HomeMy WebLinkAboutCARPENTER, ROTHANS & DUMONT-2006LEGAL SERVICES AGREEMENT
A- 2006 -314
This AGREEMENT, made and entered into this 2151 day of November 2006 by and between Carpenter,
Rothans & Dumont (hereinafter "Attorneys "), and the City of Santa Ana, a charter city and municipal corporation of
the State of California ( "City")
RECITALS
A. The City desires to retain special counsel having special skill and knowledge in the field of public entity tort
defense.
B. Attorneys represent that they are able and willing to provide such services to the City.
C. In undertaking the performance of this Agreement, Attorneys represents that they are knowledgeable in their
field and that any services performed by Attorneys under this Agreement will be performed in compliance with
such standards as may reasonably be expected from attorneys 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
Attorneys agree to provide all services necessary to defend the City from claims and lawsuits filed against
the City (the "Scope of Work ").
2. PAYMENT FOR SERVICES RENDERED.
A. FEES
City agrees to compensate Attorneys, and Attorneys agree to accept from City, as and for payment in full for all
of said services in regard the stated lawsuit, compensation at a maximum rate of $170.00 per hour for work performed.
B. REIMBURSEMENT FOR COSTS
City agrees to reimburse Attorneys for out -of- pocket expenses including mileage authorized by the City
Attorney in connection with the performance of duties under this Agreement.
METHOD OF PAYMENT
Attorneys shall, by the W day of each month, submit a statement, specifying the services performed, dates
and number of hours, itemization of expenses related thereto.
4. CONTROL OF LEGAL MATTERS
Attorneys agree that each and every matter or proceeding in which they undertake to assist the City Attorney, as
aforesaid, shall be and remain under, and subject to the control and direction of said City Attorney at all stages, and that
they shall at all times keep the City Attorney informed of all matters pertaining thereto.
Attorneys will notify City promptly of any settlement offer received by Attorneys. City will keep Attorneys
informed of all significant developments in matters relating to any representation undertaken by Attorneys.
Attorneys further agree, if and when their employment hereunder is terminated by City, as hereinafter specified,
they shall return to City Attorney any and all files then in their possession concerning each and every matter or
proceeding in which they represented the City pursuant to this Agreement.
5. ATTORNEYS INDEPENDENT CONTRACTORS
It is mutually agreed by and between the parties that, in the performance of their covenants hereunder
Attorneys are and shall be independent contractors, and not officers or employees of City.
6. INSURANCE
Prior to undertaking performance of work under this Agreement, Attorneys shall provide proof to the City Attorney
of Professional Liability (errors and omissions) insurance, with a combined single limit of not less than $1,000,000
per claim, and maintain such insurance throughout the term of this Agreement.
If Attorneys fails or refuses to produce and 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 affect
Attorneys' right to be paid for its time and materials expended prior to notification of termination. Attorneys waive
the right to receive compensation and agree to indemnify the City for any work performed prior to approval of
insurance by the City.
7. INDEMNIFICATION
Attorneys agree to and shall indemnify and hold harmless the City, its officers, agents, employees, and
representatives from liability for personal injury, damages, restitution, judicial or equitable relief arising out of
Attorneys' performance or conduct of this Agreement.
8 CONFIDENTIALITY
If Attorneys receive from the City information which due to the nature of such information is reasonably
understood to be confidential and /or proprietary, Attorneys agree 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 Attorneys disclosed in a publicly available source; (c) is in rightful
possession of the Attorneys without an obligation of confidentiality; (d) is required to be disclosed by operation of
law; or (e) is independently developed by the Attorneys without reference to information disclosed by the City.
9. CONFLICT OF INTEREST CLAUSE
Attorneys covenant that it presently has no interests and shall not have interests, direct or indirect, that
would conflict in any manner with performance of services specified under this Agreement.
10. 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: City Attorney
City of Santa Ana
20 Civic Center Plaza (M -29)
P.O. Box 1988
Santa Ana, California 92702
Facsimile (714) 647 -6515
To Attorneys: Steven Rothans
Carpenter, Rothans & Dumont
888 S. Figueroa Street, Suite 1960
Los Angeles, California 90017
Facsimile (213) 228 -0401
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.
IL EXCLUSIVITY AND AMENDMENT
This Agreement represents the complete and exclusive statement between the City and Attorneys, 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
Attorneys. The parties agree that any terms or conditions of any other instrument that are inconsistent with, or in
addition to, the terms and conditions hereof, shall not bind or obligate Attorneys 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 that are not embodied herein.
12. ASSIGNMENT
Inasmuch as this Agreement is intended to secure the specialized services of Attorneys, Attorneys 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 of this Agreement performed by City personnel or by other Attorneys retained by City.
13. TERMINATION
This Agreement may be terminated by City at any time. In such event, Attorneys shall be entitled to receive
and the City shall pay Attorneys compensation for all services performed by Attorneys prior to receipt of such notice of
termination. Asa condition of such payment, Attorneys shall deliver to the City all files and records generated under this
Agreement as of such date.
Attorneys may terminate this agreement, subject to their obligation to provide reasonable notice to arrange
alternative representation. In such case, City agrees to secure new counsel as quickly as possible and to cooperate fully
in the substitution of the new counsel as counsel of record in any litigation in which Attorneys may be involved.
14. DISCRIMINATION
Attorneys 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. Attorneys
affirm that it is an equal opportunity employer and shall comply with all applicable federal, state and local laws and
regulations.
15. 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.
16. MISCELLANEOUS PROVISIONS
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.
IN WITNESS WHEREOF, the parties hereto have executed this Agreement the day and year first above
written.
ATTEST:
UJL2f2I�_
(Patricia F. Healy
V" Clerk of the Council
APPROVED AS TO FORM:
Joseph W. Fletcher
City Attorney
CITY OF SANTA ANA, a charter city and municipal
corporation,
- David N. Ream <., J 6
City Manager
CARPENTER, ROTHANS & DUMONT
—T
Steven Rothans
Partner
Arch
Insurance Group
ARCH INSURANCE COMPANY
A Missouri Corporation
ADMINISTRATIVE OFFICE HOME OFFICE
One Liberty Plaza 3100 Broadway, Suite 511
53rd Floor Kansas City, MO 64111
New York, NY 10006
Tel: 800- 817 -3252
LAWYERS PROFESSIONAL LIABILITY INSURANCE POLICY
THIS IS A CLAIMS -MADE AND REPORTED POLICY. PLEASE REVIEW YOUR POLICY
CAREFULLY. THE POLICY IS LIMITED TO LIABILITY FOR ONLY THOSE CLAIMS THAT
ARE FIRST MADE AGAINST THE INSURED AND REPORTED TO THE COMPANY DURING
THE POLICY PERIOD UNLESS AND TO THE EXTENT THAT AN EXTENDED REPORTING
PERIOD OPTION APPLIES.
Policy Number: I ILPL3411501
Item 1 Named Insured and Address
Carpenter, Rothans & Dumont
888 South Figueroa St., Suite 1960
Los Angeles, CA 90017
Item 3. Policy Period From
4/1/2006
Item 4. Limit Liability
$ 1,000,000
$ 1,000,000
DECLARATIONS
Renewal of: 11LPL3411500
Item 2. Producer Name
Mush Affinity Group Services,
a service of Seabury & Smith
160 Spear Street
San Francisco, CA 94105
To 12:01 A.M. Standard Time at the address
4/1/2007 of the Named Insured as stated herein.
Each Claim
Aggregate
a. Claims expenses are included within the Limit of Liability.
Item 5. Deductible
$ 50,000
Per Claim
The deductible amount specified above applies to both damages and claim expenses.
Item 6. Premium
$ 26,248.00 Amount
Item 7. Forms Attached at Issue
LPL 00036 00 0902 Program ERP Endorsement
LPL 00002 05 0902 Policy Form
LPL 0060 00 1102 Specific Attorney Prior Acts
No. of Lawyers 9
By acceptance M this policy the Insured agrees that the statements in the Cedaratlons and the Application and any aaachmems hereto are the Insured's agreements and
representations and that this policy embodies all the agreements exisgng between the Insured and the Company or any M its representatives relating to this insurance
Do Not Write Remarks Countersigned At
In This BOX San Francisco
Authorized Representative
05 LPLD0090 00 12 03 L�
Issue Date
4/19/2006
4/19/2006
Countersign Date
Page 1 of 1
DEC. 10'2007 15:54 2132280401 enter ROthan9 :o -Tont H�(J�._���1� ;bRlf'P.302 /002
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AGQ.BLI. CERTIFICATE OFI LIABILITY INSUR!AN6E1
PRODUCER THIS CERTIFICAT6'I&MUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
CHATSWORTH INSURANCE SERVICES I MOLDER, THIS CERTWICATE DOES NOT AMEND. EXPEND OR
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BCS INSURANCE COMPANY
2 Mid America Plaza, Suite 200, Oakbrook Terrace, Illinois 60181
630- 472 -7700; Fax 630. 472 -7765
(hereafter referred to as the "COMPANY ")
DECLARATIONS - LAWYERS PROFESSIONAL LIABILITY
THIS IS A "CLAIMS MADE AND REPORTED" POLICY. THE COVERAGE AFFORDED BY THIS POLICY IS LIMITED TO
CLAIMS ARISING FROM THE PERFORMANCE OF PROFESSIONAL SERVICES, WHICH ARE FIRST MADE AGAINST
THE INSURED AND REPORTED IN WRITING TO THE COMPANY WHILE THE POLICY IS IN FORCE. PLEASE REVIEW
THE POLICY CAREFULLY AND DISCUSS THE COVERAGE THEREUNDER WITH YOUR INSURANCE AGENT, BROKER
OR OTHER REPRESENTATIVE.
THE LIMITS OF LIABILITY AND DEDUCTIBLE AS SET FORTH IN THE DECLARATIONS APPLY TO, AND ARE REDUCED
BY, THE PAYMENT OF CLAIM EXPENSES AS WELL AS DAMAGES.
Policy No.: IRIS002749
Item 1. NAMED INSURED: Law Offices of Carpenter, Rothans & Dumont
Item 2. Business Address: 888 S. Figueroa Street, Suite 1960,Los Angeles, CA 90017 -
Item 3. The NAMED INSURED is: _ an Individual -X-- a Partnership ^ a Corporation _ Other
Item 4. Predecessor Firm:
Item 5. PROFESSIONAL SERVICES: 11 Attorneys
Item 6. POLICY PERIOD From Aril 01 2012 to April 01 2013
12:01 AM Standard Time at address of the INSURED above
Item 7. RETROACTIVE DATE: March 01 1994
Item 8. Limits of Liability:
The Liability of the COMPANY for each CLAIM including CLAIM EXPENSES under this Policy shall
not exceed 51,000,000.00 and subject to that limit for each CLAIM, the total limit of the
COMPANY's liability for all CLAIMs including CLAIM EXPENSES under this Policy shall not exceed
in the aggregate $2,000,000.00
Item 9. DEDUCTIBLE: Applicable to each CLAIM, including CLAIMS EXPENSES $15.000.00
Item 10, Rate: Flat
Minimum Premium: 522,500.00
Deposit Premium: $22.500.00
Premium for extended discovery period of 12 months y It a y M , , n
Item 11. Endorsements: O FORM
LPL 00 00 1109 (DEC) LPL 00 04 1109 ,
LPL 00 00 1109
LPL 00 05 11 09 ,_.aura Stltt Sheed
LPL 00 02 1109 LPL 00 1111 09
LPL 00 03 1109 City Attornev
CLAIMS HELP LINE:
1- 877 - 576 -7288
Hollins & Levy LLP
23801 Calabasas Road #110
Calabasas, CA 91302
Date: April 23, 2012
LPL 00 00 1109 (DEC)
ALL CLAIMS TO BE REPORTED DIRECTLY TO:
BCS INSURANCE COMPANY
2 MID AMERICA PLAZA SUITE, 200
OAKBROOK TERRACE, ILLINOIS 60181
(630) 472 -7700
By: _
Duly Auk orized O i er or Representative
Page 1 of 21
i
Liberty
Surplus Insurance
Corporation
1le[tiller .d LI lie rt1" M wild] Gr l lf(t
Lawyer Professional Liability Policy
LIBERTY SURPLUS INSURANCE CORPORATION
(A New Hampshire Stock insurance Company, hereinafter "the Insurer")
175 Berkeley Street, Boston, MA 02117
TbVree number. 1- 800.677 -9163
DECLARATIONS
NOTICE: THIS IS A CLAIMS MADE AND REPORTED POLICY. THIS POLICY COVERS ONLY
CLAIMS FIRST MADE AGAINST 'II -IE INSURED DURING THE POLICY PERIOD OR EXTENDED
REPORTING PERIOD, IF APPLICABLE, AND REPORTED TO THE COMPANY DURING TT-IE
POLICY PERIOD OR EKITNDED REPORTING PERIOD, IF APPLICABLE. PLEASE READ TIDE
POLICY CAREFULLY AND DISCUSS THE COVERAGE WITT-i YOUR INSURANCE AGENT OR
BROKER-
UNLESS TT-IE POLICY IS MODIFIED BY ENDORSEMENT, AMOUNTS INCURRED AS CLAIM
EXPENSES SHALL REDUCE THE LIMITS OF LIABILITY AND SHALL BE APPLIED AGAINST THE
DEDUCTIBLE.
POLICY NUivIBER: PL5S779435004 RENEWAL OF:
PRODUCER: Socius Insurance Services, Inc.
626 Wilshire Boulevard, Suite 220
Los Angeles, CA 90071
ITEM 1. NAMED INSURED:
Kinlde, Rodiger and Spriggs
ITEM 2. PIUNCIPAL ADDRESS:
3333 Fourteenth Street
Riverside, CA 92501
ITEM 3. POLICY PERIOD:
From 12:01 a.m. March 14, 2012
on
To 12:01 a.m. March 14, 2013
on
Local time at the address sho%m in Item 2.
LSI 1002 (Ed. 03 09)
3
PL55779435003
aPYRd?
Laura Stitt Shee y
Assista
nt City
' Liberty
Surplus Insurance
Corporati<)n
lfrrsdk'r ui ubcrn Minusl Gump
Lawyer Professional .Liability Policy
ITEM 4. LIA41TS OF LIABILITY
Each Claim:
$5,000,000
Aggregate:
S5,000,000
ITEM 5. DEDUCTIBLE:
Each Claim:
S 50,000
Aggregate:
N/A
ITEM 6. P RE. NIlUM:
S 51,975
This policy may be subject to surplus lines taxes, stamping fees, surcharges, and certain surplus lines reporting
requirements mandated by state regulations. The Surplus Lines Broker is responsible for the disclosure of all related
taxes, surcharges, and fees. The Surplus Lines Broker is also responsible for the applicable surplus lines reporting
requirements including, but not limited to, the submission of diligent search forms.
ITEM 7. RETROACTIVE DATE:
N/A
ITEM 8. KNOWLEDGE DATE:
March 14, 2009
ITEM 9. ENDORSEMENT(S) FOIZ3"NG PART OF TITS POLICY AT ISSUANCE:
LIU 1000 (Rev. 03 09) SG7 (9/07) LSI 1781 (Ed. 03 09) LSI 1049 (Ed. 03 09)
This Declarations Page, together with the Application, the attached Lawyers Professional LiabilityPolicy Form, and all
endorsements thereto, shall constitute the contract between the Company and the Named Insured.
I.SI 1002 (Ed, 03 09)
ATI 10- 45
Lawyers Professioiiial,Liability
ITEM 4. LIMITS OF LIABILITY-
Each Claim: $5,000,000
Aggregate: S5,000,000
ITEM 5. DEDUCTIBLE:
Each Claim: S 50,000
Aggregate: N/A
ITEM b. PREMIUM. S 51,975
R - Zoo( - 31q
Liberty
Surplus Insurance
Corporation
Moll1 r of Ulxvn Mutual t;uwp
This policy may be subject to surplus lines taxes, stamping fees, surcharges, and certain surplus lines re
requirements mandated by state regulations. The Surplus Lines Broker is responsible for the disclosure of all
taxes, surcharges, and fees. The Surplus Lines Broker is also responsible for the applicable surplus lines re
requirements including, but not limited to, the submission of diligent search forms.
ITEM 7. RETROACTIVE DATE:
N/A
ITEM S. KNOWLEDGE DATE:
March 14, 2009
ITEM 9. ENDORSEMENTS) FORMING PART OF THIS POLICY AT ISSUANCE:
LIU 1000 (Rev. 03 09) SG7 (9/07) LSI 1781 (Ed. 03 09) LSI 10#9 (Ed. 03 09)
This Declarations Page, together with the Application, the attached Lawyers Professional LiabiiityPoliry Form, and all
endorsements thereto, shall constitute the contract between the Company and the Named Insured.
t SI 1002 (Ed. 03 09)
l�
BCS INSURANCE COMPANY
2 Mid America Plaza, Suite 200, Oakbrook Terrace, Illinois 60181
630 -472 -7700; Fax 630 - 472.7765
(hereafter referred to as the "COMPANY ")
DECLARATIONS - LAWYERS PROFESSIONAL LIABILITY
THIS IS A "CLAIMS MADE AND REPORTED" POLICY, THE COVERAGE AFFORDED BY THIS POLICY IS LIMITED TO
CLAIMS ARISING FROM THE PERFORMANCE OF PROFESSIONAL SERVICE, WHICH ARE FIRST MADE AGAINST
THE INSURED AND REPORTED IN WRITING TO THE COMPANY WHILE THE POLICY IS IN FORCE. PLEASE REVIEW
THE POLICY CAREFULLY AND DISCUSS THE COVERAGE THEREUNDER WITH YOUR INSURANCE AGENT, BROKER
OR OTHER REPRESENTATIVE.
THE LIMITS OF LIABILITY AND DEDUCTIBLE AS SET FORTH IN THE DECLARATIONS APPLY TO, AND ARE REDUCED
BY, THE PAYMENT OF CLAIM EXPENSES AS WELL AS DAMAGES.
Policy No.: IRIS002749
Item 1. NAMED INSURED: Law Offices of Carpenter, Rothans & Dumont
Item 2. Business Address: 888 S. Figueroa Street, Suite 1960,Los Angeles, CA 90017 -
Item 3. The NAMED INSURED is: _ an Individual _X_ a Partnership a Corporation _ Other
Item 4. Predecessor Firm:
Item 5. PROFESSIONAL SERVICES:
11 Attorne s
Item 6. POLICY PERIOD From _ April 01 2012 to _
April Ol 2013
12:01 AM Standard Time at address of the INSURED above
Item 7. RETROACTIVE DATE: March 01 1--
Item 8. Limits of Liability:
The Liability of the COMPANY for each CLAIM including CLAIM EXPENSES under this Policy shall
not exceed $1,000,000.00 and subject to that limit for each CLAIM, the total limit of the
COMPANY's liability for all CLAIMS including CLAIM EXPENSES under this Policy shall not exceed
in the aggregate $2,000,000 00
Item 9. DEDUCTIBLE: Applicable to each CLAIM, including CLAIMS EXPENSES $15.000.00
Item 10. Rate: Fiat _
Minimum Premium:2,500.00
Deposit Premium: _$22,500.00
Premium for extended discovery period of 12 months
Item 11. Endorsements:
LPL 00 00 11 09 (DEC)
LPL 00 04 1109
LPL 00 0o 1109
LPL 00 0511 09
LPL 00 02 1109
LPL 00 11 11 09
LPL 00 03 1109
CLAIMS HELP LINE:
1- 877 -576 -7288
Hollins & Levy LLP
23801 Calabasas Road #110
Calabasas, CA 91302
Date: April 23 2012
LPL 00 00 1109 (DEC)
ALL CLAIMS TO BE REPORTED DIRECTLY TO:
BCS INSURANCE COMPANY
2 MID AMERICA PLAZA SUITE, 200
OAKBROOK TERRACE, ILLINOIS 60181
(630) 472 - ))))7700
By: ,.
Duly Auiorized Q er or Representative
Page 1 of 21
INSURANCE BINDER
THIS BINDER IS A TEMPORARY INSURANCE CONTRACT., SUBJECT TO T
AGENCY
CHATSWORTH INSURANCE SERVICES
21601 Devonshire St #207
Chatsworth, CA 91311 -8410
PHONO.EtlI: (818) 998 -6162 ',FAX 'c'; (818) 700 -1679
CODE; SUB CODE:
AGENCY
CUSTOMER ID:
INSURED Carpenter, Rothans & Dumont
888 S. Figueroa Street, Suite 1960
Los Angeles, CA 90017
(213)228 -0400
S mmisin�
OATE(MMIDDIWYY)
HE GONDITIUNS 9HVWry Vry Inn nev MMDM JIwe 4r into rvnln.
COMPANY .BINDER A
''. BCS Insurance Company _T IRIS007493
EFFECTIVE E%PMATION
DATE TIME _ OATS TIME
AM �i R 1201AM
4/1/14 12:01 PM 7/1/14 u' NOON
THIS BINDER IS ISSUED TO EXTEND COVERAGE IN THE ABOVE NAMED COMPANY
PER EXPIRING POLICY N'.
DESCRIPTON OF OPERATONBNEMCLESIPROPERTY (including Location)
Lawyers Professional Liability
I Policy Period: 4/1/2014- 4/1/2015
Limits: $1,000,000/$2,000,000
Deductible: $15,000
Rratroaetive Date: 3/1/1994
ttPE OF INSURANCE COVEMGEIFORMS _ - DEDUCTIBLE COINS °A AMOUNT
PROPERTY CAUSES OF LOSS_
L- 1 BASIC BROAD L SPEC
COMMERCIAL GENERAL LIABILITY
CLAIMSMADE ~— OCCUR
ANYAUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NOWOWNED AUTOS
VEHICLE PHYSICAL
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GARAGE UAUIUTY
I ANYAUTO
pmovrD AS TO VORM
Laura A. Rossini
Assistant City Attorney
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BODILY
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ED MOTORIST is
Is
1 EXCESS LIABILITY EACH OGGURRrNQh _$
I UMBRELLA FORM 4GGREGATE
`I OTHER THAN UMBRELLA FORM RETRO DATE FOR CLAIMS MADE'. SELF-INSURED RETENTION $
' '. MK STA_TUTORV LIMITS j
WORREWS COMPENSATION E,L. EACH ACCIDENT '.$
AND
EMPLOYER'S UAMUTY E.L DISEASE EA EMPLOYEE- S
E.L. DISEASE - POLICY LIMIT $
SPECIAL This is a claims made and reported policy. EE$ _ $ _
CONDITIONS/ TAXES I$
OTHER
COVERAGE$ E STIMATED TOTAL PREMIUM s
NAME & ADDRESS
MORTGAGEE I AODITIONAL INSURED
�..'. LOSS PAYEE _
LOANA .u.-
AUINORIZED kEp %ESENTATNE
i '°F
A
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