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Home My WebLink AboutCROSSTOWN DATA AND ELECTRIC, INC.-2013INSURANCE ON PILE WORK MAY PROCEED UNTIL INSURANCE EXPIRES KOFCOUNCIL70 CLRDATE: ?1-1 NON-EXCLUSIVE LICENSE AGREEMENT BETWEEN THE CITY OF SANTA ANA AND CROSSTOWN DATA AND ELECTRIC, INC. N-2013-052 THIS NON-EXCLUSIVE LICENSE AGREEMENT ("Agreement") is made and entered into this )Aday of April 2013, by and between the City of Santa Ana, a charter city and municipal corporation, herein referred to as "Licensor", and Crosstown Data and Electric, Inc., herein referred to as "Licensee". 1. LICENSE AREA f> A. Licensor owns the properties located at 315 N. Bristol Street, Santa Ana, California (APN 008-091-01) ["the License Area"]. Licensor desires to license use of said Area to Licensee. sI c d B. Licensee represents that it desires a License in order to use said License Area as a storage area for its equipment and as a staging area while working on City CJ projects. Licensee is required, and agrees, to install fencing and maintain the chain link fencing that is already installed around the License Area. C. Licensee and Licensor shall have a pre-license meeting at the License Area in order to review the condition of the License Area and to confine that all paperwork, including insurance requirements, have been met. The pre-license and move-out meetings (see Section 7 c.) shall be scheduled with Mindy Ly, Senior Civil Engineer, (714) 647-5665. 2. GRANT OF LICENSE a. Licensor grants to Licensee a personal, non-exclusive, revocable license ("License") to encroach upon the License Area as hereinabove for its use as a staging area and storage area for construction equipment, hereafter referred to as "storage area." The term of the License period shall be from the date first stated above through October 31, 2013, unless terminated earlier pursuant to Section 5 hereof. b. Licensee is permitted to temporarily store, at grade level, non-toxic non- hazardous material. No excavation is permitted. No soil is to be exported from or imported to the License Area. C. Licensee is responsible for installation of fencing and maintaining the chain link fence along the property line around the License Area. d. Licensee may not encroach upon the License Area for any other purpose or business, other than using it as a storage area, without obtaining Licensor's prior written consent. All materials placed within the License Area by Licensee must be removed by Licensee at the end of the term. e. Licensor will not be held responsible for loss of, or damage to, any personal property left on the License Area, or improvements made by Licensee in the License Area. f. This License is made subject and subordinate to the prior and continuing right of Licensor to use the property or the use of the public right-of-way. 3. MONTHLY COMPENSATION Licensee shall pay to Licensor monthly compensation in the amount of Seven Hundred Fifty Dollars ($750.00) per month ("Compensation") for use of the License Area. Compensation will be due upon execution of this Agreement and thereafter on or before the 1" of each month, payable to "The City of Santa Ana" and remitted to the address listed hereinbelow in Section 6 - "Notices". All payments requiring proration shall be prorated on the basis of a 30-day month. A late charge of ten percent (10%) shall be applied after any payment hereunder is due but unpaid. In addition, one and a half percent (1 %%) interest per month shall be added for each month that payment hereunder is due but unpaid. 4. DUTIES OF LICENSEE a. In exercising these rights, Licensee must use reasonable care and may not unreasonably increase the burden on the License Area. Licensee agrees that any use it makes of the License Area as specified herein shall be affected with all reasonable diligence and precaution to avoid damage to the land, property or personnel. b. Licensee agrees to conform to any reasonable requirements set forth by the Licensor related to the use of the License Area as a storage area set forth by the Licensor during the course of this License. c. Licensee agrees to not install or make any improvements to the License Area without the written approval of the Licensor. Licensee agrees to pay all the costs of the installation, operation, maintenance, repair and removal of any improvements in the License Area. d. Licensee will maintain the License Area in a neat, clean, sanitary and safe condition, to the satisfaction of Licensor, at the sole cost and expense of the Licensee. It should be maintained in a manner consistent with community standards which will uphold the value of the License Area, in accordance with this Agreement, the Santa Ana Municipal Code and all other applicable local, state and federal rules, regulations and standards. e. Licensee shall be responsible for the payment of all charges in connection with utility services provided to the License Area, "utility services" shall include natural gas, electricity and sewer. f. Licensee shall not record, hypothecate, assign or attempt to record, hypothecate or assign this personal License. Any attempt by Licensee to record, hypothecate or assign this License shall automatically terminate this License Agreement and render this License void and invalid for all purposes. 5. EXTENSION/REVOCATION The parties may extend the term of the License upon a writing evidencing mutual agreement. Licensor may revoke this License, at will, upon ten (10) days notice in writing to the Licensee. 6. NOTICES Any notice to be given by either party shall be deemed to be properly served if deposited with the United States Postal Service, or other acceptable mailing service, postage prepaid, to the addresses below: TO LICENSOR: City of Santa Ana 20 Civic Center Plaza P.O. Box 1988 (M-25) Santa Ana, CA 92702 Attn: City Manager COPY TO: Public Works Agency - City of Santa Ana 20 Civic Center Plaza P.O. Box 1988 (M-36) Santa Ana, CA 92702 Attn: Mindy Ly TO LICENSEE: Crosstown Electric and Data, Inc. 5463 Diaz Street Irwindale, CA 91706 Attn: David Hernance, President Phone: 626-991-6902 TERMINATION OF OCCUPANCY a. This Agreement will automatically terminate on October 31, 2013, unless terminated earlier pursuant to paragraph 5. b. Licensee accepts the License Area in an "as is" condition and upon termination or revocation of this License, Licensee shall, at its own cost and expense, remove any improvements installed by Licensee and surrender possession of the License Area to the Licensor in good order and repair and as nearly practicable to the state and condition in which it existed prior to the grant of this License, to the satisfaction of Licensor. c. Upon termination of use by Licensee, Licensee shall notify City contact, Mindy Ly, and a move-out inspection will be scheduled in order for the Licensor to review the condition of the License Area. d. In the event Licensee fails, neglects or refuses to remove said improvements and restore the License Area, such removal and restorations may be performed by Licensor, at the expense of Licensee, which expense Licensee agrees to pay to Licensor upon demand. 8. INSURANCE a. Commercial General Liability Insurance. Licensee 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 Licensee'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. 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 3300 of the Labor Code, Licensee, if Licensee 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, Licensee agrees to obtain and maintain any employer's liability insurance with limits not less than $1,000,000 per accident. c. The following requirements apply to the insurance to be provided by Licensee pursuant to this section: (i) Licensee 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. (ii) 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. d. If Licensee 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 Licensee's right to be paid for its time and materials expended prior to notification of termination. Licensee waives the right to receive compensation and agrees to indemnify the City for any work performed prior to approval of insurance by the City. 9. INDEMNITY Licensee shall indemnify, defend and hold harmless Licensor, its officers, agents, employees and volunteers from and against any and all loss or damage, expenses, injuries, death to any person or damage to property, including property and employees, volunteers, officers or agents of Licensor or Licensee, and shall indemnify, defend and hold harmless Licensor, its officers, agents, employees and volunteers from all claims, demands, suits, actions or proceedings of any kind, and all costs and expenses, including but not limited to reasonable attorneys' fees, settlements or judgment, arising out of the construction, reconstruction, maintenance, presence, operation, use, removal or state of repair, of the License Area. 10. GOVERNING LAW This License shall be governed by and construed in accordance with the laws of the State of California, with venue in Orange County. 11. ENTIRE AGREEMENT This License, together with all attachments hereto, constitutes the entire understanding and agreement of the parties. It supersedes any and all other agreements either oral or in writing between the parties hereto with respect to the terms set forth in this License and contains all the covenants and agreements between the parties with respect thereto. Each party to this License acknowledges that no representation, inducements, promises or agreements, orally or otherwise, have been made by any party, or anyone acting on behalf of any party, with respect to such services, which are not embodied herein, and that no amendment hereto shall be effective unless set forth in writing, approved by the Licensor and Licensee. 12. INDEPENDENT CONTRACTOR It is understood and agreed that Licensee, in the performance of this License, will be acting in a wholly independent capacity and not as agents, employees, partners, or joint venturers of the Licensor. This License does not create a tenancy of any nature whatsoever between the Licensor and Licensee. 13. ASSIGNMENT BY LICENSEE PROHIBITED In no event shall Licensee assign or transfer any of the rights conferred herein without the prior express written consent of the Licensor. 1.4. ATTORNEY FEES AND COSTS In the event that any action is instituted to enforce payment or performance under this Agreement, or otherwise in connection with this Agreement, the parties agree that the prevailing party shall be reimbursed by the other party for all costs and attorneys' fees incurred by the prevailing party in such action. 15. CONFLICT OF INTEREST No member, official or employee of the City shall have any personal interest, direct or indirect, in this Agreement, nor shall any member, official or employee participate in any decision relating to this Agreement which affects his/her personal interests or the interests of any corporation, partnership or association in which he/she is directly or indirectly interested. The parties have executed this personal, non-exclusive, revocable License Agreement as of the date and year first written above. ATTEST: Maria D. Huizar Clerk of the Council LICENSOR, Kevin O'Rourke Interim City Manager APPROVED AS TO FORM: Sonia R. Carvalho City Attorney Lisa Storck Assistant City Attorney LICENS Cr to Data & Electrics, Inc. David Hernance, President ' CERTIFICATE OF LIABILITY INSURANCE I ° T,,a" o zn , 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 05 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 he 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. LICENSE NO. 0637431 CONrn CT PATRICK MCRAE NAME: PATRICK MCRAE INSURANCE SERVICES PHONE (714 779-6999 uD Na1. (7.14) 779-6903 1290 N. HANCOCKST., SUITE 210 AD ADRESS pUrncrae@sbcgIoba1.net ANAHEIM HILLS, CA 92807 INSURER(S)AFFORDINGCOVERAGE NAICN INSURER A: LIBERTY SUPLUS INSURANCE 10725 INSURED INSURER B: AMERICAN GUARANTEE & LIABILITY INS 26247 CROSSTOWN ELECTRICAL & DATA, INC. INSURER C: CENTURY-NATIONAL INSURANCE CO. 26905 5463 DIAZ STREET INSURER D: PEERLESS INSURANCE COMPANY 24198 INSU_E: SGOTTSDALE INSURANCE COMPANY 41297 IRWINDALE CA 91706 NSURER F: COVERAGES CERTIFICATE NUMBER: 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. ILTR TYPE OF INSURANCE ADDL INSR SUBR MO - POLICY NUMBER POLICY EFF MM D POLICYEXP MM/20. Y LIMITS A GENERAL LIABILITY 1000008273-02 06/03/2012 06/03/2013 EACH OCCURRENCE s 1,000,000 X COMMERCIAL GENERAL LIABILITY DEDUCTIBLE: DAMAGE TO RENTED PREMISES Ea occumnce 100,000 $ ?X $5,000 PER OCC CLAIMS.MAOE OCCUR MED ESP An one person) $ - X XCU PERSONAL &ADV INJURY $ 1,000,000 X OCP GENERALAGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG $ 2,000,060 POUCV X ?Gi LOC EBL EA CLAIM/AGG s 1,000,000 C AUT OMOBILE. LIABILITY BAP0171987 11/05/2012 11/05/2013 C M B IN EEDSINGLE LIMIT 1 000 000 a BI 1 O $ , 1 X ANY AUTO COMPREHENSIVE DED. BODILY INJURY (Per person) $ _ ALL .E. X SCHEDULED $1,000 COLLISION DED BODILY INJURY (Per acddem) $ .. X X NON-OWNED . PROPERTY DAMAGE $ HIRED AUTOS AUTOS $1 000 !Per aculdentl - , E UMBRELLALI X OCCUR XLS0082427 003/2012 06103/2013 EACHGCCURRENCE $ 10,000,000 X EXCESS LAB CLAIMSWADE UNDERLYING LIMITS: AGGREGATE $ 10,000,000 X 0 GL; AL; EL POLICIES DIED RETENTIONS _ $ _ B WORKERS COMPENSATION WC966082001 06/03/2012 06103/2013 X wC STATU- 0'rH- AND £MPLOYERV LIABILITY ANY PROPMETORIPARTNER/EXECUTIVE YEN NIA EL EACH ACCIDENT $ 1,000,000 OFFICEIRE (Mandatory In NH)CLUDEO? ' f _ E.L.DISEASE-EA EMPLOYE- $ 1,000,000 11 ps. DESCRIePTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 1,000,000 D BUSINESS OWNERS & CBP 8641920 4/10/20 04/10!201 $790,849 BUILDING CONTRACTORS $1,000 DEDUCTIBLE 12 3 $385,780 BPP-$300,000 BI WI EE EQUIPMENT GOV. INCL. THEFT $116,318 SCHEDULED EQ. DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 01, AHdManal Remarks Schedule, f more space is required) CITY OF SANTA ANA, ALONG WITH ITS OFFICERS, AGENTS, REPRESENTATIVES, & EMPLOYEES ARE LISTED AS ADDITIONAL INSURED AS REQUIRED PER WRITTEN AGREEMENT. INSURANCE BY THE AFFORDED BY THE GENERAL LIABILITY POLICY FOR THE BENEFIT OF THE ADDITIONAL INSURED IS PRIMARY INSURANCE AS RESPECTS TO ANY CLAIM, LOSS OR LIABLITY CAUSED IN WHOLE OR IN PART BY THE NAMED INSURED(S) OPERATIONS, AND ANY OTHER INSURANCE MAINTAINED BY THE ADDITIONAL INSURED IS EXCESS AND NON-CONTRIBUTORY. 30 DAY NOTICE OF CANCELLATION IN ANYEVENT. RE: CITY OF SANTA ANA/ TRAFFIC ENGINEERING (CT 1695) CITY OF SANTA ANA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TRAFFIC ENGIN yT,??iE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 CIVIC CENT ?U43T 'O?lACCORDANCEWITHTHEPOLICYPROVISIONS. AUTHORIZED REPREBENTA7 VE P.O. BOX 1988 SANTA ANA, Cfk 92 r l,twl3yc ??2 +? All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD .. , P Liberty Surplus Insluance Corporation ENDORSEMENT NO. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Endorsement Effective Date:. 06/03/2012 Policy No.: 10000008273-02 Insured: CROSSTOWN ELECTRICAL & DATA INC. ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS (FORM 9) SCHEDULE Name of Person or Organization: CITY OF SANTA ANA, ALONG WITR RS OFFICERS, AGENTS, REPRESENTATNES, & EMPLOYEES ARE LISTED AS ADDITIONAL INSURED; RE. CITY OF SANTA ANA I TRAFFIC ENGINEERING LOT 1695) (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement) WHO IS AN INSURED (Section In is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of "your work" for that insured by or for you. CGL 2010 1185 Page I of 1 P?` B Il£Sd'.TFiX1S?"dLftll yyLi R,337.C1w?'b57it'.fi?Tw ENDORSEMENT NO. 11115 ENNDORSEMENT CHANGES THE POLICY. PLEASE READ IT CARE, FULLY. Endorsement Effective Date; 06/03/2012 Policy NO.:I0000008273-02 Insured: CROSSTOWN ELECTRICAL & DATA INC PRIMARY INSURANCE CLAUSE ENDORSEMENT To the extent that this insurance is afforded to any additional insured under the policy, such insurance shall apply as primary and not contributing with any insurance carried by such additional insured, as required by written contract. Nothing herein contained shall be held to waive, vary, alter or extend any condition or provision of the policy other than as above stated, CITY OF SANTA ANA, ALONG WITH ITS OMCERS, AGENTS, REPRESENTATIVES, & EMPLOYEES ARE LISTED AS ADDITIONAL INSURED; RE: CITY OF SANTA ANA / TRAFFIC ENGINEERING (CT 1695) CGL 1031 0403 Page I of I ?.rrl.?&. a ttea-t??. ms,?oc?rrF?a?u ENDORSEMENT NO. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Endorsement Effective Date: 06/03/2012 Policy No.: 10000008273-02 Insured: CROSSTOWN ELECTRICAL & DATA INC. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US It is hereby agreed that Section IV, item S. Transfer of Rights of Recovery Against Others to Us, is modified as follows: SCHEDULE Name of Person or Organization: As required by written contract. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition (Section IV - COMMERCIAL GENERAL LIABILITY CONDITIONS) is amended by the addition of the following: We waive any right of recovery we may have against the person or organization shown in the Schedule above 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. This waiver applies only to the person or organization shown in the Schedule above. CITY OF SANTA ANA, ALONG W TH ITS OFFICERS, AGENTS. REPRESENTATIVES, & EMPLOYEES ARE LISTED AS ADDITIONAL INSN RED: RE: CITY OF SANTA ANA /TRAFFIC ENGINEERING (Or 1095) CGL 1025 0103 exwmvRr A . wTov CAMIOU, . .4 -1010 (CS`I 7A'C1I tIFK4c}G'E t1U3TVRNt ?i'tt?,tksy, ??srca en?,?x?a;ACirrr??a j):`g].An":1?C74l2AC;F't?S+.b^?'_ ms?ct?s±?i?x? aua?ts v?a??, $, -A oiS,04 n9}?epag'Wa'4_ tdi}?RCiT? 9LO s41ty: xc 5wth 3 .cu??sngYrkaa?ilz,[L a.,1s _''3 ,t?{ n ue_d-fu xIN . na 8tm ga¢ 2.,. Mggs t e ' 1dE.3a,= . 'E1Je•'ttl`frs i>rt ictusra:.n r({g, xcrtse.3c?sTSy?aareeg (hraeti ;I' t ra-a snser, itiz m•'tII ?YS!}i6rk ?d?®NesK.arir t?t?i?u4w5s'?Si;pt"RAU[gs?tglsih?krar'9Fr wh9s'??!?r in tees T'Yw 6x?ifis.s??smac,a't3?-zs.i.?u??uaxSP???s ae?rnrc 7ged?a•',?csakdakGxSrs A t1?N?C€.('?56??1ips9.t37(9CE`flh9W?f ?fA,'?NSk?.?t??'uhc@PfgCciaft?ryhitdlkrgt, 3'y '?aDm}md€-.-- n4h '? 1 lie :w3a>zx § i#?#`Ri?7na?.e?iaY`RC'L'C?SSxbS?r?:ssf?gts,Lz? 4ad. fnttl4`+paS?^vi2l?Rxa'3?it3r,?#Oc.?sis"?t CITY OF SANTA ANA, ALONG WITH ITS OFFICERS, AGENTS, REPRESENTATIVES, B EMPLOYEES ARE LISTED AS ADDITIONAL INSURED, RE CITY OF SANTA ANA /TRAFFIC. ENGINEERING (CT 16S ) R.A":XtP M 0 f"iltROA1 ?'?AC,Tf? txmin(Apoc mm"TWUNMIR wlooo.mw *14" T?t?a1?h ??r?.??E ? cn w-??.trc R•?riz?t 13,ss,k?? ?s ,? cn ec? r??z?ra€, ?oxri?. ??uktYr c r3?Ps??zac?€?s1?? CITY OF SANTA ANA, ALONG WITH ITS OFFICERS, AGENTS, REPRESENTATIVES, & EMPLOYEES ARE LISTED AS ADDITIONAL INSVRED: RE: CITY OF SANTA ANA /TRAFFIC ENGINEERING (OT 1895) Trk.;",'ISii.. ZURICH WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT- CALIFORNIA We have the right to recover from our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration ofyour employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 0.0 % of the California workers' compensation premium otherwise due on such remumeration. SCHEDULE Person or Organization: Any person or organization that the insured is required by written contract to name as an additional insured. CITY OF SANTA ANA, ALONG WITI I ITS OFFICER£i, AGENTS, REPRESENTATIVES, & EMPLOYEES ARE LISTED AS ADDITIONAL INSURED; RE; CITY OF SANTA ANA / TRAFFIC ENOINGLRING (CT 1605) This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated, (The information below is required only when this eudoracment is issued subsequent to preparation of the policy.) Endorsement Effective: 06/03/2012 Policy No.: WC966082001 Endorsement NO,: I Named Insured: CROSSTOWN ELECTRICAL & DATA, INC. Policy Effective Date: 06/03/2012 to 06/03/2013 Insurance Company: AMERICAN ZURICH INSURANCE COMPANY Countersigned By WC 252 (4-84) WC 04 03 06 (Ed. 4-84)