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Home My WebLink AboutPeranich Reporting, Inc. 1aCity of Santa Ana j Clerk of the Council AGREEMENT TERMINATION FORM Please complete this form when the attached agreement and all amendments (if any) are no longer in effect. Return form to the Clerk of the Council Office (M -30). Call 647 -6520 if you have any questions. The agreement with Peranich ,'J.. Fi MY IOF 4. ii:? J! G 20017 COTC Office Use Only No. N- 2001 -100 was completed on 06/30/2002 and final payment has been made. (List all amendments. Use space below if needed.) N -200 100 -001 Department: Personnel Services Dept. 08007 P hone /Ext.: 714- 647 -5372 Signature: Date: Revised 08 -2 &70 Jacobo- Valdez, Alma From: Mitre - Ramirez, Norma Sent: Tuesday, May 12, 2015 12:42 PM To: Jacobo - Valdez, Alma Cc: Alcala, Abigail Subject: Termination slip Attachments: Form - AGREEMENT TERMINATION FORM_goldenrod.doc Good Afternoon, Please provide termination slip for N- 2001 -100 and N -2001- 100 -001 so that we may close out file and prepare for records destruction. Thank you, Norma Mitre Sr. Deputy Clerk of the Council City of Santa Ana I Clerk of the Council Office 714 - 647 -5237 1 nmitre@santa -ana.o g 1 INSURANCE ON FILE WORK MAY PROCEED UNTIL INSURANCE EXPIRES 11-30-07 CLERKOF CW NCIL DATE: 1- ' O y Q ;PerseHnel (2)(E,1cer Smiley) FIRST AMENDMENT TO CONSULTANT AGREEMENT N- 2001 - 100 -001 THIS FIRST AMENDMENT TO CONSULTANT AGREEMENT is entered into on August 29x_ 2006, by and between Peranich Reporting, Inc., a California corporation ( "Consultant ") and the City of Santa Ana, a charter city and municipal corporation of the State of California ( "City "). Recitals: A. The parties entered into Agreement N- 2001 -100, dated June 28, 2001, (hereinafter "said Agreement') by which Consultant has provided court reporting services for Pcrsnnne! Board hearin�c. B. In accordance with the terms and conditions of said Agreement, the parties wish to amend the Scope of Services by amending the fee schedule for services. Wherefore, in consideration of the covenants contained in said Agreement, and subject to all the terns and conditions of said Agreement, except those amended in this First Amendment to Consultant Agreement, the parties agree as follows: 1. Section 2.a., COMPENSATION, shall be deleted in its entirety and replaced with the following: "City agrees to pay, and Consultant agrees to accept as total payment for its services, the rates and charges set forth in Exhibit A. The total sum to be expended pursuant to this Agreement shall not exceed $10,000, annually, during the term of this Agreement." 2. Exhibit A .shall be amended to reflect the tollowing fee changes: Per Diem from $225.00 to $250.00 O +i 'VVIwo Transcribed frum $2.65ipage to $2.95rpage Copy of Transcript from $.60 /page to $.80 /page (at employee's attorney's request) Exhibits — if attached to transcript $.35 /page (no change) Postage and handling At Cost (no change) 3. Except as herein amended, all Terms and conditions of said Agreement shall remain in full force and effect. IN WITNESS WHEREOF, the parties hereto have executed this h'iist Ain endment to Consultant Agreement on the date and year first written above. ATTEST: PATRfCL\ G. IIEALY Clerk of the Council APPROVED AS TO FORM: JOSEPH W.FLETCHER City Attorney BY; . Lau Sheedy Assistant City Attorney APPROVED AS TO CONTENT: CITY OF SANTA ANA DAVID N. REA City Manager PERANICH REPORTING, INC. / `� ' (PP1��(�t k i Y 'f FNR LVA CFIERR[L FORD PERANICH F.xecutiV �y3'ircct`_{ //� ownci Personnel Services Ageney A 2 - LJ (o 01/03/2007 10:38 714 -671 -5610 ALLCO FIILLERTON INC PAGE 01/01 ACORD CERTIFICATE OF LIABILITY INSURANCE 1 O"YYYI pOUCY NVMBER POLCTEFFEOTIVE POLICY EXRRATpN 01109=�0197 PIADUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION AI_LCO FULLERTON INSURANCE AGENCY ONLY AND CONFERS NO RIGHTS HOLDER, THIS CERTIFICATE DOES UPON THE CERTURCATE NOT AMEND, EXTEND OR P, O. BOX 1247 t f 2001' 100 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, DAMAGE TO RENTED xNMOP ED "P A., $50,000 $5,000 N - 2.001- 1 0 0 —001 FULLERTON CA 92832 INSURERS AFFORDING COVERAGE GENERAL AG REGATE NAICA IN SUREO Ponsolch Reporting INSURERA MERCURY INSURANCE PER' LOC PRODUCTS- COMPIOP AGG INSURERS. 5241 E. Santa Ana Cyn Rd INSURER C, AUTOMOBILE LIABILITY ANYAUTO ALL OWNED AUTOS SCHEOULEOAUTOS HIRED AUTOS .NON -OWNED AUTOS Ste. 199 INSURER D: OOMeINEO 91NOLE LIMIT (ER P:Deen9 Anaheim CA 92807 INS RER E' COVERAGES 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 ON 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. ININf 90' PNoum ARYOF THEABOVE DESCRIBED POUCIEB BEDANDELLED sEFORETNE EXPIRATION pOUCY NVMBER POLCTEFFEOTIVE POLICY EXRRATpN LIMIT A Y GENERAL LIABILITY X I ODMMERC WL GBNBRA LIAAIUTY 1 ^, CLANSNADE IA ,I OCCUR CCP0019182 1113012006 - 1113012007 EACH OCCURRENCE 81,000,000 DAMAGE TO RENTED xNMOP ED "P A., $50,000 $5,000 PERSONAL eADVINJURY $ 1,000,000 GENERAL AG REGATE s 2,D00,000 GEN'LAGGRECATELIMITAPPLIES OLICY PRO- PER' LOC PRODUCTS- COMPIOP AGG EXCLUDED AUTOMOBILE LIABILITY ANYAUTO ALL OWNED AUTOS SCHEOULEOAUTOS HIRED AUTOS .NON -OWNED AUTOS OOMeINEO 91NOLE LIMIT (ER P:Deen9 S OODILYINJURY (Per ParR ) BOOaYINJURY (PM eWdenU S TYC PROPERTY DANAGE PROP S OARAGE LIABILITY AWALITO AUTO ONLY -EA ACCIOSrvT OTNERTHAN EA ACC AUTO UNLL' AGO S [YCESSIUNBRELLA LIABSTrY OCCUR CLAIMSMAOE DEUUCTLILE RETENTION S EACH UCCUrsrsENCE 8 AGGR ATE S S E B MAKERS NANO EMPLOYERS' LYRn.ITY ANY PROPRIETORIEXCLUDRR'aEOUTNe ANY PR OPPICERMIENSlER ExcwOEDT I=Eee mund°f F P WC STAN MIZ E L EACH ACCIDENT S E DISEASE- EP EMPLOYEE ELDISEASE - POLIGV LIMfi OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXOLURIONB ADDED IT ENDORSEMENT! OPECIAL PROVISIONS 10 Day Notice for Non Payment of Premium \>i CERTIFICATE HOLDER IS NAMED AS ADDITIONAL INSURED .ERTI Fl CATS HOLDER CANCELLATION t PNoum ARYOF THEABOVE DESCRIBED POUCIEB BEDANDELLED sEFORETNE EXPIRATION City of Santa Ann OATS THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN 20 Civic Center Plaza W24 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, OUT FAILURE TO no so seALL Attn: Rosa Flores NMIUS NO ORIJOATION OR LIABILITY OF ANY VINO UPON THE INBURBR, In AOENTR OR Santa Ana, CA 92701 REPRESENTATNER. AUTHORIZED REPRESENTATNE �„� --! RKI> ACORD 25 (2001MO) ACORD CORPORATION 1999 01/04/2007_ 16:38 714- 871 -5610 ALLCO EULLERTON INC • PAGE 01/01 :ORD CERTIFICATE OF LIABILITY INSURANCE Bars (MLVOOmrY1 ALLCO FULLERTON INSURANCE AGENCY P.D. BOX 1747 Peranlah Reporting -' _ �'' " " "° "". `rw�c NAIC 0 5241 F Santa Ana Cyn Rd IA. ERCURY INSURAN CE Ste. 100 - Anaheim CA 92807 THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PER100 INDICATED, NOTWITHSTANDING .INY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT i0 WHICH I NAY PERTAIN, THE INSURANCE AFFORDED BY THE PCLICIES DESCRIBED HEREIN IS SHR.mn, Tn en ...e rne.... THB CERTIFICATE MAY HE ISSUED OR INSR G 5T PAIOCLAIMS. POLICY NUMBER — _._ _.._._, Pa4JCYEFrECTN6 POLIOYIXPI ATON � mw wmwI VN5 OF SUCH OENERALUAB1L," LIMITS A Y X C MMERCIALGEN£RALLMSIUtY CLAIMS MACE [K] OCCUR CCP0019182 1113012008 1113012007 EACHOCCUR ENCE $10(10550 DAMAGE TO RENTED M 5p 000 MIED ww rwn s 5 000 ERMNAL NADVINuuRY 1100 000 ENERA AGGREGATE S 2 000 000 SENT AGGREGATE UMMAPP ISO PER: E CLUDED _ POUGY PRO LOC PROOUCra- COMPOPAGG AUTOMOB&CLIABILITV ANYAVID C OFAI aNUIDSINGLE LIMB $ ALL OWNED AUTDS SCHEDULED Auras BODILY INJURY r NMEDauros NON.GWNMD AUTW BODILY INJURY (Pere ®IU.M) t PROPERTY DAMAGE fPereweerlU 5 GAPAaE LIABILITY ANYAUTO AUTO ON Y•FA ACCIDENT OTHER THAN FA ACC — IXCE94NNBRELLA LMNILITY ALn00NLY: AGG OCCUR CLPIMR MADE EACH OCCURREXCE AGGREGATE ; B DFOUCTIBLE _ REfENIION S S EMPLOYERS' LIIMPLIT TIDN ANO EMPLOYERS' LWELR'Y ay"wV aTH- L ANY PROPRICTORIPARTNERIFYECUTNE CFFIOEILMEMBER IXOLUOEDT SIL ACCIDENT EL. DI LOYEE S If MeeeNLO Untl.f R V L EASE POLICY POLICY LIMIT 13 OTHER DE!ICkIPYION Of OPRRATIDNS / LOCATION91 VEXICLPSI nu f ImnRP annen ev eunn.e�..n.....�... _____.___ 10 Day Notice for Nan Payment of Premium _c MI"'A I t HVLLtm CANCELLATION WOULD ANYOFTHEAROVS V=A B60 PDUGIe9aEGaJICeLLEGMEPORETX [EXPIRATION City of Santa Ana DATE THEREOF, THE Mum MSURER WILL SNDFAvOR TO MAIL 30 DATEWRI1TEN 20 Civic Center Plaza M.24 NOTES TO TNCOERTIMOATE HOLM NAMED TO THE 1.6FT, BUT FAILURE TO GO SO SHAD. Attn: Rota FlonOM IMPOSE NO 02UOATION OR LU MIUTY OF ART NANO UPON THC INSURER, ITS AGENTS ON Santa Ana, CA 62701 REPmm NTArvEB, AUTHORISPO REPRESENTATIVE (CORD 25(2001/09) n wn.,e.. ....rn..... SRN - fly -2AA-, 09:49 EMPIRE CO. 7148369946 P.Oi -0. 10 any ..-.. y nott ice of eAacellatiOD 80D11ee tar nenpByaent of preniTm,. City Of Santa Ana Attn: Roaa Flores P.O BOX 1988 Santa ADa, CA 92701 Ros4iCFaxNote °Ale _,q_o6 wolf YY�� pages � /F:,aIJ�LXP.SA From r CP /OAPL �. Cc Phone R� PNanep � I c� -g36 9`!4� Faxn -� I y -6�i 7,47877 931a SHOULD ANY OF THE ABOVE DESCRIBED POLIeleR BE CANCELLEO BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN HCTOE TO THE CERDFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO GO $0 SHALL IMPOSE NO OBLIGATION OR LIABILITY OP ANY RIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. A�2RU Iherr12ED REPRESENTATIVE C ` Lj Ch2rryl Young /£Mx[.r Y\W��- ® ACORD CORPORATION 1888 WnPI FlOBPCIPI $C�elree Pape 1 W 2 C A OF LIABILITY INSURANCE RATE i2o"" o7 Y' ROD R (714) 636 -9945 FAXL (714) 636 -9946 BE -he Empire Company N -A-01 -10 p ISO Parkcenter Drive ITIile 205 N-2.001 IOO-ool InAta Ana CA 92705 -3521 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLJCIES BELOW. INSURERS AFFORDING COVERAGE NAICX LURES, Laraaich Reporting, Toe. ;241 E Santa Ana Canyon #100 Liumbeim Hill. CA 92687 INSURERA Preferred Employers Inv. INSURER E: A'SURERC: INSURER D', INSURERS THE POLOIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED T07HE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NQIVNIHSTANDING ANY R69WREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WRH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANOE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. I MAY H R D ID LAIM . IER AppL TYPE OFINSURANCE POOCY NUMBER POLICY EFFECTIVE GATE MMI POLICY EXPIRATION PATE MMIODMI LMrt3 ( Y GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CuIM$MAD: ❑OCCUR EAON BENCE S DAMAGE TO RENTED S MEO EXF S PER Rv S ORAL A(.f.REGAYE S G A! L AGGREGATE LIMIT APPLIES PER P LICY PRO 1 AUTOMOBILELIABILJTY ANY AUTO ALL OWNED AUTOS SCPEDULEDAUTOS HIREDAUTVS NON-OWNED AUTOS com.mEDSINGLELIMF (Ea ameenq S BODILY INJURY (Pe Dasun�. = BOOILY INJURY B PROPERTY DAMAGE Pp eMtl6NQ S GARAGE LUMMUTY ANY AUTO AUTO ONLY- EP ACCIDENT S OTHEATHAN FA AM AUTO ONLY: AGG S S EWESSNMBRELLA LIABILITY OCCUR �CLAIMS MADE DEDUCTIBLE I TI N E AGGREGATE S S S - A MRIKERBCOMPENOATONAND R-EMPLOYERS' LIABILITY ANY PROPRIETGRPARTNEWEX9CUTIVE �OFPICEWMEMEEREXCLUDEO? B M, eesc:bP Purer PECW. PRO N baler. WXN11]683 -4 9/172006 9/1/2007 X RT — EL. EACHACCIDEW S 11 000, OQO =L DISEASE - EA EMPLOYEE S 1,000,000 E EASE POLICY LIMIT 9 1,000 000 OTNER u emus enneo uv cunne¢cmcuY,CPFf.I 11 PROVL¢IOHS �� -0. 10 any ..-.. y nott ice of eAacellatiOD 80D11ee tar nenpByaent of preniTm,. City Of Santa Ana Attn: Roaa Flores P.O BOX 1988 Santa ADa, CA 92701 Ros4iCFaxNote °Ale _,q_o6 wolf YY�� pages � /F:,aIJ�LXP.SA From r CP /OAPL �. Cc Phone R� PNanep � I c� -g36 9`!4� Faxn -� I y -6�i 7,47877 931a SHOULD ANY OF THE ABOVE DESCRIBED POLIeleR BE CANCELLEO BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN HCTOE TO THE CERDFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO GO $0 SHALL IMPOSE NO OBLIGATION OR LIABILITY OP ANY RIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. A�2RU Iherr12ED REPRESENTATIVE C ` Lj Ch2rryl Young /£Mx[.r Y\W��- ® ACORD CORPORATION 1888 WnPI FlOBPCIPI $C�elree Pape 1 W 2 C A THN -05 -2007 09:49 EMPIRE CO. 7148389y45 P.02 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and cvndNons of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holde' In lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, anti the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. Na025(0106),oe AM$ I P...2©2 TOTAL P.02 i ACORD CERTIFICATE OF LIABILITY INSURANCE DATE / ' PRODUCER (714) 836 -9945 FAX: (714) 836 -9946 The Empire Company 550 Parkcenter Drive Suite 205 Santa Ana CA 92705 -3521 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED Peranich Reporting, Inc. 02��' roo fl�� 5241 E Santa Ana Canyon #100 Anaheim Hills CA 92807 INSURER A: Preferred Employers Ins. Santa Ana, CA 92701 INSURER B: INSURER C: AUTHORIZED REPRESENTATIVE INSURER D: INSURER E: OVERAGES 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 LIMIT H N MAY H V E N REDUCED BY PAID CLAIMS. INSR ADD'L TYPE OF INSURANCE POLICY NUMBER POLICY E (MM DDIYYE POLICY DATE MM /DD/YY) LIMITS GENERAL LIABILITY CLAIMS MADE FI OCCUR ff—c:01MMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED PRE I rr n $ MED EXP An one person) $ AL A V INJURY $ GENERALAGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRO - POLICY JECT LOC - COMP /OP AGG $ -PRODUCTS AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) P-4 $ C7 BODILY INJURY (Per person) C CJ� CD BODILY INJURY N (Per accident) 00 mfi r`.,"_ , f— - PROPERTY DAMAQ� (Per accident) GARAGE LIABILITY ANYAUTO 1Y�� AUTO ONLY - EA ACCIDENT $ OTHER THAN QJ& A AUTO ONLY: AGG $ �'- $ EXCESSIUMBRELLA LIABILITY OCCUR FI CLAIMS MADE DEDUCTIBLE RETENTION EACH OCCURRENCE $ AGGREGATE $ S $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER /MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below WKNI17683 -5 9/1/2007 9/1/2008 X O STIMIT O R E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 OTHER DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS _ *10 day notice of cancellation shall apply for non - payment of premium. CERTIFICATE HOLDER CANCELLATION ACORD 25 (2001108) © ACORD CORPORATION 1988 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE City Of Santa Ana EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL Attn : Rosa Flores 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT P.0 BOX 1988 Santa Ana, CA 92701 FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Michael Condy /ERICA ACORD 25 (2001108) © ACORD CORPORATION 1988 IMPORTANT If the certificate holder 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 WAIVED, 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 of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), 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 25 (2001/08) Page 2 of 2 INS025 (oloe).oaa ACORD� CERTIFICATE OF LIABILITY INSURANCE 12i9i2o PRODU'.,ER (714) 836 -9945 FAX: (714) 836 -9946 '2he Empire Company 550 Parkcenter Drive Suite 205 Santa Ana CA 92705 -3521 8 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED Peranich Reporting, Inc. 5241 E Santa Ana Canyon #100 Anaheim Hills CA 92807 INSURER A: Preferred Employers Ins. 10900 INSURERB: INSURER C: INSURER D: INSURER E: OVERAGFS 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 IMIT HOWN MAY HAVE BE N REDUCED BY PAID CLAIMS. INSR ADD'L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MM /DD/YY POLICY EXPIRATION DATE fMMIDD/YYI LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR A R ENC $ DAMAGE TO RENTED PR MI ES LE, oc urr nce $ MED EXP An one erson $ PER NA D INJURY $ GEN. ERALAGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRO- POLICY T LOC PRODUCTS - COMP/OP A $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY ANY AUTO EXCESS /UMBRELLA LIABILITY OCCUR CLAIMS MADE DEDUCTIBLE RETENTION APPO�j�J1 j AS r .RV Laai'ct Assistant City O f,(, AUTO ONLY - EA ACCIDENT $ OTHER THAN EA AC $ AUTO ONLY: AGG $ $ $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNER/EXECUTIVE OFFICER /MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below OTHER WKN117683 -6 9/1/2008 9/1/2009 WC STATU- OTH- I ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE -POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS /LOCATIONSNEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS *10 day notice of cancellation applies for non - payment of premium. icnTlGl/+ATr 11�• e��r� City Of Santa Ana Attn: Rosa Flores P.0 Box 1988 Santa Ana, CA 92701 ACORD 25 (2001/081 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 TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE AUTHORIZED REPRESENTATIVE Irica Hornaday /ERICA �%�'iGGGt�'(d- t+•t,�oGZCS- © ACORD CORPORATION 1988 IMPORTANT If the certificate holder 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 WAIVED, 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 of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), 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. r_rl M ff`t -M 0 -n n��nn n INS025 (0108).08a Page 2 of 2 AN 9- 13 #iAters Professional I..la�i3illt L%Dllrwrziel�, d6cadwroldamn,' Mn,wMNUu LIBERTY INSURANCE UNDERWRITERS INC. (�l itock,tnrurcu�cc Cunep:u,y, hcnimd&cr the "Curnvan' DECLARATIONS COURT REPORTERS PROFESSIONAL LIABILITY CLAIMS -MAIZE POLICY NOTICE: THIS IS A CLAIMS -MADE POLICY, PLEASE READ THE POLICY CAREFULLY, THE POLICY IS LIMY1%D TO LIABILITY FOR ONLY THOSE CLAIMS THAT ARE FIRST MADE AGAINST THE INSURED AND REPORTED TO THE COMPANY DURING THE POLICY PERIOD OR THE EXTENDED REPORTING PERIOD, IF APPLICABLE.. Deducfible $0 each Claim ITafal Premium: 51,530.00 4. The Insured is engaged in practice as a COURT RBPDXTFR 5. This policy is made and accepted subject to the printed conditions in this policy together with the provisicus, stipulations and agreements contained in the following form(s) or endorsement(s): Clop -2013 (11109), CRP -3003 (11 /09), CRP-9000-CA (11109), ®FAC (08109) 6. R211RI:SENTATIIT-.: Agent oe Broker Maash U-S. COWUMOr a Service of Sedwy & SmWi' lee, Office Address: 12421 Meredi0t iDdwe UehanUe, IA 90395 l .. CRr- 2017(Ed. 11109) Policy Ntunbee CRE- 105715001 Renewal of. New Iten 1. Named Insured: Penanfeh Repeating Inc Address: state 100 44,'T., �±I1�AIv•Ii 5241 Frast Santa Ana Canyon Road t Anaheian, CA 92907 CAF, �.d r 2. Police Period: 1201 A.M. Standafd Time, At From: 09/1112012 To: k()�Dpg013 Dgc'.alxpn oCIiESignatcd. P %em ISCB 3. COVERAGE LIMITS OF LUBILITY PREMIUM Court Reporters $500,000 each 0aim $506,000 Aggregate Fsen®usa. $1,530.00 Professional Liability Deducfible $0 each Claim ITafal Premium: 51,530.00 4. The Insured is engaged in practice as a COURT RBPDXTFR 5. This policy is made and accepted subject to the printed conditions in this policy together with the provisicus, stipulations and agreements contained in the following form(s) or endorsement(s): Clop -2013 (11109), CRP -3003 (11 /09), CRP-9000-CA (11109), ®FAC (08109) 6. R211RI:SENTATIIT-.: Agent oe Broker Maash U-S. COWUMOr a Service of Sedwy & SmWi' lee, Office Address: 12421 Meredi0t iDdwe UehanUe, IA 90395 l .. CRr- 2017(Ed. 11109)