HomeMy WebLinkAboutPRESTIGE STRIPING SERVICES, INC. 2b
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City of Santa Ana
Clerk of the Council
AGREEMENT TERMINATION
1ID1 OCr 22 All ..
Please complete this form when the attached agreement is no longer in effect. 8: 51
Return form to the Clerk of the Council Office (M-30). CITY or
Call 647-5237 if you have any questions. CLERK O.j. 62"~~ftA.
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The agreement with ~4~ ~~ ~~ ,J- .
No. )I>;!. 0 0 , - () 33>> - O~ was completed on b I J..-J-/ 07
and final payment has been made. f'\"", Ai' ow~--rO\..olAl ()t=p ,(...~
Department: L.. v _ U
Phone/Ext.: L...\, 0 0 ~
Signature~ /~
Date: \ 0 J \ ot / 07
I
Revised 07-23-07
N-2006-038-02
INSURANCE NOT ON FILE
WORK MAY ~4I PROCEED
CLERKOF COUNCV~ECOND AMENDMENT TO CONSULTANT AGREEMENT
DATE: 6 -~~-a ~
THIS SECOND AMENDMENT TO CONSULTANT AGREEMENT is entered
~" ~Q4 (Z~ on Apri126, 2007, by and between Prestige Striping, a California corporation of the State
~K' (3e-arda~ of California ("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 A-2006-038 dated Apri120, 2006, (hereinafter
"said Agreement") by which Consultant has provided pavement striping services.
B. In accordance with the teens and conditions of said Agreement, the parties wish to
increase compensation to pay for additional services.
WHEREFORE, in consideration of the mutual and respective covenants contained in said
Agreement, and subject to all the terms and conditions of said Agreement, except those
amended in this Second Agreement to Agreement, the parties agree as follows:
Section 1, SCOPE OF SERVICES, shall be amended to include pavement striping
services at Kidseum as set forth in Exhibit A-1, attached to this Amendment.
2. Section 2.a., COMPENSATION, shall be amended to increase compensation by
$5,000 for a total amount not to exceed $15,000 during the 2006-2007 fiscal year.
3. Except as herein amended, all terms and conditions of said Agreement shall
remain in full force and effect.
IN WITNESS WHEREOF, City and Consultant have executed this Second Amendment
to Consultant Agreement onJhe day and yeaz first set forth above.
T:
Patricia E. Healy, Cldrk of the
APPROVED AS TO FORM:
% ~ i
~seph W. Fletcher rty Attorney
RECOMMENDED FOR APPROVAL:
~e'I,Stephen G azding, Deputy City Manager
_IJ For Development Services
CITY OF SANTA ANA
DAVID N. REA
City Manager
CONSULTANT
SABAS TRUJILLO
President
~ R ~ •7 T ~ ~ ~
~ 105 Railrod 5t
,
STRIP!(lfi SERYICRS !NC Corona, ~A 92882
fhrr Repnrnfinn rs On The Luse Phone 95 .270.2999
License# 827632
Proposal & Contract# 23866 Fax 95 .270.2899
_ ~ ~~'
ubmit To: Cnrittick s R.roj~et__ , __._.._ .._ ~ - ~ ~
~~
City Ot Santa Ana Vicky kids museum
305 e. fourth st. suite 201 Office 714-847-5390 1802 maln st.
Santa Ana, CA 92701 Fax 714647-13549 Santa ana
TG:
Date: Rr1i t;CLHlanager
5/2.5J06 belTrujjJlo __ _ _ r.~___ _~____'
15 Double White Lines
2 Handicap w/Crosshatch
1 S.F. of Path of Travel
2 Wheel Stops Repin
3 Wheel Stops Remove and Relocate
2 Wheel Stops Painted Blue...........$335.00
OPTION:
9 4' wheel stop remove & replace.....$405.00
Prestige Stri in Services _____ ~ T
Terlm : Ihia and payable upon compu ~tfon.
~~ ~ P sa valid por 30 d s from 5f251T 106.
3ugect to ofllce 7proval ropu ay
Acteotenrr of Proeeeal gBd Cn trec~~ UWp 6cespt the wNFdn propo8sl. You are aulhorketl to partorm tlx: wak comprehended herauna :r and IIWe
agree to pay the said amount in accordance with 1hE ferny set Tarth. OvrtterlCortractCr to accept Prestige Stnpmg Services Irc. Insurance lim s. Proposal
are not bid at pre+aAing wage unless specified. Not responsible far puAing pamka fees. By signing tale. PmposallConlre :t below IMle Sees to the
attaChPid Terms and CaMlltig7a.
Dale: Oxmer/CuetOmer: Print: ~_ _ _-
PLEASE SIGN AND REMIT COPY i0 ABOVE ADDRESS SIGNING FORA 1 PAGE DOCUiNENT
pagelofl E}S~IbI~ ~-1
ACORD CERTIFICATE OF LIABILITY INSURANCE
TM DATE IMMIDDIVYYY)
03/22/2007
PROpucER (909)735-5335
DFZ Preferred Insurance
2027 Hamner Avenue FAX (909)735-3758
Services 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.
Norco, CA 92860-2604
INSURERS AFFORDING COVERAGE
NAIC #
INSURED PRESTIGE STRIPING SERVICES INC. INSURER^: AMERICAN STATE INSURANCE COMPANY
353 N. CYPRESS ST. A,~P_02C1
' INSURER B: MERCURY CASUALTY INSURANCE COMPA Y
ORANGE, CA 92866 ~ o+'~
/ INSURER C: CALIFORNIA INSURANCE COMPANY
~{ ~' O~ 6
~
f{' 6 INSURER 0:
O INSURER E:
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR 7HE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANV REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL 7HE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR NSR TYPE OFINSURANCE POLICY NUMBER DATE MM/DDIYY DATE MMIDDIYI' LIMITS
GENERAL LIABILITY Ol CG 768379-3 03/22/2007 03/22/2008 EACH OCCURRENCE 5 1,000,000
X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurence S 200,000
CLAIMS MADE ~ OCCUR MEO EXP (Any one person) $ 10, 000
A PEP.GONA! E.P.OV'NJURY 5 1,000,00^
GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000
POLICY PRO LOC
JECT
AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT
$
ANV AUTO (Ea accidenU 1, OOO , OOO
ALL OWNED AUTOS BODILY INJURY
$
X SCHEDULED AUTOS AC 11071675 04/29/2007 04/29/2008 (Per person)
B
J( HIRED AUTOS BODILY INJURY $
J( NON-OWNED AUTOS (Per accident)
PROPERTY DAMAGE $
IPer accidem)
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S
ANV AUTO OTHER THAN EA ACC S
AUTO ONLY: AGG $
EXCESSNMBRELLA LIABILITY EACH OCCURRENCE $
OCCUR ~ CLAIMS MADE AGGREGATE $
$
DEDUCTIBLE $
RETENTION 5 $
WORKERS COMPENSATION ANO TORY LIMITS ER
EMPLOVERS'LIABILITV 46_006122_01_02 06/01/7.006 06/01/2007 E.L. EACH ACCIDENT $ 1,000,000
ANY PRCPRIFTOPoPARTNERlF..%FCUTI'.rE ------~----- --------------
OFFICER/MEMDER EXCLUIIED? E.L DISEASE - EA EMPLOYEE $ 1 r OOO, 000
I( yes, descnbe under
SPECIAL PROVISIONS below E.L. DISEASE- POLICY LIMIT $ 1 r OOO OO
,
OTHER
DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PRONSIONS
0 DAYS NOTICE WILL BE SENT FOR NON PAYMENT OF PREMIUM.
ERTIFICATE HOLDER IS NAMED AS ADDITIONAL INSURED.
OB: VARIOUS 706 LOCATIONS
,r1
,
:!'.r
-
%
~
verreirnre unl nco / ---- ~-- CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
E%PIRATION DATE THEREOF, THE ISSUING INSURER WILL R%~E101A(~R MAIL
~Q-DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
CITY OF SANTA ANA ~p~Rx~90H19Q~9G1fKxgCq~q~%p049(gA~FpRRA9l~rR7AM0(94X4QRriXXXX
ATTN: ROCK GARCIA
20 CIVIC CENTER PLAZA
Sl9CAHSX9HPiliPfd9(R701 RXR)C%9E KA1~9€~M(A(7lNEJ(XXXXXXXXXX
SANTA ANA, CA 92701 AUTHORIZED REPRESENTA E
ACORD 25 (2001/08) IJXIi V RU V V Rt• V RN I I V I~ . oo..
PRESTIGE STRIPING SERVICES-, INC.'
• ~ Insurance
s
TIi1S ENDORSEMENT CHANGES THE POLICY.
O1 CG 768379-3
CCMM~J~f~IA,L GENERAL LIABILITY
' CG 78 35 09 Ofi
PLEASE REA' CAREFULLY. .
LIABILITY PLUS ENDORSEMENT
This endorsement modifies insurance provided under the fotiowing:
COMMERCIAL GENERAL UABWTY COVERAOE'PART
SCHEDULE
Name 6t perion'or Oryanizatlon:
CITY OF SANTA ANA
ADDITIONAL INSURED - BY WRITTEN
CONTRACT, AGREEMENT OR PERMIT, OR .
SCHEDULE
Tha topowinp paragraph is added to 4VH0 IS AN
INSURED (Section II):
. 4. Any person or organization shown in the Sched•
ule or for.whom you are required by written con'
tract, agreement or permit to provide insurance
Is an fnswed, subject to the following additional
provisions:
a. 'The contract, agreement or.permit must be
in effect during the policy period shown In
the Declarations, and must have been exe-
cuted prior to the •tiodily lr>)ury,• "property
damage,' "personal and advertising trt(ury.'
b, Tho person or organization added as an tn•
saved by this endorsement is an insured only
to the extent you are held liable due to:
(1) The ownership, maintenance or use of
that part of premises you own, rent,
lease or occupy, subject t0 the foliowfng
additional provisions:
(a) This Insurance does not apply to
any "occurrence' which takes piece
after you cease to be a tenant In
any premises leased to or rented to
you;
(b) This insurance does not apply to
any structural alterations, new con'
struetion or demolition operations
performed by or on behalf of the
person or organization added as an
insured;
(2) Your ongoing operations for that in•
sured, whether the work Is porformed
by you or for you;
. `~~ ~t5
Includes yriphted Material of Insurance Services Office, Inc., with its permission.
CopyApht, Insurance Services, 2001
N(W ..~ IM t./r. MO. M. nOYgw.• u.a.wt. N i+,r. o«o..~w.
06 70 35 09 03 Pp.l of4 EP
?. I•
•B dil .iNurY" or •propert~:d • age' arising
(3).The malntenance,,operatton or use by ;+g' ou@'.R~~; •~;bwnershlp, mante~nce, Use or
. you of equipment.ls3'aired~td you by such ;: end+~••+. • •e to others of any aircraft, :"auto"
person or orgadzation, subject to the ~,^, • : or~nr'atefcr~8it owned or operated by or rented
fogowing addltiortal Provisions: •;~~, .. ort{ anad to spyy Insured. Use Includes oper-
(a) This Insurance does not apply to ;~:; ~ nd "to~.ding or unloading.'
any roccurrence` wNch takes place ~. ; ~'•
after the equipment lease expires; TFita, 'exclusion appges even If the claims
against any Insured allege nepllgence or
(b) This insurance' does not apply to ottieF Wrongdoing in the supervision, hiring,
'bodily injury' or 'property dam' employment, training or mottltoring of others
age' arising out of the sole negli• ~ by that Insured, if the 'occurrence" which
Bence of such person or caused the 'bodily injury" or 'property
organization; damage' Involved the ownership, mainte-
(4) Permits issued by any state or political Hance, use o entrustment to othara of any
subdiNsion with respect to operations aircraft, auto or watercraft that Is owned
performed by you or on your behalf, or operated by or rented or loaned to any in-
subjoct to the following addtional pro- sured.
vision: This exclusion does not apply to;
This Insurance does. not apply to 'bodily ~~) q wdtercraft wfille ashore on premises
Injury;' "property' damage,' "personal yrou own or rent;
and advertising Injury" arising out of op•
orations performed for the state or (2) A watercraft.you tb not own that Is:
muhiclpality. (a) Cess than s2 feet loop; and
c. The insurance with respect to any architect, (b) Not being used to carry parsons or
engineer, or surveyor added as an Insured property for a charge;
by thla ,endorsement does • not apply to
"bodiy injury,' 'property damage,' •per• (3) Parking an "auto" on, or on the ways
sonal and advertising Injury- arlsin9 out of next to, premises you own •or rent, pro-
the rendering of or the faJltue to render any vfded the "auto' is not owned by or
professlonal~ services by or for you, includ- rented or loaned to you or the insured;
Ing: (4) Uabilify assumed under any "Insured
(i) The preparing, approving, or falinp to contract" for the ownership, malnte-
prepare or approve maps, drawings, Hance or use of aircraft of watercraft; or
opinions, reports, surveys, change or- •Bodit i " ' "
dens, designs or speciRcatlons; and (~ Y NurY or property damage
aRsing out of the operation of any of the
(2) Supervisory, Inspection or englneerinp equipment listed (n paragraph f.(2) or
services. f.(3} of the definition of "mobile equip'
d. This insurance does not apply to~ •boddy moot."
injury" or "property damage' included witNn (6) An•alrcraft you do not own pravlded it is
the 'products-completed operations haz• not operated by any insured.
ard.•
TENANTS' PROPERTY DAMAGE LIABILITY
A person's or organization's status as an Insured un•
der this endorsement ends when your operations (or When a Damage to Premises Rented to you Umit is
that Insured are completed. shown in the Declarations, 'F-xclusion J. of Coverage
No coverage wW be provided q, to tla absence of tWs A, Section 1 Is replaced by the following:
endorsement, no Uability would be imposed•by law on ). Damage To Property
you. Coverage sf>aU be limited to the extent or yyoour "property damago• tb;
nepllgence or faurt according to the applicable prlnd-
ples of comparetive fault. (1) Property you own, rant, or occupy, including
any costs or expenses Incurred by you, or
NON-OWNED WATERCRAFT AND NON-OWNED any. other parson, organization or entity, for
AIRCRAFT LIAI3IUTY repair, replacement, onhancement, restore-
• uon or maintenance of such property for any
Exclusion g. of CCVERAt3E A (Section 1) is replaced reason, including prevention of injury to a
by the following: person or damage to another's property;
~J ,., E~(i';1"
`~ ~~ ~%s r•aaora
i ,, „
(2) f remises you sell, y(ve away or abandon, if
the 'property damage' arises otrt of any part
of those premises;
(9) Property loaned to you;
(4) Personal property In the care, custody or
control of the Instued~
(5) That parttcutaz part of real property on whlcfi
you or any contractors or subcontractors
working directly or indirectly on your behalf
are performing operations, if the 'property
damage' arises out of ttwse operations, or
(6) That partlcWar part of any property that must
be restored, repaired or replaced because
"your work' was )ncorcectly performed on it.
Paragraphs (1), (3) and (4) of this exclusion do
not apply to 'property damage' (other than
damage by fire) to premises, Including the con'
tents of such premises, rented to you. A separate
limit of Inswance applies to Damage To Prem•
ises Rented To You as described in Section Ili
- Um1ts Of Instsance.
Part~graph (1) does not.gppty to executive c{fiders, or
to in~rtagazs at the sujSdrvisory level or above.
SU.•~,f,EM~NTttRY R~MENTS - COVERAGES A
AN.B - yUL' BON
~..
parkDraph 1.b. of SUpF. LEMENTARY PAYMENT8 -
COVERAGES A AND B •ts replaced by the fo!lowing:
b. Up to 52,000 for cost of ball bonds required be•
cause of accidents or traffic law violations arising
out of the use of any vehicle to which the Bodily
injury IJab111ty Coverage appaes. We do not have
to furNsh these bonds.
EMPLOYEES AS INSUREDS ~ HEALTH CARE
SPRVlCE3
Provision 2.a,(1~ d. of tNHO.IS AN INSURED (Section
II) Is'deleted, unless excluded by separate endors~-
men't.
Ekl'ENbED COVERAGE FOR NEWLY /fCOU1RED
ORGAAf1ZATlON3
Paragraph (2) of this exclusion does not apply if
the premises are 'your work" and were never Provision 4.a, of 1NH0 IS AN INSURED {Section II) is
occupied, rented or held for rental by you. replaced by the following:
Paragraphs (3), (4), (5) and (8) of this exclusion a. Coverage ;under th(s provision is afforded
do not apply to (lability assumed under aside- only until the end of the policy period.
track agresinent. EXTENDED "PROPERTY DAMAGE"
Paragraph (e) of this exGUSion does not apply to
•proporty damage' includod fn the 'products' Exclusion a, or OOVERAQEA. (Se Won 1) Is amended
completed operations hazard." to read:
Paragraph 8. of Section III is replaced by the fouow•
~ing: ,
8. Subject to 6. above, the Damage To Property
Umit is the most we,will pay under Coverage A
for damages because of 'property damage' to
any one premises, white rented to you, or in the
case of damage by fire, whilo rented to you or
temporargy occupied by you with permission of
the owner.
The Tenants' Property Damage to Premissa Rented
to You limit is the higher of 5200,000 or the amount
shown to the Oelrlprattons as Damage to Premtseg
Rented to You'L1m1L
WHO IS AN INSURED - MANAGEAS
a. •Bodify inJtuy or 'property damage' expected
or intended /nom the standpoint of the insured.
71tis exclusion does not apply to •bodly injury"
or 'property damage' resufttng tram the use of
reasonable force to protect persons or property.
INCREASED MEDICAL EXPENSE LIMIT
The medical expense 11m1t is amended to 510,000.
KNOWLEDGE OF OCCURRENCE
The following is added to Paragraph 2. Dudes In The
(:vent ~ Of Occurcence, Offense, Claim Or Suit of
COMMERCWL l3ENERAC t.lAB1UTY CONDITIONS
(Section 11r):
Tha rotlowing la added to Paragraph 2a. of 4VH0 IS Krawlodge of an •occurcen'ce,• claim or 'suit" by
AN INSURED (Section II): Your agent, servant W employee shalt not in ltseu
consdttde knowledge of~the named insured uNess an
odlcer of the named insured has received such notice
from the agent, servant or employee.
co ra ss oa oa -/~,~ l~~ - r.o. o or a ..
UNINTENTIONAL FAILURE TO D1SCL05E ALL
HAZAAD8
Tho (oAowlnp Is added to ParaDraph & Representa•
dons of COMMERCIAL GENERAL LIABILITY CONDh
TICNS (Section IV);
!f you unintentionally fall to disciose any hazards ex•
istfnp at the inception data of your poUcy, we wiU not
deny coverage under this Coverage Form because of
such faAure. However, this provision dces rat affect
our right to collect additional premltun or exercise our
rlpht of Cancellation or non•renewal.
clause
The~gQoydnp paraflra~ `tis added to COMMERCIAL
QE I RI}!: l!lAB1UTY ~;; OITION3 (Section !V);
tD. •a revision to tht;~pverape Part, which would
rovide more covsrape with no addttlonal pra-
mlum, becomes effective during the policy period
in the statd shown In'the Declarations, your po--
(cy wiU automaticatly.provide this addltlonal cov
erape on the effective date of the revision.
~~~)'-Ji. ~ ,t:~M
~~.
Pay ~ of 4
ACORO,. CERTIFICATE OF LIABILITY INSURANCE I DATE (MMlDDfYYYV) I
1 06/21/2007
PRODUCER N-,z]O{, M 038 THIS CERTIFICATE IS IssueD AS f'.. MATTER OF INFORMATION ONLY AND
CONFERS NO RIGHTS UPON THE CE~TIFICATE HOLDER. THIS
AU Insurance Services I//M J.OO' -OJ,g-O/ CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE
PO Box 3646 AFFORDED BY THE POLICIES BELOW.
Omaha, NE 68103-0646 ,41 -.,lOO' - oJ/! -Ol
(877) 234-4420 INSURERS AFFOROING COvERAGE NAIC # -
-----
--- ~.R~A California Insurance Co. --- 237310
INSURED " f-=-'--
Prestige striping Services, Inc. INSURER 8'
dba prestige Striping Services .---
1054 Railroad St ~~RER c ---- ---
Corona, CA 92882-1947 ~~.~ --
, ~TL 1273 377898 INSURER 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 OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSUQANCE 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.
INSRIADD'L1 - -~-- POOt-Y EFFECTIVE POLICY' EXPIRATION I --
lTR !INSRnI TYPE OF INSURANCE POLICY NUMBER OATE MMfDDIYY DATE IMMIDDIYYI I LIMITS
GENERAlllABILITV EACH OCCURRENCE $
~ DAMAGETORENTED--'
COMMERCIAL GENERAL LIABILITY ~.EREMISES (E<:l_(,,-ccurrencel $
CLAIMS MADE DOCCUR ~_E'XP (Any 011E' lJersun) S
_ _ _ PERSONAL &_flDV Ir:!J~ ~__
I _ _ GENERAL AGGREGATf:: S
GEN'L AGGRf::GATE LIMIT APPLIES PER I
,cc--, ---, PRO n '
I I POLICY I JECT' , laC
~t~~;~
BHIREDAlITOs.-
I NON OWNED AUTOS
=--1
---
-----
-
J'.!10DUCTS_.:_COMP/OP AGG S
COMBINEO SINGLE LIMIT
(Ea accident)
I-
s
--
BODILY INJURY
{Per person)
-
"
I
--
BODILY INJURY
{Per,lr.rldf'nt)
s
-
--
PROPERTY DAMAGE
IPerdu::ldent\
,
~~GE LIABILITY
--lANY AUTO
AUTO ONl Y . EA ACC! DENT S
OTHER THAN
AUTO ONLY
EAACC S
-
AGG S
EXCESSlUMBRELLA LIABILITY
C OCCUR 0 CLAIMS MADE
EACH OCCURRENCE
$
$
.
~
$
---
~~.!E
-
DEDUCTIBLE'
---
A
RETENTION $
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED"
iiyes,d,:,scribeunder
SPECIAL PROVISIONS below
OTHER
46-006122-03-07 i
06/01/07
06/01/08
X ! T~~.jI~JI~S I IO~~-
E.L EACH ACCIDFNT 1, 000, 000
____ _2.._
E L DISEASE EA EMF'LOYEE S 1, 000 , 0 0 0
E.L DISEASE _ POLICY LIMiT S 1, 00 b , 000
'. t
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
~
.,
\. ~ '.. (;, ,-
CERTIFICATE HOLDER
CANCELLATION
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 30
305 E Fourth Street St. 201 DAYS WRITTEN NOTICE TO THE CERTIF!CATE HOLDE~ NAMED TO THE LEFT, BUT
92701 FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON
Santa Ana, CA THE INSURER, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE ~ .&2,.1:
Attnzl Rock Garcia -A-. OD7 8 3 3 6
ACORD 25 (2001/08)
@ ACORD CORPORATION 19A8