-S ~ P. O. Box 932370 MS Ga7S
14000 E. VAf..LEY BLVD. Saciame.nto, CA 94232-3700 i
err!' OF INDIJSTRY I CA 91746 (916) 657-8153
Insurer certifies that the motor carrier of property Identified herem (Insured) IS covered by an Insurance policy proVldin!1 bodily,
Injul)' or death /IabHity, propertY damag~ liability Insurance, o~ Workers' Compensation Insuranoe within the coverage limits fden~
tffied below and as required by Califomia Vehicle Code sections 34630,34631.5,34640, and by' Part 387 of Title 49 of the Code
of Federal Regulations.
TYpe OF' INSURANce Polley NUMBeR pouer EFFEC'l1vi; LIMITS j
DA T~ (MMrDPfYY)
PRIMARY LIASIUTY COMBINIED ~I~~LE LIMIT. $ 1,000,000
o CovP,lI'~ge below SlalutorY minimum BODILY INJURY OR DEA. TIi $
rllTlim. . (ONE PERSON)
aAP 525843.3-02 ,1.1/16/05 BODII. Y INJURY 0 a DEATH $ ,
e3 GOV&l'9t1l1 B~aJ t.o or nC99C1lng (MORE TIiAN ONE PERSON)
~rY minimum IImila. PFlOPEFlTY DAMAGE $ . ,
'___"_"'_".__a. _......__._.._ ---.-----...--- 1-0-.....____ '" . COMB/NED'SINGLE 4M 1M
EXCESS UAsrLITY UMTT $ In exc= of $
BODILY INJURY ' . I
o Cov~e blttwG~rim:slry cover" (ONE PERSON) $_lnexCQSecl $
age IJ ~ry nlmlJm limila.
BODILY INJURY OR I
~ Coy~r~,;e provfdl;!r;I el or above SID 5258438-02 11/16/05 DeATK (MOflETHAN $_lraxCQSs of s: ,I
Sl$IlOry mln!mulll IIrnllll. " , ONE PE;RSON)
PRC:>PERTY DAMAG~ $ _in.exCQts ot$
~ORKFRS.COMPENSATtQN o we Sta1Utory Urnlts ,
Insurer certifies triat this insurance policy covers ~[f vehicles used in conduc:tlng the service performed by the Jnsur~d for whfch
l motor qarrier permit is required whether or. not said vehicle is listed in the insurance policy. .
InstJrf1r cert/fJes that a fully executed Endorsement, on a form authorized by the Department of Motor Vehicles (DMV). is
lttached to the referenced policy, to conform the policy 10 the requirements of the Motor Garrlers of Property PermIt Act (Califomia!
(ehl~e Code Section 34600 and following) and the Nles and regyl1'ltions of the DMV. (This provlsiqn does nqt apply to Worker$'
>pmpensatlon Insurance.) , .
lnsur-er agrees that this Certificate of Insurance snall not be canceled on less than thirty (30) days notice from the Insurer to the
>MV, written on an authorized Notice of Canoellatlon form and that the thirty (30) day/period commences to run from the date oJ
1e Notloe of Canc&lIatlon was actually r9celve9 at the offioe of the California Department of Motor Vehicles, Motor Carrier Permit
:ranoh in Sacramento, California. .
Insurer agrees to furnish DMV-with a duplicate original of the referenced.policy, DMV al;ltho~zed endorsement, and alloth/:fr
rlated endorsements Md documentation upon request. ,.
Insurer agrees that for the purposes of Charitable Risk Pool Coverage that this policy meets the requirements of subdivision (b~
I the eve Section 16054.2. . . ,
y sIgning thIs form, the Insurer ct1rtifies under penalty of perjury under the ft'iW5 of the State of California that al1
tformation (;r>nta;ned in this Certificate of Insurance is true snrf porrect.
=^:=:~","_~~,;~ENDALE' CA~~ J:;:-~f!f~~~
"'l
V Il5 Me? (REV. 712002)
ASSIsta l1 -
,'V
-
ENDORSEMENT FOR
MOTuR CARRIER POLICIES OF INSURANCE FOl"l PUBLIC LIABILITY
UNDER SECTIONS 29 AND 30 OF THE MOTOR CARRIER ACT OF 1980
Issued to UNITED STORM WATER, INC. of CITY OF INDUSTRY,
Dated at GLENDALE, CA 91203 this 18TH day of NOVEMBER
Amending Polioy 1\10. BAP 525843 3 - 0 2 Effeotive Date _...
Name of Insuranoe Company ZURICH AMERICAN INSURANCE COMPANY
Telephone Number ( 1-818) 500-4700 Countersi ned b
Autho ed Oompany Represenmtiv.
The policy to which this endorsement is attached provides primary or excess insurance, as indicated by "[gI", for the limits shown:
[] This insurance is primary and the company shall not be liable for amounts in excess of 1 f 000 , 000 for each accident.
D This insurance is excess and the company shall not be liable for amounts in excess of for each accident
in excess of the underlying limit of for each accident.
Whenever required by the Federal Highway Administration (FHWA) Dr the Interstate Commerce Commission (ICC), the company agrees
to furnish the FHWA Dr the ICC a duplicate of said policy and all its endorsements. The company also agrees, upon telephone request by
an authorized representative of the FHWA or the ICC, to verify that the policy is in force as of a particular date.
Cancellation of this endorsement may be effected by the company Dr the insured by giving (1) thirty-five (35) days notice in writing to
the other party (said 35 days notice to commence from the date the notice is mailed, proof of mailing shall be sufficient proof of notice),
and (2) if the insured is subject to the ICC's jurisdiction, by providing thirty (3D) days notice to the ICC (said 30 days notice to commence
from the date the notice is received by the ICC at its office in Washington, D.C.). .
DEFINITIONS AS USED IN THIS ENDORSEMENT
ACCIDENT includes continuous Dr repeated exposure to loss, damage, or destruction of natural resources arising out of the
conditions which results in bodily injury, property damage, or accidental discharge, dispersal, release or escape into or upon the
environmental damage which the insured neither expected nor land, atmosphere, watercourse, or body of water, of any
intended; commodity transported by a motor carrier. This shall include the
MOTOR VEHICLE means a land vehicle, machine, truck, tractor, c~s: o.f removal, .and the cost of necessary measures taken to
trailer, or semitrailer propelled or drawn by mechanical power and mrn,lmlze or ~'tlgate ,damage .to, human health, the natural
used on a highway for transporting property, or any combination enVironment, fiSh, shellfish, and Wildlife.
thereof.
BODILY INJURY means injury to the body, sickness, or disease to
any person, including death resulting from any of these.
ENVIRONMENTAL RESTORATION means restitution for the
Form Approved
OMS No. 2125-0074
, CA
2004
11-16-04 "
~~~/ .::')' ._0. .:~j
PROPERTY DAMAGE means damage to or loss of use of tangible
property.
PUBLIC LIABILITY means liability for bodily injury, property
damage, and environmental restoration.
The insurance policy to which this endorsement is attached endorsement thereon, or violation thereof, shall relieve the
provides automobile liability insurance and is amended to assure company from liability Dr from the payment of any final judgment,
compliance by the insured, within the limits stated herein, as a within the limits of liability herein described, irrespective of the
motor carrier of property, with Sections 29 and 30 of the Motor financial condition, insolvency or bankruptcy of the insured.
Carrier Act of 1980 and the rules and regulations of the Federal However, all terms, conditions and limitations in the policy to
Highway Administration (FHWA) and the Interstate Commerce which the endorsement is attached shall remain in full force and
Commission (ICC). effect as binding between the insured and the company, The
insured agrees to reimburse the company for any payment made
In consideration of the premium stated in the policy to which this by the company on account of any accident, claim, or suit
endorsement is attached, the insurer (the company) agrees to involving a breach of the terms of the policy, and for any payment
pay, within the limits of liability described herein, any final that the company would not have been obligated to make under
judgment recovered against the insured for public Iiabifity the provisions of the policy except for the agreement contained in
resulting from negligence in the operation, maintenance or use of this endorsement.
motor vehicles subject to the financial responsibility requirements
of Sections 29 and 30 of the Motor Carrier Act of 1980 regardless It is further understood and agreed that, upon failure of the
of whether or not each motor vehicle is specifically described in company to pay any final judgment recovered against the insured
the policy and whether or not such negligence occurs on any route as provided herein, the judgment creditor may maintain an action
Dr in any territory authorized to be served by the insured Dr in any court of competent jurisdiction against the company to
elsewhere, Such insurance as is afforded, for public liability, does compel such payment.
not apply to injury to or death of the insured's employees while The limits of the company's liability for the amounts prescribed in
engaged in the course of their employment, or property this endorsement apply separately, to each accident, and any
transported by the insured, designated as cargo. It is understood payment under the policy because of anyone accident shall not
and agreed that no condition, provision, stipulation, or limitation operate to reduce the liability of the company for the payment of
contained in the policy, this endorsement, or any other final judgments resulting from any other accident.
The Motor Carrier Act of 1980 requires limits of financial responsibility according to the type of ~~JCI{ld~mpdity transported by
the motor carrier. It is the MOTOR CARRIER'S obligation to obtain the required limits of financial responsil5i1if{.u 1 d i
THE SCHEDULE OF LllvHTS SHOWN ON THE NEXT PAGE DOES NOT PROVIDE COVERAGE.
The limits shown in the schedule are for information purposes only.
SCHEDULE OF UMITS
Pubfic Uability
,/
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'Sheedy
: 'nrney
Form MCS-90
(Over)
UI~IFORh" INF01'lIJlATIDN S:RVIC:S. II~C
MC 1622k (10-99)
Type of Carriage
Commodity Transported
Minimum
Insurance
750,ODO
(1) For-hire (In interstate Dr foreign
com~erce).
': .,..;/~..q.: ~ :;..t'":;.... o. It.t'~~.~.);\.~~. \.
(2) For-hlfe!andPrivafe(ln .1l1t~state,
foreign, Dr intrastate commerce).
(3) For-hire and Private (In interstate
or foreign commerce: in any
quantity) Dr (In intrastate com-
merce: in bulk only).
(4) For-hire and Private (In interstate
or foreign commerce).
Property (nonhazardous). $
Hazardous substances, as defined in 49 CFR 171.8,
transported in cargo tanks, portable tanks, or hopper-
type vehicles with capacities in excess of 3,500 water
gallons; Dr in bulk Divisions 1.1, 1.2, and 1.3 materials;
any quantity of Division 2.3 Hazard Zone A Dr Division
6.1, Packing Group 1, Hazard Zone A material; in bulk
Division 2.1 Dr 2.2; Dr highway route controlled quantities
of a Class 7 material as defined in 49 CFR 173.403.
5,000;000
Oil listed in 49 CFR 172.101, hazardous materials and
hazardous substances defined in 49 CFR 171.8 and
listed in 49 CFR 172.101, but not mentioned in (2) above
Dr (4) below.
1,000,000
Any quantity of Division 1.1, 1.2 or 1.3 material; any
quantity of a Division 2.3, Hazard Zone A, Dr Division
6.1, Packing Group 1, Hazard Zone A material; Dr
highway route controlled quantities of Class 7 material as
defined in 49 CFR 173.403.
5,000,000
Note: The type of carriage listed under (1), (2), and (3) applies to vehicles with a gross vehicle weight rating of 10,000
pounds Dr more. The type of carriage listed under number (4) applies to all vehicles with a gross vehicle weight rating of
less than 10,000 pounds.
SCHEDULE OF LIMITS
Public Uability
For-hire motor carriers of passengers operating in interstate Dr foreign commerce
Minimum
Insurance
Vehicle Seating Capacity
(1) Any vehicle with a seating capacity of 16 passengers Dr more.
$
5,000,000
(2) Any vehicle with a seating capacity of 15 passengers or less.
1,500,000
lite 1 S22k (10-99) UNIFDRM II.JFDRMATIDN S:RVlC:=S, INC.
AP" ,
FORM
\.~/~;'
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LaUfd :)1 ; l
A.ssistant City Altor'm:)
Form MCS.90
COMMERCIAL AUTO
CA 99 48 09 02
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFUllY.
POLLUTION LIABILITY - BROADENED COVERAGE
FOR COVERED AUTOS - BUSINESS AUTO,
MOTOR CARRIER AND TRUCKERS COVERAGE FORMS
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
MOTOR CARRIER COVERAGE FORM
TRUCKERS COVERAGE FORM
With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modi-
fied by the endorsement.
A. Uability Coverage is changed as follows:
1. Paragraph a. of the Pollution Exclusion applies
only to liability assumed under a contract or
agreement.
2. With respect to the coverage afforded by Para-
graph A.1. above, Exclusion B.6. Care, Cus-
tody Or Control does not apply.
B. Changes In Definitions
For the purposes of this endorsement, Paragraph
D. of the Definitions Section is replaced by the
following:
D. "Covered pollution cost or expense" means any
cost or expense arising out of:
1. Any request, demand, order or statutory or
regulatory requirement; or
2. Any claim or .suit" by or on behalf of a
governmental authority demanding
that the "insured" or others test for, monitor,
clean up, remove, contain, treat, detoxify or
neutralize, or in any way respond to, or assess
the effects of "pollutants'.
"Covered pollution cost or expense' does not
include any cost or expense arising out of the
actual, alleged or threatened discharge, disper-
sal, seepage, migration, release or escape of
"pollutants.:
a. Before the "pollutants" or any property in
which the 'pollutants' are contained are
moved from the place where they are
accepted by the "insured. for movement
into or onto the covered "auto.; or
b. After the .pollutants. or any property in
which the .pollutants. are .contained are
moved from the covered .auto. to the
place where they are finally delivered,
disposed of or abandoned by the "in-
sured.. .
Paragraphs a. and b. above do not apply to
"accidents' that occur away from premises
owned by or rented to an "insured. with re-
spect to .pollutants" not in or upon a cov-
ered "auto. if:
(1) The .pollutants. or any property in
which the .pollutants" are contained
are upset, overturned or damaged as
a result of the maintenance or use of
a covered .auto.; and
(2) The discharge, dispersal, seepage,
migration, 'release or escape of the
"pollutants. is caused directly by
such upset, overturn or damage.
"ROVED AS fO 1'./.
7-, -
/- ----,-\ ,-
- -----
/ :'
't Sheedy
\ rt orney
CA 99 48 09 02
@ ISO Properties, Inc., 2002
Page 1 of 1
AG!:NT COPY
!.bie of Californill - Ca.hftlmi... i:.rwirollll'\enlal rmleolOTl ,l..itency
, ,
CERTIFICATE qF INSURAN.CE FOR PUBUC LIABILITY COVERAGE
i
D~partm:nl of i C~I'= SLlb~lant:!s Con~-o! .
T /';\tf1SPlma'liOJ:! t!t:1t
aSttO Cal C-ehter'o;j'v~'
Sacr.:mer.Io. C.A. l?S!ii's.3<:DO
(91.5) ~SS-43:;~
fPl.ME OF INSURED: "
trriited Storui Water, Inc.
, j 'ADD~SS.:.. 14000 ~. VALLEY BLVD.
CA 91746
i CERTIFfCATION'
ThE! authorize(1 signature below certifies tl't~t (a) each policy of insutan~ listed below has beel1 i."ue.d 10 !he insured named above:
anl1ls lr't fon:e at this Ume and rb) each polil;:)' so listed PROVIDES YE;HlCLE LIABILITY COVERAGE FOR "PUBUc LIASIUTY" .
WHICH INCLUDES LiABILlT'Y FOR ""BOdILY INJURY," "PROPERTY DAMAGE" AND ~ENVlRONMENTA.L RESTORA'nON"' .
PURSUANT!O SECTION 25169 O~ THEIC~U:'OR':llA ~EAl Tt:f AN~ ~~FEl"Y CODE wiLti respect to t/'le.OPEra~on, maintel'1ance or
' use bY the n;;!l'r1ecl il1$ured or 31"1y v~~t1c::le for ....tJlch regIstration or 3utnonZ;<Ihol'l 10 transport hazardcl,l'" wasle IS required by the
Department of ToX,ic Substances. Control o~ the S[ale of California regardless qr whether such vehicles are specifically described in the
policy. ' I
I
p~IMARY INSU~ANCE - COM81!\lEO SI~GLE UM'. EFFECTfVE D.o. n~ OF
INSURANCE POLICY NUMBER: j BAP 5258433-02 COVERAGE:
. . i 11-16-05
I
INSURANCE COMPANY NAME: T ADDRESS: 801 N. "'BRANp BLVD.tE TELEPHONE .NUMBER:
ZORICH AMERICAN"INS. CCKPAAf GLENDALE, CA 91203 (818) 347-5679
This policy provides c:ov~ge fQr public: liability indlJding bOr1i1y injury, properry dam_S@ arll:f enviro.nm~ntaJ re;s;loration for the
amoUnl of S 1,000,000. ! in aCCOrd.ll'Ice 'with languOlge c:onsistent with a Ml;::S-90 -endorsemenl
EXCESS UABIUTY INSURANCE
INSURANCE POLICY NUMBER:
SED 5258438-02
EFFEcnVE DATE OF
COV.E.RAGE;
11-16-05
INSURANCE COMPANY !\lAME: ADDRESS: TELEPHONE NUMBER:
ZURICH AMERICAN INS. CXl1PANt , 801 N. BRAND BLVD., iFH (818)347-'5679_
n,is p,olicy provides coverage lor' amounts i? e:x;c~s otlhe primary jasurance for public: tiab~lity including bt>dily injury, property
damage and environman~1 restoration for the amQun! of S 4,UOO,00Q In a~t:>>rdanc6 \'\lith languC!ge consistent
with a MCS-90 endorsemenl !
j
'. .
CANCELLATION ENDORSEMENT
The authorized signature below warrants ao~ guarantees thaI eac::/'l inSurance policy for whicl1 this Certificate of lnsur;mce ;s issued is
effective until t:;;il'lceled or e~ired; and, suc::ri policy l:OVe;ag~~afJ remain in 'fUlllCLrce-.:aClcieffec:LuntiLtI?-e..1h;tti~t/'l~}-Say-aI'tf;r ~
---':"Notioe-of-earn:dt~jorrtn wntin9 rs gIVen onoehalfOf the rni~ranca Company to the D~plJ11ment of To)cic Substa~ce:. Control. The
thirty (30) day period is 10 C::OlJ'lmence from t~e date the NI?[ic:e of Canr:elfS!ticn is provided to t/'Ie Depat1mel'l[ of Toxic Substances
. €;oQntrol. T (an.!opCrt..tion ~l1il : I. .
Thi$ Certificate of Insurance and any Notice of Cancenation are proparly liIed by mailing, postage p::r;d. to the Departms"t of TO:QI;
Sub~tances Control, Transportation Unit, 88aO Cal Cente.r.Drive, S<lc:ramento, C~firornia 35826-3200.
. 'I . .
.. ,I AUTHORIZED SIGNATURE
r HeREBY CERnrr tinder pert;,rty of law that: (a) all information prollided'is trtJe and correct, and (b) either the I~surance Company is
ClQrnitted by, the Depanmenl or 1n.$uranCEl in !the Slate of California to Write the listed insurance poljdes OR. if nOriJdtl"litt~d;, I am
ficansed by the Califo " Depanmenl o( It'ls~iance as a -Surplus Une& Broker" authorized 10 represent the n:Jmed Insurance Co~pany
in making Ulis t:eJ1ifi ion. I . . . .
-ep G~ TUR~nature in c:o'ntrasnl"lg C:iJlcr ink) DATE 51 GNED:
' ~ L~ I OS/24/,?-005
o cnE:. (PleQse print or type) I SURPLUS LINES BROKER NO. [If appJlt:able);
. I
U ~ !
COMPANY. NAME: . j
ZORICH AMERICAN INS. cxm>ANt
SIGNER'S COMPANY ADDRESS:
801 N. ~ BLVD., iFH
I
I
, I j5-:f I'.
(OEFrNmONS USED IN nus CERTIFlCA.TE OF INSU.RA~~E A~~ S~OWN ON THE ~,EVEi5:~E. S~E OF rHl~ FORM.)
D~C'03alfronllf71Q:Z\ .' 'I ":..~,~iL~,:~:~:'~~:'h':::::+~?~:~~~.':,>' '~',:i.st>-iSl~'" . "Cd::C\~ -.
STATE
COMPENSATION
INSURANCE
FUND
ENDORSEMENT AGREEMENT
EFFECTIVE MAY 17, 2005 AT 12.01 A.M.
REP 09
1571364-05
RENEWAL
SC
4-11-82-71
PAGE 1
ADDITIONAL INSURED EMPLOYER
, .
HOME OFFICE
SAN FRANCISCO
ALL EFFECTIVE DATES ARE
AT 12:01 AM PACIFIC
STANDARD TIME OR THE
TIME INDICATED AT
PACIFIC STANDARD TIME
BROKER COPY
UNITED PUMPING SERVICE,INC AND/OR
UNITED STORM WATER INC.
14016 VALLEY BLVD
CITY INDUSTRY, CA 91746
ANYTHING IN THIS POLICY TO THE CONTRARY NOTWITHSTANDING,
IT IS AGREED THAT
CITY OF SANTA ANA
IS HEREBY NAMED AS AN ADDITIONAL INSURED EMPLOYER ON THIS
POLICY BUT ONLY AS RESPECTS EMPLOYEES WHOSE NAMES APPEAR ON
THE PAYROLL RECORDS OF
UNITED PUMPING SERVICE,INC AND/OR
(HEREIN CALLED THE PRIMARY INSURED) WHILE THOSE EMPLOYEES
ARE ENGAGED IN WORK UNDER THE SIMULTANEOUS DIRECTION AND
CONTROL OF THE PRIMARY INSURED AND THE ADDITIONAL INSURED
EMPLOYER.
IT IS FURTHER AGREED THAT THE PAYMENT OF THE FULL PREMIUM
DUE AND PAYABLE UNDER THIS POLICY SHALL REMAIN THE SOLE
RESPONSIBILITY OF THE PRIMARY INSURED.
APPROVED I'_:~ I
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NOTHING IN THIS ENDORSEMENT CONTAINED SHALL BE HELD TO VARY, ALTER, WAIVE
OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS
POLICY OTHER THAN AS STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE
HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR
LIMITATIONS OF THIS ENDORSEMENT.
~
MAY 19, 2005
~~~
0015
COUNTERSIGNED AND ISSUED AT SAN FRANCISCO:
~
AUTHORIZED REPRESENT A TIVE
PRESIDENT