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HomeMy WebLinkAboutTRI-COUNTY INTERIORS 2City of Santa Ana Clerk of the Council 4D AGREEMENT TERMM Please complete this form when the attac are no longer in effect. Return form to the Clerk of the Coun The agreement with t C1 - v8W1f?aH No. TA - 200 - w (List all amendments. Use space below if Revised 07-22-09 ATION FORM C&f Office Use Only hed agreement and all amendments (if any) .M 19 M 2=" 42 cil Office (M-30 -Y OF SANTA ANA )• LERK OF COUNCIL `Dr'uvcal.? 9\?ertD13 as completed on b311?'??obq and final payment has been made. needed.) Department: Phone/Ext.: Signature: Date: C?t-t 5 ?gS INSURANCE NQT_ ON FILE WORK MAY NOT PROCEED CLERK OF COUNCIL DATE: ~-~-~ AGREEMENT FOR PROVISION OF SERVICES N-2008-104 a', ctip~~~>~Po+~~-~ C~~olyh (=,~Iler~~ 1HIS AGREEMENT, made and entered into this 1st day of July, 2008, by and between. Tri-County interiors, a California corporation (hereinafter "Contractor"), and the City of Santa Ana, a charter city and municipal corporation duly organized and existing under the Constitution and laws of the State of California (hereinafter "City"). RECITALS A. The City des'.res to retain a Contractor having special skill and knowledge in the field of general construction services. ?. Centracu>r represents that Contractor is able and willing to pmvide such services tii the City. C. In undertaking the performance of this Agreement, Centractor 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. NO'Vi%' ~'fflERF;;I+'C~RE, in consideration of the mutual and respective promises, and subject fci the . '~ , terms and conditions hereinafter set forth, the parties agree as follows: 1. SCOfl E OF 3ERVflCES Coutractor shall perfomr orf-call services, as needed,'for minor building and grounds repairs and renovations. The Depot Management (City) shall inform Contractor when work is needed and Contractor shall respond within five (~) working days with a written formal bid proposal. The City may accept, reject or negotiate with Contractor regarding said proposal. Contractor shall perform said services only after receiving written approval of the proposal from Depot P,4anagement. Contractor is hereby authorized to perform all services using guidelines attached'nereto in Exhibit A to this Agreement. 2. COMPENSATION a. City agrees to pay, and Contractor agrees do accept as total payment far its services, the rates and charges identified in Exhibit A. The total sum to be expended under this Agreement shall not exceed $2,000.00 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 ofperformance set forth in the Recitals which may reasonably he expected by City. 3. TERM This Agreement shall terminate on June 30, 2009, unless terminated earlier pursuant to Section 12. 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 anemployer-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 perfornance 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 maiutain commercial general liability insurance naming the City, its officers, agents, volunteers, and employees as additiohal insureds) 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 pertorrriance 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 the City with a fully executed additional insured endorsement in substantially the form attached hereto as Exhibit B upon execution of this Agreement and shall be approved in form by the City Legal Counsel. h. Business automobile liability insurance, or equivalent form, with a combined single limit of not less than $1,OOQ,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 ;lability for worker's compensation or to undertake self-insurance. Frior to commencing 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. If Contractor is or employs a licensed professional such as an architect or engineer: Professional liability (errors and omissions) insurance, with a combined single limit of not less than $1,000,000 per claim. e. The following requirements apply to the insurance [o 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 Legal Counsel. (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. £ If Contractor fails or refuses to produce or maintain. the insurance required by this section or fails or refuses to famish. 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 insuvance. 6. 1NUEIVINIF'iCAT [ON Contractor agrees to and shall indemnify and hold harnilass the City, its officers, agents,. employees, Contractors, special counsel, and representatives from liability: (1) for personal injury, damages„ just compensation, restitutio~r, 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 alLreasonable decisions with respect to its representation in any legal proceeding. CONFIDENTIALITY 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. ~. CONFLICT OF INTEREST CLAUSE Contractor covenants that it presently has uo interests and- shall not have interesrs, direct or indirect, which would conflict in any matuter •.vithpePformance of services specified under this Agreement. 9. NOTICE ~ , Any notice, t.;nder, demand, delivery, orother communication pursuant to this , " Agreement shall be in writing and shall be deemed 4o beproperly given if delivered in person or mailed by tit: t class or certified mail, postage prepaid, or sent by telefacsimile or other telegrapl!ic communication in the'manner provided in this Section, to the following persons::.'.. To Cay: Deputy City Mgr. for Development Services Community Development Agency ~ City of Santa Ana. 20 Civic Center Plaza (M-25) P.O. Box 1988 Santa Ana, California 92702 and, City Attorney City of Santa Ana 20 Civic Center Plaza (Ib1 ~9) P.O. Box 1988 Santa Ana, California 92'102 Telefacsimile (714) 647-6515 To Contractor: Tri-County Interiors, Inc. 1592 N. Batavia Orange, CA 92867 Attn: Dan Rosa A party may change its address by giving notice in writing to the other party. Thereafter, any notice, tender, demand, delivery, or other communication shall be addressed and transmitted to the new address. If sent by mail, arty notice, tender, demand; delivery, or other 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; any notice, tender, demand, delivery; or other 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 comglete 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, thaC 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 axe 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 ofthe 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 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 City Manager, or his designee, 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 of the City unless prohibited bylaw, 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 of this Agreement. 13. DISCRIMINATION Contractor shall not discriminate because of race, 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 v/ith all apphcablz federal, state and local laws and regulations. 14. JURISDICTION -VENUE This Agreement and all questions relating to its validity, interpretation, performance; and enforcement shall be governn.ent and.constmed in accordau.;e with the laws of the State of California. This Agreement has been exec~rted 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 govented 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 braught or arise out of, in connection with or by reason of this Agreement. 15. PROFESSIONAL LICENSES Contractor shall, throughout the teem 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 her 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 of this Agreement, and shalt 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 if fully set forth in the body of this Agreement. IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first above written. ATTEST: ` Patricia, E: Healy Clerk of the Council CITY OF SANTA ANA David N. Ream City Manager APPROVED AS 1'O FORM: CONTRACTOR: JOSEPH W: FLETCHER Tri-County Interiors, inc. City Attorney G ~--- Lisa E. Storck Name: Dan Rosa Assistant City Attorney Title: Tax iD# pS p~ Z 4 4-' 1 O RECOMMENDED FOR APPRO VAL: ~y_ .~ CyPtfh~a 1. PJels n, Deputy City Manager for Development Services 7 EXHIBIT B ADDITIONAL INSUKED 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 (M-25), 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 of the 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 ar organization as an insured shall not affect any right which such person or arganization 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 (M-251, Santa Ana, California 92701. (Completion of the following, including countersignature, is required to make this endorsement effective.) Effective Policy # Issued to this endorsement form as a par[ of Named Insured Countersigned by _ Authorized Representative Tri-County Drywall & Interiors, Inc. August 11; 2008 City of Santa Ana The Depot a[ Santa Ana 1000 East Santa Ana Blvd. Santa Ana, California 92701 Ref: Labor Rates (Full Burdened) Trade: Straight Time Overtime Doable CarpenterJoumeyman $46.40 $62.64 $77,27 Carpenter Foreman $48.40 $65.34 $88.21 Carpenter Superintendent $65.00 $87.75 $118.46 Laborer $36.00 $48.60 $65.61 Acoustical Journeyman $46.40 $62.64 $77.27 Acoustical Foreman $48.40 $65.34 $gg,21 Acoustical Superintendent $65.00 $87.75 $118.46 Drywall Journeyman $46.40 $62.64 $77.27 Drywall Foreman $48.40 $65.34 $gg,21 Drywall Superintendent $65.00 $87.75 $118.46 Cabinet Maker $51.20 $69.12 $93.31 Project Manager $75.00 $101.25 $136.69 Administration $38.25 $51.64 $69.71 Painting Journeyman $46.70 $63.05 $85.12 Painting Foreman $49.50 $66.83 $90.22 Concrete Journeyman $48.00 $64.80 $g7,4g Concrete Finisher $46.00 $62.10 $83.84 Tile Setter $49.60 $66.96 $90.40 Sub Contractor Mark Up (Cost Pl us) I S% Material Mark-Up (Cost Plus) 10% Equipment mark-up (Cost Plus) 10% Regular Hours: 6:00 a.m. to 2:30 p.m. Monday thm Friday. Overtime: 3:00 p.m. to 12:00 Weekdays. 6:00 a.m. to 6:00 p.m. Saturday Double Time: 12:00 a.m. to 6:00 a.m. Weekdays. Afrer 6:00 p.m. Saturday. Sunday's and Holidays. Thanks, Daniel R. Rosa 1592 N. Batavia, Orange, California 92867 714/864-7243 Fax 714/455-7766 ACORD~ CERTIFICATE OF LIABILITY INSURANCE ~ DAT~~~ Y71 MOOUCiR anonr. 171~79TY,es6 fY Ir1a7 YI'JM„ TNIi CG7RICA7E IS 1]]UED /1S A WTTER OP wPORWTON p.aC01NSURANCE, INC. ONLY AND CONF9Ra No RwNTa i1PaN rNE cuTIFICATE 1901 N. 6!IANi STRE£T NOLOER. lip CERTIFlCATE DO9A ND7 AMEND, EXTEiD OR SANTA ANA CA 9270h2779 R TN! C AFF 6Y THEP RELO91. 9 LICAt~ 03097x7 INSURERS AFFORDING COVERAGE ~ NAIC 9 _ .- .-_._ _ _~~. .. - ..._... INSiiwr~a • 6DL.DEN EAGLE INS. CORP. i wsuRED ...__._. _ __ _ TRbCOUNTY DRYWALL ANO INTERIORS, WC INNSURER a: 1692 N. BATAVIA. SUITET .. ... _._._.... ..._.._..._. _... .._ ._ _.~__._.___..,,... ORANGE CA 92967 wSURER C' _ _. .. ._-_~._._. .___. ~ I INSURER D IUWIRER E: i/re POLICIlB OP IN6UARNOE LIETEO 9ELOW NAVE lllN 198YED 70 M MSYREO NALKD A90YE POR THE POUCY PERRJD NOR:ATW, NOTTYFJNirANOwY TlRIA aA CONO1110N OF 1WT [d{TRACT OR OTHER OOCVMENT N1TN pESPECi 70TM9CN TMIf ClRrwGTE YAY aE NIRIlD OR ANT P901MlMTVJT , THE INRIRANCE AFCDR0E0 8'f TIK POLICIlS DESCRIBED 11NIEB1 re SY9JECT TO AU THE TERYS. E%CLU&Oali ANO CONDIRONS Do SUCH 'M1Y -ERTAN . ML6II:IES PN:,:AlWTF LIM,T~ ~NOVM MAY IIAYL DEEn RECYCBD rY PAq CLAMIi wM +OCY TryE Oi NISURAIKE POLICY NYWER YRI~YtGf(tsM i Pw[Y E1tIELLROM I-~. LIMITS LYP aNA L uAnIYTY CBRa24/97S 0m2N07 O2l21M9 a~.....wE 1.009, _ . XICQNM9RCIAL OtNERAL LMBILt[Yi PMRaaiL bNrlllD f SO,000 I _...., I I, , CIwM6 MADELJ(, OCCUR ~ Mvn.E1 f,.. _. . _.,-, _ „__ _ 1y000 _-.. A •..•• I Mt1glRNl411NlINJYRY P .__. I ~ T,DOD,BDD r_. ..._.___ i g~ DENERAL AGOREDATE Is x,000,000 T(1~ GENL AGORECATl LANT APPLIES PER: i~ PRODUCT6{ONPI0P AG4 ~f ._.._ _ 1000,000. ;P000YI ,J6Ci BLOC ~_ ~ I 'MITOYOMLE tlA9LITY aO$ K P '. Ow ~ ANY AUTO !S1``~l / COMBWE6 Mxft.E WAR , IlEa a!twwJ Y ~~n y GG S~ ,~ ...._ y ,ALL Ow,aD AYTOS P 4• Ptiw' : ___.-.- ._. 90gLY NJ{RY ~, ~ __....... ._._ . 1 G+~ / j `'1 ~ PErOVSm) `S ~ ~~ ' 6CNEDULEO MITOS PSSIS I ___ _ __ __~ NREO AUT09 ~ ! 900NY INAIRY I NDN-wJNED AUTOS I (Pa amwrl ..._._. ___. , ~ ~_..__...... _. .._...... PROPERTY DAMAGE li ~ i I IPBf awar.ro cauGluaelLiTr ~ 44u,~roDNL7: ERUenENr B % - WYAYTO I OTNER THAN ~ _ AUTOONLY' ACC If _. L`AI.L•SR/YMBPR4LYNlM1RY ~~ tACN OCCUPPENCE S -_- -~ --_ ~ OCCUR ICUIMf MADE _.~ ..... AGGNIGATE i ... _.__ i-' pBWCTbL! ~ _s i i RETENrgN S i _. 1 'i WORNINi IAMPFN4A7NW AND ~ NC PYA , 6T1~11 F tORYLYBYA , iEMPLOYtRS'LYMLRY _ ... E.L. EACNACCIDFN S WYPRGMNTOMWIYlNEE[W1N4 ~ ~~.__ '111FISEA'MEN9lB D14110E01 i E40159ASEdA tMPLOYEE Ii ~VFLML dYNrN Wv ~ I i EL.ONENBd000VLY1T~f O NER: ! 3 DESCRIPTION OF OPERATIONSILOCATION9NENICL.E3IEXCLkISIONS ADDED $Y ENDORSEMENT/ SPECIAL AROViSiONS SEE 5UPPLEMENTAL CERTIFICATE WFORMATION CiRTiFICATE a1LILDER L.AMC:ELLJ•TO]N CITY OF BANTA ANA SNOVLO ANY OP 7NE A90YE OESCRreEO POLY;IES BE fJVICEUFD BEFORE 7NE E DEPOT AT SANTA ANA T ~T~ DATE TN9P000• Tw IssuuaD NsURER uvLL MIIL •w wrs YJRITTEN H INTN:E TO THE CNITPICATE MOlOER NAMED TQ THE KFT. lOW t SAN I A ANA BLVD aTE 109 SANTA ANA CA 91701-3900 NpR@ORlP w ~~ / ~ / AtcantlOn: ~ - OOr/5 ACORD 26 (2001N91 CMNICAtt • 35053 07 ACORD CORPORATION 18aa 49dhi 9 5 '~ey~ amii oanlaaa~ POLICY NUMBER; CBP824f272 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGB$ THE POLICY. PLEASE READ THIS i:AKEFULLY ADDITIONAL INSURED PRIMARY COVERAGE This endorsement modifies insurance provided under the fallowing: COMMERCfAL GENERAL LIABILITY COVERAGE PART 7hi~ insurance 1c prlmary Iw the parson or organization shown in fhe schsdule, but only with respell to liability arising out of your work or that insured by or for you. Other insurance afforded to that Insured will apply as excess and not COlitribute as prlmary so the inSUranCa afforded by this endorsement. All other endorssmen! provisions, conditions and exclusions of this insurance shall remain unchanged and apply to the additional insured and described below. SGHEDULE ADDITIONAL INSURED CONTRACTlPF~ JO ECT CITY OF SANTA ANA THE DEPOT AT SANTA ANA 1000 E. SANTAANA BLVD STE 108 SANTA ANA CA 92701-3900 NAMED INSURED 7RI-COUNTY UKYVVHLL AND INTERIORS, 1NC 1592 N. BATAVIA, SUITE 2 ORANGE CA 92867 'i'0 ~~ A1?Yg~~~ Aa G1SA~ CS~OA~soeY pssls~ ~~ `~ Cenficete VI 36053 CeRificate ~ 36053 . .. .., - VJdtl~~ ,6 ,eW a~li"'il''~"an~~~ag ~3 r.t ~DtbT1TONAL a15L-aF17 c ~ FORS r mar Y7~x~raryYOLTCY Golden Eagle Insurance Company 'ibis t rnodiflCS aucte iasutanee as is afforded by ~e ptov»ioa: of Policy # CBP8241272 tY1~g m, the fallowipg t. The Ciryof,Satrta ~. ZO Civic Ceoner Plana, Strata Ana, Caiifoeale~ 92701; ita officers, employees, agents, vot~ugtsas and nepttvas aae named as additional ineoted C'additinnal innmed") with regard to lie6ility and ds8mse of earls ari~aing Trom cne opdxnons ana ~ by ar on behalf of the ttt~cdmsutdd. 2. With respect to claims arising out of the behal£of ffie Damned ~r'ed, snit ~ e.nnn ,. ae iC Al~.vd uses parfem~cd by Drop d. With rerj-act to f~ additlamisl in5ttred, dus insnrence abali not be trdppetied, ar ~ mebetially reduced in coverage or 1ia~ esoapt aiEar thirty (303 days wripee antics has been given to the City of Santa Ana, 20 Citvic Canter Piaztl, Septa Ana. Cali~ia 92701. (CemP]etion of the fbtlo~ving; iucltaiiap ootmotersignanu+r, iS r+puired to make thin eaadorseoeeut r~ctive~.) EtTiective 3/9/07 pia ~Ot~Ortaent farad a3 apart of Policy# P8241272 Issued t0 Tsi ~rnmt3r 1)r~ural7 a Tnta=j,nrs Tnr 2~iamrd T+~vur.~t Cotmt~od by _~ ;~ ~~ Au~rned l~eprc5eatative +M ~QM EQ A~pgo~~~ 5p ~ ~~oy. ~ C ~ `~~ keceived Time Mar & 9;16AM 3. Tfiis iuasltxanee applies aepa~ly to each insured whom claim ia:asdts or 5tllt is biongbt eXCapt with reapea toSbls cor~auy's limits of tiebiNey. The inclut3aa ofany pecaon or asgdnrcation as sn iusme~ absll let sffoat any right which such peason ar orsanizatipn would have as a claimant if aot eo iaolgded, ~eb .P.OS 03:55p Tllagl IV - ;;LOO&- -lot CERTHOLDER COpy STATE COMPENSATION INSURANCE FUND P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 02-19-2009 GROUP: 000236 POXY NUMBER: 0006262-2006 CERTIFICATE ID: 130 CERTIFICATE EXPIRES: 01-01-2010 01-01-2009/01-01-2010 THE CITY OF SANTA ANA 20 CIVIC CENTER PLZ M-26 SANTA ANA CA 92701-4066 SG ~OB:TC9-003 BABY CHANGER INSTALLATION 1000 EAST SANTA ANA BLVD. SANTA ANA CA 92701 Thlss to certify that we have issued a valid Workers' Compensation insurance policy in .a form Clpproved by the C.ilifornia I"su,'i.lnce Commissioner 10 the employer named below for the policy period indicated. This policy is no~ subject to cancellation by the Furd except upon SO days ad....ance wr'tten notice to the employer, We will <Iiso give you ::10 d.RYS .dv..nce notjc~ should this policy be cancelleo prior to its norm::.! e"'pir.ation. This certif,cate of insurance '5 not an Insurance policy and does not amend, extend or alter the coverage affOlded by the policy listed he'ein. Notwithstanding any requirement term or condition of any contract or other document with resDect to which this certificate of Insurance may be issued or to which it may pertain, the Insur.ance afforded by the policy described 1erein is subject to all the terms, exclusions, and conditions, of such policy. d::"EPRESENTATI ~E~ EMPLOYER'S LIABILITY LIMIT INCLUDING OEFENSE COSTS: $1,000,000 PER OCCURRENCE, ENDORSEMENT #001S ENTITLED ADDITIDNAL INSURED EMPLOYER EFFECTIVE 2009-02-19 IS ATTACHED TO ANO FORMS A PART OF THIS POLICY. NAME OF ADDITIONAL INSURED: THE CITY OF SANTA ANA ENDORSEMENT #1600 - PICHON, BERNARD W P,S T EXCLUDED. ENDORSEMENT #1600 - BARRON, FELIPE VICEPRES EXCLUDED. ENDORSEMENT #2065 ENTITLEO CERTI~ICATE HOLDERS' NOTICE EFFECTIVE 01-0'-2009 IS ------ ATTACHED TO AND FORMS A PART OF THIS POLICY. - o fORM A.PPROVED AS T / ~/ - -.J -- / '~aura SUlt :,,,ecdy Assistant City Attorney EMPLOYER GAfF GROUP, INC AND/OR TRI-CDUNTY ORYWALL & INTERIORS INC. 660 S STATE COLLEGE BLVD FULLERTON CA 92891 [BtE.SPj PRINTED 02-19-2009 (REV.2-051 p.2 SG