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Home My WebLink AboutOC SAFETY INC. 2 - 2015INSURANCE ON FILE N-2015-014 WORK MAY PROCEED UNTIL: INSURANCE EXPIRES CLERK OF COUNCIL DATE 2GI5 CONSULTANT AGREEMENT AGREIIII�I p ; Pers. /RtsK SEMENT, made and entered into this 1s` day of January, 2015 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 that it is knowledgeable in its field and that any services performed by Consultant under this Agreement will be performed in comphance with such standards as may reasonably be expected from a professional consulting firm in the held. 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. 2. 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 faits to meet the standards of performance set forth in the Recitals which may reasonably be expected by City. 3. TERM This Agreement shall commence on the date first written above and terminate on December 31, 2017, unless terminated earlier in accordance with Section 12, below. The term of this Agreement may be extended upon a writing executed by the City Manager 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 lim t 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. 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: (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 (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 With courtesy copies to: and Fax 714- 647-6956 Personnel Department Attn: Briza Morales City of Santa Ana 20 Civic Center Plaza (M-28) P.O. Box 1988 Santa Ana, California 92702 Fax 714-647-6930 City Attorney City of Santa Ana 20 Civic Center Plaza (M-29) P.O. Box 1988 Santa Ana, California 92702 Fax 714-647-6515 To Consultant: OC Safety Inc 1940 N. Tustin Street, Suite 103 Orange, CA 92865-4642 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 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. hi 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 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 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 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. IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first above written. ATTEST: --7111 &Vvia'�PG K1AAiA D. HuizAR Clerk of the Council APPROVED AS TO FORM: SONIA R. CARVALHO City A/tttoorney By: c �- Lisa Storck Assistant City Attorney FOR APPROVAL: (dau and Rayy-a� - Executive Director - Personnel Services Agency CI OF A A ®'6K e� David Cavazos r�Ba'sa6S City Manager CONSULTANT John La la Owner �p Tax ID# �J �p L —2-gz®7(J0 EXHIBIT A SCOPE OF SERVICES 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 $624.00 (includes up to 12 students) Additional Students $ 52.00 CERTIFICATE OF LIABILITY INSURANCE ATE b05/06/201 Y, POLICIES AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. -ixsado9 LI .._....._..-----'--- -...__ .-----' ........_..._.___.... -FOIaGTY EFP'L-CYNE P4LICV ERPIRATO --_._.._,__ LTR INSRO TYPE OFINSURANC,E POLICY NUMBER DATE MMIDONY GATE (MM/OO/YY LIMITS 05/06/2019 PRODUCER Ric Welssinge.r Insurance Agency, Tnc. THIS CERTIFICATE IS ISSUED AS MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Ri.c Waise:i.nger, Agent Lic 4 OC69161. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 5922 Warner Ave, Huntington Beach CA 92649 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NgIC qp INSURED O C aATH,IY INC PRL-'MA�j �SL$(Cu �u�Ierlan)`y INSURERA.State Farm General Insurance Company 25151 -' _.. ._.._. 1940 N TUSTIN ST SIT, 103 INSURER B: ORANGE CA 92865-4642 MED EXP,�Arry ono parsol� INSURER C: INSURER _--.4_...__._�..._.._.._.._._._.. INSURER Il V - PERSONAL&AUV INJURY_ $__ .L, OPO, OOP — _ 91 2, OOPrODD THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICA"FED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. -ixsado9 LI .._....._..-----'--- -...__ .-----' ........_..._.___.... -FOIaGTY EFP'L-CYNE P4LICV ERPIRATO --_._.._,__ LTR INSRO TYPE OFINSURANC,E POLICY NUMBER DATE MMIDONY GATE (MM/OO/YY LIMITS Y. X GENERAL LIABILITY 92-CC7-ECC191-9 G 04-02-2014 04-02-201.5 E.ACHOCCURRENCE S 1,000r PPO LAHORVE- E$ T i .• ly° • G'LbHY'€,irlger, Agent Y' COMMLRCIAL GENERAL�jLIAUILITY PRL-'MA�j �SL$(Cu �u�Ierlan)`y J.00, 000 CLAIMSMAOE El OCCUR MED EXP,�Arry ono parsol� ,$-� 5,000 _--.4_...__._�..._.._.._.._._._.. PERSONAL&AUV INJURY_ $__ .L, OPO, OOP — GFNFRAL AGGFEGA'E 91 2, OOPrODD GEN'LAGGRF.GAIE LIMIT'APPUESPER PRODUCTS-COMPlAf1I1 $ 2, OOP, POP X x LICY n"i X LOC PO — _- -- AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUO T (Ea 8.ee,,Q $ ALL OWNED AUTOS SODILY —-��--------- SCHEDULED AUTOS (1'er rparw parwn) HIRED AUTOS BODILY INJURY NON -OWNED AUTOS (Per awldonU $ PRO PERI'Y DAMAG E $ - j(Per accident) GARAGE LIABILITY NT AU7AGG $ OTACC $ ANY AUTO AUGO $ CXCESSIUMBRELLA LIABILITY EA,qOCGJR AGS OCLAWSMADE DEDUCTIBLE ---------_._ _ RETENTION S T $ WORKERS COMPENSATION AND WCSTATU- OTH- EMPLOYERS' LIABILITY TG, LIMITS GR ANY PROPRIETOR/PART'NERIEXLCUTIVE OFFICEWMEMHER EXCLUDED? E. L. EACH ACCIDENT — __$_ E.L. DISEASE,-AEMPLOYEE -- $ Iryoe,dewberinder SPECIAL PROVISIONS balaw EL DISEASE- POI..ICY LIMIT $ X OTHER I3Dsinc,ss Property 92-CD-KO91-4 G 04-02-2014 04-02-2015 $ 45,000 DESCRIPTION OP OPERATIONS I LOCATIONS I VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS Loc 41 - 1940 N T'USTTN ST STE 103, ORANGE, CA 92865 CERTIFICTE HOLDEE, ITS OFFICERS, AGENTS ARID EMPLOYEES ARE NAMED AS ADDITIONAL INSURED IN REGARDS TO GENERAL LIABILITY PER ATTACHED FE6609 O ICO.S inC Ic 132049 03-13-200; 9 aeownershipof e mars y elf respe Ive Owners c All rights SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION CITY OF SANTA ANA DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL30 DAYS WRITTEN ATTN: PURCHASING DEPARTMENTNOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO 50$HALL 20 CIVIC CENTER PLAZA IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR SANTA ANA, CA 92701. SENT TIV LAHORVE- E$ T i .• ly° • G'LbHY'€,irlger, Agent ACORD 25 (2001108, 1 e reIs r0 Ion n t O ICO.S inC Ic 132049 03-13-200; 9 aeownershipof e mars y elf respe Ive Owners c All rights } If 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). 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. AGORD 26 (2001/08) w.lm Policy No,: 92 CDKO91 4 SECTION 11 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 92701 FE -6609 WHO IS AN INSURED, under SECTION 11 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. Ej 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 Nnted in U.S.A. ons� Qo CERTIFICATE OF LIABILITY INSURANCE 1)04/06/0201 I] ATE tMWD a=la6�za15 PRODUCER Ric Waissinger Insurance Agency, Inc, THIS CERTIFICATE IS ISSUED AS MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Ric Weissinger, Agent Lic 8 OC69151 5922 Warner Ave, Huntington Beach CA 9.2649 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 20 CIVIC CENTER PLAZA AINSURERS AFFORDING COVERAGE NAIC # INSURED b C SAFETY INC �:/��1 /�2%.C/ INSURERkstate ram General xnsuranoe C an 25152 LTR 1990 N TDSTIN ST STE 103 /w 0 IRsuReR r. INSURER C. ORANGE CA 92869-4642 INSURER D LIMITS INSURER k x 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 DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IB SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I SR AD01 20 CIVIC CENTER PLAZA IMPOSE NOOBGC.ATroN OR LIA81LiTYOFANY RNID URON VIE INSURER, ITS AGENTS OR P EYPIRATq LTR WIRD TYPEOFINSURANCE PCIJUYINUMBER DAT@ MMNUTYI DATE(NWDDA'Y) LIMITS X x GENERAL VABILm 92 -CD -%091-4 G U41-02-2015 04-02-2016 EACH occuRRENDE S 1,000,000 PREMISES Ea wmel� 5 100,000 Y COMMERCIAL GENERAL LIABILTfY CDNSMADE OCCUR MEO EXP( are anon S 5,000 INJURY S 1,1)00,000 1 GETPERSONAL&ADV - NER AGAGGREGATE $ 2,000,000 GEMLP6�iEGaIELnNfn<P,IESFER PRODUGTB-COMI+rtFAG4 2,000,000 x x POLICY DEET Y LOC AUTOMOBILE LIABILITY ii COMBINEDSWGLELRIR S !(�aixidaN) ANYAUTO ,......__ BOD0.YINduRY ALLOWNEDAUTOS WHEOULEOAUTOS x BODILYINJURY S IPEYW:$:PlIQ NIREDAUT'O$ NONgWAEDAVTO$ PItOPEMBYDAMAGE S CPar mlrD�nA GARAGE UASRJTY AUTO ONLY -MACCNLM S OD°ERTHAN EAAOC S ANY AUTO ALTO ONLY: AGG S EACH OCCURRENCE 8 �EXCESSNMORMLALIABILm OCOUR FICLAIMSMADE A(aYaRFGATE �� S DEDUCTIBLE i RE WION S g %YORKERS GONPENSATIGN AND EMPLOYER$'JAEILm SfATI%" (iIN- ORY%WAITS Be E.L. EACHACCIDENT $ ANY PRDPRIEfORtPARnJERlEXECUTNE OFFICERM EINE ER EXC W D ED? I yes, d.s .uMer ELOLSEASE-EAEIMPLDYEE S EL DISEASE -POLICY LIMIT 5 SPECIAL PRDVISION bel. OTHER Business Property 92 -CD -x091-4 G 04-02-2015 U4-02-2016 �$ 45,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES! EXCLUSIONS ADDED 8Y BNOORSP.MUNT/ SPBCIAL PROVISIONS Loc {l - 1940 N TUSTIN ST STE 103, ORANGE, CA 92865 CERTIFICTE HOLDER, ITS OFFICERS, .AGENTS AND EMPLOYEES ARE NAMED AS ADDITIONAL INSURED IN REGARDS TO GENERAL LTA,BILITY PER ATTACFED FE6609 CERTIFICATE HOLDER CANCELLATION AUUHU 2611UUTIU6) Ina TegmtraCIOII notices i IGiB OWRemniP OT tI1H R9fM,E 132M9 08-13-2007 Dy,�,,l[ft pP.'L91Y�pTJgefS j�,1dBA4.Y9RtT VTiP'VHNtE right B� B 7 '«•w1/' T fmd I13 SHOULD ANY OF THD ABOVE OBSORK20 POLZM5 BE CANCa r m SEJOR THE B%RRADON CLTV OF SANTA ANA DATE THEREgF, THE IEDNING INSURER WILL ENDEAVOR TO MAIL 'J_0 N0.YS WNRTEN ATTN: PURCHASING DEPARTMENT NOTILETO THE CERRFICATE xDY.DER NM1M®TOTHE LEFT, BVT PA[I.[IRETO DD SDSNALL 20 CIVIC CENTER PLAZA IMPOSE NOOBGC.ATroN OR LIA81LiTYOFANY RNID URON VIE INSURER, ITS AGENTS OR 5P1JT2x ANA, CA 92701. fLEPiS_3'MTAWM MUTHATIVE Z�' iLiC YI .iSSlntJES, Agent AUUHU 2611UUTIU6) Ina TegmtraCIOII notices i IGiB OWRemniP OT tI1H R9fM,E 132M9 08-13-2007 Dy,�,,l[ft pP.'L91Y�pTJgefS j�,1dBA4.Y9RtT VTiP'VHNtE right B� B 7 '«•w1/' T fmd I13 IMPORTANT if the certificate holder is an ADDITIONAL INSURED, the policy(es) 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 conditlorus of the policy, certain poles 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($), authorrced representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2001108) uLtnn Policy No.: 92 CDK0914 rE aco IM1IMN SECTION 11 ADDITIONAL INSURED ENDORSEMENT Policy No.: 92 CDKO91 4 Named Insured: OC SAFETY INC Additional Insured (include address): CITY OF SANTA ANA, ITS OFFICERS, AGENTS, AND EMPLOYEES 20 CIVIC CENTER PLAZA SANTA ANA, CA 92709 WHO IS AN INSURED, under SECTION 11 DESIGNATION OF INSURED, is amended to include as an insured the Additional Insured shown above, but only to the extent that liability is imposed on that Additional Insured solely because of your work performed for that Additional Insured shown above„ Any insurance provided to the Additional Insured shall only apply with respect to a claim made or a suit brought for damages for which you are provided coverage. The Primary Insurance coverage below applies only when there is an "X" in the box. Primary insurance. The insurance provided to the Additional Insured shown above shall be primary insurance. Any insurance carried by the Additional Insured shall be noncontributory with respect to coverage provided to you. All other policy provisions apply. FE -6609 P*1W m O.S,A, �' DATE (NIMfDLVl'YYYj CC)Rb CEi TIFI C TE OF LIABILITY INSURANCE st� 0i' !02. 211-6 PRODUCER THS S CERTIr-I ,ATE IS 1SSUP-0 Ars MATTER OF INFi3'RMA"s ION T_-'6;�rancc qui •=,:;'t Tnc. ONLY AND rONFF=R$ NO RIGHTS UPON THE CER-nFICATE -'Ont IdC 4 C 0691 61 HOLDER. Tlqtg CERTIF;CATE DO NST AMEND, XTP -N s OR F tsr ':1`unti nc c i �'sxaac.h FA g2 L„ r� ALTE5.' I HF- COVERAGE AFFORDED BY THE POLICIES BELOW. s.,....., ENStiJF2ER5 AFFORI31NG::f}VEFtAix`e _ i N,4fG 4 7az.,,'. €`r^'�'Ic'T.'a! TT1.a61T:a na � :s:`rn.lnY '151b, .. .... j il`ISLIR[ R i - , THS POLICIES OF INSURANCE' i fSTED SELOVt+ HAVE BEEN ISSUED TO T? -IE INSURED PiFl-fSD ABC FOR THE POLICY PERIOD iNDICokkt LD, NOTA IATrKSTAN'DING. ANY R[:OVREVIENT; TI q7i 09 CONDIT ON OP ANY CONTRACT OR &T R 00C;;3MENT VM -14 Rz;S e.T TO tVKIC€i TM$ CCRTIFICATE MAY BE ISSUED OR t0A Y PERTAIN, THE INSURANCE AFFORDED BY THC POLICIES DESCRIBED HF-REI.N IS SUBJECT TO ALL -niE TERMS, EXCLLISIONS AND CONDITION$ 01* tucH OUCIES. ACGREGATC LwITS SHa"jp.,N �AAY 1,AVE LEEN REDUr-ED BY PAM CLP5ii4'CS. V.�k,tDq`LI� � PDL�Y°a�F£CT1L+E PC7LtC;Y'€7fplixJi7PpN � --- .79 1h'$RD1 TYPEOFINS€PIANC; ..._�.�ISOLICYN'UMOE"�4r I DATE tMmr=,� DAT€(IltM-00ren iFSd1T$ } x �E GENCRAL S.1A81L FTY I 92 -FA -V1 4`-9 t' a, r` "` ? '' `1' e (`! : Jr> E3 'J EACH OCCUMAENCE j 3» t;t7P4+1C €:Sf . C�CN� R4F LIAti&LPPnr' °"--"-�-' - I CtAn1f R1h.IYr I 3ftr�A _iPnp cna._�errrn;IS� :J, •i C< Pf-RSGKAL&ADVftJIRY Ail i �� ... Gt`SE:%2:Si. AGGREC.:.T� -- �r 31?G_cPL`TS �Ci4!FMY7pA a 2, (f)y .. t %: icy, u+w i..... , ?a^RiY- Ii....: � '- t I AUTOMOOILIf LIAMLIT"Y j ii I CCA!SINED SSNaE LIMIT I r"NYAVT0 I �!'-wa.R:°z7tfLyslT �3 ILII[ I. _ 1r+LL�;;rvry".I?.lF!wp A S«fP:S ; 1130DILYINjRtY 1 f Sii3m b AV-URq - # 'NON 0AINCPAUTOU � {3� �ceir4m , I � -., ..- --.. .. t PROP -,-R TY DAM;,GE �� fI°gfdixi�Mlt ty4k'AOe LIISBII.iTY ..� I [33 1iiTIWR TtIA3V i}1 lls`i� 1 ----..- _. MJTOO'ILY.� Aoc 1X--C-C�SSVM0R&LLA L4 ABILITY I A C r•GU€SRmg Is 1 $ I Vl+JI2S4�`R$Ci1f,NP�IV5t;TiP9nt�PtD I' i STRli6-' ! C9Ttf. F,A7PZ01"EP.S`1.,1A[kIY,FTl ,� 7UitXC#Ft45i'S Fix� ,wriCNY '*Rmr:F:7CYP•`rP.Ji7NEii+P>fE.Cl.3Tfi`C I :�3"I'itfRrt.SF6dSEP?�XCLLR7LC'+ i PE.L cF.s'.€cm't,*.cmT _-_ r -r omv'AD? 3.Allkr i # ', L I.eP�u�Vu.`�E,-Ery, $V&VIAL a9C.Y":1,si 15i;5t�n.",c.r'SC OT44ER E I b$SCfRIPTION OP OPERATIONS r LOCATIONS P V€HIC,T.ES I EX'CLUMONS ADDED by E'NDonsrNEt4 T d SPECIAL PROVISIONS "a' iv-ZYS7°7N ST ;a11. L` 3, DR,T#Td%-.Cg CA. 92S3fs "L G:.:yF': ':Jird'TCFia(�Yr(Atr`d`:;D1"1?LirYL4 ARE RT7ClE' ?,; a7f7TT�G: ",JR r Fri �( v O �4--, Fif.A 9d� _ �Yh .1\.C., Lr liY CERTIFICATE HOLDER CANCE!_3A 110N SFi(7UIX ANY OF TW ABOVE .DESUFUS f POLIia"'E$' CRNCUL.M ffffORF T» IKPIRA-FMII 07 a: tN I"A ANA D --TC INS4TRER WILL ENDEAVOR TO NIML =0 tAY$ WRn7EN D' ,: t'AE:Vi NT NOTICE TO THE Imri.RCATE F! 6ttlER NAMED TO THE E.EFS', W'r Fi,5Li91tE TO Y7£} 'SO SMALL `'::i,77F R A �,` ?''e° i FOSE NO aRLP4`•A-1101 OR LLAWLFYY Or- ANY MO UnN TFtF eq$ REw. its AGENTS oR IRSC we, n C5 i'e~sCisCu tfOTi PiOLPDE F[i IMa R "J'rNtlef irUp 08 the F=' aS y trJoIC �'pe IVe 0.,VnefS c: I S�»ti Piw.7S•�S�C7 Ali T7gills LASE Policy No. 92 EAV145 9 RIC WEISSINGER INS AGCY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CMP -4786.9 ADDITIONAL INSURED — OWNERS, LESSEES, OR CONTRACTORS (Scheduled) This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number: 92 EAV145 9 Named Insured: CJROBSON ENTERPRISES INC DBA OC SAFETY 1940 N TUSTIN ST STE 103 ORANGE CA 92865-4642 Name And Address Of Additional Insured Person Or Organization: City Of Santa its Officers Agents and Employees 20 Civic Center Plaza Santa Ana CA 92741 1. SECTION Il — WHO IS AN INSURED of b. SECTION II — LIABILITY is amended to in- ciude, as an additional insured, any person or organization shown in the Schedule, but only with respect to liability for "bodily injury", "property damage", or "personal and advertis- ing injury" caused, in whole or in part, by: Ongoing Operations (1) Your acts or omissions; or (2) The acts or omissions of those acting on your behalf; in the performance of your ongoing opera- tions for that additional insured; or b. Products – Completed Operations "Your work" performed for that additional insured and included in the "products - completed operations hazard". However, Paragraph 1. above is subject to the following: a. The insurance afforded to the additional insured only applies to the extent permit- ted by law; CMP -4786.1 Page 1 of 2 If coverage provided to the additional in- sured is required by a contract or agree- ment, the insurance provided to the additional insured will not be broader than that which you are required by the contract or agreement to provide for such addition- al insured; and c. If the contract or agreement between you and the additional insured is governed by California Civil Code Section 2782 or 2782.05, the insurance provided to the additional insured is the lesser of that which: (1) Is allowed for the satisfaction of a de- fense or indemnity obligation by Call- fomia Civil Code Section 2782 or 2782.05 for your sole liability; or (2) You are required by contract or agreement to provide for such addi- tional insured. We have no duty to defend or indemnify the additional insured under this endorsement un- til a claim or "suit" is tendered to us. O, Copyright, State Farm Mutual Automobile Insurance Company, 2013 Includes copyrighted material of Insurance Services Office, Inc., with its permission. CONTINUED 2. Any insurance provided to the additional in- sured shall only apply with respect to a claim made or a "suit" brought for damages for which you are provided coverage. 3. With respect to the insurance afforded to the additional insured, the following is added to SECTION it — LIMITS OF INSURANCE: If coverage provided to the additional insured is required by contract or agreement, the most we will pay on behalf of the additional insured will be the lesser of the amount of insurance: a. Required by the contract or agreement; or b. Available under the applicable Limits Of Insurance shown in the Declarations. This endorsement shall not increase the ap- plicable Limits Of Insurance shown in the Declarations. 4. With respect to the insurance afforded to the additional insured, the following is added to Paragraph 3. Duties In The Event Of Occur- rence, Offense, Claim Or Suit of SECTION II — GENERAL CONDITIONS: The additional insured must: a. See to it that we are notified as soon as practicable of an "occurrence" or an of- fense which may result in a claim. To the extent possible, notice should include: (1) How, when and where the "occur- rence" or offense took place; (2) The names and addresses of any in- jured persons and witnesses; and CMP -4786.1 Page 2 of 2 (3) The nature and location of any injury or damage arising out of the "occur- rence" or offense; b. Tender the defense and indemnity of any claim or "suit' to us and to all other insur- ers who may have insurance potentially available to the additional insured; and C. Agree to make available any other insur- ance the additional insured has for de- fense or damages for which we would provide coverage under SECTION II — LIABILITY. 5. With respect to the insurance afforded the ad- ditional insured, the following replaces SEC- TION II —LIABILITY of Paragraph 7. Other Insurance of SECTION I AND SECTION II — COMMON POLICY CONDITIONS: a. This insurance is primary to and will not seek contribution from any other insurance available to the additional insured, provided that the additional insured is a named in- sured under such other insurance. b. Regardless of any agreement between you and the additional insured, this insur- ance is excess over any other insurance whether primary, excess, contingent or on any other basis for which the additional in- sured has been added as an additional in- sured on other policies. There will be no refund of premium in the event this endorsement is cancelled. All other policy provisions apply. GMP -4786.1 1007033 148011 08-21-2014 0, Copyright, State Farm Mutual Automobile Insurance Company, 2013 Includes copyrighted material of Insurance Services Office, Inc., with its permission. aj 14:50RET k ...... -otq UATE (MM00,I(YYY� CERTIFICATE OF LIABILITY INSURANCE THIS CFRTIFICATE tS �SSUED AS MATTER OF INFORMATION ONLY AND CONFERS NQ RICHI$ UPON THE CERTIFICATE HOLDER, THIS, CERTIFICATE DOES NOT AMEND, LXTEND OR ALTER THE COVERAGE AFFORF)FD BY 7HE POLICIES BELOW. INSURE AFFORDING COVERAGE il j j: 81 1 Joy. 9 H. IVJJlAJNCC, LIS"7E.) BELOIN HAV" HEFN In"31h,"7D K) I HE NAPM:0 AFCP�E F (OR, P �E POUCY PERIOD INCqCATED. NO i I�Ny RtI6UtRFNlEN7, T"ERM OR OF AWY' Vfl�'H RESPECTTO VVHIC' 7rlfl� rIp,(r"p, I F , �r� �� C, F-,R"r "I w.roy klAY PrZF!7AW I HE IVCEURAM�'F Al f� ()N[Jl'� , f 13Y�Hl�' PCM( I(" DLP "CRMU) dEREIN Vz'N SUBJECT TO ALL THIF TFRM� , FV1 0SX'JW'J ANC I 0lE ifl7 CJA IF I INW1 f, ' iHCnME MAY HAVI.. BLUN RILLIUCED BY PAID CUMIS I �000, jpj*�k�h" y f p �F jr Vd F OLlCy RA,7110N YPE Gr INSIJPWNCC pirlH Wl-v NWAKCRI M 0XrE fVAMMmr)-i'l S UASN, rJ rp,cll p ocm mm -w I A PAMA 11it 'v i,B�V'A 70AF, ... .. .. .. .. .. . V�'J'�ONA� &AFYV�NHR-y %JP JT AU Y 6"yhUrIftL, F I, M Rq rY 7 ANY I �11- L O�Mlv, Ed I t' PS K:lu Q r RiM q? L WoW 7Y AN" J �-, 07 PT`w 71 M4 ;cv�� A;rC' UK . .... ........ DC C I Fd qrC mVAII 11! 4 0IAN �lr.L` C0901'ENSATIGN 4ND MPtl iJ"rE SIIJANLIT`( 1' 11 H ll4 R tp'?A "R C 7 F 7 X Fc, 11"' VT L L f, AC8l At: C IDE I L L E L 01 1 E r MiT-T;R710N OF C)FIrPAT GONS, 7 LOCATKM '.(FHK'J,Fq 5-XORWONS AODED BY ViaORSEMENT t SPCCmt fl E TSE t TE HOLDER t o NCELLAI10N WXJLD ANY 0F 71iZ AFKAT' Df-,SCr4Anf f1l)Rr. 'THr. r W FEE (�ANC,PTUll M n OATq PHERECIF, THE MSUMIG WSURrf-k Mil W*AVOR TO MAH I," C"ATE veruTTEN L0:I,HU1K-ARUM- TQX15C0�,HAIA NOVC� YOIHE�, I V MPO, -W NO ')H9JGAr*N CIA UAMUTV 0;AhlY KWI MION lHF NSURFR 1:77, ACFN75 OV NTAri r.s AW f vrIg . . .... Millri CORE) k6R'fFcf AH rillgh� r ad MAPORTANT Pt eht cprtlloCate hoklor is an ADD7�ONAL NSURFD Ole pohr�y�ies� Must cue emdOTI-;r�d an As ce=cate does nd cwAw hghr�,-, to the cprtic--itp hoidcr 50C -U Of SUCh CMJO'SeMEMS� ff I,-',UFR1C)GA7I0N S VVNVED, suQer, tcTic tei'TIIS ar�O ccndltt�'�n,F, of the pcj�,--Y certm pc-,flicies rnrq reqwre an endorsernenl A s[2empn,,on Vs cenmcat�t rices not coinfoF righhr, to th,-, certifrVe, h,cldu�- in Jeu of such emdorsement(s), MSCLAIMER 'Me Ctwas of Mwame on Me reveme de & thl Farm does no cmWe a cwWad beMew, the,Fjsixnq m��,unerCs), authorized TepreseMaks or puchme.r, and Me c,6,�,ilBficate, holder, nror does t aMmawey o"wgW06y arnond, exknd orals the caywage ahoded by Me ter hes Hod Hwew ACORD 25 �200=8) .. ... ....... Policy No. 92 EAV145 9 RIC WEISSINGER INS AGCY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ, IT CAREFULLY. CMP -4786.1 ADDITIONAL INSURED — OWNERS, LESSEES, OR CONTRACTORS (Scheduled) This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number: 92 EAV145 9 Named Insured: CJROBSON ENTERPRISES INC DDA CC SAFETY 1940 N TUSTIN ST STE 103 ORANGE CA 92865-4642 Name And Address Of Additional Insured Person, Or Organization: City Of Santa its Officers Agents and Employees 20 Civic Center Plaza Santa Ana CA 92701 1. SECTION 11 — WHO IS AN INSURED of SECTION 11 — LIABILITY is amended to in- clude, as an additional insured, any person or organization shown in the Schedule, but only with respect to liability for "bodily injury", 11 property damage", or "personal and advertis- ing injury" caused, in whole or in part, by: a. Ongoing Operations (1) Your acts or omissions; or (2) The acts or omissions of those acting on your behalf; in the performance of your ongoing opera- tions for that additional insured; or b. Products – Completed Operations "Your work" performed for that additional insured and included in the "products - completed operations hazard". However, Paragraph 1. above is subject to the following: a. The insurance afforded to the additional insured only applies to the extent permit- ted by law; CMP -4786A Page 1 of 2 b. If coverage provided to the additional in- sured is required by a contract or agree- ment, the insurance provided to the additional insured will not be broader than that which you are required by the contract or agreement to provide for such addition- al insured-, and c. If the contract or agreement between you and the additional insured is governed by California Civil Code Section 2782 or 2782.05, the insurance provided to the additional insured is the lesser of that which: (1) Is allowed for the satisfaction of a de- fense or indemnity obligation by Cali- fornia Civil Code Section 2782 or 2782.05 for your sole liability; or (2) You are required by contract or agreement to provide for such addi- tional insured. We have no duty to defend or indemnify the additional insured under this endorsement un- til a claim or "suit" is tendered to us. D, Copyright, State Farm Mutual Automobile Insurance Company, 2013 Includes copyrighted material of Insurance Services Office, Inc., with its permission. CONTINUED 2. Any insurance provided to the additional in- surodnhaU only apply with respect toaclaim made or a ^auU. brought for damages for which you are provided coverage. 3. With respect tothe insurance afforded to the additional imeurnd, the following is added to SECTION U -- LIMITS OFINSURANCE: If coverage provided to the additional insured is required bycontract oragreement, the most we will pay on behalf ofthe additional insured will bethe lesser ofthe amount nfinsurance: m. Required bythe contract oragreement; or b. Available under the applicable Limits Of Insurance shown inthe Declarations. This endorsement shall not increase the ap- plicable Limits Of Insurance shown in the Declarations. 4. With respect tnthe insurance afforded to the additional inmmnad, the following in added to Paragraph 3. Duties In The Event CJfQccur- remce, Offense' Claim Or Suit of SECTION |[--GENERAL CONDITIONS: The additional insured must: a. See toit that weare notified as, soon as practicable of an ~oocornanoa" or an of- fense which f-femoewhioh may result in ecloim. To the extent possible, nnhma should include: CMP -4786.1 Page amo (3)The nature and location of any injury or damage arising out of the "occur- rence" b. Tender the defense and indemnity of any claim or "suit" to un and to all other insur- ers who may have insurance potentially available fothe additional insured; and c. Agree to make available any other insur- ance the additional insured has for de- fense or damages for which we would provide coverage under SECTION || -- 5. With the insurance afforded the ad- ditional insured, the following replaces SEC- TION |U --L|AB,|L|TY of Paragraph 7 Other Insurance ufSECTION { AND SECTION U -- COMMON POLICY CONDITIONS: a. This insurance is primary to and will not seek contribution from any other insurance available 10the additional insured, provided that the additional insured is a named in- sured under such other insurance. b. Regardless of any agreement between you and the additional insured, this insur- ance is excess over any other insurance whether primary, excess, contingent or on any other basis for which the additional in- in- sured on other policies. (1) How, when and where the "occur- There will be no refund ofm ium in the event rnncn~oroffense took place; this endorsement iu cancelled. — (2) The names and addresses ofany in- jured persons and witnesses; and All other policy provisions apply. rIVIP-4/861 mm000 148011 08-21-2014 Q, Copyright, Automobile Insurance uum»anv.xuo 14:50RET k ...... -otq UATE (MMOCII(YYY� CERTIFICATE OF LIABILITY INSURANCE THIS CFRTIFICATE tS ISSUED AS MATTER OF INFORMATION ONLY AND CONFERS NQ RtOHT$ UPON THE CERTIFICATE HOLDF-R, THIS, CERTIFICATE DOES NOT AMEND, LXTEND OR ALTER THE COVERAGE AFFORF)FD BY THE POLPC�ES BELOW. INISURERSAFFORDSNG COVERAGE 81 1aJ4y. . .. .... . ...... � NAH' , # H. FIQJC�tLti; IVJJlAJNCC, LIS"7E.) BELOIN HAV" HPFN �&BlhF'D K) 1HE NAPM:0 AI30VE ME POUCY PERIOD INCqCATED, N y Rtl6UtRFNlEN7, TERM OR OF AWY' r,'d',NTRACr D(')S"VNIENI Vfl�'H RFSPECTTO 7rlfl.� cF-,R"r Ip,(r'p' Fl w.roy kJff KIAY P'F-F!7AW IHE INEURAM�'F Al H)N[Jl'& , I 13Y 4Hl�' DL"CNJBUD dEREIN Vz'N SUBJECT70 ALS THIF TFRM& , FXCHJSX'JW', AW 15LUI 0 ifl7 CJA q F I IM 11 f, 'mi I i C) aMA "A Y I WO.. U L LN RU 0 U C ED BY PA 1[) 0 INI S I �000' pnkj,"y tFk^ is "."9WF OLO"N NRA,71K)N PDArE 111; 7 prH Wl"lv NWAKCR YPE Gr �NSURANCC i fVXM,'Dmr)-f'x S' .21111 . 111, —1 �1.1.11,111.11.1.1��1.11.1-1111.1 -11--l— 11 --- 7-- i7 P F70-�, UASN rp'cll p ocm mm-w� 5, I z "JAI. iMA 11�itr 'v i,P,V'x 7JAIJP �sP !,V FD FY P Arp u ts ...... . ... ... .... .... ,WNWOM, F M Rh q rY t AIM ANY m',1 I �11- L O�Mlv' Ed I PS Cir 'T Q r RiM kF? L V,,W 7Y UK . .... ........ DT, C I tr" C olil; mAll 11! 4 1 0IAN �lr.L` N I A f ViORKERS COMMENSATION 4ND k 'a r, MPtl iJ"bEFM IIVAMLIF'f "It dtlJel Y, "N'o 1 iI1 H lll R tPTPIA 'R C 7 0,' X "'4"11'' VT L L f, AC81 At: LL 01? 1 E M :o Vt'P-rRS'7f0N WONS AODED BY ViaORSEMENT I SPCCmt. j HOLDER t ANCELLAMN 'y'HOULT) ANY OF 71iZ ABOVE Df-SCMDED, P'R (",ANCIIXIII RFMRr. 'THr. rXMIRA7,10N tiIATq PHERECIF, THE MSUMAG WSURrf-k Mil W*AVOR TO MAU I," C, A E vermrEN K-ARUWTI. T�)w�,CO�'HAIA NOTTC� YOIHE�, I V MP O, -W NO ')H99GAr*N CIA UAMUTV 0;= ANY KW'l MION lHF NSURFR 1:77, AFN75 OR AL)"I D I!Afllfig"A'l CORE) 257, TF. �-T a rrl Fi6`lkkr'e,q f 7ic a f5 P) v 0 Y I p o r u, €R 5y F,, y fr i c -s, I p o 7717 —�e Fr 9 �n—e7 F— �DACORD&ORIFOTTA775R7q "Mill AH rillgh� r o'd MAPORTANT I Me wwWTaW Wder is,an ADD7t NAL WSURFUl Oie pohccy' es) mustac- endoTsed an ths WNW does nN CmAw hghrF, t0 he cetfic--itp hoidcr n k -'U Of SUch 1',, l,-',UFR0GkFI0N INAIVED, to the tei'Tlls anO conditon,F, of the pct --Y cerzlrl pc-,fliciemy reqwra an enclorsement A X12ernFnt on VS canlmat�t r1ces not confor to thiucer-tifrMe- h,cldur in Jeu Of SuCh �--,,MdOrSem&71t(s) ,rtic, Crijficrte. of lnst,�rance. en the rever�se side of this forTn docs rrot cansNute a authorized represenuake or pro&zw, ad" l Me catkaw hoWer nu foes it - I - -. caver- e : ffirM2liVC,'IY OT IIC,�-�Ikv6y arnom, , e4r-nd, cv.��Iter thH ig �ffcjrdeid by the polick? ,-s Ested th—,reon ACORD 25 �2001108) .. ... ....... Policy No. 92 EAV145 9 RIC WE,ISSINGER INS AGCY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ, IT CAREFULLY. CMP -4786.1 ADDITIONAL INSURED — OWNERS, LESSEES, OR CONTRACTORS (Scheduled) This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number: 92 EAV1.45 9, Named Insured: CJROBSON ENTERPRISES INC DDA CC SAFETY 1940 N TUSTIN ST STE 103 ORANGE CA 92865-4642 Name And Address Of Additional Insured Person, Or Organization: City Of Santa its Officers Agents and Employees 20 Civic Center Plaza Santa Ana CA 92701 1. SECTION 11 — WHO IS AN INSURED of SECTION 11 — LIABILITY is amended to in- clude, as an additional insured, any person or organization shown in the Schedule, but only with respect to liability for "bodily injury", 11 property damage", or "personal and advertis- ing injury" caused, in whole or in part, by: a. Ongoing Operations (1) Your acts or omissions; or (2) The acts or omissions of those acting on your behalf; in the performance of your ongoing opera- tions for that additional insured; or b. Products – Completed Operations "Your work" performed for that additional insured and included in the "products - completed operations hazard". However, Paragraph 1. above is subject to the following: a. The insurance afforded to the additional insured only applies to the extent permit- ted by law; CMP -4786A Page 1 of 2 b. If coverage provided to the additional in- sured is required by a contract or agree- ment, the insurance provided to the additional insured will not be broader than that which you are required by the contract or agreement to provide for such addition- al insured; and c. If the contract or agreement between you and the additional insured is governed by California Civil Code Section 2782 or 2782.05, the insurance provided to the additional insured is the lesser of that which: (1) Is allowed for the satisfaction of a de- fense or indemnity obligation by Cali- fornia Civil Code Section 2782 or 2782.05 for your sole liability; or (2) You are required by contract or agreement to provide for such addi- tional insured. We have no duty to defend or indemnify the additional insured under this endorsement un- til a claim or "suit" is tendered to us. K), Copyright, State Farm Mutual Automobile Insurance Company, 2013 Includes copyrighted material of Insurance Services Office, Inc., with its permission. CONTINUED 2. Any insurance provided to the additional in- surodnhaU onlyapply with toaclaim made or a "suit" brought for damages for which you are provided coverage. 3. With respect tothe insurance afforded to the additional imeurnd, the following is added to SECTION U -- LIMITS OFINSURANCE: If coverage provided to the additional insured is required bycontract oragreement, the most we will pay on behalf ofthe additional insured will bethe lesser ofthe amount nfinsurance: m. Required bythe contract oragreement; or b. Available under the applicable Limits Of Insurance shown inthe Declarations. This endorsement shall not increase the ap- plicable Limits Of Insurance shown in the Declarations. 4. With respect tnthe insurance afforded to the additional inmmnad, the following is added to Paragraph 3. Duties In The Event CJfQccur- remce, Offense' Claim Or Suit of SECTION ||--GENERAL CONDITIONS: The additional insured must: a. See toit that weare notified as, soon as practicable of an "occurrence" or an of- fense which f-femsewhioh may result in ecloim. To the extent possible, nnhma should include: CMP -4786.1 Page amo (3)The nature and location of any injury or damage arising out of the "occur- rence" or offense; b. Tender the defense and indemnity of any claim or "suit" to un and to all other insur- ers who may have insurance potentially available fothe additional insured; and c. Agree to make available any other insur- ance the additional insured has for de- fense or damages for which we would provide coverage under SECTION || -- 5. With the insurance afforded the ad- ditional insured, the following replaces SEC- TION |U --L|AB,|L|TY of Paragraph 7 Other Insurance ufSECTION { AND SECTION U -- COMMON POLICY CONDITIONS. - a. This insurance is primary to and will not seek contribution from any other insurance available 10the additional insured, provided that the additional insured is a named in- sured under such other insurance. b. Regardless of any agreement between you and the additional insured, this insur- ance is excess over any other insurance whether primary, excess, contingent or on any other basis for which the additional in- in- sured on other policies. (1) How, when and where the "occur- There will be no refund ofm ium in the event rnnce~oroffense took place; this endorsement iu cancelled. — (2) The names and addresses ofany in- jured persons and witnesses; and All other policy provisions apply. rIVIP-4/861 mm000 148011 08-21-2014 (D, Copyright, Automobile Insurance uum»anv.xum f^7�{ CC1 /'D� ��. CERTIFICATE OF LIABILITI(INSURANCE DATE iMMIESDFYYYY) 051MI2017 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 EY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEI+I THE ISSUING II $UPER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) muse: have ADDITIONAL INSURED provisions or 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 StateFam RIC WEISSINGER, AGENT- LIC #OC68161 WEISSINGER INSURANCE AGENCY INC cONTACT CAROLE COOK NAME: PUHONe Exc, 714-377-1111 No: 714-377-1611 EWAIL ADDRE5S: INSURER(S) AFFORDING COVERAGE E MAIC 9 ' 5922 WARNER AVE iNSURERA: State Farm General Insurance Company 25;51 HUNTINGTON BEACH, CA 92649 INSURED INSURER 8 WSURER C: OC SAFETY INC INSURER D. 1946 N TUSTIN ST, STE 103 INSURER E ORANGE, CA 92865-4642 INSURER F: 07!0112018 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 PESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE WSURA;ICCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TEAMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAMS. !NSR LTR TYPE OF INSURANCE ADDL UBR POLICY NUMBER AOLICY EFF M POLICY EXP MMIDBIYYYY LIMITS COMMERCIAL QENERAL LIABILITY EAC14 OCCURRENCE S 1,000,000 X j CLAII�iS R7ADE OCCURP A ! I A ' 92 -EA -V145-9 I 10710112017 07!0112018 10D,C10E3 EAIS R Jrr8h92 g__—,— MED EXP (Any one person) A..5-()0() PERSCNALaADV INJURY $ 1,000.000 GEN'L AGGREGATE UMIT APPLIES PER: GENERAL AGGREGATE 3 2,000,000 I I I POUCY CET 17_LOC } i I PIOP AGG 5 2,000.00Q 3 OTHER: i I AUTOMOBILE LIABILITY ANY AUTO [ ! i I CSG RINFDSINGLF LIMIT 'S BODILY i NJURY ;Per person) S ov�NEDSCHEDULED AUTOS ONLY I AUTOS AIRED NON•OWNED AUTOS ONLY AUTOS ONLY I I BODILY INJURY (Per accident) 5 PROPERTY DAMAGE Per accident' � 3 UMBRELLA G LIAR � OCCUR ; j EACH OCCURRENCE S AGGREGATE S EXCESS LLAB CLAIMS MADE i DED I I RETENTION 5 S WORKERS COMPENSATION AND EMPLOYERS' LLABILATY YIN ANY PRPFRIETOR/PARTNERfEXeCUTIVE ❑ OFFICERiMEMSER EXCLUDED? N f A PIAT TEPH- E.L, EACH ACCIDENT ! s -- E.L. DISEASE -EA EMPLOYEEI S (Mandatory in Nit) Ifes describe under D£StRIPTION OF OPERATIONS below ! E1. DISEASE - POLICY UMET � X BUSINESS PROPERTY I i j 92 -EA -V145-9 ! 10710112017 !! 0710112018 i DESCRIPTION OF OPERATIONS t LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached It morn space is required) LOC 01 - 1940 N TUSTIN ST, STE 103, ORANGE, CA 92865 CERTIFICATE HOLDER, ITS OFFICERS, AGENTS AND EMPLOYEES ARE NAMED AS ADDITIONAL INSURED IN REGARDS TO GENERAL LIABILITY E€�.3i#lt�L+S;.lia�l��E�l�'► �liili�i��=fiE� CITY OF SANTA ANA ATTR: PURCHASING DEPARTMENT 20 CIVIC CENTER PLAZA SANTA ANA; CA 92701 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLE=D BEFORE THE EXPIRATION [SATE THEREOF, NOTICE. WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED FtE�rA e 1988-2015 ACORID CORPORATION. All hts reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD 1001406 132949.12 03-15.20;6 1 `3 Policy NO. 92 EAV145 9 RIC WEISSINGER INS AGCY CMP -4786A Page 1 of 2 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CMP -4786.1 ADDITIONAL INSURED — OWNERS, LESSEES, OR CONTRACTORS (Scheduled) This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number: 92 EAV145 9 Named Insured: CJROBSON ENTERPRISES INC BBA OC SAFETY 1940 N TUSTIN ST STE 103 ORANGE CA 92865-4642 Name And Address Of Additional Insured Person Or Organization: City Of Santa its Officers Agents and Employees 20 Civic Center Plaza Santa Ana CA 92701 1. SECTION 11 — WHO IS AN INSURED of SECTION 11 — LIABILITY is amended to in- clude, as an additional insured, any person or organization shown in the Schedule, but only with respect to liability for "bodily injury", "property damage", or "personal and advertis- ing injury" caused, in whole or in part, by: a. Ongoing Operations (1) Your acts or omissions; or (2) The acts or omissions of those acting on your behalf; in the performance of your ongoing opera- tions for that additional insured; or b. Products – Completed Operations "Your work' performed for that additional insured and included in the "products - completed operations hazard". However, Paragraph 1. above is subject to the following: a. The insurance afforded to the additional insured only applies to the extent permit- ted by law; b. if coverage provided to the additional in- sured is required by a contract or agree- ment, the insurance provided to the additional insured will not be broader than that which you are required by the contract or agreement to provide for such addition- al insured; and c. If the contract or agreement between you and the additional insured is governed by California Civil Code Section 2782 or 2782.05, the insurance provided to the additional insured is the lesser of that which: (1) Is allowed for the satisfaction of a de- fense or indemnity obligation by Cali- fornia Civil Code Section 2782 or 2782.05 for your sole liability; or (2) You are required by contract or agreement to provide for such addi- tional insured. We have no duty to defend or indemnify the additional insured under this endorsement un- til a claim or "suit" is tendered to us. (0, Copyright, State Farm Mutual Automobile Insurance company, 2013 Includes copyrighted material of Insurance Services Office, Inc., with its permission. CONTINUED 2. Any insurance provided to the additional in- sured shall only apply with respect to a claim made or a "suit" brought for damages for which you are provided coverage. 3. With respect to the insurance afforded to the additional insured, the following is added to SECTION II — LIMITS OF INSURANCE: If coverage provided to the additional insured is required by contract or agreement, the most we will pay on behalf of the additional insured will be the lesser of the amount of insurance: a. Required by the contract or agreement; or b. Available under the applicable Limits Of Insurance shown in the Declarations. This endorsement shall not increase the ap- plicable Limits Of Insurance shown in the Declarations. 4. With respect to the insurance afforded to the additional insured, the following is added to Paragraph 3. Duties In The Event Of Occur- rence, Offense, Claim Or Suit of SECTION II — GENERAL CONDITIONS: The additional insured must: a. See to it that we are notified as soon as practicable of an "occurrence" or an of- fense which may result in a claim. To the extent possible, notice should include: (1) How, when and where the "occur- rence" or offense took place; (2) The names and addresses of any in- jured persons and witnesses; and CMP -4786.1 CMP -4786.1 Page 2 of 2 (3) The nature and location of any injury or damage arising out of the Occur- rence" or offense; b. Tender the defense and indemnity of any claim or "suit" to us and to all other insur- ers who may have insurance potentially available to the additional insured; and c. Agree to make available any other insur- ance the additional insured has for de- fense or damages for which we would provide coverage under SECTION 11 --- LIABILITY. 5. With respect to the insurance afforded the ad- ditional insured, the following replaces SEC- TION II —LIABILITY of Paragraph 7. Other Insurance of SECTION I AND SECTION II — COMMON POLICY CONDITIONS: a. This insurance is primary to and will not seek contribution from any other insurance available to the additional insured, provided that the additional insured is a named in- sured under such other insurance. b. Regardless of any agreement between you and the additional insured, this insur- ance is excess over any other insurance whether primary, excess, contingent or on any other basis for which the additional in- sured has been added as an additional in- sured on other policies. There will be no refund of premium in the event this endorsement is cancelled. All other policy provisions apply. ®, Copyright, State Farm Mutual Automobile Insurance Company, 2013 Includes copyrighted material of Insurance Senrioes Office, Inc., with its permission. 1007033 148011 08-21-2014