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HomeMy WebLinkAboutPRESTIGE STRIPING SERVICES, INC. 4 -2010 ~~GA C~Doux+~,.~sr~ (Z~ ~ ~c~reh G (Rtxk Gary-ic1 N-2010-044 INSURANCE ON FILE WORK i~fAY PRGCEEL UNTIL 6NSURANCE EXPfRES'~'~ CONSULTANT AGREEMENT CLERK QF COUNCIL DATE: 1 ~ 214 THIS AGREEMENT, made and entered into this / ~ day of ~ 2010 by and between Prestige Striping Services, Inc., a California corporation (her nafter "Consultant"), 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 (hereinafter '`City"). RECITALS A. The City desires to retain a consultant having special skill and knowledge in the field of street and parking lot painting, striping and installation of wheel stops. B. Consultant represents that Consultant is able and willing to provide such services to the City. C. In undertaking the performance of this Agreement, Consultant represents that it is knowledgeable in its field and that any services performed by Consultant under this Agreement will be performed in compliance with such standards as may reasonably be expected from a professional consulting firm in the field. 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. SCOPE OF SERVICES Consultant shall perform street painting and parking stall painting as set forth in Exhibit A to this Agreement. Said services shall be provided on an as-needed basis. Consultant shall be informed by the City of each pending project. Within five (5) working days of the request of the City, Consultant shall provide a formal written proposal for each project, including compensation and timeline as to when project will be completed. The City has the discretion to accept, reject or negotiate the project proposal, and shall do so in writing to Consultant. Upon the written approval of the Deputy City Manager for Development Services, Consultant shall commence services for the project. 2. COMPENSATION a. City agrees to pay, and Consultant agrees to accept as total payment for its services, the rates and charges identified in each accepted proposal. The total sum to be expended under this Agreement shall not exceed $25,000.00 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 of performance set forth in the Recitals which may reasonably be expected by City. 1 3. TERM This Agreement shall commence on the date first written above and terminate on expenditure of allocated funds, unless terminated earlier in accordance with Section 12, below. 4. INDEPENDENT CONTRACTOR Consultant 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 an employer-employee relationship, a joint venture relationship, or to allow the City to exercise discretion or control over the professional manner in which Consultant performs the services which are the subject matter of this Agreement; however, the services to be provided by Consultant shall be provided in a manner consistent with all applicable standards and regulations governing such services. Consultant 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 performance of work under this Agreement, Consultant shall maintain and shall require its subcontractors, if any, to obtain and maintain insurance as described below: a. Commercial General Liability Insurance. Consultant shall maintain commercial general liability insurance naming the City, its officers, employees, agents, volunteers and representatives as additional 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 Consultant'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. Consultant shall supply 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 Attorney. b. Business automobile liability insurance, or equivalent form, with a combined single limit of not less than $1,000,000 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, Consultant, if Consultant has any employees, 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, Consultant agrees to obtain and maintain any employer's liability insurance with limits not less than $1,000,000 per accident. 2 r ~ d. The following requirements apply to the insurance to be provided by Consultant pursuant to this section: (i) Consultant 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 Attorney. (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. e. If Consultant 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 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 Consultant's right to be paid for its time and materials expended prior to notification of termination. Consultant waives the right to ~ receive compensation and agrees to indemnify the City for any work performed prior to approval of insurance by the City. 6. INDEMNIFICATION Consultant agrees to and shall indemnify and hold harmless the City, its officers, agents, employees, consultants, special counsel, and representatives from liability for personal injury, damages, just compensation, restitution, 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 Consultant 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. The Consultant 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 all reasonable decisions with respect to its representation in any legal proceeding. 7. CONFIDENTIALITY 'i If Consultant receives from the City information which due to the nature of such information is reasonably understood to be confidential and/or proprietary, Consultant 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 3 shall not apply to any information that (a) has been disclosed in publicly available sources; (b) is, through no fault of the Consultant disclosed in a publicly available source; (c) is in rightful possession of the Consultant without an obligation of confidentiality; (d) is required to be disclosed by operation of law; or (e) is independently developed by the Consultant without reference to information disclosed by the City. 8. CONFLICT OF INTEREST CLAUSE Consultant covenants that it presently has no interests and shall not have interests, direct or indirect, which would conflict in any manner with performance of services specified under this Agreement. 9. NOTICE 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: Clerk of the City Council City of Santa Ana 20 Civic Center Plaza (M-30) P.O. Box 1988 Santa Ana, CA 92702-1988 telefacsimile (714) 647-6956 With courtesy copies to: Deputy City Manager for Development Services City of Santa Ana 20 Civic Center Plaza (M-25) P.O. Box 1988 Santa Ana, California 92702 telefacsimile (714) 647-6549 and City Attorney City of Santa Ana 20 Civic Center Plaza (M-29) P.O. BOX 1988 Santa Ana, California 92702 telefacsimile (714) 647-6515 To Consultant: Prestige Striping Services, Inc. 1054 Railroad Street Corona, California 92882 Telephone: (951) 270-2999 Telefacsimile: (951) 270-2899 4 A party may change its address by giving notice in writing to the other party. Thereafter, 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. 10. EXCLUSIVITY AND AMENDMENT This Agreement represents the complete and exclusive statement between the City and Consultant, 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 Consultant. The parties agree that any terms or conditions of an urchase order or oth r ' y p e instrument that are inconsistent with, or in addition to, the terms and conditions hereof, shall not bind or obligate Consultant 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. 11. ASSIGNMENT Inasmuch as this Agreement is intended to secure the specialized services of Consultant, Consultant may not assign, transfer, delegate, or subcontract any interest herein without the prior written consent of the 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 consultants retained by City. 12. TERMINATION This Agreement may be terminated by the City upon thirty (30) days written notice of termination. In such event, Consultant shall be entitled to receive and the City shall pay Consultant compensation for all services performed by Consultant prior to receipt of such notice of termination, subject to the following conditions: a. As a condition of such payment, the Deputy City Manager may require Consultant to deliver to the City all work product completed as of such date, and in such case such work product shall be the properly of the City unless prohibited by law, and Consultant consents to the City's use thereof for such purposes as the City deems appropriate. 5 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 Consultant 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. Consultant affirms that it is an equal opportunity employer and shall comply with all applicable federal, state and local laws and regulations. 14. JURISDICTION -VENUE This Agreement has been executed 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 governed 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 brought or arise out of, in connection with or by reason of this Agreement. 15. PROFESSIONAL LICENSES Consultant shall, throughout the term 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. Consultant 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. COMPLIANCE WITH GOVERNMENTAL REQUIREMENTS Contractor shall carry out all services pursuant to this Agreement in substantial conformity with all applicable laws, ordinances, statutes, codes, rules, regulations, orders, and decrees of the United States, the State of California, the County of Orange, the City, and of any other political subdivision, agency, or instrumentality exercising jurisdiction over the City, including all applicable federal, state, and local occupation, safety and health laws, rules, regulations and standards, applicable state and Federal labor standards, prevailing wage requirements, the City zoning and development standards, City permits and approvals, building, plumbing, mechanical and electrical codes, as they may apply, and all other provisions of the City and its Municipal Code (as they may apply), and all applicable disabled and handicapped access requirements, including, without the limitation, the Americans With Disability Act, 42 U.S.C. § 12101 et seq., Government Code § 4450 et seq., and the Unnih Civil Rights Act, Civil Code § 51 et seq. 6 17. 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 shall 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: CITY OF SANTA ANA i•-~ t' f f G~ 1-'16;_ r j„z Wit. . 4~ / ~C.{r..._----_,. Maria D. Huizar ~ David N. Ream Clerk of the Council City Manager APPROVED AS TO FORM: JOSEPH W.FLETCHER City Attorney Lisa Storck Assistant City Attorney RECOMMENDED FOR APPROVAL: CONSULTANT ~ ~ ~~_a (,~R, Cynt is J. Nelson Sabas T j llo Deputy City Manager for President Development Services Tax ID# ~ ~ 75 ;~S' 7 CITY OF SANTA ANA PRICE LIST Single Lines Stalls Double Lines Stalls Restripe Per Line $2.75 Restripe Per Double Line $3.75 New Layout Per Line $3.75 New Layout Per Double Line $4.75 12" Single Line Per L.F. $0.65 Round Ends Stall Per Double Line $6.50 4" Single Line Per L.F. $0.35 4" Double Line Per L.F. $0.60 T/L Stall Restripe (Per Stall) $3.50 T / L Stall Restripe New Layout $4.50 Handicap Stencil Concrete Wheel Stops Standard $30 New 4' Wheel Stop Furnish & Install $30.00 Deluxe (Crosshach & Curb) $45 New 6' Wheel Stop Furnish & Install $45.00 Crosshatch (8'x 18') $20 Remove & Dispose 4 or 6 ft. $17.00 Crosshatch (Per S.F.) $0.25 Painting Solid 4/6 Wheel Stops $12.00 Stencils Miscellaneous Arrows $10 Painting Speed Bump (Per S.F.) $1.00 4" Stencil (Per word) $7 Curb Painting (Per L.F.) $0.85 6" Stencil (Per word) $12 Heavy Curb Prep (Per L.F.) $0.30 8" Stencil (Per word) $12 Meter Post Furnish & Install $450 1' Stencil (Per word) $17 Handicap & Sign Post .$160 2' Stencil (Per word) $22 Sandblastting Minimum $1200 8' Stencil (Per Letter) $12 Striping Minimum $270 1' Number/Letter (Per Digit) $1.25 Pressure washing (Up to 2hr) $475 4' Stop & Bar $25 Core Drill (4" For Post) $50.00 8' Stop & Bar $45 Notes 2°d Coat Of Paint (Add 70% To Total ) Glass Beads (Add 30% To Total ) EXHIBIT A 1 ' ACOR 4. CERTIFICATE OF L~p?~IL~T`Y ~IVSUR~I~CE DATEIMIUImDfYYrvl 03/24/2010 pRODucER phone; (951)786-6338 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION DFI - DiGerolamo Famlly Insurance Services ONLY AND cONFEI~s No RIGHTS UPON THE CERTIFICATE 2027 Hamner Ave HOLDER. THtS CERTIFICATE DOES NOT AMEND, EXTEND OR NOPCO, CA 92860 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELQW. License OD26889 rNSUliE12S AFFORDING COVERAGE NAIC INSURER A: F,gp/AMERICANSTATESINSURANCECOMPANY ~ ST1GE S7FtIpING SERVICES INC. INSURER B: MERCURY CASUALTY INSURANCE COMPANY _ 1054 RAILROAD STREET INSURER C: .I. ~ .~T/~'E COMPENSATION INSURANCE FUND CORONA, CA 92882 INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED sE1.OW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DtSCRIBED HEREIN IS SUBJECT TD ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NY6R - POLICY EFFECTIVE POLI E?tPIRATION ~ POLICY NUMBER LIMITS A y r.FUaue~ uA~rlny 01 CG76837960 03/22!2010 03/22/2011 tACH OCCURRENCE S 1 000 0 _ X COMMERCIAL GENERAL LlA61LI'fY AIGfA0ET0 RENTED ~y9D0.000 FR k, o r.. 3 CLAIMS MADE ~ OCCUR MED ExP LAny one er~~r, s 10 D00 X _CON7IZACTI.IAL' PERSONAL&ADVINJURY $ 1 O 0 • - GENERAL AOGIi~GATE S 2 000 O C~N'L AGGRL-GATE uMIT APRLIES PER; PRODUCT6 - COMp/Op AGG $ 2 DOO POLICY P LOrr B Y AUTOMOBILE WdILlTY AC110>1675 04/29/2009 DC1./z9/2010 COMRINFA SINGLE LIMIT 3 X ANY AUTO (Ea aceiaant) 100 0 ALL OWNED AUTOS SCHEDULEDAUTOS B~ODIL~Y~j RY S HIRED AUTOS " AION~OWNED AUTOS BOD4Y INJURY $ F gl~i (Per acclaenh AS ~ ~P~o~an~'AMAGE s -°ARA~ L'"~'L"~ pR AUTO ONLY- EA ACCIDENT 5 _ ANYAUro ~ ~ ~ ~ .~DEtGK 2V OThIERTNAN tAACC s ,I/~. ` ~ S QY AUTOONLY: AGG $ ExCLS$/t7MBRELL4EIABILITY ~ a,C1t EACH OCCURRENCE $ OCCUR ~ CLAIMS MAD[ Ay$~5 Y/ A~~.~ s DEDUCTIBLE l!! ~ $ 5 RETENTION S - - S C WORHERS CO1WpeN5ATION AND 044-29766~20D8 06/01/2009 06/01/2010 X ~ STATU- RTy- EMPLOYEAS' LIABILITY _ ANY PROPRIETOR/pAFtTNEWEXECUTIVE l:. L. EACH ACCIDENT S 1 ODO O OpFlCERfA7EM81J2 ExCI.UDED7 If yens, duccxiDe antler E.L. DI8EA8@ - EA EMPI.QYG .1.000.000 SPECIAL PROVI810N3 Ix3tow OTHER E.L. DISEASE -POLICY LIMB S 1 ODD OO DE6CRIPTION OP ONI:RA77ON3 ! LOCATIONS 1 VEHICLES 1 k~XCLUS10N3 ADDeD BY ENDORSEMENT ! St'tGAL PROYI910N$ 10 DAYS NOTICE WILL BE BENT FOR NON PAYIINENT OF PREIUl1UM. CERTIFICATE HOLDER I$ NAMED A5 ADDITIONAL rNSURED. CovERAGE IS PRIMgRY ~ NON CONTRIBUTORY .JOC3: VARIOUS JOB LOCATIONS REVISING CERTIFICATE ISSUED 3/23110 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOV@ pE6CR18ED POLICIES F3L CANCELLED riEPORB THE 17fPIRA710N CITY OF SANTA ANA bATk TTIEREOF, THE ISSUING INSURER WILL ~ 1AgIL =3D ppyy WRITTEN ATYN: ROCK CyARCIA NOTICE 70 THt.CER7IFICATB NflLDER NAMED TO YHk LEFT, 305 E. 47N STRELCT, SU17'E 201 SANTA ANA, CA 92701 ~RIII AUTNDR¢ED REPkI?sENTATIVE AcORD z512001/os) ~ FH E X H ~ B ~ T ~ q ACORD CORPORATION 1968 f, Printed by Kt1T on Msrch 24, 2010 at 03:38PM ~ ~ PRESTIGE STRIPING SERVICES, TNC. O1 CG 768379-6 ~ • CG 76 80 10 02 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED PRIMARY COVERAGE This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: CITY OF SANTA ANA (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) SECTION II -WHO IS AN INSURED is amended you. Coverage shall be limited to the extent of your to include as an additional insured the person or negligence or fault according to the applicable princi- organization shown in the Schedule subject to the pies of comparative fault. following provisions: The insurance provided will not exceed the lesser of: 1. The additional insured is an insured but only for liability directly resulting from: a. The coverage and/or limits of this policy, or a. your ongoing operations for the additional in- b. The coverage and/or limits required by the sured whether the work is performed by you contract, agreement or permit. or for you; or With respect to the insurance afforded the additional b. the general supervision of your ongoing op- insured, paragraph 4. of SECTION IV - COMMER- erations by the additional insured. CIAL GENERAL LIABILITY GONDlTlONS is de- l. This insurance does not apply to: leted and replaced by the following: a. "Bodily injury" or "property damage" arising 4. Other Insurance out of any act or omission of, or for defects a. This insurance is primary and noncontrib- in design furnished by or for, the additional utory, and our obligations are not affected by insured or any other insurance where the additional in- b. "Bodily injury" or "property damage" in- sured is the Named Insured, whether pri- cluded within the "products-completed oper- mary, excess, contingent, or on any other ations hazard." basis; however, the defense of any claim or °suit" must be tendered as soon as practi- A person's or organization's status as an additional cable to all other insurers which potentially insured under this endorsement ends when your op- provide insurance for such claim or "suit". erations for that insured are completed. b. This additional provision applies only to the No coverage will be provided if, in the absence of this additional insured shown in the Schedule endorsement, no liability would be imposed by law on and the coverage provided by this endorse- ApPRCa~~D ~~t.~a ~pRM ~ LISA E. STORCK cc ~s so io oz Fittorney EP Assistant City h~,~Y-12-2010 WED ].2:24 PM DFI FAMILY INSURANE FAX N0, 951. 893 2750 P, O1/O1 A~ R Aw, G DAr~ (MMroDMmI ACORN,,, CERTIFICATE OF LIABILITYs1NS1U A' -,vl~~D AS A MATTER OF IONFORMAT ON pnone: (sb1173b ONLY aNA coNF>rRS NO RIGHTS UPON THE CERTIFICATE PROpUGER pFl - DlGerolafno Family lnsuranc® Services HOLDER. THIS CERTIFICATE DOES NOT AMEND, FJCTEND 2027 Hamfter Ave ALTER THE COVERAGE AFFORDED RY THE POLICIES 6ELOw. Norco, CA 92860 NAIC # N_9cense OD268$9 INSURERS AFFORDING COVE. - _ ~ INSURERA~^611ERCURYCA511A1-TVINgURA CECOMPA_~1 INSURED ~ - PRESTNGE STRIPING SERVICES INC. 1NSUR~R~~,_--_ INSURER C' ~ - 1064 Railroad St INsuRERp_ ~ - CiOfO[la, CA 92882 INSURER E COVERAGES THE POU UIREMC-NT, T RM OR CONDIOTION OF ANY CONTRACT OR OTHER DOCUMENTEIMTH RES?ECT TO WH GH THRS CERTIFiCATOE MAY BE H SUED OR ANY REQ _ MAY PERTAGGR GATE L M TS SHOWN MAY HAVE BEENI REDUCED BY PAID CLAIMS SUBJECT TO ALL THE TERMS, F-OCCLUSIONS AND CONDITIONS OF SU H POLICIES P~I~y EFFECTNk POt-1C' EYPNiA710N LIIAI'1'S ~iy POIICY NUN®ER EI1CH OCCURRENCE S GENERAL LIABU.rTY - gpS E~E~ ncnX81L~1_ S COMiJIERCIAL GENERN. LIA6IUTY pAED EXp A aw lean CWMS MApE ~ OCCUR PERSONAI- 8 ADV INJURY S - GENERALAGGREGATE S _ PRDDUCTS - COIaPIOP AGG S GEN'L AGGREGATE 11M17 APPLIES PER: P LOC POLICY 06/06!2010 Q4/29/2011 caM01NED SINGLE urare A Y Au7o?noBlLe uaeILITY CCA0011008 (Ea aedaonl) ~ 1 OJ. 00 X _ ANY AUTO BOphY IN.IURY L ALL OW NEp AUTOS (Per paeaN SCHEDuL.EO AUTOS gOplLy INJURY S HIRED ALTOS (per ecdd~q NONAWNED AUTOS PROPERTY DAMAGE 5 (verauyoanq AUTO ONLY - CA ACCIDENT S r1AARAtiC UA9ILITY OTHER THAk _ ~ ACC S ANY AUTO AUTO ONLY: AGG 5 ~ ~ _ EACH OCCURRENCE ~ S - E7CCESSIIINBRELLALM6ILRV r ~ ~[`t ~ AGGREGATE 5 OCCUR ~ CIAlIm5 MADE icy ~j~ ~,•l, l•`~ - S P.Y i~ ~l~ ~ L'' S DEDUCnT3LS i~~` - ~ . .e°'- r ~1~V ~ ~ti~ VYC S ATU- RETENTION S ~ ~ - ,\410 . WORICRRS COMPENSATION AND J ~a ~l i `ly E.L. EACH ACCDENT pry1pL0YF-RS LIABh.ITY ,h~SS~~t`~ ~ ANY pROPRIEI'ORlPARTNERlEXEGUTIVE E.4. DISEASE - EA EMPLOYE_ S OFFICERIMEM1ABER FSCCUJp1-D7 E.L DISEASE -POLICY LIM(C b i I( s da6~ beV Sd~N3 below OTI{ER pLSCRIPTION OF OPERATIONS 1 LDCATIONS 1 VEMiICI-RS ! E%CLUSIONS AD[1E0 BV ENOORSEU~1~ ! SPECIAL. PROVlS10NS 10 DAYS NOTICE WILL DE SENT FOR NON PAYMENT OF PREMIUM. CERTIFICATE HOLDER IS NAMES AS ADDITIONAL INSURED. COVERAGE IS PRIMARY & NON CONTRIBUTOi2Y .JOB: VARIOUS JOB LOCATIONS I CANCELLATION SItOUiD ANY OF Yi16 ABOVE pESCR19G'O pOLN.lp6 BE GANCELLEO BEFORE THE EXPIRATION CERTIFICATE HOLDER THE ISSUING W6URER 1AALL ~ MA0. w30 DAY6 WRIYCP-N GATE THL'REOF. CITY OF SANTA ANA NOTICE TO THE CERTIFICATE yIOLDER NAMED To THE LEFT, AT7N: ROCK GARCIA 306 E. 4TH STREET, SUITE 201 SANTA ANA, CA 92701 AUTMORQE R 9ENYATIVE ~ FFIT © ACORp CORPORATION 1988 ACORp 25 (2001109) Printed by FHT on May 12, 2010 at 11:11AM CERTHOLDER COPY P.O. BOX 420807, SAN FRANCISCO,CA 94 ~ 42-0807 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: OB-01-2010 GROUP: 000497 POLICY NUMBER: 0001634-2009 CERTIFICATE ID: 97 CERTIFICATE EXPIRES: OB-01-2011 06-01-2010/06-01-2011 CITY OF SANTA ANA 305 E 4TH ST STE 201 SANTA ANA CA 92707-4638 This is to Certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 70 days advance written notice to the employer. We will also give you 10 days advance notice should this policy ba cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amentl, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, antl conditions, of such policy. ~~ v~~~t- thorizad Representative Interim President and CEO EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT !!1600 - TRUJILLO, SAGAS, P,S T - EXCLUDED. <al'1'ROVED AS TO FORM ~ >. ~, _ --- ~ -~.~,~ `mac c_aura Stit heedy ~~, a~t~utnt Ciiy Attorney EMPLOYER SUPERIOR PAVING COMPANY, INC. AND/OR PRESTIGE STRIPING SERVICES INC, DBA: PRESTIGE STRIPING SERVICES 14660 INDUSTRY CIR LA MIRADA CA 90638 (B13,SK] PRINTED 06-29-2010 SJ (REV.I-2010) ?/- ? o ? o - o -yy A? n c?FlC ?.? of u?u-nr ? °?? I THS GERTIFICAI'E IS ISSI.? AS A MATT®2 of ITION ANl_Y ANU OONFBi4 No lat?t-rs I.FVN TrE CBZI7FlCA7E HOLOHi. THS CEi277FlCATE OOEi NOT AFF9Fa1MT1V?Y OR NEGATIV?Y AN181O, E7CfB?? OR ALT13t 7}E O OV?7iiC? AFFDI? 6Y 71£ POLJCIE$ wF? r?lv THS C82'T7RCAl'E OF IlV3{.?fi1VCE O06 NOT OONBTIME A OONTRACT BETYII? J T}E 1331?N6 IN9l?S), ALRHORI?D ROTATIVE OR PF?OUCS2, AND T'1-E C?277FIC%?7E HOLOBt INPORTAIVT: Kole oertiflcame kidder is an A?17701it/1L INSlii?y tlta polty(tes) rrtast lie enrlor se[L K SI?C?/AT1ON IS VYAIV®1 sti?Jerx to the 76rTr8 ald r?rlditlorts d the policy, oertaln polrJes frtity rag11? en 6tYJOr9Bn'BfIL A 84tSmerrBl X OA this certlflC?Ee does not OorYer rtghts t0 the eartificaEe kidder in lieu d sud'r s - vlsaoue®x DF7 - DiC er+olat F il I S i ? to ? am y r?anoe erv ces ? ^" 2027 Harmer Ave ?3g-s3?s ; ss?l Tas3?ss ? ?? 92? In 6<tarto9.pprn . Li # o?¢6889 1 s?owaax;E NNCfi txrse !?1®lA: IN9Lf?D rn®.?e 6 • 1 ANY PRES77G? 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GTY ? .SANTA ANA TFE OCPIr7ATO1V OATS TFta7?OF, NOt1G'E VNLL BE OF_LJVEIIED IN ATTN: RI<]CK C?a14RC1A Aooora?uuc? wTl-1 TI-E rouc?r vraolnsloNs 306E 4TH STREEt' SlJ"fE 201 , SANTA ANA, C,A 92701 Atmlora?ora?rAT1?.E ? f ? , 21Lf'(.. T i6i?l?'?.?-, ®'1966-2D10 A?OOIm OOFiP'ORATIOHL All rids rsa?erved Ai00Fi0 25 (2[770/05) The AOOfiO rtarrte end logo era rragi>?ened rrarl? d AOOrm Prinhacl by FI--IT on M?129, 20'1'1 at 02:4aPM O1 CG 78837970 Goldeu Eagle Insuraricx., aim.-??n?a,?.r ?u+.r awn COMMERCIAL GENERAL LIABILITY CG 76 35 02 07 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ fT CAREFULLY. LIABILITY PLUS ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Name of Person or Organization: CITY OF SANTA ANA SCHEDULE ADDITIONAL INSURED - BY WRITTEN lease or occupy, subject to the following CONTRACT, AGREEMENT OR PERMIT, OR additional provisions: SCHEDULE (a) This insurance does not apply to The following paragraph is added to WHO IS AN any "occurrence" which takes place INSURED (Section II): after you cease to be a tenant in any premises leased to or rented to 4. Any person or organization shown in the Sched- you; ule or for whom you are required by written con- (b) This insurance does not apply to tract, agreement or permit to provide insurance is an insured, subject to the following additional any structural alterations, new con- provisions: struction or demolition operations pertormed by or on behalf of the a. The contract, agreement or permit must be person or organization added as an in effect during the policy period shown in insured; the Declarations, and must have been exe- (2) Your ongoing operations for that in- cuted prior to the `bodily injury", "property damage", or "personal and advertising sured, whether the work is pertormed injury", by you or for you; b. The person or organization added as an in- (3) The maintenance, operation or use by sured by this endorsement is an insured only you of equipment leased to you by such to the extent you are held liable due to: person or organization, subject to the following additional provisions: (1) The ownership, maintenance or use of (a) This insurance does not apply to that part of premises you own, rent, any `occurrence" which takes place after the equipment lease expires; Includes Copyrighted Material of Insurance Services Office, Inc., with its permission. Copyright, Insurance Services, 2001 CG 76 35 02 07 Page ? of 4 EP (b) This insurance does not apply to "bodily injury" or "property dam- age" arising out of the sole negli- gence of such person or organization; (4) Permits issued by any state or political subdivision with respect to operations pertormed by you or on your behalf, subject to the following additional pro- vision: This insurance does not apply to °bodily injury", "property damage", or "personal and advertising injury" arising out of operations performed for the state or municipality. c. The insurance with respect to any architect, engineer, or surveyor added as an insured by this endorsement does not apply to 'bodily injury", "property damage", or "per- sonal and advertising injury" arising out of the rendering of or the failure to render any professional services by or for you, includ- i ng: (1) The preparing, approving, or failing to prepare or approve maps, drawings, opinions, reports, surveys, change or- ders, designs or specifications; and (2) Supervisory, inspection or engineering services. d. This insurance does not apply to °bodily injury" or "property damage" included within the "products-completed operations haz- ard". A person's or organization's status as an insured un- der this endorsement ends when your operations for that insured are completed- No coverage will be provided if, in the absence of this endorsement, no liability would be imposed by law on you. Coverage shall be limited to the extent of your negligence or fault according to the applicable princi- ples of comparative fault- NON-OWNED WATERCRAFT AND NON-OWNED AIRCRAFT LIABILITY Exclusion g. of COVERAGE A (Section I) is replaced by the following: g. "Bodily injury" or "property damage" arising out of the ownership, maintenance, use or entrustment to others of any aircraft, "auto" or watercraft owned or operated by or rented or loaned to any insured. Use includes oper- ation and "loading or unloading ". This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the 'bodily injury" or "property damage" involved the ownership, mainte- nance, use or entrustment to others of any aircraft, "auto" or watercraft that is owned or operated by or rented or loaned to any in- s ure d. This exclusion does not apply to: (1) A watercraft while ashore on premises you own or rent; (2) A watercraft you do not own that is: (a) Less than b2 feet long; and (b) Not being used to carry persons or property for a charge; (3) Parking an "auto" on, 'or on the ways next to, premises you own or rent, pro- vided the "auto" is not owned by or rented or loaned to you or the insured; (4) Liability assumed under any insured contract" for the ownership, mainte- nance or use of aircraft or watercraft; or (5) "Bodily injury^ or "property damage" arising out of: (a) the operation of machinery or equipment that is attached to, or part of, a land vehicle that would qualify under the definition of "mobile equipment" if it were not subject to a compulsory or financial responsibility law or other motor ve- hicle insurance law in the state where it is licensed or principally garaged; or (b) the operation of any of the machin- ery or equipment listed in Paragraph f.(2) or f. (3) of the definition of "mobile equipment". (6) An aircraft you do not own provided it is not operated by any insured. TENANTS' PROPERTY pAMAGE LIABILITY When a Damage To Premises Rented To You Limit is shown in the Declarations, Exclusion ). of Coverage A, Section I is replaced by the following: ). Damage To Property "Property damage" to: (1) Property you own, rent, or occupy, including any costs or expenses incurred by you, or Pwrta 7 M a any other person, organization or entity, for repair, replacement, enhancement, restora- tion or maintenance of such property for any reason, including prevention of injury to a person or damage to another's property; (2) Premises you sell, give away or abandon, if the "property damage" arises out of any part of those premises; (3) Property loaned to you; (4) Personal property in the care, custody or control of the insured; (5) That particular part of real property on which you or any contractors or subcontractors working directly or indirectly on your behalf are performing operations, if the "property damage" arises out of those operations, or (6) That particular part of any property that must be restored, repaired or replaced because "your work^ was incorrectly performed on it. Paragraphs (1), (3) and (4) of this exclusion do not apply to "property damage" (other than damage by fire) to premises, including the con- tents of such premises, rented to you. A separate limit of insurance applies to Damage To Prem- ises Rented To You as described in Section Ill - Limits Of Insurance. Paragraph (2) of this exclusion does not apply if the premises are "your work^ and were never occupied, rented or held for rental by you. Paragraphs (3), (4), (5) and (6) of this exclusion do not apply to liability assumed under a side- track agreement, Paragraph (6) of this exclusion does not apply to `property damage^ included in the "products- completed operations hazard". Paragraph 6. of LIMITS OF INSURANCE. (Section III) is replaced by the following: 6. Subject to 5. above, the Damage To Premises Rented To You Limit is the most we will pay un- der Coverage A for damages because of "property damage^ to any one premises, while rented to you, or in the case of damage by fire, while rented to you or temporarily occupied by you with permission of the owner. The Damage To Premises Rented To You limit is the higher of the Each Occurrence Limit shown in the Declarations or the amount shown in the Declarations as Damage To Premises Rented To You Limit_ WHO IS AN INSURED -MANAGERS The following is added to Paragraph 2. a. of WHO IS AN INSURED (Section 11): Paragraph (7) does not apply to executive officers, or to managers at the supervisory level or above. SUPPLEMENTARY PAYMENTS -COVERAGES A AND B - SAIL BONDS - TIME OFF FROM WORK Paragraph 1.b. of SUPPLEMENTARY PAYMENTS - COVERAGES A AND B is replaced by the following: b. Up to $3,000 for cost of bail bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverage applies. We do not have to furnish these bonds_ Paragraph 1.d. of SUPPLEMENTARY PAYMENTS - COVERAGES A AND B is replaced by the following: d. All reasonable expenses incurred by-the in- sured at our request to assist us in the in- vestigation or defense of the claim or "suit^, including actual loss of earnings up to $500 a day because of time off from work. EMPLOYEES AS INSUREDS - HEALTH CARE SERVICES Provision 2.a.(1)(d) of WHO IS AN INSURED (Section II) is deleted, unless excluded by separate endorse- ment. EXTENDED COVERAGE FOR NEWLY ACQUIRED ORGANIZATION S Provision 3.a. of WHO IS AN INSURED (Section II) is replaced by the following: a. Coverage under this provision is afforded only until the end of the policy period. EXTENDED °'PROPERTY DAMAGE" Exclusion a. of COVERAGE A (Section I) is replaced by the following: a. "Bodily injury" or "property damage" expected or intended from the standpoint of the insured. This exclusion does not apply to "bodily injury" or "property damage" resulting from the use of reasonable force to protect persons or property. CG 76 35 02 D7 Paga 3 of 4 gp EXTENDED DEFINITION OF BODILY INJURY Paragraph 3. of DEFINITIONS (Section V) is replaced by the following: 3. "Bodily injury" means bodily injury, sickness or disease sustained by a person, including mental anguish or death resulting from any of these at any time. TRANSFER OF RIGHTS OF RECOVERY The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of COM- MERCIAL GENERAL LIABILITY CONDITIONS (Sec- tion IV): We waive any rights of recovery we may have against any person or organization because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products-completed operations hazard^_ This waiver applies only to a person or organization for whom you are required by written contract, agreement or permit to waive these rights of recovery. AGGREGATE LIMITS OF INSURANCE - PER LOCATION For all sums which the insured becomes legally obli- gated to pay as damages caused by "occurrences^ under COVERAGE A (Section I), and for all medical expenses caused by accidents under COVERAGE C (Section I), which can be attributed only to operations at a single "location^: Paragraphs 2.a. and 2. b, of Limits of Insurance (Sec- tion III) apply separately to each of your "locations" owned by or rented to you. "Location" means premises involving the same or connecting lots, or premises whose connection is interrupted only by a street, roadway, waterway, or right-of-way of a railroad. INCREASED MEDICAL EXPENSE LIMIT The Medical Expense Limit is amended to $0,000. KNOWLEDGE OF OCCURRENCE The following is added to Paragraph 2. Duties In The Event Of Occurrence, Offense, Claim Or Suit of COMMERCIAL GENERAL LIABILITY CONDITIONS (Section IV): Knowledge of an "occurrence^, claim or "suit^ by your agent, servant or employee shall not in itself constitute knowledge of the named insured unless an officer of the named insured has received such notice from the agent, servant or employee. UNINTENTIONAL FAILURE TO DISCLOSE ALL HAZARDS The following is added to Paragraph 6. Representa- tions of COMMERCIAL GENERAL LIABILITY CONDI- TIONS (Section IV): If you unintentionally fail to disclose any hazards ex- isting at the inception date of your policy, we will not deny coverage under this Coverage Form because of such failure. However, this provision does not affect our right to collect additional premium or exercise our right of cancellation or non-renewal. LIBERALIZATION CLAUSE The following paragraph is added to COMMERCIAL GENERAL LIABILITY CONDITIONS (Section IV): 10. If a revision to this Coverage Part, which would provide more coverage with no additional pre- mium, becomes effective during the policy period in the state shown in the Declarations, your pol- icy will automatically provide this additional cov- erage on the effective date of the revision. Pane 4 of 4 O1 CG 76837970 Golden Eagle Insurance. CG 76 190 10 02 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ R CAREFULLY. ADDITIONAL INSURED PRIMARY COVERAGE This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Name of Person or Organlzatlon: BLANKET ADDITIONAL INSURED organization shown in the Schedule subject to the ples of comparative fault. SCHEDULE (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) SECTION 11 -WHO IS AN INSURED is amended you. Coverage shall be limited to the extant of your to include as an additional insured the person or negligence or fault according to the applicable princi- following provisions: 1. The additional insured is an insured but only for The insurance provided will not exceed the lesser of: liability directly resulting from: a. The coverage and/or limits of this policy, or a. your ongoing operations for the additional in- b. The coverage and/or .limits required by the sured whether the work is pertormed by you contract, agreement or permit. or for you; or b. the general supervision of your ongoing op- respect to tha insurance afforded the additional erations by the additional insured insured, paragraph 4. of SECTION IV - COMMER- . CIAL GENERAL LIABILITY CONDITIONS is de- 2. This insurance does not apply to: leted and replaced by the following: a. "Bodily injury" or "property damage" arising 4. Other Insurance out of any act or omission of, or for defects a This in i in design furnished by or for, the additional . surance s primary and noncontrib- insured or utory, and our obligations are not affected by any other insurance where the additional in- b. "Bodily injury" or "property damage" in- sured is the Named Insured, whether pri- cluded within the "products-completed oper- mary, excess, contingent, or on any other ations hazard." basis; however, the defense of any claim or "suit" must be tendered as soon as practi- a A person's or organization's status as an additional cable to all other insurers which potentially o insured under this endorsement ends when your op- provide insurance for such claim or "suit". erations for that insured are completed. b. 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Z _ wino Slil 6fi¢edy 9??:,raNl Q'ly Allamel CTRIIRGVEHpLEIt CalD:llATON NIDI?Am ff Tf ABhE D6CNBD PW DEC E UMF?1F? CNCfSMUAAN4 TEFMAPATQSMIETEA9F,N0?(£NLLfEDBfu9EDIN AT1N: FlOd(CARCIA A7AfD1NEEYrTITEH7ILYPDN5Qd 30S E 41H S1ReET SUTE Xt1 , SAMAANA,CASiIIN PoN®nAThE E ' IcFSI ?^""© WAPOI2ATCN aldgllsr?rvaa AWfD251A16Nrf TIEAp7pDIallemdlogoaeremrl¢dAWFD Por1elty?mPpil29, Z?Iid02'OdM q? CENTURY•NATIONALlNSURANCE COMPANY 1V THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY Insured) PRBSTICB STRIPING RBRVICBS INC Policy Number BAP 173013 AUTOMATIC ADDITIONAL INSUREDS rds The following provision is addadto Section F, page 1, Wo end Phrases; Effective at inception unless a data is filled in 4/29/2011 By this endorsement, your broker may complete an Aeard additional Insured form reQulred in a written contract I"the oentract"I to name as an insured, I"the Additional Insured"I is an Insured but only whh respect to liabhltyarising out of "your work" for the Additional Insured, Tha Limits of insurano¢ provided for the Additional Insured shall not be greater than those required by the rontrect and, in no avant, shall the Limits of this polioy ba increased by this endorsement. AE Insuring agreements, e><olusions, terms and eondlficns of the Polioy shall apply to the couaragefal provided to th¢ Additional insured and such coverage shall not be enlarged or expanded by reason of the contrabt. This insurance does not apply.to BodPy Ir?uryer Property Damage ocpurrl?q after... . all work on the project to be performed by'the Named Insured at the life of the covered operations has been completed by thamAny coverage prouid¢d shall ba eXCess over any ether valid and eolleatibla insurance available to the Additional Insured Isl whathe? primary, excess, contingtnt or on any other basis, with the policy liability Ilmh shown on the declarations page, then the entity you are Attached farm CN 613, Additional Insured Endorsement, is made a part of this form. CN 6lS (SI99) -`??`?R?® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YwY) 05/31/2012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(fes) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the pol!ey, certain policies may require an endorsement. A statement on this certlflcate does not confer rights to the certlflcate holder in Ifeu of such endonsement s . PRODUCER CONTA T Chris E slurs DFI - DiGerolamo Family Insurance Services PHONE FAx ' 95 1 735-5335 ac No : 95'1 893-2750 2027 Hamner Ave E-MAIL A Chris dfilnsurance.com NOrCO, CA 92860 - INSURERS AFFORDING COV ERAGE NAIC# License # OD26889 INSURERA: (' I In N 1 n INSURED INSURER B PRESTIGE STRIPING SERVICES INC- INSURERC: 1054 Railroad St INSURER D: Corona, CA 92882 INSURERE: INSURER F ' COVERAGES C_FRTI FICA TF NIIMRFR• OOn?707a 1706199 RFVICION NI IMRFR- ?1q THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DDMlYY OMITS GENERAL LIABILITY EACH OCCURRENCE S COMMERCIAL GENERAL LIABILITY P EMI n' $ CLAIMS-MADE ? OCCUR MED EXP (An one rson $ ? - ._ ? -" ' • I PERSONAL 8 ADV INJURY $ ? ? n ? Fes ?1 ?. 1} - GENERAL AGGREGATE $ ' ??? `` ? GEN'L AGGREGATE LIMIT APPLIES PER. ? ?1 PRODUCTS -COMP/OP AGG $ POLICY PRO- LOG' ? - __-. ___-__. .'.-- $ AUT OMOBILE LIABILITY - -- COMBINED SINGLE LIMIT ? ANV AUTO --..s??- SJ???1S ?? ? ? , ? ,1 ' ??' BODILY INJURY (PBf pB50n) $ S IED ULED ??rt . (--''t ? BODILY INJURY (Pet eceitlent) $ AUTO AUTOS ??ti? A ON SWIJED P BOe E T n` AMAGE R $ HIRED AUTOS O A P ? a UMBRELLA LIAR OCCUR EACH OCCURRENCE $ E%CE33 LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ A WORKERS COMPENSATON AND EMPLOYERS' LIABILITY N WCP-BC11594-12 08/0'1/20'12 06/0'1/20'13 X VVC STATU- OTH- / ,,, ANV PROPRIETOR/PARTNER/EXECUTIVE ? E.L- EACH ACCIDENT $ 1 000,000 OFFICERrtNEMBER EXCLUDED? N N / A 1 000 000 (Mandatory In NH) E.L. DISEASE - EA EMPLOYE $ If yes. de5Uiba untler 1 000 U00 DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATONS / LOCATONS /VEHICLES IAttaetl ACORD 101, AtldlHOrul Ramsrks Scbatlub, If more space Is raqulreE) 10 DAYS NOTICE WILL BE SENT FOR NON PAYMENT OF PREMIUM. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF SANTA ANA THE EXPIRATON DATE THEREOF, NOTICE WILL BE DELIVERED IN ATTN• ROCK GARCIA ACCORDANCE WITH THE POLICY PROVISIONS. 305 E 4TH STREET SUITE 201 . , SANTA ANA, CA 92701 AUTHOR ED REPRESENTATNE a CES ?/?'?'?©T988?Di61FC'ORD CORPORATION. All rights reserved. ACORD 25 (20'10/05) The ACORD name and logo are registered marks of ACORD Printed by CES on May 31, 2012 at 03:25PM -`'`co? °- CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DD/YWY) 04/25/2012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. ? IMPORTANT: If the certifleate holder Is an ADDITIONAL INSURED, the polley(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and contlltlons of the Polley, certain polleles may require an elndoreement. A statement on this ceRiflcate does not confer rights to the certlflcate holder In lieu of such endorsement(s). PRODUCER CONTACT ,.,?_,_ ? ?,___ DFI - D)Gerolamo Family Insurance Services 2027 Hamner Ave Norco, CA 92860 License #: OD26889 INSURED INSURER B PRESTIGE STRIPING SERVICES INC. INSURERC: 1054 Railroad St INSURER D: Corona, CA 92882 INSURER E 11SVRER F COVERAGES CERTIFICATE NUMBER: 00012074-X309320 REVISION Nl1MRFR• 9a9 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION O ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED Y THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE A POLICY NUMBER ? MM/DDY/YYFYY MM%DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY PR MI S CLAIMS MADE ? OCCUR - MED EXP (Any one rson $ PERSONAL 8 ADV INJURY S ' GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG $ POLICY PRO- LOC $ A AUT OMOBILE LIABILITY Y N BAP173013 04/29/2012 04/29/2013 Ee eBoCaDt SINGLE LIMIT ,I OOO OOO X ANY AUTO BODILY INJURY (Per person) $ ALL OtMJED AUTOS SCHEDULED AUTOS BODILY INJURY Per aoodant ( ) $ X HIRED AUTOS X NON-0NR?IED AUTOS PROPERTY DAMAGE Per aCCideM $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS IJAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATON KC STATU- OTH- AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDEDi ? N / A G.L. EACH ACCIDENT $ (Mandatory In NH) E.L. DISEASE - EA EMPLOYE $ IT yes, dasbiba under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ DESCRIPTON OF OPERATONS / LOCATONS /VEHICLES (Attach ACORD 101, AddWOnal Ranvrka SebeauM, M more space Is raqulrad) 10 DAYS NOTICE WILL BE SENT FOR NON PAYMENT OF PREMIUM. CERTIFICATE HOLDER IS NAMED AS ADDITIONAL INSURED. JOB: VARIOUS JOB LOCATIONS CERTIFICATE HOLDER cANCFI 1 ATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF SANTA ANA THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ATTN• ROCK GARCIA ACCORDANCE WITH THE POLICY PROVISIONS. 305 E 4TH STREET SUITE 201 . , SANTA ANA, CA 92701 AUTHOR D REPRESENTATIVE a CES V???"F©TgBg`?15'rd1fC'IORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD PrinteU by CES on April 25, 20'12 aY '12:'16PM CENTURY-NATIONAL INSURANCE COMPANY V THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY Insured' PB,ESTIGL" STRIPING 38RV2CH3 IlTc Policy Number BAP 173013 Effective at inception unless a date is filled in _ 4 / 29! 12 AUTOMATIC ADDITIONAL INSUREDS The following provision is added to Section F, page l , Words and Phrases: By this endorsement, your broker may complete an Aoord additional Insured form with the policy liability limit shown on the declarations page, then the entity you are required in a written conrtract ("the contract") to name as an insured, ("the Additonal Insured°) is an insured but only with respect to liability arising out of "your work" foc the Additional Insured. The Limits of insurance provided for the Additional Insured shall not be greater than those required by the contract and, in no event, sha[I the Limits of this polioy be increased by this er?dorsement_ All insuring agreements, exclusions, terms and conditions of the Polley shall apply to the coverages) provided to the Additional insured and such coverage shalt not be enlarged or expanded by reason of the contract. This insurance does not apply-to Bodily Ir?jury.or Property Damage occurring after. ._ . . ail work on the Project to be performed by 'the Named insured at the site of the covered operations has been completed by them. Any coverage provided shall be excess over any other valid and collectible insurance available to the Additional Insured (s) whether primary, excess, contingent or on any other basis. Attached form CN 67 3, Additional insured Endorsement, Is made a pars of this form. CN 615 (5/99) ACORO ? c?r??ci?.? of u?uTr ?nisu?cE ? ? , TiS CERTIFlC?7'E IS ISSUm AS A NIAI'"fETi OF IPFOFaNATON Of?Y AND OONFEFiS NO RIGI-1'TS UPON T-E CFJ7T7FlCATE HOLOEFt TES CER'f7FlCA'1'E 006 NOT AFFlRl1MT\/E1Y OR NC{aATVE1Y ANENIO, EXfETm OR ALT32 T? CONERAC? AFFORDED 6Y Tf POLIpES BE10V1/. TiS CB2ilFlCATE OF INSIIRAWCE GOES NIOT G?ONSf1TJiE A CO/VTRAGT BE7VVEf7N Tf ISSUING INSUF2ER(S), AUTFIOR17?0 Fi?frATVE OR PRODUCER, ANO T? CERYIFlC'ATE HOLDEFd INi10RTANT_ H the certificate kidder is an ADDITONAL IN6URED, the pdicy(ies) mist ba arldorsed ff SUBROGATON IS WAIVm, su6ja[.?t to The tams anti corlditlons of the pdi[,y, certain policies n,ay rs¢ire an erldorserrlerl? A staLerrent on this certiflcabe does r1e1: confer rtgllts to the O@fiifiCa6@ kidder in lieu Of such end«se/TSrtgs). ProoLCOx ?F7 OiG l F il I ? Frar1 T1orYas - ero arno am y rst?rarto>? Services PAx 202/ H A (est ?35s335 „/ w : (ss?)a9a-z?so armer ve N (" A 92860 EJYWL irsararlce.corn orco, . Li # 1 S AFFOI7flING NAICYt certse : O INSIIiE]2 A : A111ESi1CAN STATES IIVSI.IFtAPICE COIVPANY INSI.f?D irc>«ixs: CFJYI"l.1RY NA'1"IONAL INSURANCE PREST7C?E STRIPING SE3Z1/ICES INC. INSUrmxc: NT NATONiAI_ INJSl.A3ANCE 1054 Railroad St rsLr?x o: Ct7??aa CA ?$2 x.LS?rslx E 11?6117f]2 F OOVE32AC?S CB2T7RCATE Pl_lUBB2 oou?2n7e.-_i'inat2n [2F1nCl?fw1 ne [iIIF?R• mat THS IS TO d3=T1 Fl'T'FIAT TF£ POUd6 OF INSURAI?A."'E UST® C?BQ/V H4VE B®V 1 tc Fri TO TI-E I n6URED NM/®ABOVE FCF2 TF-E PpUGY P[SdCip tNac?.aTml N?lw?r?srsv?anG?+Nrl?nul?avE?vr.?aa?noRCCinnlzloN?furroavrFxx.-rocxrnr$xDO?rw-rrlr?crTavwd-+n-Is d32T7F7G4TE M4Y BE I c4 r-r? OR NIAY PE?ifAl N, Tt-E IN3JF7fif.1C? PFFCF?® 61' T'FE PQJd6 OES6d [3® F-B?] N IS SLBJECT TdPLL TFE Tom. pfd I ?On6 AND G?ITCT6 d= SUCH POUd 6 UMl'S SFIOi/1N N14Y F44\/E ?J F?L1C® 6Y PAl D dJV I1/G LiR TYPE aF 11 ?K.Y NlJti?t PQIGY BF POLICY EXP ?? A ?w Lu+?LrrY Y N 01 CC761?i79-8 oa?z2i2o?12 o3Y22i2o1 s ?a i ooc?w?-cE $ 1000 000 X ?LIAauTY vr?n rte.-.,-a..?e $ 1000000 auMS^n"r-'e ? ooc(?rz M? om (A„Y ? r>e?,) $ 1 O 000 X CONTRAGTLAL P6t?JOWiLCf+U/INJLf2Y $ 1000 000 c?-?s?L? $ 000 000 C?YL A>?CATE LIMTAPPIJES PF3t pRCDU[?r^-OOygCiaK3' S QOD OO(] ?c?- X ?° Loc $ g Aur olloaLELUaeLrrY Y N BAP7730'13 ON29/2Dtt 04/29/2012 Eaam?x uMT 1000000 X ANYALfrO BC?C]ILY IN,I_riY (F?r pasvi) $ A11Ql?f?® p?? 9G-F3MJ F^ ?? BUSILY INJLF2Y (Fi3 amclPiY) $ X 1-rr?aa rros X ? rO"?"y'? s $ w?LA Luca oocLSZ EaC71 mc?lax?.cE $ E)ccETas LUas Q/yMGn/aLE AS?TE $ om IzEra.rr?c>u$ $ C LUaa? N WCP-BC1169?t-11 oc?wi?l? osiwi2m2 X vlcsrAny orrl- Y/ N , ? N/A EL Fxr.s.mcarr $ 1,000x000 a? Fxa?cma (N II? a 4merY 1^NW EL dSFA?-EA $ 1000,000 y a w IOFSGTi1?ON ?H3liTQ.G bciov EL CJIgA?-PaJGY LIMT $ 1000,000 pESOlaPil01.1 OF OPERATIQJS / LOrATIQ?S / ?/E]iC1..ES (IYtxJi AOOr2p 101. Addtivd Reaivf6 Stlasotala, it rava apace is ragaJrey 10 QAYS NOTICE WLL BE SBYf FOR NON PAYIVH?iT OF PRE311?UM CER:77FICATE 1-IOLOg21S NAN® F.S ACOITIONAL INSURED. C?OMBZ4G? IS PRIINARY 8. NON CONTRIBIffORY .106: VARIOIfS ?IOB 1 M-eT10KS C?FZiiHC:Alt /-7C.A17FJi _ ?C.JC __ _ .._/---_(X ?f'ELeTON Laura Stit' ?i. Assistant C i "?. i t ? . , ?^I-IOtLO ANY OF Tl-E A®01/E OESCRIBm POLICIES BE L'_AIVf'Fl I r-r1 BEFORE CITY OF SANTA ANA nE exPlRAnoN ?4TE TI?OF, Nonce wtLL BE rKI .v6sm w ATTN. ROCK GiARGA Aooor?Anlce VNT-I TMta= va?ev PRCT/ISIOPLS. 30ra E 4TH ST1?T, SIJTE 201 SANTA ANA, CA 9270'1 .u,r>~IV:?_ o ?.svarAT/n.E ©'I?2010 AOOF20 OOFZPORP.TONL All rights reserved. AOOF20 2S (2D'10/0? T?1e ACORN narriz and logo are regist8red rrtarl¢ aAF ACOr? PrirYel:i by FF-ff on N/hrdi 20. 20'12 at 1216PM PRESTIGE STRIPING SERVICES, INC. OI CG 768379-8 COMMERCIAL GENERAL LIABILITY CG 76 35 02 07 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. LIABILITY PLUS ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: ANY PERSON OR ORGANIZATION FOR WHOM YOU ARE REQUIRED BY WRITTEN CONTRACT, AGREEMENT OR PERMIT TO PROVIDE ADDITIONAL INSURED COVERAGES ADDITIONAL INSURED - BY WRITTEN lease or occupy, subject to the following CONTRACT, AGREEMENT OR PERMIT, OR additional provisions: SCHEDULE (a) This insurance does not apply to The following paragraph is added to WHO IS AN any ^occurrence" which takes place r INSURED (Section II): premises leasedto or rented to any 4. Any person or organization shown in the Sched- yOU• ule or for whom you are required by written con- (b) This insurance does not apply to tract, agreement or permit to provide insurance any structural alterations, new con- is an insured, subject to the following additional struction or demolition operations provisions: performed by or on behalf of the a. The contract, agreement or permit must be person or organization added as an in effect during the policy period shown in insured; the Declarations, and must have bean exe- (2) Your ongoing operations for that in- cuted prior to the "bodily injury°, "property sured, whether the work is performed damage^, or °personal and advertising by you or for you; injury.. (3) The maintenance, operation or use by b. The person or organization added as an in- you of equipment leased to you by such sured by this endorsement is an insured only person or organization, subject to the to the extent you are held liable due to: following additional provisions: (1) The ownership, maintenance or use of (a) This insurance does not apply to that part of premises you own, rent, any °occurrence" which takes place after the equipment lease expires; Includes Copyrighted Material of Insurance Services Office, Inc., with its permission- Copyright, Insurance Services, 2001 CG 76 35 02 07 Page 1 of 4 EP AFP-META2-14-PPINT001-297?-00.5SA "" REPRINTED FROM THE ARCHIVE. THE ORIGINAL TRANSACTION MAV INCLUDE ADDITIONAL FORMS "" (b) This insurance does not apply to "bodily injury" or °property dam- age" arising out of the sole negli- gence of such person or organization; (4) Permits issued by any state or political subdivision with respect to operations performed by you or on your behalf, subject to the following additional pro- vision: This insurance does not apply to "bodily injury", "property damage", or `personal and advertising injury" arising out of operations performed for the state or municipality. c. The insurance with respect to any architect, engineer, or surveyor added as an insured by this endorsement does not apply to "bodily injury", °property damage^, or °per- sonal and advertising injury" arising out of the rendering of or the failure to render any professional services by or for you, ihclud- ing: (1) The preparing, approving, or failing to prepare or approve maps, drawings, opinions, reports, surveys, change or- ders, designs or specifications; and (2) Supervisory, inspection or engineering services. d. This insurance does not apply to "bodily injury" or °property damage" included within the "products-completed operations haz- ard". A person's or organization's status as an insured un- der this endorsement ends when your operations for that insured are completed. No coverage will be provided if, in the absence of this endorsement, no liability would be imposed by law on you. Coverage shall be limited to the extent of your negligence or fault according to the applicable princi- ples of comparative fault. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the °bodily injury" or °property damage" involved the ownership, mainte- nance, use or entrustment to others of any aircraft, °auto" or watercraft that is owned or operated by or rented or loaned to any in- sured_ This exclusion does not apply to: (1) A watercraft while ashore on premises you own or rent; (2) A watercraft you do not own that is: (a) Less than 52 feet long; and (b) Not being used to carry persons or property for a charge; (3) Parking an `auto" on, or on the ways next to, premises you own or rent, pro- vided the "auto^ is not owned by or rented or loaned to you or the insured; (4) Liability assumed under any "insured contract" for the ownership, mainte- nance or use of aircraft or watercraft; or (5) "Bodily injury" or "property damage" arising out of: (a) the operation of machinery or equipment that is attached to, or part of, a land vehicle that would qualify under the definition of `mobile equipment" if it were not subject to a compulsory or financial responsibility law or other motor ve- hicle insurance law in the state where it is licensed or principally garaged; or (b) the operation of any of the machin- ery or equipment listed in Paragraph f.(2) or f.(3) of the definition of °mobile equipment". (6) An aircraft you do not own provided it is not operated by any insured. NON-OWNED WATERCRAFT AND NON-OWNED AIRCRAFT LIABILITY Exclusion g. of COVERAGE A (Section I) is replaced by the following: TENANTS' PROPERTY DAMAGE LIABILITY When a Damage To Premises Rented To You Limit is shown in the Declarations, Exclusion j. of Coverage A, Section I is replaced by the following: g. °Bodily injury" or "property damage" arising out of the ownership, maintenance, use or 1' Damage To Property entrustment to others of any aircraft, °auto" "Property damage" to: or watercraft owned or operated by or rented or loaned to any insured. Use includes oper- (7) Property you own, rent, or occupy, including ation and `loading or unloading". any costs or expenses incurred by you, or Page 2 of 4 AFP-META2-14-PRINTOOl4970-0056-A "" REPRINTED FROM THE ARCHIVE- THE ORIGINAL TRANSACTION MAY INCLUDE ADDITIONAL FORMS "" any other person, organization or entity, for repair, replacement, enhancement, restora- tion or maintenance of such property for any reason, including prevention of injury to a person or damage to another's property; (2) Premises you sell, give away or abandon, if the "property damage" arises out of any part of those premises; (3) Property loaned to you; (4) Personal property in the care, custody or control of the insured; (5) That particular part of real property on which you or any contractors or subcontractors working directly or indirectly on your behalf are performing operations, if the "property damage" arises out of those operations, or (6) That particular part of any property that must be restored, repaired or replaced because 'your work" was incorrectly performed on it. Paragraphs (1 ), (3) and (4) of this exclusion do not apply to "property damage° (other than damage by fire) to premises, including the con- tents of such premises, rented to you- A separate limit of insurance applies to Damage To Prem- ises Rented To You as described in Section 111 - Limits Of Insurance. Paragraph (2) of this exclusion does not apply if the premises are "your work" and were never occupied, rented or held for rental by you. Paragraphs (3), (4), (5) and (6) of this exclusion do not apply to liability assumed under a side- track agreement. Paragraph (6) of this exclusion does not apply to "property damage" included in the `products- completed operations hazard". Paragraph 6. of LIMITS OF INSURANCE (Section III) is replaced by the following: 6. Subject to 5. above, the Damage To Premises Rented To You Limit is the most we will pay un- der Coverage A for damages because of °property damage" to any one premises, while rented to you, or in the case of damage by fire, while rented to you or temporarily occupied by you with permission of the owner. The Damage To Premises Rented To You limit is the higher of the Each Occurrence Limit shown in the Declarations or the amount shown in the Declarations as Damage To Premises Rented To You Limit. CG 76 35 02 07 WHO IS AN INSURED -MANAGERS The following is added to Paragraph 2.a. of WHO IS AN INSURED (Section II ): Paragraph (1) does not apply to executive officers, or to managers at the supervisory level or above. SUPPLEMENTARY PAYMENTS -COVERAGES A AND B - BAIL BONDS - TIME OFF FROM WORK Paragraph 1.b. of SUPPLEMENTARY PAYMENTS - COVERAGES A AND B is replaced by the following: b. Up to $3,000 for cost of bail bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverage applies- We do not have to furnish these bonds. Paragraph 1.d. of SUPPLEMENTARY PAYMENTS - COVERAGES A AND B is replaced by the following: d. All reasonable expenses incurred by the in- sured at our request to assist us in the in- vestigation or defense of the claim or "suit", including actual loss of earnings up to $500 a day because of time off from work- EMPLOYEES AS INSUREDS - HEALTH CARE SERVICES Provision 2.a.(1)(d) of WHO IS AN INSURED (Section II) is deleted, unless excluded by separate endorse- ment. EXTENDED COVERAGE FOR NEWLY ACQUIRED ORGANIZATIONS Provision 3.a. of WHO IS AN INSURED (Section II) is replaced by the following: a. Coverage under this provision is afforded only until the end of the policy period. EXTENDED "PROPERTY DAMAGE" Exclusion a. of COVERAGE A (Section 1) is replaced by the following: a. "Bodily injury" or "property damage" expected or intended from the standpoint of the insured. This exclusion does not apply to "bodily injury" or "property damage" resulting from the use of reasonable force to protect persons or property. Pege 3 0l 4 EP A F P-M ETA2-t 4-P R I Ni001-2e?0-0057-A "" REPRINTED FROM THE ARCHIVE. THE ORIGINAL TRANSACTION MAY INCLUDE ADDITIONAL FORMS "" EXTENDED DEFINITION OF BODILY INJURY Paragraph 3. of DEFINITIONS (Section V) is replaced by the following: 3. `Bodily injury" means bodily injury, sickness or disease sustained by a person, including mental anguish or death resulting from any of these at any time. TRANSFER OF RIGHTS OF RECOVERY The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of COM- MERCIAL GENERAL LIABILITY CONDITIONS (Sec- tion IV): We waive any rights of recovery we may have against any person or organization because of payments we make for injury or damage arising out of your ongoing operations or "your work^ done under a contract with that person or organization and included in the "products-completed operations hazard". This waiver applies only to a person or organization for whom you are required by written contract, agreement or permit to waive these rights of recovery. interrupted only by a street, roadway, waterway, or right-of-way of a railroad. INCREASED MEDICAL EXPENSE LIMIT The Medical Expense Limit is amended to $t 0,000. KNOWLEDGE OF OCCURRENCE The following is added to Paragraph 2. Duties In The Event Of Occurrence, Offense, Claim Or Suit of COMMERCIAL GENERAL LIABILITY CONDITIONS (Section IV): Knowledge of an °occurrence ", claim or °suit" by your agent, servant or employee shall not in itself constitute knowledge of the named insured unless an officer of the named insured has received such notice from the agent, servant or employee. UNINTENTIONAL FAILURE TO DISCLOSE ALL HAZARDS The following is added to Paragraph 6. Representa- tions of COMMERCIAL GENERAL LIABILITY CONDI- TIONS (Section IV): AGGREGATE LIMITS OF INSURANCE - PER LOCATION For all sums which the insured becomes legally obli- gated to pay as damages caused by "occurrences" under COVERAGE A (Section I), and for all medical expenses caused by accidents under COVERAGE C (Section I), which can be attributed only to operations at a single "location^: Paragraphs 2.a. and 2.b. of Limits of Insurance (Sec- tion III) apply separately to each of your °locations" owned by or rented to you. `location ^ means premises involving the same or connecting lots, or premises whose connection is If you unintentionally fail to disclose any hazards ex- isting at the inception date of your policy, we will not deny coverage under this Coverage Form because of such failure. However, this provision does not affect our right to collect additional premium or exercise our right of cancellation or non-renewal. LIBERALIZATION CLAUSE The following paragraph is added to COMMERCIAL GENERAL LIABILITY CONDITIONS (Section IV): 10. If a revision to this Coverage Part, which would provide more coverage with no additional pre- mium, becomes effective during the policy period in the state shown in the Declarations, your pol- icy will automatically provide this additional cov- erage on the effective date of the revision. Page 4 of 4 AFP-M ETA2-14-PP INTOOI -2870-0058-A PRESTIGE STRIPING SERVICES INC. O1 CG 768379-8 CG 76 80 10 02 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED PRIMARY COVERAGE This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Name of Person or Organization: BLANKET ADDITIONAL INSURED SCHEDULE (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) SECTION 11 -WHO IS AN INSURED is amended you. Coverage shall be limited to the extent of your to include as an additional insured the person or negligence or fault according to the applicable princi- organization shown in the Schedule subject to the ples of comparative fault. following provisions: ?. The additional insured is an insured but only for liability directly resulting from: a. your ongoing operations for the additional in- sured whether the work is performed by you or for you; or b. the general supervision of your ongoing op- erations by the additional insured. 2. This insurance does not apply to: a. °BOdily injury" or "property damage" arising out of any act or omission of, or for defects in design furnished by or for, the additional insured or b. "Bodily injury" or °property damage° in- cluded within the "products-completed oper- ations hazard.° A person's or organization's status as an additional insured under this endorsement ends when your op- erations for that insured are completed. No coverage will be provided if, in the absence of this endorsement, no liability would be imposed by law on CG 76 80 10 02 The insurance provided will not exceed the lesser of: a. The coverage and/or limits of this policy, or b. The coverage and/or limits required by the contract, agreement or permit. With respect to the insurance afforded the additional insured, paragraph 4. of SECTION IV - COMMER- CIAL GENERAL LIABILITY CONDITIONS is de- leted and replaced by the following: 4. Other Insurance a. This insurance is primary and noncontrib- utory, and our obligations are not affected by any other insurance where the additional in- sured is the Named Insured, whether pri- mary, excess, contingent, or on any other basis; however, the defense of any claim or "suit" must be tendered as soon as practi- cable to all other insurers which potentially provide insurance for such claim or °suit". b. This additional provision applies only to the additional insured shown in the Schedule and the coverage provided by this endorse- ment- EP AFP-MEfA2-14-PRINT001-2870-0059-A ,r 0c"k, (J?r7frr. 1 ncoRCb® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 1ft 06/11/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT Fran Thomas NAME: DFI DiGerolamo Family Insurance Services PHONE (951)735-5335 ac Nn: (951)893-2750 AID No.,Xu. 2027 Hamner Ave E- MAIL ADDRESS: Fran@dfiinsurance.com Norco, CA 92860 " // ? . ? U' - INSURERS AFFORDING COVERAGE NAICB 6J / ? License #: OD26889 ? / fJC INSURER A: Amercian States Ins. Co. INSURED INSURER B. Century National Insurance PRESTIGE STRIPING SERVICES INC. INSURER C: 1054 Railroad St INSURER D: Corona, CA 92882 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 00012074.4488788 REVISION NUMBER: 392 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYpE OF INSURANCE ADDLSUSR POLICY NUMBER POLICY EFF I POLICY EXP MMIDDIYYYY' MMIDDIYYVV LIMITS A GENERALLIABILITY Y 01CG76837990 03/22/2013 0312212014 EACH OCCURRENCE $ 1 060000 X COMMERCIAL GENER AL LIABILITY PREMSES Ea accorre $ 1 000 000 ? ? CLAIMS-MADE til OCCUR MED EXP(Anyone person) $ 10,000 X CONTRACTUAL _ PERSONAL aADVINJURY _ $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATELIMIT APPLIES PER PRODUCTS-COMP/OP AGO $ 2,0000,000 POLICY X PRO- LOC _ S B AUT OMOBILE LIABILITY Y BAP0173013 1 0412912013 04I29I2014 COMB INEDSINGLE LIMIT Ea accdent i $ 1,000,000 X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accltlenQ $ X X NON-OWNED PROPERTYDAMAGE _ $ HIRED AUTOS AUTOS (Per accident $ MBRELLA LIAR OCCUR ry ` 1, ?- EACH OCCURRENCE $ EXCESS LIAR ?r ?9 ' R/ ?t _ A CLAIMS-MADE H I1 F1 ^" 1/? AGGREGATE $ _ RETENTION$ DIED $ WORKERS COMPENSATION K ? WC STATU- GTH- AND EMPLOYERS' LIABILITY S R C O LIM TS YIN ?ISA e ECUTIVE? ANY PROPRIETORIPA NIA {C Attorn E.L. EACH ACCIDENT $ OFFICEWMEMBEER EXCLUDED? (Mandatory In NH) i 515tan E.L. DISEASE-EA EMPLOYE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ l DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) 10 DAYS NOTICE WILL BE SENT FOR NON PAYMENT OF PREMIUM. CERTIFICATE HOLDER IS NAMED AS ADDITIONAL INSURED. COVERAGE IS PRIMARY & NON CONTRIBUTORY JOB: VARIOUS JOB LOCATIONS CERTIFICATE HOLDER CANCELLATION CITY OF SANTA ANA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ATTN: ROCK GARCIA ACCORDANCE WITH THE POLICY PROVISIONS. 305 E 4TH STREET SUITE 201 . , SANTA ANA, CA 92701 AUTHORIZE ENTATIV ( FHT ep @ 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD Printed by FHT on June 11, 2013 at 12:56PM PRESTIGE STRIPING SERVICES INC. 01 CG 768379-9 CG 76 80 10 02 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED PRIMARY COVERAGE This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: BLANKET ADDITIONAL INSURED (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) SECTION 11 - WHO IS AN INSURED is amended to include as an additional insured the person or organization shown in the Schedule subject to the following provisions: 1. The additional insured is an insured but only for liability directly resulting from: a. your ongoing operations for the additional in- sured whether the work is performed by you or for you; or b. the general supervision of your ongoing op- erations by the additional insured. 2. This insurance does not apply to: you. Coverage shall be limited to the extent of your negligence or fault according to the applicable princi- ples of comparative fault. The insurance provided will not exceed the lesser of: a. The coverage and/or limits of this policy, or b. The coverage and/or limits required by the contract, agreement or permit. With respect to the insurance afforded the additional insured, paragraph 4. of SECTION IV - COMMER. CIAL GENERAL LIABILITY CONDITIONS is de- leted and replaced by the following: a. "Bodily injury" or "property damage" arising 4. Other Insurance out of any act or omission of, or for defects a. This insurance is primary and noncontrib. in design furnished by or for, the additional utory, and our obligations are not affected by insured or any other insurance where the additional in- b. "Bodily injury" or "property damage" in- sured is the Named Insured, whether pri- cluded within the "products-completed oper- mary, excess, contingent, or on any other ations hazard." basis; however, the defense of any claim or "suit" must be tendered as soon as practi- A person's or organization's status as an additional cable to all other insurers which potentially insured under this endorsement ends when your op- provide insurance for such claim or "suit". erations for that insured are completed. b. This additional provision applies only to the additional insured shown in the Schedule No coverage will be provided if, in the absence of this and the coverage provided by this endorse- endorsement, no liability would be imposed by law on ment. APPROVED AS TO FORM CG 76 80 10 02 _ EP L SA E. 57f)RCK Assistant City Attorney AFPMETA2-14 PRiNT00128700059-A Y ... REPRINTED FROM THE ARCHIVE. THE ORIGINAL TRANSACTION MAY INCLUDE ADDITIONAL FORMS -- PRESTIGE STRIPING SERVICES INC. CG 86 72 10 02 I POLICY NUMBER: 01-CG-768379-7 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED OWNERS, LESSEES OR CONTRACTORS COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: Any person or organization for whom you are required by written contract, agreement or permit to provide completed operations Location and Description of Completed Operations: coverage Additional Premium: (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) SECTION II - WHO IS AN INSURED is amended to include as an insured the person or organization shown in the Schedule, but only to the extent you are held liable due to "your work" at the location designated and described in the schedule of this endorsement for that insured and included in the product-completed operations hazard". Includes Copyrighted Information of ISO Properties, Inc., 2001 with permission APPROVED AS TO FORIA CG 86 72 10 02 __ ._....EP a A E', /(f Assistant City AttfF rq?7 2214rPRINT001-28700060-A CENTURY-NATIONAL INSURANCE COMPANY V THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY Insured: PRESTIGE, STRIPING SERVICES INC Policy Number BAP 173013 Effective at inception unless a date is filled in__Qd/29?3_- AUTOMATIC ADDITIONAL INSUREDS The following provision is added to Section F, page 1, Words and Phrases: By this endorsement, your broker may complete an Acord additional Insured form with the policy liability limit shown on the declarations page, then the entity you are required in a written contract ("the contract") to name as an Insured, ("the Additional insured") is an insured but only with respect to liability arising out of "your work" for the Additional Insured, no d event, shall r the Emits of this greater policy be insurance The Limits of those equirredby the contracted afor nd, the increased by this endorsement. All insuring agreements, exclusions, terms and conditions of the Policy shall apply to the coverageis) provided to the Additional insured and such coverage shall not be enlarged or expanded by reason of the contract. after. This insurance does not to be apply-to y -th perrfformed be Named Insured at the occurring all site of the all work on the project to be p covered operations has been completed by them. ?Any coverage provided shall be excess over any other valid and collectible insurance ( available to the Additional Insured (a) whether primary , excess, contingent or on an ??ppther basis. Attached form CN 613, Additional Insured Endorsement, is made a part of this form. APPROVED AS TO FORM LISA E. 570?,CK ???_? CN 615 (5/99) Assistant City Attorney AC"Ra' CERTIFICATE OF LIABILITY INSURANCE DATE IMMIODmVY) 04126/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the pollcy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT SDZIe Marie Motes NAME: DFI - DiGerolamo Family Insurance Services P FAX HONE (951)736-5335 Alc No: 957 893-2750 2027 Hamner Ave E-MAIL ADDRESS: suzle@dflinsurance.com Norco, CA 92860 I ' {? q / ? J A /° y n / 1 ' { J -44" ) 10 -( -0 INSURERB AFFORDING COVERAGE NAIC# License #: OD26889 INSURERA: Century National Insurance INSURED INSURER 6: PRESTIGE STRIPING SERVICES INC. INSURER C: 1054 Railroad St INSURER D: Corona, CA 92882 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 00012074-4488788 REVISION NUMBER: 381 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR R TYPE OF INSURANCE ADOL SUER POLICY NUMBER MMIDDYIYYYEFF YY MMIDD? LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence $ CLAIMS-MADE ? OCCUR MED EXP(Anyoneperson) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ G U AGGREGATE LIMIT APPLIES PER'. _ PRODUCTS - COMP/OP AGG $ POLICY PRO LOC ?EUT $ A AUTOMOBILE LIABILITY Y N BAP0173013 0412912013 0412912014 CO MBINED SINGLE LIMIT EA accident) 11000,000 $ X ANY AUTO BODILY INJURY(Perperson) $ ALL OPMED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) $ X HIRED AUTOB X A?TOSWNED 1 Per acid nDAMAGE 1 $ UMBRELLA LIAB OCCUR 13 EACH OCCURRENCE $ EXCESS LIAB 9 CLAIMS-MADE '4V' AGGREGATE $ 0 DED RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY C?Oe? 5 ' 7 pv . WC STATLL OTH- YIN Lt ;'(,1 Vt t - - -- ANYPROPRIETORIPARTItlER/EXECITFIVE ? NIA t'd ?I ' E. L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? l a v vJ (Mandatory In NH) ? ' 1. E.L. DISEASE - EA EMPLOYE $ If yes, describe under DESCRIPTION OF OPERATIONS below wtir' E, L, DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space le required) 10 DAYS NOTICE WILL BE SENT FOR NON PAYMENT OF PREMIUM. CERTIFICATE HOLDER IS NAMED AS ADDITIONAL INSURED. COVERAGE IS PRIMARY & NON CONTRIBUTORY JOB: VARIOUS JOB LOCATIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF SANTA ANA THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ATTN: ROCK GARCIA ACCORDANCE WITH THE POLICY PROVISIONS. 305 E 4TH STREET SUITE 201 . , SANTA ANA, CA 92701 AUTHORIZED REPRESENTATIVE /`?J,p???? `' •?' K? SMM ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD Printed by SMM on April 26, 2013 at 02:11 PM CENTURY-NATIONAL INSURANCE COMPANY V THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY insured: PRESTIGE STRIPING SnVICES INC Policy Number BAP 173013 Effective at inception unless a date is filled in Q4/2J/ 013 . AUTOMATIC ADDITIONAL INSURED$ The following provision is added to Section F, page 1, Words and Phrases: By this endorsement, your broker may complete an Acord additional insured form with the policy liability limit shown on the declarations page, then the entity you are required in a written contract ("the contract") to name as an insured, ("the Additional Insured") is an insured but only with respect to liability arising out of "your work" for the Additional Insured, The Limits of insurance provided for the Additional Insured shall not be greater than those required by the contract and, in no event, shall the Limits of this policy be increased by this endorsement. All Insuring agreements, exclusions, terms and conditions of the Policy shall apply to the eoverageis) provided to the Additional insured and such coverage shall not be enlarged or expanded by reason of the contract. This insurance does not apply-to Bodily injury.or Property Damage occurring after. all work on the project to be performed by,the Named Insured at the site of the covered operations has been completed by them. Any coverage provided shall be excess over any other valid and collectible insurance available to the Additional insured (s) whether primary, excess, contingent or on any other basis. Attached form CN 613, Additional Insured Endorsement, is made a part of this form. CN 615 (SJ99) A?R&' CERTIFICATE OF LIABILITY INSURANCE DATE MMIODP(YYYj THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: It the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Patriot Risk & Insurance Services CONTACT NAME: 8105 Irvine Center Drive #400 Irvine, CA 92618 PHONE wc.No,Exo: (949) 486-7900 'PAX (AID, Not: (949) 486-7950.. E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAICk wvrw.pairisk.Carn. _ 9665454.._... INSURERA: Old.Repubhc Construction. , 24139. IN UREO rest+ga Str(pin Services, Inc. 1054 Railroad treat INSURER B: i. INSURER C Corona CA 92882 111-0190 0 -0-i/y INSURER D { INSURER E : INSURER F: COVERAGES CERTIFICATE NUMBER: 16 63079 REVISION NUMBER; THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSH' {ADOLSUBRi LTR TYPE OF INSURANCE I ... ... POLICY EPF POLICY E%P. POLICY NUMBER I Y i LIMITS 1 GENERAL LIABILITY 1 EACH OCCURRENCE IS GOMMERGIAL GENERAL LIABILITY DAMAp6?'E TO RENTED PREMISES(Ea oeeurmneo) !S CLAIMS MADE I.........I OCCUR MEG EXP(An, one person) ITS PERSONAL S ADV INJURY IS... i .. .... '.. i I I GFFIERAL AGGREGATE (S G_GN'L AGGRCGAT_E LIMIT APPLIES PER. I PRC)• PRODUCTS COMPIOP AGE -I F Qy? P POLICY LOS IFCT ...._.? AJ S _ A 01 ..._._ .d TO AUTOMOBILE LIABILITY V INE D SINGLE LIMIT S aCcj A L _i ANY AUTO BODILY INJURY (Per person{ S AL L OWNED SCHEDULED {iAUTOS !AUTOS - ---?"'"BODILY INJURY (Par acGtlenp l$ •.?,,,y, HIRF.U AUTOS NON.O`AMLD AUrOS j She w,,,..?-• C?'tyegCl? Pf`OPERTY DAMAGE atlfa Stitt (Por accldeng_ _ S t ' l istant City Attorney S Ass UMBRELLA LIAR OCCUR % EACH OCCURRENCE IS EXCESS LIAB CLAIMS-MADE AGGREGATE $ ,. I UED ` _! RETENTIONS S S A WORKERS COMPENSATION ' AIC,W06191300 611/2013 16/1/2014 ? rDaY LIAMPE OEt?I- IANDEMPLOYERS LIABILITY YIN -, - ANYPROPRIETORIPARTNERIEXECUTNE Et EACH ACCIDENT $ 1 000 000 D NIA OPFICERIMEMBER EXCLUDEOT l (Mantlatory In NIh , , - - r 1 EL DISEASE PA EMPLOYEE! S 1,000000 Dunder DESCRIPTION OF OPERATIONS bHOw , EL DISEASE POLICY LIMITS 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks SCnddule, If mom apnea la roqulmd) 30-days notice of cancellation / 10-days for non-payment of premium. CERTIFICATE HOLDER NDPI I ATION CA , SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn: Rock Garcia ACCORDANCE WITH THE POLICY PROVISIONS. 305 E. 4th Street Suite #201 Santa Ana CA 9'2701 AUTHORIZED REPRESENTATIVE k Leonard E. Ziminsky ©1998.2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010106) The ACORD name and logo are registered marks of ACORD li ?z1 "t i issued certificates. ILkFiin ccxtil'1' cate"cane, s -ans°siipe'x.lec le ". I p '- y