HomeMy WebLinkAboutEAST EDINGER MEDICAL CENTER 1-2000
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AGREEMENT FOR THE PROVISION OF SERVICES
BY EAST EDINGER MEDICAL CENTER
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, 2000, by and between East Edinger Medical
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THIS
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AGREEMENT, made and entered into this ~~ day of
Center, hereinafter referred to as "VENDOR", and the City of Santa
Ana, a municipal corporation and charter city duly organized and
existing under the Constitution and laws of the State of
California, hereinafter referred to as "CITY".
TERMS AND CONDITIONS
1. TIME FOR COMPLETION.
The services to be performed pursuant to this Agreement shall
be completed on or before June 30, 2001.
2. VENDOR INDEPENDENT CONTRACTOR.
VENDOR agrees that VENDOR is an independent contractor, and
not an employee of CITY.
VENDOR shall not subcontract any of the services required
hereunder without written approval of CITY.
3. SCOPE OF SERVICES.
VENDOR agrees to perform medical screening services,
influenza vaccines and wellness physicals per proposals dated
January 20, 2000 and February 22, 2000, copies of which are
attached hereto and incorporated herein by reference.
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4. COMPENSATION.
CITY agrees to pay, and VENDOR agrees to accept for said
services, fees as listed in attached proposals.
The total sum payable hereunder shall NOT EXCEED ten thousand
dollars ($10,000) for all services provided during the contract
period. VENDOR shall submit a detailed invoice showing services
performed. Payment by CITY shall be within thirty (30) days
following receipt of said invoices for work performed, subject to
CITY accounting procedures.
5. INSURANCE.
VENDOR will provide evidence of the following insurance:
A. Workers' Compensation including a waiver of subrogation;
B. Business Auto Liability insurance in the amount of
$1,000,000. combined single limit (CSL) for bodily injury
and property damage;
C. Liability insurance in the amount of $1,000,000. CSL for
bodily injury and property damage adding the City of
Santa Ana, its officers, employees, agents and volunteers
as additional insured. VENDOR will have the attached
CITY'S Additional Insured Endorsement completed and
returned to CITY.
D. Medical malpractice in the amount of $1,000,000 each
claim; $3,000,000 aggregate.
E. All the above insurance will have 30 days advance notice
of cancellation or material change mailed to CITY.
F. VENDOR to provide certificates of insurance on A through
E above and CITY'S Additional Insured Endorsement on B
and C above prior to beginning work.
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'6. HOLD HARMLESS CLAUSE.
VENDOR agrees to indemnify, defend and hold harmless CITY,
its officers, employees, agents and volunteers from any and all
loss or damage, and from any and all suits, actions and claims
filed or brought by any person or persons, however caused, arising
out of VENDOR'S negligent performance or failure to perform, any
and all things necessary to and required to be done by VENDOR
pursuant to this Agreement.
7. MISCELLANEOUS PROVISIONS.
A. VENDOR covenants that it presently has no interest, and
shall not have any interest, direct or indirect which would
conflict in any manner with the performance of services required
hereunder.
B. VENDOR will not discriminate against any employee, or
applicant for employment, because of race, color, religion, sex,
marital status, or national origin. VENDOR will take affirmative
action to ensure that applicants are employed, and that employees
are treated during employment, without regard to their race,
color, religion, sex, marital status, or national origin. Such
action shall include, but not be limited to, the following:
employment, upgrading, demotion or transfer, recruitment, or
recruitment advertising, layoff or termination, rates of payor
other forms of compensation, and selection for training, including
apprenticeship.
C. This agreement may be terminated by either party upon
thirty (30) days written notice of termination.
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IN WITNESS WHEREOF, the parties hereto have executed this
Agreement the day and year first above written.
ATTEST:
APPROVED AS TO FORM:
(~Q: {~
/f:sJT, City Attorney
RECOMMENDED FOR APPROVAL,
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CITY OF SANTA ANA
a municipal corporation of the
State of California
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,tJavid N. Ream
City Manager
CONTRACTOR
East Edinger
Medical Center
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Randy Jon , .D.
Medical Director
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Employer ID number
4
AUG.2l'2D00 09:59 7142550872
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~~ditioDallnsured I HCF-X91
EntIty Endorsement
#531~ P.002/002
American H.e:lfrhcare Indemnity
CO.......NY
Amen~rng Polrey Number;
HCF0000155
Endor6~~nr. Humber:
6
N,.m~d In&lJred:
EM T [I) INGER "'(0 I CAL CENTroR
EffOCt.1 ve Date of EndorG.ement; 1/01/2000 12:01 A.M, STi\nd,~rlf ilm,c
Date Issued: 8/08/2000
(xpl~~t'on D.tg or Endorsament: 1/01/2001
Addftfonel Premlu~:
$.00
Rstl.lrn Promlum:
$.00
In consideration of the premium charw:d, ic i. bereby understood and agreed tbat the obo,,", captioned
poli.cy (the 'Policy") i. amended .s follows:
The term Insured In t~e PolIcy sholl also inClUde ftnd 016Q mean the entfty
~e&l~n~tp.d Derow;
lhe City o~ Sent. Ana, 20 Civic Centor Plez8, S~nt.a Ana, CA 92101
Its Qfrlc~r&. employees, 8gent&, VOJunteer~ BOd represent8tlve6
l "00& I llnatet,l Ent' tylt,
T~e DeSignateD EntIty understond6~ .ek~a~IQ49~s and D9r~~$ that if the
PolICy termInates Qr 13 cenCQ'ed for .ny r9Ason, t~ls cndor&ement~ and alt
Coverages srrorded hereunder, shall be deemed DYtom.tJcD'J~ tarmJnated,
wl~hout fUrtnor B~knQ~Iedgm~~t by the Company, as or the date of
term(natlon or Ca"ce"~tlun or $'~h POlicy.
It Is rurth~r understood and agreed
rIght to purchase Qr Qthorwfse
endorseMents pur&lJant 'to SeetfQn
nonr9ne~al Qr other terminat.lon Qf
tha~ the Oe~(g"Qted Enttt~ haG no
aCq~rrQ a reporting endorsement or
8 of the Poffr.~ upon ClnQofl3tiQn~
thf6 ondorsement.
All otb~r te!'lm and condition. rem.;n unchonged.
Amt"ti~.n He:\',I~I'W;are Indflmnily Company
By
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HCF-X91
1,8198)
APPROVEp AS
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TO 1.\_'i....Jyj
Michael Vigliott
Deputy City /\t~()rllC\
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East Edinger 1vfedicaI Center
INDUSTRIAL AND FAMILY
Randy Joneo. M.b.
ModIc", lli'edot
Janwuy 20, 2000
To: Ann GarcialCity of Santa Ana
From: Michelle HarrisonlEast Edinger Medical Center
RE: Contractual Pricing
City of Santa Ana Contract for medical screening
Cost of Services:
Post Exposure TB screen ( includes any Dec'''"ilSBry X-rays) $50.00
Post Exposure blood screen (including mv. Hep B & C) S120.oo
Blood Lead Level Test
Asbestos Screening
$33.75
535.00
Above pricing will be in effect for 1 year.
Company:
East Edinger Medical Center
1530 East Edinger Ave.
Santa Ana, CA 92705
d}~llt ~~ (~~
(714) 542-8904
Signature/Tiffe:
Telephone:
.'"pricing will only increASe if OUT Jab fee>; i~
1530 E. Edinger. Santo Ana.CA 92705 . (714) 542-8904 . FAX (714) 541-5313
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East Edinger Medical Center
INDUSTRIAL AND FAMILY
Randy Jones, M.D.
Medical Director
February 22, 2000
To: Lucia Lanzner/City of Santa Ana
From: Michelle HarrisonlEast Edinger Medical Center
RE: Contractual Pricing
City of Santa Ana Contract for medical screening
Cost of Services:
Annual Flu Vaccines
$5.00
Fire Department Wellness Physicals
$75.00
Above pricing will be in effect until June 2001.
Company:
East Edinger Medical Center
1530 East Edinger Ave.
Santa Ana, CA 92705
nJ<'klb ~~
SignaturelTitle:
Marketing Director
Telephone:
(714) 542-8904
**pricing is subject to change due to increased lab costs. Will notifY prior to any
pricing change.
1530 E. Edinger. Santa Ana. CA 92705. (14) 542-8904 . FAX (714) 541-5313
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Entity Endorsement .
Me 41", Pclley NUMber: 1tC100oo"5
En4or..~n' Numb.r.
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EAST EO'"GI!l\ HED ,........ CENTEI<
tH f;t'vc puo or ["do,....."I:: 7/DJlRDOO I1ml A.M..$llIhlSarosTIrr...
Dot. '".ued, a/OD/~oQo
(xp rot'." Oatt or rndo~.."nt: 7/0 lJ%OD J
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$.00
"eturp prA",IIIISI:
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on.ideration or \he PrmUlJlIT ,he1JFd, illl bctoby llndor>to~ And ....a thai u,o above caplioned
(lbe "PoJj<y1 b un.ndod .. follow"
the t~r~ I~$ur.d In t~* 'Dr'e~ eft." .'.D !~cIUde ~nd a'5Q ~.n ~h~ cn,lty
4@~lanat~d betcw~
1~. CI~y Qr ..bt. Ani. 20 e,v'~ c.n~Dr P'a%., ;,nt, An_. CA P2701
It' arr'cer,. e~p'o~.,'. Agentf. ~o'vnt.er. end r~p'e..nt.~Jv~5
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C~O~.'g~.ted rntt~~)
the p.SIQnlt.d tntfl~ und.rG~4nd~# .ek"ov'odl~C and .9r..~ t~~t 'f ~he
policy tcr~'n.te. Dr fl e~neaf.q fQr .~ r8Q;Q~~ thl& gndor'.msn~. _nd aI'
Cl)vnrtoes. .rrordl(td hareun"." I "h~f I be d".lIIed Olltqlllttt/ CO, lor tor~"""Ud..
yl~hov. rOrthe~ QGkno~l.d9.~"t ~y thB ~Oftp'ny. II Or the ~at. or
~.r~lnotIQn or ~.ncell"tfu~ or IUch pOflcy.
I~ 1& rur~h~r ~n4.r.~oQ4 and .g~e~d ~hit the P..',n.eed (ntJt~ ~J no
rl,h~ to ~urch_,. Qr Dtho~rse Dcq~lro . ~epor~lhg endQts...nt or
."dorsefllen,.. pt,jr's,unt ~o SeC'tton e 0' the POlln'y I,1pnn t;;.,n=ClI' ,.,tlo",
"anr.nGv~1 or ~th4r terml~'tIQn Qf th'. .nd.r.~.nc.
All otJu:r mu and cfJnditjQnt RfI;1.io t~chln
Am<<,iul1 Hu.(lhc:.rCl h~r.-..I'1'" C.""at'\)I
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APM:nuZJfO:M _
Mjchacl VigJiolla ~.~
Deputy City AUorne.y
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~ POLICY CHA E EN/JOR$EMfNT
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This endorse ent summart~es the Chang..s to
your POlicy. All other term" of your policy not
.ffect"d by eSe changes remain the same.
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>- How YDII' Pel Is Ch8llged
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Por Locati
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Number 001, additional intereetCs) have been adeled. Refer to the
ofes5ion~1 Office Packag.. Location Cover.,e S~maary for nam.s of
81 intere.to.
Nu~ber 002, ~dditional intereatCs) have been added. Refer to the
ol....ional OfEice Package Location Coverage Summary for name. of
81 interests.
Th. pr.mi~ .hoWn below i. th" total net premium of all additions. change.,
and deleti ns for this endoreement to your pOlicy.
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Premlllm C
Additional
e Which I, Due NDW
emium
$0.00
Returned Premium $0.00
It Issueu at r the Uete your policy
begin., thes Spllceu must be completed
and our repr sent"live must sign below.
Policy i:osued tt>
EAST EDIltIGER MEDICAL CENTER &
EAST EDINGE/I. MANAGEMENT COMPANY, LLC
AlIt
endorsement takes etrect
07/28/00
Processing Date: 08/01100
4 Printed in U.S.A. Endorsement
and MarIne Insurance Co. 1984 All Rights Reserved
Policy Number
-- -- FK06604489
11.21 002
PIIge
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. ~ PfIOFfSSION OFFICI PACKAGE lOCA nON CaVfRAGf SUMMARY
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'-' This summar shows the Limits of Coverege
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and any Opti. nai Coveraglls you have fOr this
location.
lhoStlltul
lOCltion # 00
8 Aftt'.ss: ~~:~. E:..EDINGEA M 92705
S__ .A ""A ""
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~ Propeny Pro~ crloll
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g Bu.ine.. re Bonal Property
Property ne ~etibl.: $500
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limit
$43,000
Prollli,,",
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3 Co.puter CCl'erage
It Data, x, ie, And Software
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Hardware Limit:
Limit;
~lOO.OOO
(\10,000
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Slltlstkll "', "-'011
p....tection CI..., 01
Torr; tory, : 007
Cla.s 998
Cf/lutructic '. NOn-COllbUltible
N..... of Inll ad
EAST EDINGI < MEDICAl. CENUIl. &
PlIllcy Nlllllter FK06604489 Eff.cti". DaI.07/28/00
Processlnll Dat. 08/01100 11:21 002
46159 Ed.?-9 Printed in U.S.A. Coverage Summary
-St.Paul Fin. find Marine Insurance Co.1998 All Rights Reserved
Page
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~ PROfESS/DNA Dff/CE PACKAGE LOCAT/ON COWRAGE SUMMAJll'
- CONTINUED
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This form is contlnuation of the Profesl!lional
Office Pecka e Location Coverage Summary.
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WHO WE'LL P Y FOR LOSS
LOCATION tI 001
SNAKE: COPEL 0 CAPITOL
LEASE INS AGENCY SERVICES
z AllDR: 15325 S.E. 30TH PLACE #100
.
BELLE UE WA 98007
~ OelcriptionOf Covered Property:
E CONT IS
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TYPE:
NAME:
ADDR;
ADDITIONAL ROTECTEO PBRSONS
LandI
GLEN
5626
ORAN
rdl
TOCKING
AHTIAGO CANYON RD.
CA 92669
bed Peraon or Ortanization
F SAHTA ANA
20 CI Ie CtNTER PLAZA
ANA CA 92701
CONTRACTS WITH CITY TO DO PHYSICALS FOR NEW HIRES
TYPE;
HAllE:
AIlDR:
Name ., lnl ell POlicy Number PlC;066044B? Effective Ollte 07/2.8/00
BAST ED1NC HEDICAL CINTEI( &. ProCestlng 0_08/01/00 11:21 002
46159 Ed.7-9 Printed In U.S.A. Coverage Summary Continued
~St.P8ul Fire nd Marine Insurance Co.199S All Rights Reserved Page J
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ij PRORSS/ONA OfFICE PACKAGE lOCATION COVERAGE SUMMARV
1IIIIBflltul
<.> This summar f shows the Limits Of Coverage
<.> and any Optl nal Coverages you hove for this
locollon.
Lo~ltlatlll 00
8 Address: 15 0 EAST EDINGER
SA TA AJlA CA ~270S
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~ /'rope", /'rot CtiOA
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g Busin..s Plfrsonai Property
Property D ~uctibl.; $500
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Limit
~111,300
Premium
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Stll/stlcll III rlll8/illA
Protection Class: 01
Territory : 007
Cl... I 998
Construeti n : Non-Combustible
NIllIe of Ins red POlity Nulllller FK0660448!1 . . - Eflealve DlIte 07/28/00
EAST EDING R KEDICAL CENTER" Proenslng DIlt1l 08/01/00 11;21 002
46159 Ed.7" 8 Printed In U.S.A. Coverage Summary
uSt.Paul Fir lInd Marine Insurance Co. 199B All Rights Reserved
Page 1
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~ PROFISSIONA OFFICe PACKAGE LOCATION COVeRAGE SlNMARY
- CONTINUED
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\J Thla form Is contlnuiltion of th" Pro/eQuionol
Office Peck. e Location Covaragl! Sommary.
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Wl:l0 WE'LL P Y FOR LOSS
---~----------------------~----------------------------------------~----
LOCATION # 002
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8 NAKE: COPEL 0 CAPITOL
LEAS INS AGENCY SERVICeS
· ADDl. 15325 S.E. 30TH ~LACE #100
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bELL UE WA 98007
.. De.eriptio Of Covered Property:
~ COliT IS
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ADDITIONAL ROTECTEO PERSONS
-------------------------------------------------------------.----------
TYPE: De.e
NAKE: CIty
ADDR: :to c
SANT
De.<:riptio
INS
bed Person or Ortanization
F SANTA ANA.
Ie eKNTE;K PLAZA
ANA CA 92701
.
CONTRACTS WITH CITY TO DO PHYSICALS FOR NEW HIRES.
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NlIIle of Ins ed Pallcy Number FK06604489 . . ~ Eff8~lh', DlIIe 07/28/00
EAST EDING MEDICAL CENTEa & Procelllng DlIIt 08/01/00 11,21 002
46159 Ed.7- Printed In U.S.A. Coverage Summary COntinued
eSt.Paul Fir and Marine Insurance Co.1998 All Rights Reserved Page 3
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DESCRIBED P SON DR ORGANIZATION ENDORSEMENT _
AlJDlnllNAL ROrs:TrD PERSONS
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This endors ent changes your Commercial
Generalliab lity ProteCtion.
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How tov".g Is Chlnged
The followi
Under This
adds certain
protection.
Deacrlboll per on or orpniUlioL The pereon Or
organlut;o hown In the Coverage Summary
liS a describ person or organization is 8
protected p son. But only for covered Injury
or damage t t resulls from; ,
'premiaes y u own. rent or lease; or
'your work.
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is added to the Who Is Proteoted
rllement section. This change
rolected persons and limits their
We explain What we mean by your work in the
Product" and <;ompf"t"d work totolfim't
Gection~
Other Terms
All other terms of your p"lioy remoln the sarna.
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43358 Ed.7 Primed In U.S.A.
eSt.Paur Fir" nd Marine Insuronce Co.19BS
EnClorsemem
Poge 1 of 1
ACORD CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDfYY)
~ . 03/15/2001
PRUOUCER (714)990-4430 FAX (714)255-0872 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE .-..
R. W. ~ortimer & Assoc. Insurance HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
~BA: HealthCare Professionals' ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
PO Box 9699 INSURERS AFFORDING COVERAGE
Brea, CA 92822-9699
INSURED East Edinger Medical Center INSURER A: St. Paul Fire & Marine Ins Co.
East Edinger Management Co Llc INSURER B: American Healthcare Indemnity
1530 E Ed;nger Avenue INSURER c:
Santa Ana, CA 92705 INSURER 0:
I 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 CERTIf:"ICA TE MAYBE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGG"EGAIE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
I'em TYPE OF INSURANCE POLICY NUMBER DATE (MMIDDIYY) DATE (MMIDDIYY) LIMITS
GENERAL LIABILITY FK06604489 OS/20/2001 OS/20/2002 EACH OCCURRENCE $ 1,000,001
X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Anyone fire) $ 1,000,001
J CLAIMS MADE 0 OCCUR MED EXP (Anyone person) $ S,OOl
A PERSONAL & ADV INJURY $ I,OOO,O!!!
GENERAL AGGREGATE $ 2,OOO,0(j1
~N'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COM~OPAGG $
D :..Cl PRO- n
POLICY JECT LOC
AUTOMOBILE LIABILITY FA06600432 OS/20/2001 OS/20/2002 COMBINED SINGLE LIMIT
- (Eaaccident) $
ANY AUTO
- ALL OWNED AUTOS
BODILY INJURY
X (Per person) $
SCHEDULED AUTOS
A r---
HIRED AUTOS BODrl Y INJURY
r- (Peracddenl) $ 750,O!!!
NON-OWNED AUTOS
r- ~~22:la~
PROPERTY DAMAGE $
- ..... ,~ (Per accident)
GARAGE LIABILITY .. ~, AUTO ONLY - EA ACCIDENT $
=i ANY AUTO ~ ~~~\ ]1 OTHER THAN EAACC $
'It) ,..\~ AUTO ONLY: AGG $
~
EXCESS LIABILITY c:.I;o"\ sa~ ~ EACH OCCURRENCE $
o OCCUR o CLAIMS MADE . )f. ",.t\O .;y! AGGREGATE $
P,\S
~ $
j, DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION ANO .1 TORY lIMITSl .-l ER
EMPLOYERS' LIABILITY E.L EACH ACCIDENT $
EL DISEASE ~ EA EMPLOV-,=-E $
EL DISEASE - POLICY LIMIT $
OTHER HCFOOOOlS5 07/0l/2000 07/01/2001
Profess;onal Uab;];ty
B laims Made Form $1,000,000 Each Claim
_Ann $3,000,000 Aggregate
DESCRIPTION OF OPERATlONSIlOCATlONSNEHICLES/EXCLUSIONSADDED BY ENDORSEME lu~1 It;; --UKlV/
Retroactive Date: 6-17-85
Michael _VigliiJila f -,-~ -~._--~--~-"'_~M.
Dcpuly City,,' /11,rnl:v
CERTIFICATE HOLDER ~ -L ADDITIONAL INSURED; INSURER LETTER: CANCELLATION
SHOULD ANY OF THE AbOVE DESCRlfJED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF. THE ISSUING COMPANYWfLLENDEAVOR TO MAil
City of Santa Ana, its officers, agents & ----1L DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
El11Jloyees
ATTN: ROSA FLORES BUT FAILURE TO MAIL SUCH NonCE SHALL IMPOSE NO OBLIGATION OR UABIUTY
20 Civ;c Center Plaza OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES.
Santa Ana, CA 92701 AJ:jZEDRJSE{ZfM J:Ja.
. ~. J -Ltl..<- A/I/\L)
,..'" '''.'1 FAX: 714 647-S311 , "v.. 0>00
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