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Home My WebLink AboutPRG INSURANCE STAFFING 1 - 2005 I~SURANc'1 ON FILL WORK MAY r,;OCEED UNTIL iI,SURANCE EXPIRES Co~ :;.05 CLERK OF COUNCIL DA1Ei-4-/S-0) . . ~ ~ 'I THIS AGREEMENT, made and entered mto thiS 1-/ day of" n , 2005 by o pg2S and between PRG Insurance Staffing, a California corporation (hereinafter' Consultant"), and (R.>1O(25) 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"). A-2005-0?3 -~~} CONSULTANT AGREEMENT RECITALS A. The City desires to retain a consultant having special skill and knowledge in the field of placing skilled temporary employees with knowledge of workers compensation rules and regulations. 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 temporary employees (Assigned Employees) to assist City in workers compensation claims services, as set forth in Exhibit A to this Agreement. Consultant shall recruit, interview, screen ensure compliance with legally required pre- employment obligations, background check including criminal conviction record for state and county, social security search and employment history for all Assigned Employees to be assigned to City prior to their assignment to City. 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 swn to be expended under this Agreement shall not exceed $64,800.00 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. c. Consultant waives its right or claim to any placement fee, conversion fee, or liquidated damages in the event City hires directly on to its own payroll and Assigned Employee at any time after such Assigned Employee has worked at City facility fro at least ninety (90) days in anyone calendar year, with no break in service of more than five (5) business days, provided that City has paid to Consultant all invoiced amounts for such Assigned Employee. In the event that City hires any Assigned Employee prior to such 90 day period, City shall pay to Consultant the direct hire fee of twenty percent (20%) of annualized salary, minus any profit from temporary billing. 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 Executive Director of the Personnel Services Agency 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. 2 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 $ I ,000,000 per accident. c. If Consultant is or employs a licensed professional such as an architect or engineer: Professional liability (errors and omissions) insurance, with a combined single limit of not less than $1,000,000 per claim. d. The following requirements apply to the insurance to be provided by Consultant pursuant to this section: (i) Consultant shall maintain all insurance required above in full force and effect for the entire period covered by this Agreement. (ii) Certificates of insurance shall be furnished to the City upon execution of this Agreement and shall be approved in form by the City Attorney. (iii) Certificates and policies shall state that the policies shall not be canceled or reduced in coverage or changed in any other material aspect without thirty (30) days prior written notice to the City. 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. INDEMNIFICATION Consultant agrees to and shall indemnify and hold harmless the City, its officers, agents, employees, consultants, special counsel, and representatives from liability 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. 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 effects, arising from this Agreement. The Consultant further agrees to indemnify, hold harmless, and pay all costs for the defense ofthe City, including fees and costs for special counsel to be selected by the City, regarding any action by a third party asserting that personal injury, damages, just compensation, restitution, judicial or equitable relief due to personal or property rights arises by reason of the effects arising from this Agreement. City may make all reasonable decisions with respect to its representation in any legal proceeding. 3 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. 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: Executive Director of Personnel Services City of Santa Ana 20 Civic Center Plaza (M-41) P.O. Box 1988 Santa Ana, California 92702 telefacsimile (714) 647-6994 Ann: Workers' Compensation Administrator and City Attorney 4 City of Santa Ana 20 Civic Center Plaza (M-29) P.O. Box 1988 Santa Ana, California 92702 telefacsirnile (714) 647-6515 To Consultant: PRG Insurance Staffing 125 E. Baker #290 Costa Mesa, California 92626 telefacsimile (714) 424-5942 Attn: Barbara N ute-Bowser A party may change its address by giving notice in writing to the other party. Thereafter, any communication shall be addressed and transmitted to the new address. If sent by mail, communication shall be effective or deemed to have been given three (3) days after it has been deposited in the United States mail, duly registered or certified, with postage prepaid, and addressed as set forth above. If sent by telefacsimile, communication shall be effective or deemed to have been given twenty-four (24) hours after the time set forth on the transmission report issued by the transmitting facsimile machine, addressed as set forth above. For purposes of calculating these time frames, weekends, federal, state, County or City holidays shall be excluded. 10. EXCLUSIVITY AND AMENDMENT This Agreement represents the complete and exclusive statement between the City and Consultant, and supersedes any and all other agreements, oral or written, between the parties. In the event of a conflict between the terms of this Agreement and any attachments hereto, the terms of this Agreement shall prevail. This Agreement may not be modified except by written instruntent 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 instruntent 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. II. 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 ofthe 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 5 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. 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, tltroughout the term of this Agreement, maintain all necessary licenses, permits, approvals, waivers, and exemptions necessary for the provision of the services hereunder and required by the laws and regulations of the United States, the State of California, the City of Santa Ana and all other governmental agencies. Consultant shall notify the City immediately and in writing of its inability to obtain or maintain such permits, licenses, approvals, waivers, and exemptions. Said inability shall be cause for termination of this Agreement. 16. MISCELLANEOUS PROVISIONS a. Each undersigned represents and warrants that its signature hereinbelow has the power, authority and right to bind their respective parties to each of the terms of this Agreement, and shall indemnify City fully, including reasonable costs and attorney's fees, for any injuries or damages to City in the event that such authority or power is not, in fact, held by the signatory or is withdrawn. 6 b. AU Exhibits referenced herein and attached hereto shall be incorporated as if fully set forth in the body of this Agreement. II II IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first above written. ATTEST, ~ ~~::. PATRlCIAE. HEALY Clerk of the Council APPROVED AS TO FORM: JOSEPH W. FLETCHER City Attorney BY~~/A ~ ~ ouf; La Sheedy Assistant City Attorney CITY OF SANTA ANA blfiJc2~ DAVIDN.REAM City Manager CONSULTANT "BARBARA NUTE-BOWSER Sales M~er ~ TaxID# -3.0&8/-770:< 7 EXHIBIT A COMPENSA nON Job Description Approximate Bill Rate Senior Workers' Comp Claims Examiner Junior Workers' Comp Claims Examiner Workers' Comp Claims Assistant Hearing Rep / Litigation Examiner Workers' Comp Unit Managers $53.00 - 60.00 $35.00 - 50.00 $25.20 - 30.00 $54.00 - 60.00 $55.00 - 65.00 First placement at 35% mark-up, 2_5th placement 35-45% mark-up, 6th placement and forward 35% mark-up. 8 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 of the additional insureds. 3. This insurance applies separately to each insured against whom claim is made or suit is brought except with respect to the company's limits of liability. The inclusion of any person or organization as an insured shall not affect any right which such person or organization would have as a claimant if not so included. 4. With respect to the additional insureds, this insurance shall not be cancelled, or materially reduced in coverage or limits except after thirty (30) days written notice has been given to the City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701. (Completion of the following, including countersignature, is required to make this endorsement effective. ) Effective Policy # Issued to , this endorsement form as a part of Named Insured Countersigned by Authorized Representative 9 1). - J-Cl'''j-(1 "7-z... .-- . ACORD_ CERTIFICATE OF LIABILITY INSURANCE OP 10 K~ DATE (MMID01YYYY) PRGIN-1 03/22/05 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE CTK Insurance Services, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 1240 N. Lakeview, Suite 240 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW_ Anaheim CA 92807 Phone: 714-779-2000 Fax: 714-779-4129 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Insurance Corp of Hannover PRG Insurance Staffing INSURER B: Traveler's Insurance dba: West Coast Insurance INSURER C National Casualtv Co. Consultants 125 E Baker6ASuite 290 INSURER 0 I Costa Mesa 92626 I INSURER E COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDA80VE FOR THE POLICY PERIOD INDICAlED. 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 lNSURANCE AFFORDED BYTHE POLICIES DESCRIBED HEREIN IS SU6JECTTO 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 MMfDDIYY Pg,kl{e'(r~~~D~~K LIMITS GENERAL LIABILITY EACH OCCURRENCE $1,000,000 - A ~ :=]Mtv\ERC1AL GENERAL lIABILITY H67P052504 06/05/04 06/05/05 PREMises (Ea occurence\ . - CLAIMS MADE [!] OCCUR MED EXP (MY one person) .$ 5,000 PERSONAL &. ADV INJURY $1,000,000 GENERAL AGGREGATE .2,000,000 i-l'~ AGG~~t~L1MIT AP~~tIPER: PRODUCTS - COMP/OP AGG $2,000,000 X POLICY ~~8T LOC ~TOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000 ANY AUTO (Eeaccidenl) ,- - ALL OWNED AUTOS BODILY INJURY . SCHEDULED AUTOS (Per person) ,- A ~ HIRED AlJTOS H67P052504 06/05/04 06/05/05 BODILY INJURY ~ NON-OWNED AUTOS (f'eraccident) . PROPERTY DAMAGE . {Peracc\tlen\) ~RAG' LIABILITY AUTO ONLY - EA ACCIDENT . ANY AU10 OTHER THAN EA ACC . AUTO ONLY. AGG . ~ESS1\JMBRELl..A lIABILITY EACH OCCURRENCE $1,000,000 A X OCCUR 0 CLAIMS MADE H67X052504 06/05/04 06/05/05 AGGREGATE Sl,OOO,OOO I' PROVED} S TO FO, , ~ ~'DUCTIBLE , X RETENTION .10,000 \/A/ ! ! /~ . WORKERS COMPENSATION AND /' , - I To~iLI~lf's I IV ER- EMPLOVERS' LIABIUTI ---- Sti Sheedy [_aura ANY PROPRIETOR/PARTNER/EXECUTIVE EL. EACH ACCIDENT . OFFICER/MEMBER EXCLUDED? ",>IS[(lnt 42i y Attorney E,L. DISEASE - EA E.MPlO'fE . If yes, describe under -> SPECIAL PROVISIONS below El. DISEASE. POLICY LIMIT . OTHER B Crima Coverage 104350558 08/17/04 08/17/05 Ded: $10k $1,000,000 C Errors & Omissions THOOOO0481 01/27/05 01/27/06 Occ./Acc. Slmil/$2mil DESCRIPTION OF OPERATIONS I LOCATIONS 'VEHICLES I EOXCLUSIONS ADDED BY ENDORSEMENT' SPECIAL PROVISIONS Additional Insured per Attached Endorsement as Respects to General Liability Only CERTIFICATE HOLDER City of Santa Ana 20 Civic Center Plaza (M-41) PO Box 1988 Santa Ana CA 92702 CANCELLATION SANTA03 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELL.ED BEF'ORE THE EXPIRATION DATE THEREOF', THE ISSUING INSURER W1LL~MAtL 30 DAVS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LeFT~ ACORD 25 (2001/08) c ACORD CORPORATION 1988 '. Named Insured: PRG Insurance Staffing dba: West Coast Insurance Consultants POLICY NUMBER: H67P052504 COMMERCIAL GENERAL LIABILITY CG20 10 1001 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: City of Santa Ana. it's officers, agents, employees, representatives and volunteers 20 Civic Center Plaza PO Box 1988 Santa Ana, CA 92702 (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement). A. 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 on90in9 operations performed for that insured. B. With respect to the insurance afforded to these additional insured, the following exclusion is added: 2. Exclusions This Insurance does not apply to "bodily in- jury" or "property damage" occurring after: (1) All work, inclUding matarials, 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 add'l- 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 organization other than another con- tractor or subcontractor engaged In performing operations for a principal as a part of the same project. APPROVED AS TO FORM I\J::'I~I,J1H ;_->1'L> i''''''lCV CG 20 10 10 01 @ ISO Properties, Inc. 2000 Page 1 of 1 0 . ACORD. CERTIFICATE )F LIABILITY INSURANC OPID,~ DATE (MMlDDNYVY) PRG~N 1 06/20/05 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE CTK Insurance Services, Xno. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 1240 N. Lakeview, Suite 240 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Anahaim CA 92807 Phone: 714-779-2000 Fax:714-779-4129 INSURERS AFFORDING COVERAGE NAIC# INSURED A- - Zo:>S -013 INSURER A: Insurance Corp of Hannover PRG Insurance Staffing, Inc. INSURER B: Traveler's Insurance dba: West Coast Insurance INSURER c: National Casualty Co. Consultants 125 E Baker, Suite 290 INSURER 0: Costa Mesa CA 92626 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANV REQUIREMENT, TERM OA CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH AESPECTTO 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, AGGREGATEUMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. DATE(MMI~ LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MM/D LIMITS ~NERA1. LIABILITY EACH OCCURRENCE $1,000,000 A .!.. COMMERCIAL GENERAL LIABILITY H67-1000470 06/05/05 06/05/06 PREMISES (Ea occurence) 0 - ~-C~MSMADE ~ OCCUR MED EX? (Anyone person) 05,000 - PERSONAL & AOV INJURY $1,000,000 - GENERAL AGGREGATE $ 2, 000, 000 il'LAGG~nE;:~ APn~ PER: PRODUCTS. COMP/OP AGG $ 2,000,000 X POLICY JECT . LOG ~OMOBILE LtABII.ITY COMBINED SINGLE I.IMIT $1,000,000 ANY AUTO (Ea accldent) - - ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Perpef'&on) 0 - A .!.. HIRED AUTOS H67-1000470 06/05/05 06/05/06 BODilY INJURY (Per accident) 0 .!.. NON-OWNED AUTOS - PROPERTY DAMAGE , (Peraccltlent) ==fAGE LIABILITY AUTO ONLY- EAACCIDENT , ANY AUTO OTHER THAN EA ACC , AUTO ONLY: AGG 0 fJESSJUMBRELLA LIABILITY EACH OCCURRENCE '1,000,000 A X OCCUR D CLAIMS MADE H67-2000470 06/05/05 06/05/06 AGGREGATE $1,000,000 APPROVED AS TO FOR ~ , ~ DEDUCTIBLE . X AETEI'mON '10,000 c./7/ ,~ 0 WORKERS COMPENSATION AND // //2 ITORy"LIMITS I I\JJ~- EMPLOYERS' UABILITY Laura Slfl E.L. EACH ACCIDENT . AtN PROPRIETOR/PARTNER/EXECUTIVE t/ Sl'i8(';Oy OFFICER/MEMBER EXCLUDED? A:;sistallt Cit Atlornc)' E.L DISEASE - fA EMPLOYEE $ ~~~clltS~~~v~~rO~S below E.L. DISEASE - POUCY LIMIT . OTHER B Crime Coverage 104350558 08/17/04 08/17/05 Limits: $1,000,000 C Errors &; omissions THOOOO0481 01/27/05 01/27/06 Occ./Agg. $lmil/$2mil DESCRIPTION OF OPERATIONS f LOCATIONS/ VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROViSIONS Additional Insured per Attached Endorsement as Respects to General Liability only CERTIFICATE HOLDER City of Santa Ana 20 Civic Center Plaza (M-41) PO Box 1988 Santa Ana CA 92702 CANCELLATION SAN'l'AO 3 SHOUL.D ANY OF THE ABOVE DESCRIBED POL.1CIES BE CANCEL.LED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE lEFT, BUT FAILURE TO DO SO SHALL ACORD 25 (2001108) ACORD CORPORATION 1988 .' . Named Insured: POLICY NUMBER: PRG Insurance Staffing, Inc. H67-1000470 COMMERCIAL GENERAL LIABILITY CG20101001 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: City of Santa Ana 20 Civic Center Plaza (M-41) PO Box 1988 Santa Ana, CA 92702 (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement). A. Section II - Who is an Insured is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of your ongoing operations performed for that insured. B. With respect to the insurance afforded to these additional insured, the following exclusion is added: 2. Exclusions This Insurance does not apply to "bodily in- jury" or "property damage' occurring after: APPROVED AS TO FORM /$ '=-/2- Laura Stitt Sheedy Assistant City Attorney CG 20101001 @ ISO Properties, Inc. 2000 (1) All work, inciuding 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 organization other than another con- tractor or subcontractor engaged in performing operations for a principal as a part of the same project. Page 1 of 1 0 . -" ~ , -A'CORD. CERTIFICATE OF LIABILITY INSURANCE OP 10 1.n1 DATE (MM/DOIYYYY) PRG~N-1 06/20/05 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE CTK Insurance Services, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 1240 N. Lakeview, Suite 240 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Anaheim CA 92807 Phone: 714-779-2000 Fax:714-779-4129 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Insurance Corp of Hannover PRG Insurance Staffing, Inc. INSURER B- Traveler's Insurance dba: West Coast Insurance INSURER c: National Casualty Co. Consultants 125 E BakerCASuite 290 INSURER D: I Costa Mesa 92626 T 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 OA 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 DESCAIBED 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 I PD~'i'~~MMJDDfvy\1: DATE MMJDDfYY LIMITS ~NERAL LIABILITY EACH OCCURRENCE S 1, 000,000 A X COMMERCIAL GENERAL LIABILITY H67-1000470 06/05/05 06/05/06 I PREMISES (Ea occurence) $ - ".~ CLAIMS MADE ~ OCCUR i MED .~~~ {Any ~ne p~rso~___ ~5, OO()n___ PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 il'~ AGG~~~E LIMIT APnS PER PRODUCTS - COMP/OP AGG 'S 2.000,000 X POLICY jf8,: LOC =lDMDSILE LIABILITY , COMBINED SINGLE LIMIT ANY AUTO (Eaaccidenl) S 1, 000,000 _! ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) f- A ~ HIRED AUTOS H67-1000470 06/05/05 06/05/06 BODILY INJURY , (Peraccidenl) $ ~ NON-OWNED AUTOS f- PROPERTY DAMAGE I (Per accident) GARAGE LIABILITY i AUTO ONLY. EA ACCIDENT $ R ANY AUTO OTHER THAN EAACC $ AUTO ONLY' AGG S ~ESS/UMBRELLA LIABILITY EACH OCCURRENCE $1,000,000 A X OCCUR D CLAIMS MADE H67-2000470 06/05/05 06/05/06 AGGREGATE $1,000,000 A~ ., S ~ DEDUCTIBLE APPR( VED ,) 0 FORiv; $ X RETENTION $10,000 $ WORKERS COMPENSATION AND '/ :/jI "on, ./z._ ITORYlIMITS I -[DJ"f' EMPLOYERS' LIABILITY ::<: <!V_.-'l..~t; .-.-.-.-...-..- .-. E.L. EACH ACCIDENT S ANY PROPRIETORlPARTNER/EXECUTIVE L...UI<-l.. d.< ,J., ,cJ i OFFICER/MEMBEn EXCLUDED? As :::iiSl"i1: City /\1fi;~r ~ " E.L. DISEASE. EA EMPLOYEE $ ~p~el~tS~~~v~s?o~s below E.L. DISEASE. POLICY LIMIT S ! OTHER B I Crime Coverage 104350558 08/17/04 08/17/05 Limits: $1.000,000 C Errors & Omissions THOOOO0481 01/27/05 01/27/06 Occ./Agg. $lmil/$2mil DESCRIPTION OF OPERATIONS J LOCATIONS J VEHICLES J EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Additional Insured per Attached Endorsement as Respects to General Liability only CERTIFICATE HOLDER CANCELLATION SANTA03 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCEllED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAil ~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR City of Santa Ana 20 Civic Center Plaza (M-41l PO Box 1988 Santa Ana CA 92702 ACORD CORPORATION 1988 ACORD 25 (2001108) .' ' . Named Insured: POLICY NUMBER: PRG Insurance Staffing, Inc, H67-1000470 COMMERCIAL GENERAL LIABILITY CG20101001 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION Thi5 endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: City of Santa Ana 20 Civic Center Plaza (M-41) PO Box 1988 Santa Ana, CA 92702 (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement). A 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 ongoing operations performed for that insured. B. With respect to the insurance afforded to these additional insured, the following exclusion is added: 2. Exclusions This insurance does not apply to "bodily in- jury" or "property damage" occurring 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 organization other than another con- tractor or subcontractor engaged in performing operations for a principal as a part of the same project APl'h.u Ii iD A;) HJ . " ~2/L Latira SI \1 (;- ~<dy -",l.' 1;:,.1 CG20101001 @ ISO Properties, Inc. 2000 Page 1 of 1 D