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HomeMy WebLinkAboutCLINICAL LABORATORY OF SAN BERNARDINO 11B - 2007INSURANCE ON FILE WORK MAY PROCEED ~JNTIL INSURANCE EXPIRES ,~-/-08 CLERK OF COUNCIL ' ne7F: AEG 2 ~ ~0f~ O ~ ~ ~YV A ~ W aler C2) Tam 'Aix SECOND AMENDMENT TO AGREEMENT THIS SECOND AMENDMENT TO AGREEMENT is entered into on December 5, 2007, by and between Clinical Laboratory of San Bernardino, 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 that certain Consultant Agreement #A-2003-239, dated December 31, 2003, (hereinafter "said Agreement") by which Consultant has provided domestic water quality testing. B. In accordance with the terms and conditions of said Agreement, the parties wish to renew said Agreement for an additional two-year period. 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 Second Amendment to Agreement, the parties agree as follows: Consultant shall continue to provide domestic water quality testing as set forth in Exhibit A to said Agreement, at the rates and charges set forth in Exhibit B to said Agreement. 2. Section 2.a., COMPENSATION, shall be amended to add $147,370.00 to pay for services provided during the term from January 1, 2008 through December 31, 2009. Section 3, TERM, shall be amended to extend the term for an additional two-year period, through December 31, 2009. 4. Except as hereinabove amended, all terms and conditions of said Agreement shall remain in full force and effect. // // // // // A-2007-246 IN WITNESS WHEREOF, the parties hereto have executed this Second Amendment to Consultant Agreement on the date and year first written above. ATTEST: CITY OF SANTA ANA PATRICIA E. HEALY ~ DAVID N. RE Clerk of the Council City Manager APPROVED AS TO FORM: JOSEPH W.FLETCHER City Attorney ura Sheedy Assistant City A rney CLINICAL LABABORATORY OF SAN BERNARDINO ~//Jl~ l~l ~,~~s~,2vc;`Z (NAME) F~icH~aO J<~~s© (Title) ~. ' ~y I~irrs.~z~h .ACORQ. CERTIFICATE OF LIABILITY INSURANCE OP ID V DATE(MM/DD/YYYY) - CLINI-1 05 31 07 'ROdUC~R ' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION !~ndreini & Company-South Coast ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE License 0208825 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR one MacArthur Place, Suite 100 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. South Coast Metro CA 92707 Phone:714-327-1400 Fax:714-327-1499 NSURED A _ ~C~3 -a3°i Clinical Laboratories of ~ ~~00,~ '07,3'''/- 5an Bernardino, Inc. P.O. Box 329 San Bernardino CA 92402 ~ , ~~ ~ ~( INSURERS AFFORDING COVERAGE ~ NAIC # URERA. American Casualty Company of I 20427 INSURERB~ Zenith Insu ranee Company _ _ ~INSURERC -_ _ _ _-__- SURER D ' __.__ - SURER 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NSR DD' _ -- - I -- - - -- -- LTR NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE- POLICY EXPIRATION I DATE MMIDD/YY DATE (MM1DD/YY LIMITS GENERAL LIABILITY ;EACH OCCURRENCE $ 1, OOO, 000 A X ~' X j COMMERCIALGENERALLIABILITY TCP2068975201 02/01/07 ~ 02/01/08 YAI91A-GE T0- RENI~ Ems.. PREMISES (Eaoccurence) $ 100, 000 CLAIMS MADE ~}(, i OCCUR MED EXP (Any one person) $ 10 , 0 0 0 ~ I PERSONAL&ADV INJURY - $1,000,000 V ~ GEivERAL Au R GATE $ 2 , OO O , C O O GEN'L AGGREGATE LIMIT APPLIES PER~.I II' , PRODUCTS COMPlOP AGG ... - $ Excluded I$ i POLICY I I JERCOT- LOC I I I IF -- - Emp Ben. ---- Z, 000, 000 AUTOMOBILE LIABILITY 9 li ~ COMBINED SINGLE LIMIT 1$ 1, 0 0 0, 0 0 0 I (Ea accident) A ANVAUTO BUA2068 75084 02/01/07 i 02/01/08 ~ ALL OWNED AUTOS I ' I i BODILY INJURY - SCHEDULED AUTOS ' I ~ I I ~ II (Per person) - -- - I $ }~ ', HIRED AUTOS ~, ~ ~, F- -- --- - '. BODILY INJURY ~-- $ I $ ~. NON-OWNED AUTOS ~ (Per accidenll 'I __ i l _- _ .. ___--.. _. _---. - __ ~ j i ~ ~ I ~ PROPERTY DAMAGE ~~, ~ (Per acadenq i $ GARAGE LIABILITY - ~ AUTO ONLY - EA ACCIDENT '~ - - - -- $ ---' ---- - ~ ~ ANY AUTO I I EA ACC I OTHER THAN _ ~ r $ r ~ -- ~ - ~,' ,AUTO ONLY AGG~, $ '~ EXC ESSIUMBRELLA LIABILITY , EACH OCCURRENCE $ 5 , O O O , O O O A X OCCUR ~ CLAIMSMADE f CUP20689753444 ~ 02J01/07 ~ 02/01/08 j AGGREGATE I $ ~ DEDUCTIBLE $ ~, }( '~~RETENTION $lO, OOO ~ r ~ $ WORKERS COMPENSATION AND ~ X j TORY LIMITS j ~ ER EMPLOYERS' LIABILITY B 10066924302 ANY PROPRIETOR/PARTNER/EXEGUTIVE 02/01/07 ~ . 02/01/08 IEL.EACHACCIDENr _ --- sl,Opp,OpO OFFICER/MEMBER EXCLUDED? ~ I _ _ _ E L UiSEASE - FA EkIPLOYEE' _ $ 1, 000 , 000 If yes, descnbe under '~, I, --- ~ ---- -- -- - -- I SPECIAL PROVISIONS below ', E L DISEASE -POLICY LIMIT $ 1 , 0 00 , 00 0 OTHER i I A Property Blanket TCP2068975201 02/01/07 02/01/08 Property 1113000 ~ S ecial .+•-.+..•~•• • •.~•~ .+• ..~ ~•~.. ~ wn., • w.... ivies • v n c , cn avrv,~ Huvcu o r cnuvrtacmcrv i ! JYCI.IHL YKV VIJIUlVA . j Certificate Holder is additional insured as respects to General Liability per written contract per attached G-17957-G99 ~ The CANCELLATION notice herein is amended to read ZO days as respects~'an ~~- ~/jr` cancellation due to non-payment of premium CERTIFICATE HOLDER CANCELLATION CITYSAA City of Santa Ana Department Of Public Works 220 S. Daisey Ave. Santa Ana CA 92703 ACORD 25 (2001108) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MFUL 3 O DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHgLL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. ATIVE © ACORD CORPORATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy{ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement{s}. DISCLAIMER The Certificate of insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ;t/~ z~l CORD 25 (2001/08) C/1/A U-i ia5~-uy~ (Ed. 10!01) IMPORTANT: THIS ENDORSEMENT CONTAINS DUTIES THAT APPLY TO THE ADDITIONAL INSURED IN THE EVENT OF OCCURRENCE, OFFENSE, CLAIM OR SUIT. SEE PARAGRAPH C.1.OFTHIS ENDORSEMENT FOR THESE DUTIES. ALSO, THIS ENDORSEMENT CHANGES THE CONTRACTUAL LIABILITY COVERAGE WITH RESPECTS TO THE "BODILY INJURY" OR "PROPERTY DAMAGE" ARISING OUT OF THE "PRODUCTS-COMPLETED OPERATIONS HAZARD." SEE PARAGRAPH B.3. OF THIS ENDORSEMENT FOR THIS COVERAGE CHANGE, THiS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTOR'S SCHEDULED AND BLANKET ADDITIONAL INSURED ENDORSEMENT WITH LIMITED PRODUCTS -COMPLETED OPERATIONS COVERAGE This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organizat[on: Designated Project: (Coverage under this endorsement is not affected by en entry or lack of entry in the Schedule above.) A. WHO IS AN INSURED (Section 11) is amended to Declarations of this policy, whichever is less. include as an insured any person or organization, These Limits of Insurance are inclusive of, and not including any person or organization shown in the in addition to, the Limits of Insurance shown in the schedule above, (called additional Insured) whom you Declarations. are required to add as an additional insured on this 3, The coverage provided to the additional insured policy under a written contract or written agreement; by this andorsemen# and paragraph f. of the but the written contract or written agreement must be: definition of "insured contract" under i. Currently in effect or becoming effective during the DEFINlTiONS (Section 1n do not apply to "bodily term of this policy; and injury" or "property damage" arising out of the 2. Executed "products-completed operations hazard" unless prior to the "bodily injury," "property required by the written contract or written damage," or "personal and advertising injury." agreement. When coverage does apply to "bodily B. The insurance provided to the additional insured is injury" or "property damage" arising outs of the limited as follows; products-completed operations hazard such coverage will not apply beyond: i. That person or organization is an additional a. The period of time required by the written insured solely for liability due to your negligence contract or written agreement; or and specifically resulting from your work for the additional insured which is the subject of the b. 5 years from the completion of `your work" on written contract or written agreement. iVo the project which is the subject of the written coverage applies to fiabiiity resulting from the sole contract or written agreement, negligence of the additional insured. whichever is less. Z. The Limits of Insurance applicable to the additional insured are those specified in the 4. Tha insurance provided to the additionai insured written contract or written agreement or in the does not apply to "bodily injury," "property G-17957-G99 w ,~~ ~ 3 /~ Page 1 of 2 (Ed. 10!01) tta. ~ uiu~ ~ damage," or "personal and advertising injury" arising out of an architect's, engineer's, or surveyor's rendering of or failure to render any professional services including: a. The preparing, approving, or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; and b. Supervisory, or inspection activities performed as part of any related architectural or engineering activities. C. As respects the coverage provided under this endorsement, SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS are amended as follows: 4. Other Insurance b. Excesslnsurance 1. The following is added to the Duties In The Fvent of Occurrence, Offense, Claim or Suit Condition: e. An additional insured under this endorsement will as soon as practicable: (1) Give written notice of an occurrence or an offense to us which may result in a claim or "suit" under this insurance; (2) Tender the defense and indemnity of any claim or "suit" to us for a loss we cover under this Coverage Part; (3} Tender the defense and indemnity of any claim or "suit" to any other insurer which also has insurance for a loss we cover under this Coverage Part; and (4} Agree to make available any other insurance which the additional insured has for a loss we cover under this Coverage Part. f. We have no duty to defend or indemnify an additional insured under this endorsement until we receive written notice of a claim or "suit" from the additional insured. 2. Paragraph 4.b, of the Other insurance Condition is deleted and replaced with the following: ~'~ y~Y G-17957-G99 (Ed. 10/01) This insurance is excess over any other insurance naming the additional Insured as an insured whether primary, excess, contingent or on any other basis unless a written contrac# or written agreement specifically requires that this insurance be either primary or primary and noncontributing to the additional insured's own coverage. This insurance is excess over any other insurance to which the additional insured has been added as an additional insured by endorsement. When this insurance is excess, we will have no duty under Coverages A or 8 to defend the additional Insured against any "suit" if any other insurer has a duty to defend the additional insured against that "suit." if no other insurer defends, we will undertake to do so, but we wilt be entitled to the additional insured's rights against all those other insurers. When this insurance is excess over other insurance, we will pay only our share of the amount of the loss, if any, that exceeds the sum of: (1) The total amount that all such other insurance would pay for the loss in the absence of this insurance; and (2) The total of all deductible and seif- insured amounts under ail that other insurance. We will share the remaining loss, if any, with any other insurance that is not described in this Excess Insurance provision and was not bought specifically to apply in excess of the Limits of Insurance shown in the Deciaraitons of this Coverage Part. Page 2 of 2 ACORD CERTIFICATE OF LIABILITY INSURANCE OPID N DATE (MM/DD/YYYY) CLINI-1 02/15/08 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Andreini & Company-South Coast ~^t License 0208825 /~t '" ~~~i ~'~ ~y ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE H . „ OLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR One MacArthur Place, Suite 100 ~ ~ ~ ~9 ~ d ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. ^ South Coast Metro CA 92707 ~ ~~d '/ Phone: 714-327-1400 Fax: 714-327-1499 INSURERS AFFORDING COVERAGE NAIC # INSURED - (, 11 (~~ ~„ ~J //_ x v V 7 (~ INSURER A: American Casualty Company of 20427 Clinical L b t i f INSURER 6: a ora or es o San Bernardino , Inc . INSURER c: P . O . BOX 32 9 San Bernardino CA 92402 INSURER D: INSURER E: VVVC 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR TYPE OF INSURANCE POLICY NUMBER LICY FE TIV DATE MM/DD/YY) P LI Y EX IRATION DATE MM/DD/YY LIMITS GENERAL LIABILITY EACH OCCURRENCE $1,000,000 A X X COMMERCIAL GENERAL LIABILITY TCA2068975201 02/01/08 02/01/09 PREMISES (Eaoccurence) $ 100,000 CLAIMS MADE ~ OCCUR MED EXP (Any one person) $ 10 , 000 PERSONAL & ADV INJURY $ 1 OOO OOO , , GENERAL AGGREGATE $2 000 000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG , , $ Excluded X POLICY PE ~ LOC Em Ben. 1,000,000 AU TOMOBILE LIABILITY A ANY AUTO BUA2068975084 02/01/0$ 02/01/09 COMBINED SINGLE LIMIT (Ea accident) $ 1 000 i r000 ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) X HIRED AUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LU\BILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 5 ~ 000 ~ 000 A X OCCUR ~ CLAIMSMADE CUP20689753444 02/01/0$ 02/01/09 AGGREGATE $ DEDUCTIBLE $ X RETENTION $ l O, 0 0 0 $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? If yes, describe under E.L. DISEASE - EA EMPLOYEE $ SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS /LOCATIONS !VEHICLES !EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS Certificate Holder is additional insured as respects to General Liability per written contract per attached G-17957-G99. The CANCELLATION notice herein is amended to read 10 days as respects any cancellation due to non-payment of premium. r+~ c nvcvcr~ l-AN!'FI ~ ATIrl1U CITYSAA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3O DAYS WRITTEN City of Santa Ana NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Department Of Public Works IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR 220 $ . Dailey AVe . REPRESENTATIVES. Santa Ana CA 92703 AUTHORIZEDR~PR NTATIVE ww '' A!~/'1An n vv vv """"' `" t`~" ""°/ //-~ f`L~~ ~/ ~/ V ©ACORD CORPORATION 1988 G/ ~ / IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ~v VI\/ LJ ,GVV IIVV~ CU-t 7957-G99 (Ed. t 0/01) IMPORTANT: THIS ENDORSEMENT CONTAINS DUTIES THAT APPLY TO THE ADDITIONAL INSURED iN THE EVENT OF OCCURRENCE, OFFENSE, CLAIM OR SUIT. SEE PARAGRAPH C.1.OF THIS ENDORSEMENT FOR THESE DUTIES. ALSO, THIS ENDORSEMENT CHANGES THE CONTRACTUAL LIABILITY COVERAGE WITH RESPECTS TO THE "BODILY INJURY" OR "PROPERTY DAMAGE" ARISING OUT OF THE "PRODUCTS-COMPLETED OPERATIONS HAZARD." SEE PARAGRAPH 8,3. OF THIS ENDORSEMENT FOR THIS COVERAGE CHANGE. THiS ENDORSEMENT CHANGES THE POLICY. PLEASE READ iT CAREFULLY. CONTRACTOR'S SCHEDULED AND BLANKET ADDITIdNAL INSURED ENDORSEMENT WITH LIMITED PRODUCTS -COMPLETED OPERATIONS COVERAGE This endorsement madif{es insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 5CHEDUI.E Name of Person or Organization: Designated Project: (Coverage under this endorsement is not affected by an entry or lack of entry in the Schedule above.) A. WHO 1S AN INSURED (Section 11~ is amended to Declarations of this policy, whichever is less. include as an insured any parson or organization, These Limits of insurance are Inclusive of, and not lnciudfng any person or organization shown in the in addition to, the Limits of insurance shown in the schedule above, (called additional insured) whom you Declarations, are required to add as an additional insured an this ~, The coverage provided to the additional Insured policy under a written contract or written agreement; by this endorsement and paragraph f. of the but the written contract ar written agreement must be: definition of "insured contract" under 1. Currently fn effector becoming effective during the DEFIN1710NS (Section V) do net apply to "bodily term of this policy; and injury" or "property damage" arising out of the "products-completed operations hazard° unless 2. F~cecuted prior to the "bodily Injury," "property required by the written contract or written damage," or "personal and advertising InJury." agreement. When coverage does apply to "bodily B. The Insurance provided to the additional insured Es injury" or "property damage" arising out of the " " limited as follows: products-completed opera#lons hazard such coverage will not apply beyond: i. That parson or organization is an additional insured solely far liability due to your negligence a. The period of time required by the written and specifically resulting from '~-our work" for the contract or written agreement; or additional insured which Is the subject of the b, 5 years from the completion of "your work" on written contract or written agreement. No the project which is the subject of the written coverage applies to Ilablllty resulting from the sole contract or written agreement, negligence of the additional Insured. whichever is less. 2. The Limits of Insurance applicable to the addltianai insured are those specified in the 4, Tha insurance provided to the additional Insured written contract ar written agreement or in the does not apply to "bodlty injury,° "property G-17957-G99 Page 1 of 2 (Ed.1010i) (Ed. i i)/~i ) damage," or "persona! and advertising in)ury" arising cut of an architect's, engineer's, or surveyor's render€ng of or failure to render any professional services Including: a. The preparing, approving, or fall€ng to prepare or approve maps, shop drawings, opinions, reports, surveys, f€sid orders, change orders or drawings and specifications; and b. Supervisory, ar inspection actly€ties performed as part of any related architectural or engineer€ng activifles. C. As respects the coverage provided under this endorsement, SECTION lV - COMMEI~CiAL GENERAL LIABILITY CONDfT10NS are amended as follows: '1. The following is added to the Duties In The Event of Occurrence, Offense, Clalrn or Suit Cond[tion: e. An additional insured under this endorsement will as soon as practicable; ('1) Glve written notice of an occurrence ar an aifense to us which may result in a claim or "suit" under fh€s insurance; (2) Tender the defense and indemnity of any claim or "suit" to us for a loss we cover under #his Coverage Part; (3) Tender the defense and Indemnity of any claim or "suit" to any other insurer which also has insurance for a loss we covet under this Coverage Part; and (4} Agree to make available any other insurance which the additional insured has fora loss we cover under this Coverage Part. f. We have no duty to defend ar indemnify an additional insured under this endorsement until we receive written notice of a claim or "suit" from the additional Insured. 2. Paragraph 4.b. of the Other Insurance Condition is deleted and replaced with the following: 4. Dther insurance b. Excess Insurance This insurance is excess over any other insurance naming the addit€anal Insured as an insured whether primary, excess, contingent or on any other basis unless a written contract or written agreement specifically requires that this €nsurance be either primary or primary and noncontributing to the additional insured's own coverage. This insurance Is excess over any other Insurance to which the add€tional insured has been added as an additional insured by endorsement. When this insurance fs excess, we will have no duty under Coverages A or 8 to defend the additional insured against any "suit" If any ocher Insurer has a duty to defend the additional insured against that "suit." If no other insurer defends, we will undertake to do so, but we will be entitled to the additional €nsured's rights against ail chose other insurers. When this insurance is excess over other insurance, we wi}I pay only our share of the amount of the loss, if any, that exceeds the sum of: (i) The total amount that ail such other Insurance would pay for the lass in the absence of this insurance; and (2) The total of a!i deductible and self- insured amounts under all that other insurance. We will share the remaining loss, if any, with any other Insurance that is not described in this Excess Insurance provision and was not bought specifically to apply in excess of the Limits of insurance shown in the Declarations of this Coverage Part. G-17957-G99 (Ed. i Q/Q1 } Page 2 of 2 ~- ao03-~-?~7' 7146473345 p • ~ Rpr O1 OB 03:39p Public Works ~- ~.,~~~.., ~. „nnNle'nl .~~o. Faxlu tiW-3/8-8361 To. ThamanD A,.2OO3~-~~j'~-a( Date: q/16008 1113 AM Page. ^-~4 A -aco~- a'-rl~ ACORD CERTIFICATE OF LIABILITY INSURANCE ~ i °Aoa/oi el PRDaxFR a Aadreini S Company-South COa&t THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY License 0208825 wno GONPGrta HO RIOHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND EXTEND OR One MacArthur Place, Suite 100 , ~ ALTER THE COVERAGE AfFORDED 8Y THE POLICIES BELOW. South coast xetxo CA 92707 Phone: 714-327-1400 Tar:714-327-1499 INShREN ~ }INSURERS gFFORDING COVERAGE lu ~q ~- 1_q 'N~"°" ~ uFncrn c.Fw:<y coapany .f __ 20427 clinical Lahoratories of ^JF_FP LAn<mentLL G,wllY Ceyarv/ ~- ~ -~ -- - -- x H2Bno, Zac. P SS llsuaE:~' -` - O. O San Bernardino CA 92402 ~'""""- __ _ _ _ _. -. a. REF ~ c.nvcRAr.Fc "+ ,tL.r sLRw.. ri VCCL '..rwJ reEM1'IS U' ~--ms[1-.~ .__~e.a 'R cH~Lr-'~rC ~. i., iAFEO NtN,H~tardE"rc ; W I FT rN 17 7E M PL-'p'I /J ' CM11P4:1 I t L' 1mG ' , l f?-6 4 M 4LS Le E NY EE I$$LGC L^Z ~~ r w _ a rF_~E n Fu'Lre c IHee L;w~I 1 r ~~ 1 I, 0 1 JE FJC I= L,rn r roao a. F 2e~: _ p:.l i_..~Ulp,{cir l.a p3T.~\N MP1 n9yFNrPp'6: U'LtGB`NA'h:A!-p~ ~ - _- LTRN sRV 'VpE OF INSURANCE POLICYMIMRER ~LI~R~PDLT~q~Q~Qpr~p~~- - - ~-~~ ~ R _ ~ D2 F IMMA]0 tE (NW0DRT I LIMTS ) GENERAL LIABNTV I ~ ~ 4H0 Ina:^aE a1 O00 DOD A X X ti MYI ,u Er.EO4 0 L'n' TCA206S975201 , , 02/01/08 02/01/09 c Ft~~~~`E „ 5100 000 J EL IM arr ~ X I .;.vt ~ ~ ~ , I ~ - J I -E[_, rv .n m..~,: 510,000 ~ ~ 1 IF rnAnIV9. s'v@'A.~~R_ ~1,DDDrDDD IEEALAC hraAre ,a DaD ooo EN', \. .j.. :l \I. h •LiEb'°ER , , µ;E 51[U IS f`•.F' P.y=: 5 Excluded x •'t l..~.,<* ~h,. - _ ~_ I ,FaLp Ben. 1,000,000 - ~- - - auroEloecE LMelutt + - I r` 'ifs IBUA2D69975D94 h ""' I, ;~aa;cae.a; ~s 1,000,000 02/01/08 02/OS/09 I E ~TSS ~ +LO1LY'TI ~Ir, IP Ual ' 1 ~XI RE' ~ -,- - I L:1 -I! qV fM1 ~ R~ L IDi'~ P xr; > ~ - i c RUP[PiE C~wNC{ S GARAGE LIABILITY ~' ~ ~ - ~ N9p J.VLV EA hUr;L~tNf 'S r.. .. - hEC Iti\ Cn<_L ~5 FJ r H 'i _. _ E%CESS/UMBRELl0. LIABILITY ~ ~ ~ A ~ X ~" LE ~ -l rcvn vmr ~ CUP206S975399 chH ~ URfEN:. 'S$, DOD, OOO ~ ' - i L-. ~ 02/01/08 U2/Ol/09 G RCf TE L ~ ' E' '..-1 " i - ~ F X RF mvnln i10 00 0 6 _ _ _ L- -, }_ - ~ j WONtERSCOMPENSAiIVNAW ~ ~ EMYLOYEflS' LIABIL'Y ~ T 4 IM i< `~ fiIC"'HIYrvi Ik-DEL ~llv~ ~ ~ I A InC~.rt ! g ~ Itln a_ .u. - _ _ .I A ..:.Fi I L 01<I"4 FS FM1'LnYE= j f' ICIL'If_Eelw. ~----- tOTHER E _ __ V?LICV Lylll 5 -+-- _ _ B Professional EEA275170923 02/OI/OBI 02/01/09 Claim/Aqq 3,000,000 Liahilit (ESO) ~ - L_ I Deduct. 100,000 0ESCRRi1pN 0f OPERATION51_0C0.TI0NSt VEHICLESI E%LWBIONS ADDED BY ENDORSEM1LNLi SVE'.IAI PROVISIONS - ++REVISES F REPLAC~3 CERTIFICATE ORIGINALLY ISSUED 02/15/08++ Certificate Holder is additional insured as respects to General Liahility per wsrttea contract per attached G-17957-699 The CANCELLATION notice herein is amended t o road 10 dgys as respects nay csacellation due to non-payment of premium. csanclcarE unr nvR _ . _ _ _... CITYSAA SH00.DanT OF THE PBGVE 0ESCRIBEp POlI0E5 BE CANCELLEC BEFORE THE E%PIRATION UATE THEREOF THFBSLANG nSURER WILL EN0EAV0q i0 MAR 3O DAYS WPortEN VUTICE LO THE CfftTIFCAR •OLOER NAMED TO THE LEFT. BUi FAILURE ie DO SO SHgLL City oP Santa Ana Depart$$at Of Pllblie Works IMPOSE Nn OPJ_ICnwN nR UntllLltt aF ANV XINp uPON THE IN811RER, Irs AGENTS OR 220 s. Daisey Ave. RErRESfnrnnves. Santa Ana CA 92703 AtrTwR¢EO RDPRE~nTAl~ie _ d~ -- Rpr O1 08 03:39p Publ>c Works _,,.,,_ .. -.~~~~oii.. ~1 ~.u rawu bbU-3/tl-0351 To TF OmasD 7146473345 Oate. 4/12W8 1113 AM Page 3of4 IMPORTANT If [he certificate holder is an ADDITIONAL INSUh'FU, the pOlicy(ies) musi be endorsed. A statement on this cert;ficate does not confer rights to the certificate holder rn lieu of such endorsemen}(s). If SUBROGA71ON IS WAIVED, sublecr to the terms and conditions of the policy, certain policies may require an endorsernenl. A statement on f'tis rertl`ICate cues not confer rights to the certificate holder In list, aF such endorsement(s) DISCLAIMER p.3 The Certificate of Insurance on the reverse side of mis furm does nu. constitute a contraci between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it aff~.rmafively or negatively amend, eMend or after Uie coverage attorded by the policies listed thereon Rpr O1 06 03:39p Public Works ---~~-.....~~w ~i„i. o raxiU tibO-3iA 4367 To T.nLmdsJ 7146473345 Date gH/?C0A 11 13 qM Pey. c of q CERTHOLOER COPY STATE P.O. BOX 420807. SAN FRANCISCO,CA 94 1 42--0807 COMPENSATION INSURANCE FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: pa-01-2008 GROUP POLICY NUNHER: 1886779-2008 cEHTIFicAT~ Ic a CERTIPCA~E EXpIRC5: 02-01-2009 02-01-2008/02.01-2009 CITY Of SANTA ANA SG DEPARTMENT OF PUBLIC WORKS 220 $ DAI9Y AVE SANTA ANh CA 92703-4336 ih.s is to cerLiy Nal we have asUed a valid Workers' Cmm~ensauon insurance potlcv .n a form approved by the Ca~ito•nis Insurance Commisswner ;n the employer named be•ow for the policy paned and+cated. Thu oollCy Is ncl sub;e[I to cancelfa40n by the Fund except upon 10 tlays advance .u ~dlen notice to the enlpl DVer. 'vL'e will also gwe yes f0 days advance 90tice should tn.i ppllgy ce cancelled pnor ce its normat expiration. This cw-[i ticate of insw ante ,not at insvnnee polity and noes not amentl extend or altar the coverage afforded by the polio/ hated herein, NC:wiln5tantlinq any requirement, ;arm o: condlhpn of any ~ontracl or other do_ument with respect Ic wh¢h this certificate of insurance may be rssvad or to which LL may aerlaln, the insurance oflerded by ditl pobcy de5enbed herein I5 Subfe Ct to all the terms Bz Cusie'~s, and CendltlOrle, of such pplipy. STN-0HIZED REr"RESENTA*I ~~ / ""'s"-~`--~ PHESIOENT EMPLOYER'S LIAB[LITY LIMIT [NCLUOINO DEFENSE COSTS 51.000,000 PER OCCURRENCE. .lv1PLCYEH CLINICAL LABORATORIES OF SAN BERN AND/pR GEO MONITOR ZNC PD BOK 328 SAN eERNARDf Np CA 92802 1B15,NA iaevs-osl ~ PRINTED 04-01-2008 SG p.4 MAR-16-2009 MON 08;55 AM FAX N0. P, Ol MAR-16-2009 MON 08 56 AM FAX N0. .......... ~'"p'yVi ~.11 w BUSINESS AUT~MC~~31[~E INSURANCE COMPANY: American Casualty Company of Reading, PA POLICY TEF~M: February 1, 2009 to February 1, 2010 Limits of Insurance Combined Single i_imit Bodily Injury and Property , $ 1,000,000 pamage Per Accident -Owned 1 Non-Owned and Hired Autos Onl 5,000 Medical payments $ 1,000,000 Uninsured /Underinsured Motorists Liability Employers Non-Owned and Hired Automobile Liability ~ ~ 1'42;000 Faired Automobile Physical Damage peductibles $ 1,000 Comprehensive $ 1,000 Collision -Waived Rents! Reimbursement $ 50 per Day 30 Days Coverage Extensions + 30 Notice of Cancellation, except 10 days for Nan-Payment + SR75 Filing Included + >=mployees as Insureds + Fellow Employee Exclusion Deleted CONPl710N5 + 3 ar more moving violation + p.U.l. conviction within the last 3 years P. 01/01 Exclusions All policies contain conditions and exclusion, all which cannot be listed in a proposal. Please read your policy carefully far all policy terms, conditions and exclusions. ~~1'PRUVFll . AS TO FORM ~~ . _.~- ,~, :~ ;.aura Stitt Speedy ~;,.,~~t~nt City At.torn~tpn~;IrnerccamfrwwY r,~ ~t+~wllct*Q Al ["I'l1MARl1 F MAR-16-2009 MON 08 57 AM .._...-- _. _t - --- QQn~~sSiaNAt~ L1AB1~.{TY FAX N0. Limits of Insurance ~ 3,OpO,OOO Each Claim $ 3,OpO,OOO Aggregate $ 'IOO,OOD peductible (Included Defense and Expenses Cosfs) Claim Extension Period cancels or non-renews' • From Cancellat1OO ~o Annual~Premtium lnlnc uded 12 Months aQ Retroactive pates Fu11 Prior Acts • Clinical laboratory Full Prior Acts • GAO Monitor Rating t3asis • $2,3OO,OOQ Gross Sales Terms & Conditions: • Full Prior Acts Coverage • Coveragefar ADA/FMAIOSHA claims • Free Pre-Claims Assistance • Circumstance Reporting Coverage + limited Contractual Liability Coverage + slanket Joint Venture • Mediation Deductible Credits Defense Reimbursement Provisions + Personnel leased by You • Innocent Principals Coverage • Retired Consultant Personnel P, e~n•~a~Yrx- - r~ ~(~RM _1 ~.. ....; ~heedy .._ »uy Attorney pNp~INI & C4MpANY Continental Casualty Company 1NSURANGE CQIIAPANY: PpLICY TERM: February 1, 2009 to February 1, 2O1D _ -r_,....... i ~ w en QTY MAR-16-2009 MON 08 58 AM FAX N0. P, 01/01 ...~~ 7~~ ~C C~MM~RCIA~. GENERAL LIABtL.tTY INSURANCE COMPANY: American Casualty Company of Reading, PA POLICY TERM: February 1, 2009 to fFebruary 1, 2010 Limits of insurance ~ 1,000,000 Each Occurrence $ 2 000,000 General Aggregate ProductslCompleted Operations ~ , 2,0Q0,000 Personal and Advertising Injury ~ $ 1,000,000 100,000 f=ire Damage Liability ~ 000 10 Premises Medical Payments , Employee Benefits Liability ~ 1,000,000 Aggregate $ 1,000,000 Per Occurrence Deductible -1=B>-Only $ 1,000 Retroactive Date ?J01~04 Coverage Extensions In addition to the policy terms and conditions, coverage extensions include, but are not limited to: • Liability Assumed under an Insured Contract • Broad Named Insured Clause + Notice of Loss Modification + Unintentional Errors & Omissions in Application Clause + ~lostile t=ire Exception to a Pollution Exclusion + Aggregate limits by Location • Blanket Additional Insured Endorsement Provides "property damage ligbility" coverage for elevators and sidetrack agreements + Provides "Nan-Owned" Aircraft Liability coverage ifi other coverage is not otherwise available • 60 Day Notice of Cancellation except 10 days for Nan-Payment Exclusions All policies contain conditions and exclusion, all which cannot be listed in a proposai_ Please read your policy carefuAy far all policy terms, conditions and exclusions. APPROVBi~ ~~ 'i'ce r~,•_~. ~; ,~~ Assistant ~(~q~~11YXPAriY COMMERCIAL GENERAL LIABILITY POLICYHOLDER COPY STi~TE P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807 COMPENSATION INSURANCE U N ~ CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 02-01-2009 GROUP: POLICY NUMBER: 1886779-2009 CERTIFICATE ID: 4 CERTIFICATE EXPIRES: 02-01-2010 02-01-2009/02-01-2010 CITY OF SANTA ANA SG DEPARTMENT OF PUBLIC WORKS 220 S DAISY AVE SANTA ANA CA 92703-4334. 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 advance written notice to the employer. We will also give you 10 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. THORIZED REPRESENTATI ~~ `~~ PRESIDENT EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. APPROVEll AS TO PQRM Laura Stitt Shee Assistant City A orney EMPLOYER CLINICAL LABORATORIES OF SAN BERN AND/OR GEO MONITOR INC PO BOX 329 SAN BERNARDINO CA 92402 SG M0409 IRev.z-o5> PRINTED 01-16-2009 STATE P.O. BOX 420807, SAN FRANCISCO, CA 94142-0807 COMPENSATION I N S U R A N C E F U N ~ CERTIFICATE OF WORKERS' COMPENSATION INSURANCE FEBRUARY 1, 2G09 POLICY NUMBER: 1$86779 - 09 CERTIFICATE EXPIRES: 2-1-10 CITY OF SANTA AKA DEPARTMENT DF PUBLIC iiDRRS 220 S DAISY AVE SANTA ANA, CA 92703-4334 JOB: ALL CALIFORNIA OPERATIONS 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 ten days' advance written notice to the employer. We will also give you TEN 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. A HORIZED REPRESENTATIVE ~- PRESIDENT EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: 51,000,000 PER OGGURREHG>~. ppRpv I. EMPLOYER CLINICAL LABORATORIES OF SAN BERHARDIHO ANDlDR GEO MONITOR INC. P. O. BOX 329 SAH BERHARDIHD~ CA -:924x2.... l ~~~--- "" e~ `~ Laura Stitt `~~` nctzc4 (;ity Asyistaot #596 SCIF 10262 (REV. 02-08)