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HomeMy WebLinkAboutOC SAFETY INC. - 2013INSURANCE ON FILE WORK MAY PROCEED UNTIL INSURANCE EXPIRES N-2013-001 CLERK OF COUNCIL DATE: 4JAN g 2013 CONSULTANT AGREEMENT ?. ??? C I? ?Y?zc.P?? THIS AGREEMENT, made and entered into on January 1, 2013 by and between OC Safety Inc., a California corporation (hereinafter "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 emergency first aid and CPR/AED training. B. Consultant represents that it is able and willing to provide such services to the City. C. In undertaking the performance of this Agreement, Consultant represents chat 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: SCOPE OF SERVICES Consultant shall perform those services as set forth in Exhibit A to this Agreement. COMPENSATION a. City agrees to pay, and Consultant agrees to accept as total payment for its services, the rates and charges identified in Exhibit A. The total sum to be expended under this Agreement shall not exceed $25,000 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 imay reasonably be expected by City. 3. TERM This Agreement shall commence on the date first written above and terminate on December 31, 2013 unless terminated earlier in accordance with Section 12, below. The term of this Agreement may be extended upon a writing executed by the Executive Director of the Personnel Services Agency and the City Attorney. 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 which 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, $2,000,000 in the aggregate. Such insurance shall (a) name the City, its officers, employees, agents, volunteers and representatives as additional insured(s); (b) be primary and not contributory with respect to insurance or self-insurance programs maintained by the City; and (c) contain standard separation of insureds provisions. b. Worker's Compensation Insurance. In accordance with the provisions of Section 3700 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. C. If Consultant is or employs a licensed professional such as an architect or engineer: Professional liability (errors and omissions) insurance, with a combined single limit of not less than $1 ,000,000 per claim. 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. f. 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 affect 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: (1) for personal injury, damages, just compensation, restitution, judicial or equitable relief arising out of claims for personal injury, including death, 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; and (2) from any claim that personal injury, damages, just compensation, restitution, judicial or equitable relief is due by reason of the terms of or effects arising from this Agreement. This indemnity and hold harmless agreement applies to all claims for damages, just compensation, restitution, judicial or equitable relief suffered, or alleged to have been suffered, by reason of the events referred to in this Section or by reason of the terms of, or effects, arising from this Agreement. The 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 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 shall not apply to any information that (aj 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 Fax 714- 647-6956 With courtesy copies to: and To Consultant: Personnel Services City of Santa Ana 20 Civic Center Plaza (M-28) P.O. Box 1988 Santa Ana, California 92702 Fax 714- 647-531 ] City Attorney City of Santa Ana 20 Civic Center Plaza (M-29) P.O. BOX 1988 Santa Ana, California 92702 Fax 714- 647-65 1 5 A party may change its address by giving notice in writing to the other party. Thereafter, any communication shall be addressed and transmitted to the new address. If sent by mail, communication shall be effective or deemed to have been given three (3) days after it has been deposited in the United States mail, duly registered or certified, with postage prepaid, and addressed as set forth above. If sent by telefacsimile, communication shall be effective or deemed to have been given twenty-four (24) hours after the time set forth on the transmission report issued by the transmitting facsimile machine, addressed as set forth above. For purposes of calculating these ti?r?e 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 teens or conditions of any purchase order or other instrument that are inconsistent with, or in addition to, the terms and conditions hereof, shall not bind or obligate 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 entitied 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 Executive Director 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 property of the City unless prohibited by law, and Consultant consents to the City's use thereof for such purposes as the City deems appropriate. b. Payment need not be made for work which fails to meet the standard of performance specified in the Recitals of this Agreement. 13. DISCRIMINATION 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 its inability to obtain or maintain such permits, licenses, approvals, waivers, and exemptions. Said inability shall be cause for termination of this Agreement. 16. MISCELLANEOUS PROVISIONS a. Each undersigned represents and warrants that its signature hereinbelow has the power, authority and right to bind their respective parties to each of the terms of this Agreement, and 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. ?-FF SAN ANA IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first above written. ATTEST: ??i!! MARIA D. HUI7_..A'1 `_'C{erlc ofche Cauncil PAUL M. WALTERS City Manager APPROVED AS TO FORM: SONIA R. CARVALH City rney By -n-??• Jo Stro/a hi f Assistant City Attorney RECOMMENDED FOR APPROVAL: Edw? Ram y? Executive Director Personnel Services Agency CONSULTANT Jo a Placa, ner EXHIBIT A SCOPE OF SERVICES Exhibit A Heartsaver ®First Aid CPR AED The Heartsaver ®First Aid CPR AED course provides first responders with training in basic first aid and CPR AED procedures. Participants will receive an American Heart Association 2-Year Certification card at the successful completion of the training. The course covers: First Aid Basics Medical Emergencies Injury Emergencies Environmental Emergencies Adult CPR AED Adult Choking Minimum Rate $564.00 (includes up to 12 students) Additional Students $ 47.00 WORKERS' COMPENSATION DECLARATION I (? a ktJ Lfl (LpCk I'?'DES 10?•('r hereby affirm under penalty of perjury, the (Name/Title) following declaration I certify on behalf of ?C SR?E"(?J ?t?pG . that during the term of my (Organization Name) contract with the City of Santa Ana, I will not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. DATE: ? ? ? ?»? Y? Name: ? ltl? ? -?L-?C?" c Title: ?1?5??%tJ"? Telephone: ???- G?- ?? ?, WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. -4c v® CERTIFICATE OF LIABILITY INSURANCE DATE IMM/DD/YYYY) G7/lO /2012 PRODUCER THIS CERTIFICATE IS ISSUED AS MATTER OF INFORMATION Ric wai ss ingc>r- Tnsl; ra nce Aganc y, inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Ric Weiss ir_ge r, Agent Lic q GC65167 HOLDER- THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 5922 Warner P_ve, Hunt :.ng ton Beach CA 52695 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW_ a - INSURERS AFFORDING COVERAGE _. NAIC 7C INSURED N=2013-001 O C SAFETY INC' .._------------- INSURERA-State Farm Genfial. I.nsu Tanctl Company 2S1Si _. __ ......... .. . ... ... _ -_ -. _. - ?-- ? ??_- $952 BOOTHBe'1Y CT_R INSURER B- HUNT INGTN BCH CA 92 69 6-4 4 02 INSVRERC INSURER D INSURER E COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER OOCUM ENT WITH RES PEC7 TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES- AGGREGATE LIMITS SHOWN MAY HAVE BEEN REOUC ED BY PAID CLAIMS. INSR ADD'L - - POLN]Y EFFECTIVE POLICY EXPIRATNJN -- LTR IN$RD TYPE OF INSURANCE POLICY NVNBER DATE NM/pD/YY DATE NM/DD/YY LIMITS X X GEN ERAL LIABWTY 52-CD-K091-4 G 04-02-2012 04-02-201 3 EACH OCCURRENCE $ 1, GOO, OOO X COMMERG WL GENERAL LIABILITY PREMISES Ea pcarrence 5 100,000 _ _ CLAIMS MADE ?OCCVR MEO EXP An one arson S 5. JOO ._. _. _.__._- PERSONAL6ADV INJURY $ r OOO r'OOG GENERAL AGGREGATE S 2. 0 0 0, G O G GENE AGCfiEG4TE ! MTa-QI-IES PEa PRODUCTS - coMPIOPAGC E 2 , O O G , G O O X PR6 X POLICY JECT X LOC AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT S (Ee arsdan0 ANY AUTO ALL OWNED AUTOS BODILY INJURY E (Par parson) SCHEDULED AUTOS HIRED AUTOS BODILY INJURY E NON-OWNED AUTOS (Par ar<wanp - PROPERTY DAMAGE $ (Per aCtderN) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ Q ? ANY AVTO A'Q ' ? ? OTHER THAN EA ACC S 11 AVTO ONLY. AGG $ EYCESSIUNBRELIA LIABILITY Q EACH OCCURRENCE S OCCUR C? CLAIMS MADE 44? ? AGGREGATE $ A ? ? oto st< E S b ? DeoucnBLE ?C ? s _ S? G, _ __ RETENTION $ S WORKERS CONPENSATIOM AND EMPLOYERS' LIABILITY ?iJts TORY LIMITS ER ANY PROPRIETOR/PARTN ER/EXECUTIVE E.L. EACH ACCIDENT E OFFICER/MEMBER EXCIUDED9 E.L DISEASE - EA EMPLOYEE E If yas. Describe rMar SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT E X OTHER ? 6usiness Property 92-CD-KG51-4 L 04-02-20 L2 G9-02-"201.3 S 45, OGO DESCRIPTION OF OPERATIONS / LOCATKJNS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS ::oC kl - 199E N TUSTIN ST STE 103, ORANGE, CA 92865 CFRT?FICTE HOLUF_R, TTS OFFICERS, AGENTS AND EMPLGYL:ES AlYE NAMS?D AS ADDITIONAL INSCTRRD 7N REGARDS TO G?NT_-:RAE LSABI LI7'Y t'ER l'YTACHED FEF?G9 C FRTI FIC ATF HCII T]FR C:ANC ELI_A r IL)N SHOVED ANY OF THE ABOVE DESCRIBED POUCIE6 BE CANCELLED BEFORE THE EXPIRATION C 1'I'Y OF' SANTA RNR DATE THEREOF, THE ISSUING INSURER WILL ENBEAVBR TO MAIL 32 DAYS WRITTEN RT TN PU RC HAS ING DE PARTMF: N'L' NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, L 20 CIVIC CENTHR PLAZA SANTA ANA, CA 92::11 HOR42 D R RE3 TA E • • 'c ?ssinger, Agent T32B49 03-13-2007 ? ? • v All rights f@SBrVBd IMPORTANT ff the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2001108) uLiM Policy No.: 92 CDK091 4 FE-ssos SECTION II ADDITIONAL INSURED ENDORSEMENT Policy No_: 92 CDK091 4 Named Insured: OC SAFETY INC Additional Insured (include address): CITY OF SANTA ANA, ITS OFFICERS, AGENTS, AND EMPLOYEES 20 CIVIC CENTER PLAZA SANTA ANA, CA 9270'1 WHO IS AN INSURED, under SECTION II DESIGNATION OF INSURED, is amended to include as an insured the Additional Insured shown above, but only to the extent that liability is imposed on that Additional Insured solely because of your work performed for that Additional Insured shown above. Any insurance provided to the Additional Insured shall only apply with respect to a claim made or a suit brought for damages for which you are provided coverage. The Primary Insurance coverage below applies only when there is an "X" in the box. ® Primary Insurance. The insurance provided to the Additional Insured shown above shall be primary insurance. Any insurance carried by the Additional Insured shall be noncontributory with respect to coverage provided to you. All other policy provisions apply_ FE-6609 Printetl in U.S.A. AcH CER TIFICATE OF LIABILITY INSURANCE 0 0 3 0 4/10/2 1 04/10/2013 PRODUCER THIS CERTIFICATE IS ISSUED AS ATTE OF INFORMATION Ric Weissinger Insura ce Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Ric Weissinger, Agent Lic J1 OC6916L, HOLDER. THIS CERTIFICATE DOES NOT A MEND, EXTEND OR 5922 Warner Ave, Hunti y ng tah` Ssgch" G 9'2-b4 y ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. . i INSURERS AFFORDING COVERAGE NAIC # INSURED O C SAFETY INC _ INSURERA State Farm GeneYal Insuranc Cofran 25151 -- 1940 N TUSTIN ST STE 03 INSURER B: ORANGE CA 92865-46 2 INSURER C: INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE ISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PER IOD INDIC ATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THI S CERTIF CAPE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCL USIONS A ND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS HO_WN MAY HAVE SEEN REDUCED BY PAID CLAIMS, INSR ADM POLICY EFFECTIVE POLICY EXPIRATION LTR INSRD TYPEOFINSURAN POLICYNUMBER DATE MBMIDDfYY) DATE MNDIDnY LIMITS x r, GENERAL LIABILIN 92-CD-K091-4 G 04-02-2013 04-02-2014 EACHO CURRENCE $ 1,000,000 MMERCIAL GEN E LIABILITY PREMISE Ea OC nca $ 100,000 CIAIMS MADE OCCUR MED EYP An ona $ 5,000 T PERSON L$AOV IN URY $ 1,000,000 GENERA AGGREGA E $ 2,000,000 GREGALMT GIN PER. PRCOUC -COMP AGG s 2,000,000 X PRO ICY JECT X L( AUT OMOBILE LIABILITY COMBINE SINGLE L MIT (Ea acrid M) $ ANY AUTO ALL OWNED AUTOS BODILY It JURY SCHEDULED AUTOS (Pwpe ) $ HIREDAUI'OS BODILY If JURY $ NON-0WNED AUTOS (Per acrid n1) _ PROPER DAMAGE $ (Per acrid nf) GARAGEUABIIJTY AUTOON Y-EAAC IDENT $ ANY AUTO OTHER? AN ACC $ AUTO ON ,Y: -' AGG $ EXCESSIUMBRELLA LIABIL EACH OC CURRENCE $ I OCCUR F? CL R A S MADE -` AGGREGA TE $ r .?g'fy ?'?? / f 8 DEDUCTIBLE 7 w ,w - RETENTION ??-- WORKERS COMPENSATION AND " ? 1? IA - WC TATU- OTH- EMPLOYERTLIABILI7Y ._••" 1,V' = pe '?y ' TOR LIMITS ER ANY PROPRIBTURIPARTNERIEXEC TIVE `. ?^ \;. J1 ?4 E.L. EACH ACCIDENT $ OFFICEIVUEMBER EXCLUDED? p,=,.3 yes demdba under ELDISEA E-EAEM LOYEE $ , SPECIAL E. L. DISE E-POLIO LIMIT $ X OTHER Business Property 92-CD-KO91-4 G 04-02-2013 04-02-2014 $ 45, 00 DESCRIPTION OF OPERATIONS I LOCH IONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS Lon #1 - 1940 N TUSTIN ST STE 103, ORANGE, CA 92865 CERTIFICTE HOLDER, ITS OFFICERS, AGENTS AND EMPLOYEES ARE NAMED AS ADDITIONAL IN URED I REGARDS TO GENERAL LIABILITY P R ATTACHED FE6609 CER I i Fi CA e c HOLDER (;ANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIE S BE CANE ED BEFORE THE ExPIRA'nCN CITY OF SANTA ANA DATE THEREOF, THE ISSUING INSURER WILL N05AVOR O MAIL ..AO DAYS WRITTEN ATTN: PURCHASING DEPAR'T'MENT NOTICE TOTHE CERTIFICATE HOLDER NAMED? THE LEFT OUT FAILURE TO DO SO SHALL 20 CIVIC CENTER PLAZA IMPOSE NO IGA,TION OR LIABILITY (INo UPON THE INSURER, ITS AGENTS OR SANTA ANA, CA 92701 q REPR TATIV S. I If ' c RUTH RIZED R R NT V r ger, Agent e registration no Ices indicate ownersIp of t e ma s y weir respective owners (9) RPORATION 1988,2007 132845 03.13.2007 All rights resemod IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endors ed. A st atement on this ce ficate does not confer rights to the certificate holder in lieu of such endor sement( s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, cer tain poll ies may require an endorsement. A statement on this certificate does not confer rights o the c rtificate holder in li u of such endorsement(s). DISCLAIMER The Certifi ate of Insurance on the reverse side of this form does not constitute a ontract etween the issuing insurer(s), authorized representative or producer, and the certificate h der, n does it affirmativel or negatively amend, extend or alter the coverage afforded by the policie i i i i i i li s listed hereon. ACORD 25 (2001108) UUM Policy No.: 92 CDKO91 4 FUS00 SECTION 11 ADDITIONAL INSURED ENDORSEMENT I C Policy No.: 92 CDKO91 4 Named Insured: OC SAFETY INC Additional Insured (include address): CITY OF SANTA ANA, ITS OFFICERS, AGENTS, AND EMPLOYEES 20 CIVIC CENTER PLAZA SANTA ANA, CA 92701 WHO IS AN INSURED, under SECTION II DESIGNATION OF INSURED, is amended to include as an insured the Additional Insured shown above, but only to the extent that liability is imposed on that Additional Insured solely because of your work performed for that Additional Insured shown above. Any insurance provided to the Additional Insured shall only apply with respect to a claim made or a suit brought for damages for which you are provided coverage. The Primary Insurance coverage below applies only when there is an "X" in the box. Primary Insurance. The insurance provided to the Additional Insured shown above shall be primary Insurance. Any insurance carried by the Additional Insured shall be noncontributory with respect to coverage provided to you. All other policy provisions apply. FE-6609 Printed in U.S.A.