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Home My WebLink AboutDIXIE DIESEL AND ELECTRIC INC. (2) -2008City of Santa Ana t Clerk of the Council AGREEMENT TERMINATION pq MAR 23 OM 8: 01 Please complete this form when the attached agreement is no longer in effect Return form to the Clerk of the Council office (M-30). CITY OF SAN"' ' AN � Call 647-6520 if you have any questions. CLER� OF G(1 LNC,i' - ---------------------- i The agreement with bxxx- DTESe-L £ ELEcT�2C3r/VC No. f f �� (I� core, was completed on and final payment has been made. 1 A•1ab$•7.-17-ol CIA) A• zolp-lob C113) R..d 12-OT07 DELIVERED MAR 2 2 231E Department: jVl rj,. A -lit [1& IAA2:),jT• Phone/Ext.: x -500 Signature: Date: & ,2, / r. 2008-277-01 INSURANCE ON RILL GVORK MAY PROCEEC UNTIL INSURANCE _ViRF? 10 -A FIRST AMENDMENT TO AGREEMENT CLERK OF COUNCi- nATF --S:M _4?T THIS FIRST AMENDMENT TO AGREEMENT is entered into on April 6, 2009, by and between DIXIE DIESEL & ELECTRIC, INC., a California corporation ("Contractor") and the N City of Santa Ana, a charter city and municipal corporation of the State of California ("City"). r??J RECITALS: d S A. The parties entered into that certain Agreement #A2008-277, dated October 6, 2008, (hereinafter "said Agreement") by which Contractor has provided generator maintenance and - repair in City facilities. C.1 B. Due to a clerical error, the term of said Agreement was incorrectly stated. C. In accordance with the terms and conditions of said Agreement, the parties wish to amend the Term to correctly state the agreement of the Parties. 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 First Amendment to Agreement, the parties agree as follows: 1. Section 2.a., COMPENSATION, shall be deleted in its entirety and replaced with the following: "City agrees to pay, and Contractor agrees to accept as total payment for its services, the rates and charges identified in Exhibit A. The total sum to be expended under this Agreement shall not exceed $40,000, annually, during the term of this Agreement." Section 3, TERM, shall be deleted in its entirety and replaced with the following: "This Agreement shall commence on the date first written above and terminate on September 30, 2010, unless terminated earlier in accordance with Section 12, below. The City may renew this Agreement for up to three additional one-year terms at the pricing set forth in Exhibit A." 3. Except as hereinabove amended, all terms and conditions of said Agreement shall remain in full force and effect. /// - IN WITNESS WHEREOF, the parties hereto have executed this First Amendment to Agreement on the date and year first written above. ATTE ?yPATRICIA E. H LY Clerk of the Council CITY OF SANTA ANA DAVID N. REAM City Manager APPROVED AS TO FORM: JOSEPH W.FLETCHER City Attorney By: Laura Sheedy Assistant City Attorney DIXIE DIESEL & ELECTRIC, INC. (NAME M L=•L tf'ff CAPr -rp*do (Title) C.o,ePokwa Sf cRc-Ti4Ay . ; -4 FROM :DIXIE DIESEL nn ELECTRIC FAX NO. :5626954800 Oct. 01 2008 02:32PM P2 AA ?Q? Policy Number. LMU33526 Ra?C4EZRRTIFIICCATE aF LIABILITY INSURANE uc? 1409 2. 22musand Oata suite A g1TId. 2hon+and Oaks, CA 91362 Phone: (805) 497-1290 Fox (805) 497-3970 D Dixie bieael i it aatria, Ine. . 11552 s. '~4ahinVt4,n Bjwd. Dnit z Mhittier, G 90606 Y^AND CONFERS Date Entered: 10/1/2001 DA'ie ArrDplYy?Yl •"° %-Iwvr-K^UE AFFORDED BY TFinu TEND OR E POI.?CIE8 BELOW. INSURERS AFFOMNG COVERAGE PISU. RAL k ulua7tre`"- - MBURER B,D'ise Znattsa?nq? ?? .--- - ?BURER` CRAO? InD17rAnLy NSURER E: _ T ANY HE REQUIREMENT, POLICIES EEIN I St1RM O LISTED BJ-LOW HAVE BEEN ISSUED II THE INSWREO MAMEp AaOVE FOR THE POLICY PERIOD IN UF ANY MAY PERTAIN,MHN$WRANC AFFORD LIO S OSC r'C DH WU E T WITH RR TO ALL THE TO OLICJE6 -AGGREGATE LIMITS SHOWN MA 0 y I BY HAVE THE BEEN REDUCED BY PAID CLAIMS, WIT WHICH THIS CERTIFICATE Tiaa I DING P Iy 8E ISSUED OR THE R - --- . TERMS, EXCLU91ONS AND CONDITIONS OF SUCH GENERAL LAALM COL""0& OPWRAL LwBILITY -- _ ..? cLA11A6 MADE E.J OCCUR 33526 LIEN L AQGREOATE UaNT' AAPLIE6 ftR: POLICY LOC !!vfoMOaltas LIADa M ANY AUTO ALL OWNED AUTOS 9CNEDULEDAUTO6 9419-52-77 HIRED AUTOS NON-MD &Me uwuge UaaLI7Y ANY AUTO ?LLA LMgILITY OCCUR C? CLAIMS MADE L*'OUCTwu-' RETENTION i Al OMPENaATM AND LtARILRY A M CUfIVE MMUMDEO? MCC+?LPaOv> allow OVER -" VCCURRENCE i 1, 000, 000 10/1/2008 10/1/2009 6F i50,oo0 MEDElfP(Anyaf+parson), 65,000 ,, aEReenut A ADV MuuRY a 1, 000 , 000 OFNERALAGC?REGATE i2,000,OOO rRwucTa - couN,Oa Aoa i 2 , DOO , 044 - 1/22/2008 + 1/22/2009 10/1/2008 1 10/1/200.9 CONFINED BWOLE UMM --- (E+roglary) S1,000, 000 ED par GIMLY.?I?NJURy -- ?> OILLYY CRY ' i IF r .AUTO ONLY. FA ACCIDENT ; OTHER THAN CAACC i - AUTO ONLY: - `- .-... - AOG i Sac 2ggyR_RM =5, )00,000 AAGREOATE _ -- 3 /11 r 'rt?11? ) 4L VDFNI 6 ._ - EA EtaPLOYEE : -OOIM I.... _ ..?. -- ----•-...-,.+.navE??TaE;? AY F.I?OIt?1Ea1L.NTlJ PRDyKIONE ft=1d "Y of the polieita be 1ea001.1,d Moro the expiration tail. (3) days t/tittea notaao to the certificate Folder a& tad on to thes'eof, the is the left, ru'?4 S' V412 City Of Santa An& 20 CtviC Cantor pj,a% 'on" Asa. CA. 9270.2 CORD 25/9A/Nxua SNG" ANY OP 7Taf AOM AWSOPUM POLCM R DATE TNMCW M i7R? CAAM'LLM "FORE 771! ?{pwa ?N NOT= TO 716 tUILL EMJWOR TO MAL3:O bays v4vr 7.N Co-p-TE MOUNIt NAWO M Tw LJEF7. our FALURE TO 00 BO SKALL. 7MUGArON M OF AMY MIIQ IIPpI '* -4 AQMM OR Iuptl usRp Parrtx 9o++Plus >;,,,,+,+,.ref??? I??ars ?A?++hs+o Ana-2oa?+7y 'FROM :DIXIE DIESEL nn ELECTRIC FAX NO. :5626954800 Oct. 01 2008 02:32PM P3 L AWMARK AMERICAN MURANCE COMPANY ThIS Endorsement Changes The Policy. Please Reed R CateWy. ADDITIONAL INSURED BLANKET - PRIMARY AND YOUR WORK This endorsement modMw kmrarm Wovkw under the kftMng: COMMERW L GENERAL LMI IW COVERME POW of Person or Ommkelton; nY Person ex Crg Lmdon to whom or bo which you am o*aled by Mw If a wrftban oon6•ad or by the lasuance or exit of a w ttlen pem p,10 rovlde insurance such as is afforded by lhls W ft- _- A. SG=ON If - WHO 18 AN INSURED Is amended to Include as an ae sl tneumd the person(s) or 00 on(e) shown In the SCHEDULE, but only woh respect No Iiao ty for 'bed ly kW, -Pmp" demW Or 'Pawmel and adveft ft injury` Caused, In whoa or In part, by: 1. Your acts or omissions or 2. The aeMs or omissions of Nxrse ading on ymw behalf; In the POOOM anoe of your ongoing operatlo K &WOr 'yoW WOW daf- d for the addiNonel irlsureet(s) des Wood d we included In the "fnodt+ets?:arrlpiated Mona hard. S. If you are reWked by a wrtaen =**d 11D provide Primary haurarm. this Policy shell be prime" and 3OGWIN IV - COMME.RCIAL. GENERA! L L40LITY CONI7fI "$. S. O#W tnsWWM dues not "My. but only wph respect to coverage Provided by We policy. City of Santa Ana, it's officers, agents, employees And volunteers as additional insured(s). This endora MMA e?fee" 1Ql01I2w farms parted PdkY MM11 r I..HAMIM issued to DDW DIESEL AND ELECTRIC. INC. by Larslmark American Insurenoe C4mparly Endorsement Nw PSG 150171207 Inow" oopyrow material of hleur+ano9 Servbee OF", Inc. 1e84 (Til)ls) W1111 its permission 10/0x/2009 20:33 a009 Y ?,`j"1 COI #2000 P.003/010 I -Policy Number. SCS0020638 Date Entered: 10/1/2009 C ERTIFICATE OF LIABILITY INSURANCE F °""'""°" VY) PRO-N= ER-My ' 10/1/2009 A011CY Y WIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 14139 H. T boa¦ Oaks Blvd. ONLY AND CONFI=RS NO RIGHTS UPON THE CERTIFICATE Snits A HOLOM THIS CEPTIF1CATIE GOES NOT AMEND EXTEND OIL Thousand O"s, , CA 91362 ALTER THE COVERAGE AFFORDED BY THE POLICIE$ BELOW. Phone: (805)497-1x90 F¦x: (805) 497-3970 INSURERS AFFORDWG COVERAGE NAIC 0 Riamb Di:io piss01 RUSCI=ra¦ INSURERA:SCOttsdWA In*=&r46 Cc?rul.Y NA"w rLt 315 INSURERS' 0 Maxaon Eln? CAA fd INSURER C: , INSURER D: INSU IRER E: COVERAGES THE POLICIES OF INSURANCE LIS BELOW HAVE MIEN MM D TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTMATHSTANDING ANY REQUIREMENT, TERM OR . OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CI_RTIFICKM MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE FORDED BY THE POLiOIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. FXCW610146 AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS S - MAY HAVE BEEN REDUCED BY PAID CLAIMS. IN POLL NUM OR POLIGI( agLrcr lo(P Tldl LIM" ??// ORNERALNJARLM EACHOCCUARENCE 31,000,000 A x COMIMERCUU.GENERAL UTY PREMISES (Ex o 150,000 MAIMS MADE OCCUR 90020638 10/1/2009 10/1/2010 MEDW bft $5,000 PERSONAL a AOV INJURY $1,000,000 . GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE UMIT APPL ES PER- PRODUCTS. COMPNDP AGG s2,000,000 RO W7LiCY P JErT LOC AIR OM0911.E LIAe1LRY sMB ? SpVGLELIMIT . ANYAUTO ? O (FA ALL OWNED AUTOS SCHEDULED AUTOS BOpILY WJURY (Par parson) i HIREDAUT09 NON-OWNED AUTOS BODILY fNJIIFNV (Par aooaw 3 PROPERTY DAMAGE GARA¦E UA¦LLnY AUTO ONLY - EA ACCIDENT 6 ANY AUTO OTHER THAN EA ACC i AUTO ONLY, AGG 6 A E> NI O UNINNELLA LIAMLITY EACH OMURRENCE $5,000,000 OCCUR a CLABA MADE 50062434 10/1/2009 10/1/2010 AGMEOATE 35, 000, 000 01 DEDUCTIBLE ?C T J F'^ OR "'• _ RETENTION i OV 6 WORIOIRS CgMPENSATON AND EAAFLOIIlRa' LJANLITY TORY TFF ANY PROPRIETOR,PARTNEA,PyaUrl OFF>L'BtlMFA 1BEEXaUDED7 YIN E1. EACH ACCIDENT I LPRQ NSbe10M L ura Stitit AL oI ey EL.DLgRASE-CAEMPLOYEE s E.L. DISEASE -POLICY LIMIT i OTHER SS t7 n '? DWRM rION OF GPERATxm I LGGATioN ! wmOcL[A / Exau japm Am= eY wffx2 llMENT I SFROM PRDwMNoN9 rV . N Qztilicalta holder to k o named a6 Additional, IA¦8T¦!d. CERTIFICATE HOLDER CANCE"TION atx or Santa Ana SHOULD ANY OF THE AaGYE COMM" POLKNE6 BE CAN ORF THE WIRATiON 20 Civic Center aga RATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR .._ 0 w wrurrEN NOTICE TO THE MRTWATE HOLDER NAreo To THE LEFT, RU LURE T(MO SO SMALL Santa Ana, Ch 927 1-4058 RIPOK NO OUSAT ON OR LIANUTY OF. ANY NRND 4PON THE INauwE rre AGENTS OR RVINIIIESENTAVAK AUTHO"' ATAI? ACOIW 25 (40091071 - ---- - ,: w TNr¦¦-suus AUVRW GORFORATION. All rights reserved. The ACORD name and logo we rwglstRred marks of ACORD Amd LWq Fame Roam Plus *ftwe. YVYIa %wow; knprown P161YOn0 W0.2W1877 10/04/2009 20:33 92000 P.006/010 INS[JRAI M CO ANY ENDORSEMENT NO. ATMOM TO AI0 WJM crFecrlYe DATE 9:01 A.Y.ffrMo m YMIAi) A1?D IMSNREA AGeilrN0. BCS0020638 10-01-2009 DDU DIESEL HUMAN RESOURCE MANAGEMENT CO 04786 ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. For coverage O Addit (CG,' X Addit X Add'id'e The insurance X Primal E3 Primal Q INSURED-OWNERS, LESSEES OR CONTRACTORS SPECIAL CONDITION wided in the following endorsements as indicated by an 'Vin the box below: al Insured--Owners, Lessees' Or Contractors--Schedulad Person Or Organization 10). ai In&ured-Owners, Lessees Or Contractors-Automatic Status When Required In ction Agreement With You (CG 20 33). al Insured--Owners, Lessees Or Contractors Completed Operations (CG 20 37). rovided is amended to be (Indicated by an "e in one box below): and noncontributory, ofSom Am ies OMNI% ADM%? MMIOYM APPROVED AS TO Fo't. s'i ura Sett ShL?d`J Assistant City Attorney OLS-2SU (4-08) AUTHORIZED REPRESENTATIVE DATE pw1Oit 10/04/2009 20:34 #2000 P.009/010 POLICY NUMBER, CS0020638 COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 THIS END RSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADD! IONAL INSURED - OWNERS, LESSEES OR CO TRACTORS -COMPLETED OPERATIONS This endorsement Modifies insurance provided under the following: COMMERCIAL ENERAL LIABILITY COVERAGE PART SCHEDULE Name Of O dlt wW Insured Person(s) Or anization s - Location And Description Of Corn feted O rations ANY PERSON OR ORGANIZATION WHEN YOU AND ALL LOCATIONS SUCH PERSON O ORGANIZATION HAVE AGREED IN WRITING IN A CO CT OR AGREEMENT, EXECUTED PRIOR TO THE CURRENCE" TO WHICH THIS INSURANCE APPL IES, THAT SUCH PERSON OR ORGANIZATION RE DED AS AN ADDITIONAL INSURED ON YOUR POLICY Information r ire to complete this Schedule, if not shown above, will be shown in the Declarations. Section II - Who Is An Insured is amended to include as an addtional insured the person(s) or organization(s) shoi in in the Schedule, but only with respect to !lability fa ? "bodily injury" or "property dam- age" caused, in w e or in part, by 'your work" at the location designated and described in the sched- ule of this endorse ant performed for that additional insured and incl ed in the "products-completed operations hazard". APPROVED AS ?ro FOs€.ivt Laura Stitt speedy Assistant City Attorney CG 20 37 07 04 0 ISO Properties, Inc., 2004 Page 1 of 1 0 10/04/2009 20:34 BCS0020638 #2000 P.010/010 COMMERCIAL GENERAL LIABILITY CO 20 33 07 04 THIS ENJR SEMENT CHANCES THE POLICY. PLEASE READ IT CAREFULLY. ADDONAL INSURED - OWNERS, LESSEES OR CO RACTORS - AUTOMATIC STATUS WHEN REOUIR IN CONSTRUCTION AGREEMENT WITH YOU This endorsement COMMERCIAL A. Section U - % include as an a ganization for w when you and agreed in writir such person or tional insured c ganization is a spect to liabil damage" or " caused, in whop 1. Your acts or 2. The acts or behalf; in the performa the additional in A person's or of insured under I operations for pleted. insurance provided under the following: LIABILITY COVERAGE PART io Is An Insured is amended to S. With respect to the insurance afforded to these ditional insured any person or or- additional insureds, the following additional exclu- om you are performing operations sions apply: uch person or organization have This insurance does not apply to: in a contract or agreement that organization be added as an addi- 1. "Bodily injury", "property damage" or "personal your policy. Such person or or- and advertising injury" arising out of the render- additional insured only with re- ing of, or the failure to render, any professional f for "bodily injury', "property architectural, engineering or surveying ser- arsonal and advertising injury' vices, Including; or in part, by: a- The preparing, approving, or failing to pre- omissions; or pare or approve, maps, shop drawings, missions of those acting on your opinions, reports, surveys, field orders, change orders or drawings and specifica- tions; or ce of your ongoing operations for fired b. Supervisory, inspection, architectural or . engineering activities. anization's status as an additional is endorsement ends when your 2. "Bodily injury" or "property damage" occurring rat additional insured are com- after: a. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than ser- vice, maintenance or repairs) to be per- formed by or on behalf of the additional in- sureds) at the location of the covered operations has been completed; or b. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontrac- tor engaged in performing operations for a principal as a part of the same project. APPROVED AS TO FORM ura Stitt sheedy Assistant City Attorney 00 2033 07 04 1 0 ISO Properties, Inc., 2004 Page 1 of 1 0 10/04/2009 20:33 STATE IX P RSATHM .FUND ISSUE DATE: 10-0 CITY OF SANTA ANA 20 CIVIC CMER PL UNTA ANA CA 029'01 This is to certify that California Insurance G This policy is not CERTHO AER COPY SC P.O. BOX 420807, SAN FRANCISCQCA 84142-0807 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE GROL F: POLICY NUMBER: 1777140-2000 CERTIFICATE ICk 470 CERTIFICATE EXPIRE& 02-211.2010 02-21-200/02-21-20`10 THIS CERTIFICATE SUPERSEDES AND ACTS CERTIFICATE # 070 DATED 10-00-0000 SC have Issued a valid Workers' Compensation Insurance policy in a tam approved by the issianer to the employer named below for the policy period indicated. to cancellation by the Fund except upon g0 days advance written notice to the employer. We will also yive you 40 days advanca notice should this policy be cancelled prior to its normal expiration. This eertMlcate of km ce is not an insurance policy and does not arnMld. extend or alter the opvrrage afforded by the policy listed her irL Notwithstardkv any reWirernenk term or condition of " contract or other document with respect to which certificate of Inswance may be issued or to which it may pertain the insurance afforded by the policy abed herein is'sub)ect to all the terms, exclusions, and conditions, of such policy, HQRIZED R EPRESIDENT ENPWYMR,1S LIABIL TY LIMIT :NOLUDINC DEFENSE COSTS; $1,000,00D PER O=RRD CB- EMDORSil111111lUfl #0015 ENTITLED ADDITIONAL INSIJRlD F,IIPLOYER EFFECTIVE 2000-10-02 IS ATTAt$M TO AND FIRM A PART OF THIS POLICY. NAME OF ADDITIONAL INWRED: CITY OF SHWA ANA ENOORSFONT #IBM - DANES SKAFF P,S T - EXCLUDED. ENDORSEMENT #1000 - TERRY D BNITH VPRES - EXCLUDED. EIDORSUBIT #2006 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 02-21-2006 IS ATTACH90 TO AM Fdii A PART OF THIS POLICY. EMPLOYER DIXIE DIESEL A EL! DIESEL ii1NAN RESM 8180 MAXSdi RD IL ilRMtTO CA 01795 REM-= APPROVED AS TO FORM r tiaura Stitt SA?ttoedy rney Assistant City C. INC AND/OR DIXIE XC NONT CO INC APPROVED AS TO FORM aura Stitt Sheedy Assistant City Attorney Is11,scl POINTED : 10-02-2000 #2000 P.004/010 12;'1012010 C10, :03 ? -771 ; 94450 P.002/003 Policy Number. BcBW23080 Date Entered: 12/9/2010 CERTIFICATE OF LIABILITY INSU NCE 4471"=N" 12/9/2010 THIS CEFMRCATE 18 HUED AS A MATTER OF INFORMATION *MY ANO CONFERS NO ROMM M THE CERTIFICATE HOLDER. 7M CERTIFICATE OOrs,B NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND Oft ALTER 7W AFFORIM BY -Mg POUCFEB BELOW. Tlft CERTIFICATE OF INSURANCE GOES ? A COWntAeCT SEIVAM THE 1 NQ INSURER($). AUTHORUEA REPRESWATWE OR t!22LKE 01 WL MPORTAtUr If ft atHIlp - is an AMMNAL N1sURED, the PoNcy(Int1 nNw Ira omicrssd St1E1ROli MM 18 WANED, s la the to. and conciRkm s of 0* _ Palma i vT r?tla?An adorsommiL A tl -1- 111 et cat aerlifleals dos not catltrf• noble to the ' gellNuft holder In Neu of am* ?? t cwwa ==PA= G1 Th 1489 X d O k Bl d (805)497-126 0 . (a0?f 497-3970 coxs . a s v . 1 1 6 snits A 4 ?wft Thwomd Oaks, to 91962 co?6lAOf: tulcr ?A: compm 7r Dude Diesel i 9160tMIC, Z=. BIYI?R B r C: 3150 Mtrsaoa Rapd C 1 2 Monts, A 9173 9 "UW low 1: COVERAOEB CERTIFICATE NUMBER: REVISION NUMBER: 7M ar TO Ct x TY THAT 'nee MCM OF 09RAMCF! usrtw a q6M HAW traev -M yHe WMM ADM 7M rover r mw ocomw wr mHtirmow ANY REmmteN w 150 On 0own7bN of ANY CoNmwr OR oYma% oocutrrf w1m Rt CI ro mcK 7vn Ciii1MAW MAY Fad OR MAY MffAK TM QAaMMM Aft rvrecrsr UMM 9" May- - -Pao L=5 fiFJ1t9k11f.LIM&M EAMOCCUM OE W 4,000,000 A- sswrs3t 4ALwjo AL wo N ? WWO23690 0/112010 O 1/201 t? 50 0 - . / 5 , 00 ?? acctaR ... MED otf+ as 35,000 Per M&SADWWARY i pOQ QpO , , 3MMLA6011MTE 2 000 000 , , c RW-AIELWAMUasvat '.:. - PRODUCT9-COMOPAeo $2,000,000 ?aoutw roc..... .. _ ... .. ,. _ _ ANY(AtlTO: _ 010535 /20/2010 20 AL .QyM 1AAtID6.., 29/ % 11GfklYINMY0'wFIwon). Is ,?'!?(A,NDArlr? fit7D?LYtNJI?rY?A??opllala! i HIRtDA(JY978 U _ PVMPWN PAMAU 5 NON4MMW-DA M 3 LWANdSAJ '''"' aacrss wu arcuR /7C? r&r, o i..M :s, ooo, Qaa 069591 0/1/2010 0/1/201 5 A( TE $ , 000, 000 R? wawteiaeoat?ti+A 17r%Q N 4 M, RATL? VIM i #IY -- - - S , A iV OWtIE1DtLPARt717?11R11E. QRqCUtAV=Ra=juom " ,. ? M%A _ . : _. ... R Ft7 da?br if tetr - d EL cr sistant City Attorney As >saoRrsr,oN o? Ci'iRA710Ni1 r ccnrowrt vrsura r5 t MM gym, A00 wWReams $do0 . goV t om b w¦ Shoald MW of the Paicias bo '0000 ,I.4" botmo the oa"=tioa date th ? ?tafl..l8) days nsitt o antiaa to the aor iPicato haldar.nawa aEn .tbr..Wt.,. the issuing meow +dll ...._ . CERTIFICATE MOLDER C?AItICl?LLATION City 8 ta? aaa 7HR ompATION bA7E F. 1iQ7ICE VYILL Be irRLARRBb IN 20 Civic Oea?tar B].asy SlAt# Aaa, CL 92762 r• , wvrswv ,cv ?Rr'f.)riA l iUN. Atl t'?h?''ftrMdrlPad. 12/11)/2010 0^:04 "rh scorTSDA= mtsUaaNcE cohf Parnr' #4450 P.004/008 ENDORSEMENT NO. •rtnaeaira?n FO?APWOF j n #1A1ti NOWAD ,wWpo BC=23080 1001-2010 DIXIE DID & t": LEMIC, INC. 04781 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ ! CAREFULLY. ADMTXKU ED-OM WYA LESSM OR OR$ SPECIAL CONDITION For coverage pwided in the fo&mft endorses as indicated by an V in ti * box below: a Additional ItMued-Owners. Lessees Or led person Or Organi sban (CQ 2010). AddMWW Insured--0wrrarsI.98eees Or CorK =Ws- AuDamatic 8 On When Rg gdmd in ConWuc Oon Agmment With You (CG 2D 33). .Addillonalinsurpd-4awam. Lessees Or C.c:ntraa N-Cor oaffid Opa ns (CG 20 M, The • • ? . ,., _ .- - --- . _ ..? .. . amended .. - ? _,.... _.?. by an'yc' in one box Q Primary- - _.,... _.... _... ....,, . ,,. , q -tf'ft-boor- is checW;- fS ?app?ies,artly 6o the tolim tnQ 111cm aF I?+adfsY.... ... .. .. _ _ . o6 -IF G timid (3-10) AWTHOR12EL1 %-PRt 6ffATnM P"O I d 1 DATE 1^/10/2017 0^:04 POLICY NUMBER: ROS0023080 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE ADDITIONAL INSURED - OWNERS, CONTRACTORS - COMPLETED O This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHE=DULE #4450 P.008/008 GENERAL UABILITY CO 20 37 07 04 IT CAREFULLY. EES OR TIONS Name Of Additional Insured Peredn(s) Or Organization(s): Location And Descrip tion Of Corn ted Operations ANY PERSON OR ORGANIZATION WHEN YOU AND. SUCH PERSON OR ORGANIZATION HAVE AGREED IN ALL LOCATIONS WRITING IN A CONTRACT OR AGREEMENT, EXECUTED PRIOR TO THE `OCCURRENCE" TO WHICH THIS INSURANCE APPLIES, THAT SUCH PERSON OR ORGANIZATION BE ADDED AS AN ADDITIONAL INSURED ON YOUR POLICY Information r uog to complete this Schedule if not shown above will be show in the Declarations. 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" or "property dam- age" caused, in whole or in part, by "your work" at the location designated and described in the sche- dule of this endorsement performed for that addi- tional insured and included in the "products- completed operations hazard". 1^;-'10/'2010 M:04 #4450 P.006/008 COPY P Q BOX 420807, SAN FRANCISCO,CA 941 CEMFICAT'B OF WORM W COMPONSATION MMOAM tSSNE BATE: 1E-OY-2010 GRIM P. 000467 POLICY NULMFb 00170U-2000 CIStTIFIf..AM U>; 3139 CSKnFICATE EXP 02-41-40111 04-41-401 OQ-21-2011 CITY OF 5M1t'A ANA 20 CtvzC Cam PLZ SANTA ANA G 04701-40M so This Is to certify :hat we haw lssued a VOO Workers COmpentetfon insurame Mary In # arm approved by the Capfarnis lnswwm Conrr>issioner to the employer nand below for fin poffcy period Ind! This Polley is note )ad to camepetlan by the Fund except ;,pan 41) days *&.Wm written sodm to the san00yer. We will also diva you 80 days advance notice should thls Poiley be c amelled prior to ft •dxplratiam This csertiffph of irwnwe Is not an Wwxm o popsy and does not amend, extend or Ater tM covergs afforded by the policy listsd herein Notwt ark requirwnelrt,twM of condition of any con t or other 4aoument with repeat to which Chit esetif i1r>rroo MW b! issued Or t0 which it may the irourwwm afforded by the policy. described herein is "Ject to ap the terms excksions, and of Koh paltry. Authorised R.presentatlva PrAlook-exi CEO :-.7: CIpLOYMS LIABILITY LIMIT MMUM M DEFENSE COSTS: *1.00O,OOQ PER w9unp . MM 00016 ENTITLED ADDITIONAL ZNSUOMD M UYRR EFFECTIVE 201 0-011 12 ATTAf.M TO AMI FORS A PART OF TMS POLICY, NAME OF ADDITIONAL Y D: CITY OF SANTA ANA BMWRSEMRMT f1A00. - larm TERRA VICE PRESIOW !il:CRBTART - EigCLUDED, ENDDRSEMW #IWO - WAFF, VAMES A PMI0W TWWRER EXC1.1pMED. ENOORSENEW #4065 ENTITLED CERTIFICATE iNOLDERRI MMM OFFUTIV! 0e-0 -20110 IS ATTAOM TO AM FOIFa116 A PART OF THIS POLICY. ZMPLOYER :...... • . -_APPROVE;`v,. AS TO F ]21V1 .. _... -Assistant City At.tJr-ne PWI! Ott"L & ELECTTtIC; lCAtC AND/OR DIXIE SC. 031"1. MWAN -f+iftaoly0 Mme" Cfl1 ZINC 41169 RD EL MN'1'i: CA $1na. _ te11,F3CJ ? : +s-ai?toto SC