HomeMy WebLinkAboutTUSTIN IRVINE MEDICAL GROUP 1 -2003
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WORK Mfl. N PROCEED
. CLE.RK COUNCIL N-2003-013
o . '2- 1-03 CONSULTANT AGREEMENT (5 ;,
THIS AGREEMENT, made and entered into this 21 ~ day of ~ l, 2002 by
and between Tustin Irvine Medical Group, a California corporation (hereinafter "Co ultant"),
and the City of Santa Ana, a charter city and municipal corporation organized and existing under
the Constitution and laws of the State of California (hereinafter "City").
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RECITALS
The City desires to retain a consultant having special skill and knowledge in the field of
audiology, to perform annual hearing tests for City employees who are occupationally
exposed to loud noises.
B. Consultant represents that Consultant is able and willing to provide such services to the
City.
C. In undertaking the performance of this Agreement, Consultant represents that it is
knowledgeable in its field and that any services performed by Consultant under this
Agreement will be performed in compliance with such standards as may reasonably be
expected from a professional consulting firm in the field.
NOW THEREFORE, in consideration ofthe 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 $5,000.00 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 November I, 2002 and terminate on October 31,
2003, 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 Personnel
Services and the City Attorney.
4. INDEPENDENT CONTRACTOR
Consultant shall, during the entire term of this Agreement, be construed to be an
independent contractor and not an employee of the City. This Agreement is not intended nor
shall it be construed to create an employer-employee relationship, a joint venture relationship, or
to allow the City to exercise discretion or control over the professional manner in which
Consultant performs the services which are the subject matter of this Agreement; however, the
services to be provided by Consultant shall be provided in a manner consistent with all
applicable standards and regulations governing such services. Consultant shall pay all salaries and
wages, employer's social security taxes, unemployment insurance and similar taxes relating to
employees and shall be responsible for all applicable withholding taxes.
5. INSURANCE
Prior to undertaking performance of work under this Agreement, Consultant shall
maintain and shall require its subcontractors, if any, to obtain and maintain insurance as
described below:
a. Commercial General Liability Insurance. Consultant shall maintain commercial
general liability insurance naming the City, its officers, employees, agents, volunteers and
representatives as additional insured(s) and shall include, but not be limited to protection against
claims arising from bodily and personal injury, including death resulting therefrom and damage
to property, resulting from any act or occurrence arising out of Consultant's operations in the
performance of this Agreement, including, without limitation, acts involving vehicles. The
amounts of insurance shall be not less than the following: single limit coverage applying to
bodily and personal injury, including death resulting therefrom, and property damage, in the total
amount of $1 ,000,000 per occurrence. Consultant shall supply City with a fully executed
additional insured endorsement in substantially the form attached hereto as Exhibit B upon
execution of this Agreement and shall be approved in form by the City Attorney.
b. Reserved.
c. Worker's Compensation Insurance. In accordance with the provisions of Section 3300
of the Labor Code, Consultant, if Consultant has any employees, is required to be insured against
liability for worker's compensation or to undertake self-insurance. Prior to commencing the
performance of the work under this Agreement, Consultant agrees to obtain and maintain any
employer's liability insurance with limits not less than $1,000,000 per accident.
d. Professional liability (errors and omissions) insurance, with a combined single limit of
not less than $1,000,000 per claim.
2
e. The following requirements apply to the insurance to be provided by Consultant
pursuant to this section:
(i) Consultant shall maintain all insurance required above in full force and
effect for the entire period covered by this Agreement.
(ii) Certificates of insurance shall be furnished to the City upon execution of
this Agreement and shall be approved in form by the City Attorney.
(iii) Certificates and policies shall state that the policies shall not be canceled
or reduced in coverage or changed in any other material aspect without
thirty (30) days prior written notice to the City.
f. 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: (1) for personal
injury, damages, just compensation, restitution, judicial or equitable relief arising out of claims
for personal injury, including health, and claims for property damage, which may arise from the
direct or indirect operations of the Consultant or its contractors, subcontractors, agents,
employees, or other persons acting on their behalf which relates to the services described in
section I of this Agreement; 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
of this Agreement, or asserting that personal injury, damages, just compensation, restitution,
judicial or equitable relief due to personal or property rights arises by reason of the terms of, or
effects arising from this Agreement. City may make all reasonable decisions with respect to its
representation in any legal proceeding.
7. CONFIDENTIALITY
If Consultant receives from the City information which due to the nature of such
information is reasonably understood to be confidential and/or proprietary, Consultant agrees
that it shall not use or disclose such information except in the performance of this Agreement,
and further agrees to exercise the same degree of care it uses to protect its own information of
3
like importance, but in no event less than reasonable care. "Confidential Information" shall
include all nonpublic information. Confidential information includes not only written
information, but also information transferred orally, visually, electronically, or by other means.
Confidential information disclosed to either party by any subsidiary and/or agent of the other
party is covered by this Agreement. The foregoing obligations of non-use and nondisclosure
shall not apply to any information that (a) has been disclosed in publicly available sources; (b) is,
through no fault of the Consultant disclosed in a publicly available source; (c) is in rightful
possession of the Consultant without an obligation of confidentiality; (d) is required to be
disclosed by operation oflaw; or (e) is independently developed by the Consultant without
reference to information disclosed by the City.
8. CONFLICT OF INTEREST CLAUSE
Consultant covenants that it presently has no interests and shall not have interests, direct
or indirect, which would conflict in any manner with performance of services specified under
this Agreement.
9. NOTICE
Any notice, tender, demand, delivery, or other communication pursuant to this
Agreement shall be in writing and shall be deemed to be properly given if delivered in person or
mailed by first class or certified mail, postage prepaid, or sent by telefacsimile or other
telegraphic communication in the manner provided in this Section, to the following persons:
To City:
Clerk of the City Council
City of Santa Ana
20 Civic Center Plaza (M-30)
P.O. Box 1988
Santa Ana, CA 92702-1988
telefacsimile (714) 647-6956
With courtesy copies to:
Executive Director of Personnel Services
City of Santa Ana
20 Civic Center Plaza (M-28)
P.O. Box 1988
Santa Ana, California 92702
telefacsimile (714) 647-6994
Attn: Emilyn Buenafe
and,
4
City Attorney
City of Santa Ana
20 Civic Center Plaza (M-29)
P.O. Box 1988
Santa Ana, California 92702
telefacsimile (714) 647-6515
To Consultant:
Tustin Irvine Medical Group
800 N. Tustin Avenue, Suite A
Santa Ana, California 92705
Telefacsimile (714) 285-0400
Attn: Dr. John G. Alevizos
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
the City's prior written consent shall be considered null and void. Nothing in this Agreement
5
shall be construed to limit the City's ability to have any of the services which are the subject to
this Agreement performed by City personnel or by other consultants retained by City.
12. TERMINATION
This Agreement may be terminated by the City upon thirty (30) days written notice of
termination. In such event, Consultant shall be entitled to receive and the City shall pay Consultant
compensation for all services performed by Consultant prior to receipt of such notice of termination,
subject to the following conditions:
a. As a condition of such payment, the Executive Director may require Consultant to deliver
to the City all work product completed as of such date, and in such case such work product shall be
the property of the City unless prohibited by law, and Consultant consents to the City's use thereof
for such purposes as the City deems appropriate.
b. Payment need not be made for work which fails to meet the standard of performance
specified in the Recitals of this Agreement.
13. DISCRIMINATION
Consultant shall not discriminate because of race, color, creed, religion, sex, marital
status, sexual orientation, age, national origin, ancestry, or disability, as defined and prohibited
by applicable law, in the recruitment, selection, training, utilization, promotion, termination or
other employment related activities. Consultant affirms that it is an equal opportunity employer
and shall comply with all applicable federal, state and local laws and regulations.
14. JURISDICTION - VENUE
This Agreement and all questions relating to its validity, interpretation, performance, and
enforcement shall be governed and construed in accordance with the laws of the State of
California. This Agreement has been executed and delivered in the State of California and the
validity, interpretation, performance, and enforcement of any of the clauses of this Agreement
shall be determined and governed by the laws of the State of California. Both parties further
agree that Orange County, California, shall be the venue for any action or proceeding that may
be brought or arise out of, in connection with or by reason of this Agreement.
15. PROFESSIONAL LICENSES
Consultant shall, throughout the term of this Agreement, maintain all necessary licenses,
permits, approvals, waivers, and exemptions necessary for the provision of the services
hereunder and required by the laws and regulations of the United States, the State of California,
the City of Santa Ana and all other governmental agencies. Consultant shall notify the City
immediately and in writing of her inability to obtain or maintain such permits, licenses,
approvals, waivers, and exemptions. Said inability shall be cause for termination of this
Agreement.
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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.
IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year
first above written.
ATTEST:
CITY OF SANTA ANA
CE:?'~
City Manager
~~~~o
,1 (J'\ ATRICIA E. HEALY
1) Clerk of the Council
APPROVED AS TO FORM:
JOSEPH W. FLETCHER
City Attorney
BY~,)/1J,~j, t?007
La ra Sheedy
Assistant City Attorney
RECOMMENDED FOR APPROVAL:
CONSULTANT
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3:3 -(fJr;, 93/JJ?
Employer ID # or Individual SS #
7
FrOm:TIMG SANTA ANA
714 2850400
07/03/200209:37 #120 P.00I/003
.
Tustin
Irvine
Medical
Group
Employee Heallh Cente..
"'We rakt care of
emplo~e healrh while
yOu rake care of business. N
JULY 2 2002
MISS EMILYN BUENAFE
CITY OF SANTA ANA
RISK MANAGEMENT DIVISION
POBOX 1988 M-28
SANTA ANA, CA 92702
DEAR MISS BUENAFE,
THIS IS TO CONFIRM THAT TUSTIN IRVINE MEDICAL
GROUP IS CAPABLE OF PERFORMING AUDIO TESTING FOR
THE C~ OF SANTA ANA.
THE FEE FOR EACH TEST IS S9.00.
PAYMENT FOR THE ABOVE MENTIONED SERVICE CAN BE
ADDRESSED TO OUR CORPORATE ADDRESS IN SANTA ANA.
THIS AGREEMENT SHALL BE VALID FOR ONE YEAR.
SEE THE ATTACHED PROTOCOL CREATED FOR AUDIO TEST
AND PROOF OF INSURANCE COVERAGE.
SINCERELY,
Corporale Office
Santa Ana Facility
800 N Tushn Avenue
Suite ^
Santa Ma, CA 92705
[714) 245-0800
1714) 285-0400 Fax
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ROZE BARRIO
DIRECTOR OF MARKETING,SANTA ANA
24-Hour Care
Irvine Facility
15374 Alton Parkway
Irvine, CA 92618
(949) 788.0960
(949) 753.0423 Fax
EXHrRIT A
. .
EXHIBIT B
ADDITIONAL INSURED ENDORSEMENT
FOR COMMERCIAL GENERAL LIABILITY POLICY
Insurance Company
This endorsement modifies such insurance as is afforded by the provisions of Policy
# relating to the following:
I. The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 9270 I; its
officers, employees, agents, volunteers and representatives are named as additional insureds
("additional insureds") with regard to liability and defense of suits arising from the operations
and uses performed by or on behalf of the named insured.
2. With respect to claims arising out of the operations and uses performed by or on
behalf of the named insured, such insurance as is afforded by this policy is primary and is not
additional to or contributing with any other insurance carried by or for the benefit of the
additional insureds.
3. This insurance applies separately to each insured against whom claim is made or
suit is brought except with respect to the company's limits of liability. The inclusion of any
person or organization as an insured shall not affect any right which such person or organization
would have as a claimant ifnot 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 9270 I.
(Completion of the following, including countersignature, is required to make this endorsement
effective.)
Effective
Policy #
Issued to
, this endorsement form as a part of
Named Insured
Countersigned by
Authorized Representative
8
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CERTIFICATE HOLDER COPY
STATE P.O. BOX 420807, SAN FRANCISCO, CA 94142-0807
COMPENSATION
INSURANCE
FUN 0 CERTIFICATE OF WORKERS' COMPENSA TrON INSURANCE
SEPTEMBER 12, 2002
GROUP:
POLICY NUMBER: 1443685-2002
CERTIFICATE 10: 4
CERTIFICATE EXPIRES: 04-01-2003
04-01-2002/04-01-2003
CITY OF SANTA ANA
ATTN, JEFF STEVENS, RISK MANAGEMENT DIVISION
20 CIVIC CENTER PLAZA, ROOM #M28
SANTA ANA CA 92702
JOB: CITY OF SANTA ANA
AUDIO TESTING
This is to certify that we have issued a valid Worker's Compensation insurance policy in a form approved by the California
Insurance Commissioner to the employer named below for the policy period indicated.
This policy is not subject to cancellation by the Fund except upon 10 days advance written notice to the employer.
We will also give you 10 days advance notice should this policy be cancelled prior to its normal expiration.
This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the
policies listed herein. Notwithstanding any requirement, term or condition of any contract or other document with
respect to which this certificate of insurance 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.
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PRESIDENT
AUTHORIZED REPRESENTATIVE
EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS, $1,000,000 PER OCCURRENCE
AI'FRO V bJ AS 10 IORl'vJ
~y
4::aura ShC~
Deputy City Attorney
EMPLOYER
JOHN G ALEVIZOS, DO. INC AND TUSTIN-IRVINE MEDICAL
GROUP, INC DBA, JOHN G ALEVIZOS, DO
800 N TUSTIN AVE STE A
SANTA ANA CA 92705
selF 10265
IEPF-UI, AE 1
from:TIMG SANTA ANA
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Tustin
Irvine
Medical
Group
EmF'loyee Health Centers
'We rake care of
employee health while
you take care of bU5Iness."
Corporate Office
Santa Ana facility
800 ~. Tustin Avenue
Suite A
Sanla Ana, CA 91705
(714) 245-0800
(714) 285-0400 fax
24-Hour Care
Irvine Facility
, 5374 Alton Parkway
Irvine, CA 9261 a
(949) 78a-0960
(949) 753.0423 Fax
714 2850400
01/06/2003 16:22 #315 P.001/002
JANUARY 6,2003
CITY OF SANTA ANA
EMIL YN BUENAFE
RISK MA.~AGEMENT
P.O.BOX 1988 M-28
SANTA ANA, CA 92702
IN REGARDS: CAP MPT PROFESSIONAL LIABILITY PROTECTION
MEMBERSHIP NUMBER 9275
COVERAGE 12.01.02 THROUGH 12.01.03.
IN THE EVENT THAT THE POLlCY COVERAGE OF TUSTIN IRVINE MEDICAL
GROUPfCAP-MPT WOULD BE GIVEN A 30 DAY NOTICE OF CANCELLA TIm
TUSTIN IRVINE MEDICAL GROUP WILL IMMEDIA TEDL Y GIVE THE CITY 0
SANTA ANA A 30 DAY NOTICE OF POLICY CANCELLATION
~O
DIRECTOR OF MARKETING, SANTA ANA
SEE ATTACHMENT
S 'IU FOR.
A r . 1,-0 V ED A
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;-;~;PU1Y CilY /\ttorney
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lr.mDI CERTIFICATE OF INSURANCE
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PAODUCER
INSUIlEO
PAGE 02
ISSUE 0'-' TE (MMlDOIVY) ,
I I I
THIS CIEIIITIFICATE . IUUlED ..a A MATTER Of INFOMlATION 0Ml Y ,AND CONflAa
NO RIGHTII UPON 1ME CEIn~TI: HQl.Dt!R. ". Cf,IIIT1FICAU: DOES NOT MlI!JIIO.
EJTEIlIl DlO .... TEll THE COYE.....GE .- .' THE I'Ol.IClES alLOW.
KENNY T PALMA INSURANCE AGENCY
15605 CARMENITA RD SUITE 102
SANTA FE SPRINGS CA 90670
TEL: (562) 926-4416
COMPANIES AFFORDING COVERAGE
f~~Y A TRUCK INSURANCE EXCHANGE
1"18 ... TO CEJIITIFY THAT ..eUClts OF INSURANCE: LISTED BELOW H.-rE BEEN ISSUE.D fO THE INSURED NAMED "eo"!: FOFl1H':' POL.ICY PEAIOD INDICATED
NQTWlttl9TANDING .."'. MQUIREMEfIIT, TEfW OR COtIPlTtON OF ANY CONTRACT OR OTHER DOCUME.N'T WrTH RE~CT TO WHICK THIS CERTIACAT. MAY
BE ISSUlD OR YAY PERlAIN, THE INSURAI'tCE AFfORDED 11"1 THIE POLICIES DESCRIBED tttAf'IN 18 SO&lf.C1' TO ALl THIE TEAMS, EllCLUStON8, AND CONDI-
TIONS OF sue" f'OLICIU.
i
TUSTIN IRVINE MEDICAL GOURP INC
800 N TUSTIN AVE
SANTA ANA CA 92705
COMPANY
LETTER .
COMPANY C
LETTER
TYPE OF INSUAJl.NCE
GEHEUL u,.,8111TY
~RE"E~VE fORM
PREloIISESiOPEIlATIONS
UNOERGR<)JNO
EXPl.OSION . COlLAPSE H~
PflOO\JCTS/tOMPl.EnD OPEIlATIONS
CONTRACTUAL
INOtPENDENT CONTRACTORS
BROAD FOAM PROPERTY OAMAGf
Pf:RSON.Al INJURY
POLICY NUMBER POllCTWEC1M I'ClICYEIl~TlON
()AT~ (MMJOONYl DAlllto&WOl'Nl aOOAEClATE.
ace
BODILY $ S
09407-10-51 11-01-0 lNJUAY
CONTINU US pROPERT'Y $ $
OAM,t.OE
UNITL C NCELLED
CQMP"NV D
LETtER
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IE
.
~~~~eo $2MILL S2MILI..
PERSON.AL INJUAV $
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IIl{AACCf(Itf)
PRO PEA"" $
Q,aMaGE
II' PO $
COMBIN'fO
IlII a PO $
COMBINEO
STATuTOR.Y
Aurouo-u LIABILITY
ANVAUTO
All QWNfO AUTOS (PRI\I PASS,)
AlL OWNED AUTOS (~J:Rp~)
",RIO AUTOS
X NON.OWlIEO AUlDS
GAAMiI UAIlIUI'I
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ElCESIS u~un
UMB~llA FORM
OTHER Ht.'" lJMBFlEllA FORM
WOflKfllll' COMP~N"TION
_NO
eMPLOYERS' LI....UTY
OTHER
DESCRIPTION Of OPERATtON6IlOCATIONSJVEHtCL.E6ISPECIAlITEMS
AUDIO TESTING - FROM NOVEMBER 2002 THRU OCTOBER 2003
RISK MANAGEMENT DIVISION
. . .
CITY OF SANTA ANA
RISK MANAGEMENT DIVISION
20 CIVIC CENTER PLAZA, M-28
SANTA ANA CA 92702
(EACH ACCIDlNn
(OISEASE-PC\ICY liMIT)
(OISEASE.IAC" E.....OyE!)
STATE
C:OMPE!H,SA1'IQN
I tl 5 U fOr", H C E
FUND
. "-"
po. BOX 807,
^ ,', ' . ~RTHOLDER COpy
C ,""'>: :fi ''<,:',{:,,1'<, '<','
SAN FRANClsc~e~0;~4 r~~07
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ISSUE DATE:
, - - " .', ,,,': .::v <"
CERTIFICATE OF; WORKERS' CQMPl!NSATlOl\llNSUJiA:NcE
I;! ,~;<: - , - i' '
04-0t-2o<l3 GROuP:
, POLlCY NUMBER: 1443685-2003
,.CEflTIFICA TE ,10: '.. 4
CERTIFICATE .EXPlRES, 04-01-2004
04-01-2003104-01-2004.
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C (TV OF SANTA ANA Sf> c'
AnN: 'JEFF St~VEtIS. RI$XANAGEIU.MT lJfV1SI.ON
20 C I VI C CENT~R Pl:AZA.:' ROO/'l."llT28
SANTA ANA CA,~2702
\;;,
JOB; uOB; bTY OF SANTA ANA
, 'AUDIO 'TESTING,
?i
This is to certtfy that we ",ave ,issued a valid W!'rkers' Co~en$ation insurance poliCY in a ',form ~prov~d by the
California" msuianc:e Commissiorrer---to'.'tfore employ. -named" bl,tfOw--tor,:the"-pct!cy-pcriod incficlJ1:ed.-
This poliCY is not subject to cano"Jlatlbn by tha' FUMo- except upon 10 days' advance written notice to the employer.
We will also give YOY"-'0 days'- 'adva'r'lce notice should this poHt:y be cancelled -prior to 'its 'no1rr\al" flxpiratioh.
This certifjcate<'of, insurance" is _ not ,an in$Urance, pOlicy'-'
by the policies listed here,,,.lII01Wlthstandi/lg atir ,r.eM
with respect to which this certificate 6f insurAlrlee nDj!
policies ~scribed herein is subject'to all :,the \t$triS},~
- , ,,'
,
P:~s not arilet1<l. e><.tend' or alter llie CQverage 'afforded
fJ;ti.t~,t9rm.- or cQrid.tiOF\ 9f'any comr.ct-br other document
, . $Oed -or may'-:.per.Ulin/ the insurance afforded by the-:,' " "
ns and condit!-ori~ of 'sueh policies. ~ '
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AUTHORIZED REPReSENTA rive
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PRESIDENT
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EMPLOVER'S LIABILITY LIMIT INCLUDING DEFENSE (:os"'$; $i,Ooo,cioo.oo PER~OcctiRRENCE.
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EMPLOYER
LEqAL'MAME
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'JOliN G ALEVllO~.. riO. ItIC
8~' N .rUST! NAVE STE A
SANTA ANACA 92705 ,
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