HomeMy WebLinkAboutON-SITE FABRICARE SERVICE, INC. 1 - 1999
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UNlIL \~1"U/~c _ WORK !il~Y ~r Pit(",;!:,!,:)
eLFR\( OF cout:U'~f ON-SITE FABRICARE CLERK OF WIJ!'!t1~
c:::f:: 1..-,;r~ R91. MAINTENANCE AGREEMENT D;\TE: ~ -/1-'1 {
c. ~tv J ;>ou5
THIS AGREEMENT, made and entered into this ~ day of thV\L, 1999,
by and between the CITY OF SANTA ANA, a charter city and municipal corporation of
the State of California, hereinafter CITY, and On-Site Fabricare Service, Inc.,
hereinafter FABRICARE.
TERMS AND CONDITIONS
1. Scope of Services
For and in consideration of the hereinafter stated payment by CITY to FABRICARE,
FABRICARE agrees to perform, at its own cost and expense, the maintenance services
for the Santa Ana Police Facility, hereafter FACILITY, as listed in Exhibit "A" attached
hereto and incorporated herein by reference. Services shall be performed at the
request of CITY. FABRICARE agrees to respond and provide maintenance service
within seven (7) calendar days of a request by CITY.
2. Term of AGREEMENT
This AGREEMENT will become effective July 1, 1999, and will continue in effect until
June 30, 2003.
3. Termination of AGREEMENT
CITY and FABRICARE each have the right to terminate the AGREEMENT, without
cause, with thirty (30) days written notice to the other party. Notice is deemed received
upon personal service or five-days after mailing. FABRICARE shall be paid for all work
satisfactorily completed prior to the effective date of such termination.
3. Non-assignment of Agreement
Inasmuch as this AGREEMENT is intended to secure the specialized services of
FABRICARE, FABRICARE may not assign, transfer, delegate, subcontract or sublet
any interest therein without the prior written consent of the CITY and any such
assignment, transfer, delegation, subcontract or sublease without the CITY's prior
written consent shall be considered null and void.
A. Nothing in this AGREEMENT shall be construed to limit the CITY's ability to
have any of the services which are the subject of this Agreement performed by
CITY personnel or by other contractors retained by the CITY.
4. Compensation
CITY agrees to pay, and FABRICARE agrees to accept as total payment for its
services, the charges identified in Attachment A. The total sum to be expended under
,
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this AGREEMENT, shall not exceed $10,000.00 during the term of this contract Upon
mutual written agreement of the parties, the rates may be adjusted at the end of each
one-year period of the AGREEMENT. Maintenance payments are payable by the
customer in accordance with the terms and conditions set forth herein.
5. Payment Schedule
Upon City's request, FABRICARE shall provide maintenance services to the FACILITY.
FABRICARE shall provide a detailed invoice of the maintenance services provided
each month. Payment by CITY shall be within thirty (30) days following receipt of an
invoice detailing work satisfactorily performed, subject to CITY accounting procedures.
6. Failure to Pay
Invoices which are not paid within thirty (30) calendar days after receipt shall result in
the cessation of maintenance services until payment is received. Service shall resume
on the same day payment is received. No credit shall be given for days on which no
service was performed due to late payments.
7. Taxes
The rate schedule does not include taxes and CITY shall pay for any sales, use, excise,
personal property or similar taxes or fees applicable to the maintenance.
8. Insurance
A. FABRICARE shall provide worker's compensation insurance as required by
California law. In addition, FABRICARE shall carry comprehensive general
liability insurance, including product, contractual, and broad form vendor's
coverage, with minimum limits of one million dollars ($1,000,000.00).
FABRICARE shall furnish to CITY a certificate of insurance indicating that such
insurance is in effect
B. Comprehensive General Liability Insurance shall contain the following clauses:
1) "The City of Santa Ana is added as an additional insured as respects
operations of the named insured performed under AGREEMENT with the
City of Santa Ana."
2) "It is agreed that any insurance maintained by the City of Santa Ana shall
apply in excess and not contribute with, insurance provided by this policy."
C. If FABRICARE fails or refuses to procure or maintain the insurance required by
this paragraph 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.
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9. Indemnification
A. FABRICARE shall indemnify, defend and save CITY harmless from and
against any and all claims for damages, including bodily injury and property
damage, arising out of FABRICARE's performance of this AGREEMENT which
constitutes negligence or willful misconduct.
B. Neither party hereto may assert against the other party any claim in connection
with this AGREEMENT unless the asserting party has given the other party
written notice of the claim within six (6) months after the asserting party first
knew or should have known of the facts giving rise to such claim.
10. Personnel
Employees of FABRICARE will be subject to the CITY's Rules, Regulations and
Guidelines at all times while on CITY premises. In its sole discretion, CITY shall, in its
sole discretion, have the right to determine the acceptability of any FABRICARE
employee assigned to work inside the FACILITY.
11. Employment Status
FABRICARE shall, during the entire term of the AGREEMENT, be construed to be an
independent Contractor and not an employee of the CITY and all CONSULTANT's
personnel shall be employees of CONSULTANT and not employees of the CITY.
CONSULTANT agrees that CONSULTANT is an independent contractor and not an
employee of the CITY. 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.
This AGREEMENT is not intended nor shall it be construed to create an employer-
employee relationship, a join venture relationship, or to allow the CITY to exercise
discretion or control over the professional manner in which FABRICARE performs the
services which are the subject matter of the AGREEMENT; provided always, however,
that the services to be provided by FABRICARE shall be provided in a manner
consistent with all applicable standards and regulations gOllerning such services.
12. Warranty of FABRICARE
FABRICARE warrants that FABRICARE and each of the personnel employed or
otherwise retained by FABRICARE are properly certified and licensed under the laws
and regulations of the State of California, if required, to provide the special services
herein agreed to.
13. Notification
All notices or other communication hereunder shall be deemed to be duly given when
made in writing and delivered in person or deposited in the United States Mail, postage
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paid, certified mail, return receipt requested and addressed as follows:
To CITY:
To FABRICARE:
Mary Calderwood
Property Manager
City of Santa Ana
60 Civic Center Plaza, M-97
PO Box 1981
Santa Ana, CA 92702
Annie Fitzpatrick
On-Site FABRICARE Service, Inc.
7711 Amigos Avenue, Suite B
Downey, CA 90242
14. Conflict of Interest Clause
FABRICARE 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.
15. Certification of Nondiscrimination
FABRICARE shall not discriminate because of race, color, religion, marital status, sex,
sexual orientation, age, national origin, disability or status as a Vietnam Veteran, as
defined and prohibited by applicable law, in the recruitment, selection, training,
utilization, promotion, termination or other employment related activities. FABRICARE
affirms that it is an equal opportunity employer and shall comply with all applicable
federal, state and local laws and regulations.
16. Exclusivity and Amendment of Agreement
This AGREEMENT represents the complete and exclusive statement of this
AGREEMENT between the CITY and FABRICARE, and supersedes any and all other
agreements, oral or written, between the parties. This AGREEMENT may not be
modified except by written instrument signed by authorized representatives of the CITY
and FABRICARE.
17. Validity
If any term, covenant, condition or provision of this AGREEMENT is held by a court of
competent jurisdiction to be invalid, void or unenforceable, the remainder of the
provisions hereof shall remain in full force and effect and shall in no way be affected,
impaired or invalidated thereby.
18. Laws Governing this Agreement
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
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action or proceeding that may be brought or arise out of, in connection with or by
reason of this AGREEMENT.
19. City's Contact Person
For the purposes of this AGREEMENT, Property Manager, Mary Calderwood, or
her designee, will be the CITY's contact person for all matter relating to this
AGREEMENT. All contract responsibilities that belong to the CITY will be coordinated
and managed by Mary Calderwood.
IN WITNESS WHEREOF, the parties hereto have caused this AGREEMENT to be
signed by their duly authorized representatives the day and year first above written.
ATTEST:
CITY OF SANTA ANA, a municipal
corporation of the State of California
i e C. Guy
lerk of the Council
~~
City Manager
APPROVED AS TO FORM:
'71~
Hugh Halford
Assistant City Attorney
On-Site Fabricare Service, Inc.:
RECOMMENDED FOR APPROVAL:
rthuW~
Annie Fitzpatrick
Account Executive
(-), '
\M fAciA-
Paul M. Walters
Chief of Police
1j~;, ~(,p6 7glt;
Employer ID # or Individual SS #
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ATTACHMENT A
SCOPE OF SERVICES
On-Site Cleaning of the Santa Ana Police Department Facility
Description
Quantity Unit Price Total Price
Cafeteria:
Dining Chairs
Booth Seating
Fabric Wall Panels 4'wx8'h
Fabric Wall Panels 4'wx3'h
8.25
22.50
12.50
8.50
0.00
0.00
0.00
0.00
Main Lobby and 3rd Floor Lobby (Pricing Per Floor)
Carnegie Xorel Wallcovering, Full Cleaning
Modular Seating (Per Seat Unit)
135.00
10.50
0.00
0.00
Spot Cleaning of Wallcovering, Panels, Seating and Carpeting
throughout the facility to be billed at $50.00 Per Person Hour.
Minimum on Site Service Fee: $225.00 (Per Trip)
Maximum on Site Service Fee not to exceed $500.00 (Per Trip)
(Customer to advise scope of work and timing as required.
Subtotal
0.00
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DATE.w..r;iiOlvv} ~
07/07/1999
~O Uu 70-18
U3 City B.lvd.. Wl!.st, Ste. 400
range. CA 92!6~~/048
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CalP.o.~~ LlC
On-Sit~ Fabr1car~ Servicet LlC
1111 AlJligQ~ A'lt'enl,je. Suite B
OQ~ncy. CA '0242
E.I: -166
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lllll Y AND l;llllFER:5 NO RIGHTS UPOII T~l! CERTIFICA 11i!
HOl~R. THIS CERTlFICATE DOES NOT AMEND, EXTEIlD ~
AI.1ERTHE COYERAGE AFFORCEC BY THE POLICIES BELOW.
COMPANIES AFFORDING COVE~"
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;:~l"'''''' ClAl~ MADE [.");".1 OCCUR!
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, OffflER''s & CONTllACTOq'S ProT :
10/01/1996 ' 10/01/1999
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UMBAEUA FORJ,I!
OTHER~ANUMBR8lAFORM
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DUCAlPTJQN OF ap9AA1IO....QCA"T\CIHStV..ttl;I.liiS..1:lAL rrEMS
HE CITY OF .AHTA ANA. ITS OFFICERS. AGENT,' EMPLOYEES ARE NAMED As
DOIrIOHAl INSOREO PE. FORM FMI01.1.1'59 ATTACHEO.
10 OAYS NOTICE Of CANCELLATION FOR NON~PAYMEHT OF PREMIUM
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M . '.K__ .. J~*~~.~;t,:aro-~:~~!ti~.Mt:''!",:..t~.... ".:~~,.:::,.......,
CITY OF SANTA ANA
ATT~' OORIs TORLEY
FAX ~71'/6'7~69.6
PO SOX 1.88 M~Z5
SANTA ANA. CA 9170Z
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sHOOlDNf'f (I" IIlE ABOVE mSCRlBEO 'POLICES 8'E CANCEllIm DEFORE THE
DPlftATlOM DATI!! y~.u..o,. n1f tSSUINGCOMPANV WILL .~!lRftl'IIl MAIL
-6L DAYS WRITTEN NCmCI. TO~I!. CEll'mFlCA1E HOlDER HAlED to 'nU! LEFT.
N_~l!llIl~Il!_IIll~lIXX
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~ Crum&Forster
r:r Insurance
THIS ENDORSEMENT CHANGES THE POLlCY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES, CONTRACTORS,
MANAGERS OR LESSORS OF PREMISES, ARCHITECTS, ENGINEERS, OR SURVEYORS
ThIs endorsement mOdifies insurance pr<:Mc:led undertha following:
COMMERClALGENERALLlABIUTY COVERAGE PART
SCHEDULE
NarneolPersoflorOrganlmion: ANY PERSON OR ORGANIZATION fOll. WHOH YOU RAVE AGUED III
(includUddl'e$undlor iob locallon) WRITING UNDER CON"IRACT OR AGREEMENT TO PROVIDE INSURANC
HOWEVER, THE INSURANCE PROVIDED SHALL NOT EXCEED THE SCOPE OF COVERAGE AND/OR LIMIts
or THIS POLICY. NOTWITHSTANDING THE FOR!CCING SENTENCE IN NO EV~NT SHALL caE INSURANCE
PROVIDED EXCEED THE SCOPE OF COVERAGE AND/OR LIMITS REQUIRED ~y SAID CONTRACT OR
AGREtMl::NT.
SECTION 11- WHO IS AN INSURED is amended fa Include as an additronalll1Sured thli person or
organ~on shown in the schedule above. The Insurance provided to the additional InsUl'ed applIes as
foncws:
A. 1. That plIrson or organizBtion is cnly an addltlonallnsuroo with re.pectlc liabiNly caused by your
negligent acts or omissions at or from:
(a) premises you own, rent, lease. or occupy or
(b) your ongoing operations performed for Ihat addillonal insured attMe 101) indk;ated by centraCl or
agl'llement.
2. The limits of insurance applicable tothe additional Insured aremose splclfllld in the written contract
or agreement or in the Declarations of ttis policy wI1iehevl!r are less. These limits of Insurance are
Inclusive of and not in addition 10 tne limits oflnsurance shown in Ihe Declarations.
8, Illhe addltlonal jns~ed lsan archilect, ~ngln_, or surveya', the insurance provided to me addltfonal
Insured does not applyto"bOdily injury", "propereydamage". . personal Injury", or"aclvertlsing injllY'
caused by Ihe rendering cf or failure to render any professional services including: ,
,. the preparing, approving, orfaJlfng to prepare or approve maps, drawings, opinions, repol"lS, sUl"Jeys,
change orders. deSigns ""speclfications: and
2. supervisory, Inspection, or engineering sllJ'\/lces.
C. Sec:lion IV -COMMERCIAL GENERAL UABILITY CONDITlONS. under 4. oth...lnsurance,
Is amended as fQllollts:
The following Is added to item a.:
Regardlessofwhether other insurancels aveilabfe Ie the additional insured on a primary basis, thi~
Insurance will be primary ana noncontributory if a written contraCl between you and the additional HlslJI'ed
speciftcaUyrequiresthatlhis I"SlJral1ce be primary.
FM 101.0.1459 (3195)
Plge t 01 2
EO/GO 'd
'ON XI;J.:J
Ud !V:VO G3n 66-LO-lOf
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O. WIth rll'lpedtc Ihe Insurance a1forded these additional Insureds, Ihe following additional exclu$/on
apples:
This insurance dQ8slIOl apply 10:
1, "ScdllyinjurY"or"propGrtydamagc"cccurringllfler:
(a) allwlll" k, lncludJng materlllls, parts or 8quipmenc furnished In connection with sUllh Work. cn the
project (other than service. maJntenatlCll or fll1l8irs) 10 be performed by or on bend cI the additional
In...8<I(3) at Ihe site at the CCYlIred oper81lons hae belln camplllled; or
(b) thar portfc.1n of''yoiw work" out of which the In!I.I:Y or damage arif;es has been put to its Intanded use
by any person a organization other than another conrractor or subcontractor IIngaged In perfor minq
cplKallOR'l for tI principal <l$ part 01 the same project.
THIS ENDORSEMeNT ISAPAATOFYOUR POUCV AND TAKES EFFECT ON THE EFFECTIVE DATE OF
YOUR POUCYUNLESSANOTHEfl EFFECTive OAT!! IS SHOWN BElOW.
CG-03
Endorsement ~mber
10-1-98
Elfedlve Oate of Endorsement
5060030967
Folley Number
Ca1J?ac, LIe
Named Ins..ed
10-1-98
COUntersigned Dale
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"AUtnorrted" Heplesentalllfe '
I'M 101.0.14U (3195")
Page 2 of 2
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PROOUCI!R(ii4)939:0800 FAX
al-Surance Associates, Inc.
PO Box 7048
333 City Blvd., West. Ste. 400
Orange, CA 92863-7048
Att": Apri 1 ,Wal ker
'iNSlIREO'"
CalPac, LLC
On-Site Fabricare Service, LLC
7711 Amigos Avenue, Suite B
Downey, CA 90242
Ext: 466
07/07/1999
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
COMPANIES AFFORDING COVERAGE
COMPANY ........U.~.i-t'e-d"..S.t.a.t'e.s....F.i..r.e...i~.~-:'-. Co.
A
COMPANY
B
North River Ins. Co.
COMPANY
C
S ta te ...c.o.iilp.e.~.s'a.t.i..o.n".i~.~.~.~a-~.c.e.. Fun d
COMPANY
D
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.'f~i~i~t62~~tij;y THATTHEPOUcfEifoi"iNSUAANCE listED .~~i.bWHAV~ ~~~Ni~gtEbT6'tHEiNSUREO' NAMEO'ABOVE'FORTHEPOLicy'PERIb!j'"
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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO
LTR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE EXPIRATION
DATE (MM.'DDIYY) DATE (MM/DDlYYI
LIMITS
GENERAL LIABILITY
X COMMERCIAL GENERAL L1ABIUTY :
CLAIMS MADE X OCCUR
A !060030967
OWNER'S & CONTRACTOR'S PROT :
B
AUTOMOBILE LIABILITY
X ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
X HIRED AUTOS
X NON-OWNED AUTOS
1336252968
GENERAl AGGREGATE $ 2,000,000
PRODUCTS - COMP/OP AGG $ .2...0.0.0.,.000
PERSONAL & ADV INJURY $ 1,000,000
10/01/1998 10/01/1999
EACH OCCURRENCE $ ....... ..~, ~..q .~. ~..~ .~q.~..
FIRE DAMAGE (Anyone fire) S 100,000
MED EXP (Anyone person) $ 5,000
COMBINED SINGLE LIMIT S
1
BODILY INJURY S
(Per person)
10/01/1998 10/01/1999
BODILY INJURY S
(Per accident)
PROPERTY DAMAGE S
$
B
THE PROPRIETORJ
PARTNERs/EXECUTIVE
OFFICERS ARE:
OTHER
INCL
EXCL
046990006606
01/01/1999
01/01/2000
EL DISEASE. POLlCY LIMIT
EL DISEASE. EA EMPLOYEE
GARAGE LIABILITY
ANY AUTO
EXCESS LIABILITY
UMBRELLA FORM
OTHER THAN UMBRELLA FORM
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
DESCRIPTION OF OPERAT10NSlLOCATIONSNEHICLESfSPECIAL ITEMS
HE CITY OF SANTA ANA, ITS OFFICERS, AGENTS & EMPLOYEES ARE NAMED AS
ODITIONAL INSURED PER FORM FM101,1,1459 ATTACHED.
10 DAYS NOTICE OF CANCELLATION FOR NON-PAYMENT OF PREMIUM
AIl0RD;.211i!l.{119'!..... ..
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SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL~~ MAIL
~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
~\(I)(Il(\Jl.J/_MHIll(_~M~~l!m!"~~X
~~~MX~~!{l': !\1l(~,*"WWM;xxxxxxX
AUTHORIZED REPRESENTATIVE ~
... .. . .~.r'i.~..;.......\.j;;;...~ ................I......III~;~___T!R!!l!~..
CITY OF SANTA ANA
ATTN: DORIS TURLEY
FAX #714/647-6956
PO BOX 1988 M-25
SANTA ANA, CA 92702
, r Crum&Forster .
'CJ' Insurance '-'
''wttI
,
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAAEFULL Y.
ADDITIONAL INSURED. OWNERS, LESSEES, CONTRACTORS,
MANAGERS OR LESSORS OF PREMISES, ARCHITECTS, ENGINEERS, OR SURVEYORS
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIASILIlY COVERAGE PART
SCHEDULE
Name 01 Person or Organization: ANY PERSON OR ORGANIZATION FOR WHOM YOU HAVE AGREED III
(include address and/or job location) WRITING UNDER CONTRACT OR AGREEMENT TO PROVIDE INSURANC
HOWEVER, THE INSURANCE PROVIDED SHALL NOT EXCEED THE SCOPE OF COVERAGE AND/OR LIMITS
OF THIS POLICY. NOTWITHSTANDING THE FOREGOING SENTENCE IN NO EVENT SHALL THE INSU~~CE
PROVIDED EXCEED THE SCOPE OF COVERAGE AND/OR LIMITS REQUIRED BY SAID CONTRACT OR
AGREEMENT.
SECTION II . WHO IS AN INSURED is amended to include as an add~ionai insured the person or
organization shown in the schedule above. The insurance provided to the add~lonai insured applies as
follows:
A. 1. That person or organization is oniy an additional insured with respect to lIabiiity caused by your
negligent acts or omissions at or from:
(a) premises you own. rent. lease, or occupy or
(b) your ongoing operations performed forthat additional insured at the job indicated by contract or
agreement.
2. The limits of insurance applicable to the additional insured are those specified in the written contract
or agreement or in the Declarations of this poHcy whichever are less. These Iim~s of insurance are
inclusive of and not in addition to the limits of insurance shown in the Declarations.
8. If the additional insured is an architect, engineer, or surveyor, the insurance provided to the additional
insured does not apply to "bodily injury', "property damage", "personal injury', or "advertlsing injury'
caused by the rendering of or failure to render any professional services including:
1, the preparing, approving, or faiiing to prepare or approve maps, drawings, opinions, r9ports. surveys,
change orders, designs or specifications: and
2. supervisory, inspection, or engineering services.
C. Section IV. COMMERCIAL GENERAL LJAS I LIlY CONDITIONS, under 4. Other Insurance,
is amended as foHows:
The foHowing is added to item a.:
Regardiess of whether other insurance is availabie to the additional insured on a primary basis, thi~
insurance will be primary and noncontributory if a written contract between you and the additional Insured
specifically requires thatthis insurance be primary,
FM 101.0.1459 (3/95)
Page 1 of 2
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D. With respect to the insurance afforded these additional insureds. the following additional exclusion
applies:
This insurance does not apply to:
1. "Bodily injury' or "property damage" occurring after:
(a) all work. including materials. parts or equipment furnished In connection with such work, on the
project (other than service. maintenance or repairs) to be performed by or on behalf of the addltfonal
insured(s) at the site of the covered operations has been completed: or
(b) that pOrtion of "your work" out of which the injury or damage arises has been put to its intended use
by any person or organization other than another contractor or subcontractor engaged In performing
operations tor a princlpal as part of the same project.
THIS ENDORSEMENT IS A PART OFYOUR POUCY AND TAKES EFFECT ON THE EFFECTIVE DATE OF
YOUR POUCY UNLESS ANOTHER EFFECTIVE DATE!S SHOWN BELOW,
CG-03
Endorsement Number
10-1-98
Effective Date of Endorsement
5060030967
Policy Number
CalFae, u.c
Named Insured
10-1-98
Counterslgnea Oate
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'AUthorlZ80 Representative .
FM 101.0.1459 (3195)
Page 2 of 2
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I. ASS I G N MEN T S II On-Site Fabricare Srv. I
ATTORNEY: Lisa Storck by Ben Kaufman
DATE: 07/20/99 COMPLETED:
FILE NO: CONTACT: Betty Dang
DESCRIPTION:
07/20/99 Approve/Reject certificate of insurance for CalPac, LLC
j./rd2-& Is;: 5 ee- I I C C'1 04 (/ be --C:eA1 C-r;
ACTIONS: \..1../ I ~
j! C<^ I ftJ,c
j(qV[ lJ f; t~ t--/
I
7/ll/;f
ACORD..
(714 as,.otoO
:al-SuNnce As!lOCbtlK. Inc.
PO _ 1041
))3 City 8lvd.. West. Ste. 4110
Ol'ltIge. CA 12163-7041
On-Site Fabr1ClU'8 Servlce, llC
7711 AIIlflDll A__, SlIite II
DolInay. CA 10242
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DATI_.",
07/ZS 000
ONLY NIIJ COfIFEM NO RIQKTlI U_ nlE CERTIF/C,t.TE
HOLDER. ,... CllmFICATE DOES NDT AIIEND, EXTEND ~
ALlIiR lIE COV!/WiI!! JIIII'tlIIDEII BY nlE POLICIES BELOW.
IIISllREllS AFFORDING coveRAGE
Gl'eat rft Iasllrancll Co. (CIIu
FlIlIe...l Insurance Co. (Chubb)
Ute CCIltMnset 01\ ~nsur..nc:e Fu
Elllll'l USTfJD I-I'lVE I3EI!ll THE I FOR \ INDICIi .
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PWCIES. AGllM;GATE um-s SHOWN MAY H.\W NEN REDUCED 6Y PAID 0lAI1IlS.
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TIlE ern' OF SANTA NUl, m OFFICERS, ACiOOS.. BlPlOYiES An twlED AS
\llIJDlIlHAL INSURED PElt FQIIII 10 02 2305 ATTN::Hal.
'10 DAYS NOlICE Of CAHCELLATmN FOR NON-PAYIIENT OF PRQIDJI
MOflIONALlXIUkIIDi IMlUAl!RlET1'lSR
CITY OF SANTA ANA
, i\ml ~.n 1tJ111'"1
FAX '114/147-6956
PO SOl( 1911 11-2S
SAmA I\NA. CA !2702
SMDUlI>MfY..TIlIi__ PCIUCIOlIllEoAACtu.I!II__
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Uij 9r:80 a3M OOOG-9G-l0r
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Uability Insurance
Endorsement
Policy Period:
Etrcct/Ve Dale:
Policy Number.
InslJl9d:
10-1-99tolO-l~
10-1-99
35755795
On-Site Fabricare Service, lLC
Name of Company. Great Northorn Insurance Company (Chubb)
Dat& lsaue(/.
This Endonlemlll'1t appll" \0 the followlng forml:
Genllral LIability
Under '^"'" 1111lSUI'ed The FoIIowfng PfO'Iieion 10 Added:
Who Is Insured
Ownenr, LNS." Or
Coot1Jl1;tOrS
Any pel1lOn or IlflllI'Ilzalioo deslgnaled below Ie "" InSlnd, bul only with respect \0 thalr Ilablnty
M owner, 18_ or conI1ac:tgr .nsin9 oUl 01 your ongolng opendillns perrorm8d lor IhEll inSlnd.
DesllJIated Owner, L....ee or Contractor
11lF. CllY OF SANTA ANA. ITS OFFICERS, AGENTS & Io:MPLOYEES
A" other terms and condltlone remaln unClWlged.
/wIhorI;:Qd RepresetlIaIiw;
~/_ J" ~
U3bJIily In8IIlfll1Gf1 AddiIJotr8/ lMurI1d . Qwn&I.s. I _n Or COIlI19c/Jm
Form 80-02.z3O!S(E~4-94) Endorsoment
lasl pago
p.gv t
GO/ZO 'd 'ON KlJ:I
!lit 91:110 craM OOOZ-9Z-W
A,- b(Hi -n. .
..~90RQ. .CERTIFICATE OF LtABILlTY INSURANCE DATE (MMIDDIYY)
04/20/2001
PROOllCER (714)939-0800 FAX (714)939-1654 . , THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Cal-Surance A~sociates, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
PO Box 7048 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
333 City Blvd., West, Ste. 400 INSURERS AFFORDING COVERAGE
Orange, CA 92863-7048
INSURED CalPac, LLC; OnS,te Fabricators, LLC INSURER A: Great Norhern Insurance Co. (Chubb)
DBA: Onsite Furniture Service INSURER B: Federal Insurance Co. (Chubb)
9200 Sorenson Avenue INSURER c: State Compensation Insurance Fund
Santa Fe Springs, CA 90670 INSURER 0:
I ~'n.,....l1 L< 1'7'~ . - ~ INSURER E:
COVERAGES fI U
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,
INSR TYPE OF INSURANCE POLICY NUMBER P~k.li~.~f.~6~ POLICY EXPIRATION LIMITS
LTR
~NERAL LIABILITY 35755795 10/01/2000 10/01/2001 EACH OCCURRENCE S 1,000,000
X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Anyone fire) $ 100,000
I CLAIMS MADE [!] OCCUR MED EXP (Anyone person) $ 10 . 000
A PERSONAL & ADV INJURY $ 1,000,000
- 2,000,000
- GENERAL AGGREGATE $
~.~ AGG~EnE ~L1MIT APr~~t IPER: PRODUCTS - ceMP/OP AGG $ 2,000,000
POLICY ~:gi LOC
~OMOBILE LIABILITY 73260159 10/01/2000 10/01/2001 COMBINED SINGLE LIMIT
~ ANY AUTO (ElIsccidenl) $ 1,000 000
- ALL OWNED AUTOS BODILY INJURY
$
SCHEOULED AUTOS (Per person)
B X
HIRED AUTOS BODILY INJURY
X (Peraccidenl) $
- NON-OWNED AUTOS
- PROPERTY DAMAGE $
(Per accident)
R^GE UABILITY AUTO ONLY. EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS UABIUTY EACH OCCURRENCE $
P.OCCUR D CLAIMS MADE AGGREGATE $
$
R DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND 46016606 01/01/2001 01/01/2002 X I To*-i'm.1N. I IOJIt
EMPLOYERS' LIABILITY EL EACH ACCiDENT $ 1,000,001
C l,Ooo.OO(
E.L. DISEASE. EA EMPLOYE $
EL DISEASE. POLICY LIMIT $ 1 000 001
OTHER
DESCRIPTION OF OPERATIONSlLOCATIONSNEHICLESlEXCLUSIONSADDED BY ENDORSEMENT/SPECIAL PROVISIONS
SANTA ANA POLICE DEPARTTolENT, CITY OF SANTA ANA, ITS OFFICERS, EMPLOYEES, AGENTS, VOLUNTEERS ..
REPRESENTATIVES ARE NAMED AS ADDITIONAL INSURED PER FORM 80022305 ATTACHED.
APPROVE') AS TO i~,--",l"'"
*10 DAYS NOTICE OF CANCELLATION FOR NON-PAYMENT OF PREMIUM ~ ~ ,
{ -
CERTIFICATE HOLDER I I ADDITIONAL INSURED; INSURER LEnER: CANCELLATION M C ael V jullOwJ
SHOULD ANY OF T~'" ~IESlQftGt.JQBI BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
SANTA ANA POLICE DEPARTTolENT 30* DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
A1TN: BETTY DANG, CLERK OF COUNCIL BUT FAILURE TO MAIL SUCH NOTICE SHALl-IMPOSE NO OBLIGATION OR LIABILITY
P.O. BOX 1988 M-30 OF AllY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
SANTA ANA, CA 92702 AUTHORIZED REPRESENTATIVE ~~" L:?
Crain Lewis '
ACORD 25-5 (7197) FAX: (714)647-6515 ~ /' CORPORATION 1988
,T
Liability Insurance
Endorsement
Policy Period: 10.1-00 to 10-1-01
Effective Date: 10.1-00
Policy Number: 35755795
Insured: OnSite Furniture Services
Name of Company: Great Northern Insurance Company (Chubb)
Date Issued:
This Endorsement applies to the following forms:
General Liability
Who Is Insured
Owners, Lessees Or
Contractors
t~.PPROV ED A~ J. v .
Michael Yigliotta
Deputy City Attorney
Liability Insurance
Form 80-02-2305(Ed.4-94)
Under Who Is Insured The Following Provision Is Added:
Any person or organization designated below is an insured, but only with respect to their liability
as owner, lessee or contractor arising out of your ongoing operations performed for that insured.
Designated Owner, Lessee or Contractor
SANTA ANA POLICE DEPARTMENT, CITY OF SANTA ANA, ITS
OFFICERS, EMPLOYEES, AGENTS, VOLUNTEERS & REPRESENTATIVES
All other terms and conditions remain unchanged.
Authorized Representative:
~
Additional Insured - Owners, Lessees Or Contractors
Endorsement
last page
Page 1
ACORD' CERT,FICA TE OF LIABILITY INSURANCE DATE {MMIDDIYY)
_', -..,-'... Tlol . ' 05/17/2001
PRODUCER (714)939-0800 FAX (714)939-1654 ONLY AND 'CONFE'~~ NO RIGHTS UPO~ ~~~ CERTIFICATE
Cal-Surance Associates, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
PO Box 7048 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
333 City Blvd., West, Ste. 400 INSURERS AFFORDING COVERAGE
Orange, CA 92863-7048
INSURED CalPac, LLC; OnSite Fabricators, LLC INSURER A: Great Norhern Insurance Co. (Chubb)
DBA: Onsite Furniture Service INSURER B: Federal Insurance Co. (Chubb)
9200 Sorenson Avenue INSURER c: State Compensation Insurance Fund
sa~:.:Re SP~ CA 90670 INSURER 0:
~ 'J''': ~--"D) INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOlWlTHSTANDING
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.
LTR TYPE OF INSURANCE POLICY NUMBER DATE IMMIDDrrl)E DATE (MMlDDrVY) LIMITS
GENERAL LIABILITY 35755795 10/01/2000 10/01/2001 EACH OCCURRENCE $ 1,000,001
>x COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Anyone fire) $ 100 , OO(
I CLA.IMS MADE [K] OCCUR MED EXP (Anyone person) $ 1O,00(
A PERSONAL & ADV INJURY $ l,OOO,OO(
-
GENERAL AGGREGATE $ 2,OOO,00(
-
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGO $ 2,000,000
I ,nPRO. n
POLICY JECT LOC
AUTOMOBILE LIABILITY 73260159 10/01/2000 10/01/2001 COMBINED SINGLE LIMIT
f-=- (Eaaccident) $
X ANY AUTO 1,000,000
I-"-
ALL OWNED AUTOS BODILY INJURY
f- $
SCHEDULED AUTOS (Per person)
B X
HIRED AUTOS BODILY INJURY
X $
NON-OWNED AUTOS (Per accident}
-'..:.
PROPERTY DAMAGE $
(Peraccidenl)
GARAGE LIABILITY AUTO ONLY. EA ACCIDENT S
~ ANY AUTO OTHER THAN EA ACC S
AUTO aNL Y: AGG S
EXCESS LIABILITY EACH OCCURRENCE S
~ -OCCUR 0 CLAIMS MADE AGGREGATE S
S
~ ~EDUCTIBLE S
RETENTION $ $
WORKERS COMPENSATION AND 046016606 01/01/2001 01/01/2002 X I TORY L1~''fS I TI,\"
EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $ 1,000,000
C EL DISEASE. EA EMPLOYEE $ 1,000,000
E.L. DISEASE. POLICY LIMIT $ 1,000,00C
OTHER
DESCRIPTION OF OPERATIONSJLOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDQRSEMENTfSPECIAL PROVISIONS
SANTA ANA POLICE DEPARTMENT, CITY OF SANTA ANA, ITS OFFICERS, EMPLOYEES, AGENTS, VOLUNTEERS &
REPRESENTATIVES ARE NAMED AS ADDITIONAL INSURED
*SUPERCEDES CERTIFICATE DATED 4-20-01**
CERTIFICATE HOLDER I I ADDITIONAL INSURED; INSURER LETTER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY W1LL~ MAIL
SANTA ANA POLICE DEPARTMENT ~ DAYS WRiTTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
ATTN: BETTY DANG, CLERK OF COUNCIL IllXIll*J{)(~K)(I'JI.9OO(9l~M!lXl){J1Jl)lllll(~J{JOO(
P.O. BOX 1988 M-30 Jl";:~ ~9Ill0llfJ(IOOOlllJro()()(XXXXX
SANTA ANA, CA 92702 AUTHORIZED REP
Crain Lewis
J -':::1-;) lll~fJ , """...... I ,....u...
-
FAX. (714)647 6515
. .
ADDITIONAL INSURED ENDORSEMENT
Insurance Company GREAT NORTHERN INSURANCE COMPANY.
This endorsement modifies such insurance as is afforded by the provisions of Policy
#35755795 relating to the following:
1. The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California
92701, Its officers, employees, agents and representatives are named as
additional insured ("additional insureds") with regard to liability and
defense and suits arising from the operations and uses performed by or on
behalf of the named insured.
2. With respect to claims arising out ofthe operations and uses performed by
or on behalf of the named insured, such insurance as is afforded by this
policy is primary and is not additional to or contributing with any other
insurance carried by or for the benefit ofthe additional insureds.
3. This insurance applies separately to each insured against whom claim is
made or suit is brought except with respect to the company's limits of
liability. The inclusion of any person or organization as an insured shall
not affect any right which such person or organization would have as a
claimant if not so included.
4. With respect to the additional insureds, this insurance shall not be
cancelled, or materially reduced in coverage or limits except after thirty
(30) days written notice has been give 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 10-01-00, this endorsement forms as a part of
Policy #A25755795
Issued to CALPAC DBA: ONSITE FABRICATORS. LLC: ONSITE FURNITURE
SERVICE
Named Insured
Countersigned by
~
'10.:.13/00 FRl 13: 05 FAX 9499556799
TANGIWI
~002
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~II. Tangram
Ttll,cram Intft.rlO-fS 2~::)u SOi.lth Red Hill AvenuQ. SUlt~ 100 . Sant4J Ann. C.f]foornJl1 9270'
'U,.Oof8' 955 6700 FAll."" ass ~:r9g wwW-t.llInt.rllmlr'ltt'fJOrS.com
October 13, 2000
Mary CalderwQO(j-Chiechi
City of Santa Ana
Police Department/ M-95
PO Box 1981
Santa Ana. CA 92702
Dear Mary:
This letter is in reference to the contract between On-Site Fabricare and the Santa
Ana Police Department_ Tangram Interiors purchased On-Site Fabricare in 1998. On-
site Fabricare stlfl uses the On-Slte name, but has since been relocated to Tangram's
Santa Fe Springs headquarters. We have combined our operations departments and
all invoicing is done throullh Trangram.
Any outstanding contractS between On-Site Fabricare and the Santa Ana Police
Department will continue to be honored.
If you have any questions please contact me at (949) 955-6740.
Sincerely,
,-~d
Andy Anzar
Tangram Interiors
A DM
'714)9 9-0&00
Cal-5urance Associates, Inc.
PO BoX 7041
11) City Blvd., West, Ste. 400
Oranlltl. 'CA 92163-7041
Pac. i On e a ~'ca~Grs, ~
DBA! Onsite furniture Servic~
9Z00 Sorenson Avtnue
Santa Fe Springs. CA 90670
DATE I~D1'I'Y)
12/05/Z001
OML Y AND CONFERS NO RIQHTS UPON TilE CERTIF1CATI
1I0LDIR. THill CERTIFICATE DOIli NOT AMIiND.I!XTENIl OR
AL TI!R THE COY.RAG! AFFORD!IlIlY '1'111 POLlcl!S BELOW.
IN$URI!RS AFFORDING COVERAGE
I~UI\ERA:
INSUMRII:
Itt:llft'RCi
IN$UIltM 0:
It4'JFl&R~
Great Norhern In_uranee CD. (Chubb)
Fed.....l Insuranc.. Co. (Chu )
Stat.. COmp..n$at'Dn Insurance Fund
8 l . OliN ISsullO !~:;!'.!! IN"_U,,"P ....M~~ ~ov'_.~~_TIit~GY PERIOD '''''Lc.o.TEO..NDTWITHS,ANDING
ANY REQUI~EMENT, TeIlM OR CONDITION OF ANY CONTRACT OR OTMI~ DOCUMENTWrTM flISPECrTO WHICH '!HIS CERTLFICATE MAY BE ISSUED OR
MAY PIRT,.,N, TMllNSuRANCE AFFOI\OEO OY THE POlICIES DESCIIIBEO H!REIN IS SUBJECT TO All THE TIifIMS. EXCLUSIONS AND CONDlnONS OF SUOH
POlICIES. AGG!\EGAT! liMITS SHOWN MAY HAVE BIIN REDUCIiD BY PAID CLAIMS.
~ TYfII or INSlJItNIG! pOL.ICV NUUSGR 'n'.."T'E' m- 10/0~Z~ I'ACH<X:CI.JIIR5NOi LIMIT"
~WL UAIOLI'" 1575:0795 ll17ll1/2001 I 1 000 OO~
X COMNUO",," QIiNe.~ '-IAWtv I'll@. C1AM.l.Gi. (Any 0"0 fire) . Incl udlld\
I CLAIMS MACE [!] OCCUR MED exP tMY Ol'i' pelRn) . 10.00
A 'PI;RSONAl &. ADV INJUlty I 1 000,00
- eENe.m IoGGtd!!GATE. . 2.000.00
- .M PROQucrs. COMPter AGO , Z OOo.oor
l,],EN\IIGG~E~U lTA!'PLII!!~R:
I POLICV ~r8r n lOC
AUTOMaLE UMIUTY 71260159 10/01/2001 10/01/200Z CQMDINI:D &1t4~L.& lIML"
'f"",AUlO (~.tdClent) I 1 OOO,OO~
.:.;:..
AU. OWNIiiO AU108 aoglLY IHJUFlV
- SCMIDULEO AUTOS (P~rper5Ont .
B X _.AUTOS
welL V INJ\.nW
"t NO!+<)WN"" J'\\JTOIi (Perllocld8nl) .
f-'-'-
- 1l'R09;RT"( OAMAQI;; .
(Ptr.iil~ent)
c;ww1I uulUTV AUTO OHL. Y -liA ActibENT .
=1- AUTO OTH~R THAN IiAACC S
ALJTO ONI. '1'; .<co .
I!)ljce& LlAIIUTT EACM oCCUI'lRiNCii I
::J OCCUR 0 ClAIMS""" AilC.EG,A.... I
.
R tlEDlJCTI8L! .
RITI!HTIQN . xrnm'M'rf' I"!II'" I
WOfU(!U CO.!NaATlDN ANO D4f01Ei60G 01/01/2001 01/0112002
EM",OVPS' UAllU'I'Y e.l. 'EACK M;CIOENT . 1.000,000
C E-L. Dl9EAG'. iA. !MPt.OY&1 5 1 000.000
e,t.,OIllASe..PQUCYL.INIT S 1.000.000
o"tti1R
:naNSN ~c ; ~~I?!!~ ~1 ,....
SANTA ANA POUCE DfPARTIIENT, cm OF sANTA ANA. ITS OFFICERS. WLOYEES. AGENTS. voLUNTEERS ..
REPRESENTATIVES AIlE NAMEfl AS ADOITIONAL IMSURW
*SUPERCEDES CERtIFICATE DATED 11-21-01..
CEaTI KQLIlPl T -1 ""omoNN-1NSU..O, ,NSOMIl linER
8MDULD Nftf 0.11'11 AtDYe DESCftlB!D I'O~CIa al: ~ELl.BJ "'ORE THE
mtPIftATtON DATIl 'floEtdOII, TIoI! ISIUlNG COMPANY WlU."",~~ r-tAIL
SANTA ANA POLICE DEPARTMENT ..:iD!- DAlSWRlTTIN NOTtC~ TOTHfOll\TIFIC;"l'II'tOI-DUl WAMIDTOTHII..II=T.
ATTN; MARY CALIIERWOOO-CHIECHI ~lJlllMKM,--~ !YllllOlllllllUllI"9I1llll!lll'~JllIl()lXX
P.O. BOX 19" M-30 APPROVED ~ XXXxxxx
SANTA ANA. c:A 92702 V ~ .~ //
~ / / A _ c:;;ii 'JtsIvti S .
'\""1 FAX: (714)647-(;515 Laura Sh~edY / '" j-' "..... ,..
Deputy Clly Attorney
EOIIO 'd
'ON Xli:!
~Ii 90:01 03M 100G-SO-Q30
,,;.,;.
IMPORTANT
If the certlficaie holder i. en ADDiTIONA~ INSURi:D, the polley(ies) must be endorsed. A .tatement
on tills certlfiC81e does not conler rights to the certificate holder in lieu of sUl;h endorsermml(.).
If SUBROGATION IS WAIVED, subject to the term. and condRion. of the polioy, cerlain po>lieles may
require an endortement. A e~l$menl on this certlllcale aoes not oonl9r rights to the cerllficaie
holder in lieu of such enaorsement(s).
DISCLAIMER
The Certificate of I n.uranee On the ..verse side of \111, fOtm does not constitute a contract between
the Issuing Insuret(s), authorized representative or produoer. and the certifioate holder, nor dQ'" II
effirmatlvely or neg.tively amend, o>dend or alter the coverage affOrded by the policies IIsled thereon.
.,. '"
.
EO/GO 'd
'ON X\;Jj
W\;J LO:Ol 03M IOOG-90-Q30
.... I
ADDITIONAL INSURED ENDORSEMENT
Insurance Company GREAT NORTHERN INSURANCE COMPANY.
This endollQ11cnt modifies such insurance II! is afforded by the provisions of Policy
#3!17~~79!! relating to the following:
1. The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California
9270 I. Its officers. employees, agents, volunteers and representatives are
named as additional insured ("additional insureds") with regard to liability
and defense and suits arising from the operations and uses performed by or
on behalf of tbe 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 "enetit ofthe additional insureds.
3. this insurance lIPplies separa.tely to each insured lI.gainst whom claim is
made or suit is brought except with respect to the company's limits of
liability. Tbe inclusion of any person or organization 115 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, tltis insurance shall not be
cancelled, or materially reduced in coverage or limits except after thirty
(30) days written notice has been give to the City of Santa Ana, 20 Civic
Center Plaza, Santa Ana, California 92701.
(Completion of the following, including countersignature. is required to m*e this
endorsement efThcti ve.)
Effective 10-01-01. this endorsement forms as a part of Policy #35755795
Issued to f-A.I.l'AC DB....' ONSITE FABRICATORS. LLC: ONSITF. FURNITURE
SERVICE
Named Insured
Countersigned by
ti,;j~# ~
APPROVED AS TO FORM
~f~
,{aura Shee y
Deputy City Attorney
EO/EO 'd
'ON XlJ~
WlJ LO:OI 03M IOOc-90-030
ACORD CERTIFICATE OF LIABILITY INSURANCE
_ . TIl ,
PROD'JeER (7i4)939-0800 FAX (714)939-1654
(al-Surance Associates, Inc.
. PO Box 7048
333 City Blvd., West, Ste. 400
Orange, CA 92863-7048
INSURED CalPac, LLC; OnSite Fabricators, LLC
DBA: Onsite Furniture Service
9200 Sorenson Avenue
Santa Fe Springs, CA 90670
DATE (MMlDDNY)
11/21/2001
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE
INSURER A:
Great Norhern Insurance Co. (Chubb)
Federal Insurance Co. (Chubb)
State Compensation Insurance Fund
INSURER B:
INSURER c:
INSURER 0:
INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOlWITHSTAND1NG
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.
11~.p: TYPE OF INSURANCE POLICY NUMBER DATE (MMfDDIYY) DATE (MM/DDIYY) LIMITS
GENERAL L1AalLlTY 35755795 10/01/2001 10/01/2002 EACH OCCURRENCE $ 1,000,000
f--
X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Anyone fire) $ Included
__J CLAIMS MADE [Xl OCCUR , MED EXP (Ai11' Ofie J}erson) , 10 , UOO
.--
A PERSONAL & ADV INJURY S 1,000,000
- 2,000,000
- GENERAL AGGREGATE $
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $ 2,000,000
II 'n~RO- n,
POLICY JECT LOC
~TOMOBILE LIABILITY 73260159 10/01/2001 10/01/2002 COMBINED SINGLE LIMIT
X ANY AUTO (Eaaccident) $ 1,000,00C
-"-
- ALL OWNED AUTOS BODILY INJURY
{Per person) 5
SCHEDULED AUTOS
B -
~ HIRED AUTOS BODILY INJURY
(Peraccidenl) $
~ NON-OWNED AUTOS
- PROPERTY DAMAGE $
(Peracciden1)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT 5
~ ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS LIABILITY EACH OCCURRENCE .
b OCCUR 0 CLAIMS MADE AGGREGATE $
$
R DEDUCTIBLE $
RETENTION . $
WORKERS COMPENSATION AND 046016606 01/01/2001 01/01/2002 X I TORyl'MITS I ~- --
EMPLOYERS' LIABILITY . E.L EACi j AC'::;iDi::NT ., 1,000,000
r
'- E.L. DISEASE - EA EMPLOYE $ 1,000,00C
E.L. DISEASE. POLICY LIMIT $ 1,000,OOC
OTHER
DESCRIPTION OF OPERATIONS/LOCA TIONSlVEHICLESlEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
SANTA ANA POLICE DEPARTMENT, CITY OF SANTA ANA, ITS OFFICERS, EMPLOYEES, AGENTS, VOLUNTEERS &
REPRESENTATIVES ARE NAMED AS ADDITIONAL INSURED
*SUPERCEDES CERTIFICATE DATED 11-5-01**
CERTIFICATE HOLDER I I ADDITIONAL INSURED; INSURER LETTER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL~^~ MAIL
SANTA ANA POLICE DEPARTMENT ~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
ATTN, MARY CALDERWOOD-CHIECHI ~K)(~I()(~PIlIIOO@l)(JI)QJlllI~x.JlXX
P.O. BOX 1988 M-30 JI~JlIOilllXX!'I!ll~~JOOm:~XXXXXX
SANTA ANA, CA 92702 AUTHORIZED REPRESENTATIVE ,# \ ~
Cra i a Lewi s .1' _;I1/IV<f
i (flOf) FAX: 714 647-6515 f , ,...
( )
1
IMPORTANT
If the certfficate 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.
"
r
. .
i
ADDITIONAL INSURED ENDORSEMENT
Insurance Company GREAT NORTHERN INSURANCE COMPANY.
This endorsement modifies such insurance as is afforded by the provisions of Policy
#35755795 relating to the following:
1. The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California
9270 I, Its officers, employees, agents, volunteers and representatives are
named as additional insured ("additional insureds") with regard to liability
and defense and suits arising from the operations and uses performed by or
on behalf of the named insured.
2. With respect to claims arising out ofthe operations and uses performed by
or on behalf of the named insured, such insurance as is afforded by this
policy is primary and is not additional to or contributing with any other
insurance carried by or for the benefit of the additional insureds.
3. This insurance applies separately to each insured against whom claim is
made or suit is brought except with respect to the company's limits of
liability. The inclusion of any person or organization as an insured shall
not affect any right which such person or organization would have as a
claimant if not so included.
4. With respect to the additional insureds, this insurance shall not be
cancelled, or materially reduced in coverage or limits except after thirty
(30) days written notice has been give 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 10-01-01, this endorsement forms as a part of
Policy #35755795
Issued to CALPAC DBA: ONSITE FABRICATORS. LLC: ONSITE FURNITURE
SERVICE
Named Insured
Countersigned by
~'...--~-.
,
'AC(j)~Lt CERTI
, '(714)!B!l-0800
Cal-Su~nce Associates,
PO BOx }Q4B
333 Ci~y BlVd., West. Ste. 400
Orange, CA 92863-7048
,. 01 Pac, LLC; On te Fa rica ors, llC
DBA: ~site Furniture 5arvice
9200 Sorenson Avenue
Santa Fe springs, CA 90670
NeE
DA."tMP04IDDI'I'Y)
11/05/Z001
ONLY ANlIlOONFEftS NO RIGHTS UPON THE CERTIFICATI!
HOLDER. THIS C~RllFICAT! DOES NOT AMI!Nb. EXTEND OR
AlTER THE COVERAGE AFFORDED IIY THE POLICI!!! IlI;LOW.
INSURERS AFFORDING COVERAGE
Itl\$UP.EJoIIA:
1N&J~&1il: I:
INSUIU:A c:
INSURER D:
INSU~E:
Great Norhern Insurance CO. (Chubb
Feral Insurance Co, ubb)
State C ensation Insurance Fund
lOOVellAD S
T I INSURA LI C eEL v N ISSUED TO THIINSUR AM ABOVE i PO Ie 'II I 01 ED. WITHSTA INe
~Y REQUIREMENT. TIRM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMlNT WITH RE$~IOT to WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY P!Il'!'AlN. THI; INSUIWlOI Ai'l'ORDED BY THE POLICIES DESCftlBED HEREIN IS SUIJECTTO ALL THITERMS. EXC\.USIONS AND OONOITIONS OF SUOH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN ftEOUOEO BY P~ OLAlM$.
L
1YPI OF INtURANCI
CINIItAL UABIUTY
X COMMERCIAL GENERAL LIABILITY
CLAINS MAC. 00 OceUR
POUCy NUMD~
35755795
TIi C ....DOIYr
10/01/io02
l.1MITS
~~ oeCU""!!NCI:: $
FiRe [)AM/LGE (Any onl nr@o) S
t.lI1D~P[Anyon.""PIM} .
P"R,iQNAL." AUV IN.lIJRY S
G~EftALAGQR.GATE $
jorlllODI.,ICTV - COMP'iOP A!itji 16
1 000,000
Include
10 00
1 000 00
2,000 00
2 000 00
A
73260159 COM!INIiD SINGLE: LIMIT
(Ea.eell!I....ll 1 000 00
ALL OWNEC AUTOS BOOI1. Y INJU~Y .
iOolEOUlEO AUTOS (PIrCltrtCli'lJ
B X HIRM AUTO'
80011. Y lNJUI{Y
X NON.oWN&l AUTOS (Pr;arQCCIlt8f\'l
....OPERTY DAMAGe .
lPer ;;n;~ldllm)
lUJlAC! UABIL.I1V AUTO ONLY. U ACCIDENT .
ANY AUTO OTH'R. THAN EAAC~ I
AUTO ONLY: AGG $
IXOIH UMIUTY eACH oceUMII:NI;Ji .
OCCUR o CLAIMS MACE AGGREGATe .
.
DfiDUCTIBU;: .
R;T;NTlO~ . .
46016606 01 OllZOOl 01/01/2002 X TO .
WOKKU5 COWENIAnoN AND LII ER
EMItLOY.rur Ll,...UTY li.l. gel-! ,f.,CCIOENT . 1.000 0
C 1i.1., DlSwE . If>.. QtPt.OYr. . 1 ODD 00
E..L. OISHAS.. POUCY LIMIT . 1 000 00
I ON Q tDL I NaN DEI DVI I
SANTA ANA POLICE DEPARTMENT, cm OF SANTA ANA, ITS OFFICERS, EMPLOYEES, AGENTS, VOLUNTEERS &
REPRESENTATIVES ARE NANEO AS ADDITIONAL INSURED
-SUPERCEDES CERTIFICATE DATED 9-26-01*.
AODmOtlAL I~SUREtJIIN9URUI LI.'!"I'I"
C
SHOULD ANT 01"0" TNI MOVI DBSCRlUC POUCIEB EM:. CANCiL.l'D I.I'O~! 'ni!
~RAnDH DATI 'fHEiliro... THIIIS'UIN9 ClOM..AHY wu.L MWUlJIIUVJO MAIL
..lO!....OAY8 WRITT1lN NOTIC.TO THE QIUIRCATC HOI.DER NAMliD"JO "". L!IlT.
-
. _.~~nx
xxxxxx
SArnA ANA POLICE DEPARTMENT
Am I MARY CALDERWOOD-CHIECHI
P.O, BOX 1988 M-30
SANTA ANA, CA 92702
FAX: (714)647-6515
Crai
_~v,. -.
tono 'd
'ON Xl;l.:l
Wd OO:EO NOW IOOG-SO-~ON
.
.
IMPORTANT
II the certificate holder 10 en ADDITIONAL INSURE;O, the pollcy(Ie$) m~sl be endorsed. A statement
on this certificale does not confer rights to the c<!trtlflcata holder in Ii.u 01 such endorsement(!).
II SUBROGATION IS WAIVED. !~bject to the torms end condj~on. olthe policy. certain policjes may
require en endorsement. A statement on IhI9 certlflcate does nllt conler rights to th. certificate
hoider in lieu 01 suoh .ndorsemenl(s).
DISCLAIMER
The Certificale of Insurance on the reverse side of this form dces nol conslit~t. 8 contract between
the Issuing insurer(s), authorized representative or prod~cer, and the cartilicate holder, nor does It
ilffirmativaly or negetively amend, extend Dr alter the coveNge afforded by tile pillicies listed thereon.
EO/GO 'd
'ON Xli:!
Wd OO:EO NOW IOOG-50-^ON
.
ADDITIONAL INSURED ENDORSEMENT
Insurance Company GRF.AT NORTHF.RN INSURANCE COMPANY.
This endorsement modifies such insurdIlee as is afforded by the provisions of Policy
#3575~79!l relating to the folIowing;
1. The City of Santa Ana, 20 Civic Ce!1.ter Plaza, Santa Ana, Califomia
92701, Its officers, employees, agents and representatives are named as
additional insured ("additional insureds") with regard to liability and
defense and 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
)loliey is primary and is not additional to or contributing with any othi:!'
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 wi.th respect to the company's limits of
liability. The inclusion of any person or organization as an insured shall
not affect any right which such person or organization wouJI;l. have as a
claimant if not 50 included.
4. With respect to the additional inSYreds, this insurance shall not be
cancelled, or materially reduced in coverage Of limits excejlt after thirty
(30) da~ written notice has been give to the City of Santa Ana, 20 Ci'lic
Center Plaza, Santa Ana, California 92701.
(Completion of the folIowing, including cO\lIltersignature, is required to make this
endorsement effective.)
Effective 10-01-01, this endorsement forms as a part of
Policy #3S7~~79~
Issued to CAI,PAC DBA: ONSlI1'F. FABRIC.ATORS. LLC: ONSTTF. FI1RNTTIJRE
SERVICE
Named Insured
Countersigned by
EO/EO 'd
'ON X\I.:l
Wd OO:EO NOW \OO~-SO-^ON
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:
1. 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 ofthe 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.)
, this endorsement form as a part of
Effective
Policy #
Issued to
Named Insured
Countersigned by
Authorized Representative
~C~RD CRT' 'CAT OF LIABILITY lNSURANd# W'Jl.v~I~O~')
_____N 05/17/2001
p",," (714)939-0800 FAX (714)939.1654 -- I"IITS"CEI\TTFICATEl'OISSUtOlrJliS',l("liI)\"Tre,;;-uF NFOIl1\IIATIO,.----
ea' -Suranee A~5ociates, ~nc, ONLY AND CONFERS NO RIGHTS UPON HiE CERTIFICATE
~ HOLDER, THIS CERTlnCATE DOES NOT AMEND, EXTEND OR
PO lIox 7048 ALTER TflE COVERAGE AfFORDED I>YfHE POLICIES IlELOW.
H3 City Blvd" West, Ste. 400 ----;;;~R~R$A~~ORtlIN~COVE;-~~-..-'-.-
Orange, CA ~2IG}-7041
l~u~lPac, L~OnSite -Fabricatorg';--o:C--'
DBA! nsit Furniture Service
9200 orenson Avenue
Santa Fe Springs, CA 90610
~t
IN';ul~--Greilt 'filii-her;;' rnsu;a~roCo:'-(Chubb)'--
iNOuiitii'"~ae;:ar-il'-sur"iice Co.-' ((hublif'----..,-.--
1;j~URE" c "..St8 tee-.n..,,,";,,t llln'-jiisurancoi'ilnij-- ,-
,-,"._'~ ~.".--~>.-._--_..,,-_..,.._._....""'_.
IN~UR"H. D~
INSLr{FR-~-.'-----""'_.'''''''._-''_.'''-----' ------..
VE ES
TH POLICI.S OF INSURANC L15T.0 ow HA SEEN IS5UEb '1'0 THE INSURED NAMED ABOVE FeR Tl m ,,1i[,CY PcHIOD '''JlcATED Noii'ii'r,1S .ANDiNO
AN< R"OUIREM!:NT. TERM OR CONDITIoN OF ANV OONTRACT on OTHER UOCUMCNr WITIl RE~PECT TO WHICH TH.>; CERTIFICATE MAY [t:i IE,SUEI) W
MAY PERTIIIN, Tl1E INSVRANCE AFFORC[D BV T"~ PQLICI(S DE3CRi~ED H.R.IN IS S'JBJ~CTTO At L THE T.oMS. EXCLUSIONS AN\) CONDITIONS 0, sUCH
POLICIES, AGGREGATE L1MI1'S SHOWN M^V HAV" ~E.N REOUC'" UV PAID CUlIMS,
F( - -~.......-----"" :rcy &.1-~VE" ~Ocn;V"EXt'fflA'rnJN.
I. R TlPEOI=IN!iUftANCE I"Q\,I~YNlIMis&;R bATE:(MPNOONYl O^lE,IMM1DD.l!.'H
OENEM"'AOI"'Y 5755795 -- 10/01/2000 10/01/2001
X COMM6~IALGENER"L LA6r..ITY
-... cL.f'.IM$o MAOi! 00 oCCUR.
---,--~.---
~_.....---_.,'...-_. "'_._~---
UIl.4ITS
el>eIIOOOURRr,NCIO ....--1-0'0000
,. .__._.. ..___._, M._..... ..'..--"'_..~~'
1'1 t}; rJ#l.M/l,CE (An' oVlh n(~l $ 100 000
~,.._____"'~_' _..... .._____.riJ-
.M..r.o ty~~~,~I,l~!" '__..__. _~~,_Q9_
N: r-:sON....L 3. f.J.'N INJlltlY li 1 000.00
__. n"__ .." __. ., .__--1... .--'--
Gr:~LI~~.l._~~~!.'::.__ ~~._.~OQ_O~.~Q
::~LJUC~~: ~~~.~.~__ _:s_"_....".~~<!~j,Q..Q,O
A
GEN'l AQORF{':>f\n: lIMIT t\PPI.It;.$ Pli:R
1 ......, "w" ll,ne
f'OLI~~ .
AUTOMD"L~ L1AOIllTY 73260159
.!. "'W AUTO
ALL OWNtD AUTO:;
S.CHliDUlCO ",UTOS
...--.-,......--.--
, 10/01/2000
10/01/2001
COMI~~Nm SIN(,)LE l"IMI1'
(to!K.\:ldl.ml)
,,~-",-" .--..-',
.
__~ .~.!!.~--,-~O_
s
nOOI'L't'INJVt,y
(;J\". flLll~anj
,n~'----'''''--
II
l( ti',REO ""UTOS
,~
~loon. Y lNJUr-t'r'
(l1i.irxdtll!H',1
-.,,-' .---".....---"- _.....----...~ .--
NON-OWNED AUTOS
PH<;:rt;."i.'~ ~^Mo\ct.
(f'll;!r :Jc~idont)
.
--~.._-
...----~-
AU-lc""QNlY:'tA'AccaDLN'- '.--'.--"
__._..'___' ,...-__d__-
FI\ACC S
orll~l~ I PAN
AUTO ONL":
,---.---.".---....-
GMAGe. ""ABlllTY'
A'IlV AUTO
^(,~O ~
-~----'_."'
Oc.cUC.TlDlt
RETENTION S
WQRI<<i.AS toMPItNSATION AND
EMPLOYERS'UA61U1V
46016606
-~._-_.".---_. ,. $-....'."------...........
.---=',---'"._. ._.~......"--
.
01/01/2001 -'ill/Ol/20028::G.'O~y'tiUN~~C!Dr1II ====-=
f"t. EACH,\CC10C:.NI', $ L 000,00
. 1;.\" t'1:li:J'.~~;',~~:i.r~v! . i--' " '-1 ,000 j'OQ
'~.I. Oll,Cl\Sl:.'. ~~)L.lcYUMi'r '.;--"'i 00t) ,"O(f'
-------~_. ,....--!'..,"--~
~CH oc~unIiLNC;;-'" :)
---_.~"-_."..
I\OontOAl 6 ~
-'"._"..,__ ,,________w_..
.
. ,._-",.,--
1:!XC~ UAl!llll1'Y
cJCCUJ\ 0 CLAIMS fAAOO
(
11r;;1t
,,~ oO.,IDN OF D"...n"NSlLDe ID'!;IV' ~LU~IQN' AEu.. A. 'NUD~st;i.L1/S.EClAL ~"DVI~iDN~ ~--,,---,--"'-----'----"
,.,,, .. ""'" .....,,,,,"'. an " "." "', U>-PiWi.'l"'I<I'''''-'''' .",",,'" ,
IIEPRESENTATIVES ARE NAMED AS ADDITIONAL INSUREll'PPK l~
'.SUPERCEDES CERTIFICATE DATED 4-20-01'''' .Ji1~ J).. ~....
Michael VigliDtla ,
ADDtrlONAL IN.SURCDj IN$UfU:R 1.e.1 TF:R ,D;pu ty ($JIJI'(ClRL~T~.....-
8HOULO ^NY OF 'nIl: ^\3OV~ Cl!stRlP,[;.D ro'UClbS Ill!: CAttCilLtCl f.\t:;tORt THIe.
r;;~IRAtION DAU "tHiRtDf, lHE I:sSUINO '::OMPI\N'l WiLl~ MAr\.
j.O~_ DA"'$W~ITT~N ~OTlc.E 'ro 1t-tG. CI!Rllj.:ICA fe HOlOtH I'IA\1t" 1"0 me t,rr-'f!
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SANTA ANA POLICE OEPARTMENT
ATTN, BETTY DANG, ClER~ OF COUNCIl.
P.O. BOX 1988 M-iO
SANTA ANA, CA 92702
@AI.>--o
F~;" (714)641-6515
GalLO 'd
'ON Xli.:!
Wd 80:10 nHl 100G-LI-AliW
,
.
ADDITIONAL INSURED ENDORSEMENT
Insurance Company _G~lJ.I!I1~LUiJ.N5lLlt~n'~ CO.Ml~N"":"
This endorsement molliJies such insurance as i~ alIol"dcd by Iho provisions of Policy
#357557lJ:'; relaling 10 the following;
I, The City of S:m\a Anu) 20 Civtc Cenlcr Plaz.a, Sml\a Ana) Calif~)I'nia
92701, Its oCliecrs, employees, agenls and representatives arc mUlled ,1~
ai;lditioml! insmell ("additional insureds") with regal'(l to liabilily and
derense and s~lilS arising from the opcl'atiQ1\s and llSCS pelJorll1ed by or on
hehalfofthe !lamed insul'Cu.
2. Wilh respect to claims urishJg O\lt o[(he operalions and uses perfurmed by
or all behalf ofthe named insured, snch insurance as is (l[lorded by lhis
policy is primary and is not u~klitiol1all0 01' contribuling wi lh .'lllY other
insurance e,lrl'ied by or [i)1' Ihe hcncfil of the additional inslll'e(ls.
3. This insurance a\l1iliCs s~Jim':l\ely to each insured against whonl claim is
made or suit is brought except with rcspecllo tbe company's limits of
liability. The inclusion of any persall or organir,ulion us nn insLI\'ed shalt
1\ot affect <1ny righl which such persoll or organizalion would have as a
elainlant ifnot so included.
4. With respect 10 Ulll addilional insureds, this insurance shull not bll
cancelled, or lllatcrially reduced in cowrage or IimiLs except aller thirty
(30) days wdllenl1lJtiee has been ~ive La the City of Sanla Ann, 20 Civic
Center Plaza, Sunla Ana, Califomiu 92701.
(C01J,plelion of the Jollowillg, including COlltiLcrsignalllrc, is required to make lhis
endorscrmml effective.)
Effeclive 10-01-00, this endorsemenl forms as a part of
Policy J;'A2575S195
Issued to CALfA{.~AiJl~SJTl';J0\ B'ij.1CA rHR&JJ ,r.; ONS 1TIUi!)J~.I'iIT!] 1~.t:
SERVICE
Named Inamed
AI' ~.)
~-'."'
Cuuntersign~d by ~"\ -~- ----
APPROVED A--s-Tu c~
m 1- ~~
Mi.;hae\ Vigliolt
Deputy City ^ ttornev
GO/GO 'd
'ON X\7:l
Wd 80:10 nHl 100G-Ll-A\7W