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HomeMy WebLinkAboutRLS GENERAL CONTRACTOR & BUILDING MAINTENANCE - 2007 . - . N-2007 -116 INSURANCE. ON ~ILE WORK MAY PROCEED UNTIL. INSURANCE EXPIRES 1 ~~ ~1-o7 CLERK OF COUNCIL DATE: OCT 1 6 2007 C', C.OA(Z) Ken S. \ vc. CONTRACTOR AGREEMENT THIS AGREEMENT, made and entered into on Oc+ob.vr is, 2007 by and between RLS General Contractor & Building Maintenance, a California corporation (hereinafter "Contractor"), and the City of Santa Ana, a charter city and municipal corporation, organized and existing under the Constitution and laws of the State of California (hereinafter "City"). RECIT ALS A. The City desires to retain a contractor having special skill and knowledge in the field of general construction, for the Community Development Agency Downtown Office. B. Contractor represents that Contractor is able and willing to provide such services to the City. C. In undertaking the performance of this Agreement, Contractor represents that it is knowledgeable in its field and that any services performed by Contractor under this Agreement will be performed in compliance with such standards as may reasonably be expected from a professional consulting firm in the field. NOW THEREFORE, in consideration of the mutual and respective promises, and subject to the terms and conditions hereinafter set forth, the parties agree as follows: 1. SCOPE OF SERVICES Contractor shall provide on-call services, on as needed basis, for general construction projects such as concrete, carpentry, plumbing, electrical and welding. The Deputy City Manager for Development Services, or his representative, shall inform Contractor of a pending project. Contractor shall submit a written proposal, including compensation requirements and the time line for completion of the project. The Deputy City Manager for Development Services may accept, reject or negotiate with Contractor, in writing, regarding any such proposal. 2. COMPENSATION a. City agrees to pay, and Contractor agrees to accept as total payment for its services, the rates and charges identified in each accepted proposal. The total sum to be expended under this Agreement shall not exceed $25,000.00 during the term of this Agreement. b. Payment by City shall be made within thirty (30) days following receipt of proper invoice evidencing work performed, subject to City accounting procedures. Payment need not .,~ . be made for work which fails to meet the standards of performance set forth in the Recitals which may reasonably be expected by City. 3, TERM This Agreement shall commence on the date first written above and terminate on expenditure of allocated funds, unless terminated earlier in accordance with Section 12, below. 4. INDEPENDENT CONTRACTOR Contractor shall, during the entire term of this Agreement, be construed to be an independent contractor and not an employee of the City. This Agreement is not intended nor shall it be construed to create an employer-employee relationship, a joint venture relationship, or to allow the City to exercise discretion or control over the professional manner in which Contractor performs the services which are the subject matter of this Agreement; however, the services to be provided by Contractor shall be provided in a manner consistent with all applicable standards and regulations governing such services. Contractor shall pay all salaries and wages, employer's social security taxes, unemployment insurance and similar taxes relating to employees and shall be responsible for all applicable withholding taxes. 5, INSURANCE Prior to undertaking performance of work under this Agreement, Contractor shall maintain and shall require its subcontractors, if any, to obtain and maintain insurance as described below: a. . Commercial General Liability Insurance. Contractor shall maintain commercial general liability insurance naming the City, its officers, employees, agents, volunteers and representatives as additional insured(s) and shall include, but not be limited to protection against claims arising from bodily and personal injury, including death resulting therefrom and damage to property, resulting from any act or occurrence arising out of Contractor's operations in the performance of this Agreement, including, without limitation, acts involving vehicles. The amounts of insurance shall be not less than the following: single limit coverage applying to bodily and personal injury, including death resulting therefrom, and property damage, in the total amount of $1 ,000,000 per occurrence. Contractor shall supply City with a fully executed additional insured endorsement in substantially the form attached hereto as Exhibit A upon execution of this Agreement and shall be approved in form by the City Attorney. b. Business automobile liability insurance, or equivalent form, with a combined single limit of not less than $1,000,000 per occurrence. Such insurance shall include coverage for owned, hired and non-owned automobiles. c. Worker's Compensation Insurance. In accordance with the provisions of Section 3300 of the Labor Code, Contractor, if Contractor has any employees, is required to be insured against liability for worker's compensation or to undertake self-insurance. Prior to commencing 2 the performance of the work under this Agreement, Contractor agrees to obtain and maintain any employer's liability insurance with limits not less than $1,000,000 per accident. d. The following requirements apply to the insurance to be provided by Contractor pursuant to this section: (i) Contractor shall maintain all insurance required above in full force and effect for the entire period covered by this Agreement. (ii) Certificates of insurance shall be furnished to the City upon execution of this Agreement and shall be approved in form by the City Attorney. (iii) Certificates and policies shall state that the policies shall not be canceled or reduced in coverage or changed in any other material aspect without thirty (30) days prior written notice to the City. e. If Contractor fails or refuses to produce or 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 effect Contractor's right to be paid for its time and materials expended prior to notification of termination. Contractor waives the right to receive compensation and agrees to indemnify the City for any work performed prior to approval of insurance by the City. 6. INDEMNIFICATION Contractor agrees to and shall indemnify and hold harmless the City, its officers, agents, employees, consultants, special counsel, and representatives from liability: (l) for personal injury, damages, just compensation, restitution, judicial or equitable relief arising out of claims for personal injury, including health, and claims for property damage, which may arise from the direct or indirect operations of the Contractor or its contractors, subcontractors, agents, employees, or other persons acting on their behalf which relates to the services described in section 1 of this Agreement; and (2) from any claim that personal injury, damages, just compensation, restitution, judicial or equitable relief is due by reason of the terms of or effects arising from this Agreement. This indemnity and hold harmless agreement applies to all claims for damages, just compensation, restitution, judicial or equitable relief suffered, or alleged to have been suffered, by reason of the events referred to in this Section or by reason of the terms of, or effects, arising from this Agreement. The Contractor further agrees to indemnify, hold harmless, and pay all costs for the defense of the City, including fees and costs for special counsel to be selected by the City, regarding any action by a third party challenging the validity of this Agreement, or asserting that personal injury, damages, just compensation, restitution, judicial or equitable relief due to personal or property rights arises by reason of the terms of, or effects arising from this Agreement. City may make all reasonable decisions with respect to its representation in any legal proceeding. 7. CONFIDENTIALITY 3 If Contractor receives from the City information which due to the nature of such information is reasonably understood to be confidential and/or proprietary, Contractor agrees that it shall not use or disclose such information except in the performance of this Agreement, and further agrees to exercise the same degree of care it uses to protect its own information of like importance, but in no event less than reasonable care. "Confidential Information" shall include all nonpublic information. Confidential information includes not only written information, but also information transferred orally, visually, electronically, or by other means. Confidential information disclosed to either party by any subsidiary and/or agent of the other party is covered by this Agreement. The foregoing obligations of non-use and nondisclosure shall not apply to any information that (a) has been disclosed in publicly available sources; (b) is, through no fault of the Contractor disclosed in a publicly available source; (c) is in rightful possession of the Contractor without an obligation of confidentiality; (d) is required to be disclosed by operation of law; or (e) is independently developed by the Contractor without reference to information disclosed by the City. 8. CONFLICT OF INTEREST CLAUSE Contractor covenants that it presently has no interests and shall not have interests, direct or indirect, which would conflict in any manner with performance of services specified under this Agreement. 9. NOTICE Any notice, tender, demand, delivery, or other communication pursuant to this Agreement shall be in writing and shall be deemed to be properly given if delivered in person or mailed by first class or certified mail, postage prepaid, or sent by telefacsimile or other telegraphic communication in the manner provided in this Section, to the following persons: To City: Clerk of the City Council City of Santa Ana 20 Civic Center Plaza (M-30) P.O. Box 1988 Santa Ana, CA 92702-1988 telefacsimile (714) 647-6956 With courtesy copies to: Community Development Agency City of Santa Ana 20 Civic Center Plaza (M-25) P.O. Box 1988 Santa Ana, CA 92702-1988 telefacsimile (714) 647-6736 and City Attorney City of Santa Ana 20 Civic Center Plaza (M-29) P.O. Box 1988 4 '.. Santa Ana, California 92702 telefacsimile (714) 647-6515 To Contractor: RLS General Contractor & Building Maintenance 18372 Gothard Street Huntington Beach, CA 92648 Telefacsimile: (714) 375-8994 Attn: Robert Schaefer A party may change its address by giving notice in writing to the other party. Thereafter, communication shall be addressed and transmitted to the new address. If sent by mail, communication shall be effective or deemed to have been given three (3) days after it has been deposited in the United States mail, duly registered or certified, with postage prepaid, and addressed as set forth above. If sent by telefacsimile, communication shall be effective or deemed to have been given twenty-four (24) hours after the time set forth on the transmission report issued by the transmitting facsimile machine, addressed as set forth above. For purposes of calculating these time frames, weekends, federal, state, County or City holidays shall be excluded 10, EXCLUSIVITY AND AMENDMENT This Agreement represents the complete and exclusive statement between the City and Contractor, 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 Contractor. The parties agree that any terms or conditions of any purchase order or other instrument that are inconsistent with, or in addition to, the terms and conditions hereof, shall not bind or obligate Contractor nor the City. Each party to this Agreement acknowledges that no representations, inducements, promises or agreements, orally or otherwise, have been made by any party, or anyone acting on behalf of any party, which are not embodied herein. 11. ASSIGNMENT Inasmuch as this Agreement is intended to secure the specialized services of Contractor, Contractor may not assign, transfer, delegate, or subcontract any interest herein without the prior written consent of the City and any such assignment, transfer, delegation or subcontract without the City's prior written consent shall be considered null and void. Nothing in this Agreement shall be construed to limit the City's ability to have any of the services which are the subject to this Agreement performed by City personnel or by other contractors retained by City. 12. TERMINATION This Agreement may be terminated by the City upon thirty (30) days written notice of termination. In such event, Contractor shall be entitled to receive and the City shall pay Contractor 5 compensation for all services performed by Contractor prior to receipt of such notice of termination, subject to the following conditions: a. As a condition of such payment, the Executive Director may require Contractor to deliver to the City all work product completed as of such date, and in such case such work product shall be the property ofthe City unless prohibited by law, and Contractor consents to the City's use thereof for such purposes as the City deems appropriate. b. Payment need not be made for work which fails to meet the standard of performance specified in the Recitals ofthis Agreement. 13. DISCRIMINATION Contractor shall not discriminate because ofrace, 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. Contractor affirms that it is an equal opportunity employer and shall comply with all applicable federal, state and local laws and regulations. 14. JURISDICTION - VENUE This Agreement has been executed and delivered in the State of California and the validity, interpretation, performance, and enforcement of any of the clauses of this Agreement shall be determined and governed by the laws of the State of California. Both parties further agree that Orange County, California, shall be the venue for any action or proceeding that may be brought or arise out of, in connection with or by reason of this Agreement. 15. PROFESSIONAL LICENSES Contractor shall, throughout the term of this Agreement, maintain all necessary licenses, permits, approvals, waivers, and exemptions necessary for the provision of the services hereunder and required by the laws and regulations of the United States, the State of California, the City of Santa Ana and all other governmental agencies. Contractor shall notify the City immediately and in writing of its inability to obtain or maintain such permits, licenses, approvals, waivers, and exemptions. Said inability shall be cause for termination of this Agreement. 16. MISCELLANEOUS PROVISIONS a. Each undersigned represents and warrants that its signature hereinbelow has the power, authority and right to bind their respective parties to each of the terms ofthis 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. b. All Exhibits referenced herein and attached hereto shall be incorporated as iffully set forth in the body of this Agreement. 6 IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first above written. CITY OF SANTA ANA ATTEST: 0Jal. DA VID N. REAM City Manager ~ APPROVED AS TO FORM: JOSEPH W. FLETCHER City Attorney /"--' ~-- ! By::. ~ ':?{j fltauia Sheedy '"Assistant City ttorney RLSGENERALCONTRACTOR & BUILDING MAINTENANCE RECOMMENDED FOR APPROVAL: ROBERT SCHAEFER Owner Federal ID # 33-0963405 tuYv' '~ lffi.S;TEPHEN . HARDING V Deputy City anager for Development Services 7 - EXHIBIT A ADDITIONAL INSURED ENDORSEMENT FOR COMMERCIAL GENERAL LIABILITY POLICY Insurance Company This endorsement modifies such insurance as is afforded by the provisions of Policy # relating to the following: 1. The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701; its officers, employees, agents, volunteers and representatives are named as additional insureds ("additional insureds") with regard to liability and defense of suits arising from the operations and uses performed by or on behalf of the named insured. 2. With respect to claims arising out of the operations and uses performed by or on behalf of the named insured, such insurance as is afforded by this policy is primary and is not additional to or contributing with any other insurance carried by or for the benefit ofthe additional insureds. 3. This insurance applies separately to each insured against whom claim is made or suit is brought except with respect to the company's limits of liability. The inclusion of any person or organization as an insured shall not affect any right which such person or organization would have as a claimant if not so included. 4. With respect to the additional insureds, this insurance shall not be cancelled, or materially reduced in coverage or limits except after thirty (30) days written notice has been given to the City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701. (Completion ofthe following, including countersignature, is required to make this endorsement effective. ) Effective Policy # Issued to , this endorsement form as a part of Named Insured Countersigned by Authorized Representative 8 ACORQ.. CERTIFICATE OF LIABILITY INSURANCE I DA TE (MM/DDIYYYY) 08/09/2007 PRODUCER Phone: 916-987-2071 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Sorci Commercial Insurance Services ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 9266 Madison Ave HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Orangevale, Ca 95662 license #: 0707817 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Lincoln General Insurance Company Robert Schaefer INSURER B: DBA: RLS General Contractor & Build INSURER C: 18372 Gothard Street INSURER D: IHuntington Beach, CA 92648 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 I'NSURANCE 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. IN;: ~'~ POLICY NUMBER P.?AL?~~~~gtWf Pg~IfJ EXPIRATION A Y ~ERAL LIABILITY 6320017981 02 12/27/2006 X COMMERCIAL GENERAL LIABILITY = =:J CLAIMS MADE ~ OCCUR LIMITS 12/27/2007 EACH OCCURRENCE $ 1 000 000 $ 100000 $ 5 000 $ 1 000 000 $ 2000.000 $ included PREMISES (Ea occureneet MED EXP (Anyone person) - PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS-COM~OPAGG GEN'L AGGREGATE LIMIT APPLIES PER: Xl POLlCyn- ~fg: n LOC AUTOMOBILE LIABILITY - - r- ANY AUTO ALL OWNED AUTOS Ree eived BV City 0 Santa J~na A J6 14 2007 COMBINED SINGLE LIMIT $ (Ea accident) BODILY INJURY $ (Per person) BODILY INJURY $ (Per accident) PROPERTY DAMAGE $ (Per accident) AUTO ONLY - EA ACCIDENT $ f-- SCHEDULED AUTOS f-- HIRED AUTOS NON-DWNED AUTOS r- r- GARAGE LIABILITY R ANY AUTO EXCESSlUMBRELLA LIABILITY P OCCUR 0 CLAIMS MADE R DEDUCTIBLE RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERlMEMBER EXCLUDED? ~P~(;I~S~~~~~NS below OTHER uuWnTO~ n LJevelc pmenr IDivisinn OTHER THAN AUTO ONLY: EA ACC $ AGG $ A. '- _' .... /. j~j ---~..4 ~j;Io'3 .:,./ v EACH OCCURRENCE $ AGGREGATE $ $ $ $ I T~2,n~Ws I [OJ~- EL EACH ACCIDENT $ EL DISEASE - EA EMPLOYE $ EL DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Desc: general construction I commercial jobs Loc: AIUOps Santa Ana, Ca. 92701 City of Santa Ana named as additional insured per endorsement to follow from carrier. CERTIFICATE HOLDER CANCELLATION City of Santa Ana Attn: Ken Silva 20 Civic Center Plaza Santa Ana, CA 92701 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENOEAVOR TO MAlL~ 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 INSURER, ITS AGENTS OR REPRESENTA TlVES. AUTHORIZED REPRES ACORD 25 (2001108) - POLICY NUMBER: 6320017981 02 COMMERCIAL GENERAL LIABILITY LG CG 201002 06 THIS ENDORSEMENT CHANGES THE POUCV. PLEASE READ IT CAREFULL V. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION INCLUDING PRIMARY COVERAGE This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person(s) or Organlzation(s); Locatlon(s)of covered operations; Additlonallnsurecl(s) Address: CITY OF SANTA ANA RE: ALL PROJECTS EXCEPT ROOFING, FRAMING & FOUNDATION WORK AS A SUB-CONTRACTOR, FOR THIS ADDITIONAL INSURED DURING THIS POLICY TERM. 20 CIVIC CENTER PLAZA SANTA ANA, CA USA 92701-0000 (If no entry appears above, information required to complete this schedule, if not shown above, will be shown in the Declarations. A. Section 11- Who Is An Insured is amended to include as an insured the person(s) or organiza- tion(s) shown in the Schedule, but only with re- spect to liability for ''bodily injury., "property dam- age" or "personal and advertising injury. caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. B. With respect to the insurance afforded to these additional insureds, the following exclusions ap- ply: This insurance does not apply to "bodily injury" or "property damage" occurring after: (1) All work. including materials, parts or equipment furnished in connection with such work, on the project (other than ser- vice, maintenance or repairs) to be per- formed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or (2) That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or or- ganization other than another contractor engaged in performing operations for a principal as part of the same project. C. The insurance afforded by the policy to the Addi- tionallnsured(s) listed in the Schedule for the de- scribed location(s) is primary insurance. Any other insurance or self-insurance maintained by the Addi- tionallnsured(s) is excess of this insurance and shall not contribute to it. ./ ~.-- ~-,. PC.- c~.~ . / ') . .) .' _ . ....... c::_.-<e_) ./ !_~ LG CG 20 10 02 06 Contains Copyrighted Material of the Insurance Services Office, Inc 2004 Page 1 of 1 0 - Producer Copy Policy Number 6320017981 02 COMMON POLICY CHANGE ENDORSEMENT Endorsement No. 002 LINCOLN GENERAL INSURANCE COMPANY Named Insured ROBERT LLOYD SCHAEFER Effective Date: 12 - 27- 06 12:01 A.M., Standard Time Agent Name FRANK SORCI Agent No. 027047 POLICY CHANGES ENDORSEMENT DESCRIPTION (CONTD) THE FOLLOWING ADDITIONAL INSURED HAS BEEN ADDED TO THE POLICY: CITY OF SANTA ANA RE: ALL PROJECTS EXCEPT ROOFING, FRAMING & FOUNDATION WORK AS A SUB-CONTRACTOR, FOR THIS ADDITIONAL INSURED DURING THIS POLICY TERM. 20 CIVIC CENTER PLAZA SANTA ANA, CA 92701-0000 THE FOLLOWING FORM(S) HAS BEEN ADDED: LG CG 20 10 02-06 ADDITIONAL INSURED-OWNERS, LESS OR CONTRT ALL OTHER TERMS AND CONDITIONS REMAIN THE SAME t- '..Xc..; fl" -:::>.. 0) '.-:./ '_.'. ./ REMOVAL PERMIT If this policy includes the Commercial Property Coverage Part, the following applies with respect to the Coverage Part: If Covered Property is removed to a new location that is described on this Policy Change, you may extend this insurance to include that Covered Property at each location during the removal. Coverage at each location will apply in the proportion that the value at each location bears to the value of all Covered Property being removed. This permit applies up to 10 days after the effective date of this Policy Change; after that, this insurance does not apply at the previous location. CW-GHANGEDESC {01/97} ProdUC9( Copy POL! CYHOL DER y SG STATE COMPENSATION INSURANCE FUND PD. BOX 420807. SAN FRANCISCO,CA 94142-0807 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 07-01-2007 GROUP: POLICY NUMBER: 1854827-2007 CERTIFICATE ID: 2 CERTtF/CATE EXPIRES: 07-01-2008 07-01-2007/07-01-2008 CONTRACTORS STATE LICENSE BOARD WORKERS COMPENSATION UNIT PO BOX 26000 SACRAMENTO CA 95B26-oo26 SG LIC PERMITH: 790965 INCEPTION DATE:07-01-2007 DO:SG This 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 indicated. This policy is not subject to cancellation by the Fund except upon 10 days Cldvance written notice to the employer, We will also give you 10 days advance notice sllould 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 to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herE/in is SUbject to all the terms, exclusions. and cOflditions. of such policy. a::- REPRESENTAll - ~ UNLESS INDICATED OTHERWISE BY ENDORSEMENT. COVERAGE UNDER THIS POLICY EXCLUDES THE FOLLOWING: THOSE NAMED IN THE POLICY DECLARATIONS AS AN INDIVIDUAL EMPLOYER OR A HUSBAND AND WIFE EMPLOYER; EMPLOYEES COVERED DN A COMPREHENSIVE PERSONAL LIABILITY INSURANCE POLICY ALSO AFFORDING CALIFORNIA WORKERS' COMPENSATION BENEFITS; EMPLOYEES EXCLUDED UNDER CALIFORNIA WORKERS' COMPENSATION LAW. EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1.000,000 PER OCCURRENCE. yJj:8 EMPLOYER SCHAEFER. ROBERT D8A: R L S GENERAL CONTRACTOR & MANT~C 18372 GOTHARD ST HUNTINGTON BEACH CA 92648 M0409 IREV.2-051 PRINTED 06-15-2007 lNTERlNSllRt\NCE EXCHANGE of the AUTOMOBILE CLUB Ii..ra..."'~' . ~'g.' . 4~... ~~JJJ ~ MAILlt'-G ADDRESS: PO Box 2500], Santa Ana, Cillifornia 92799-5001 Policy Nurnber G5484272 BINDER OF INSURANCE Name and Address of Lienholder or Additional Insured Loan Number NOTICE TO LlE:'oIHOLDER IN THE EVENT OF CANCELLATION OF 11HS BINDER, THE EXCHANGE \-'{ILL GJVE THE LIENHOLDER ]0 DAYS WRiTTEN NOTICE OF CANCELLATION nle InteO:ls:.arance Excblngc (If th~ AutOmJbile Club of Southe::m California hereby ackn:rwleeges llse;:U bCUlld lo L'lC Jla~d ins.ured for L1C l:o\'erJges spe.;ificd in th~ sch:~duJc soojCCt to ~11 provis.ion:;. of the Exchange's applicable policy fofm. TIlt: issua.nce of:l policy to tk:: n:lrned in:;urOO. Of, if D poEcy is in force, the: lssuanc(: of an endorsement cCo\"t:ring. ,he automobile. ooat or tr.J.iler des::ribed herein shall void tbis b~nder. A pro rata prcntiam charge coft1>Cled fOT the terlU. (If co",:el'3.gc in accnrdance \\ith (he current nlcs of the Exchange in effc.ct at mception of tlle bind", ",11 be l1l3d.: unles, seell a policy or poli<:y endorsement is issued. ,b,s binder sh~1I Dol be conslrued to afford cumulative insumoce witll any <ousting p~Jicy. Name ofInsured ROBERT SCHAEFER DESCRIPTION OF AUTOMOBILE, BOAT, OR TRAILER Trade Name Ty e of Bod V or Boat C2500 ED P F250 p/U Identification Number IGBHC29U2SE207466 IFTEF2SY6HPA3B379 Cart: Year 2005 1987 CHEV FORD 1 2 'X' jndic>lte Coverage AUTO.MOBll.E INSURA.l~CE LIMITS OF LlABILITY bound and afforded Car # 1 Car #2 Bodily Injury Liability 1,000,000 thousand dollars, each person X X 1,000,000 thousand dollars, each occurrence Property Damage Liability 1,000,000 thousand dollars, each occurrence X X Medical Payn"lents $ each person Underinsured Motorist!l:ninsured Motorist Not Less Than $15,000 each person 1$30,000 each accident Comprehensive (ine. Fire and Theft) (a) Actual Cash Value less $ deductible Limit of Liability of$ less $ deductible Fire and Theft only (a) Actual Ca3h Value less $ deductible Limit of Liability of $ less S deductible Collision (a) Actual Cash Value less 'f) deductible [SlUninsured Deductible Waiver Limit of Liability ofS less $ deductible Uninsured Collision WATERCRAFT INSURAt'lCE (Boat) LI.:vtITS OF LIABILITY 'X' indicate Coverage bound and afforded Physical Damage Actual Casb Value llot to ex.ceed Limit of Liability of $ Jess S deductible Policy Effective Date 08/04/2D07 Policy Expiration Date Dl/10/2008 Effective Date of Binder 08/04/2007 12:01 AM This biader shall expire 60 days from the effective dale or may be canceled by the named insured at any time during sueh GO-day period. The Exchange may c3:lecl :his binder by n13iling to lhe named insured at the addn:ss shown abo':c written not,ce stating when, not less than 10 days thereafter, such cancellation shall be etTectiv, n.e maili~E ofsuc:h nolice shall be suHicicnl proof ofnoticc. District Office HUNTINGTON 3El>_CH OFFICE {714) 596-5765 By JUDY EDWARDS (Authorized Representative) ACSC Management Sen:ice, Inc. A TTORNEY -IN-FACT ~