HomeMy WebLinkAboutGAFF GROUP, INC.
AGREEMENT TERMINA nON
Please complete this form when the attached agreement ~OB~inmifff.~O
Retu,"? form to the t. Deputy Clerk of the Council (M-~Pfy9'1l 647SJl! A~rp.u have any
questions. C' ED. '''.'eIL
L.. i'c' 0 uh I
- - - - - - - - - - - - - - - - - ~- - - - - - - /J - - - - - - - - - - - - - - - - - - - - - - -1- - - - u --
" -?' /J r/'" ( -7j) tf /\--j -./1
Theagreementwith.L'~I/,/;- \__./ fCCI-,<[) ,No.;u v(Lv"0 T(,?
. - II r--
was completed on 1/1 j [;'0/0 7 , and final pay has n mad .
~ / /
Date:
Department:
Signature
Revised 8-7-03
City of Santa Ana
Clerk of the Council
"
N-2006-046
~NSURANCE NOT ON FILE
WORK MAY ~ PROCEED
CLERK OF COUNCIL CONSULTANT AGRJ<;EMENT
DATE: ../~Ob
o:c""/l~(l)
<"",,100 THIS AGREEMENT made and entcred into this I" day of .June, 2006 by and between
Gaff Group, Inc" a California corporation (hereinafter "Consultant"), and the City of Santa Ana,
a charter city and municipal corporation organized ami existing under the Constitution and laws
of the State of California (hereinaHer "City").
RECIT ALS
A. The City desires to retain a consultant having special skill and knowledge in the field of
general contracting ami maintenance services, to repair various sites at the Depot in
Santa Ana.
B. Consultant represents that Consultant is able rmd willing to provide such services to lhe
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 pcrfomlcd in compliance \\/ith slIch standards as may reasonably be
expected from 1:1 professional consulting tirm in the field.
NOW THEREFORE, in consideration of the mutual and respective promises, and subject to the
terms and conditions hereinafter set forth, the parties agree as follows:
l. SCOPE OF SERVICES
Consultant shall1'urnish and install custom picture frames at the Dcpot in Santa Ana, as
sel 1'orth in Exhibit A. Consultant may be asked to provide additional general contracting and
maintenance services at the Depot in Santa Ana. Consultant shall provide a written estimate for
those requested services, \vhich will be authorized hy the signature of the Executive Director of
the Community Development Agency, or her designee,
2, COMPENSA nON
a. City agrees to pay, and Consultant agrees to accept as total payment for its services,
the rates and chargcs identified in Fxhihit A. Additional services shall be paid in accordance
with the accepted proposal for said services. The total sum to be expended under this Agreement
shall not exceed $10,000,00 during the term of this Agreement
b. Payment by City shall be made within thirty (30) days following receipt of proper
invoice evidencing \vork 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 reasonahly be expected by City.
3. TERM
This Agreement shall commence on the date first \\-Titten above and terminate on June 30,
2007, unless terminated earlier in accordance with Scction 12, helow.
4. INDHJ<;NDENT 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 he construed to create an employer-employee relationship, ajoint venture relationship, or
to allow the City to exercise discretion or control over the professional manner in vvhich
Consultant performs the services \'I/hich are the suhject matter of this Agreement: ho\vcver, the
services to be provided by Consultant shall be provided in a manner consistent with all
applicable standards and regulations guverning such services. Consultant shall pay all salaries and
wages, employerls social s(;x:urity taxes, unemployment insurance and similar taxes relating to
employees and shall be responsible for all applicable withholding taxes,
5. INSURANCE
Prior to undertaking perrormanee of work under this Agreement, Consultant shall
maintain and shall n:quire its subcontractors, if any, to obtain and maintain insurance as
described bclow:
a. Commercial General Liability Insurance. Consultant shall maintain commercial
gcneralliahility insurance naming the City'-, its officers, employees, agents, volunteers and
representatives as additional insurcd(s) and shall includc, but not he limited to proteetion against
claims arising from bodily and personal injury, including death resulting then:i:rom and damage
to property, resulting from any act or occurrence arising oul or Consultant's operations in the
performance or this Agreement including, without limitation, acts involving vehicles. The
amounts of insurance shall be not less than the following: single limit coveragc applying to
hodily and personal injury, including death resulting therefrom, and property damage, in the total
amount of $] ,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 lorm by the City Attorney,
b. Rusiness automobile liability insurance, or equivalent form, with a combined single
limit of not less than $1,000,000 per occurrence. Such insurance shall include coverage lor
owmxl hired and non-owned automobiles.
c. \V'orker's Compensation Insurance. In aCl.;ordance \vith the provisions of Section 3300
of the Labor Code, ronsultant, ifConsullant has any employees, is required to be insured against
liability for \vorker's compensation or to undertake self-insurance. Prior to commencing the
performance of thL: \\'ork under this Agreement. Consultant agrees to ohtain and maintain any
employer's liability insurance with limits not less than $1,000,000 per accident.
2
d. 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 bc furnished to the City upon execution of
this Agreement and shall be approved in form by the City Attorney.
(iii) Certificates and policies shall statc that the policies shall not bc canceled
or reduced in c.overage or changed in any other material aspl:ct \vithout
thirty (30) days prior written notice to the City,
e. If Consultant fails or refuses to produce or maintain the insurance required by this
section or fails or r~ruses to furnish the City \vith 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. Sueh 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 for personal injury,
damages, just compensation, restitution. judicial or equitable relief arising out of claims r()r
personal injury, including health, and claims for propcrty 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 whil:h relates to the services described in
section 1 of this Agreement.
7, CONFIDENTIALITY
If Consultant receives from the City information whieh due to the naturc of such
inl'ormation is reasonably underslood to bl.: confidential and/or proprietary, Consultant agrees
that it shall not use or disclose such information except in the performance of this Agrccmcnt,
ami further agrees to exercise the same degree of care it uses to protect its o\\/n information of
like importance, but in no event less than reasonable cme. "Confidential Information" shall
include all nonpublic information. Confidential information includes not only written
information, bm also information transferred orally, visually, electronically, or by other means.
Confidential inf()nnation disclosed to either party by any subsidiary and/or agent of the other
party is cuvered by this Agreement The foregoing obligations of non-use and nondiselosurc
shall not apply to any information that (a) has been diseloscd in publiely availahle sources; (b) is,
through no fault ofthc Consultant disclosed in a publicly availahle source; (c) is in rightful
possession ofthc Consultant without an ohligation of confidentiality; (d) is required to be
disclosed by operation of law; or (e) is independently developed by the Consultant without
reference to information disclosed by the City,
3
8. CONFLICT OF INTEREST CLAUSE
Consultant covenants that it presently has no interests and shall not have interests, direct
or indirect, which would conl1it:t 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 deerned to be properly given if delivered in person or
mailed by lirst 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
telcfacsimile (714) 647-6956
With courtesy copy to:
executive Director of Community Development
City of Santa Ana
20 Civic Center Plaza (M-25)
P.O. Box 1988
Santa Ana, Cali1urnia 92702
telefacsimile (714) 647-6736
To Consultant:
GaiT Group, Inc,
Mr. Dan Rosa
1592 N, Batavia #2
Orange, California 92867
telefacsimile (714) 998-9793
A party may change its address by giving notice in \\.Titing to the other party. Thereafter.
any communication shall he addressed and transmitted to the new address. If sent by mail,
communication shall be effeetive or deemed to have been given three (3) days alter it has been
deposited in the United States mail, duly registered or cet1ified, with postage prepaid, and
addressed as set forth above. If sent by telefacsimile, communication shall be effective or
deemed to have been given twenty-four (24) hours after the time set forth on thc transmission
report isslled by the transmitting facsimile machine, addressed as set forth ahove. For purposes
of calculating these time lrames, weekends, federal, state, COlmty or City holidays shall be
exeluded.
4
10. EXCLUSIVITY AND AMENDMENT
This Agreemcnt rcprcsents thc complete and exclusive statement hetween the City and
Consultant, and supersedes any and all other agreements, oral or written, between the parties. In
the event of a cont1iet hetwccn the terms or this Agreement and any attachments hereto, the
tcrms or 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 arc inconsistent
with, or in addition to, the tcrms and conditions hereof. shall not hind or ohligate Consultant nor
thc City. Each party to this Agrcement acknowledges that no representations, inducements,
promiscs or agreements, orally or otherwise, have been made by any party, or anyone acting on
behalr or any party, which are not embodied herein,
I I. ASSIGNMENT
Inasmuch as this Agreement is intended to secure the specialized services or Consultant,
Consultant may not assign, transfer, delegate, or subcontract any interest herein without the prior
\vritten 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
shall be construed to limit thc City's ability to havc any ofthc scrviccs which arc the subject to
this Agrccment perl(mned hy City personnel or hy other consultants retained by City.
12. TERMINATION
This Agreement may bc terminated by thc City upon thirty (30) days written notice of
termination. In such event. Consultant shall he entitled to receive and the City shall pay Consultant
compensation for all services performed by Consultant prior to nx:eipt UfSllCh nutice ul'tenninatiun,
subject to the follO\ving conditions:
a. As a condition of such payment, the Executive Director may require Consultant to deliver
to the City all work product completed as ofsueh dale, and in such case such vmrk product shall he
the property of the City unless prohibited by law, and Consultant consents to the City's use thereof
I(lr such purposes as lhe City deems appropriate.
b. Payment need not be made for work which fails to meet the standard of pcrformance
speci fied in the Reeitals of this Agrecmcnt.
13, mSCRIMINATlON
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, selcction, training, utilization, promotion, termination or
other employment related activities, Consultant affirms that it is an equal opportunily employer
and shall comply with all applicable federal, stale and local laws and regulations,
5
14. JURISDICTION - VENUE
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 Agrccmcnt
shall bc determined and governed by the laws of the State of California. Roth parties further
agree that Orangc County, California, shall he the venue tile any action or proceeding that may
be brought or arise out of in connection with or by reason or 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 Uniled Stales, the Stale orCalilurnia,
the City of Santa Ana and all other governmental agencies, Consultant shall notify the City
immediately and in writing of its inability to obtain or maintain such permits, licenses, approvals,
waivers, and excmptions. Said inability shall be cause for termination of this Agreemcnt.
16. MISCELLANEOUS PROVISIONS
a. EaL:h llIllkrsigned represents and warrants that its signature hereinbelo\v has the poweL
authority and right to bind their respective parties to each of the terms of this Agreement, and shall
indcnmi(y City fully, including reasonable costs and attorney's fees, for any injuries or damages to
City in the cvcnt that such authority or power is not, in fact, held hy the signatory or is withdrawn.
b. All Exhibits referenced herein and attached hereto shall be incorporated as if fully sct
f,mh in the body of this Agreement.
//
II
II
II
II
II
II
II
II
6
IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year
first abov'e written.
ATTEST:
~ . A z'1;
--- ;- /
-~ PA RICIJ\ E. HEAIy v
Clerk oi'the Council
APPROVED AS TO FORM:
.(,~,
RECOMMENDED FOK APPROVAL:
~~j1 ~)tL{do
JI1\J'ATRICI '. WHI rAKER
toU Executive Director of the
Community Development Agency
CITY OF SANTA ANA
~
DAVIDN, REAM
City Manager
CONSULTANT
4?
DAN ROSA
Vice President
Tax 10# "t; -0 ~(.- 2.<:t4-<:j
7
GAFF Group Inc.
General Contractor
Proposal
Date: 51912006
To~ City of Santa Ana Project: Picture Frames Installation
The Depot at Santa Ana
LOOO East Santa Ana Blvd. Suite 108
Santa Ana, California 92701
Alln: Carolyn Fuller! Fax No. 714/565-2693
HEREIN IS AN ITEMIZED QUUTA1l0NjPHOPOSAL FOR THIi CONTRACTSUMANO/OR TIME FOR THE ABOVE REFERF.NCF.D PRO]ECf_THIS
DOCUMENT,WHEN FULLY EXECVfED, AS AL'CEJ7l."ED, SHALL CONSllTUTE AUTHORIZATION TO PROCEED WITH THE WORK DF..5CRlBliD.
Furnish and install (13) Custom Picture frames as directed. Paint frames as selected by client.
1,692.00
SUB-TOTAL:
10.0%
1,692.00
169.20
.9uhOH &P
GC
Subtotal
Insurance Fee 0.5%
1,861.20
9..11
TotalCost $
1,871.00
GENERALCONTRAcrOR
GAFF Group, Inc.
Daniel R. Rosa
~eClltive Vice President
Date~
51912006
OWNER
City of Santa Ana
I ACCEPT
J 00 NOT ACCEPT
I
{Signature)
Title:
Data:
159Z N. Bntavla #2 Orang~ California 92867 714199809789 Fax 714/998-9793
EXHIBIT A
EXHIBIT B
ADDITIONAL INSIJRED ENDORSEMENT
FOR COMMERCIAL GENERAL LIABILITY POLICY
Insurance Company
This cndorsemcnt modifies such insuranee as is a!lorded by the provisions of Policy
# relating to the following:
L 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 trom thc operations
and uses performed by or on behalf uflhe named insured.
2. With respect to claims arising out of the operations and lIses performed hy or on
behalf of the named insured, such insurancc as is afforded by this policy is primary and is nut
additional to or contributing with any other insurance carried by or lor the bene/it ofthc
additional insureds.
3. This insurance applies separately to each insured against whom claim is made or
suit is brought except \-vith 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
\Nould have as a claimant if nol so im.:luucu.
4. With respect to the additional insureds, this insurance shall not bc eancelled, or
materially reduced in coverage or limits cxcept after thirty ('10) days written notice has been
givcn to the City of Santa Ana, 20 Civic Center Plaza, Santa Ana, Calil(lfllia n70 I.
(Completion of the Jolluwing, ineluding countersignature, is required to make this cndorscment
eITective,)
, this endorsemcnt form as a part of
Efrective
Poliey #
I ssued to
Named Insured
Countersigned by
Authorized Reprcsentative
8
.' 't';...,
r! 0 ~ ':1 i D
ACQRD
,.
p
Wdtil -'II'/ew-aWlj P"'ISl'~
CERTIFICATE OF LIABILITY INSURANCE lllAr~;~::.;"')
Pfl:OOU(;EA ~1IIlo1". (7H)1l13-I"U F~' (11<11,,::10Q811 TH!!) C.eA.TIFICATE I$ISSUEO AS A M"nIiR OF INFORMATION
ELMCO INSURANCE,/NC ONLV AND CONfERS NO RIGHTS UPON 11t!: CEftTlflCATI!:
1108 N. MAIN STREET HOLDtlR. llIS CERTlP1CAU: DOlI. ,",01" -."'IiNb eUiNQ OR
CfANTA ANA CA 92706-2179 At Tl:R nil! OO....f':RAG!! AfFORD." iiy THe pou'CIES &ELOW_
Ageng: !!~_ 0509747
INSURERS AFFORDING COV~Gt:
IINSU~ER A:~LDI\""ti'~G1."~ INSURANCE CORPORA nON
IIN~UR~~~~:_ AMfj~I~,~jNrli~Nj!!ONAL_ SP~C"l .~ :~.-.
IINS':lREA c: ., .._._ _._ .._
INSUR~R o.
iINsuRERe~-
IMSURED
GAFF GROUP INC~
1592 N, BATAVIA. SUITt: 2
ORANG!!. CA'Iz667
FAX; 714-ii8.J793
N- ;l.to(p -0 'Ir'o
COVERAGfS
THE pOLICIES Ci tN8l1MNct lllTfD BelOllllI-tAVE Il!:EIII1!lSUfO TO THE INSURfD j),I\8O\IE FOR THE POUCYPl!RjOO INDICA.1l:D, NO,wmliTAWO,lIIG
~ AEQUlR&lEiNl. 'n!"!III 01'1 CONllmQj..l 0': 1W't CONTRACT OR. O'PHCR aOCut.tl!NT wn'14 fIE::Il'fCT '1'0 \"lt1ICH nus Ciil'HIFtCATf liIAY It 11l.:illfO OR
""'1 PERrALll n-tE INlIU'V\NC~ llJII'OFlDl;O 11'1' TttE P,JUClfS DESCAl8Ii:I) HfRl:IN la :WilJior TO Il1L THE TERMS. EXCLUSIONS AND COHDI'r'ON' ()l: SUCH
I"OllCU!'S .t.GGFlE(tAl'c LIMITS !lHOWN MAV u..lJlii lltOtiN REDUCED BV PAlO CLAIM!
w...I.um'-1 rw-F'eOl' I~:SURANCE
.rlll~
JlOUlotU1'EC'J1'4
~~
POLl!,;..,. NUM8ER
CBPIt.:;i7D734
~Ytlll1lUollON
"
03/11/01
u.=
e:...CM OCCUR:Nt;NCE s
~OiiHi~-~------ "
I""~_~~li._~____\
MCOI:XPIA/llrOMPJrhQ'l1 "
j_~~_~~ & Piv i~~Rv---.I' ~
,Gl':NeRAl. AGGRt:GATE a
I "RODl}~T!.~OUP1~ ~- - ; ~
SlNIiR.t.L LlA8IUlY
I X I COlll~..iIlCIAl GfNfltAl L'A6IU1Y!
I I CLAIMS MADEJ X. OCCUfl
03111/06
A
, I I
&:N-l.lllOGRfGATE llMH APPliES PI:'"
I --- PRO I
.. PUUCY ; JECT, lOC i
AUl'OMOeA.2UU1lITY
I MlYAUTO
AllOIlltNEO.t.UTOS
SCrlECuU:C AUTOS
l-I ~:::~S'U'b'
COM~INUl :Ullllilt LlMff
'&Cllllli4IlntJ
IlODIlYlNJUflY
(......~l
IIlOUILYII\lJU~Y
'(1'...."""-11
IPROPfiFtT't ONlAGe
IP<or..wanl)
G.AAG.I!LIAeIUlY
~'_- ~l ANY"'lUO
~!'!!.Q.qNl'(k~~~ElIIT ..
Ottfl':Fl THAN lOA Ace I
AtlTOONl't': -'-A~ ,
I:AtHOCCtIlfREIIlCl a
ItJ.lili~ Illlll8RE'LLA LIABILITY
.X'IOCCUR r.....1ClAWlIlIwIAL:1E
BE9304G31
Ql/'t't1a6
0111110'1
AMftl!BaT'
-.---..,--.
FOLLOWiNG rORM
..~ --
. EXCliSSCGlONl..,
I
,
,
,
"
I.
..-.-..\...-
I,
.
oeOUCT~Le
RllTEN'ffOU::l
1D,OOO!
~ICtl
,
~...
I
. __,jIO.OUO
_.... ,!~laOO
_ _n.~_l~O
J'~I,~O;!).
~!~O.O,ODO
~~.OO~OOO
.
j~
,
~~O,OCb
__.,~~_OOO
GTA'hl, "'ioflili
~'J:!!l!s. . .
Ie-L EACKACCIOliN1' I'
; ::~,~::a~W'~wnvE E_'- O';;;;:~~.&..UIV'''O''EE - $:.
!;:::.-;~.=::.~:....... E,L01~~~lCfllMlT' i~
o EI SSPERSONAL CPP911G7U O3I11/Q6 03/11/07 $55.000 PROPERTY LIMIT
A 'I PROPeRTY. SpeCIAL fORM, IbEOUCTlftle: $500.00
fU!l>LACIEMaHTCiOST,60'V. LOCATtON.1692N.8AYAVlA 5UITE2
COtNSURANCE . .
OESCN'PIION Of OPERATIONS/LOCA.TIONSlVEHICLE5/fiXCtU3fONS ADDED BY ENOORSI!Ml!NTI SPECIAL PROVlS10l11S
CARPENTRY .10 DAY NOTlCEi DUt;;: TO NONPAYMI!NT
'fH[; OIl!POT AT $AN'1'A AMA ~ ~ Of THf IIBOVE DESCRllleD POliCIeS ~ CAMUlleo BEfORE THe
fXJ>JRA't1ON OATf 1IEREDI'. THE ISWING IN8UAER WILL '''i'0 '-P "'0 MNL "30
"00 EAST SA.TA ANA BLVD SUITE '~ DAYS 1I'l/an--TlN .-o1lCE 10 THE CERTU'lCAlI: HOLDlfl. NNIIID to TIlE lfFT,.III.J.
.A.TA ANA CA92701 ._ ~//2., Inillfll!R. TI ilL In 9.. AlPRU[lfl'" Jr rES'
#'Ut!-fORIliD RfPRE6fHT,.,T/Vf
)~<-:?/\)r i~.&L
Attunlion: - "v. allSh
CERTIFICATE HOLOER
CANCt:LLA T10N
ACORD 25 (2001108)
CC111fic"'lcM :t415D
~ACORDtoRPORATION '891
.
~dO'1
No 2 iJ I J P
I! A1~ aWI1 pa^!aJaH
COMMERCIAL G!:NEllAI LIABiliTY
N d Y ! i !. J ~I:> 'J. ~ .I ,I.>.,'~
POLICY NUMBER CBP9576734
THIS ENDORSEMENT CHANGES THE POLICY PLFASE READ THIS CAF<EFU11 Y
AODITIONAlINSURED PRIMARY COVERAGE
This endorsement modifies Insurance pro",lded undef the following"
COMMERCIAL GENERAL liABILITY COVERAGE PART
"fhis insurance is primary for the penton or organization Ghown In the schedule. but only with respect to liability arising out at your
work OJ that insured by or fQr ~OU. Olhcl' insuranM afforded to thi:ll insured will apply as e)Ccess and no~ co/lb'i~.u!e.~,~,pri,m~~xto.tnl;lo
jl1&Uftln~.~,1TQ(q~,ct~YJ~I,S_~11t:10f&e.r:n~l)t~h ,";<., _.,.<c <, '.~-h '. -. ..
i'_"'C"~"""-"""-'" _c_.
All othr;( flndor6em~nt prov,sions, conditions and Itll'GIUSions or this insufcnn;t: ,11.11 'umaln uflchllnged and apply 10 the addlllonal
Insured and dtll'crtbed blil'Juw
SCHEDULE
ADDITIDNAL INSURED
THE DEPOT AT SANTA ANA
1000 EAST SANTA ANA BLVD SUITE 108
SANTA ANA eA 92101
CONTRACT/PROJFCT
NAMED INSURED GAFF GROUP INC
1592 N. BATAVIA. SUITE 2.
Or~ANGE. CA 92867
FAX 71'i-998-97G3
Cen.ifjeall!l" 34150
tit z-l"L
CERTHOLDER COPY
SG
STATE
COMPENSATION
INSURANCIi
FUND
P.O. BOX 420807, SAN FRANCISCO,CA 94142.-0807
CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
ISSUE DATE: OSw09-200B
GROUP: 000229
POLICY NUMBER: oo2307B-2006
CERTIFICATE ID: 94
CERTIFICATE EXPIRES: 01-01-2007
01-01-2006/01-01-2007
THE DEPOT AT SANTA ANA
1000 E SANTA ANA BLVD STE 108
SANTA ANA CA 92701-3900
sa
This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the
C.ilifornia Insurance Commissioner tathe employer namedbelovv for the policy period indlcated.
This policy is flot subject to cancellation by the Fund except upon30 days advance written notice to the employer,
We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration.
This certificate 01 insurance is not an insurance policy and does not amend, extend or alter the coverage afforded
by the policy listed herein. Notwithstandin!il any rl9quirement:. term or condition of any contract or other document
with respect to which this Cllrlificahll of Insurance. may be issued or to which it may pertain, the insurance
afforded by the policy described herein is SUbject to all the terms, exclusions, and conditions, of such policy.
~REPRESENTATI
EMPLOYER'S LIABILITY LIMIT
~
PRESIDENT
INCLUDING DEFENSE COSTS: $1.000.000 PER OCCURRENCE.
ENDORSEMENT #2085 ENTITLED CERTIFICATE HOLDERS' NOTICE EffECTIVE 01-0t-2005 IS
ATTACHED TO AND fORMS A PART OF THIS POLICY,
-
EMPLOVER
GAFF GROUP, INC AND/OR TRI-COUNTY DRYWALL &
INTERIORS INC. DBA: GAFF GROUP, INC DBA:
TRI-COUNTY DRYWALL & INTERIORS, INC.
1592 N BATAVIA ST STe 2
ORANGE CA 92867
fflry
PRINTED
leKS,eN!
05-09 -2006
(REV.2-051