HomeMy WebLinkAboutHISPANIC BUSINESS CONSULTANTS 2A -2003
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AMENDMENT TO AGREEMENT
A-2003-020
.-
THIS AMENDMENT, made and entered into this 3m day of February, 2003, by and between Hispanic Business
Consultants ("Contractor") and the City of Santa Ana, a charter city and municipal corporation duly organized and
existing under the Constitution and laws of the State of California ("City").
RECIIALS
A. The City and Contractor entered into that certain Agreement dated June 17,2002, hereinafter referred to as
"said Agreement", to provide entrepreneurial training to Spanish speaking dislocated workers and the Latino
community for starting their own businesses.
B. The parties hereto now desire to amend the "City's Obligations" amount found in Section 2 of said
Agreement.
WHEREFORE, in consideration of the mutual and respective covenants and promises hereinafter contained and
made, and subject to all of the terms and conditions of said Agreement as hereby amended, the parties hereto do
hereby agree as follows:
I. The "City's Obligation" section of said Agreement will be amended to read:
"...a sum not to exceed 'h4'i 00000."
2. Except as hereinabove modified, the terms and conditions of said Agreement remain unchanged and in full
force and effect.
IN WITNESS WHEREOF, the parties hereto have executed this Amendment to said Agreement the date and
year first above written.
ATTEST: " /.
~-. ~ ~iJ
. ~ __J.(
Patricia E. Healy
Clerk of the Council
CITYTl;2jj
,162.
David N. Ream, City Manager
APPROVED AS TO FORM:
HISPANIC BUSINESS CONSULTANTS
~~~.~
By: Lisa E. Storck
Assistant City Attorney
t. a~~~
Ed':: F f(~.~~~,h-
RECOMMENDED FOR APPROVAL:
Jo P. Reekstin, Executive Director
Community Development Agency
INSURANCE ON FILE
WORK MAY PROCEED
UNTIL IN~RANCE EXPIRES
1-:::;> -aLl
CLERK OF COUNCIL
DATE: '113b/03
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11-02003 - ~
I DATE
10-24-2003
ACORD~ CERTIFICme OF LIABILITY INSURA~CE
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION I
TUTTON INSURANCE SERVICES INC/PHS ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR
251107 P: (866)467-8730 F: (877) 905-0457 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
P. O. BOX 33015
SAN ANTONIO TX 78265 INSURERS AFFORDING CGYERAGE
JNSURED INSURER A, Hart ford Casualtv Ins Co
EDUARDO FIGUEROA DBA HISPANIC BUSINESS INSURER B:
CONSULTANTS INSURER c: .
5 CORNS ILK INSURER 0: i
IRVINE CA 92614 INSURERE: :
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING I
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR i
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.
.... TYPE OF INSURANCE POLICY NUMBER ~~f!J~~~g~E I ~k!fl,FfJl~:~IN LIMITS
LTR
~NERAL LIABiliTY 101/03/04 EACH OCCURRENCE .1,000, 000
A COMMERCIAL GENER~ABllITY 172 SBA AB6463 01/03/05 FIRE DAMAGE (Any one fir,,1 I $ 3 0 0 , 0 0 0
I CLAIMS MADE ~i OCCUR I MED EXP lAny one person) 1.10,000 I
~ Business Liab I PERSONAL & ADV INJUAY 1.1,000,000 I
- I GENERAL AGGREGATE 1.2,000,000 i
~'l AGGRE~Al ~~~~ API~lIEl PER: i PRODUCTS - COMP/OP AGG i .2 , 000 , 000 i.
POLICY JEer X LOC i
~TOMOBILE LIABILITY 01/03/05 COMBINED SINGLE LIMIT .1,nOO,000 I
A ANY AUTO 72 SBA AB6463 01/03/04 (Eeeccident! I
-
- ALL OWNED AUTOS BODilY INJUAY
(Per person) .
- SCHEDULEO AUTOS
~ HIRED AUTOS ,
I BODilY INJURY .
~ NON-OWNED AUTOS (Perl!lCcident)
- PROPERTY DAMAGE .
(Per accident)
~AGE L1ABlLrTY i AUTO ONLY - EA ACCIDENT .
R ANY AUTO OTHER THAN EA ACe .
, AUTO ONLY: AGG .
-: EXCESS LIABILITY ! I EACH OCCUARENCE I.
U OCCUR U CLAIMS MADE AGGREGATE .
.
H DEDUCTIBLE .
RETENTION . .
T WORKERS COMPENSATION AND I T,:(~JT ~r~~ I !~-
'I EMPLOYERS' UABILITY I E.L. EACH ACCIDENT c3 . -"On
0-
, E.L. DISEASE - EA EMPL.Ql'ft: ::'~t ~
I , .
E.L.. DISEASE - POLlCY L1~ $ .:::::<rT~C
OTHER W i-=j ~~'; ~:
-
i '1--. -,
rl'-<.~
D9CRIPTION OF OPERATJONSILOCATlONSNEHIClESlEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVt610NS ~
I Those usual the Insured's Operations. ~~ c::-::'-,.
to , -" -
-<= =:::.,..
0
CERTIFICATE HOLDER
I X I ADDITIONAL INSURED; INSURER LfTIER"
A
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
30 DAYS WRITTEN NOTICE 110 DAYS FOR NON-PAYMENT} TO THE CERTIFICATE
HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO
OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
The City of Santa Anna
PO Box 1988
Santa Anna, CA 92702
i
ACORD 25-S (71971
.gOQ~.e:~~__
e ACORD CORPORATION 19BB
/(IQby
.
'-"
'....I
Hispanic Business Consultants
Corporate Training & Entrepreneurial Seminars
2510 N. Grand Ave., Santa Ana, CA 92705
Phone (714) 516-1111' Fax: (714) 516-1114 E-mailhbcnew@aol.com
htto:/ /www".eduardofigueroa.com
April 11,2003
To the City of Santa Ana
I, Eduardo Figueroa, am under a contractual relationship with the City of Santa Ana to provide
Business training in Spanish and understand the City's insurance requirements. While I have
the necessary insurance coverage plus the Additional Insured Endorsement, as required, my
insurance carrier Hartford Insurance willllQJ; agree to the cross-outs in the cancellation clause
(bottom right hand corner).
Therefore, I Eduardo Figueroa, on behalf of Hispanic Business Consultants, 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,
t: '. ~*-fQ<L)
=:d~i~~'~
Hispanic Business Consultants
Name of Contractor
(Enclosure)
APPROVED AS TO FORM
Lau~
Ocputy City Attorney
"\ACORDm CERTIFICAw: OF LIABILITY INSURAN.....,i ~I MT'
UODC 04-10-2003
"""""" THIS CERTIPICATE IS ISSUED AS A KATTD. OP INFORMATION
AlP INSURANCE SERVICES/SCIC ONLY AND CONFERS NO RJ:GBTS CPON THE CERT:IFI:CATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR
251467 P.(866)467-8730 F I (877) 905-0457 AL'1'!:B. THE COVERAGE AFroRDED BY THE POLICIES BELOW.
P. O. BOX 33015
SAN ANTONIO TX 78265 INSURERS Al"l"ORDDfG COVERAGE
11l.llURED mllllEll ..Hartford Casualty Ins Co
EDUARDO FIGUEROA DBA HISPANIC BUSINESS DlSlJRER 91
CONSULTANTS II!lSlJRER CI
5 CORNSILK IlII5tlRERDI
IRVINE CA 92614 IlIIBURER B.
COVEllAGES
'IRE POLICIES OF INS1JllANCE LISTED BELOW HAVE BXBN ISSUED 'fO 'lHB INSURED NAMED ABOVE FOR THB POLICY PERIOD INDICATED. NOTWITBSTANDDT
ANY REQUIRKMENT. 'l'ERM OR CONDITION OF ANY CONTRACT OR OTHER OOCUMEN'l' WITH RESPECT TO WHICH THIS CBRTIFICATE MAY BE ISSUED OR
MAY PERTAIN. THB INSURANCE AFFORDED BY THE POLICIES DESCRIBED HERBIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF sue
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BERN REDUCED BY P~D CLAIMS.
~~ TYPIi: OF nlSUllAIIICE POLlCY :I'1lIIB1:R. ~~cr DPRC'i'IVE ~;;Y EXPllUll'WJII LIKt1'S
~ERAL LIAI![LITY EACH OCctJJlJlEWCE ,1 000 000
A COl!llo!!\RCIAL G3NERlIoL LIABILITY 72 SBA AB6463 01/03/03 01/03/04 FIRE DAMJ.Gr: (Anv 0.... it . 300.000
I CUDlS IWlE OOOCCCll lIED BU M)' QIUI plIr.Qn) . 10 000
X Business Liab PBRSORkL ~ lIoDV ItIJOR.l .1. 000.000
- co.EiNERAL AlOCORBca7B ,2 000 000
~':L AGGRBn ~T Afi!tS PW I l'RODlJCTS _ COMP/OP At;(; ,2.000.000
POLICY X LOC
~OM08ILE LIABILITY CDMllrMBD SItilGLB LUll'! ,1,000,000
A I-- AM All'!O 72 SBA AB6463 01/03/03 01/03/04 (B4 ...=identj
f- ALL OWNED 1oUTO.9 BODn.! ltIJ1lRy
IPElr i"'r.onj ,
X SClIBDULBD AUTOS
RI:R.BD All'l'OS BODILY IlIJ1JRY
X I P.r ace~Rt) ,
= !I0N-OWllBD AtI'lOS
- PROPRR'I'Y DAMJoGB ,
IP..ra.ccidoilRtj
f L".mn All'!O ORLY - EA ACCIDlDl'I' ,
.un AUTO O'l'llBII. TIaN EA '"'0 .
AD'!O ORLh AGe .
'~~r~s LIAa.ILIT'Y EACII OCClJRREJICE ,
OCCUR Dcr.ADl.'i I!IAIlB AGGRBGA1'B ,
APPROVED PS FOF M ,
=i "COCT"", TO .
:R.S'l'BNTIOlI . .
wal.l:E:R.lI ~ElRllt,[,Im.-A"Jl ,fI 1t2 .41 .; I ~:rlt.TO- j 10711-
DS'LOrDS' LIMn.nr B.L. BACK ACCIDIm"I' ,
L;;fra~heedY B.L. DHISUE - SIt. IIIlIPLO ~
{"';tv Atla ney B.L. DlSBASE _ PO'Lrcy L ,.
0"",,
DElICllIPTIOJII Ol!' O(>gRA'fIO.II/LCcA'I'IOWll/VEHICLES/EXCLUSIOIIB ADDlilO BY EIlDORlluv:n'/IIPEClMo lmOVIBIOJIIS
Those usual to the Insured's Operations. The City of Santa Anna, it's
officers, employees, and agents are named as additional insured.
CERTIFICATE HOLDER 1 X I ADOITIOlIAL UJBUlI.W, llUJUUR LE'l'TEIU A CANCELLATION
IsHOULC ANY OF 'l'HE ABOVE DESCRIBED POLICIES BE C1\N~LLED 8EP'ORK THE
~XPIRATION OATE TBEREOF. THE ISSOING INSURER WILL ENDEAVOR TO MAIL
30 Da!B WRIT'rBN NOTICE (10 DAn FOR NON-E'AYImNT) TO THE CBUIFICA'T
The City of Santa Anna ~OLDBR NAMED TO TBE LEFT. BO":I' l"AiLURB: '1'0 DO SO SHALL IMPOSE NO
pBLIGATION OR LIABILITY OF ANY XINO UPON THE INSURER, ITS AGENTS 0
PO Box 19B8 IasPR1!:SENTA'I'IVB:8 .
Santa Anna, CA 92702
~~ k
t ~--"'L-
ACORD 25-6 (1/91)
CI ACORD CORpORATION 1988
,04 ~ 10/2003 05: 16PM
THE HARTFORD
YAUr. z ur ~
- "
'""
'"oJ
THIS ENDORSEMENT CHANGES THE POUCY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - DESIGNATED PERSON OR
ORGANIZATION
This endorsement modifies insurance provided under the following:
EDUARDO FIGUEROA DBA HISPANIC BUSINESS CONSULTANTS
72 SBA AB8463
BUSINESS UABILITY COVERAGE FORM
C. Who is an insured in the BUSINESS
LIABILITY COVERAGE FORM is
amended to include as an insured the
person or organization shown in the
Declarations but only with respect to
liability arisinR out of the operations of the
nemeet Insured.
For losses covered under the BUSINESS
LIABILITY COVERAGE of this policy this
insurance is primary to other valid and
collective insurance which is available to
the person or organization shown in the
Declarations as an Additional Insured.
The City of Senta Anne, it's officers,
Employ..s end agents
PO Box 1988
Senta Anne, CA 02702
APPROVED AS 10 FORM
Lau <l Sheedy
D'-"lllt' e'
-t- \" 11v ''\ttorney
Form SS 04 49 06 93 Printed in U.S,A. (NS)
Copyright, Hartford Fire Insurance Compsny, 1995
I. At;ORD CERTIFICA\.i OF LIABILITY INSURA.JCE I DATE (MMJDDIYYYY)
'" 04/10/2003
PRODUC'R (949)261-5335 FAX (949)261-1911 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Tutton Insurance Services, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
2913 S. Pullman St. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Santa Ana, CA 92705
INSURERS AFFORDING COVERAGE NAIC#
INSURED Eduardo Figueroa INSURER A: The Hartford Insurance Group
DBA: Hispanic Business Consul tants I z. / INSURER B: State Compo Insurance Fund
5 Cornsilk fJ ~{)OV INSURER C
Irvine, CA 92614 4~V:x>3'" 01--0 INSURER D:
INSURER E
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDIN
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 NSR TYPE OF INSURANCE POLICY NUMBER DATE "/MMJDDNYl DATE MM/DDNY LIMITS
GENERAL LIABILITY 72-SBA-AB6463 OX 01/03/2003 01/03/2004 EACH OCCURRENCE . 1,000,000
ex COMMERCIAL GENERAL LIABILITY PRE~~~S Ea occurence\ . 300 ,000
I CLAIMS MADE 00 OCCUR MED EXP (Anyone person) . 10 , 000
A PERSONAL & ADV INJURY . 1,000,000
f-- GENERAL AGGREGATE . 2,000,000
f--
GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG . 2,000,000
"I rnPRO- n
POLICY JEer LOC
AUTOMOBILE LIABILITY 72-SBA-AB6463 OX 01/03/2003 01/03/2004 COMBINED SINGLE LIMIT
- (Eaaccidenl) . 1,000,001
ANY AUTO
- ALL OYINED AUTOS
BODILY INJURY
- (Per person) .
SCHEDULED AUTOS
A X HIRED AUTOS
BODILY INJURY
X (Per accident) .
NON-OWNED AUTOS
-'-'--
APPROVI D AS TO ORM PROPERTY DAMAGE .
(Peraccidenl)
GARAGE LIABILITY fJ3t^ - JL AUTO ONLY - EA ACCIDENT .
=1 ANY AUTO EAACC .
OTHER THAN
0;- :_-. ~"eerl ( AUTO ONLY AGG .
EXCESSIUMBRELLA LIABILITY Deputy City Attorney EACH OCCURRENCE .
b OCCUR D CLAIMS MADE AGGREGATE .
.
R DEDUCTIBLE .
RETENTION . .
WORKERS COMPENSATION AND 1679144-03 02/01/2003 02/01/2004 X 1T'O);.;" L:;';,~s I IUER'-
EMPLOYERS' LIABILITY EL EACH ACCIDENT . 1,000,000
B ANY PROPRIETOR/PARTNERlEXECUTIVE
OFFICER/MEMBER EXCLUDED? E.l. DISEASE. EA EMPLOYEE $ I, 000 , oOii
~~~~i1tS~~bOv~~~b~~s belOW E,LD!SEjl.SE-P~..idMlT ~ 1:,000,000-'
OTHER .... ~:....
- ::>::-<
;a ::Ol'T10
1'T1=<:..."
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES f EXCLUSIONS ADDEO BY ENDORSEMENT / SPECIAL PROVISIONS -:- ,.,;VJV)
ertificate holders are named as additional insureds, endorsement to be issued by carrler. <n~
020
his insurance is primary per policy form. "0 ""3;-,
10 day notice wil be sent in the event of cancellation for non-payment of premium. CJ:u:l>
W c:l>
- zz
en =i>
The City of Santa Ana, its officers,
employees & agents
P.O. Box 1988
Santa Ana, CA 92702
CANCELLATION
SHOULD ANY OF THE ABOVE OESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
..!.3.0..... DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
CERTIFICATE HOLDER
OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
Stanle
Tutton/CLAUDI
(J/~
ACORD 25 (2001/08)
@ACORDCORPORATION 1988
O~/1?/2093 05:16PM
,
THE HARTFORD
PAGE 2
OF 2
""
"""
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - DESIGNATED PERSON OR
ORGANIZATION
This endorsement modifies insurance provided under the following:
EDUARDO FIGUEROA DBA HISPANIC BUSINESS CONSULTANTS
72 SBA AB6463
BUSINESS LIABILITY COVERAGE FORM
C. Who is an insured in the BUSINESS
LIABILITY COVERAGE FORM is
amended to include as an insured the
person or organization shown in the
Declarations but only with respect to
liability arising out of the operations of the
named insured.
For losses covered under the BUSINESS
LIABILITY COVERAGE of this policy this
insurance is primary to other valid and
collective insurance which is available to
the person or organization shown in the
Declarations as an Additional Insured,
The City of Santa Anna, it's officers,
Employees and agents
PO Box 1988
Santa Anna, CA 92702
ED AS TO FORM
APPROV
'lllr" Sheedy
" r' AU rney
Depu\Y ,,,t\y
Form 55 04490593 Printed in U.S.A. (NS)
Copyright, Hartford Fire Insurance Company, 1993
PACE 2/2 * RCVD AT 4110/2D03 2:15:27 PM [paclnc Daylight Time) * SVR:f2. CNIS:22. CSID:THE HARTFORD. DURATION (mm-ss):D1.14
, I
ACORD CERTIFIC.\.;E OF LIABILITY INSUR...,JJCE DATE (MM/DOfYYYY)
'" 04/10/2003
PRODUCER (949)261-5335 FAX (949)261-1911 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Tutton Insurance Services, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
2913 S. Pullman St. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Santa Ana, CA 92705 INSURERS AFFORDING COVERAGE
NAIC#
INSURED Eduardo Figueroa INSURER A: The Hartford Insurance Group
DBA: Hispanic Business Consultants 1~1 INSURER B: State Compo Insurance Fund
5 Cornsilk {)()2-- INSURER c:
Irvine, CA 92614 ~~~3- 01,0 INSURER 0
INSURER E
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSUREO NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDIN
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.
I'LrR t'NSR TYPE OF INSURANCE POLICY NUMBER DATE MMfDDIY'f'''" DATE /MMIDDJYY LIMITS
GENERAL LIABILITY 72-SBA-AB6463 OX 01/03/2003 01/03/2004 EACH OCCURRENCE . 1,000,000
X COMMERCIAL GENERAL LIABILITY ~REMISE~ YE~~~~~nce\ . 300,000
I CLAIMS MADE [K] OCCUR MED EXP (Anyone person) . 10,000
A PERSONAL & ADV INJURY . 1,000,000
GENERAL AGGREGATE . 2,000,000
GEN'l AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG . 2,000,000
~ POLICY n ~~8T n Loe
AUTOMOBILE LIABILITY 72-SBA-AB6463 OX 01/03/2003 01/03/2004 COMBINED SINGLE LIMIT
- AAY AUTO (Eaaccidenl) .
1,000,000
- ALL OWNED AUTOS
BODILY INJURY
- (Per person) .
SCHEDULED AUTOS
A X HIRED AUTOS
BODilY INJURY
X (Per accident) .
NON-OWNED AUTOS
- ORM
f- APPROV! D AS TO PROPERTY DAMAGE .
(Peraccidenl)
GARAGE LIABILITY ';I3t, , . AUTO ONLY - EA ACCIDENT .
==J ANY AUTO OTHER THAN EAACC .
T.:;;,-, ~hee / AUTO ONLY: AGG .
EXCESSJUMBRELLA LIABILITY Deputy City Attorney EACH OCCURRENCE .
~ OCCUR o CLAIMS MAOE AGGREGATE .
.
H OEDUCTlBLE .
RETENTION . .
WORKERS COMPENSATION AND 1679144-03 02/01/2003 02/01/2004 X I To~,;"l~MI~S I IUER-
EMPLOYERS' LIABILITY E.L. EACH ACCIDENT . 1,000,000
B ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA~OYEE $ 1,000,000
~~~tl~~5r.Jf.;'v~s16~.s below E.L_ DISE.-\SE - PO -b:MlT "'-'-'-l:iOOO, 000-
OTHER ~ ?6-i
2t; :>:-<
:0 :OfTlO
- fTl"=!--.,
DESCRIPTION OF OPERA TlONS I LOCATIONS 1 VEHICLES f EXCLUSIONS ADDED BY ENDORSEMENT f SPECIAL PROVISIONS - /T1 C/)
~ertificate holders are named as additional insureds, endorsement to be issued by carrier. <C"'))':>.
"0 02:
~his insurance is primary per policy form. 83:;ti
'10 day notice wil be sent in the event of cancellation for non-payment of premium. :u
W c::<>
.- Z2:
Ul ::;:<>
-
The City of Santa Ana, its officers,
employees & agents
P.O. Box 1988
Santa Ana, CA 92702
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
....!l..(L DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
CERTIFICATE HOLDER
OF ANY KINO UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
Stanle
Tutton/CLAUDI
0'~
ACORD 25 (2001/08)
@ACORDCORPORATlON 1988
.04'/10/2D03 05: 16PM
THE HARTFORD
PAGE 2 OF 2
"""
"'"
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - DESIGNATED PERSON OR
ORGANIZATION
This endorsement modifies insurance provided under the following:
EDUARDO FIGUEROA DBA HISPANIC BUSINESS CONSULTANTS
72 SBA AB6463
BUSINESS LIABILITY COVERAGE FORM
C. Who is an insured in the BUSINESS
LIABILITY COVERAGE FORM is
amended to include as an insured the
person or organization shown in the
Declarations but only with respect to
liability arising out of the operations of the
named Insured.
For losses covered under the BUSINESS
LIABILITY COVERAGE of this policy this
insurance is primary to other valid and
collective insurance which is available to
the person or organization shown in the
Declarations as an Additional Insured.
The City of Santa Anna, it's officers,
Employees and agents
PO Box 1988
Santa Anna, CA 92702
"ED AS TO FORM
APPRO'
~
auCilY At! rney
OopulY
Form SS 04 49 05 93 Printed in U.SA (NS)
Copyright. Hartford Fire Insurance Company, 1993
PAGE 212. RCVD AT 4/10/2003 2:15:27 PM [pacific Daylight Time]. SVR:/2. DNIS:22. CSID:THE HARTFORD" DURATION (mm-ss):01-14
--
'....I
\c BlJ~ii
,,,{\ 1',
,,~~..., ~:j
.
C'O'''i__;
Hispanic Business Consultants
Corporate Training & Entrepreneurial Seminars
2510 N. Grand Ave., Santa Ana, CA 92705
Phone (714) 516-1111' Fax: (714) 516-1114 E.mai1 hbcnew@aol.com
hUo:l/www.eduardofigueroa.com
October 18, 2002
To the City of Santa Ana
I, Eduardo Figueroa, am under a contractual relationship with the City of Santa Ana to provide
Business training in Spanish and understand the City's insurance requirements. While I have
the necessary insurance coverage plus the Additional Insured Endorsement, as required, my
insurance carrier Hartford Insurance will not agree to the cross-outs in the cancellation clause
(bottom right hand comer).
Therefore, I Eduardo Figueroa, on behalf of Hispanic Business Consultants, 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,
. :..----
Eduardo Fi roa
HisDanic Business Consultants
Name of Contractor
(Enclosure)
aye., AS TO FORM
AiJ:;~
(la cedY.
Deputy City Attorney
""
"""
ACORD~ CERTIFICATE OF LIABILITY INSURANCE S~I DATE
, DaDC 09-17-2002
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ASSOCIATED PRODUCERS INS./SCIC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR
180756 P: (800) 457-2379 F: (210) 732-3593 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
P. O. BOX 33015 INSURERS AFFORDING COVERAGE
SAN ANTONIO TX 78265
INSURED INSURERA:Hartford Casualtv Ins Co
EDUARDO FIGUEROA DBA HIRP1>.NIC BUSINESS INSURER B:
CO=TANTS "\" ~ -
INSURER c:
5 NSILK INSURER 0:
IRVINE CA 92614 INSURER E:
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.
"IfR TYPE OF INSURANCE POLICY NUMBER ':P.HCY EFFECTIVE ~lfCy EXPIRATION lIMITS
TR T TE
~NERAl llABll.lTY EACH OCCURRENCE .1,000,000
A I- 3MMERCIAL GENERAL LIABILITY 72 SBA AA1213 01/03/02 01/03/03 FIRE DAMAGE (Anyone firel . 300 000
I- CLAIMS MADE 0 OCCUR MED EXP (Anyone personl . 10 000
X Business Liab PERSONAL & ADV INJURY .1,000,000
I- GENERAL AGGREGATE .2,000 000
rl'L AGG~EnE LIMIT APMS PER: PRODUCTS - COMP/OP AGG .2 000 000
POLICY ~~;. X LOC
~UTOMOBIlE LIABilITY 01/03/02 01/03/03 COMBINED SINGLE LIMIT .1,000,000
A f--- ANY AUTO 72 SBA AA1213 (Eaaccident)
I- ALL OWNED AUTOS BODILY INJURY
.
I- SCHEDULED AUTOS IPerperson)
1'- HIRED AUTOS BODILY INJURY
.
1'- NON-OWNEO AUTOS (Peracciclent)
- PROPERTY DAMAGE .
(PeraccidenU
=rOE '/A'HIH AUTO ONLY - EA ACCIDENT .
ANY AUTO OTHER THAN EAACC $
AUTO ONLY: AGG .
jE~S LIABILITY EACH OCCURRENCE .
OCCUR 0 CLAIMS MADE AGGREGATE .
APPROVE[ AS TO F aRM .
R ~EDUCTlBLE . glj) ~j .
RETENTION . $
WORKERS COMPENSA TION AND ~'.i/7' YlV I TVX~JTA~!!;, I IOJ~-
EMPLOYERS' UABILlTY laura Sheedy tltey
E.L. EACH ACCIDENT .
Deputy CitY I E.L. DISEASE - EA EMPLOYEE $
E.L. DISEASE - POLICY LIMIT .
OTHER
DESCRIPTION OF OPERA TIONSIlOCA TIONS/VEHlClESlEXClUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
The City of Santa Ana, it's officers, employees, agents are named additional
insured as their interest may appear with respect to liability.
CERTIFICATE HOLDER I X I ADDITIONAL INSURED: INSURER LETTER: A CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
30 DAYS WRITTEN NOTICE 110 DAYS FOR NON-PAYMENT) TO THE CERTIFICATE
The City of Santa Ana HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO
OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
20 Civic Center Plaza REPRESENT A TIVES.
Santa Ana, CA 92701
~RlZEDREPRESENT~
l~~
ACORD 25-S 17/971
. ACORD CORPORATION 19BB
COVERAGES
THE X
HARTFORD
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
"'"
..[-
ADDITIONAL INSURED. DESIGNATED PERSON OR
ORGANIZATION
This endorsement modifies insurance provided under the following: 72 SBA AA 1213
EDUARDO FIGUEROA DBA HISPANIC BUSINESS CONSULTANTS
Who is an insured in the BUSINESS LIABILITY or losses covered under the BUSINESS
C. Who is an insured in the BUSINESS LIABILITY
COVERAGE FORM is amended to include as an
insured the person or organization shown in the
Declarations but only with respect to liability arising
out of the operations of the named insured.
For losses covered under the BUSINESS
LIABILITY COVERAGE of this policy this insurance is
primarily to other valid and collective insurance which is
available to the person or organization
shown in the Declarations as an Additional Insured.
The City of Santa Ana
20 Civic Center Plaza
Santa Ana, CA 92701
APPROVED AS TO FORM
"/
Form SS 04490593 Printed in U.S.A. (NS)
Copyright, Hartford Fire Insurance Company, 1993