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HomeMy WebLinkAboutSOUTHLAND CAR COUNTERS 5A - 2006INSURANCE NOT ON FILE WORK MAY ~ PPROCEED CLERK OF COUNCIL DATE: 6-11"°~ ~ o: PYrAC~X.s. ~" FIRST AMENDMENT TO AGREEMENT THIS FIRST AMENDMENT TO AGREEMENT is entered into on June 30, 2006, by and between Field Data Studies dba Southland Car Coiunters, 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 A-2005-114, dated June 6, 2005, (hereinafter "said Agreement") by which Consultant has provided traffic counting and data collection services. A-2005-114-01 B. In accordance with the terms and conditions of said Agreement, the parties wish to amend the term of said Agreement. `vr WHEREFORE, in consideration of the covenants contained in said Agreement, and subject to all the terms and conditions of said Agreement, except those amended in this First Amendment to Agreement, the parties agree as follows: 1. Section 3, TERM, shall be deleted in its entirety and replaced with the following: '`This Agreement shall commence on June 6, 2005 and terminate upon expenditure of allocated funds, unless terminated earlier in accordance with Section 13, below." 2. Except at 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 First Amendment to Consultant Agreement on the date and year first written above. APPROVED AS TO FORM: Ct-ctiw~,-~ ~ik~t~c~ ~~JOSEPH W.FLETC R City Attorney CITY OF SANTA A ~~ MES G. ROSS xecutive Director 1, Public Works Agency AT!<a6STi Cf ERK Of TNf COUNL'K AL`ORD CERTIFICATE OF LIABILITY INSURANCE OP ID DaTE (MM/ODIYYYY) NATIO-5 O5 07 07 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Freeman 6 Pearce Ins . - COCIA ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE LiC. #0559854 HOLDER. THIS CERTIFICATE DOES NOT AMEND EXTEND OR 1216 N. Tustin Street , ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Orange CA 92867 Phone: 714-558-1334 Fax:714-626-1330 INSURERS AFFORDING COVERAGE ~NAIC# INSURED National Data & Surveying A•D~ ~-rry, INSURER A' Colden [a93e/PCeilesa xna Co ~' 10$36 SerV1Ce4 Ino. DBA: SOUTHLAND CAR COUNTERS A-zoos-uy-or INSURER B' DBA: FIELD DATA SERVICES INSURER C: 8370 Wilshire Blvd Ste 209 Beverly Hills CA 96211 INSURER D: INSURER E. CO 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 MAV PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IB SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IRSR LTR NSR TYPE OF INSURANCE POLICY NUMBER ~qTE MM/OD/ri DATE MM ~DlYY _ _ I LIMITS !GENERAL LIABILITY EACH OCCURRENCE $1,000,000 A X X COMMERCIAL GENERAL LIABILITY CBP9888381 09/30/06 09/30/07 PREMISES Ea occurence $ 1DD, DDO CLAIMS MADE '.~ OCCUR MED EXP (Any one Person) 8 1 D r D D D I f FERSONHL3ADVIIJJURY 1$1,000,000 GENERAL AGGREGATE $2, QODrQDO GEN'L AGGREGATE LIMIT APPLIES PER'. PRO ' PRODUCTS -COMP/OP AGG $ 2 , 000 , D D D ' - LOC POLICY JECT AU TOMOBILE LIABILITY oQ INGLE LIMIT e S ANY AUTO E accitle ALL OWNED AUTOS ~b)~ ~E°~~ ~~' ~~~ .~~~~q~s SCHEDULED AUTOS /A~.L PFi~~rl®~13 C~Fi6B '(GATES ~ ~ IP oPersloN~J)URY $ HIRED AUTOS ' BODILY INS JURY $ t NON-OWNED AUTOS ' (Per accidenq ( i ~ PROPERTY DAMAGE (Par accidenq $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANV AUTO OTHER THAN EA ACC $ AUTO ONLY. qGG $ E%CESSlUMBRELLA LIABILITY EACH OCCURRENCE $SrQDD~OQO A X OCCUR CLAIMS MADE CU 8070943 09/30/06 09/30/07 AGGREGATE $SrOOO, ODD $ I DEDUCTIBLE 8 ' RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY - - TORY LIMITS ER I ANY PROPRIETORIPARTNERlEXECUTIVE ~ E.L. EACH ACCIDENT '. $ OFFICERIMEMBER EXCLUOED9 It ye; describe under c. L. DISEASE - EA EMPLOYEE( $ i SPECIAL PROVISIONS below E. L. DISEASE-POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES f EXCLUSIONS ADDED BY ENDORSEMENT( SPECIAL PROVISIONS *CANCELLATION - EXCEPT 10 DAYS NOTICE FOR NON PAYMENT OF PREMIUM. THE CITY OF SANTA ANA, ITS OFFICERS, EMPLOYEES, AGENTS & VOLUNTEERS, __ , PRIMARY WORDING PER FORM CGODOI 10/O1 & NAMED AS ADDITIONAL INSURED q,.,,, „°,=Y PER FORM GECG602 9/04 BUT ONLY INSOFAR AS THE OPERATIONS UNDER THIS CONTRACT ARE CONCERNED.RE: TRAFFIC DATA COLLECTION ctrc I o-wn I L: n~LUtH; CANCELLATION SANTO 13 SHOULD ANV OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3O * DAYS WRITTEN CITY GF SANTA ANA, NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO 00 SO SHALL PUBLIC WORKS AGENCY Attn: Shahir Gobran IMPOSE NO OBLIGATION OR LIABILITY OF ANV KIND UPON THE INSURER, ITS AGENTS OR 20 CIVIC CENTER M-93 REPRESENTATIVES. SANTA ANA CA 92702 12ED RE7RE5EIJT?TI'(E - - ACORD 25 (2001!08) ©ACORD CORPORATION 1988 b. If a claim is made or "suit" is brought against any insured, you must: (1) Immediately record the specifics of the claim or "suit" and the date received; and (2) Notify us as soon as practicable. You must see to it that we receive written no- tice of the claim or "suit" as soon as practica- ble. c. You and any other involved insured must: (1) Immediately send us copies of any de- mands, notices, summonses or legal pa- pers received in connection with the claim or "suit"; (2) Authorize us to obtain records and other information; (3) Cooperate with us in the investigation or settlement of the claim or defense against the "suit"; and (4) Assist us, upon our request, in the en- forcement of any right against any person or organization which may be liable to the insured because of injury or damage to which this insurance may also apply. d. No insured will, except at that insured's own cost, voluntarily make a payment, assume any obligation, or incur any expense, other than for first aid, without our consent. 3. Legal Action Against Us No person or organization has a right under this Coverage Part: a. To join us as a party or otherwise bring us into a "suit" asking for damages from an insured; or b. To sue us on this Coverage Part unless all of its terms have been fully complied with. A person or organization may sue us to recover on an agreed settlement or on a final judgment against an insured; but we will not be liable for damages that are not payable under the terms of this Coverage Part or that are in excess of the ap- plicable limit of insurance. An agreed settlement means a settlement and release of liability signed by us, the insured and the claimant or the claim- ant's legal representative. 4. Other Insurance If other valid and collectible insurance is available to the insured for a loss we cover under Cover- ages A or B of this Coverage Part, our obligations r are limited as follows: a. Primary Insurance This insurance is primary except when h. be- iowapplies. If this insurance is primary, our ob- ligations are not affected unless any of the other insurance is also primary. Then, we will share with all that other insurance by the method described in c. below. b. Excesslnsurance This insurance is excess over: (1) Any of the other insurance, whether pri- mary, excess, contingent or on any other basis: (a) That is Fire, Extended Coverage, Builder's Risk, Installation Risk or similar coverage for "your work"; (b) That is Fire insurance for premises rented to you or temporarily occupied by you with permission of the owner; (c) That is insurance purchased by you to cover your liability as a tenant for "prop- erty damage" to premises rented to you or temporarily occupied by you with permission of the owner; or (d) If the loss arises out of the maintenance or use of aircraft, "autos" or watercraft to the extent not subject to Exclusion g. of Section I - Coverage A -Bodily Injury And Property Damage Liability. (2) Any other primary insurance available to you covering liability for damages arising out of the premises or operations for which you have been added as an additional in- sured by attachment of an endorsement. ~~ ~~~ CG 00 01 10 01 ©ISO Properties, Inc., 2000 Page 11 of 16 ^ The following Provisions are also added to this Coverage Part: A. ADDITIONAL INSUREDS - BY CONTRACT, AGREEMENT OR PERMIT 1. ' Paragraph 2. under SECTION II -WHO IS AN INSURED is amended to include as an insured any person or organization when you and such person or organization have agreed in writing in a contract, agreement or permit that such person or organization be added as an additional insured on your policy to provide insurance such as is afforded under this Coverage Part. Such person or organization is not entitled to any notices that we are required to send to the Named Insured and is an additional insured only with respect to liability arising out of: _--~y a. Your ongoing operations performed for that person or organization; or b. Premises or facilities owned or used by you. With respect to provision 1.a. above, a person's or organization's status as an insured under this endorsement ends when your operations for that person or organization are completed. With respect to provision 1.b. above, a person's or organization's status as an insured under this endorsement ends when their contract or agreement with you for such premises or facilities ends. 2. This endorsement provision A. does not apply: a. Unless the written contract or agreement has been executed, or permit has been issued, prior to the "bodily injury", "property damage" or "personal and advertising injury"; b. To "bodily injury" or "property damage" occurring after: (1) All work, including materials, parts or equipment furnished in connection with such work, in the project (other than service, maintenance or repairs) to be performed by or on behalf of the '~ additional insureds) at the site of the covered operations has been completed; or ,~7 (2) That portion of "your work" out of which the injury or damage arises has beeri put to its intended w y use by any person or organization other than another contractor or subcontractor engaged in ~, ~ performing operations for a principal as a part of the same project; Q. To the rendering of or failure to render any professional services including, but not limited to, any =, professional architectural, engineering or surveying services such as: (1) The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; and ., _ (2) Supervisory, inspection, architectural or engineering activities; "~ y ~. To "bodily injury", "property damage" or "personal and advertising injury" arising out of any act, error or omission that results from the additional insured's sole negligence or wrongdoing; e. To any person or organization included as an insured under provision B, of this endorsement; f. To any person or organization included as an insured by a separate additional insured endorsement issued by us and made a part of this policy. B. ADDITIONAL INSURED-VENDORS Paragraph 2. under SECTION II -WHO IS AN INSURED is amended to include as an insured any person or organization (referred to below as "vendor") with whom you agreed, in a written contract or agreement to provide insurance such as is afforded under this policy, but only with respect to "hodily injury" or "property damage" arising out of "your products' which are distributed or sold in the regular course of the vendor's business, subject to the following additional exclusions: 1. The insurance afforded the vendor does not apply to: a. "Bodily injury" or "property damage" for which the vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to liability for damages that the vendor would have in the absence of the contract or agreement; b. Any express warranty unauthorized by you; c. Any physical or chemical change in the product made intentionally by the vendor; Includes copyrighted matedal of Insurance Services OKces Inc. with I15 permission. GECG 602 (09!04} Page 4 of 5 AGFNT COPV d. Repackaging, unless unpacked solely for the purpose of inspection, demonstration, testing, or substitution of parts under instructions from the manufacturer, and then repackaged in the original container; e. Any failure to make such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the course of business, in connection with the distribution or sale of the products; f. Demonstration, installation, servicing or repair operations. except such operations performed at the vendor's premises in connection with the sale of the product; g. Products which, after distribution or sale by you, have been labeled or relabeled or used as a container, part or ingredient of any other thing or substance by or for the vendor; or h. To "bodily injury" or "property damage" arising out of any act, error or omission that results from the additional insured's sole negligence or wrongdoing. 2. This insurance does not apply to any insured person or organization, from whom you have 2cquired such products, or any ingredient, part or container, entering into, accompanying or containing such products. APPROF:'=-'-? ~_-' 'TO FOfiM ____--~~Y~~ A~,.. GECG 602 (09104) Includes copyrighted material of Insurance Services Offices Inc. with its permission. Page 5 of 5 BOLTON & COMPANY PC BOX 6030 PASADENA, CA 91102 626-799-7000 ci r i----=°®-~-~-~ ~.ww.,,.,.o.a Policy number: 03312696.1 Undenvntten hy. United Financial Casualty Company February 2, 2007 Poet oft -~O -r/k A ~oo~ lly-a Certificate of Insurance teAHicate Holder Insured Add !' anal Insured ._... FlELD DATA SERVICES INC. CITE ':F SANTA ANA 8370 WILSHIRE BL 209 PUB'-~ :WORKS AGENCY BEVERLY HILLS, CA 90211 20 CIvIC CENTER PLAZA M-43 SAN i A ANA, CA 92702 Agent BOLTON & COMPANY PO BOX 6030 PASADENA, CA 91102 This document certifies that insurance policies identified below have been issued by the designated insurer to the insured named above for the periods} indicated. This Certificate is issued for information purposes only. It confers no rights upon the certificate holder and does not change, alter, modify, or extend the coverages afforded by the policies listed below, The coverages afforded by the policies listed below are subject to all the terms, exclusions, limitations, endorsements, and conditions of these policies. pofiry Effective Date. Nov 26, 2006 Pohry Expiration Date: Nov 26, 2007 Insurance coverages) Limits Bodily Injury/Property Damage $1,000,000 Combined Single Limit UninsuredlUnderinsured Motorist $1,DOO,ODO/$1,000,ODD Employer's Non-Owned Auto BIPD $1,000,000 Combined Single Limit Hired Auto Bodily Injury/Property Damage $1,000,000 Combined Single Limit De';ription of LowtionNehicles/Special Items Scheduled autos only 1994 TOYOTA 4RUNNER SRS JT3VN29V6R002499B Stated Amount $&,000 Medical Payments $5,000 Comprehensive $500 Ded Collision $SOD Ded AFi RC _ e:- T`7 FORM ~~~ ~/~ .,, . .. , : . _y Continued Policy number: 03312696-1 Page 2 of 2 Certificate number 03307N20696 Please be advised that additional insureds and loss payees will be notified in the event of amid-term cancellation. c~-~' Form szai (ioroz) APPd20`•~i'~~j~•.:; `~/ty~ 1~C3IZ~Vl n.,,. BOLTON & COMPANY PO BOX 6030 PASADENA, CA 91102 fi26-799-1000 rlrivo• ~i ~.W„r,.,.o.araao~ Policy number: 03312696-t Underwritten by: United Finanual Casualty Company January 25, 2007 Page 7 of 1 ~-aoos i~v A'~005 - /l y - D I Certificate of Insurance Certificate Holder IHwred A9e^t CITY OF SANTAANA FIELD DATA SERVICES INC. BOLTON & COMPANY 2D CIVIC CENTER PLAZA M-43 637D WILSH!RE BL 209 PO BOX 6D30 SANTA ANA, CA 927D2 BEVERLY HILLS, CA 90211 PASADENA, CA 91102 This document certifies that insurance policies identified below have been issued by the designated insurer to the insured named above for the period(s) indicated. This Certificate is issued for information purposes only, It confers no rights upon the certificate holder and does not change, alter, modify, or extend the coverages afforded by the policies listed below. The coverages afforded by the policies listed below are subject to all the terms, exclusions, limitations, endorsements, and conditions of these policies, Polity Effective Date: Nov 26, 20D6 Polity Expiration Date: Nov 26, 2007 Inwrence covxage(s1 ~~ Bodily InjurylProperty Damage 81,000,000 Combined Single Limit Description of LowtionNehicles/Special Items Scheduled autos only Certificate number 02507HVC696 Please be advised that the certificate holder will not be notified in the event of a mid-term cancellation. U wrmszaurarozl A`'Irf~r' l,C 'TO FORM As,,:,~..... _ ,,:u~ ~. z.Y BOLTON & COMPANY ff Yi VG" PO BOX 6030 ~"~'~- PASADENA, CA 91102 ooozss ~"'°""""`"°"""~Afd~ Policy number: 03312696-1 Underwritten by: United Fioanaal Casualty Company Insured: FIELD DATA SERVICES INC. CITY OF SANTA ANA 20 CIVIC CENTER M-43 February 2, 2007 SANTA ANA, CA 92702 Policy Penod: Nov 26, 2006 -Nov 26, 2007 a -coos Div Mailing Address A- ,20 06' /~y - °~ Unted Financial Casualty Company PO Box 94739 Additional insured endorsement Cleveland,°"44,°' B00.444.4487 For customer service, 24 hours a day, Name of Person or Organization 7 days a week CITY OF SANTA ANA 20 CIVIC CENTER M-43 SANTA ANA, CA 97702 The person or oryanization named above is an insured with respect to such liability coverage as is afforded by the policy, but this insurance applies to said insured only as a person liable far the conduct of another insured and then only to the extent of that liability. We also agree with you that insurance provided by this endorsement will be primary for any power unit specifically described on the Declarations Page. - Limit of Liability Bodily Injury No[ applicable Property Damage Not applicable Combined Liability $1,000,000 each accident All other terms, limits and provisions of this policy'r•emain unchanged. This endorsement applies to Policy Number: 03312696-1 Issued to (Name of Insured): FIELD DATA SERVICES INC. Effective date °i endorsement: 1 112 612 00 6 Policy expiration date: 11/26/2007 Form 1198 (01/e4) r t`i'2131~ ~ _ _ ", ; TO FORM ~...~,. 01/29/2007 15:47 FAX 3237820130 FDS Sou7hlBnd ®ooz POLICYHOLDER COPY ~ STATE PO BOX 420807, SAN FRANCISCO,CA 94 1 42-0 807 ~ _,2005'~~y COMPENSATION INSURANCe FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE A- o2OQ5 - ~~'y-O~ ISSUE DATE: 01-22-2007 GROUP. POLICV NUMBEq; 1BB02BB-4006 CERTIFICATE ID' 6 CERTIFICATE EXPIRES 0+-01-2007 oa-ot-41106/oe-of-2007 CI7T OF SANTA MIA PUBLIC IAIRXS AGENCY SC dOB:ALL CALIFORNIA OPERATIONS ATTN: SNAHIR G06RAN 20 CIVIC CENTER PL2 N-a3 SwNTw ANA CA 82701-4058 . ihl;_.ls to certify that we hwe Issued . valid Workers' Compensation Insurance policy in a form approved by the California Insurance Commissioner to the employer nametl below far she policy period Indlcaud. This policy rs not subject to cancellebon Dv the Fund except upon 10 tlayz advance wriHen notice to ilia employer. Ws wdl also glue you to days advance nonce should this policy De cancelled prior to ps normal expuanon. This certificate of Usunnce is nor an Insurance policy and does not amend, extend or alter the cavarage affordetl by the policy listed herein. Notwlthstndin9 my rsqurromenL [arm or contll0on of ym contract or other document with respect to which this cer[lfiu[e of Insurance may be Issued or to which It mN Pertain, the lnsunnce alfor de0 by ilia Dollcy described herein is wblect to dl the terms, exclusions, and contlitlons, of such policy. THORIZEO REPRESENTATI PRES~~ EMPLOYERrS LIABILITY LIMIT INCLUDING DEFENSE COSTS: 51,000,000 PER OCCl1RRENCE. ENDORSEMENT M1600 - ABRAWW TASMNMI PRES. - EXCLUDED. ENDORSEMENT M16oo - MICHAEL GLITZ CFO SEC. - EXCLUDED. VLr) A~ 'r~ F rJ]'.Nl AprRO ps tsg nt ~;ity Attormey EMPLOYER FIELD DATA SERVICES CORPORATION eJ70 MILSHIRE BLVD STE 208 BEVERLY HILLS CA 80217 IME~A'a51 SC [ESI,SPJ PRIMED of-24-4007 O1/J1/2007 15:54 FAX J2J7b20130 FDS Southland POLICYHOLDER COPY STATE PO BOX 420807, SAN FRANCISCO,CA 94142,-0807 INSUIanNCe F V N © CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 01-22-2007 GROUP POLICY NUMBER: 1880288-2008 CERTIFICATE ID; B CERTIFICATE EXPIRES: 04-07-z007 04-01-2006/04-01-2007 CITY OF SANTA ANA PUBLIC WORKS AOENCT SC JOB: ALL CALIFORNIA OPERATIONS ANN: SHAHIR GOBRAN 20 CIVIC CENTER PLZ N-43 SANTA ANA CA 82701-4058 Thlt.lb to earn}y that we have Issued a valid Workers' Oempeneahon insurance pokey In a form approved by the Califmnla Insurance Lolnmissioner to [he employer named below for the policy period Indicated OOJ Sc ~ - p2o05-1iy A - aaas- iiti - o I This policy lb no[ sub]sc[ to cancelNUOn by the Fund sxcep[ upon f0 days advance written notice to the employer. We well alw give you f0 tlays adwnce nonce should this policy be uncalled prior Io its normal sxpvauon. Tnn car bf icate of lmurance is not en insurance policy end does not amend. extend or aher the coverage afforded by the policy listed herein. Notwlthstantling any requirement, term or Condition o} "any contract or other tlocumem with respect Io which this ear tiiiu[e of insurance may ba issued or m whleh It may Dertaln, eke ineurance alfortlsd by the policy desaibsd herein is subject to all the terms. exclw~ons, rid conditions, of such policy. THORIZED REPRESENTAT' PRESIDENT EMPLOYER'S LIABILZTT LIMIT INCLUDING DEFENSE COSTS: 21,000,000 PER OCCURRENCE. ENDORSEMENT N1800 -ABRAHAM TA3HMAN PRES. - EXCLUDED. ENDORSEMENT N1800 -MICHAEL BLITZ CFO SEC. -EXCLUDED. °~. ,"'•~'~:v/ ASS TC FORYi EMPlOYEq FIELD DATA SERVICES CORPORATION 8370 WILSHIRE BLVD STE 208 BEVERLY HILLS CA 80211 a[sv.rasr '- .,...,Cij~ A~•..~ta.ll Lity i~t(or;cy SC IESI,SP] PRINTED 01-22-2007 01/29/2007 15:47 FAX 0237920130 FDS Southland I~j001 i NHS National Data & Surveying Services f IELDl~A7AJERVICEs SoutMlanA car Counters NDS is Darent Company of Field Data Services antl Southland Gar Gountere Fax Corporate Office 8370 Wdsflhe Blvd Ste 205 BevBfly Hills, CA 90211 T- (723) 782.0090 F- (323) 782.0130 E-mail. Infc~ntlstlata com 70: 1 '.,~ 0~ ~~.~~~. Fmm: ~u Santostefano A**N: S o'l ~ ~ FaY: //11 ~~ ~ A /' 1 vagas:p{ (Including,C[,foNV~ler~) Re: 7"~y' ~ '6 s~ ~: - ate- ~- ~ ~ (~~% ~ , ~- ~~d recea ~~ ~~ Tlianl~s Lp To orderJobs or to renuest an estimate a/e+ase I'AX: 323-782-0130 1;N1A11,: orders~~ndsdata-com Ur call 323-782-0090 ' CERTHOLDER COPY SC STATE P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807 q, ~cOO~ _ ~~ ~- COMPENSATION ft INSURANCE FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ~ ~ °~~ Jr - I' ~ - 0 ISSUE DATE: OS-02-2007 GROUP: POLICY NUMBER: 7880289-2007 CERTIFICATE ID: 23 CERTIFICATE EXPIRES: 04-01-2008 04-01-2007/04-01-2008 CITY OF SANTA ANA SC JOB:ALL CALIFORNIA OPERATIONS ATTN: SHAHIR GOBRAN 20 CIVIC CENTER PLZ M-43 SANTA ANA CA 92701-4058 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the Calif orris Insurance Commissioner to the employer named below for the policy period indica[etl. This policy is not subject to cancellation by the Fund except upon30 days advance written notice to the employer. We wilt also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy antl does not emend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditiens, of such policy. V THORIZED REPRESENTATI PRESIDENT EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT X1600 - ABRAHAM TASHMAN PRES. - EXCLUDED. ENDORSEMENT #1600 - MICHAEL BLITZ CFD SEC. - EXCLUDED. ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 04-01-2007 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. EMPLOYER NATIONAL DATA AND SURVEYING SERVICES INC OBA: FIELD DATA SERVICES DBA: SOUTHLANO CAR COUNTERS 8370 MILSHIRE BLVD STE 209 BEVERLY HILLS CA 90211 APi ~r>=,' t-~) J,h:}~TO FORM Assistant City Attorney [SLC,SP] IREV.4-06) PRINTED OS-02-2007 CERTHOLDER COPY SC STATE P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807 COMPENSATION A - ~QQ$ - I/L~ INSURANCE FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ~ ~ ~QQS' / ~ y - ~ ISSUE GATE: 05-OZ-2007 GROUP: POLICY NUMBER: 1880289-2007 CERTIFICATE ID: 23 CERTIFICATE EXPIRES: 04-01-2008 04-01-2007(04-01-2008 CITY OF SANTA ANA SC JOB:ALL CALIFORNIA OPERATIONS ATTN: SHAHIR GOBRAN 20 CIVIC CENTER PLZ M-43 SANTA ANA CA 92707-4058 Thls Is to certify that We have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period Indlcatetl. This policy is not subject to cancellation by the Fund except upon30 days advance written notice to the employer. We will also give you 30 days advance notice should this policy be Cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect tc which this certificate of insurance may 6e issued or to which it may pertain, the insurance afforded by the policy described herein is subject to aVl the terms, exclusions, and conditions, of such policy. THORIZED REPRESENTATI PRESI EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: 81,000,000 PER OCCURRENCE. ENDORSEMENT N1600 - ABRAHAM TASHMAN PRES- - EXCLUDED. ENDORSEMENT N1800 - MICHAEL BLITZ CFO SEC. - EXCLUDED. ENDORSEMENT N2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 04-01-2007 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. EMPLOYER NATIONAL DATA ANO SURVEYING SERVICES INC DBA: FIELD DATA SERVICES DBA: SOUTHLAND CAR COUNTERS 6370 WILSHIRE BLVD STE 209 BEVERLY HILLS CA 90211 (SLC,SP] PRINTED 05-02-2007 IFEV.2-05) ,c. e.-H. 50/S , At;OR!}.. CERTIFICATE OF LIABILITY INSURANCE OP 10 ~~ D~tE (MMU)/"{'(('(t HATIOOl 10/16/07 PRODUCER ~ .?u:S- \ \ Lj THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Marshall , sterling ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE upstate Inc. .- ;;kD5 - ( ltf -DI HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR 113 saratoqa Road ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW. Glenville NY 12302 phone: 518-384-1100 Fax:51B-3B4-0193 INSURERS AFFORDING COVERAGE NAlC# 0 INSIJAED no/S\..RERA CNA Insurance COIllPJ!nies 0' INS\..RfR ~ r"--~ Nati~nal Data , surveying ,. - ._'_m____ - INS:..RER c: ,\ Se"v CtS inc. .. 8370 W lah re Blvd Ste 205 1N$L.RER 0 BeverlY HillS CA 90211 -------- , IIlSI..PER ~ fJ\o\' wo(\:.S fuer.G'J Co'1~+; .5tRh'u' (:"Ob\l.LYL COVERAGES Tl-E ;:';LICIES C1' 1~.6l.PA'''':E tlSTE:' 6::U:....n1A~E [lEE', I$SLED TO: Tn: :.~;~.:. r~C: ,s.ao'.'E FCi:I T~E Pa. :. ;::E~hOO ''c :Ar:C tI)T\.",T-"TA,'C, ."- I.Jn Pf "L ;;1'0"1:1(' IT::;''' (~C(ton:'j I_~ ;.Jj~ ...!'.l;.;JI.O:l ~ .'IH:I<I C....:V.'EW ;",'I'"1-t..E5PfC t:.o .......1(11 IMIS CE"'-rFtC";'"E 1.'/>.1 l:l:: IS'S_l:l" ;. \.IoloY :;EJO'~;,Jtj T-E '.SJ:ulI:E AFFC,p:~C fT '~E ~"(l :IES :€So..:PIE\E:i l"'E;;€li'1 15 SLe.E:TT': .lot. TrE fElO,.ti E.'ClL!SIC'l5 ~J{) :ODITI':<'l; :' ; '-'1 ~':l:C ES ~;':;'ATE 1..l!.1ITS ::~'.~;MAo' w.~E eEE~j I;';C...:ED El. Pto.:, CLA.\'S ~ nPE OF OGURAUCI! POUCl' NUMBER : ~ENERAL UA8lUTY A : X ..!-~M.'~RCl,.'.l :-D'(~ LLi<Oll.,n 82098024255 I _~CL.to.lJSt.~ 1iJ(."'_l~ - - (oEPI1,. ~:':.I;er...;.c L ,....T ~f:E:; I/>I).JC' I~:~ I 11(' C1AlIlmwD/'l"r) DATE {tMOD1Y'l'1 LO'." 09/30/07 09/30/08 ::.<0,:" :.:'; ~:;;~Ij'f f 1000000 :::;;EM 3-[; (E~' :',l~.,." ~~ ~'f 300000 \"01::_'1:....,.:..,,, ...t,~" : f 10000 :::E"S.:"J<{ tAl" _..2.: _L~_1000000 :.::P.(I;A~ ":""-:;(~.~T ~ 12000000 :::~rc"n~, ','1"". ~". i I 2000000 A ~MOBIUi L.IABI.JTl X ;':j~,",JJT(. i"::".=.L.::'/,'''::c~c:; f-- _ 5-Cl-E[UEO t.1f'OS _ HI"EDA..TC'-:, _ NCtI.o.\'N!:O Alj'QS 2098024269 09/30/07 I I _.Nl"~, [ ,'. __. "1 09/30/08 · .".', ,.. I I ~~~: r-o',~:; I J.. !::((,'III.",.;, :r'". /I~( jo-ffl , :, 1000000 " i--J.,/'..-I:..'I'L'/IMII'-t (Po)"lCto:W-ll 'J1H~'" I'WI AUT(, :",L' t-..... I , I !' ~.. ! ! .- I I GARAGl! u.<sUtY =-=i ;,w AUTC ~e$SNM8RElLA Lt.l8lUTY ~O:':Cl~ On;"I-,'-;\.tJlrF IIUI"';".L" l,","" It'fll' :,",:/0 ...:,:,_t.-~f'~_t ,il.,-....>;f'.:,Tr ~ hCUV:T'&E I IP(IT',TI':otl I WORK&RS COIoCPENSAllON um EMPLOYERS' UA8lUTY A >-:" P::Cf1;:E.CPIPA,.::T",EPJE).:;':UT ~E '"FFI-~;j,,",EW~EP F)~ .u:-.;:c: , iJE~-I~\;~~(tv ~~,:i~;M OTHER e--~"O- , IO'~. ~ .:.;' I WC298024272 09/30/07 09/30/08 " E;. .~, "' - 1,.('," ~~~.:." l."'\": f :. I ,,'; ~ . ! ,11000000 . ---~~--- 11000000 11000000 I, ~ " I DESCRlP'MPlOf OPERA'TIOHS! LOCA'JIOta I VEH!CLEs. I EXCLUSIONS ADOeD 8'1' 1~Ea.\l. PROVISIONS city of santa Ana is provided Additional Insured status when required by written contract or a9reement with respect to operations of tbe Named Insuz:ed. CERTIFICATE HOLDER CANCELLATION CITY108 SHOULD AH'f Of THE ABOVE DESCRIBED POLICIES BE CAtlCELLED BEFORE THE EXPIRATlOtI DATE THEREOF, 'THE ISSWlQ-INIWRER WILL EUOEA\lOR TO MAll. 30 DAYS WRl1TEN '. f,,' 'i\) FO NOTlCS TOTHli aiR1tFICAT& HOLD&Rt.lAMED TOTWE LifT. BUT fAlLU~ TO DO so SHALL ...05& NO OBlIGATION OR UAIIlITY OF J.If( t<ltlD Ul"OO THE IUSURER. ITS :'OENT$ OR REPRESENTAnvES. . (tPRe.SENf~TJVE City of santa Ana Public Works Agency Attn: Shahi" Gob"an 20 Civic Center H-43 Santa Ana CA 92702 ACORD 2S (20011081 0N I '/'-1 +,~',(V;j ! .-:~. A..,~\~.L, l V $ACOROCORPORAnoNl~ IMPORTANT If the cert~icate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A stalement on this certificate does not confer rights to the cert~icate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and cond~ions of the policy, certain policies may require an endorsement A statement on this certificate does not conter rights to the certificate holder in lieu ot such endorsement(s). DISCLAIMER The Certificale 01 Insurance on the reverse side of this form does not constilute a contract between the issuing insurerls), 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 2512001108) .. CNA S&146968-A (Ed. 01106) ~ IMPORTANT: THIS ENDORSEMENT CONTAINS DUTIES THAT APPLY TO THE ADDfTfONAL INSURED IN THE EVENT OF OCCURRENCE, OFFENSE, CLAIM OR SUIT. SEE PARAGRAPH C., OF THIS ENDORSEMENT FOR THESE DUTIES. THIS ENDORSEMENT CHANGES THE POLICY. PlEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED ENDORSEMENT WITH PRODUCTS-COMPLETED OPERATIONS COVERAGE It BLANKET WAIVER OF SUBROGAnON Architects, Englnecn and Surveyors this endorsement modlIies insurance provided under the following: BUSINESSOWNERS UAl3ILITY COVERAGE FOAM BUSlNESSOWNERS COMMON POLICY CONDI11ONS A. WHO IS AN lHSURED (SedIon C.) of !he Suelneesowners lJabjlity Coverage Form Is arn&IlCllld to include as an Insured any person or orgarn.:ation whom you are raqulrad 10 acid $S an addlllonal iIlaured on this polley undsr a wrlttan conttaet or wrlttan agrument; but the writlIln CQTrtract or writlIln agreement must be; 1. Currently in e1fect or becoming eflectIve during !he term of lhls polley; and 2. Executed prior to the 'bodily injury" "prop8r1y damage.' or 'personal aM adv8l1i8ing InJury.' 8. The iIlaurance provided to the additional Insured Is limited as follows: 1. That person or organlZatfon Is an addltlonal Insured solely for liablllty due to yaur negligence spacifltlally faSllltln9 from "YOUr work" for the additional insured which Is the subject at the wrltlan contract or wrlttan agraamanl No coverage appllas to Ilalllllty resultlng from the sole negllg8!lC8 of tile addlllonalillaured. 2. The Umlls of insurance appDcable to the addlUonal iIlaured are thoea epeclflad In the Wllllsn contract or wrlttan agreament or in the Declarations of this polk;y. whichtlVllr Is less. These Umite of Insurance are incluslwl of, and not In addltlon to, the UmI1s of Insurance shown In the DeoIaraUons. 3. The coverage provided to !he additional insured within this andorsllment and section 1ltIecl LlASIUTY AND MEDICAL exPEI_ DEFIHITIONS - "1n!wnKI ConIr8rlt" (S11:tion F.9.) within the Businessownars Liability Coverage Form. do$S not apply to "bodily Injury' or 'property damage' arlslng out of the 'produc\lN:Ompleled operations hazard' unless required by the wrttten contract or wrttten agreement. ~ == ;;;;;;;; ii - - ..... - - ;;;;;;; - ..... I I I o SB-l46968-A (Ed. 01106) 4. The Illsulanoa provided to 1he additional insured do$S I'lOt apply to 'bodily Injury: 'property damage,' 'Peraonal and advarllslng Injury' arising out of an archllect'a. enginael'lJ. or aurveyal's rendering of or failure lQ render any profasalonal eeMces lncIudlng: a. The preparing, approving. or failIng to prepare or approVe maps. shop drawlngs, opinions, raporls', surwys, field ordIIre. change orders or drswlngs aM spsolffcations by any archilllol, engineer or SUMlYor parformlng saMces on a project of which you a8m $S oonsllUOIion manager; or b. InepecUon, sUP8f1/lsiOn, quality control, engineering or erchlt&ctural SlIrvJoas done by you on 8 project of which you SllIVa 8$ conelrUctlon manager. 6. This illsurence does not epply lQ "bodlly Injury; 'property damage,' or 'peI$OllSl and ad118I1i8ing Injury' al\$lng out of: a. The CO/lllIrUCllOn or damoli1lon work While you are acting as a consIrucllon or dernoIltion contractor. This exclusion does not apply to work done for or by you at your premleee. C. BUSlNE$SOWNERS GENERAL UABI.ITY CONDmON$ - DutIes In The Evenlof Oacurrenoe, Of!-. Ctab or SUit (8eGtIon E.2.) of the Businessowners Uablll!y Coverage Form Is amended lQ add the following: An addl1ional Insured under this endorsement win as aoon as prsollcable: 1. alVe wtilt$n notice of an ooourrence or an offense to us which may resuIl in a claim or 'suit' under this insurance; Page 1 of2 2. Tender the defense andlndeml1ity of any claim or 'suit" 10 us for a loss we cover under this CoverallEl Part; 3. Tender the defense and indemnity of any daim or 'sult' to any olhar insurer whk:h alllo has insurance for a loss we cover under this Cov9l'8lJ'l Part; and 4. Agree 10 1'Il8ke available any olhar insuranoe which the additional insured has for a Iosa we cover under this Cov9l'8lJ'l Part. We have no duty to defend or Indemnify an addllional insur<ad under this endor$emlll1t until we reC$f\Ie wrilIsn notlce of a clalm or 'sult' from the additional insured. D. OTI{ER INSIJflANeE (SectIan ... 2.. . 3.) 01 the Businessownelll Common PoIk:y ConditIons are deIlIIed and replaced with the following: 2. This Insurance Is excess ever any other insuranoe naming lha addllional insured sa an Insured wl1$ther prImaJy. excm, ccnlingenf or on 8IIy other basis unless a wrilIsn c:ontracl or wtitIen agreement specIfieaJly requtres that thie lneurance be elIher prim8Jy Of primary and ncncontribllling to the addllional 'Insured's own cover.. ThIs insurance Is excess over any other InsIll1llJC8 to which lha adcfllional Insur<ad has been added as an additional insured by andmernent. a. When this insUrance is excess, we Will have no duty under Coverages A or 8 to defend the addllional insured against any 'suit' if any other insurer has a duty 10 defendlha addIIionallnsured SB-t46ll6ll-A (Ed. 01106) SB-t46968-A (Ed. 01108) "} against that 'suil' If no other insurer defends, we will undertake to do so, but we will be errtitIed 10 the additlClnal insured's rights against all thoss olhar InsurlltS. When this inslll1llJC8 Is excess over other Insuranea, we wiU pay only our shara of the amount 01 the Iosa, if any, that exceeds the sum 01: (e) The totel amount tIJat all such other Insurance would pay for the lese In lha abeence of this insuranoo; and (b) The total of aU o;ledIJctiblG and aslI~nsured amounts under all that other inSUl8llCll. We wtll ahara the ramairlillglosa, II any, with any other insurance thet Is not desctibed in this Excese lnsurahc:e provision and W8S not bought speclflcally to apply in excm 01 tha Umlls 01 Insurance $hown In tha D&elarations 01 this Coverage Part. E. TIWISFIR OF RIGHTS OF ReCOVERY AGAINST OTHERS TO, US (SedIcIn K.2.) 01 tha B~ Common POlicy eondlllons Is deleted and replaced with the following: 2. Wa waIVe any right 01 _ery we may have lIlIaInst any person or orgenlzallon against whom you , have II9reed to .... such right 01 rllCOV8ly In a Written contract or aureemant because 01 payments we make lor !nIUtY or dsma:llll arllling out 01 your ongoing opllllllicnS or 'your work" done under . c:ontracl with that person or OlgaIllzation and IncIIlded WIIhlIllha .~ operatiort$ hazart!.' ~ Pege20f2 . N. ~ '\ 'I;, '.'\-;1\\ l' +"1" s Corporate Office 8370 Wilsrtire Blvd S~e 205 Be-..el1y Hi;ls CA 902\1 T. (32::n 752.0090 p- '323> 782-0130 E-n1i1ll in1o@ndsdtlta.com National Data & Surveying St:!rviccs NOS IS parent Company of Field Data Services and Southland Car Counters October 19, 2007 City of Santa Ana Public Works Agency 20 Ollie Center M-43 Santa Ana, CA 92702 Dear Shah!r Gobran, This correspondence is to inform you that National Data & Surveying Services (NOS) is formally and legally the parent Company of Field Data Services, Southland Car Counters and All Traffic Data. Our FederallD number and other pertinent business information is the same. NATIONAL DATA & SURVEYING SERVICES INC. NOS is a parent company of see, Field Data Services & All Traffic Data 8370 Wilshire Blvd. Ste 205 Beverly Hills, CA 90211 Tel. 323.782.0090 Fax. 323.782.0130 Fed ID: 33-0608605 Thank you very much and we look forward to a continued relationship with your organization. Sincerely Yours, '- it /1 I AVI Tashman CEO