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HomeMy WebLinkAboutEARTHEK INTERNATIONAL 1City of Santa Ana Clerk of the Council AGREEMENT TERMINATION G 100 � 7T rr, L J aid 9-' 3 Please complete this form when the attached agreement is no longer in effect. - Return form to the Clerk of the Council Office (M -30). Call 647 -6520 if you have any questions. = f The agreement with No. N -2009 -050 and final payment has been made. � 1Ma , was completed on /— 30 o� Department: r1/V14 -A}GA; Phone /Ext.: AWO Signature: Date: ~NaukriVCE ~N ~'~~ N-2009-050 ~"JO~;t v1n~' PROCEED UNTil. iiJSURANCE EXPIRES 3 -~6 -~ 0/d oArEK of couNCtt~ AGREEMENT ALLOWING INSTALLATION JUN - g quo ~: r%MsC~) ~F ENERGY SAVING TECHNOLOGY ON CITY PROPERTY Mario Glris:i THIS AGREEMENT ("Agreement") is made and entered into this 2na day of March, 2009 by and between EARTHTEK INTERNATIONAL ("EARTHTEK") and the CITY OF SANTA ANA, a charter city and municipal corporation organized and existing under the Constitution and laws of the State of California (the "City"), with respect to the following: RECITALS A. EARTHTEK desires to demonstrate an energy saving technology by installing it at the Newhope Library Learning Center, located at 122 North Newhope Street, Santa Ana, CA 92703. B. The City desires to accommodate EARTHTEK's desire to demonstrate the technology, at no cost to the City, by granting a right of entry and license to EARTHTEK upon certain terms and conditions. NOW THEREFORE, in consideration of the mutual and respective promises, and subject to the terms and conditions hereinafter set forth, the parties agree as follows: 1. Right of Entry and License. a. Provided that all of the terms and conditions of this Agreement are fully satisfied, the City hereby grants to EAR TEK, its employees, agents and contractors the nonexclusive right to enter upon the property ocated at 122 North Newhope Street, in the City of Santa Ana, County of Orange, commonly own as the Newhope Library Learning Center ("the Property") and hereby grants to EARTHY K a license for the following: Purpose: Install EART TEK's Kilowatt Buster on the existing electrical wiring, to channel and direct the fl w of the electrical current, thereby reducing the amount of energy used to power th Property. The Kilowatt Buster wil be installed for three months (the "demonstration period"), during which the City w 1 receive the benefit of any energy savings, without charge or obligation. Installation ill be complete on June 15, 2009. City will be invited to th~ final wrap party, at which the energy saving results of the program are announced. r~ If City desires to purcha the Kilowatt Buster, or any other product manufactured by EARTHTEK, City shall e granted a 25% discount on such purchase for use at any City owned property. EARTHTEK shall utiliz a licensed electrician to install the Kilowatt Buster and to repair and restore the electrical system during the term of this License. e At the completion of the demonstration period, EARTHTEK shall remove the Kilowatt Buster and restore the electrical system to the condition it existed prior to the installation of said Kilowatt Buster. This License and Right of Entry shall commence on execution of this Agreement and shall expire September 30, 2009, unless extended by written agreement between the undersigned and the City. The term of this Agreement may be extended at the sole and absolute discretion of the Executive Director of the Finance and Management Services Agency and the City Attorney, or their designees. b. It is expressly understood that this Agreement does not in any way grant or convey any rights of possession, easement or other interest in the Property and/or fixtures and/or personal property affixed to said Property to EARTHTEK. It is further expressly understood that EARTHTEK shall be accompanied by the City's Property Maintenance Supervisor while on site at said Property. 2. City Obligations City shall provide to EARTHTEK, utility bills for the Property for the period from June - September 2008 and June -September 2009. City shall inform EARTHTEK of any changes in the use of the Property during the past one year period. City certifies that the Property is separately metered, is not currently using power conditioners and has not undergone material improvements, such as installing A/C within the last year. 3. Agreement. By execution of this Agreement, EARTHTEK agrees for itself and on the behalf of its employees, agents, consultants and contractors as follows: (a) EARTHTEK warrants that the Kilowatt Buster directs the electrical current without producing thermal energy, and will not damage, in any manner, the electrical system of the Property. (b) EARTHTEK warrants that it will not permit any dangerous condition to be created on the Property. (c) All work done by EARTHTEK on the Property will be done in a careful and reasonable manner by a licensed electrician, in accordance with all federal, state and local laws. (d) EARTHTEK shall enter the Property to install and monitor the Kilowatt Buster entirely at its own cost, risk and expense. (e) The rights herein granted to EARTHTEK, are exclusive, and EARTHTEK may not assign, transfer, delegate or subcontract any interest herein without the prior expressed written approval of the undersigned. (f) Prior to undertaking performance of work under this Agreement, EARTHTEK shall maintain and shall require its subcontractors, if any, to obtain and maintain insurance as described below: i. Commercial General Liability Insurance. EARTHTEK shall maintain commercial general liability insurance naming the City, its respective officers, employees, agents, volunteers and. representatives as additional insureds) and shall include, but not be limited to protection against claims arising from bodily and persona] injury, including death resulting therefrom and damage to property, including the Newhope Library and Learning Center, resulting from any act or occurrence arising out of EARTHTEK's operations in the performance of this Agreement, including, without limitation, acts involving vehicles. The amounts of insurance shall be not less than the following: single limit coverage applying to bodily and personal injury, including death resulting therefrom, and property damage, in the total amount of $1,000,000 per occurrence. EARTHTEK shall supply City with a fully executed additional insured endorsement in substantially the form attached hereto as Exhibit A upon execution of this Agreement and shall be approved in form by the City Attorney. ii. Worker's Compensation Insurance. In accordance with the provisions of Section 3300 of the Labor Code, if EARTHTEK has any employees, it is required to be insured against liability for worker's compensation or to undertake self insurance. Prior to commencing the performance of the work under this Agreement, EARTHTEK agrees to obtain and maintain any employer's liability insurance with limits not less than $1,000,000 per accident. iii. The following requirements apply to the insurance to be provided by EARTHTEK pursuant to this section: EARTHTEK shall maintain all insurance required above in full force and effect for the entire period covered by this Agreement. Certificates of insurance shall be furnished to the City upon execution of this Agreement and shall be approved in form by the City Attorney. 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. iv. If EARTHTEK fails or refuses to produce or maintain the insurance required by this section or fails or refuses to furnish the City with required proof that insurance leas been procured and is in force and paid for, the City shall have the right, at its election, to forthwith terminate this Agreement. (g) EARTHTEK shall not permit any mechanics', materialmen's or other liens of any kind or nature ("Liens") to be filed or enforced against the Property in connection with the installation, monitoring or removal of the Kilowatt Buster. EARTHTEK shall indemnify, defend and hold harmless City from all liability for any and all liens, claims and demands, together with costs of defense and. reasonable attorneys' fees, arising from any Liens. City reserves the right, at any time and from time to time, to post and maintain on the Property or any portion thereof, or on the improvements on the Property, any notices of non-responsibility or other notice as may be desirable to protect City against liability. In addition to, and not as a limitation of City's other rights and remedies under this Agreement, should EARTHTEK fail, within ten (10) days of written request from City, either to discharge any Lien or to bond for any Lien, or to defend, indemnify, and hold harmless City from and against any loss, damage, injury, liability or claim arising out of a Lien, then City, ai its option, may elect to pay such Lien, or settle or discharge such Lien and any action or judgment related thereto and all costs, expenses and attorneys' fees incurred in doing so shall be paid to City, as applicable, by EARTHTEK upon written demand. (h) EARTHTEK shall not have any interest in the Property or be entitled to any reimbursement or repayment for any work performed upon the Property pursuant to this Agreement. (i) EARTHTEK shall take all necessary precautions to prevent the import and/or release into the environment of any hazardous materials, which are imported to, in, on or under the Property through the installation, removal or presence on the Property, of the Kilowatt Buster. If hazardous materials are imported onto the Property as a result of the Kilowatt Buster, EARTHTEK shall be solely responsible for removing such imported hazardous materials in conformance with all governmental requirements. EARTHTEK shall report to the City, as soon as possible after each incident, any unusual oi• potentially important incidents with respect to the environmental condition of the Property. 4. Indemnity. EARTHTEK hereby agrees to defend, indemnify and hold the City and their officers, officials, members, employees, agents and representatives, harmless from and against any and all loss, damage, injury, liability, claim, cost or expense (including, without limitation, reasonable attorneys' fees, expert witness fees, court costs, and expenses) arising from or attributable to the activities of EARTHTEK or any of its employees, agents, consultants or contractors upon the Property at 122 North Newhope Street, Santa Ana, CA 92703 pursuant to this Agreement. All use of and entry upon the Property shall be at the sole cost, risk and expense of EARTi-ITEK. 5. NotlCe. Any notice, tender, demand, delivery, or other communication pursuant to this Agreement shall be in writing and shall be deemed to be properly given if delivered in person or mailed by first class or certified mail, postage prepaid, or sent by telefacsimile or other telegraphic communication in the manner provided in this Section, to the following persons: To City: Executive Director of Finance and Management Services City of Santa Ana 20 Civic Center Plaza (M-21) P.O. Box 1988 Santa Ana, California 92702 Fax 714- 647-5421 Attn: Mario Ghizzi and City Attorney City of Santa Ana 20 Civic Center Plaza (M-29) P.O. Box 1988 Santa Ana, California 92702 Fax 714- 647-6515 To EARTHTEK: EARTHTEK INTERNATIONAL Fax 714-667-0174 , Attn: , •~y A party may change its address by giving notice in writing to the other party. Thereafter, any communication shall be addressed and transmitted to the new address. If sent by mail, communication shall be effective or deemed to have been given three (3) days after it has been deposited in the United States mail, duly registered or certified, with postage prepaid, and addressed as set forth above. If sent by telefacsimile, communication shall be effective or deemed to have been given twenty-four (24) hours after the time set forth on the transmission report issued by the transmitting facsimile machine, addressed as set forth above. For purposes of calculating these time frames, weekends, federal, state, County or City holidays shall be excluded. 6. EXCIUSIVIty and Amendment. This Agreement represents the complete and exclusive statement between the City and EARTHTEK, 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 EARTHTEK. The parties agree that any terms or conditions of any purchase order or other instrument that are inconsistent with, or in addition to, the terms and conditions hereof, shall not bind or obligate EARTHTEK nor the City. Each party to this Agreement acknowledges that no representations, inducements, promises or agreements, orally or otherwise, have been made by any party, or anyone acting on behalf of any party, which are not embodied herein. 7. Terminatl0n. This Agreement may be terminated by either party upon thirty (30) days written notice of termination. In such event, EARTHTEK shall remove its Kilowatt Buster and restore the Property to the condition it was prior to the commencement of this Agreement. 8. Miscellaneous. (a) Choice of Law. This Agreement is to be governed by, and construed in accordance with, the laws of the State of California. (b) Remedies. Either party shall, in addition to all other rights provided herein or as may be provided by law, be entitled to the remedies of specific performance and injunction to enforce its rights hereunder, except to the extent expressly provided to the contrary in this Agreement. All rights and remedies under this Agreement are cumulative and no one of them shall be exclusive of any other, and each party shall have the right to pursue any one or all of such rights and remedies or any other remedy which may be provided by law, whether or not stated in this Agreement, except to the extent expressly provided to the contrary in this Agreement. (c) Counterparts. This Agreement may be executed in two (2) or more cow~terparts, each of which shall be deemed an original but all of which together shall constitute one and the same instrument. (d) Non-Liability of Public Officials. No officer, employee, member, agent or rep-•esentative of the City shall be personally liable to EARTHTEK, or any successor in interest, in the event of any default or breach by the City, or for any amount which may become due to EARTHTEK or its successor, or for any breach of any obligation of the terms of this Agreement. IN WITNESS WHEREOF, the parties hereto have entered into this Agreement as of the date first set forth above. CITY OF SANTA ANA PATRICIA E. HEAD Clerk of the Council DAV[D N. R M City Manager APPROVED AS TO FORM: JOSEPH W. FLETCHER City Attorney ~_. Laura Sheedy Assistant City Attorney APPROVED AS TO CONTENT: FRANCISCO GUTIERREZ Executive Director- FMSA THTEK INTERNATIONAL (N,~,PGt E) (Title) /, ~,~ S rCC~ EXHIBIT A ADDITIONAL INSURED ENDORSEMENT FOR COMMERCIAL GENERAL LIABILITY POLICY Insurance Company This endorsement modifies such insurance as is afforded by the provisions of Policy # relating to the following: 1. The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701; its officers, employees, agents, volunteers and representatives are named as additional insureds ("additional insureds") with regard to liability and defense of suits arising from the operations and uses performed by or on behalf of the named insured. 2. With respect to claims arising out of the operations and uses performed by or on behalf of the named insured, such insurance as is afforded by this policy is primary and is not additional to or contributing with any other insurance carried by or for the benefit 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 or organization as an insured shall not affect any right which such person or organization would have as a claimant if not so included. 4. With respect to the additional insureds, this insurance shall not be cancelled, or materially reduced in coverage or limits except after thirty (30) days written notice has been given to the City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701. (Completion of the following, including countersignature, is required to make this endorsement effective.) Effective Policy # . Issued to this endorsement form as a part of Named Insured Countersigned by Authorized Representative ~ N R.L.. ACORD~, CERTIFICATE ~F ' "°"J •• ~1Y 1676.7.77 LIABILITY INSURANCE °'~B PRDDNCER Bart J. DeLio Iasoraace Lacy ~ni~t~0i THIS CERTIFICATE IS SUED AS A BiFlTTER OF BIFORIIMTION 5055 E N~t1eS Plaza Ste 110 ONLY MID CONFERS NO RIGHTS UPON THE CERIFICKTE Loag Beat Ca 90003 HOLDER. THIS CERTIFICATE DOES NO7 MIEND EXTEND ~! ALTER THE COME RAGE AFFORDED BY THE POljCES BELOW . (862)433-8300 N-2009-050 01SURERS AFFORDNG COVERAGE INNYRBD Earthtek Iateraational Corp INBURERA: Cagitoi Iauin/nity Corporaetioa Mr. George Dewberry INSURER N: P.O. Baa[ 40259 DISURERC: LOS kill~lZeS 1 INSURER D: NIF3URER E: CO1JERlt~s ruc nn, . ANY REQUIREIdIENT, TERRA OR CONDRiON OFANY CONTRACT OR OTHER DOCUMEM' 1d/~ITH RESPECT TO WHCHTHIS GERTIFlCATEMAYBE IST SUED OR~I~ MAY PERTAIN, THE INS URANCE AFFORDED B YTHE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THETERMS, EXCLUSIONS AND CONDTi~NS OF SUCH POIIC~S. AGOREOATE LMITS S HOYUN MAY HAVE B EEN REDUCED BY PAID CLAMS. INNR TYPE OPINNNRkNC@ POlIOY NNOBER POKY BFRBCTIYE POLICY ER gRAigN tNIflTN ONTIiRAt IIANItITY Q1ICN000URRENCE S 1 N0 000 COAIIAERCMLOENERALLPMILTTY cLAUU ~ BROi2925',f9 3!26!2009 3/26f2010 PNiEDAMAiOE Nyore ; ]081000 SUAOE occuR IdeD EXP oK aot ; 5 000 /ERSONALiADYIlUURY 1 N0 000 ' OEN7 AGOR GENERALA[i0RE0AT E ; 2 000 006 . BGATEliA1RAPPtR~ PEIC P PRODUCTS-COIRPAPAGO ; 2 000 OOO POLICY LOC kYT Op0916 t1ABIUT Y pINYA~O ~~~,SIK3LELINiR i RlL OUWIED AU10S 6CNEDULED AUTOS ~D~~ INiY --- s HRED AUW9 ION-0Y~RIEDAU709 ~~Il~ C~P~ Y ; ~t~10efNpA1MGE i okRkoE ukBlurv AUTO ONLY-EAACCIDENT i ANY AUTO O'THERTMP,~1 Ea ACC ; AUlO 0 NLY: ACC ; iR00^ UApl1T T ~ f~acNOOCURRENCE ; OOCUR CLARASUADE AOGR~iATE ; __'- DEDUGTNLE _--_.-... IR T APPR VED AS O FORM ; . ENTIDN ; s YPO RK EAN OONI PEN NAT ION AN D NY PIOYERB' t1ABItIT Y e.l. ~CNACCweNr ~ Tiur~ s tt ~ eay, EA. DISEASE_ EA EMPLOYEE --- ; OTNBR S18t8IIt its ~ torney E.L DISEASE-~LCYLMITT' ; 0 BNO A PR 10 M O P OPBRAT 10 M NJt OCAT 10 NNYBNIOI NN)IERCt Y N10 N N k0 DED BY EN DO R NQAEIIT 1N PEO)kt PROUI p0 NN CERT~ICATE HOB nFQ ..,....___.._-•-_-- -__._-- -_--_-- _ ___- City of Santa Ana 20 Civic Center Plaza Santa 7bU31 CA 9201 /NONt D AY T OF TY E ABOVE DENCRIBED PO1101E/ 6E OAMOEtI EO BETORE TY 6 ENgib0.TlpN DATETN®IBD1; TNEINNpNO1NNNRBRYNII ENDBAVORTO NWl1O DAMN YYINTTBN NOTICE TO T NE CERTIFICATE MOLDER NAINED TO iME LEFT, BYT PJ/tYRE TO DO NO NNALL NNPON6 NO OBlgAT10N OR LIANIIITY OF ANY HIND NPON iNEI#NNRpI, ITN ADENTN OR REPR EN ENT ATIVEN. AYT NO RI:.E D R EPREN EYT AT IVE Deli o Bart J. DeLio ~-~"~"'•- ~~= Capitol Indemnity Corporation P.O. Box 5900 Madison, WI 53705 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AMENDMENT OF OTHER INSURANCE CONDITON PRIMARY ADDITIONAL INSURED This endorsement modifies insurance under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Additional Insured: CITY OF SANTA ANA Designation of Premises: 20 CIVIC CENTER PLZ, SANTA ANA CA 92701 (If no entry apppears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement. The following is added to Section N -Commercial General Liability Condition Paragraph 4. Other Insurance, a. Primary Insurance: This provision applies to the Additional Insured schedule above but only in the event of the named insured's sole negligence. CGL 344 {01-06) Page 1 of 1 Copyright, Capitol Indemnity Corporation, 2006 POLICY NUMBER: BR01292559 COMMERCIAL GENERAL LIABILITY CG 2010 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS -SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Or anization s : Locations Of Covered O erations See Attached Additional Interest Schedule CGE 067 Information re uired to com lete this Schedule if not shown above will be shown in the Declarations. A. Section II -Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the pertormance of your ongoing operations for the additional insureds) at the location(s) desig- nated above. B. With respect to the insurance afforded to these additional insureds, the following additional exclu- sions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equip- ment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be pertormed by or on behalf of the additional insureds) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its in- tended use by any person or organization other than another contractor or subcontractor engaged in pertorming operations fora princi- pal as a part of the same project. CG 2010 07 04 ®ISO Properties, Inc., 2004 Page 1 of 1 p Capitol Specialty Insurance Corp P.O. Box 5900 Madison, WI 53705 COMMERCIAL GENERAL LIABILITY COVERAGE PART FORM SCHEDULE POLICY NUMBER POLICY PERIOD AGENCY BR01292559 03/26/2009 03/26/2010 04608 NAMED INSURED AND ADDRESS AGENT EARTHTECK IN'I.'ERNATIOusr• CORP PO Box 48259 BASS UNDERWRITERS INC Los Angeles, CA 90048-0259 (Los Aaqeles CTY) Forms and Endorsements applying to this Coverage Part and made a part of this policy at time of issue: FORM3 APPLICABLE TO ALL PREt~3E3 ArID COVERAC}ES Form Edition Description CICL 042 0708 Cameral Liability Declarations CICL 043 0608 C~eaeral Liability Schedule CC3 03 00 0196 Deductible Liability 2asuraace CCa 20 10 0704 Addl Ins-Owners, Lessees or Contractors - Scheduled CC~L 344 0106 Amendment of Other 2asurance Coad Primary Add'1 Ias Ca 00 O1 1207 Co~mmnercial Cleaeral Liability Coverage Form Ca 21 50 0989 Amendment of Liquor Liability Exclusion Ca 21 60 0998 Excl-Year 2000 Computer-Related and Other Elect Prob Ca 21 70 0108 Cap on Losses frown Certified Acts of Terrorism Ca 21 76 0108 Excl of Punitive Damages Certified Acts of Terrorism CC3L 288 0803 Amendment - Contractual Liability CCU 292 0306 Co®biaatioa Endorsement 1 CC3L 322 0404 Limitation Classification CICL 044 (10-93) Insured Copy Capitol Specialty Insurance Corp P.O. Bax 5900, Madison, WI 53705 COMMERCIAL GENERAL LIABILITY SCHEDULE POLICY NUMBER POLICY PERIOD AGENCY BR01292559 03/26/2009 03/26/2010 04608 12:01 A.M. Standard Time at the address of the insured stated herein NAMED INSURED AND ADDRESS AGENT EARTHTECK INTERNATIONAL CORD PO Box 48259 Los Angeles, CA 90048-0259 (Los Angeles CTY) BASS UNDERAltiTERS INC 20350 VENTURA BLVD, SUITE 120 Aoodland Hls, CA 91364 EFFECTIVE DATE OF CHANGE: o3/2s/loos - o3/2s/2olo 12:01 A.M. Standard Time at the address of the insured stated herein Cade Premium Rate Classification No. Basis Pr/Co Other ELECTRICAL PART/ACCESS MEG-NOC 52438 10,000 156.800 3.120 GROSS SALES ADDITIONAL INSURED FLAT RATE ADD'L TO NEET POLICY MININ[7M 49950 1 Advance Premium Pr/Co Other 1,568 31 Total Advance Premium DATE- 04/21/2009 Amendment CICL 043 (06-08) 1,568 100 3,301 3,432 sjv o9/oi/loos cA Insured Copy Capitol Specialty Insurance Corp P.O. Box 5900, Madison, WI 53705 COMMERCIAL GENERAL LIABILITY COVERAGE PART DECLARATIONS RENEWAL OF NUMBER: New POLICY NUMBER POLICY PERIOD AGENCY BR01292559 03/26/2009 03/26/2010 04608 12:01 A.M. Standard Time at the address of the insured stated herein NAMED INSURED AND ADDRESS AGENT EARTHTECK INTERNATIONAL CORP BASS UNDERWRITERS INC PO Box 48259 20350 VENTURA BLVD, SUITE 120 Los Angeles, CA 90048-0259 Woodland Hls, CA 91364 (Los Angeles CTY) General Aggregate Limit $i, ooo ooo (Other Than Products-Completed Operations) , Products-Completed Operations Aggregate Limit $1, ooo, ooo Personal and Advertising Injury Limit $i, ooo, ooo Each Occurrence Limit $i, ooo ooo Damage To Premises Rented To You Limit , $ loo, ooo Any One Medical Expense Limit $ s, ooo Fire Any One Person BUSINESS DESCRIPTION AND LOCATION OF PREMISES Form of Business: CORPORATION Business Description: AMRKET/SALES OF EBERGY SAVING DEVICE Location of All Premises You Own, Rent or Occupy: SEE ATTACHED LOCATION SCHEDULE, FORM # CICG 176 PREMIUM Code Premium Rate Advance Premium Classification No. Basis Pr/Co Other Pr/Co Other SEE ATTACHED COMMERCIAL GENERAL LIABILITY SCHEDULE #CICL 043 Total Advance Premium $ 5, o4s * THE LIABILITY PREMIUM BASIS OF THIS POLICY IS SUBJECT TO AN AUDIT. ADDITIONAL PREMIUM MAY BE DUE. FORMS AND ENDORSEMENTS: SEE COMMERCIAL GENERAL LIABILITY COVERAGE PART FORM SCHEDULE #CICL 044 COUNTERSIGNED 04/21/2009 gy Authorized Representative CICL 042 (07-08) Insured Copy Capitol specialty Insurance Corp P.O: Box 5900, Madison, WI 53705 POLICY CHANGE ENDORSEMENT POLICY NUMBER POLICY PERIOD AGENCY BR01292559 03/26/2009 03/26/2010 04608 12:01 A.M. Standard Time at the address of the insured stated herein NAMED INSURED AND ADDRESS AGENT EARTHTECK II~1'PERNATIONAL CORD BASS UNDERWRITERS INC PO Sox 48259 20350 VENTURA BLVD, SUITE 120 Los Aaqeles, CA 90048-0259 Woodlaad Hls, CA 91364 {Los Aaqeles CTYy CHANGE # 1 EFFECTIVE DATE OF CHANGE: 03/26/2009 Annual Additional Premium Annual Retum Premium 1.0000 Additional Premium Due Retum Premium Due Pro Rate Factor Short Rate Factor X Annual No Change In Premium BELOW IS A DESCRIPTION OF THE CHANGES: ADDED ADDITIONAL INSVRLrD THIS CHANGE ENDORSEMENT WILL NOT BE USED TO AMEND POLICY CONDITIONS. Authorized Representative Date Issued 04/21/2009 siv CICG 349-PCE (06-08) Capitol Specialty Insurance Corp P.O. Box 5900, Madison, WI 53705 POLICY COVERAGE PART FORM SCHEDULE POLICY NUMBER POLICY PERIOD AGENCY BR01292559 03/26/2009 03/26/2010 04608 NAMED INSURED AND ADDRESS AGENT EARTHTECK INTERNATIONAL CORP PO Box 48259 BASS UNDERWRITERS INC Los Angeles, CA 90048-0259 (Los Angeles CTY) Forms and Endorsements applying to this Coverage Part and made a part of this policy at time of issue: FORMS APPLICABLE TO ALL PREMISES AND COVERAGES Form Edition Description CICG 174 0708 Common Policy Declarations CGE 064 0208 Notice -Offer of Terrorism Coverage CGE 112 0496 Important Notice! CGE 263 0307 Policyholder Audit Information CGE 067 0803 Additional Interest Schedule CICG 176 1093 Location Schedule CGE 126 1004 Amendment-Minimum Earned Premium CGE 071 0306 Service of Suit IL 00 17 1198 Common Policy Conditions IL 00 21 0498 Nuclear Energy Liability Exclusion Endorsement IL 09 85 0108 Disclosure Pursuant to Terrorism Risk Insurance Act BJP190 0306 Commercial Lines Policy Jacket CICG 179 (01-08) Insured Copy Capitol Specialty Insurance Corp P.O. Box 5900, Madison, WI 53705 LOCATIONS SCHEDULE POLICY NUMBER POLICY PERIOD AGENCY BR01292559 03/26/2009 03/26/2010 04608 NAMED INSURED AND ADDRESS AGENT EARTHTECK INTERNATIONAL CORP PO Box 48259 BASS UNDERWRITERS INC Los Angeles, CA 90048-0259 (Los Angeles CTY) Prems. No. Street City St. Zip 001 805 S Atlantic Blvd Apt 5 Alhambra CA 91803 Los Angeles CICG 176 (10-93} Insured Copy capitol Specialty Insurance Corp P.O. Box 5900, Madison, WI 53705 ADDITIONAL INTEREST SCHEDULE POLICY NUMBER POLICY PERIOD AGENCY BR01292559 03/26/2009 03/26/2010 04608 rvHm~u irvsuKtu AND ADDRE55 AGENT EARTHTECK INTERNATIONAL CORP PO Box 48259 BASS UNDERWRITERS INC Los Angeles, CA 90048-0259 (Los Angeles CTY) LIABILITY: Additional Insured CITY OF SANTA ANA 20 Civic Center Plz Santa Ana, CA 92701-4058 CG2010 - CA - Loc #1 -ADDITIONAL INSURED FLAT RATE -FULLY EARNED CGE 067 (08-03) Insured Copy WORKERS' COMPENSATION DECLARATION I G`~°~ ~ ~~~^~ ~`''~''`~ hereby affirm under penalty of perjury, the (NameJTitle) following declaration I certify on behalf of ~~~~i ~~ %~ ~'rNu~ oNUL that during the term of my rganization N e / ~ contract with the ~X°L ~i~~ o /~iJ~;~~.-e ~ ~wf '~, Ci y of Santa Ana, I will not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. DATE: ~~ ~ ~ % ~ V-~ c' ~ /ti TC-~L Nl~Tir~N~C ~I B y• Name: /' o r~ ~. ~ ~=+~ ' e V' V Title: ~ S i 1(,~~-N~ Telephone: ~L ~ ~ ~7~ ~ ~ 35~~~ WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.