HomeMy WebLinkAboutNELSON, KATHLEEN 2
A
MAY03'051l:37 RCVD
AGREEMENT TERMINATION
1lIJll SEP 18 At! S: 57
Please complete this form when the attached agreement is no longer in effect.
CITY C i fA ANA
Return form to the Sr. Deputy Clerk of the Council (M-30). Call 647.gg!lt;,(you laa\'\:I~l
questions.
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The agreement with I\) Vson ') ~ , No. -Ai -J.{;OS -0-11-
was completed on l 2.-/3\/ [f; , and final payment has been made.
Department: _p 'f)
Signature:~~
Date: ~j~/b'j
. .
Revised 8-7-03
City of Santa Ana
Clerk ofthe Council
· INSURANCE ON flU
'!JOllh ~r,'( PROCEED
'!\1m. i:iSURANCE EXPIRES
1- 1- oiso
CLERK OF COUNCIL
(I~JE! 'I- ;,>,g-cs
N-2005-044
CONSULTANT AGREEMENT
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THIS AGREEMENT, made and entered into this ;W day of.. r I , 2005 by
and between Kathleen Nelson, an individual (hereinafter "Consultant"), an 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
instructing classes on drug education, health education and drug awareness.
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 A. The total sum to be expended under this
Agreement shall not exceed $10,000.00 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
December 31,2005, unless terminated earlier in accordance with Section 12, below. The term of
this Agreement may be extended upon a writing executed by the Chief of Police 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, 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
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.
c. The following requirements apply to the insurance to be provided by Consultant
pursuant to this section:
(i) Consultant shall maintain all insurance required above in full force and
effect for the entire period covered by this Agreement.
(ii) Certificates of insurance shall be furnished to the City upon execution of
this Agreement and shall be approved in form by the City Attorney.
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(iii) Certificates and policies shall state that the policies shall not be canceled
or reduced in coverage or changed in any other material aspect without
thirty (30) days prior written notice to the City.
d. If Consultant fails or refuses to produce or maintain the insurance required by this
section or fails or refuses to furnish the City with required proof that insurance has been procured
and is in force and paid for, the City shall have the right, at the City's election, to forthwith
terminate this Agreement. Such termination shall not effect Consultant's right to be paid for its
time and materials expended prior to notification of termination. Consultant waives the right to
receive compensation and agrees to indemnify the City for any work performed prior to approval
of insurance by the City.
6. INDEMNIFICATION
Consultant agrees to and shall indemnify and hold harmless the City, its officers, agents,
employees, consultants, special counsel, and representatives from liability: (l) for personal
injury, damages, just compensation, restitution, judicial or equitable relief arising out of claims
for personal injury, including health, and claims for property damage, which may arise from the
direct or indirect operations of the Consultant or its contractors, subcontractors, agents,
employees, or other persons acting on their behalf which relates to the services described in
section I of this Agreement; and (2) from any claim that personal injury, damages, just
compensation, restitution, judicial or equitable relief is due by reason of the terms of or effects
arising from this Agreement. This indemnity and hold harmless agreement applies to all claims
for damages, just compensation, restitution, judicial or equitable relief suffered, or alleged to
have been suffered, by reason of the events referred to in this Section or by reason of the terms
of, or effects, arising from this Agreement. The Consultant further agrees to indemnify, hold
harmless, and pay all costs for the defense of the City, including fees and costs for special
counsel to be selected by the City, regarding any action by a third party challenging the validity
of this Agreement, or asserting that personal injury, damages, just compensation, restitution,
judicial or equitable relief due to personal or property rights arises by reason of the terms of, or
effects arising from this Agreement. City may make all reasonable decisions with respect to its
representation in any legal proceeding.
7. CONFIDENTIALITY
If Consultant receives from the City information which due to the nature of such
information is reasonably understood to be confidential and/or proprietary, Consultant agrees
that it shall not use or disclose such information except in the performance of this Agreement,
and further agrees to exercise the same degree of care it uses to protect its own information of
like importance, but in no event less than reasonable care. "Confidential Information" shall
include all nonpublic information. Confidential information includes not only written
information, but also information transferred orally, visually, electronically, or by other means.
Confidential information disclosed to either party by any subsidiary and/or agent of the other
party is covered by this Agreement. The foregoing obligations of non-use and nondisclosure
shall not apply to any information that (a) has been disclosed in publicly available sources; (b) is,
through no fault of the Consultant disclosed in a publicly available source; (c) is in rightful
possession of the Consultant without an obligation of confidentiality; (d) is required to be
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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.
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:
Chief of Police
City of Santa Ana
20 Civic Center Plaza (M-97)
P.O. Box 1988
Santa Ana, California 92702
telefacsimile (714) 245-8007
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:
Kathleen Nelson
9962 Sunderland Street
Santa Ana, California 92705
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
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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 ofthis Agreement and any attachments hereto, the
terms ofthis 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. As a condition of such payment, the Executive Director may require Consultant to deliver
to the City all work product completed as of such date, and in such case such work product shall be
the property of the City unless prohibited by law, and Consultant consents to the City's use thereof
for such purposes as the City deems appropriate.
b. Payment need not be made for work which fails to meet the standard of performance
specified in the Recitals of this Agreement.
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13. DISCRIMINATION
Consultant shall not discriminate because of race, color, creed, religion, sex, marital
status, sexual orientation, age, national origin, ancestry, or disability, as defined and prohibited
by applicable law, in the recruitment, selection, training, utilization, promotion, termination or
other employment related activities. Consultant affirms that it is an equal opportunity employer
and shall comply with all applicable federal, state and local laws and regulations.
14. JURISDICTION - VENUE
This Agreement has been executed and delivered in the State of California and the
validity, interpretation, performance, and enforcement of any of the clauses of this Agreement
shall be determined and governed by the laws of the State of California. Both parties further
agree that Orange County, California, shall be the venue for any action or proceeding that may
be brought or arise out of, in connection with or by reason of this Agreement.
15. PROFESSIONAL LICENSES
Consultant shall, throughout the term of this Agreement, maintain all necessary licenses,
permits, approvals, waivers, and exemptions necessary for the provision of the services
hereunder and required by the laws and regulations of the United States, the State of California,
the City of Santa Ana and all other governmental agencies. Consultant shall notify the City
immediately and in writing of her inability to obtain or maintain such permits, licenses,
approvals, waivers, and exemptions. Said inability shall be cause for termination of this
Agreement.
16. MISCELLANEOUS PROVISIONS
a. Each undersigned represents and warrants that its signature hereinbelow has the power,
authority and right to bind their respective parties to each of the terms of this Agreement, and shall
indenmify 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.
II
II
II
II
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IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year
first above written.
ATTEST:
CITY OF SANTA ANA
0~~~
'DAVIDN. REAM
City Manager
PATRICIA E. HEALy
Clerk of the Council
APPROVED AS TO FORM:
JOSEPH W. FLETCHER
City Attorney
By: . "'of,,,/' ,( if I . /
Laura Sheedy
Assistant City Attorney
RECOMMENDED FOR APPROVAL:
CONSULTANT
(.; l
k ! I \., ~<,:,-
I.. \-. 0 \.
PAULM. WALTERS
Chief of Police
~a.-Z/~~L:lL<C/~~
KATHLEEN NELSON (
Tax ID#
".. /j/, --; /-) /, .-..l ::; /)'
yr ........- .' L--' _~ '.~. -- L
7
EXHIBIT A
SCOPE OF SERVICES
Consultant will conduct classes on drug and health education and drug awareness for inmates at
the Santa Ana Jail. The topics covered will include those listed in the Teaching Materials
attached hereto as Exhibit A-I.
Consultant will instruct said classes at the Santa Ana Jail, eight (8) hours each week, at the
following times:
. Mondays 1 :00-4:00pm
. Tuesdays I :OO-4:00pm
. Wednesdays I :OO-3:00pm
COMPENSATION
City will pay Consultant $24.00 per hour. Total compensation to be paid Consultant for services
pursuant to this Agreement shall not exceed $10,000, during the term of this Agreement.
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TEACHING MATERIAL
VIDEOS
I.NOVA- THE HUi\1AN BODY
A MIRACLE OF LIFE
B UNIVERSE WITHIN
C. ULTIMATE JOURNEY
2. IfUMAiIi BODY SYSTEMS AT WOHK
A BRAIN AJ'ID NERVOUS SYSTEM
B. SKELETAL SYSTEM
C. OR
D. Cl'LATORY SYSTEM
E. RESPIR.A.TORY SYSTEM
F. MLSCULAR SYSTEtvI
G. DlGESTIVE SYSTEM
3. CHOLESTEROL EXPLAINED
4. CONTEMPOR-\RY iliUTRlTION
5. FOOD FOR RECOVERY
6. NUTRITION FOR LIVING
7. NUTRITlO:'>i FOOD LABELS
8. BODY INVADERS ON DIGESTIONS
9. BODY STORY
10. BBC A1"'A TOMY
11. HYPERTENSION- ~THE FACTS"
12. PREVEI'iTING A HEART ATTACK
13. BLOOD SET
14. UNSAFE SEX AND IT'S CONSEQUENCES
15. DrGHESTlO,"" DIGEST- PART I, 2, 3.
16. CNN FAT CHANCE- "OBESITY"
17. NUTRITION PATHWAYS-ALL CHAPTERS
18. MOYERS ON ADDICTION-PARTS A, B, C, D.
19. PEOPLE LIKE US-~A[DS"
20. EMERGL"G DRUG EPIDEMICS
21. 20120 - "GliB & ALCOHOL"
22. 48 HRS. - "GBB & ALCOHOL"
23. ALCOHOL "BL"iGE DRINKING BLOWOUT"
24. EXTREME DANGERS UF ALCOHOL USE
25. DRUG DASGER L'" THE BR-\.L"i
26. MEDICAL ASPECTS OF MIND ALTERING DRUGS.
27. ECSTACY FRIED
28. RUINED LIVES - "METH"
29. ATHLETES & DRUGS
30. ECSTACY THE AGONY
31. PRICE OF ECSTACY
32. "I'M ON ECSTACY"
33. WALKING DEATH
34. DRUG BABY
35. AIDS - "EVERYTHI,"G YOU SHOULD Kl'iO\V"
36. AIDS - "SEX DRUGS"
37. AIDS -" CONFEREl\CE"
38. NATURE OF DRUG DEPENDENCY
39. DRUG PROFILES
40. H..UTE ASHBlJRY METH.
41. ALCOHOL & COCAL"E - "SECRETE OF ADDICTION"
EXHIBiT fA-I
42. COCAL"fE & HUMAN PHYSIOLOGY
43. SMOKABLE COCAINE
44. HOOKED ILLEGAL DRUGS - VOL. I & 2
45. "WASTED" GiN - ALCOHOL
46. DESIGNER DRUGS
47. HEROIN - NBC
48. STANDARD DEVIANT-PART I & 2
49. ICE
50. METH
51. "ALL THE RAVE"
52. ECSTACY - DANGER IN A PILL
53. SMOKE & MIRROR'S
54. SCENE SMOKING
55. BEHIi'iD THE SMOKE SCREEN
56. Sl\IOKfNG & TOBACCO INDUSTRY
57. TRUTH ABOUT TOBACCO
58. "URGES WITHiN"
59. BRAI,," OVERTIME
60. "BRAIN" - DISCOVERY CHANNEL
61. "R~GE TO REVENGE"
62. DATE R/t.PE
63. DA TU'iG VIOLENCE
64. RESPONSIBILITY
65. DENL~L
66. HANGOVER
67. "FIRES OF THE MIND'
68. SURVIVL'<G DISASTERS
69. GANGS, GUNS & GRUFITI
70. HOPKINS "ER"
71. COOK COUNTY GENERAL ER
72. "MS" - MBC LOCKUP PRISONS
73. BREAST CANCER
74. PRE\'Ei'iTINGA HEART ATTACK
75. FOOD GUWE PYR~MID
76. "MATTER OVER MIND"
77. "IT'S GOOD TO BE ALIVE"
78. "MY TRIP TO THE DENTIST"
79. SHORTCUTS TO HEALTH & FITNESS
80. PILATE'S DYNAMIC FIR'\'UNG& FLEXING
81. TAlem
82. YOGA MEDITATION
83. YOGA FOR ATHLETES
84. YOGA FOR KIDS
85. THE FIRl"1 - BASICS
86. STRETCHING - BOB ANDERSON
BOOKS
1. NURSING DRUG GUIDE
2. NURSING DRUG REFERENCE
3. BIOLOGY FOR DUJ\LYlIES
4. NIJTRITlON RAP
5. NUTRITIONAL HEALING
6. LIFR FITI'ESS CENTER WORKBOOK
7. PHYSIOLOGY COLORH,G BOOK
8. HEALTHY HEALfNG
9. UNDERSTANDH,G YOUR HEALTH
10. PEDS
I I. HEALTH - "SKfLLS FOR WELLNESS"
12. WONDERS OF SCIENCE - "THE HUMAN BODY
13. HUJ\L...N EODY - VISUAL GUIDE
14. HUiVL\N BODY - DK
15. BODY ATLAS
16. CONCISE ENCYCLOPEDL'" OF THE HUMAN BODY
17. EJ\JOTIONAL INTELLIGENCE
18. PRINCIPALS OF HUJ\L\N ANATOMY
19. PDR HERBAL MEDICINES
20. 6 WORKBOOKS - VARIOUS TOPICS
21. FIRST AID lYL...TERL...LS + BOOKS
22. RECOVERY OPTIONS
23. SUBSTANCE ABUSE
24. CRITICAL INCIDENT STRESS DEBRIEFING
25. THE NEW "FIT OR FAT"
26. FIRST 12 MONTHS OF LIFE
27. CARING FOR YOUR UNBORN CHILD
28. A CHILD IS BORS
29. "HABITS OF HIGHLY EFFECTIVE PEOPLE"
30. "THE HEALING MIND" - MOYERS
31. WHEN YOUR KIDNEYS FAIL
32. "WHERE THERE IS NO DOCTOR'
33. HEART
34. BLOOD
35. REFLEXOLOGY
36. HEALING MASSAGE
37. 5 MINUTE lVL...SSAGE
38. BODY FOR LIFE
39. TAE EO
40. THREE STEPS TO STRONG FAMILIES
41. THE HEART OF ADDICTION
42. TEACHING CHILDREN VALUES & RESPONSIBILITIES
43. SY1\OPSIS OF PSYCHIATRY
44. LfSTENING TO PROZAC
45. FOODS THAT HAR1H & FOODS THAT HEAL
46. UNDERSTANDING NUTRITION
-..
CRi\.RTS
I. THE RESPIRA TORY SYSTEM
2. THE DIGESTIVE SYSTEM
3. THf MUSCLE SYSTEM
4. SiVfOKL'I'G AND YOUR HEALTH
5. HARMFUL EFFECTS OF:
A. SMOKING
B. STERIODS
C. ALCOHOL
D. COCAINE
E. MARAJUA1\'A
F. INHALENTS
6. UNDERSTANDING CHOLESTEROL
7. UNDERSTANDING HYPERTENSION
8. HEART DISEASE
9. ANATOMY FLIP CHARTS
10. AIDS & HN
II. TRANSMISSION OF AIDS
12. FIRST AID
13. V ARIOlTS EXERCISE CHARTS
COMWUTERPROGRAMS
1. DEATH & DRUGS
2. BODY WORKS
3. BRITANNICA - "MY BODY SELF"
4. HEALTH QUEST
5. CHILD DEVELOPMENT
6. HUl'tlAJ.;"' 3-D"
7. INTER~CTIVE HUMAN BODY
8. SNAP "HUMAN BODY"
9. SNAP "CHL"ESE MED"
10. DISCOVERY CIHNNEL
A. SHARKS
B. HOW AN1MALS J\!OVE
C NILE PASSAGE TO EGYPT
D. BEYOND PLANET EARTH
.
EXHIBIT B
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:
I. 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 ofthe
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
Policy #
Issued to
, this endorsement form as a part of
Named Insured
Countersigned by
Authorized Representative
9
.
EVANSTON INSURANCE COMPANY
CERTIFICATE NO.:
CERTIFICATE OF INSURANCE .
EXCLUDES COVERAGE FOR NOMINEE EVENTS. SEE SEPARATE APPLICATIONS FOR NOMINEE EVENTS.
SPECIAL EVENT LIABILITY PROGRAM
PRODUCER:
PUBLIC ENTITY (ADDITIONAL INSURED)
Driver Alliap.t Insurance Services
P. O. Box 28323
Santa Ana, CA 92799-8323
(949) 660-8163
License No: OC 36861
NAMED INSURED (EVENT HOLDER):
Ka.t:hle.e.n NWon I
CUI} 06 San:ta Ana
I, zo C.i.v.i.c- Ce.n.teJ1. P!aza, M-U
San.ta Ana, CA 9Z701
EVENT lNFORMA TION:
TYPE: 1/'l.6.twctionlLf-Se..t6
DATE(S): 1/ Ubi U~ - I Z I j 1/ U~
LOCATION: S.A. JlUt
ImpftOv e.me.n.t
This is to certify that the policies of insurance. listed below bave been issued to the insured named above for the policy period
indicated. Notwithstanding any requirements, terms or conditions of any contract or other document with respeer to which this
certificate may be issued or may pertain, the insurance afforded by the policies descnbed herein is subject to all the tenm,
exclusions and conditions of such policies. Limits shown may bave been reduced by paid claims.
INSURANCE CARRIER: Evanston Insurance Company
MASTER POLICY NUMBER: 05SEPlOOOOOl
MASTER POLICY DATES: EFFECTIVE: JANUARY I, 2005 EXPIRATION: JANUARY 1,2006
COMMERCIAL GENERAL LlABIUTY
General Aggregate Umit
Producls & Completed OperatiOlls
Personal & Advertising Injury
Each Occurrence Umit
Fir<: Damage (Any One Fino)
Medical Payments (Any One Person)
OCCURRENCE FORM
DEDUCTffiLE: NONE
$ 2,000,000
J .000,000
1,000.000
1,000,000
50,000
5,000
The limits of insurance apply separately to each event insured by this pOlicy as if a sepan.te policy of insurance has been issued for that event
"Who is insured" is amended to include, as IltI insured, the person or organization shown in this schedule. but only with respect to liability arising out of the
ownership. maintenance Of use of the premises used by the named insured (event holdet'). This insurance does ~ot apply to: Any "occurrence" which takes place
after the event holder ceases to'be a tenant in that premises.
OTHER ADDITIONAL INSUREDS
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/ ~((-</.. .' .,,, ,-..-. -
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,
CANCELLA nON: Should the above described policy to cancelled before the expiration date thereof. the issuing company will mail 30 days written notice to \he
certificate holder and additional insureds listed.
AUTHORIZED REPRESENTATIVE:
u;Z~
DATE ISSUED:
JaYUlaJLl} 6, Z005