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HomeMy WebLinkAboutXANADU SERVICE SYSTEM 3B -2014INSURANCE ON PILE WORK MAY PROCEED UNTIL INSURANCE EXPIRES 9� - /5` CLERK OF COUkIGIL. J 2OI DATE: JtI( cl 1 I C*) A- 2014 - 105 -01 b P9,10, FIRST AMENDMENT ND14'I'ENT TO CUSTODIAL SERVICES AGREEMENT avxw THIS FIRST AMENDMENT TO AGREEMENT is entered into this 12TH day of June, 2015, by and between Xanadu Service System, Inc. ( "Xanadu "), and the City of Santa Ana, a charter city and municipal corporation duly organized and existing under the Constitution and laws of the State of California ("City"). RECITALS A. On June 1, 2014, the City entered into Agreement #A -2014 -105 with Bell Building Maintenance Company, Inc. to provide janitorial and custodial services for park restrooms in Districts 1, 2, 3 and 4 for a one -year term with two one -year options exercisable by the City. B. By letter dated May 27, 2015, the City exercised the first option and extended the term of the Agreement for an additional one -year period, from June 1, 2015 to May 31, 2016, C. Effective June 1, 2015, as evidenced by Exhibit A, Bell Building Maintenance Company, Inc. merged with Xanadu; and is now doing business as Xanadu Service System, fine. In view of this change, the parties wish to amend die agreement as below. The Parties therefore agree: 1. All references to `Bell Building Maintenance Company, Inc." are changed to "Xanadu Service System, Inc." 2, Section 10, NOTICE, is amended in part to read: TO CONTRACTOR: Xanadu Service System, hic., 3010 Wilshire Blvd., Suite 315, Los Angeles, CA 90010, Attu. Alice Chung or and Bruce Hwang. 3. Except as hereinabove modified, the terms and conditions of said Agreement remain unchanged and in full force and effect. IN WITNESS WHEREOF, the parties hereto have executed this First Amendment to the Agreement the date and year Cirst above written, ATTEST: Maria D. T.Iiuzar Clerk of the Counril APPROVED AS TO FORM: Sonia R. Carvaiho, City Attorney j hn M. Fund Assistant City Attorney CI SAN AN David Ca zos City Manager RECOMMENDED FOR APPROVAL: GERARDO MOUET Executive Director of Parks Recreation, and Community Services Agency XANADU SERVICE SYSTEM, INC. ,G►e' RbP CERTIFICATE OF LIABILITY INSURANCE 06i(04 2019 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 Ileu of such endomement(s). PRODUCER CONTACT KENNY CHOI NAME: INSURANCE LAND INSURANCE SERVICES �CNEO 1,213- 388 -5505 aCNO:213- 388 -7148 4032 WILSHIRE BLVD EMAIL INSURANCELAND@SBCGLOBAL. NET ADDRESS: STE 309 INSURERS AFFORDING COVERAGE NAIC# LOS ANGELES CA 90010 INSURERA:COLONY INSURANCE COMPANY $ 5,000 INSURED INSURER B; EMPLOYERS PREFERRED INSURANCE A XANADU SERVICE SYSTEM, INC. INSURER C: INTEGON PREFERRED INSURANCE INSURER D : 3660 WILSHIRE BLVD. SUTIE 506 GENERAL AGGREGATE 2,000,000 INSURER E: LOS ANGELES CA 90010 1 INSURER F: ___$_ PRODUCTS - COMP /OPAGG 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. S ILTR TYPE OF INSURAN CE ADOL IN INSIR SUER MD POLICY NUMBER POLICY SEE MMIDDNYYY POLICY EXP MM/DDNYYY LIMITS GENERALLIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 14 OCCUR GL4136354 09/15/2014 09/15/2015 EACH OCCURRENCE A RE ED PREMISES Ea occurrence $ 11000,000 $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL &ADV INJURY S 1,000,000 A GENERAL AGGREGATE 2,000,000 GENT AGGREGATE LIMIT APPLIES PER', ___$_ PRODUCTS - COMP /OPAGG $ 11000,000 POLICY PRO- LOO _- $ AUTOMOBILE LIABILITY 2003172588 06/04/2015 06/04/2016 COMBINED SINGLE LIMIT ANY AUTO BODILY INJURY (Per person) $ C _ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ HIREDAUTOS NON -OWNED _ AUTOS PROPERTY DAMAGE$ Per accitlent UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE _ $ EXCESSLIAB CLAIMS -MADE DEB RETENTION$ $ B WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN ANY ECUTIVE� OFFICER /MEMBEER EXCLUDED? NIA EIG 1663447 02 04/02/2015 04/02/2016 WCSTATU- OTH- 9SY_LN E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE -EA EMPLOYE '- -' $ 11000,000 (Mandatory In NH) es, d scope under E.L. DISEASE - POLICY LI MIT $ I 000 00 U SCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) eA V CERTIFICATE HOLDER IS AS AN ADDITIONAL INSURED. F;e'Ve" \�P/ >000�0000' CERTIFICATE HOLDER CANCELLATION laQ CLERK OF THE COUNCIL SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF SANTA ANA THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE Wl;H J POLICY PROVISIONS. 20 CIVIC CENTER PLAZA (M -30) AUTHORIZED REPR ENTATI E SANTA AN CA 92701 ,,, © CORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered a s of ACORD Policy# GL4136354 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. 8 0 • 1 W 1 0 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Additional Insured Person(s) or Organization(s) Additional Insured): Location(s) of Covered Operations: All persons or organization as required Locations as required by a by a written contract or agreement written contract or agreement with the named insured. with the named insured. A. SECTION II - WHO IS AN INSURED is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule for whom you are performing operations 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 respect to liability for "bodily injury", "property damage" or "personal and advertising injury" casued, 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(s) at the location(s) designated above. A person's or organization's status as an additional insured under this endorsement ends when your operations for that additional insured are completed. B. With respect to the insurance afforded to these additional insureds, the f *wing additional exclusions apply: This insurance does not apply to: �eJy2 t O Additional Insured Contractual Liability I/ pJaS� "Bodily injury" or "property damage" for which the additional insur .�gryyp, a 6d to pay damages by reason of the assumption of liability in a contract or a Spy, GcJp Finished Operations or Work QQ "Bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. 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. Negligence of Additional Insured "Bodily injury" or "property damage" arising directly or Indirectly out of the negligence of the additional insured(s). ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. U156 -0310 Includes copyrighted material of ISO Properties, Inc., Page 1 of 1 with its permission. Insured AC,i0RL> —�— — ip r CERTIFICATE OF LIABILITY INSURANCE �21I(3O" ✓201 THIS CERTIFICATE KATE' 15 CSSUED AS A MATTER OF gNFdRMAT1dN QN'LY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS BELOW. DOES NOT AFFCRMATIVELY OR NEr,ATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BEPRE THUS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BEWi EEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE dR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT;. If thB Certificate holder Is ali ADDiTiONAL INSURED, the policy {ies) malst be endorsed. if SUBROGATION IS'VgfAtVED, subject to the terms and conditions of the policy, certain policies may roquiro an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s), PRODUCER ONTAC KENNY" fIQT NAME. INSURANCE LAND INSURANCE SERVICES PHONE � � .. 4032 WILSHIRE BLVD 213- 388^ S'a5__._ . . .. �.i &P,A. 213 -3e8-7148 1ruCq,.Bal}� .... STE 309 y AD�oss, INSi9F .ANt3ELANTJC�?SBCGLOBAL.NET r) FFORDING COVE LOS ANGELES CA. 90010 - INSURI<R_{ §�G _ 9 NAIL .. ...._. -- — INSURERA COLONY INSURANCE COMPANY INSURED INSl1 EMT'LOYERS PREFERRED SNSURANCd XANADU SERVICE SYSTEM, INC. RER8 INSURER. C INTEGON PREFERRED INSURANCE . 10002 PIONEER BLVD., STE 101 tusu(z(zo: SANTA FE SPRINGS INSUREat,c; CERTIO KATE NUMBER 70 IN 5URER r : �T COVERAGES REVISION NUMBER: THIS 1S TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR TIE 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, GENERAL LIABILITY ?,� 1 COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR J_..�. -. ......_ - .. ..........._.......,.. GEN L AGGREGATE (LIMIT APPLIES PER ICY r PRA I I; LOC AUTOMOBILE LIABILITY ANY AUTO ALL OVMIED SCHEDULED A6TO5 . AUTOS NON -OWNED biIREDAU7O5 _ AUTOS.. UMBRELLA LIAR OCCUR EXCESS LIA17.. 11 ,., — WORKERS COMPENSATION I AND EMPLOYERS' LIABILITY Y i N i. ANY PROPRIETORIPARTNERPEXECUTIVL $ OFFICERIMEMBER EXCLUDED? Y N I A i (Mandatory In NH) 11 ties. derscNba undor MMTIGIG'(NYYY9.�, LIMIT° URE' ;ENCr: +47,1421 69f 15 ✓2415 09/15/2616 -EACI OCCURRENCE taAMA0LL-TCCR!1mr () I - 1001,000 I i M.D E P (Airy on.. e nel son) _. 5,000 .. PERSCNAL & ACV INJUR V 0 , V Q 0 ---11-0 .. GE AGGREGATE M ._.. -., ...... , $ ... 2,000,0 00 ....._ (PRODUCT$ COMP,,O'P,GG 3 1 (}C10x000 ..— ...... '. C.C3r &D Nt [; SINGLE L IVIT 2003172x88 106/04/ 261566 /04/'2016, 4F88cc" nh ; Ann EIG 16634,47 02 104/02/2015864/02 /2016 DESCRIPTION OF OPERATIONS 1 LOCATIONS P VEHICLES (Attach ACORD 101, Addlllonal Remark Schedule, It Mora space is required:.) q BODILY INtURY (Per Pelson) 6 BOCILY INJURY (PPr acdo nnp PROPERTY OWWGF ASi Llg rnr) EACH OI C.UR t4ENC(: :> s F: L EACH ACCR)EN] E L- OISF ASE EA EM 1,000,000 1, 0 0: O. r f?_(i 0 CERTIFICATE HOLDER IS AS AN ADDITIONAL INSURED. � a ^ � CERTIFICATE HOLDER CANCELLATION CLERK OF THE COUNCIL SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF SANTA ANA THE EXPIRATION AATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE W170 THE POLICY PROVISIONS. 20 CIVIC CENTER PLAZA (M -30) SANTA ANA CA 92701 AUTHORIZED rJ&15RESEN'1"A1IVE @88- 20'101 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered rks of ACORD GL4171421 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - I SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Name of Additional Insured P,erson(s) or Organization(s,) (Additional Insured): Location(s) of Covered Operations: All persons or organization as required Locations as required by a by a written contract or agreement written contract or agreement with the named insured, with the named insured. A. SECTION 11 - WHO IS AN INSURED is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule for whom you are performing operations when You and such person or organization have agreed in writing in a contraCir 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 respect to liability for "'bodily injury", "property damage" or "personal and advertising injury" casued, 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 insureds) at the location(s) designated above. A person's or organization's status as an additional insured under this endorsement ends when your operations for that additional insured are completed, B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to: Additional Insured Contractual Liability "Bodily injury" or "property damage" for which the additional insured(s) are obligated to pay damages by reason of the assumption of liability in a contract or agreement. Finished Operations or Work "Bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be per-formed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. 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. Negligence of Additional Insured 01 . "Bodily injury" or "Property damage" arising directly or indirectly o th e,,, P glige of the additional insured(s). ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN U156 -03101 Includes copyrighted material of ISO Prope Page 1 of I with its permission., J, Insured Policy Change Number THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. IL 12 0111 85 POLICY CHANGES POLICY NO. POLICY CHANGES EFFECTIVE GL4171421 09/15/201! 5 NAMED INSURED Bruce Hwang DBA Xanadu Service System, Inc. COVERAGE PARTS AFFECTED Commercial General Liability COMPANY Colony Insurance Company AUTHORIZED REPRESENTATIVE Harry W. Gorst Co., Inc. It is further agreed that the insurance provided by the Blanket Additional Insured endorsement form U156-0310 shall be primary and non-contributory, but only in the event of the Named Insured's sole negligence, CjN Signature GU 269 (11 -86) Copyright, Insurance Services Office, Inc., 19183 IL 12 01 11 85 Copyright, ISO Commercial Risk Services, Inc., 1983 Page 1 of 1 Insured DATE CMIMrDDfYYYY9 CERTIFICATE OF LIABILITY INSURANCE �T f�6,✓1s /Ia16 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 SUB140GATION 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 Milder in lieu of such endorsement(s). PRODUCER CON ACT �"IT KTF+i _ _ NAME: .__._.. INSURANCE LAND INSURANCE SERVICES PRICNyEoJtl: 213 -3I38 -5505 _ EalyNo} �13 -3t�'6 -74th 4032 WILSHIRE BLVD ADDRESS, insurance)land@gtiail.com STE 309 INSURER(Sp AFFORDING COVERAGE NAiC q LOS ANGELES CA 901010 -_......., .._.._._ _. _In,suRERA COLONY IusURA_ xCE COMPANY 39993 � 99 9W9._3 INSURED INSURER B : EtILOYE R PREFERRED INSURANCE 10345 XANASU SERVICE SYSTEM, INC . INSURERC: INTEGO PREFERRED- TNSURAN&i _ ,...w 3'1488 3010 WILSHIRE BLVD. SUITE 315 INSURER D: _INSI�RER E LOS ANGELES CA 90010 INSURER F: _ ,^°r°a%/=Ar-' =Q ( rDT1CIe ATIl:Mnrn M11=0r RFVmirw NIIMRFP- THIS BS 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 DOCUMI.NT' WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DE$QRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ............ - �..._, ....___,...,�.A47o4atl66Fi _........,.. __...._. :., ....�..., POLICY EF%�POLIt;.Y EXP INSIi f.... TYPE OF INSURANCE I POLICY NUM DER M.MIOIiIYYV "Y MMMWYYYY LIMITS ACCORDANCE WITH THE POLICY PROVISIONS. COMMERCIAL GENERAL LIABRLITY t_..,,_... AUTHORIZED RE=PRESENTATIVE GL4171421 09/15 ✓2015 09115 ✓2016 EACH'.,9 OCCURRENCE At. "01 iORENTED $ 1,000,000 _.. OCCUR S 100,000 CLAIMS -MADE EREMISF'4LE-3 pt,.argncg}_ ME EXP (Any ano Pefsan} $ .. 5,000 A ,,. _. ..___ _. __... Y Y PERSONAL & AQV INJURY 5 1,000,000 .. GENE AGGREGATE LIMIT APPLIES PER: GENER 41 AGGR12GATE � $ 2,000,000 POLICY PRO- PRO LCC L... ° s PRODO� TS COMPICPAGf I. $ 1,000,000 -._ OTHER: 4 _ _ S AUTOMOBILE LIABILITY' u....... 20031725/88' --01 05/04 /201..5 CQMBINEP 06/04/2017 1NNGCLLILIMII _tFaatri,ienl} $ 11000,000 _ ANY AUTO ( BODILY INJURY (Per parson) - O ALL OWNED SCHEDULED 4 BODILY INJURY (Per accident) $ AUTOS AUTOS /._ NON- OWNED HIRLOAUTOS i 9 I ..._..�� PROPERTYDAMA1aE $ _1L AU'70S L 1 1A.B OCCUR ! EACH CCCURRENCE a EXCESS OAS AGGRE AIE _�CLAIMSMADEI p OED 1 RETENTION _ I( COMPENSATION "LIABILITY p EIG 1663447 03 04/02 ✓2017 ER STATIiTE ER AND EMPLOYERS YIN ANY PR9PRIET0R1PARTNERJLXECUTIVE I�—�+�q } .04/02/2016 } E L EAC H ACGIDE..NT g 11 0 00 , 0 0 0 B OFFICERWEMBER EXCLUDED? E�J` (Mtandatory In NH) N I A I I - -- - .., �- i E.L.. DISEASE - EA EMPLOYEE1 _ . _ — $ 1,000,000 I E.L.UISEA E -POLICY LlIT S 1,000,000 ilf yes, describe under c - BESCRIFTICN OF OPERATIONS below i r I DESCRIPTION OP OPERATIONS d LOCATIONS I VEHICLES. ACORD 101, Additional Remarks 5r:heduie, may be attached it moro spaca is requir.dy e J\ CERTIFICATE HOLDER IS AS AN ADDITIONAL INSURED. / (,ejy�j r.��ralrr�rarr�!!rirl�i�- rr��.rM�����rrna�Ir� CLERK OF THE COUNCIL SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. CITY. OF SANTA ANA AUTHORIZED RE=PRESENTATIVE 20 CIVIC ' CENTER PLAZA (M-30) SANTA ANA CA 92701 - 'u-) Itsoo-zuI% MV,Ur%w 11V1U.: n l u lryrlla rvau, I... ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD