HomeMy WebLinkAboutHARTL, DAVID E (GENERAL LEARNING CLIMATES 5)-2006
NOTICE OF ASSUMPTION
Re: Consultant Agreement A-2006-21I for Meeting Facilitation and Policy Implementation
Consulting Services including appraisal and right of way acquisition services.
NOTICE IS HEREBY GIVEN by General Learning Climates, Inc. to the CITY OF SANTA
ANA (hereinafter referred to as the "City") as follows:
1. The City of Santa Ana and General Learning Climates, Inc., entered into Consultant
Agreement A-2006-211, dated August 7, 2006 for provision of meeting facilitation and
policy implementation consulting services; and
2. Said Agreement was signed by David Hartl as the President of General Learning
Climates; and
3. Said company has been reorganized and is now doing business as davidhartl.com, a
sole proprietorship. Service of Process will be to: davidhartl.com, P.O. Box 2788,
Orange, CA 92869; and
4. davidhartl.com hereby agrees to honor the terms of "Consultant Agreement A-2006-
211" dated August 7, 2006, attached hereto as "Exhibit A" and by this reference made
a part hereof; and
5. davidhartI.com hereby accepts and assumes the rights, liabilities and obligations of
General Learning Climates, Inc. under said Agreement, from and after the effective
date of reorganization; and
6. All required insurance documents and bonds shall be issued in the name
davidhartl.com, and all payments by the City shall be made in the name of
davidhartl.com.
DATED:
( ;'~/o7
, ,
Davidh~rtl.Com .5Jk
BY: ~S ill}
TITLE:
...-;<7 .. '
.\ ,,~\ V\, C \ <;/(:1 ~
,
TAX ID #22-3949474
The City of Santa Ana hereby acknowledges and accepts the terms outlined in this "Notice
of Assumption" agreement.
ApPROVED TO FORM:
Joseph W. Fletcher
City Attorney
)
CITY OF SANTA rJ
/~IAIAO/:
I ~MES. Ross
( xecutive Director of Public Works
,/It) Ie 7
DAn:'
ATTEst.
~dd
P/JTRICIA E. HEALY ~
C/.:'r,.,,, OF THE COUNCIL
Pb (J.)
~,~
. .orrrrl){Y-" ,..-
INSURINCt NCil( \UI~~l1
~ \NOR~, \1' 1 If OOEED
wt~ CLEt:~ (F ( C ~NCIL
D~TE: 8.- do 3 roCp
THIS AGREEMENT, made and entered into this ih day of August, 2006 by and between
General Learning Climates, Inc., a California corporation (hereinafter "Consultant"), 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").
A-2006-211
CONSUL T ANT AGREEMENT
RECITALS
A. The City desires to retain a consultant having special skill and knowledge in the field of
policy implementation required for the City to provide policy implementation required
for the City to provide continuous quality service to the public.
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 of the mutual and respective promises, and subject to the
terms and conditions hereinafter set forth, the parties agree as follows:
1. SCOPE OF SERVICES
Consultant shall provide policy implementation and planning and meeting facilitation
services and assist in defining organizational issues and enhancing internal communications
within the City, as set forth in Exhibit A, attached to this Agreement, and incorporated by
this reference.
2. COMPENSATION
a. City agrees to pay, and Consultant agrees to accept as total payment for its services, an
hourly fee of one hundred, seventy-five dollars ($175.00). The total sum to be expended under
this Agreement shall not exceed $60,000.00 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 July 1, 2006 and terminate upon expenditure of
allocated funds, unless terminated earlier in accordance with Section 12, below.
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. Due to the nature of services provided, Commercial General Liability Insurance is not
required.
b. 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.
c. 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.
6. INDEMNIFICA TION
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 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,
2
employees, or other persons acting on their behalf which relates to the services described in
section 1 of this Agreement.
7. CONFIDENTIALITY
If Consultant receives from the City information which due to the nature of such
information is reasonably understood to be confidential and/or proprietary, Consultant agrees
that it shall not use or disclose such information except in the performance of this Agreement,
and further agrees to exercise the same degree of care it uses to protect its own information of
like importance, but in no event less than reasonable care. "Confidential Information" shall
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 of law; 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:
Captain of Administrative Services
Santa Ana Police Department
60 Civic Center Plaza (M-97)
P.O. Box 1981
Santa Ana, California 92702
telefacsimile (714) 245-8007
Executive Director - Public Works Agency
City of Santa Ana
20 Civic Center Plaza (M-21)
P.O. Box 1988
Santa Ana, California 92702
telefacsimile (714) 647-5622
3
and
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:
Dr. David Hartl
General Learning Climates, Inc.
P.O. Box 2788
Orange, California 92859-0788
telefacsimile (714) 544-5061
A party may change its address by giving notice in writing to the other party. Thereafter,
communication shall be addressed and transmitted to the new address. If sent by mail,
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, 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
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.
4
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 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.
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
5
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
"--_ftg;;c<~JJ---er
PATRICIA E. HEALY /)
Clerk of the Council
(l4a.
DAVIDN. REAM
City Manager
APPROVED AS TO FORM:
JOSEPH W. FLETCHER
City Attorney
BY:~:u~
La~ heedy
Assistant City Attorney
CONSULTANT
GENERAL LEARNING CLIMATES
~~-"'; ')
ci / /;
DR. . DHARL -=-
President
Tax ID# 33-0067744
6
-
EXHIBIT A
SCOPE OF SERVICES
Consultant shall, as requested and in collaboration with the department heads, provide
consultation and training in the following areas:
1. POLICY ANALYSIS
Assessing the impact of implementation of policies designed to improve the quality of services
provided by the Agencies and Departments comprising the City of Santa Ana.
2. CONSULTATION SUPPORT
Providing assistance with managing the changes required as the organization undergoes ongoing
transformation to continuous quality management and services. Providing assistance with
insuring that the organizational climate supports the values of integrity, community safety and
security, community participation, courteous and efficient service and organizational growth.
3. TRAINING SUPPORT
Providing in-house training and team development experiences for organizational executives,
managers, supervisors and employees to support the transformation of services to a quality basis.
4. DEPARTMENTAL ORGANIZA TION/COMMUNICA TION
Consultant will assist in defining organizational issues and enhancing internal communications
by performing the following tasks:
· Conduct interviews with selected employees for the purpose of identifying issues and
concerns that should be incorporated into a survey instrument.
· Prepare a survey instrument to be used for employee surveys
· Conduct a pilot administration of the survey with a selected group of employees and
modify the instrument as required to optimize its validity
· Administer the survey instrument on site to effected employees and collect the completed
surveys for tabulating immediately upon completion
· Tabulate and analyze survey responses and organize findings
· Prepare the various reports that are required to communicate the survey findings to
effected employees and managers
· Present the survey findings to necessary leaders in the effected department and help to
determine how the reports will be used for guiding continuous improvement in
organizational effectiveness.
7
::avid Hartl
FRX NO. :714-633-1299
Sep. 06 2006 01:25PM Pi
':':.~~~>.ftli~S~
/".1.0
. ..~....
CERTIFICATE OF UABILIlY INSURANCE
P DATI;(~
~~~1 03 24 06
THIS CERTIACATE IS ISSUED AS A MATTER OF INFORMA110N
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER WE COVERAGE AFFORDED 6Y THE POLICIES BELOW.
,.,:?:, I:\suranc& Ag8nay Ine
~~::..1 ~ureka Avenue iF
'"~<':-:-h~, Linda CA 92886
--: 714-572-9700 1;'",,:714-572-9880
INSURERS AFFORDING COVERAGE
NAIC#
- :'c'XC LEJ.RNING CLIMATES
::'",,"I"J:O HAR~L . /
~~.""Y ~'78E1 /; '1A1I_--e:J.1.
.::; C:J,. 92859-0788 fl OluVlf'
INSURER A: STATB (l(lNPBMSA'nCM XN!l PUlftl
INSU..R .: HARTFORD CASUJlLTY INS CO
INSUR'EiR c=
INSURER D:
INSURIO.RE:
29424
.. ,::, or.- INSURANe~ 1,1$i"'GO ,1iil,.OW HAIlE BEEN ISSUED TO Tl-tE IN$U"liiP NAMeD AIOVE FOR THe POLICY PERlOO INDICATED. NOlWITHST4NClNIJ
.;:,"l";', T~ OR CONOfTION OF ANY. CONTRACT OR OTWI!~ OOCUI\IIENT WITH RESPeCT TO WWI~ THIS CliATIFlCATE MAY 9E ISSUED OR
-'.'E NSURANI:S AFFOl':tDIUI DV TI1E POlICIIiS DESCA.leeD I1IO~EIN 15 6U8JECT TO AU. THE TERM6, EXCLUSIONS ANO CONDtTIONS OF SUCH
,-:' :n~C:A~L1M~.$S_MOV"t'''~Y.'HAVI!;~~I!N,13,~RUJ~~JV..ehIi:!,CLAIMS,..' -' .~. .'- -',----'-' -".-'.
.. -7. -1..SR~ TYI'~ 0' lHaURANCIi
i ~~IiRAL UASIUTY
8 X fXl COMMERCIA\. GE:NIiRAL LIABilITY
~ CLAIMS MAnE 00 OCCUR
'.",,:~~~~s Owners
POUCY NUMB~
OArs
LIMITS
72SBAK09228
04/01/06
04 01/07
eACH OCCURR~NCE
PReMISES lea occuteneEI
MEO EXP (Any one p8t'800)
PERSONAL & ACV INJURY
GEMERALAGGREGA'TE
PRODUCTS. COMP'IOP AOO
s 1000000
s 300000
'10POO
, 1000000
s 2000000
s 2000000
coo
~ -~<A9UTY
COMBINED SINGLI! LIMIT .
(!!:aaedr;kJnt)
tIODll Y INJURY .
(PMl)EII'iIOr'I)
.eOOll Y INJURY .
(PlJr/ilQ;lClentJ
PROP5RTY DAMAG5 ,
(Pe(aCCldenO
AUTO ONLY - CA ACCI061'(f $
. """,'IJT0
.,~; 1,\;1'05'
S . . SCHEOULEo AUTOS
I HIRIiiDAUTOS
NON.()WNeO AUl'OS
_....1
OTH~R THAN
AUTIO ONLY:
EAACC I
.AGG .
"'---"~''l.'M8REiLU UAall.lTY
, ~CCUR [J CLAIMS MA~E
EACH OCOURRENCE
AGl)REGATE
.
.
.
.
,
7!C~J $
I WORKERS CQMPEN3ATlON ANO
, EMpL.OYERS'LlABlLITY
,i\,. ! ANY PROP~'ETOR!PAR"N!:RfEXECUTIVl;;
. OI=FICIiiM.4EM!;!I!R l;;XCLUOEO?
, -:le~liIl.lndet
-.-,.,. ;'~t: PRO\IlSIONS be/ow
1443563
04/01/05
04 01/06 .1000000
,1i.L DI6eASE-EA EJdPLOYE6 '1000000"
E.l.,OtSeASe.POLlCYUMlT S 1000000
'.~ '",'J..tiAATIONs II"QCATtONSI VEHtCU!81 EXClUSKlNI ADDED'QY ENDORSEM!NT 1 SPECIAL MOI/ISlONS
(ZIONS OF THE INSUREO AS COV!:IUilO BY THESE 5'OLICIES.
':~CITY OF. Sl\N'1'A.~, I~SOFFICERS, AGENTS, EMP
., ARE NAM!lO ADDITIONAL INUSiU!:O PEa ATTAClIED CG2010
-". CANCELLLATION APPLIES FOR NON-PAYMENT OF PREMIUM.
.: :::.~'9CATE HOLDER
CANCELLATION
: CONSULTING
ES; .I\ND
/93. TEN DAY
CITYOFS
SHOUU) ANY Of THE I; DIiSCR.lllED POlIelU .~E C LLIi]) DEFORE THE EXPIRATION
DATIi.THI!:R~F,"rHEIS! ING1N_~URERWll;.L.[ '__ ~ DAV&wmn~
. -- --..-"-- -.:./. ~,
NO"nC1! TO Yttlt: ~T1fIOATE HOLDER ~o TO THi(L.EFt. ~UT"'fiImgg::lCR2'.-..s.fnW.L
"POD NO OBUaA11ON Oft UA8LlTYOP"ANY KINO UPON M INSUA.~ In AQENTS OR
REPRElENTATP41.. / //
AUTMO~ REP TIVe ~/.
-.~y OF SAN~A ANA
"':'~ ~;:'! (:LEiU(
"~VIC CENTli:a FLAM
'-',. ,'I.~'J\ CA 92701
~~.-
. '-':'!)
@ACORDCORPORATION 1888
:::'(QM :Dr. David Hartl
FRX NO. :714-633-1299
Sep. 06 2006 01:26PM P2
~..,. ., '._, ' -'. ."" " ., '.,' \
. .. ":"A'~"';"':'
. " "..,....i"W..'''"~.
':,<'."I;,':"I'.'~"_'.:..'I:.~J~
" :v NUMBER: 72SBAKD9228
COMMERCIAL GENERAL LIABILITY
,;";;;I\,,D: GENERAL LEARNING CLIMATES
THIS ENDORSEMENT CHANGES THE POL.ICY. PL.EASE READ IT CAREFUL.lY.
ADDITIONAL INSURED. OWNERS, LESSEES or
CONTRACTORS [Form B]
. e1corsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
"__ _:___....:..,_',__',J_~~. _.-'_'_~ ,.
'----:'-._,-~,--_.'_.~~ ---
~--- .-.'-- - ---.-
SCHEDULE
Name of Person or Organization:
Chy of Santa Ana, its officers. agents, employees and volunteers are named additional insured.
.. d/ appears above, inlonnation required to complete this endorsement wiil be shown in the Declarations as applicable'
o ~j:dorsement.) ..
~ e, , .
,-<) IS AN INSURED (Section II) is amended to include as an insured the person or organization shown inthe
SChedule, but only with respect to liability arising out of "your work~' for that insured _ by you. ..' ..
, . ,,," ,_, .,,' "", .'''' " ."'., ..t.
. - ." '''!RTHER AGR,EED THAT SUCH INSURANCE AS IS AFFORDED BY THIS POLICY FOR THE BENEFIT OF THEAHOVE; ....
~:c~:ONAL INSURED(S) SHALL BE PRIMARY INSURANCE AS RESPECTS TO ANY CLAIM, LOSS OR LIABILITY ARISING
i G? THE NAMED INSURED'S OPERATIONS, AND ANY OTHER INSURA~CE MAINTAINED BY THE ADDmONAL
'11f-'3D(S) SHALL BE NON.CONTRIBUTORy'WITH THE INSURANCE PROVIDED HEREl.lNt>ER. .
/38, - '7 /7
. '--- '''-.
(//> '
---,,_._- ~,.._--'~.\._------'-...,-"....:._,~..
. .....,,'. .-."
---"'-- --------.-----.;-,----'-- - ._- .,-;...,..~..:..,,,..,."~ ...-
.
C020101185
~"':l"riQht, Insurance Service OffIce, Inc., 1984 .
STATE FARM
A
INSURANCE
SEPTEMBER 05, 2006
AUTO POLICY STATUS
HARTL,
3808 E
ORANGE
DAVID E
LARKS TONE DR
CA 92869-5355
B PHONE:
MUTL V54 1083-A15-75P
00 LEXUS LS 400
4DR
VIN: JT8BH28F3Y0177545
(714) 544-5000
IRG: 26 LRG: 05
ZIP: 92869
CLASS: OH30CV1F
ACC FREE: JUL-15-85
BIRTH: APR-03-39
STATUS:BAL D DUE DATE:SEP-13-06 TERM DATE: TOT PREM:
AMT DUE: 311.51 OXD:JUL-15-88 COY DATE:AUG-28-06 PREY PREM:
631.50
647.74
A 1MM /lMM /lMM
C5000
D100
G250
H
262.80 R1 80% /500
16.23 U 30 /60
78.24 U1
239.04
3.20
16.80
14.11
1. 08
AMT PAID: 325.87 DATE PAID: JUL-25-06
GRP 07/15/96, CDR SR 575.33, MCD 149.41,
LD 6 116.58, CGDD 157.88, VSD 30% 7.06,
ODM 57357 01-05, MLD 15% $108.04 HOMEOWNERS.
REPLACED POLICY: V541083-750
B PHONE: (714) 544-5000
POLICY FORM: 9805A
NAME: HARTL,DAVID E
EXCEP. & END: FINANCED
TERM NOTICE - CITY OF
SANTA ANA CA 92701.
DRVR DT OF LIC RL
DAVID 04/03/1955 SR
- MARIWEST PO BOX 53953 SAN JOSE CA 95153, INS. CERT
SANTA ANA CT ATTN: CITY CLERK 20 CIVIC CENTER PLAZA
NXT RL-DT
ACC/CONV DATE INFORMATION
REC CHG:
COY. S & Z NAMES
S AMT
Z
.
.
6037F.ll CERTIFICATE OF INSURANCE
58230-4-M 4 M
Agent 8549
AFO 419
This is to certify that:
State Farm Mutual Automobile Insurance Company
Illinois has coverage in force as shown below for the named insured.
days written notice to:
, of Bloomington,
If the coverage is changed or temlinated we will give 10
CITY OF SANTA ANA CT
ATTN: CITY CLERK
20 CIVIC CENTER PLAZA
SANTA ANA CA 92701-4058
DesCllption of Vehicle: 2000
LEXUS
JT8BH28F3Y0177545
LIABILITY - COVERAGE A
Limits ofLiability
Bodily InjUlY
each person I $eaCh accident
$ 1000000 1000000
Property Damage
each accident
Bodily InjUlY and Property Damage
Single Limit
$ 1000000
$
each accident
This Certificate oflnsurance does not change the coverage provided by the described policy.
'6'
~
~
~
o
.
S
'"
o
o
N
N
o
~
Named Insured HARTL, DA VID E
Policy Number
V54I083-A15-75P
~~\<.--\9/.
Chief Executive Officer
Effective Date
AUG 282006 ,/
12:01 A.M. Standard Time
Countersigned
~
'"
o
~
"-
'"
(Year)
6037F.ll
By
Authorized Representative
r7)
(!j'^" ....
,~"
.>
STATE FARM' INSl1RANCE COMPANIES@
..
900 Old River Road
Bakersfield CA 93311-0001
DATE OF NOTICE: FEB 152005
CODE:
38A
A
R
CITY OF SANTA ANA CT
ATTN j CITY CLERK
20 CIVIC CENTER PLAZA
SANTA ANA CA 92701-4058
NOTE: PLEASE NOTIFY STATE FARM AT THE
ADDRESS LISTED AT THE TOP, tEFT CORNER
OF THIS PAGE REGARDING ANY CHANGE OF
ADDRESS INFORMATION.
7
6
4
3
11.1....1.11...111......11.1..111....1.1.1..1...1.111.....1.11
<Xl
o
o
8
~
ADDITIONAL INSURED'S NOTICE OF COVERAGE
State Farm Mutual Automobile Insurance Company
NAMED INSURED: POLICY NO: V541083-A15-75N
g HARTL,DAVID E & JOHNSON,JERENE YR/MAKE/MODEL: 2000 LEXUS 4DR
~ 3808 E LARKSTONE DR VIN/CAMPER: JT8BH28F3Y0177545
::: ORANGE CA 92869-5355 AGENT NAME: TANYA PEARSON
AGENT PHONE: (714)289-1226
ENDORSEMENT NO: 6028AU
8549-F418-M
COVERAGE:
BI AND PD LIABILITY
$ 1 MIL /$ 1 MIL /$ 1 MIL
$100 DED. COMP
$250 DED COLL.
,I ,Wi'~
. it
~
:>
GO
II:
..
l::i POLICY MESSAGES:
:8 The policy includes a loss payable clause protecting the additional insured's interest in the described car to the extent of the insurance
~ provided and subject to all policy provisions. The additional insured will be given 20 days notice if the policy is terminated. Until such notice
;d is provided, it shall be presumed that the required renewal premiums have been paid. The additional insured must notify us within 10 days of
N any change of interest or ownership coming to their attention. Failure to do so will render this policy null and void.
on
C
C')
...
POLICY EFFECTIVE
JAN 10.2005 UNTIL TERMINATED
-," )
.. .,~ .....~.
,
.-:-~ ..
; , ,-
~.?
.. - "~. .
v\;.c .
.1./ )'1..') .
'. ";...... ',-)./ .tU POk~1'
____-../.-,. '\: . .LY.l
--. "'-..;t I.., ;
,i;, "",,-,,,_~.~I c.:j,C~
''''''I~
. >"i""d! Ci;y ~i)eedY7'"---
ttorl1ey
0..
FRT
6037F.ll CERTIFICATE OF INSURANCE
12212-4-M - 4 M
Agent 8549
AFO 418
\
Tllis is to certify that:
State Farm Mutual Automobile Insurance Company , of Bloomington,
Illinois has coverage in force as shown below for the named insured. If the coverage is changed or terminated we will give 10
days written notice to:
CITY OF SANTA ANA CT
ATTN: CITY CLERK
20 CIVIC CENTER PLAZA
SANTA ANA CA 92701-4058
Description ofVehic1e: 2000
LEXUS
JT8BH28F3YOI77545
LIABILITY - COVERAGE A
Linlits of Liability
Bodily Injury
each person each accident
Property Damage
each accident
Bodily Injury and Property Damage
Single Linlit
$
1000000
$
1000000
$
1000000
$
each accident
This Certificate of Insurance does not change the coverage provided by the described policy.
'6'
'"
"-
0>
o
C1l
:2-
'"
o
o
N
N
o
'"
Named Insured HARTL,DA VID E & JOHNSON,JERENE
Policy Number V541083-A15-75N
~~~~~$;>,.
Chief Executive Officer
~
o
CD
~
'"
Effective Date JAN 10 2005 ~~OVED AS >, ,Countersigned
12:01 A.M. Standard Time
-'
. .~ :!_,
.~:-" ( ) J/'\JJ"-- ~
(Year)
I trq By==_
6037F.ll
Assistalll ;,_.
Authorized Representative
q
· STATE FARM INSURANCE COMPANIES~
900 Old River Road
Bakersfield CA 93311-0001
DATE OF NOTICE: JUN 232006
CODE:
23 39A
A
CITY OF SANTA ANA CT
ATTN; CITY CLERK
20 CIVIC CENTER PLAZA
SANTA ANA CA 92701-4058
NOTE: PLEASE NOTIFY STATE FARM AT THE
ADDRESS LISTED AT THE TOP, LEFT CORNER
OF THIS PAGE REGARDING ANY CHANGE OF
ADDRESS INFORMATION.
11.1....1.11...111......11.1..111....1.1.1..1...1.111.....1.11
---.-----
LA- rZ()()d; -0<2//
-1
/
I
J
~
<:>
<:>
<::>
<.:l
ti
I ADD!TIONAL INSURED'S NOTICE OF COVERAGE
State Farm Mutual Automobile Insurance Company
NAMED INSURED: POLICY NO: V541083.A15-750
g HARTL,DA VID E & JOHNSON,JERENE YR/MAKE/MODEL: 2000 LEXUS 4DR
ClI 3808 E LARKSTONE DR VIN/CAMPER: JT8BH28F3Y0177545
~ ORANGE CA 92869-5355 AGENT NAME: TANYA PEARSON
AGENT PHONE: (714)289-1226
ENDORSEMENT NO: 6028AU
8549- F419- M
COVERAGE:
BI AND PD LIABILITY
$1 Mil 1$ 1 Mil 1$ 1 Mil
$100 DED CaMP.
$250 DED. CalL.
iii.....!
..
'If!
,;
G>
a:
POLICY EFFECTIVE
JUN 142006 UNTIL TERMINATED
~
N POLICY MESSAGES: This policy shown above supersedes policyl V541 083-75N.
~ The policy includes a loss payable clause protecting the additional insured's interest in the described car to the extent of the insurance
.!!..
.... provided and subject to all policy provisions. The additional insured will be given 20 days notice if the policy is terminated. Until such notice
!2 is provided, it shall be presumed that the required renewal premiums have been paid. The additional insured must notify us within 10 days of
~ any change of interest or ownership coming to their attention. Failure to do so will render this policy null and void.
.;
C')
....
~
FRT
--
6037F.ll CERTIFICATE OF INSURANCE
00894-4-M - 4 M
Agent 8549
AFO 419
This is to ce rti fy that:
State Farm Mutual Automobile Insurance Company , of Bloomington,
Illinois has coverage in force as shown below for the named insured. If the coverage is changed or terminated we will give 10
days written notice to:
CITY OF SANTA ANA CT
ATTN: CITY CLERK
20 CIVIC CENTER PLAZA
SANTA ANA CA 92701-4058
Description ofVehic1e: 2000
LEXUS
JT8BH28F3YOI77545
LIABILITY - COVERAGE A
Limits of Liability
Bodily Injury
each person each accident
Property Damage
each accident
Bodily Injury and Property Damage
Single Limit
$
1000000
$
1000000
$
1000000
$
each accident
This Certificate ofInsurance does not change the coverage provided by the described policy.
s
U1
"-
en
o
'"
2-
(Y)
o
o
N
N
o
U1
-'
Named Insured HARTL,DA VID E & JOHNSON,JERENE
Policy Number VS41083-AlS-7S0
~~\{~-\9/.
Chief Executive Officer
Effective Date
JUN 142006
12:01 A.M. Standard Time
Countersigned
"-
(Y)
o
CD
~
(Y)
(Year)
6037F.ll
By
Authorized Representative
, /
i ry(ji .r7
\'I':;!/..p/>
I
e.~..
,IAN, 1 1),20(18 9: 28f'M
STATE ~ARM
NO, 096
p, 2/4
....--.. . CERTIFICATE OF LIABILITY INSURANCE I DATE I~M/DDIYYYYJ
~c~d 01/11/08
PRODUCER THIS CERTIFICATE IS ISSUED AS MATTER OF INFORMATION
ONLY ANO CONFERS NO RIGHTS UPON THE CERTIFICATE
TANYA PEARSON A'ZENCY HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
7822 E. CHAPMAN STE. B AL TER THE COV-ERAGI! AFFORDED BY THE POI.ICIES B&LOW.
[IJ ORANGE, CA 92889
(714) 289-1226 INSURERS AFFORDING COVERAGE NAIC fI
lllNl1lll ii._
INSURED ...v. INSURER A; StatIO! E"1lrm Mutual Auto In.:;urance Comtlanv 25176 25178
HARTL, =~T~" DR -LA - 0200~ -02 /7] INSURER B;
3808 E INSURER C:
ORANGE CA 92869-5355
INSUR!;R D:
INSUFlER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED aELOW HAVE BEEN rSSUE:D TO THE INSURED NAMEO ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY Rl:QUIREMENT, TI!RM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH nHS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLlCles DESCRIBED HEREIN IS SUBJECT TO Al.L THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES, AGGR.EGATE UMITS SHOWN MAY HAVE BEEN RalUCED BY PAlO CLAIMS.
l~: r:~ 1.t1LK~Y.EFFECl1V1i PClLlCY EXl'IRA 110N UIIlITS
'lYPE OF INSURANCE POLICY NUMEIER DATE IIllWDDlVYI DATi IMIIIODlVYI
!mlERAL I.tMlll.lTY :=fl:rR~CE s
- ~ERCfAl GENmAL LIAIlILllY P rOE~~~ncel .
- CLAIMS MAD~ 0 OCCUR MED EXP rAllY one _sanl S
PERSONAL SAOV INJURY S
l!iENERAL AGGR!;;GATE $
GEM..ACQlEG6.Tl:LMT ~PER; -COMPIOP m3 S
1114 . n:flO- nl
OllCY .meT LOC
A X .!!!!OMOBIU! UABDJTV V54 1083-A15-75F 01/16/08 07/15/08 COMarN~D SINGle LIMIT
(fIl Q<<:ident) $
- IWf AUTO
X ALL OWNED AUTOIl BODILY INJURY $ 1,000,000
(P~ (lIIfaon)
- IICHeOULI,D AUTOS
- HIReD AUTOS BODIL V INJURY $ 1,000,000
NON'()\IYN~D AUTOS (per sockl9l1l)
-
P/ilOpERTY DAMAGe $ 1,000,000
(Pel' accident)
~ o\CHl UABlLITY AUTO ONL V - EA ACCIDENT S
- PJfY AUTO OTHER THAN EA ACe S
AUTO ONLY: AGG S
~~UMElREDBILITV I:ACH OCCURRENCE $
OCCUlt CI.AlM$ MADE AGGREGATE S
S
11DEDUCTIBLE S
RETENTION S - )( S
WORKERS COMPENlA11ON AND p~ I,WC STATU-g1 I OJ'~H.
I!MI"LOVl1RS' LIAEIILITY " TORY LIMITS R
ANY PROPflIIITORIPAATNER/ElCECUTIVE E L EACH ACCIDENT Is
OFFICERlMI!MBI:R (;J(CLUOED?
If m deacr1be under i:.L. DISEASE. t:A EMPLOYEE S
S e fAl PROVISIONS belllW I E,L DISEASE - POLICYLIMIT $
OTHER
1I1:$CR1PTrON OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADOI'D SY ENDORSEMENT I SPECIAl. PROVISIONS
THE FOLLOWING lS LISTED AS AN ADDITIONAL INSURED:CIT~ OF SANTA ANA 20 CIVIC CENTER PLAZA S~TA ANA CA
92701 ATTN: crTY CLERK
CERnFICATE HOLDER
CITY OF SAN').',. ANA
ATTN: CITY CLERK
20 CIVIC CENTER F~A
SANTA ANA, CA 92701
18~49 03. 3.2007
CANCeLLATION
SHOULD Nl'f 01' THI! ASOVE lllillCRIBED POLICIES 11I1 CAliICEllm BSFORE THE EXPIRA'IlON
DATE THEREOF, TttE; I$IlUING INSURER WILL E;NDEAVOIl TO MAIL _ DAVS WRlnEN
NO'I1CE to TttE Cl!!It1lFlCATE HOLDER NAMED TO THE LliFT, BUT FAILURE TO DO SO SHALL
IMP06E NO OlK.IGATtDN OR LIABILITY OF ANY KIND UPON THE INSlll!t:R, ITS AGENTS OR
REPRESI!NTA1'1\IES.
AUTHORIZED REPRSsENTAl1VE
TANYA I?EARSON'
e ma s y elf l'fISp lYe owners
,IAN. < 0.2008 9: 28PM
S TATE FARM
NO. 096
P. 4/4
IMPORTANT
If the certificate holcler 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 WANED. 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 ot such endorsement(s).
DISCLAIMER
The Certificate of Insurance on the reverse side of thiS form does not constitute a contrad between
the Issuing insurer(t), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend. extend or alter the coverage afforded by the policies listed thereon.
ACORD 26 (2001/08)