HomeMy WebLinkAboutALL CITY MANAGEMENT SERVICES, Inc. 2C-2007AGREEMENT TERMINATION
8: 53
Please complete this form when the attached agreement is no longer in effect.
Return form to the Deputy Clerk of the Council (M-30). Call 647-5237 1 wx have any gUesti ns,
The agreement with
No. was completed on
and final payment has been made. nn
Department: l�
501505 A - 200 0'AH Signature:
i
Date:
City of Santa Ana
Revised 08-28-06 Clerk of the Council
INKY ~.~ fIEED
UNT11.1N5UR"'vC<<IXPIFiES
-6
^,LERKOPCAONCit. THIRD AMENDMENT TO CONSULTANT AGREEMENT
~'. t`~olcc~v
G~.d•r Paul 6o~s",>I'HIS THIRD AMENDMENT TO CONSULTANT AGREEMENT is entered
into on December 3, 2007 by and between All City Management Services, a California
corporation ("ACMS") 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-2006-019, dated February 22, 2006,
(hereina8er "said Agreement") by which Consultant has provided crossing guard
services.
B. In accordance with the terms and conditions of said Agreement, the parties wish to
extend the term of said Agreement and increase compensation to pay for services
during the extended period.
A-2007-273
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
Third Amendment to Consultant Agreement, the parties agree as follows:
1. Section 2.a., COMPENSATION, shall be amended to add $894,447.00 to pay for
crossing guard services during the extended period mm~ing from February 29, 2008
through February 28, 2009.
2. Section 3, TERM, shall be deleted in its entirety and replaced with the following:
"This Agreement shall continence on March 1, 2006 and terminate on February 28,
2009, unless terminated eazlier in accordance with Section 12, below. The City may
extend the teen for one additional one-year period, by a writing executed by both
parties."
3. Except as herein amended, all terms and conditions of said Agreement, as previously
amended, shall remain in full force and effect.
//
//
//
IN WITNESS WHEREOF, the parties hereto have executed this Third Amendment to
Consultant Agreement on the date and year first written above.
ATTEST:
~/
PATRICIA E. HEALY
Clerk of the Council
CITY OF SANTA ANA
DAVID N. RE
City Manager
APPROVED AS TO FORM:
JOSEPH W.FLETCHER
City Attorney
s
By: /~ ~^
Lau a S~` he y~~~ /
Assistant City Attorney
ALL CITY MANAGEMENT SERVICES
r ~ ~~..,~~,~
ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID DATE (LM.VDO/YYYY)
ALLCI-1 04 03 07
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ISII Curry Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Lid #0588757 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
489 S. Colorado ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Pasadena CA 91101
Phone: 626-449-3870 Fax: 626-449-5268 INSURERS AFFORDING COVERAGE NAICN
INSIIREO INSURER A: Admiral Insurance C an
INSURER B: RSIII Indemnit Co an
All City Management, Inc. INSURER C:
1749 South La Cienega Blvd. INSURER D:
Los Angeles CA 90035 ,.,~~,o~o ~.
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWI IHSIANDING
ANV REOUIREMEM, TERM OR CONDITION OF ANKCONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAV BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BV THE POLICIES DESCRIBED HEREIN IS SUBIECT TO ALL THE TERMS, IXCLUSIONS AND CANDITIONS OF SUCH
wv ,rice erracreTF I IMRS SHOWN MAV HAVE BEEN REDUCED 8V PAID CUIMS.
LTR !SR TYPE OF NSVRANCE POLICY NUMBER DATE DATE MMID ATE
GENERAL LIAe1lITY EACH OCCURRENCE $,1,000,000
A $ $ COMMERCIAL GENERAL LIABILITY CA00000365307 04/01/07 04/01/08 PREMISES Eaoa:ircence) E 50,000
CLAIMS MADE OCCUR MED EXP (Anyone person) $eXClIIded
DSDIICTIBLE ~`S, OOO PERSONALA ADV INJURY $1,000,000
PHR CLAIM GENERAL AGGREGATE E2, OOO, OOO
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $1,000,000
POLICY JET LOC
AUT OM081LE LIABILITY COMBINED SINGLE LIMIT E
ANY AUTO (Ea accidenQ
i
- -
ALL OWNED AUTOS BODILY INJURY E
leer person)
SCHEDULED AUTOS
! HIRED AUTOS BODILY INJURY E
(Per accitlenH
NON-OWNED AUTOS -
PROPERTYDAMAGE $
-' - (Per accidenQ
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG '. $
EXCESSAIMBRELlALV1BILTTY EACH OCCURRENCE E4,000,OOO
B X OCCUR CLAIMS MADE NHA218686 04/01/07 04/01/08 AGGREGATE E4, OOO, 000
DEDUCTIBLE $
_.
RETENTION $ $
WORKERS COMPENSATION AND TORY LIMITS ER __
EMPLOYERS' LIABILRY , - - - ~ E.L. EACH ACCIDENT $
ANY PROPRIETOfLPARTNEHIE%ECUTIVE ' -
OFFICERMIEMBEREXCLUDED? , E.L. DISEASE-EA EMPLOYE b
If yes, tlescdbe under DISEASE-POLICY LIMIT
EL $
SPECIAL PROVISIONS below .
OTNER -
~rvrue, r nrArnuc r vcHrc l Fs r FYCI uSKINS ADDED eV ENDORS EMENT I SPECIAL PRO VISONS
* 10 Days notice of cancellation in the event of non-payment of. premium.
The City of Santa Ana, its Officers, Employees, Ageata,and Volunteers ar
e additional insureds as respects operations o£ the named insured per forms
CG2010 (07/04) and AD0657 (12/03) attached.
CERTIFICATE HOLDER CANCELLATION
SNTAANA SHOULD ANY Of THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUMlG M15URER WILL ENDEAVOR TO MAIL *3O DAYS WRR'TEN
r ~ NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUi FAILURE TO DD 50 SHALL
L~ss~ I `
The City Of Santa Ana Ul)4tU i IMPOSE NO OBLIGATION OR LIABILfTY OF ANY KIND UPON THE WSURER, RS AGENTS OR
60 Civic Center Drive ` ~ REPRESENT Es.
Santa Ana CA 92702 ~ I ("~ (., au E RES ATIVE `
D.cha r P
ACORD 25 (2001Po8) ®ACORD CORPORATION 1988
Policy Number: CA000003653-07
Effective Date: 04/01/2007
CG 2l1 t0 Q7 04
TICIS ENDORSERIENT C1IA1~iGES THE POLiC:Y. PLEASE READ IT' CAREFULLY.
.ADDITIONAL INSURED - C)'WNERS, LESSEES OR
CONTRACTORS - SCHEDULED PERSON OR
ORGANIZATION
Thin endorsement modifies ntstuatu.c provided antler the fallowing:
CO~IlvtliRCLAL GENERrV. I.IAI3R.i7'Y COVERAGE P,tR"f
SeftED[i1.E
A. Section li- tVho Is An insured is arrx:rtdcd to
include as an additional insured dre pcrsan(sl ur
orgnnizadon(s) shown in ttie Schedule, but only with
respect to Iiabdiry for'"bodily irtjwp". "property
damage" or "persmta! and advertising injury" caused,
in whale or in part, by:
1. Your acts ar omissions; ar
2. 17rc acts or omissions of thosu acting an your
behalf;
in the perforrnance of your ongoing operations for the
sddiiiunai instueJ(s) at the Nrcation(s) design~ied
aM>t'e.
6. ~t'ldt respect to dte insuratu-e afforded lu tf>«
additional insureds, tht fallowing additional
exclusions apply:
This irtstnance does not apply to "txxliiy injury" or
"property dama~ce" oawriug atttx:
t. Atl work,.. iactuding rtrateria3s, pans or cquiptmnt
Futniahed in connectitm with snch work, on the
project (other than senu:e, mtintenance nr
repairs) ra be perfanned by ar nn behalf of tfu.
adrlitionat insutcd(sy at t~ Focatian of the
coveted operations has been contpletcd; ar
4. '1'IiaFportion of "ynur work" nut of w3ieh the
injury or damage arises has been put to its
intended use by any person nr nrganiutian athtr
d>vt anaSlter contractor or subcnntractar engaged
in purt'ornting operations f+rr a principal as a part
of fhe same project.
~'G XO IO 07 t14 <' 1S0 Properties, hu ., Oir4 Page 1 of [ ^
Policy Number: CA000003653-07
Effective Date: 04/01/2007
CG 24 04 10 93
THIS ENDORSEYLEIVT CI{ACVGIaS THF. Pt3LitG`1'. PLF,ASE RE.iD TT CAREi~Ui.LY
"WAIVER ~~" TRANSFER OF' RIGHTS OF RECOVERY
AGAINST OTHERS TO US
This endorsement modifies insurance provided under the Co1lowMng:
CON1,4SliRCIAL 6I:IvERAi; i.G1IIILITY CC7VERACiI? Pr'1R'f ~ .,
SCHEDULE
Name of Person ar Organization:
Any person ar argaaization, but arily if tltc l`o!lowittg cotulitions ara rttet:
a. Ytxr have expressly agreed to the waiver in a wriurm contract entered inm by you; and
h. The injury or damage occurs auhsegirent to tho execution of Ote written contract.
(Itno entry appwrs above, information tt~gttued to catrplete this endarsetrtant will be shown in the Declararioos as applicable
m this endorsement.)
The TRANSFER OF RIGHTS OF Rlft)VFItS' ,GAINS I` t7TII6RS TC} US CAndition (Section 1\' -- CQMR1fiRClF~i.
GEA~ERAL LIAfiIL11Y CQivDfflpNSj is aax:rxicd by the addition of the folbwittg:
Pr'e waiac any right of recovery wo troy Nava against tha patstxtor or~anizatron shown in the Schedule above because of
Irayrneats wa nxake for injiny or darnaga arising art ofyour on~roing operation9 ar "yoni work" dorms uraler a contract a~th
that person, ar mpp~rnization ark araladccl in the "products-cotupleted operations hazard".'17iia w-rivcrapplies only to tlta Ix:r-
smr or oreani~atioh shown in the Schedule above.
CtG 24 0410 93 Capyri;;ht, Insurarttc: 5c7vices OfFicc, inc., 1992 Page I of I Q
Policy Number: CA000003653-07
Effective Date: 04/01/2007
AD OG S71Z 03
T}}IS ENBORS.1j?k1E1VT GRANGES T}CE PO},ICY. PLEASE READ IT CAREFULLY.
p[t.IMARY/NflN-CONTRLBUTiNG INSURANCE
ENDORSEMENT
This endorseirrent modifies insttrancc prnt'rded under the foilrnving:
COMMERCIAI. GEN&RAL LL14311,1TY CUVCRIaGE PART
SCIIEIIL'1_E
A\rY PLsRSON OR OROA1s7I7,ATlOti C)UA1,Jf3'li+'G Afi AN hv9UREP C3NIfER THC ADll1TIO;`3AL 32VSURED -
04'v'ERS, LESSEES OR CONTRA('TOR31 ~~'DOR$EYfENT I'OR,~1 CO 20 10 0"I 04 ATfACflEI7 7'C) 7'liL'i POLiCI'.
h is agreed that Commercial Oetreral Liability Coverage
Eonn CO DO Ol SeMion IV paragraphs 4.b. and d.c, do rat
apply with respest io other valid and collectible CnrtanUs-
ciat General Liability insrnance, whether prinr;u} or excess,
available to the person nr nrganiratoa shown irf du Sched-
ule antis
1) 1Vho is an insured under an Arlditiona] Insruril-
Otn+:rs. Lessees irr £rmtractom etsdrusem:nt :R-
tachcl to Orin policy; and
2) Wtta requires by specific w7itten contract that dsis
iaeamncc is to he primary and!or rmn-t:ontributory
to oder valid and eallecpble insurance available to
that person nr organisation.
"ibis endorsemntE <hies not cikattgc the scope of coverage
provided io the person or aryanization by airy Additional
lnsured cndarsrnn~nt.
All utiter tenor atul cbnduiwrs rcmaiarutchauKcxi.
,,'.
Al) 06 571 Z 03 page 1 of i
4 CERTIFICATE OF INSURANCE
SUCH INSURANCE AS RESPECTS THE INTEREST OF THE CERTIFICATE HOLDER NAMED BELOW WILL NOT BE
CANCELED OR OTHERWISE TERMINATED WRHOUT GIVING 70 DAYS PR10R WRITTEN NOTICE TO THE
CERTIFICATE HOLDER, BUT IN NO EVENT SHALL THIS CERTIFICATE BE VALID MORE THAN 30 DAYS FROM
THE DATE WRITTEN. THIS CERTIFICATE OF INSURANCE DOES NOT CHANGE THE COVERAGE PROVIDED BY
ANY POLICY DESCRIBED BELOW.
This certifies tltat: ®STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY of Bloomington, Illinois
^ STATE FARM FIRE AND CASUALTY COMPANY of Bloomington, Illinois
^ STATE FARM COUNTY MUTUAL INSURANCE COMPANY OF TEXAS of Datlas, Texas
^ STATE FARM INDEMNITY COMPANY of Bloomington, Illinois, or
^STATE FARM GUARANTY INSURANCE COMPANY Gi Bloomington, Illinois
e.,~ ...,.,e.y,.e :., fnrrc fnr+hn fnllnwinn NamRtl Insufed as SI+OWri belOW:
NAMEDINSURED: aLL cITY MANAGEMENT
ADDRESS OF NAMED INSURED: 1?49 S. LA CIEIJGA LOS ANGELES, cA 90015- 960-
POLICY NUMBER 065-0693-A16-?5
EFFECTIVE DATE
OF POLICY 2/8/07-210/Oe
DESCRIPTION OF
VEHICLE(IndudingVlN} EN,OL
LIABILITY COVERAGE ®YES ^ NO ^YES ^ NO ^YES ^ NO ^YES ^ NO
LIMITS OF LIABILITY '
a. Bodiy Injury 1,000,000
Each Person
Each Auident
b. Properly Damage
Each Axident
a Bodily injury & ':
Property Damage
Single Lima
Each Accident 1 MILLION
PHYSICAL DAMAGE yES
^ ®NO ^YES ^ NO ^YES ^ NO ^YES ^ NO
COVERAGES
a. Com rehensive $ Deductible $ Dedudihla $ Deductible $ Deductible
^ YES ®NO ^YES ^ NO ^YES ^ NO ^YES ^ NO
b. Collision $ Deductible $ Deductible $ Deductible $ Dad uctfble
EMPLOYERS NON•OWNED YES ^ NO ^YES ^ NO ^YES ^ NO ^YES ^ NO
calz LwBlury covElucE
HIRED CAR LIABILfrY
^YES
®NO
^YES
^ NO
^YES
^ NO
^YES
^ NO
COVERAGE
FLEET' • COVERAGE FOR
AD. WJNED LICENSED YES ®NO ^YES ^ NO ^YES ^ NO ^YES ^ NO
MOTOR HIC S
THE CITY OF SANTA ANA
60 CA'I CENTER CRIVE
SANTA ANA, CA 92702
ATT: LINDA FLORES -" ~~ - ~~
INTERNAL STATE FARM
+zzazas ReY. 07-26-2C05
C3/Ol
~~ STATE FARM INSURANCE COMPANIES
11090 SANTA MONICA 3LVD. STE.
,.~_._ JtGs'_ANGELES, CA 90025-7515
Sr t_
_: at Lity
420
Request permanent Cedficate of Insurance fa liability wverage.
Request Certificate HoNer to be added as an AddiCronal Insured.
t•d 96ZlELb06£ 96i;1-£L4-Ol£ wleH eIe}S dtiL~ZL LO l0 ~E~d
O CERTIFICATE OF INSURANCE
t
CANCELEDRORCOTHERWISE TERMINA EDR W THOUT G VENG F10ADAYS PR OR WRITTENL NOT CIELTO THE
CERTIFICATE HOLDER, BUT IN NO EVENT SHALL THIS CERTIFICATE BE VALID MORE THAN 30 DAYS FROM
THE DATE WRITTEN. THIS CERTIFICATE OF INSURANCE DOES NOT CHANGE THE COVERAGE PROVIDED BY
ANY POLICY DESCRIBED BELOW.
This certifies that: ~ STATE FARM FIRE AND CASUALBTY COMPANY oP Bloom ngton,olllBloismington, Illinois
^ STATE FARM COUNTY MUTUAL INSURANCE COMPANY OF TEXAS of Dallas, Texas
^ STATE FARM INDEMNITY COMPANY of Bloomington, Illinois, or
^ STATE FARM GUARANTY INSURANCE COMPANY of Bloomington, Illinois
has coverage in force for the following Named Insured as shown below:
1799 S. LA
POLICY NUMBER
EFFECTIVE DATE
OF POLICY
DESCRIPTION OF
VEHICLE (Including VIN)
LIABILITY COVERAGE
LIMITS OF LIABILITY
a. Bodily Injury
Each Accident
b. Prope
c. Bodily Injury &
Property Damage
Single Limit
PHYSICAL DP
COVERAGES
065-0693-7
ENOL
® YES
1,000,000
1 MILL.
^ YES
^ YES
6-75
CA 90015-9601
^ NO ^ YES ^ NO ^ YES ^ NO ^ YES ^ NO
NO ^ YES ^ NO ^ YES ^ NO ^ YES ^ NO
ctib
d
®ductible $ Deductible $
^ YES Deductible
^
N0 $
^ YES u
pe
^ NO
® NO ^ YES ^ NO d
~
b. Collision
EMPLOYERS NON-OWNED ~
®YES "°""""""
YES ^ NO ^ YES ^ NO ^ YES ^ NO
^ NO ^
CAR LIABILITY COVERAGE
HIRED CAR LIABILITY
^ YES YES ^ NO ^ YES ^ NO
®NO ^ YES ^ NO ^
COVERAGE
FLEET - COVERAU~~D
ALL WVNE~hl61<-.,
DI YES ~
®NO ^ YES ^ NO ^ YES ^ NO ^ YES NO
AGENT
75-1289 03/01/2007
TRIe Agenc s wa° ,."~, •--.
Signa u o A rize Rep septa Name and Address of A ent
Name and Address of Certificate Holder WILLIAM HAMMONDS, AGENT
THE CITY OF SANTA ANA STATE FARM INSORANCE COMPANIES
60 CIVI CENTER DRIVE 11090 SANTA MONICA BLVD. STE. 920
SANTA ANA, CA 92702 LOS ANGELES, CA 90025-7515
RTT:LINDA FLORES
INTERNAL STATE FARM USE ONLY: OR quest Certf atetH Ider totbe addedaaanoAddR Onal Insured.
122428.3 Rev. 07-26-2005
A- 2067-:2-73
CERTHOLDER COpy
SC
STATE
COMPENSATION
INSURANCE
FUND
P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807
CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
ISSUE DATE: 10-01-2008
GROUP: 000780
POLICY NUMBER: 0000227-2008
CERTIFICATE ID: 257
CERTIFICATE EXPIRES: 10-01-2009
10-01-2008/10-01-2009
SANTA ANA PDLICE DEPARTMENT
LINDA FLORES
60 CIVIC CENTER PLZ
SANTA ANA CA 92701-4060
SC
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 30 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 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 conditions. of such policy.
tREPRESENTATI
EMPLOYER'S LIABILITY LIMIT
~~
PRESIDENT
INCLUDING DEFENSE COSTS: $1,000,000 PER DCCURRENCE.
ENDDRSEMENT #2065 ENTITLED CERTIFICATE HDLDERS' NOTICE EFFECTIVE 10-01-2007 IS
ATTACHED TD AND FDRMS A PART OF THIS POLICY.
-
-
~
EMPLOYER
ALL CITY MANAGEMENT INC
1749 S LA CIENEGA BLVD
LOS ANGELES CA 90035
SC
M0408
PRINTED 09-17-2008
IREV.2-QS}
STATE
COMPENSATION
INSURANCE
FUND
IN AEPl Y REFER TO:
OCTOBER 31, 2008
SANTA ANA POLICE DEPARTMENT
LINDA FLORES
60 CIVIC CENTER PLZ
SANTA ANA CA 92701-4060
11/05/0816:31 RCV[I
i'I'l(petre',.I ~ A - ;:xr.n-J-/3
CERTIFICATE OF WORKERS'
COMPENSATION INSURANCE
CANCELLATION/CONVERSION NOTICE
RE: CERTIFICATE DATED MAY 21, 2008
THE WORKERS' COMPENSATION COVERAGE PROVIDED UNDER THE
POLICY LISTED BELOW IS BEING CONVERTED TO A NEW POLICY
EFFECTIVE OCTOBER 1, 2008.
THE NEW POLICY WILL PROVIDE
UNINTERRUPTED COVERAGE.
YOU WILL RECEIVE A NEW CERTIFICATE OF INSURANCE UNDER
THE NEW POLICY NUMBER: 780-0000497-08.
IF YOU HAVE ANY QUESTIONS, PLEASE CONTACT THE CUSTOMER
SERVICES UNIT AT THE NUMBER LISTED BELOW.
EMPLOYER:
ALL CITY MANAGEMENT INC
1749 S LA CIENEGA BLVD
LOS ANGELES, CA 90035
POLICY 780-0000227-07
CUSTOMER SERVICES UNIT
LOS ANGELES DISTRICT OFFICE
(323) 266-5000
1275 Market Street. San Francisco, CA 94103-1410
Mailing Address: P.O. Box 420807 . San Francisco. CA 94142-0807
selF 19102
STATE
COMPENSATION
INSURANCE
FUND
IN REPLY REFER TO:
OCTOBER 31, 2008
SANTA ANA POLICE DEPARTMENT
LINDA FLORES
60 CIVIC CENTER PLZ
SANTA ANA CA 92701-4060
11/05/08 16:31 RCVD
CERTIFICATE OF WORKERS'
COMPENSATION INSURANCE
CANCELLATION/CONVERSION NOTICE
RE: CERTIFICATE DATED OCTOBER 1, 2008
THE WORKERS' COMPENSATION COVERAGE PROVIDED UNDER THE
POLICY LISTED BELOW IS BEING CONVERTED TO A NEW POLICY
EFFECTIVE OCTOBER 1, 2008.
THE NEW POLICY WILL PROVIDE
UNINTERRUPTED COVERAGE.
YOU WILL RECEIVE A NEW CERTIFICATE OF INSURANCE UNDER
THE NEW POLICY NUMBER: 780-0000497-08.
IF YOU HAVE ANY QUESTIONS, PLEASE CONTACT THE CUSTOMER
SERVICES UNIT AT THE NUMBER LISTED BELOW.
EMPLOYER:
ALL CITY MANAGEMENT INC
1749 S LA CIENEGA BLVD
LOS ANGELES, CA 90035
POLICY 780-0000227-08
CUSTOMER SERVICES UNIT
LOS ANGELES DISTRICT OFFICE
(323) 266-5000
1275 Market Street. San Francisco, CA 94103-1410
Mailing Address: P.O. Box 420807 . San Francisco. CA 94142-0807
selF 19102