HomeMy WebLinkAboutTom Malloy dba Trench Shoring 1 (2)
AGREEMENT TERMINATION
Please complete this form when the attached agreement is no longer in effect.
Return form to the Sr. Deputy Clerk of the Council (M-30). Ca11647-5238 if you have any
questions.
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was completed on
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Revised 8-7-03
City of Santa Ana
Clerk of the Council
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CONSULTANT AGREEMENT
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THIS AGREEMENT, made and entered into this 20th day of December 20, 2005 by and
between Tom Malloy Corporation dba Trench Shoring Company, 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
training in excavation, trenching and sloping techniques, protective systems, soils
classifications and confined space entry safety.
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 train 25 City employees on CAL-OSHA Title 8, Section 1540 through
1541.1, requirements pertaining to excavations, trenching and sloping techniques, protective
systems and soils classification, with an introduction to confined space entry safety, 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,
$125.00 per trainee. The total sum to be expended under this Agreement shall not exceed
$3,125.00 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 June 30,
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
ernployees and shall be responsible for all applicable withholding taxes.
S. 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:
2
(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.
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 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 1 of 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
3
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:
Public Works Agency - Water Administration
City of Santa Ana
220 South Daisy Avenue
Bldg A (M-85)
Santa Ana, California 92703
telefacsimile (714) 647-3345
Attn: Ray Burk
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:
Trench Shoring Company
636 E. Rosecrans Avenue
Los Angeles, California 90059
telefacsimile 310-327-5700
Attn: Kelley Malloy
4
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 te1efacsimile, 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:
Payment need not be made for work which fails to meet the standard of performance
specified in the Recitals of this Agreement.
5
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 and all questions relating to its validity, interpretation, performance, and
enforcement shall be governed and construed in accordance with the laws of the State of
California. 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 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.
b. All Exhibits referenced herein and attached hereto shall be incorporated as if fully set
forth in the body of this Agreement.
II
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IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year
first above written.
ATTEST:
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PATRICIA E. HEALY
Clerk of the Council
APPROVED AS TO FORM:
JOSEPH W. FLETCHER
City Attorney
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By. . ". \ (. . I -_~"', ,,{ ,,11 /
Laura Sheedy /
Assistant City Attorney
RECOMMENDED FOR APPROVAL:
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CITY OF SANTA ANA
D^VI~a-
City Manager
CONSULTANT
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EXHIBIT A
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 ofliability. 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
8
"'-
...
Date (mm/dd/yy
Produ
Bobbie Detki
1/19/2006
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.
THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE
COVERAGE AFFORDED BY THE POLICIES BELOW.
Wood Gutmann & Bogart Insurance Brokers
15901 Red Hill Ave,. Suite 100
Tustin CA 92780
714505.7000
www.wgbib.com
License No, 0679263
IN UR R A
RDIN
VERA E
INSURER Hartford Fire Insurance
A
Insured
Tom Malloy Corporation
DBA: Trench Shoring Company
636 Rosecrans
Los Angeies
INSURER Transcontinental Insurance Co
B
INSURER
C
Hartford Insurance Company
of the Midwest
CA
90059
INSURER
INSR TYPE OF INSURANCE POLICY NUMBER LIMITS
LTR
GENERAL LIABILITY EACH OCCURRENCE $
COMMERCIAL GENERAL LIAS 72CESOA2655 11/1/2005 11/1/2006 FIRE DAMAGE (An 1 fire) $
CLAIMS MADE [Z]OCCUR MED EXP (An one I!f'son) $
PERSONAL & ADV INJURY $
GENERAL AGGREGATE $
PRODUCTS-COMP/OP AGG $
LOC $
2087913231 11/1/2005 11/1/2006 COMBINED SINGLE LIMIT $ 1,000,00
BODilY INJURY
(Per person) $
BOOll Y INJURY
(Per accident) $
PROPERTY DAMAGE
{Per accIdent) $
AUTO ONLY - EA ACCIOENT $
OTHER THAN EAACC $
AUTO ONLY: AGG $
EXCESS LIABILITY EACH OCCURRENCE $
OCCUR D CLAIMS MADE AGGREGATE $
$
DEDUCTIBLE $
RETENTION $ $
WORKERS' COMPENSATION & " STATUTORY LIMIT THER
EMPLOYERS' LIABILITY EL EACH ACCIDENT $
72WEOA8670 12/9/2005 12/9/2006 EL DISEASE, EA EMPLOYEE $
EL DISEASE - POLICY LIMIT $
"
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
(
City of Santa Ana
Public Works Dept-
Me. Mike Murrietta
220 S, Daisy Ave, Bldg, A
Santa Ana
CA 92703
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
~DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION
OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRE.
SENTATIVES. .10Da s for Non-Pa ment of Premium
AUTHORIZED
REPRESENTATIVE
~~7~~
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ACORD 25.S (7/97)
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.
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created at www.eCertsONLlNE.com
, .
EXHIBIT B
ADDITIONAL INSURED ENDORSEMENT
FOR COMMERCIAL GENERAL LIABILiTY POLICY
Insurance Company Hartford Fire Insurance
Thill endOrSCll1Cnt rnudiflcs such insurance ns is ariordcd by (he provisions t)fPolit.:y
# 72CES0A2655 relating to the following:
L 'nle City ofS;mlll Ana, 20 Civic Center Plaza, Sonlll Ann, Clllilhm;a 91701: ib
officers. employees, agents. volunteers 1I1ld representatives are named us additiollul insu"cus
("additional jnsureds") with regard to liobility and defense of suilS arising from thc opcl1llillns
and uses performed by 01' on behalfofthe named insllred,
2. With respect to claims arising out of the operations and uses ped'orlllcd by or (Jll
behaJfof!he named insur<XI, such insurance as is afthrded by thlS policy is primmy ami i,\ nol
additional to or contributing with any othcr inslll'Unce carried by or I," the hencl!1 ol':he
additional insllreds,
3, This insumnce applies separately 10 each insured agai""1 wl)(lm claim is madc or
sllir is brollg]H except with respect to the wmpany's limits of Ii~biljty, Th,' inclusion or an)'
person nr org~niZlllion a" an insured shall not affecl any right which such person or organization
would have as II cluimun! if'lO! so included.
4, With respect to Ihe additional inslU't.'<is, this inSUra!lCe shall nul be cuneelled, or
materially reduced in eovemgc or limits except uftn thirty (30) days wrillen nOliee ha, been
given to the City of SlInla Ana, 20 Civic CCOIer Plaza, Sanm Ana, Cali Fornia 9270 I,
{Completion oFlhc (ollowing, including countersignature, is required (0 l11ukc this clldorsenlent
ctlcctive. )
Effectiv(' 01/18/06 , this endorsement form us u part of
Policy II 72CES0A2655
Issued to The Tom Malloy Corporation dba DBA: Trench Shoring Co,
Named jnsured
C0l1l1tcrsigncd by
/
AUlhorLzed Rcpn::senlUllvc
~J8
8
~coib' 1..CERT'f"leA'fEiOELI.JA.~1L.r(",Y.INslJRA~E5." ! Date (mmfddfyy)
.. ... . 12/12/2005
Producer Gina Gradillas THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.
Wood Gutmann & Bo~art Insurance Brokers THIS CERTIFICATE DOES NOT AMEND. EXTEND OR ALTER THE
COVERAGE AFFORDED BY THE POLICIES BELOW,
15901 Red Hill Ave., uite 100 J1~ERS A~F
Tustin CA 92780
714505.7000 INSURER Hartford Insurance Company
www.wgbib.com A of the Midwest
License No. 0679263
INSURER
Insured B
Tom Malloy Corporation II -;;00&- oor! INSURER
DBA: Trench Shoring Company C
636 Rosecrans INSURER
Los Angeles CA 90059 D
COVERAGES -cc 'i.;. / . .
'..;" ..... ....../.. .. '.
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 CONDITIOriS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
POLICY POLICY
INSR EFFECTIVE EXPIRATION
TYPE OF INSURANCE POLICY NUMBER DATE DATE LIMITS
LTR M
GENERAL LIABILITY EACH OCCURRENCE $
::J~MERCIAL GENERAL LIAS FIRE DAMAGE An'" 1 fire} $
CLAIMS MADE OOCCUR MED EXP (Anv one oerson) $
PERSONAL & ADV INJURY $
GENERAL AGGREGATE $
GEN'L AGG LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $
I POLICY nPROJECTnLOC $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
ANY AUTO .
ALL OWNED AUTOS BODILY INJURY
SCHE.DULED AUTOS I?~)'" (Perpersonl $
HIRED AUlDS '; ~---ejC /; BODILY INJURY
f- NON-OWNED AUTOS (Per accident) $
PROPERTY DAMAGE
(Peraccidentl $
R~RAGE LIABILITY AUTO ONLY - EA ACCIDENl .
ANY AUTO OTHER THAN EAACC $
AUTO ONLY' AGG $
EXCESS L1ABIUTY EACH OCCURRENCE $
P~CCUR 0 CLAIMS MADE AGGREGATE $
$
H~EDUCTIBLE $
RETENTION $ $
WORKERS' COMPENSATION & STATUTORY LIMIT' I h-rHER 6
EMPLOYERS' LIABILITY EL EACH ACCIDENT $
, 72WEOA8670 12/9/2005 12/9/2006 EL DISEASE - EA EMPLOYEE $
EL DISEASE - POLICY LIMIT $
DESCRIPTION OF OPERATIONS/LOCATIONSNEHIClES/EXClUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
This certificate is evidence of Workers Compensation renewal coverage only.
CERTIFICATE HOLDER '>' .. CAI\lCEl..LATION../J< ...... .' '.'
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCEllED BEFORE THE
City of Santa Ana EXPIRATION DATE THEREOF, THE ISSUING COMPANY Will ENDEAVOR TO MAil
~DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHAll IMPOSE NO OBLlGA lION
OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRE.
20 Civic Center Plaza SENTATIVES. * 10 Davs for Non-Pa"ment of Premium
Santa Ana CA 92701 AUTHORIZED
REPRESENTATIVE ~~/~~
Donald L. Wood
ACOIlOil!s.s (7/97) 712 '.. ci"ea~$datWJNW,~~'C'ertsoNUNE.cOt1'\:~? (;)..ACORD CORPORA riOt.! 1988
>- '
~
ACORD 25-5 (7/97)
IMPORT ANT
If the certificate holder is an ADDITIONAL INSURED, the policy(jes) 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 atter the coverage afforded by the policies listed thereon.
created at www.eCertsONLINE.com
Wood Gutmann & Bogart Insurance Brokers
1.5901 fled Hill AVe.. Suite 100
Tustin CA
eCertsonline
CertificateS oIlns"ranee & EMenea oIl'roperty
U.S. Mail Document
Gina Gradillas
City of Santa Ana
Phone: 714 505.7000
Certification of Insurance
The Tom Malloy Corporation
12/12/2005
20 Civic Center Plaza
Santa Ana CA 92701
No.ofPagesj 3
www.wgbib.com
This document was created by eCertsONLlNE.
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