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Home My WebLink AboutCOMMUNITY VETERINARY HOSPITAL, INC. 2Cr AGREEMENT TERMINATION Please complete this form when the attached agreement is no longer in effect.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 647-5238 if you have any questions. -__ -------------------- The agreement with /~'.'h;~j~- c . y ~ ~'-~;~c'-~1.~.~ tit A z ~ - ~ _~~ ~~~- ~- was completed on l ~j 3 ~ ~ ~~ 1 ana final payment has been made. AGREMNT Department: ~ n NUMBER SUFFIX ~ ~ ~` ; , ~- ~ --~- -- ~_.3~..! Signature: ~ ~ 'N-2005-068 2 ~J i ~ <:? s ;~ ~. ~ . __ __ A-2006-095 ,2a Date: c ~. ~ 3i :~ ~a N-2005-068-01 '2b ~~ '~ ~~ ~- (41., Lw~ N-2005-068-02'2c City of Santa Ana Clerk of the Council Revised 05-22-05 iltill;RaNt,t ON FILE U;,i~ ,~,r•,r PROCEED ~~„ ~~ ii~aURANCE EXPIRES lD'1-o ~' ;,t€RK OF CbUNCIL oAfiE: s a9-~~ THIRD AMENDMENT TO AGREEMENT N-2005-068-02 ~ ~O~' `~ ~~"~ THIS THIRD AMENDMENT TO AGREEMENT is entered into on the 4`h day of LUV ~ ~''rD"' "' April, 2008, by and between COMMUNITY VETERINARY HOSPITAL, INC., 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 N-2005-068, dated May 24, 2005, (hereinafter "said Agreement") by which Consultant has provided veterinary services for Police Service Animals, B. In accordance with the terms and conditions of said Agreement, the parties wish to renew said Agreement for an additional one-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 Third Amendment to Agreement, the parties agree as follows: 1. Section 1, SCOPE OF SERVICES, shall be deleted in its entirety and replaced with the following: "Consultant shall provide services as set forth in Exhibit A-1 to this Amendment, attached hereto and incorporated by reference." 2. Section 3, TERM, shall be amended to extend the term for an additional one year period through June 30, 2009. 3. Except as 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 Third Amendment to Agreement on the date and year first written above. CITY OF SANTA ANA ATTEST: PATRICIA E. HEALY Clerk of the Council APPROVED AS TO FORM: JOSEPH W.FLETCHER City Attorney Laffra Sheedy Assistant City Atto y APPROVED A5 TO CONTENT: ~P'Ai(L M. WAL Chief of Police DAVID N. RE City Manager CONSULTANT TERS LIAM A. GRANT, Chief of Staff EXHIBIT A-1 SCOPE OF SERVICES Community Veterinarian Hospital shall provide the following services for Police Canines: • Initial canine physical and evaluation for police service dogs, including but not limited to blood work, x-rays and medical examination • Veterinarian treatment as required for sick and/or injured canines • Annual physical examination and recommended vaccinations • Surgeries as required • Consultation regazding all canine related medical care and treatment COMPENSATION (commencing July 1, 2008) Radiographs $90.00 Radiographs Additional Views $67.50 Complete Blood Profile (caGChem/Tyyroia) $90.00 Heartworm Blood Test $25.00 Urinalysis 528.75 Urine Collection Fee $0-$15.00 Heartguard 272mcg 535.00 Sentine151-1001bs $67.00 IV Catheter $34.75 Hospitalization per day Canine $35.00 1-25 lbs Based on weight $40.00 26-SO lbs $45.00 51-751bs $50.00 76-1001bs 560.00 >1001bs Feline $32.50 Hospitalization PART DAY Canine $28.00 1-49 lbs $35.00 50-991bs $42.00 >1001bs Feline $22.75 .._ .. GLgntlf• 1163X1 ~----..----""`-".""...... ! ~ DATE (MNR7GITYYY) I~IY!, v... C;~. .-~' n -- ~',~"l~lC;~~f'~', flF_C_llAkillL!•'i"'~' VWSi~3~1NC+ 121197D7 .._ -- -.. ---- - TH1R ClRTR1CATE IS ISSULED,w13 uMAT' pE CO ~ILyTIfICMATAEION raooucen N-~•CaLYO_O~$ ~ ulLLf'ANDCDNFEfk9:u0F. {usoefatlon Unit I HOLOpJl.TNIS pERTIFICATE DOES NOT AMEND, EXTEND O0. ABQIneU•Fr:rpAFinancl?alger•ICels N'~~'~~~ ~ ALTER?1fE_COVERwOEAF^FOIiDEDBVTHEPOL.ICIE38E10W. 2480 Natrmr5 PArk D~. Ruke 200 N -a-oo 5 -O(o~-ol rtnlc e INSURERS AFFORDING COVERAGE Sacramento, CA 95833_ ----^^ ~uneRA. F{nmm'p Fund Inaunnw -_ INSURCG CominunityYelerMeryHospitaS,loc. NsuucRC~. 1s29GEsctl~~nror; rTSURERC. _--- Ga,•COn 13feK, C,L iRB43 INEURFR O: ~-..-- INE U+i'R°. coveRn~ee _ _ - -- THEP000IE3OFINSURANCELIS'fGD FLOW NAVE BEEN I$SUEO TO THE MISLREO NAIAED ABOVE FOR THE FOLtCY PE RR]O INCACATED.NOIWITNSTAN0IN ANY REC.~IRE??5N' TFPM OR C1INDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH TNS CFRTIFICATE IAAV BE ISSUED OR POLIC 6?AGGf'ECATEu:7hnTSSROriN MAYBM VE OEEN REOUCEDB VPMC LLA)NS.SU~~TD ALLTFIETERMS, IXC:.A`110NS ANOCONDUR~tat50FSUCH _- GATEMWGG ._----• a1 ODO OOO ------ ~ - 1Dfi1ro-r ~( f.'1!!'k4JA*`Fn ERAI IIA&.Iry~ _F^LJQ!-NNPMMR___..__._ ~~ 1OfOtMo is ICH G:.CURRE`'Cd L a _._ - knzceoansnl . , -- A X as Nt'rA~_vr r•u:Y i,13. ~.. .` N.yae;tr,:m:ALUS,:n ~'i0y000 ' R _ac,.~,,t:aYiN+um_ E1 000 _.., [~ WINS MML XI CCCLIR ( _ _ ____~ ~ ~ IT:Lre<ALAGGnnwlt s2 DOD 00 _ RIODUCTa•L91r~Y'A_G 62060606 GENT. AGGRCGATE UM r AFPLI ,9 PGR.i ------' RRiG I LCJI; PCPC'r _ .JSCT _1._1---____-....-.---._-_...- IC(NdaINEO SINGLE LIMT f A'JTGM0a4E LUa1LITY F l-E l.,rsienr. •~~ AN'!AUTC g(IGILY IN.e1RY S iL ALL n!SNEn AUTCIj i (rM O,MN 6'.HEUU~_EG AUrLlS ,, yUUILY MANY S I'IIRCD AUP]: I F(EN et6Ga!LI ~~ f„hN.CN1NE0 Atl rfis I PF:Op-RTY WNAnF y ~ (Pti etUOellrl ~~ _ _ -^ _ I .MRO CNLY •CR ACCIL'GNT S TGARAaE LW61LITT EA ACC S ri H .R'fNAN -- -iANY ALrtn ALTO CNLY: AGG S .,-_ I __ _._.... -__ _- __ _ _ . _. _. ------_ -..._- _-.._. ~0/.Cl, GGCURRCNCC _.. S a^.cun !. J cLAINS wG4 I GwvcreL I A WORNCR: ;AnPCKSATION ANR EMPlR7YERe' JA lift: Or ICCN ~JAOCR E%RTP.Ed,u~ hCln hf: ---~.ILa-~~ = -...... -. Y OESCRMnGN L': M`RAT.l14r I l:tC.,'!M!SE.' Y!°H'~~C~J rN[l4aNIN5 AGaeG 9' " SuPPk~+~al Name " Do;ng DUS;ueAR Ar,: Community tieterlnary HotpiLVl,lnc. (dba) Mlmai Frienf}s Pen Hutcl (dba) Animal Ufaoount Clinic (Sae Attaehoa Gmsc:iptlonsj -^... _..--.^-^r_ CAtfGLLtAT1ON Tin Osv Neelt - EHOLLLOwNYnFTNEAHOVCDESLRIBCO ('GLIU1C3 nC CANCELLEG aCFGREO ~~111PR1~Rt~ [n[; RCRE'1P, ~He IC3~11+F iNsUR2R YALL'!M~EAVGRTI WUL _.36- Clty o1 Sinty Ana • . ~ N.rS: TC TMC GE0.TR'I^.A*e Nnl!7ER VASIEATfJ THE LEFr. et+T ~AII.LRE tt7 o0 EG SMALL ~,1 f:1V1c t~~.^~t4r l~iMZUr l+h~h'} .,. ..~ i)i-I~nuVtl geuAAT!gNMLI,AbrtYY OE I.NY R11a111PIM TNeINEURdL nS AGCNTr GR $,ggfF1 jAVLS, •^,A •J71'~ r /" ~F,L -y ___ R...' lore 9' --s Y16'~6`'S4Y1° t' ' I.i. ;1Ut+ CCIMNUVETE 07!61107 ISRCCIAL J21' '= :LCGRD POLICY NUMBER: AZC80806771 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -DESIGNATED PERSON or ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: City of Santa Ana 20 Civic Center Plaza, M-30 Santa Ana, CA 92702 (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS AN INSURED (Section II} is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of your operations or premises owned by or rented to you. Certificate Holder is named Add'1 Insured as respects to Veterinary Services performed by the named insured. .1A ~: .,. .. < , OCT -24-2008 09: 10 FROM: CVMA 9166469183 TO:714 2458550 Ii) -, ( l_;> , -, C /- P.\'3 ACORD. CERTIFICATE OF LIABILITY INSURANCE OPID Me I DA TIi. ..IIIDDlY"lVVI CCXVE-l 10124/08 l'IlODUCIIj"- THIS C~RTIFICATE IS ISSUED AS A MATTER OF INFORMATION Veterinary 108. Service. Co. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE CA Lice".. 1101'64180 HOLDER_ THIS CERTIFICATE DOES NOT AMiNO, ElO'ENO OR 14 DO Ri......, Park D~iv., '180 ALTER THE COVERAGe AFFORDED BY THE POLICIES BELOW_ Sacramento CA 95815 I NAIC. Pho"e:888~762-31A3 Fax:916-921-2266 IN5URERS AFFORDING COVERAGE - INSU'Re INSURER A: nreman:. F\i1lt3 I".v..."n~ Co. C"""""",,it.I V..teri"ap' H~it.al ~EA~ .i~liam Grant ~ , 0 INSURER C -- 13200 Kuoiid St.,eet. -- GRl:den Grove CA 92843 ~.~o'.. - - INSURER e: COVERAGES 'niE POLIC1E:S or INSURANCE LISTED SElOW HAVE D~~ISSUeOTO THE INSURED NAMED ADOVE J:Oft 'rHE POliCY PERIOD INDICATED. NOTWITHSTANL)INO ANY' AEQUIIU,MENT, TEAM OR CONDITION OF AAY CONTRACT Oil: OTHE~ OOCUMENl'WITtI RCSPGCT TO WHICH THIS CI;RT1J:ICArf: M,ot,Y BE ISSUED Q~ MAY PE'RTAIN. THE INSURANCE AFFORDED BY THE POLICIES DtOSCRI8ED HEREIN IS ~tJeJECl TO ALL THE T~R-MS, eXCLUSIONS AND COJf~ITIONS OF ~UCH POUCIES. AGGRIZGATE LIMITS SHOWN MAY HAVE 8EEN REDUCED BY PAID CLAIM6 ~~~ - 'p~~r:MD~ '~'r1'"=b~N \ YVfli 01" INSUFtA"OI! POLICY NUMBER UMlTO alNi:RAL U....l.lty l:AC:I-IOCCURRENce '1,000,000 A X :x COMI.4ERCIAL GENE~AL LIABILITY 8HtAZC80832A74 10/01/08 10/01/09 ~~"E6(~~~ce) . ;00,000 t-..1 CL~rMS MADE [X I OCCUR -- -- I- ~.~o ~.p (Anr C1nl;1 J;I'rtO~) .10,000 - f- PERSONAL 6 MJV INJURV . 1--- -- ~NE~~"'GGREGATE; . 2,000,000_ _OEN'LAGG~E LIMIT "'nSP~ PRODUCTS.COMPffiPAGG '_1,000,000 _ I '"'0. SIllO Ben. 1 DOli 000 I POLICy JECT LOC ~UTOMOilLI! L1ABILI'Y"Y COMBINED SINGLE: L1M(f '1,000,000 A ANY AUTO 8U4AZC80832474 10/01/06 10/01/09 (ESllOCiG<<>nl) r- - - f--- ALL OWHED AUlOS BOOIL Y INJURY ...... . sr.loll;DuLED ....UTOS [P&rp.rSC"l - -. - - X "lIR!.D AUTOS , QODll'V INJURY ex '-/1LJv//2'l~1 WeraOClllenlJ . NON-OWNICO AUTOS r= - - -- - -j vi PROPCRTY QAMA.OE . (P.~ ~a:ldqnt) GAMe! LllUIIUTY ,I ,c' ".., ~ AUTO VNL Y - CA ACCfQFNT . ~ ANY Auro V - - Ollo/FR THAN EA....CC . AU'ro DNl V. 'co . I!JtCE8S1UMI!lR!LLA I.IABlLrTY EACH OCCURRENCc,. . 5,000,000 :::J OCCUR lJ CtAlMS M'O' -- - A 8114AzC80832A74 10/01/08 10/01/09 AGGREGATE .5 OOO,O~ . - -- ~ DEtlUCTIBLE . X RETENTION . , WOItiC.IRB COMI'''NSAT1(IN AND J[ !T~Y;)~I~W5 I !l}~~- A IiIIlPLOYEItS'LIABlI.rT'Y 8RtWZP80g65134 07/01/08 07/01/0g ANY PROFlIElORIPAATNl:RiEXE.CUTlVE LL EACI1 AccrDCp.,'T '1,000,000 o~~ IC€RIMEMIlEA F...xCLUOEO? ~ISEASE. EA F.Mf>l?y~e $1,000_,000 ~~~tl:8~~';:~ONS lNllGW E.l. OIS!:ASf:.. POLICYUMIT '1 000,000 _OR DEGCRlPTKNII M OPERATIONS I LOCATIOJ,lS I VENJCLES I EXCLUSIONS ADDEIt IV ENDORSEMENT / SPiiC;IAL PflOVIIIONII ~h.. ce~tificate holder is named as adcli.tional inau.t1d. 10-day notiee of cancellation for non-payment. -.Ce.tificate holder continues: it.s offiC8CS, earployeesf agent.s, volunteers and repr.santatives. CERTIFICA,TE HOLDER CANCELLATION CITlrSA3 ~OUlC ANY 01' THli "'SOVE" DE6CRIIIED I"OUClI!1l alii CANClllL.eo IICPORE 'nlli EJ;PIRA'nOfr,l DAn Tt1eRIOfI', T'" l$8urHG INSUflERWfl.L _l r -..NWL ~ DA.VS WRm'EN NOTlCi 1"0 THE CER"FlCATE H01.CER NAMl!a TOTtli t.E", GUT.lID_" "tLIl' SHALL "'POU NO OBLIGATION l)R Ll,qlL.lTY all A~Y KIND UPO~ 'rHIi /IolSU"Sft, 1'1'8 MI!NT$ OR fUi:PREB!lITATlvG , AUTHO All ~ VP ""ACORD CORPORATION 1988 Cit:y of Santa Ana, ...... 591:. Mart.y Shirey/Can.ine I1n.it 20 Civic Cent:e~ Plaza M-30 Sant.a Ana CA g2702 IloCORD 2.S [2001/08) III dJ-ClO"'- -O(,g---O~ 'OCT-24-2008 09:10 FROM:CVMA 9166469183 TO:714 2458550 P.3'3 Additional Insured - Owners, Lessees or Contractors - AD 90 67 12 93 Policy Amendment Section 11 Insured Community Veterinary Hospital William A. Grant 11, DVM Policy NlUDber 8H4AZC80832474 Producer Veterwwy Ins Services Co Elfeeli ve Date I % 1/2008 Schedule Name ofPenon(.) or Organization(_) City of Santa Ana, irs officers, employees, agenls. volunteeNi and representatives Primary insurance: It is agreed thaI such in.mrM,'e as afforded by tM< policy for the benefit ofrhe additional insured .<l1all be primary in.<urance a> respects CUlY claim. Ius.. or liability arising directly or indirectlv from the in:.'Ured ~< operations and any other insurance maintained by the additional insured .<ha// be /1(m-conlributory with the in:mranc~ provided h.'rermder (Ifno entry appears above, informatioa required to complete this Endor<cment will be shown in the Declarations "' applicable to this Endorsement) The tollowing i, Added 10 Pal! I - WHO [S AN IN. SURBD in the Business Liability Section of this policy arising out of you, work for that insured by or for Y(IU. 5. The person or organization shown in the Schedule is al," an insured, but only with respects 10 liability All other terms 8JId conditions of the policy apply. This funn n,us!' be attnc.hcd to Change Endorremcm when i~ucd after thr. polky is writtel1. One ofthc: Fireman's Fund Insur'anrr (;ompanics as I'ulmcd in lhc policy Sel.:rctlll)' Prc:sident "'1'9(16112~1 Coftt8in~ OOp,Yri~tod M"""1I1 of [Usllr'ilnc(: Scrvi~ Otiict1, tile. '984 . OCT-24-2121I21B 1219: 1121 FROM:CVMA 9166469183 TO:714 245855121 P.2/3 IMPORTANT If the certificate holder is an ADDITIONAL INSURED. the policy(ies) must be endorsed. A statement on this certificate does not CQnfer 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 conler rights to the certificate holder in lieu of such endor&emenl(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized represen1aWe or producer, and the certificate holder, nor does it affirmatively or negabvely ..mend, extend or alter the coverage afforded by the policies listed thereon. A.CORD 2512001108) OCT~ 24-cQG_18 a°: 10 FROM:CVMA 9266469183 T0: 714 2458550 P.1'3 ,~coRV CERTIFICATE OF LIABILITY INSURANCE aPID roc DATE(MWDDIVYYY) PRODUCER COI+NE-1 lO 24 0$ THIS CERTIFICATE IS ISSUED A3 A MATTER OF INFORMATION Veterinory xas . 3®rviCes Co . CA License #OS64180 ONLY ANO CONFERS NO RIGHTS UPON THE CERTIFICATE 1900 River park D~'ive #180 OT RD ~ E E , AL ER THE COVERAGE AFFO ED B THE POLIC ES BELOW_ 3acr~n~ CA 85815 phone:888~762-3163 Fax: 916-921-2266 INSURERS AFFORDING COVERAGE INSURED _ • NAIC i{ INSURER A; Fireman's l~W1a7 ineacanoa Co. C~nit veterinary Ho itel WSVRER B - ~ '- ~~ ltilllam ~ Grant jI , DVl~ INSURER C' Garde A o e - INSURER O. n Gr v CA 9 843 - INSURER E~ '- COVERAGES 'THE POltC1E5 Ot INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THC INSURED NAMED ABOVE FOR'iHE POLICY PERIOD INDICATED. NOTWITNSTANUING ANY REDUIRGMENT, TERM OR CONDITION OF ANY CONTRA T C OR OTHER DOCUMENT WITH RCSPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DES(:RI~O HEREIN IS SUBJECT TO ALL THE TEAMS PO C U I E . EXCLUSIONS ANO CONDITIONS OF SUCH S. AGGREGATE LIMITS SHOWN MAV HAVE BEEN REDUCED BY PAID CLAIM6 LL~~ ' LTR N Rtl TYPE OF INSURANCE POLICY NUMBER ~ ~ ~ ~ATt?CTIVE POQLWEYPf11A~jpN - - DATE NRIUDDm UMfTB GENERAL LIABILITY A R R COMMERCIAL GE NERpI LUIBILITY EACH OCCURR ENCC S 1, OOO r OOO BH`ASC60832674 10/01/09 10/01/09 PREMIStS(E.9oocurxlce) s 100,000 _ CLAIMS MADE ~ I OCCUR MED EXP (Any anp Qeraon) S 1O , OOO ~~ - PERSONAL 8 ADV INJURY 1 ~- GENERALAGGREGAfE S 2,000,000 OEN'L AGGREGATE LIMIT APPLIES PER; _ _ x POLICY JPERCT LOC PRODUCTS • COMPIDP AGG S 1 , OOO , OOO _ ~ AuTnlawLE uABILrn Hen • 1 000 000 ~ ANy AUTO s~~csos3z474 lO/Oi/O8 lO/O1/O9 COM9INED; INGLE LIMIT f 1 , OOO (Efi 80Citlenl r OOO ALl OWNED AUTOS _ Sf.NF,OVLED AUTOS BODILY INJURY f (Perperaon) R HIRED AUTOS _ NON-OWNED gUTpg BODILY INJURY f ~ ( sr ecTJCenI) t I. .. .. .. OARACE LIABILITY ANY AUTO BkCEBS/UMBRELLA LIA81LfTY I A OCCUR ~IcLAiMSMADE 8Ei4AZC80832471 10/01/08 DEDUCTIBLE x RETENTION 1 MIORKAgB COMPlNSATNk/ AND A OINPLOYERB' LIA&LRY ANY PRDPRIETDRlPARTNERfEXECUTIVE 18K6ilTLp80965134 07/01/08 O~tICER/MEMBER FXCLUDED9 Ilyes, pBBpIDB UIWvr ~w~rur ~n~w Vr OPERATIONS / 40CATION3! V EHlCLES / El(CLUSIONB ADDED BV ENDORSEMENT / SPiCIAL Tho certificate holder is named as additional ].nsurad. 10-day notice of cancellation for nos-payment. PROPCRTY DAMAOE I f (Par a¢iegnt} I AUTO ONLY • EA ACCIDENT $ OTHER THAN EA ACC 5 AU'fU ONLY. ACC i EACH OCCURRENCE ~S,OOO,000 _ 10/01/09 AGGREGATE s 5 000, OOO -_ - _. _.. ... I 1 .. .. 07/01/08 C.LEACHACClDENr 1],,000,000 E L DISEASE - EA EMPLOYEE 1 ], , OOO , OOO E,L. DISFA$ • POLICY IIMI, 1 O t_ .,, w.,_ ; .. ... , I ~/ INS ..... ...._ _,._..__..._..-.._ Laura Sig; `;:~~:n Assistant L: iiy f, tE orney **Certifi.cate holder continu®s: its officers, employees, agents, volunteers and reproaantativea. CANCELLATION CYTYSA3 SHOULD ANY OP TM4 ABOVE DEBCRNiED POLIGEB BE CANCELLED BEiIOR6 T-IE E1tPNGTIO DATE TNERiOP, THE IbSVlNO INSURER Will EMAIL 3O DAYS WRITTEIy Clty Of $aata Ana, ** NOTICE TO THE CERTIFICATE HOLDER NAMED TO TNi ~~.g~sNALL Sgt • Marty Shirey/Canine Tait IMPOSE NO OBLIGATION OR uAB11JTY OP ANY KIND UPON 7ME 1NSUR 20 Civic CeAt®r Plaza I"I-3O REPRESENTATIVE . 8R. 1T8 AOENTS OR Santa And CA 92702 nirru.,.~s e~ _--_-- - _ ACORD N-aoor-o6~-c~/ i~CT-24-2008 09:10 FROM:CVMA 9166469183 T0: 714 2458550 P.3~3 Additional Insured -Owners, Lessees or Contractors - AB 90 6712 93 Policy Amendment Section ll Insured Community Veterinary Hospital Policy Ntunber SH4AZC80832474 William A. Gtartt 11, DVM Producer Veterutary Ins Services Cn )affective .Date 1 0/0 1 12008 5ched ulc Numc of 1Peraoa(s) or Organization(s) City of Santa Ana, its officers, employees, agents, volunteers and representatives I'rimaryln,surunce: !t is agreed that such insurance as afforded by tlai.c policy for the benefit of the cldditional insured shall be primary inrura»~cy ~ respects any e~aim• lass or liability crrisi~g directly or indi,'eetly fro-n the insarred ;c operations and any vlher insurance maintained by the additional insured .durll be non-~unbibutorv with the insuaance provided hereunder. (If no entry appears above, information required tt- complete this Endorsement will be shown in the Declarations ns applicable tp this Lndorsement) Th(; tbllowing is Added co Part I -WHO [S AN tN- SURF..D in the Business Liability Section of this policy 5. The person or organization shown in the Schedule is also an insured, but only with respeeta to liability arising out ol'your work for that insured by or for you. All other terms and conditions ofthe policy apply. This form ntusc be attnchccl to Chtutgc Endorsement when issued aRer the policy is written. One of'tho Fireman's Fund insurance Companies ~ ntimcd in t}ic policy. tie0rctary - Presidcnt - Atlvp67 I?~93 C:onffiin~ c;npyR~~ -~atenol of tn.uraacc Scrvicr~ Utiiccs, Inc: , 19t{q r~Cj-24-2008 09:10 FROM:CUMA 9166469183 T0: 714 2458550 P.2~3 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(sj. bISCLAIMER The Certifcate 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.