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Home My WebLink AboutSILVER ROSE ENTERPRISES , LLC 2 -2001 ,-. ...., SILVER ROSE ENTERPRISES, LLC N-2001-140 AMENDED BY A-2001-225 . SEE A-2001-225 . II....,RANCfl4tll Oft F~E200 1-140 WORK r,'!llL\Ll PROCd:.O CLERK OF COUNCil ft.I.:rE' ~~ ~~O\ ~ un " ( : C il4 I fA/. THIS AGREEMENT, made and entered into this 1st day of July ,2001 by and between Silver Rose Enterprises, LLC., a Delaware Corporation (hereinafter "Consultant"), and the City of Santa Ana, a charter city and municipal corporation organized and existing under the Constitution and laws ofthe State of California (hereinafter "City"). , Co OI-l fILE INSuRA,l1" ~ -.c~' '1"'Y' Ihi\'/ f\.,Dl.:-~~cS v,-',,:\, ....!.'..<. ~.~~.!:. UNlil \N::U~~"J.\~Y1'---- / Q.!'..:3fC" lr;"'\ Of 'tU";'l~~-;.L ~:'~'t 10" r.P1 CONSULTANT AGREEMENT RECITALS A. The City desires to retain a consultant having special skill and knowledge in the field of motivational workshop to increase morale, relationships and productivity for employees. 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 frnn 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 $9,000.00 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 June 30, 2002, 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 Community Development Agency and the City Attorney. " , '-' 'WI 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$l,OOO,OOO 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. Business automobile liability insurance, or equivalent form, with a combined single limit of not less than $1,000,000 per occurrence. Such insurance shall include coverage for owned, hired and non-owned automobiles. c. Worker's Compensation Insurance. In accordance with the provisions of Section 3300 ofthe 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 ofthe work under this Agreement, Consultant agrees to obtain and maintain any employer's liability insurance with limits not less than $1,000,000 per accident. d. The following requirements apply to the insurance to be provided by Consultant pursuant to this section: 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. 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: (I) 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 ofthis 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 ofthis 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 3 "-' 'wi 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 ofIaw; 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 Community Development Agency City of Santa Ana 20 Civic Center Plaza (M-76) P.O. Box 1988 Santa Ana, California 92702 telefacsimile (714) 647-6549 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: Silver Rose Enterprises, LLC. 1319 West Seascape Drive Gilbert, AZ 85233 telefacsimile (480) 558-1116 Attn: Silver Rose A party may change its address by giving notice in writing to the other party. Thereafter, any notice, tender, demand, delivery, or other communication shall be addressed and transmitted to the new address. If sent by mail, any notice, tender, demand, delivery, or other 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, any notice, tender, demand, delivery, or other 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 5 "-' ...." 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 ofthe 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. 13. DISCRIMINATION Consultant shall not discriminate because ofrace, 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 government 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 ofthe 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. 6 - "'" 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. 7 low> ($500 - $10,000 agreement) '-' IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first above written. ATTEST: PATRICIAE. HEALY Clerk of the Council APPROVED AS TO FORM: JOSEPH W. FLETCHER City Attorney By: ~v ~~ Lisa torck Assistant City Attorney RECOMMENDED FOR APPROVAL: 1// Job<< Reekstin Executive Director ofthe Community Development Agency CITY OF SANTA ANA (ltfi/l~ DAVID N. REAM City Manager CONSULTANT ~;21~~?~~~ Owner ~s--'{ '7:<'0 1rr d- Employer ID # or Individual SS # 8 SILVER "-' ROSE .....; Enterprises, LLC www.CelebrateTheHarvesl.com PRICING One-Day Workshoo $1,500' Half-Dav Workshoo $ 1,000' FOllOW-UP REINFORCEMENTS Tele-Proaram (60 minute nmnram via telephone) $ 250 Weeklv "Column" & Dailv Emails $ 500/mo Quarterlv Half-Dav Refresher Courses $ 1,000' _ Monthly Audiotape $250/mo $3/tane One-On-One Coachina via Telephone $ 100/session Grouo Coachino via Teleohone $ 200/session 'Plus travel & expenses (budget to be agreed upon In advanoe) )( 6 MONTH PACKAGE, Includes: One-Day Workshop Monthly Tele-Program or Tape Weekly Column & Daily Communiques TOTAL PRICE: $ 5,000" "$1,000 discount travei & expenses are extra and tapes Of chosen) are $31ea, _ 3 MONTH PACKAGE, Includes: One-Day Workshop Monthly Tele-Program or Tape Weekly Column & Daily Communiques TOTAL PRICE: $ 3,250'" ***$500 discount; travel & expenses are extra and tapes are $3/ea. EXHIBITA'1 1119 West Seascape Drive Gilbert, AZ 85233 4801558-1115 (voice) 4801558-1116 (fax) SR[a)CelebrateTheHarvesl.com SILVER ...... ROSE ....; Enterprises, LLC www.CelebrateTheHarvest.com Change Your Focus Change Your Life Celebrate the Harvest A Program to Increase Morale, Motivation, Relationships & Productivity Silver Rose Edu-tainer & Success Coach The expressway to success is paved with celebration and laughter. -SIlver Rose PROGRAM OUTLINE Workshop I. Law of Attraction - What You Focus On, You Get Known to many but leveraged by few, this principle is the foundation of the Celebrate the HaNest philosophy. Participants learn how to apply it to their work to achieve better results and stronger relationships. II. Following Your Instincts Most successful business leaders will tell you that, once they've gathered and absorbed all the data, following their "gut instincf' has produced the best results. Participants will learn how to start listening to and following their own instincts. III. The Hidden Gift Behind Cynicism and Negativity Most people are uncomfortable with their own negative emotions and even more uncomfortable seeing them in others. But strong emotions, negative and positive, provide key insights into what's really important to us. Participants learn how to interpret negativity in a way that can open up meaningfui communication and improve working relationships. IV. Using Celebration and Laughter to Achieve More of What You Want In the frenzy of today's world, few of us take the time to stop and acknowledge accomplishments. We rush on to the next "to do," left with an unsettling feeling of never doing enough or being enough. Following the workshop, as participants learn to laugh with delight at what they've achieved each day, they'll also begin to notice marked improvements in productivity. V. The Power of Decision A decision is not a wish or a goal. It is the declaration, "This will happen." Participants leam how to produce more tangible results using the power of decision. 1319 West Seascape Drive Gilbert. AZ 85233 4801558-1115 (voice) 4801558-1116 (fax) SR<a1CelebraleTheHarvest.com SIL VER ~ ROSE '-' Enterprises, LLC www.CelebrateTheHarvest.com VI. How Appreciation Can Transform Any Relationship or Situation We all have people in our lives with whom we have troubled relationships: co-workers, clients, and bosses, even family. Rather than settling for the defeatist attitude of "What can I do?" participants learn ways to focus on what they appreciate about the other person versus focusing on all that is wrong. Where there is appreciation, no matter how small, respect can begin to grow. VII. Thank God it's Mondayl Celebrating Your Work What would life be like if, instead of "I have to go to work," we said (and truly believed) "I get to go to work." Participants learn how to shift their altitudes and return to the days when they were excited to have landed their job. VIII. Identifying Your Purpose, Passion and Vision Participants are guided through exercises to assist them in identifying these key elements. They have an opportunity to uncover a compelling reason to get up every day, excited about the work before them. IX. What Will Your Legacy Be? We hear it all the time, "I want to make a difference," or "I want to leave my mark." Participants explore ways to achieve this in their current roles. FORMAT This highly interactive workshop uses four teaching components: . Lecture . One-on-one coaching of volunteer participants . Exercises . Discussion of real life exampies (from both the workshop leader and participants themselves) BENEFITS The following results are available to participants who integrate into their work lives what they learn in this workshop: . Getting more done in a day than previously thought possible . Having more time and energy to spend on the important, but less time-critical projects . Increased energy, commitment, creativity, and enthusiasm . Improved relationships with co-workers and customers . Producing results vs. completing tasks . Higher morale and motivation . A heightened sense of teamwork and community . More celebrationsl Il19 West Seascape Drive Gilbert. AZ 852ll 480/558-1115 (voice) 480/558-1116 (fax) SRIiUCelebrateTheHarvest.com SILVER low' ROSE .....,1 Enterprises, LLC www.CelebrateTheHarvest.com Follow-Up Reinforcement As with any program, the learning deepens when the principles are reinforced on an ongoing basis. To accomplish this, the foliowing tools and techniques are available: . Monthly Audiotape - available to listen to when convenient (to and from work, for example) . Tele-Programs (60 minute programs via telephone) . Weekly "Column" about one of the principles to set the tone for the week. This could be distributed to each employee via interoffice mail, email, or at weekly staff meetings. (If at staff meetings, managers could use it to stimulate discussion and for people to share ''wins".) . Daily emails or Inter-office memos (1-2 paragraphs only) reinforcing one of the principles . One-an-One Coaching via Telephone For managers For specific situations that warrant more focused attention . Group Coaching via Telephone A manager and her staff, for example, wanting to brainstorm how to approach an Issue A group of managers interested in applying the principles to an upcoming change or an existing challenge . Quarterly Half-Day Refresher Courses ABOUT THE FACILITATOR Silver Rose brings over 20 years of business experience to her clients. During her 12 years in human resources consulting, Silver worked with clients across a wide spectrum of industries. Client companies have included Platinum Software, Wells Fargo Bank, Kaiser Permanente, Transamerica, The Gap, and Mitsubishi Motors Credit Corporation. A former stand-up comedian, Rose is regularly asked to emcee both business and social events. An accomplished speaker, coach, and workshop facilitator, Rose has become known for effectively combining wisdom and humor to facilitate breakthrough results for her clients. She has three published books of humor, Women Who Joke Too Much (Berkley Publishing Group, 1995), the Comedians' Quote Book, (Sterling Publishing Company, 1993), and You're The Reason Our Kids Are Ugly, a book of Country Western Quotes (Harper Perennial, 1995). In 1988 she won the top award in her Dale Carnegie speaking course. She is a member of the National Speakers Association; the National Association of Women Business Owners (NAWBO); and the Professional Mentors and Coaches Association (PCMA). Currently working on her 4.h book, Celebrate the Harvest - The Business Case for People Loving Their Work, Rose is committed to all individuals having work that causes them to say, "Thank God it's Monday!" 1319 West Seascape Drive Gilbert, AZ 85233 4801558-1115 (voice) 480/558-1116 (fax) SRtalCelebrateTheHarvest.com SILVER '-' ROSE -' Enterprises, LLC www.CelebrateTheHarvest.com TESTIMONIALS From the April, 2001 California Workforce Alliance Conference: .Once in a while I am fortunate to have something as wonderful as this workshop come into my life - thank you! It was just what I neededl" Colleen Ellis, Gienn County MRA "Life changing seminar. Great job! The relaxed style of the presenter was most valuable. . George T. McQueen, Ed.D., Executive Dean Yuba Community College District Wonderful workshop. It was alf valuable. .. Jeanne Hough, STEP, Inc. From a Tele-Program participant: "I wanted to briefly express how excited I am about the noticeable progress I have made implementing the suggestions from our recent workshop. Your question, "What would happen if we prioritized our day around the parts of our work that are the most fun and exciting?" has literally caused several of my most crucial projects that had not received the attention they deserved,.. to leap forward! By starting on the tasks that excite me, I am then more inspired to tackle tougher challenges and the momentum created at the beginning of the day carries me cleanly through my to-do list. In light of the positive results I continue to see by implementing even one of your suggestions each week, your coaching and courses are a valuable asset with a very high ROI (return on investment). I am having more fun, while getting more done. My life's work has become a seamless part of my life. Isn't that what it's all about? Douglas J. Kosarek Executive Searcl1 Consuitant President and Founder Human Capitallnlemational 1319 We.. Seascape Drive Gilbert, AZ 85233 4801558-1115 (voice) 480/558-1116 (fax) SR(a)CelebrateTheHarvest.com SIL VER '-' ROSE ..." Enterprises, LLC www.CelebrateTheHarvest.com ~onday,June 18,2001 Deborah Sanchez, Director Santa Ana WORK Center 1000 E. Santa Ana Blvd, Suite 200 Santa Ana, CA 92701 Dear Deborah It was a pleasure meeting you on Friday and talking with you and Patty about doing a workshop for the combined WORK Center staff and partners. I know you are specifically looking for something that will help to excite the staff and motivate them to participate more fully in the day-to-day workings ofthe Center. Celebrate the Harvest seems tailor-made. Attached is a proposal in which the details of the program are outlined. I could not fmd specifics in my notes but I believe we were talking about a Half-Day Workshop. I have included pricing for both Half-Day and Full-Day workshops. If we are talking about a Half-Day program, let's discuss whether you'd like to retain my services for the full day. Perhaps I could facilitate a meeting with some of your key stakeholders on a specific topic (vision and mission both come to mind). We can brainstorm some possibilities for that when next talk. Lastly, I invite you to also strongly consider the Follow-Up Reinforcement programs we offer. A workshop is a great starting point but, without timely reinforcement, it will be difficult to maintain any kind ofmomenturo. I have you on my calendar for Friday, August 3"'. I know your preference would be September 7"'. I should know by the end of ~ay whether I can switch you to that date. If I can, I will be happy to do so. I look forward to hearing back from you on the steps that need to be taken to finalize this. Warm regards, Silver Silver Rose SR(@'CelebrateTheHarvest.com cc: PattyNunn 1319 West Seascape Drive Gilbert, AZ 85233 480/558-1115 (voice) 480/558-1116 (fax) SR(@'CelebrateTheHarvest.com '-' '-' Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion Lower Tier Covered Transactions This certification is required by the regulations implementing Executive Order 12549, Debarment and Suspension, 29 CFR Part 98, Section 98.510, Participants' responsibilities. The regulations were published as Part VII of the May 26, 1988 Federal Register (pages 19160-19211). (BEFORE COMPLETING CERTIFICATION, READ INSlRUCTIONS FOR CERTIFICATION - Attached) (I) The prospective recipient offederal assistance funds certifies, by submission of this proposal, that neither it nor its principals are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any federal department or agency. (2) Where the prospective recipient of federal assistance funds is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this proposal. ~.1;;:;s~;:~';.:.:"it~ 22 . """ ..". CERTIFICATION REGARDING LOBBYING CERTIFICATION FOR CONTRACTS. GRANTS. LOANS and COOPERATIVE AGREEMENTS The undersigned certifies, to the best of his or her knowledge and belief, that: 1 ) No Federal appropriated funds have been paid or will be paid, by oron behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an 9fficer or employee of Congress, or an employee of a Member of Congress'in connection with the awarding of any Federal contracts, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment or modification of any Federal contract, grant, loan or cooperative agreement. 2) If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan or cooperative agreement, the undersigned shall complete and submit Standard Form - LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions. 3) The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including agreements) and that all subrecipients shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by 31 U.S.C. 1352. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10.000 and not more that $100,000 for each such failure. S\l,~?~~ / G"",,,leo",""" ":0;""00 7/tI~J ~\\~ ~6S~ Name of Certifying Of Icial Signature .;lCORD,. CERTIFICA..iE OF LIABILITY INSU~NCerL~~~ D~ DATE jMMIDD/YY) 10/11/02 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Flagstaff Insurance, Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P.O. Box 1807 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 2100 E. Cedar Ave. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Flagstaff AZ 86002 I Phone: 928-774-6631 Fax:928-779-1765 INSURERS AFFORDING COVERAGE I INSURER A , INSURED Auto-Owners Insurance CO. INSURER B: Silver Rose Enterprises, LLC INSURER c: ~ 1/0- Marsha Rose 1319 W seasca~e Dr INSURER D: 1. , 'f I....... ~ Gilbert AZ 85 33 , INSURER E: , .., 1- ]::J 2> COVERAGES ..- ~ J Illn THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING 'V -.c. vv , , , v ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR' TYPE OF INSURANCE POLICY NUMBER ~2~~rM~~~rE P~l-+~~~r~If'~?N LIMITS LTR' [fNERAL LIABILITY .1 EACH OCCURRENCE , 1000000 A xl:r:'ERC".LGENE";'-LLlABILlTY i 4558167800 10/31/02 10/31/03 FIRE DAMAGE (Anyone fire) 5100000 __ CLAIMS MADE l_ ~ OCCUR MED EXP (Anyone person) , 10000 i PERSONAL & ADV INJURY , 1000000 - ---'-'~-' --- I GENERAL AGGREGATE _..~. ' 1000000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMPIOP AGG , 1000000 'II 'I PRO, III POLICY i JECT LOC a-""- COMBINED SINGLE LIMIT (Ea accident) . ANY AUTO All OWNED AUTOS , BODilY INJURY I, , {Per person) ~.. SCHEDULED AUTOS I , HIRED AUTOS i I BODilY INJURY I {Per accident) , _-----.j NON-OWNED AUTOS i__ PROPERTY DAMAGE , (Per accident) ~R~GE LIABILITY . AUTO ONLY - EA ACCIDENT , ; ANY AUTO I OTHER THAN EA ACC , , I i AUTO ONLY: AGG $ EXCESS LIABILITY , i EACH OCCURRENCE $ ~ OCCUR C CLAIMS MADE ! : AGGREGATE . i T9;AORM $ l ~EDUCTIBLE APPRO AS . RETENTION $ . i WORKERS COMPENSATION AND /' LEE SHAW i I i-~R~I~~YTSI IU~~- ! EMPLOYERS' LIABILITY CRI E.L EACH ACCIDENT '5 Deputy City Attorney E.L. DISEASE - EA EMPLOYEE . E.L. DISEASE - POLICY LIMIT , : OTHER I i DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS City of Santa Ana, its officers, agents, and employees are named as additional insured as respects work performed by named insured CANCEllATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIO DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO 00 SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KINO UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUm~:::5~TIV/~ CERTIFICATE HOLDER Y I ADDITIONAL INSURED; INSURER LETTER: SANTAAN City of Santa Ana Lydia Morgan 20 Civic Center Plaza Santa Ana CA 92701 ACORD 25-S (7/97) @ACORDCORPORATION 1988 "" ""-' IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25-5 (7/97) Sent ay:.F~AGSTAFF INSURANCE; . . -..... ....."... ~ '"" '. . !I52lIZ1~ I ' COMIIEIlCIIlL GENERAL UADIUTY THIS ENOohSEMENT CHANGO THE POUCY. PlEASE A~ IT CAREFULLY. 520 779 1 765; Oct-28-02 3:05PM; Page 2/2 PalVumber 0046ZS-455'UM- EXClUSI ADDmONAllNSUREO i - PRODUCTS-COMPLETED OPERATIONS 1 I This endorsement modi1le. in"ranee provided IInder the bllOwing: ,. COMMERCIAL GENERAL ~ASIUTY COVERAGE FOAM. SCltIDUll __ Ilf '- ar , (....IIIclMI......): CITY OF SANTA ANA. it offieau. a,ants arid a.ployae' (If no entJy appears above, i , applicllble to thi5 endor..me ;) t_ UlKIer Section II - WHO I ~ INSUMD, thefolJowlnl '- added: 1IolII'Iquillld 10 comp.thit endoraeme~t will be .hown in the Declarations as IIIown III the abaw1l Schedule I. an Addltlonal ~.uted, but only with respect 10 liability , ;ror that Insured by or for you. ' 2_ Under Section I, COYER. S, 2. Exclullons, the foIlowlllg exclusion is a~lld: The iIIsurance provided . rein to the Additionallllsurad doe, not apply ~o the 'produets-completed operalion. hazard'. 3_ Under Section III - UMIT . OF INSURANCE. lhe bllowlll9 it added: TIlls Insurance i. prima for 1M penon or ol'g1llllzationIhOwIlIII tile Schedule, but only wit" felpect to liability arislllg out of 'your woR. : far tbat ..._ or OI1l8IIizatlon by or far you. Other Ill8uralloo available 10 the p- or organization ,howll : the ScIIedule will apply as _ Inaura_ llIld not contribute.. primary illsuranee lolhe In8\lra_ pl'OYld by thi, endorsement. . Additkll'IaI' lII.urn ... tlloM specified in tile (written COIllracl or agreement batween - lessee or contrador, not toeX\l8edthe Umltl .JOVided in this policy. These limit. .re Ion 10 III. limits of iRlurance shown ill lhe O.,laraliolll, IAL GENERAL LIABILITY CONDITIONS. 4. Olher Insurllnce, Ihe foIlowtng il added: The timlts of liability for Ihe insured and tbe ow inclueiva of and not In & ' 4. Under Sectlon IV . CO J ED AS TIN!; LE H W ' ~,,,,a.cI"""l of -.......ll~'I... ilo",-_ .1 COpll'lv~~ 1nI....tti'~ltlllI~f.1 FORM I ~ '. Iw' -.J 5l~o E n t e r p r i s e s, t t c December 3, 2002 To the City of Santa Ana I, Silver Rose, am under a contractual relationship with the City of Santa Ana to provide training and coaching services and understand the City's insurance requirements, While I have the necessary insurance coverage plus the Additional Insured Endorsement, as required, my insurance carrier Auto-Owners Insurance Co, which provides my commercial general liability insurance will not agree to the cross-outs in the cancellation clause (bottom right hand comer), Therefore, I, Silver Rose, on behalf of Silver Rose Enterprises, LLC" agree and promise that I will personally provide the City with the required 30 days' notice should my coverage be cancelled or materially reduced in amounts, Very truly yours, 5\ Silver Rose 1125-8 Arnold Drive, Suite 187 Martinez, CA 94553-4104 (877)840-5416 (tel) 888-240-9232 (fax) www.SilverSDeaks.comVictoria{al.silversoeaks.com "~c..~D_ CERTIFICAT~ OF LIABILITY INSUR. DATE IMMlDDIYY) ClOP 10 JE ~LVE-6 07/31/01 THIS CERTIFICATE IS I ED AS A MATTER OF INFORMATION ONL Y AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, I , ! r5R~\j~YT51 IU~R. I I E.L. EACH ACCIDENT , E.L. DISEASE - EA EMPLOYEE S E.L. DISEAse. POLICY LIMIT , i 4558167800 10/31/00 10/31/01 , Business $10,000 , , i Protlertv PRODUCER Flagstaff Insurance, PO Box 1807 2100 E. Cedar Ave. Flagstaff AZ 86002 Phone: 520-774-6631 INSURED Inc. Fax:520-779-1765 INSURERS AFFORDING COVERAGE INSURER A INSURER B INSURER C INSURER 0: INSURER e" Silver Rose Enterprises, LLC Marsha Rose 1319 W Seascape Dr Gilbert AZ 85233 COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE fOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. lr/G TYPE OF INSURANCE I POLICY NUMBER ~NERAL LIABILITY I A X COMMERCIAL GENE~IABllITY 4 5 5 816 7 80 0 i CLAIMS MADE L!J OCCUR &~~~"'jMMlDDNYi - DATE'IMW~{ff~~N EACH OCCURRENCE 10/31/00 10/31/01 FIRE DAMAGE (Anyone fire) - - ~'L AGGRE~E lllMIT AP~S PER: I POLICY I ! ~~T I IlOC ~TOMOBILE LIABILITY ANY AUTO MED EXP (Anyone person) PERSONAL & ADV INJURY - - - - - - ALL OWNED AUTOS SCHEDUlEO AUTOS HIRED AUTOS NON-OWNED AUTOS GENERAL AGGREGATE PROOUCTS . COMPIOP AGG ! l COMBINED SINGLE LIMIT I , (Ea accldenl\ i , i BODILY INJURY I ! (Per person) BODilY INJURY (Per accidenl) I PROPERTY OAMAGE (Per acodenl) I AUTO ONLY. EA ACCIDENT I OTHER THAN EA ACC AUTO ONLY AGG I EACH OCCURRENCE AGGREGATE , I , , I ~~GE LIABILITY I I ANY AUTO i EXCESS LIABILITY ! =:J OCCUR D CLAIMS MADE I I DEDUCTIBLE I I RETENTION S I I WORKER:::. COMPH~SATICN AND EMPLOYERS' LIABILITY OTHER A Property Section LIMITS , 1000000 , 50000 , 5000 , 1000000 , 1000000 , 1000000 , I I' , , , , , , , , , , DESCRIPTION OF OPERATlON$1LOCATlONSlVEHICLES/EXCLUSIONS ADDEO BY ENDORSEMENT/SPECIAL PROVISIONS City of Santa Ana, its officers, agents, and employees are n~ed additional insureds with respect to all operations by the named insured. . 10 day AP~VED AS TO FOB}/ notice of cancellation will be sent for no-payment of premium. -~~ I ~y~ C ISTINE L.EE SHAW CERTIFICATE HOLDER l'l i ADDITIONAL INSURED, 'NSURER LETTER, CANCELLATION DeputY ~IlY ,,,,,..' , '1 " SANTAAN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPlRATID DATE THEREOF, THE ISSUING INSURER WILL.. MAIL ~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, City of Santa Ana 100 S. Santa Ana Blvd Ste 200 Santa Ana CA 92701 ACORD 25-S (7/97) @ACORD CORPORATION 1988 ;" ... '-' '...,I 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 affinnatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25-5 (7/97) 9-27-2001 1,50PM U./~'JU~ 1~j~~~.!~ PAA I. ~RO~NTA ANA WORKCENTER 714 565 2~ ~dU _de ~~.. 3l~r AV.~P U..J~a SILVER ROSE Enterpriselt,LLC ~ ~jl,r.l'fI'R'lIftTbt81 J.ilI'IIHt .eMt seplC'lll..... !7. 2001 Cbri.slinoShaw CiI)' or San.. Ano C;iI~ A1IOtnay., orne. 2li Civic Cl!Il"" PI... M 29 SIIlII Ana. CA 92101 ~, "b. Sb...., p~ )'611' rlIqUCit, "'is loner will '...,0 to ""'on! my "srwml!ll' Wjl~ I/Ic Cily 01'5_ An. 10 provide at lcost 30 de;r. 'Minll1l DOli... of _B.tiOD Oflllt rou""ju; in$lIr__ policy: Atno-Own... ""uran"" Policy. 00~16i99J 'fbi. .pcomenr II voIId 1M at l~ut 0>1. War er- .... de obo~. or _)'War Ii'om lbe la.t dllfC of..y ........ prvvided b;r 511.... Roo, Iio.lmpri.... LLC "''''. City of So.... Ana, wbl,II<vcr d... Ia I...... PI- nIl muI48ll-~60-94S2 ilyou h."" UI}' quntiou.. 1......~ yoo fw l'O\Ir ottcati(ln 10 lhU _. SioOflSly, ~...-----1 (~~r-, Silv...Ro,", PrtOidnt SA6riC c1d,r*TlwllarvwLi:OI~ 4k AS TO ~RM . 3~ CRl INttE'E ~A Deputy City Attorney 13",g w;i ~,;.;p; Orlve __M'_' _ _. .~. G"Den. A:l.. 86233 48OIlI58-1"~ ~." 4801568-1111 (fllll) P.2 tIJ uu.tJ UU.L 10-16-2881 3,49PM Sent By, Fl~rAFF IN6U~ANC!; FROM St>"ITA ANA WORKCENTER 714 565 2602 '-' 5~O 779 1765; Oct-Hl.01 4:~j P.3 Pilg& 2J:i .AIdo.0rtmet7 '- 1 ; I"'J 17-D71 -.L J_ N-01-IOO1 ,'AIL..,... IlIIDTH'I'IIII ,,, 1ft -. .M'''' Ch&n8 Endor...-n\ E~.e~tve 07-1'-ZOO) rcy _ "_'_1671-'. KY~ l~~Ol .... 12~Ol a... n-Il-ZOOD to 18-31-2101 tllS\IIIIIIlCE COtl'IllIV 61.1 ANACArRI IlYD., LANSINU. ~J "'17-"" _ I'I.MIIiTN'F INS.NICE IllC 2f"1I015-., VNlT 1~ _ IlLWD 1m lIITaPIIla' LLC _ un II SP~~ IIll flU!!tT. 'l '5m-!&Sz JnaIP:rl.. .. CIIMGI 55167 -....ItlllilfoL lliMeD I:ITY IIF. sm. "Mol TPII$.ICT!otI _UER, 812 ~$_ I'RDllll"" Nt ClWI8I! o,eo ld 5OL6 'ON I 1 j mil smMO Olnv YidtH IOOl '5 '.00 10-16-2001 3,d9P~ .FR~ANTA ANA WORKCENTER 71d 565 2~ Sent 8y: FLAGSTAFF INSURANCE; 520 779 1765; Oet.'6.01 4:S0Pij; -. . . P.d PO!}" 3/3 .. "fellCy e... 25-0035-00 lIQIi"l' NumW 00661S-65'l.1671 ..." l"''''1 COMMEllClAL~FlAL U,o.OI(,IT" THl.INDOlI....urr CHANGI" 'ftI! POlICY. "~I! ReAD IT CM.ULLY. AODl11ON.AL INSURED - OWNE CONTRACTORS (F . , LESSEES or 8) Tllfs ",,,,--CIII_mes Inou,.n" pnMaea .nGerthe ilIlawinO: ~ftaA1 ~NfIi"L LlAillL/T'I" co~ot PAM. IC~ _,,__~...D__ -i ~ IAJmI'IAII......-Jr ~ Of, IUTa a"a I.~. off1,ce.t'o. ....ploy.... &Illllltll,. iO Ci!oll.c: Center F1a~a Sa~t~~ Ana. CA 9Z701 ~OlWlt6G~ alld r..p........Uti....... I .. j (W no IlI9Y ........ I~. i......llltllll .....uil'l'llll "","._11111 .nilofqpe"l willi. .....n in 1M Deetlral_ IS ..,tlcMlII to lIIlI ..do,...ment.) I' 1. WHO., 18 All INlURED (Sec:IIOn III IS amendld to Indun u .. Inlu.... Ill. _n at o,...iZedon IhtrNn i. the Sdledule. "Ill DIlly _ rei. 10 lilblllly MI'iIlg OUI 01 oJflU' war!(' ltr thlllnlurtlll frJ or 101' you. a. TII. __n. .. _II ... LIMITS or IfIIURNItE lSecllon ftU, .. The II.... ... I~ IIr lite adlllllanoJ ;lISurtIII ....1IlDM. .....0 .... In....... _d '" _', ...... . -.rIaor, not 10 limif5... iMIIII.... <<_ Mt I" _n I&tIlO liMilllII In tIl. wtIIlIn lXlntratt or ..I....... C.. tIlIlI""" fIlI1'lnd in 1~" polley. TI1... ._ In the Oee~... "UNI:lERQlNDIH~ 4. OT11eR INSURANce: (5l!CT10~ JV). THE FOLlOWING PlUWI:SioN '15 1'd)C-:!D:' . TMIS IMSURAhCE {:5 PRlfo'AI\Y FOR THl: PERSON OR rNlZATION SHOWN IN THE SQlEOOU, WTONI." WITH RESPECT ro UABIL TV ARDiING OUT OF "YOUR WORK" "OR Tl'lAT PERSON OR ORGANIZATlON a OR I'OR YOU. ()TI-IER :tJItSUJUJiH;E AVA!1.As..~ :ro "i141! PERSON OR oRGANI%A ON SHOWN !N THE SCHl!DUt.E WILL, ~PPl '( AS !lXCES5 INSUll.\Na ANI) NPT C;OHTRIBUTE AS PRIMARY J;NSUlUJ\C;:6" TO THE INSURANCE Pltovttlm Il~ THIS [NOORSEMENT. 11lCI..... ilODYflaMlllIIMtNI " 111111_ _lOll _J I"c.. wlt1l .. ..","..ion ~,III""_"_ 0IlI';:~. I_ i ~~~ roBII j ISTINIi LEE tHAW ] Caputy City Attorney I' Ed' S0160N Y5,1'I mNMO Olny Vidt~: l lGOZ'; '~~Q Sent By: FLAGSTAFF INSURANCE; 520 779 1765; Oct-23-01 3:09PM; Page 2/4 /1/-;;001- jttJ ACORD. CERTIFICA T"-'OF LIABILITY INSURAh.tIt'f&~6 "'TI~ 10/23/01 _. THIll CEIlTIFICA'II:_,!. A 'l"'~.ff I~ane.. IDe. ClNl Y MIl CON_ NO IaGl111I UPON TH! Cl!RTIflCA'II: PO Box 1107 IIOl.DEIl THIll C!ItTIFICATE Dan NOT AMIIID. EXTEND OR 3100 .. Cedar Ave. ALTER THE COVIiIlAGE AFFOIlIlED BY TH! POl/CI!IBELOW. rl...~.ff AS 1'003 INIURlRS AFFORDING COVERAGE PboDe'530-774-'631 Pax. 520-77'-1765 - ...........A: Aut.o-OwrLer. xa.aUXUlCe eo. - 'UFi =.. ...~."I'rh... LLC ~IS: ..Z'. .. prfSlJAIf'c: --- 111' ....i;!. D~ _0. o u..rt AI , 33 -....- -., COVEltAGU llEPOlCI!I Of' ftIUWIC(; UlTliDIElOWIUl.W IIBN ~1O THE IN&UA!I:I NMIEOMl:Mi J(JR.... POLEY PBIOo fiaCA'fm. N01'WI rt4TANDtNG MY flIEQl. fI&lJIi,fT, TBW OftCCNOmollOlJl: NfV ~ OROfH!li': ~vwnt RllPICrTOWHlCh THlSCUlT'P1(:ATI MAY n IIIUED Oft MAy "'mllltN. nfE 1NIUAAJtcI...,~ BY THE POUCES DE.SCRI:IED........ ~ IUIIr.IICT TO ALL ~,...... ~..V6IONltNilO cotoTION3 Of' sue" IIOlCU. AOGAEGAT! L..-s 8IOWN MAY MAW IEEN AEDUCED BY PM) Q.AIMI;. L'" ""CW~I POUCT_ ......... ........, " X {jOl~1EfII:1Al_""LMIIl.ITY .....1OlOE[!J""""" 4551167800 10/31/01 10/31/03 ~OCCUilllllEflCa FIRE DMW>> (Aftt' ....fire) MEDillP...............1 ~ &NNIMAR\" GiNIiIW..AGWREGATE PRODUCTS. C()W.QJ AGO ........ '1000000 '100000 510000 '1000000 51000000 '1000000 G!N'L AOGN!MtI: LIMIt APPlEI PiR POLICY MOO lOC .... : lla 1.IMI..nY; _ AUTO AU. 0MEl1lUTOl ICHitU.WAUTOd ""..., AU10S """""",,EDAU'!'Ot llOOU(;,*, RETENTiON . WfOIUCIM; g a II l.!lJ'lGN'" ~......... COUBIEDSN1LE LtMlT 5 lQ~) 100II. Y INJURY . (..... ,..,) """"-V INJURV . lFw_ """""""~ . (...- AUTO ONly. "'1CeClENT 5 OTHIIO ....... "loCe I AUTO ONly, AM . EACH OCCUlOlWlCE 5 _TE . . 5 . CJ.. CACH ACCRlCNT 5 t:,t..~.1A . E.L. DI8&A&E - POlICT uwr 5 -........, -""'" - '-'--"" OCCUR D tIAIMs....., "'- DllClll'nGltOF ~___IY"Cl .,_ lLMlWIIIONI City of 8aat. -.... i~. Officer.. agea~., aDd ~loyeea ar. named additio...l iA......d .i~ E.:......::~. ~o _rk perfo....d by tile ..-.I i...ured ..............'11: IlOUlER T ADDrTIDNALfIIIUIIID;.....l..I'F1Wb IlUlTAAIl CMCEI.I.ATlON SHOULDM' (AI.... MIJft DllCWID POIJCIq ..CAIltCIL.LIP IHFOIIe ~ IMRA OA'M......... ~~ ..........Wl.LINDMVDRlO.... .!!........Ml"IMlITJIN NUt1CE TO,.. Cl!lnlPtCATI ~ NMID '"' THI LIPf. IUTrM..UM 'JO DO IOIHALL ~ 1iID~'IIONORUAllUTYOFNfftaHOWONlME~f1tAlNlfTlOR ~AmIH. City of Bant. "". Lydi. 110"9- 20 Civio e.D~.r Pl... ._t. ADa CA '3701 a;..... oJ 7.rz~ 2". (7/17) CACORD CORPORATION 11" 10-31-2001 10,27AM Sont By:.~LAGBTAFF INSURANCE; ::,. - FROM SANTA ANA WORKCENTER '-' 520 779 1 765 ; 714 565 2F"'2 Oct-al -01 ,-",97AMj P.3 Page 2/2 . AgellOY COde 2!HI03!l-ao PoliGy Number OD4625-4SH1671 _~I coulllalCiiloL GEiieAAL LWlILITY TtlIS EHOQRSEMEHT CHANGES TtlE POLICY. PLEASE RlAD IT CAREFUllY. ADDlllONAL INSURED EXCLUSION. PRODUCTS-COMPLETED OPEAA1l0NS This oildor.om.nl mQljific. in.Ul1InA prvvided und.,- thto fgU_inll: COMMERCIAL GENERAL UABtLlTY COVERAGE fORM. SCHEDULE N_ eI P._ '" ~lzdon IAdclIllDMlIIllllNll): CITY DF SNlTA ANA. ite officer.. a.ent. ..nd elllploy.... (If no en"" appears above. infOrmation rIIquil1ld to comp_ this endorsement will be shown in Ih, Declar,tions ,. apjilicablelolhis IlndCli'llement.! 1. UIHI.r. SfClion II . WHO IS AN INSURED. tht 1CllJOWjnt is added: The person or organizalion .!town in Ihe allOve Selledul. Is .n Additional Insured. bul only wilh respecl to liabllllY aiilint Oill of "yollr W<:l11c' for IhM inaUl'Vld by or fot you. 2. Vnder Section I. COVERAGES. 2. Exeluskllls. llle folloWing t)Ccl_i9n i. .dd.lI, The iIlsuranee provided herein 10 the AdditiQllal Insu.." Iloe, nol apply 10 Ihe 'prodllels-<:tJmpleled operalilln, hazard'. 3. Undwr SKIk>n III - LIMITS Of INSURANCE, the fgllglll/illll is .dlled: The liinits 01 liability lor the Adllillonallnsurcd artllhose specified in the wrillen contract or agrnll1llnt between Iht iniurtld and tilt owner, It_ or eCllWr:lc:tof. ftllllO exeeef Iht limits pmYided in Ihis potk:y. T"".. limit. are im"usi." 01 and noi in addition 101h.. limits of insurance shown in ihe Decllor.tions. 4. Und,,~ St:crion IV. COMMERCIAL GENERAL LIABILITY CONDITIONS. 4. Other Insurance. the follaoring i. added: This uisurallce is prim.IV fo( 1M ,...- or O....lIiZaliollstlown in the iGhwIM. !rul ,,"Iy IIIrith t1ISpact to liability aris;n, out DI.your worlo" for tlwIl person Of' organization by Of' for you. Other i...uranoe evallable to the penon or orvanilllton shown in lhe Schedule will apply as ..cess insuranc. and nO! conlrlbut. " primary insuranc. to Ihe.illsul'l!_ pl'OYidcd by'lhi. .nllclts._t. ~rtlil~ c.yr'ghtlld ........1.1 '5" lnivr..... Sw""Wt ""'C'C.. 1fK:.. WP.f't." permt.pg" COp~ht. InIUI'an_ s.-. Oftt_. 1IKl.. 10M ~lO_ . . LEES~ "- Deputy City Attorn.y