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HomeMy WebLinkAboutWEISSKER, HERMAN 1-2014MKITUM INSURARCE ON FILE WORK MAY trRO CEED ant. INSl1RAME E1tiI"1RFS NON- EXCLUSIVE RIGHT OF ENTRY CLERK OF QUNCIL4 20,14 AND LICENSE AGREEMENT DAM BETWEEN THE CITY OF SANTA ANA W11"111�Ci AND HERMAN WEISSKER, INCORPORATED it THIS NON - EXCLUSIVE RIGHT OF ENTRY AND LICENSE AGREEMENT ("Agreement") shall be effective as of October 30, 2014, by and between the City of Santa Ana, a charter city and municipal corporation, herein referred to as "Licensor', and Herman Weissker, Inc., herein referred to as "Licensee ". 1. LICENSE AREA a. Licensor owns the property located at APN 004 - 123 -52, Santa Ana, California [ "the License Area "]. See Exhibit I attached hereto and incorporated herein. Licensor desires to license use of said Area to Licensee. b. Licensee represents that it desires a License in order to use said License Area to install temporary security fence across the property and the right to bring and store temporarily any and all necessary vehicles, materials and other construction equipment and stockpile (not higher than 6 feet tall) on the Temporary Workspace (all of which is hereafter referred to as "Work"). The Licensee requests the right to perform the Work within all area of approximately 9,100 square feet. This area is referred to hereafter (individually and collectively) as "Temporary Workspace" (Exhibit 1). Licensee is required, and agrees, to install and maintain the License Area with screening material on the existing perimeter fence along the south property line. Licensee shall maintain said screening during the entire period covered by this Agreement. 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 confirm that all paperwork, including insurance requirements, have been met. The pre - license and move -out meetings (see Section 5 d.) shall be scheduled with Mindy Ly, Senior Civil Engineer, (714) 647 -5665. 2. GRANT OF LICENSE. a. Licensor grants to Licensee a temporary, personal, non - exclusive, revocable license to encroach upon the License Area as hereinabove to install temporary security fence across property and the right to bring and store temporarily any and all necessary vehicles, materials and other construction equipment and stockpile (not higher than 6 feet tall) on the Temporary Workspace. The Licensee requests the right to perform the Work within an area of approximately 9,100 square feet. No excavation is permitted. No soil is to be exported from or imported to the License Area. b. Licensee may not encroach upon the License Area for any other purpose or business, other than to, install temporary security fence across property and the right to bring and store temporarily any and all necessary vehicles, materials and other construction equipment and stockpile (not higher than 6 feet tall) on the Temporary Workspace without obtaining Licensor's prior written consent. All equipment and materials placed within the License Area by Licensee must be removed by Licensee at the end of the term. C. 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. d. 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. SECURITY DEPOSIT /COMPENSATION a. Licensee agrees to pay to Licensor a security deposit in the amount of Five Thousand Dollars ($5,000.00) prior to gaining legal access to the License Area. Said security deposit may be paid to the City of Santa Ana in the form of a cashier's check. Said security deposit will be held by Licensor during the term of this Agreement and shall be returned to Licensee within thirty (30) days after termination of the Tenn of this Agreement. Any clean -up, damages or repairs necessitated by Licensee's use of the License Area shall be paid for out of the security deposit by Licensor, with the remainder being returned to Licensee within said thirty day period. b. Licensee agrees to pay Licensor monthly compensation for the use of the License Area in the amount of Three Thousand Nine Hundred Fifty Dollars ($3,950.00) per month, due and payable upon execution of this Agreement. Payment shall be issued to the City of Santa Ana at 20 Civic Center Plaza (M -36), Santa Ana, CA 92702, to the attention of Mindy Ly. 4. DUTIES OF LICENSEE A. General Duties: 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 2 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, water, electricity and sewer. f Licensee shall not record, hypothecate, assign or attempt to record or assign this this personal License. Any attempt by Licensee to record or assign this License shall automatically terminate this License Agreement and render this License void and invalid for all purposes. B. Specific Duties: Furthermore, Licensee shall include, implement, and maintain but not be limited to the following Best Management Practices (BMPs) at the License Area year round (not just during the rainy season (Oct. 1 -April 30): 1. Waste management and Materials Pollution Control BMPs shall be implemented to prevent the contamination of stormwater by construction wastes and materials. 2. Tracking control (TC) BMPs to control off -site sediment tracking shall be implemented and maintained. 3. Sediment control (SE) BMPs shall be implemented at all locations along the site perimeter, at all operational storm drain inlets and at all non - active slopes, as appropriate. 4. Pollution prevention practices shall be implemented. 5. Non- stormwater management measures to prevent illicit discharges and control stormwater pollution sources. 6. Erosion Control BMPs shall be implemented, as appropriate. 7. Wind erosion control BMPs (dust control) shall be implemented, as appropriate. 8. Non - stormwater ,BMPs shall be implemented to reduce or prevent the contamination of stormwater from construction activities. For specific guidance reference, reference the Construction Runoff Guidance Manual (Orange County Stormwater Program, December 2012) [ htfps: / /media.ocgov.com /uov /pw/ watersheds / documents/ bmp /constructionactivities.aspl or the California Stormwater Quality Association (CASQA) Stormwater BMP Handbookfor Construction. 5. TERM /TERMINATION OF OCCUPANCY a. This Agreement will terminate on December 1, 2014, unless extended pursuant to Section 6. The parties may agree to extend this Agreement by written amendment executed by both parties. 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. Licensee's failure to comply with "Licensee Duties" in section 4 above, shall constitute grounds for termination by Licensor. d. Upon termination of use by Licensee, Licensee shall notify Mindy Ly, Senior Civil Engineer, and a move -out inspection will be scheduled in order for the Licensor to review the condition of the License Area. e. 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. 6. EXTENSION /REVOCATION The parties may extend the Tenn of the License by executing a writing evidencing mutual agreement. Licensor may revoke this License, at will, upon fifteen (15) days notice in writing to the Licensee. 7. 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, M36 Santa Ana, CA 92702 Attn: Mindy Ly TO LICENSEE: Herman Weissker, Inc. 1645 Brown Avenue Riverside, CA 92509 Attn: Jeff Hooks, Director of Operations (951) 826 -8843 8. INSURANCE Prior to undertaking performance of work under this Agreement, Licensee shall maintain and shall require its subcontractors, if any, to obtain and maintain insurance as described below: a. Commercial General Liability Insurance. Licensee shall maintain commercial general liability insurance naming the Licensor and its officers, employees, agents, volunteers and representatives as additional insured(s) 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 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 $1,000,000.00 per occurrence. Such insurance shall be endorsed as follows: (a) name the Licensor, 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 Licensor; and (c) contain standard separation of insureds provisions. (Sample Additional Insured Endorsement attached hereto as Exhibit 2.) b. The following requirements apply to the insurance to be provided by Licensee pursuant to this section: Licensee shall maintain all insurance required above in full force and effect for the entire period covered by this Agreement. Certificates of insurance shall be furnished to the Licensor upon execution of this Agreement and shall be approved in form by the Licensor's Legal Counsel. • 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 Licensor. c. If Licensee fails or refuses to produce or maintain the insurance required by this section or fails or refuses to furnish the Licensor with required proof that insurance has been procured and is in force and paid for, the Licensor shall have the right, at its election, to forthwith terminate this Agreement. d. Licensee shall not permit any mechanics', materialmen's or other liens of any kind or nature ( "Liens ") to be tiled or enforced against the Property in connection with this Agreement. Licensee shall indemnify, defend and hold harmless Licensor from all liability for any and all liens, claims and demands, together with costs of defense and reasonable attorneys' fees, arising from any Liens. Licensor reserves the right, at its sole cost and expense, at any time and from time to time, to post and maintain on the Property, or any portion thereof, or on the improvements on the Property, any notices of non - responsibility or other notice as may be desirable to protect Licensor against liability. In addition to, and not as a limitation of Licensoe's other rights and remedies under this Agreement, should Licensee fail, within ten (10) days of written request from Licensor, either to discharge any Lien or to bond for any Lien, or to defend, indemnify, and hold harmless Licensor from and against any loss, damage, injury, liability or claim arising out of a Lien, then Licensor, at its option, may elect to pay such Lien, or settle or discharge such Lien and any action or judgment related thereto and all costs, expenses and attorneys' fees incurred in doing so shall be paid to Licensor, as applicable, by Licensee upon written demand. 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 both parties. 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. 14. SEVERABILITY If any term or provision of this Agreement shall, to any extent, be held invalid or unenforceable, the remainder of this Agreement shall not be affected, and shall remain in full force and effect. 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 Right of Entry & License Agreement as of the date and year first written above. LICENSOR: PUBLIC WORKS AGENCY OF THE CIT OF1 ANTA ANA By: Fred Mo avip u Executive 'Director Public Works Agency APPROVED AS TO FORM: Sonia Carvalho City Attorney Lisa Storck Assistant City Attorney LICENSEE: HERMAN WEISSKER, INC. By: Title: nt CITY OF SANTA ANA Davi az City Manager ATTEST: Maria D. Hui uizar Clerk of the Counc' 7 I � \� ` FTI 91 / \�� \� �� � \� ` FTI 91 Ac"R" CERTIFICATE OF LIABILITY INSURANCE 1111 DATE(MMIDDNYYY) 10/29/2014 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 Edgewood Partners Insurance Center (EPIC) 19000 MacArthur Blvd. PH Floor Irvine, CA 92612 CONTACT Cristin Nolette PHONE FAX E t: 949- 417 -9178 AIC No: 949- 263 -0906 ADDRESS: cnoletteaed ewoodins.com INSURERS AFFORDING COVERAGE NAIC4 INSURERA: Starr Indemnity & Liability Com any 38318 www.edgewoodins.com INSURED Herman Weissker, Inc. 1645 Brown Avenue INSURER B: Hanover Insurance Company 22292 NsuRERC: CLAIMS -MADE 121 OCCUR INSURER D: Riverside CA 92509 INSURER E: INSURER F: $ 100,000 ✓ COVERAGES CERTIFICATE NUMBER: 22144711 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. LTR TYPE OF INSURANCE JN LS BR POLICY NUMBER MMIDIDYYYFY POLICY EXP MMIDDIVYVY LIMITS A V COMMERCIAL GENERAL LIABILITY 1000025225141 10/31/2014 10/31/2015 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE 121 OCCUR DAMAGE T11E1 PREMSES Ea oo.'ance $ 100,000 ✓ MED EXP(Any one person) $ 5,000 Contractual Liab ✓ X D U PERSONAL& ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE 2,000,000 POLICY 171 PRO- IECT LOG PRODUCTS - COMPIOP AGO $ 2,000,000 _ $ OTHER: A AUTOMOBILE LIABILITY SISIPCA08277414 10/31/2014 10/31/2015 COMBINED SINGLE LIMIT Ea accident 1,000-000 ✓ BODILY INJURY (Per person) _ -_,_ $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ ✓ PROPERTY DAMAGE (Per $ NON -OWNED HIRED AUTOS ✓ AUTOS 1 000 Comp Ded. $ $1,000 Coll Ded. UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION$ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNER /EXECUTIVE YIN OFFICER /MEMBER EXCLUDED? �N (Mandatory in NH) NIA 1000001270 10/31/2014 10/31/2015 I a/ STATUTE E.L. EACH ACCT DENT $ 1,000,000 E DIDISEASE -EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.LDISEASE-POLICY LIMIT '— $ 1,000,000 B Inland Marine RH3A14277601 10/31/2014 10/31/2015 Equipment Floater: $ 9,549,292 - Leased /Rented Equipment $600,000 Per Item /Per Occurrence $10,000 Deductible - Bus. Pars. Prop. - Special Form Re lacement Cost $500,000 Limitt 5 000 Deductible DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES (ACORD 101, Addltlonal Remarks Schedule, maybe attached If more space Is required) RE: All operations; City of Santa Ana is named as Additional Insured. Primary wording applies. NJ a CUI a LAC \r ai LV III III ail City of Santa Ana Public Works Agency 20 Civic Center Plaza, Ross Annex, M -93 Santa Ana CA 92701 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE © 1988.2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD 'ENT NO.: 22144'111 Cristin Nolette 10/29/2014 11:48:03 HM (POT) Page 1 of 6 Herman Weissker, Inc. 10/29/2014 Policy Number: 1000025225141 COMMERCIAL GENERAL LIABILITY CG 20 33 07 04 THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II — Who Is An Insured is amended to include as an additional insured any person or or- ganization for whom you are performing opera- tions when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy. Such person or organization is an additional insured only with re- spect to liability for "bodily injury ", "property dam- age" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured. A person's or organization's status as an addi- tional insured under this endorsement ends when your operations for that additional insured are completed. CG 20 33 07 04 B. With respect to the insurance afforded to these additional insureds, the following additional exclu- sions apply: This insurance does not apply to: 1. "Bodily injury", "property damage" or "personal and advertising injury" arising out of the ren- dering of, or the failure to render, any profes- sional architectural, engineering or surveying services, including: a. The preparing, approving, or failing to pre- pare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifica- tions; or b. Supervisory, inspection, architectural or engineering activities. 2. "Bodily injury" or "property damage" occurring after: a. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than ser- vice, maintenance or repairs) to be per- formed by or on behalf of the additional in- sured(s) at the location of the covered operations has been completed; or b. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcon- tractor engaged in performing operations for a principal as a part of the same project. © ISO Properties, Inc., 2004 TEAT NO.: 22199711 Cri.stin Nole[Ce 10/29/2014 11:48:83 AM (PDT) Page 2 of 6 Page 1 of 1 ❑ Insurance Company Starr Indemnity & Liability Company This endorsement modifies such insurance as is afforded by the provisions of Policy # 1000025225141 relating to the following: 1. The City of Santa Ana, its officers, employees, f 4 +- r!! wf _ + — / benefit 2. With respect to claims arising out of the operations and uses performed by or on behalf of the named insured, such insurance as is afforded by this policy is the 3. This insurance applies o i• or suit is brought except M the company's limits of liability. The 4. With respect to the additional insureds, this insurance shall not be Plaza, Ross J. M-93, Santa Ana, - A (Completion of the following, including countersignature, is required to make this endorsement effective,) Effective 10/29/2014 this endorsement form as a part of Policy# 1000025225141 Issued to Herman Weissker, Inc. _ _ Gamed Insured) a��e Countersigned by--- (Authorized Representative) Dev/Forms[Addllnsuredfo m TENT NO.: 22144911 Criatin Nolette 10/29/2014 11:48:03 AM (PUT) Page 3 of 6 Herman Weissker, Inc, POLICY NUMBER: 1000025225141 COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 W M I A W"JUNNUIR1101. Zf;�� A; This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART qK1951asup Name Of Additional Insured Porson(s) Or gr (panixation(s). Location And Description Of Completed Operations Blanket When required by Written Contract Per Written Contract Inform anon re aired fo complete Phis Schedule, if not shown above, will be shown in the Declarations. WT Section 11 — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property dam. age" caused, in whole or in part, by "your work" at the location designated and described in the sched- ule of this endorsement performed for that additional insured and included in the "products-completed operations hazard". CG 20 37 07 04 Oc ISO Properties, Inc., 2004 RRT NO.: 22144711 Cri5tin NolPtt 10/29/2014 11:48:03 AM KT) Page 4 Of 6 Page I of 1 12 10/29/2014 Kztll r' Starr Indemnity & )Liability Company Dallas, TX 1- 866- 519 -2522 Primary and Non - Contributory Condition Policy Number: 1000025225141 Named Insured: Herman Weissker, Inc. This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part Effective Date: 10/3112014 at 12:01 A.M.] A. SECTION IV —CONDITIONS, condition 4. Other Insurance is amended as follows: 1. The following is added to paragraph 4.a. of the Other Insurance condition: This insurance is primary insurance as respects our coverage to the additional insured, where the written contract or written agreement requires that this insurance be primary and non - contributory. In that event, we will not seek contribution from any other insurance policy available to the additional insured on which the additional insured is a Named Insured. 2. The following is added to paragraph 4.b, of the Other Insurance condition: This insurance is excess over: Any of the other insurance, whether primary, excess, contingent or on any other basis, available to an additional insured, in which the additional insured on our policy is also covered as an additional insured by attachment of an endorsement to another policy providing coverage for the same "occurrence", claim or "suit'. All other terms and conditions of this Policy remain unchanged. Signed for STARR INDEMNITY & LIABILITY COMPANY Charles H. Dangelo;e'President ` x T Nehemiah E. Ginsburg, General,UCounsel PC -115 (02100) Page 1 of 1 Copyright © C. V. Starr & Company and Starr Indemnity & Liability Company. All rights reserved. Includes copyrighted material of ISO Properties, Inc., used with its permission. 'ERT NO.: 22149711 Cristin Nolette 30/29/2014 11:48:03 AM (PDT) Page 5 of 6 MEMO To: Whom it may concern From: Angela Rabbitt Named Insured(s): Herman Weissker, Inc. Policy Number(s): HM14277601 SISIPCA08277414 000001270 1000025225141 RE: Notice of Cancellation City of Santa Ana Certiricate Holder Public Works Agency 20 Civic Center Plaza, Ross Annex, M -93 Name & Address Santa Ana CA 92701 Should the above described policy be cancelled before the expiration date thereof, change in coverage or reduction of limits, we will mail 30 days written notice to the Certificate Holder named above; except, 10 days notice for non - payment of premium. C1Tl l�PYP7[I Vice President - Construction (949) 417 -9175 10/29/2014 19000 MacArthur Blvd., PH • Irvine, CA 92612 P: 949.417.9175 • P: 949.809.2375 • CA License OB29370 www.edgewoodins.com 'L+RT NO.: 22144711 Cr-i.9tin Nole[[e 10/29/2014 11140:03 AM (PDT) Page 6 of 6