HomeMy WebLinkAboutSANTA ANA PROFESSIONAL SERVICES - 2015N -2016 -181
INSURANCE N 01 ON BILE
WORK MAY PROCEED
CLERK OF COUNCIL
DATE:
: DEC
2015 PRQFESSI4�
P J Sorne AI SERVICES A0EENEl3
nw
'THis AGpEplvfsNT is, made and catered into this 16`x' day of October, 2015 by and
��" between Santa Ana Professional Services (Qoutraetor"), and the City of Santa An.a, a charter
city and zn rololpal corporation organized and existing under the Constitution and laws of the
State of California ("City ").
RECITALS
A Tho City desires to retain a contractor who is car authorized live scan provider, certified,
by the California Department of Justice to providelingerprinting services.
B. Contractor has previously provided fingerprinting services with the City and the City
desires to coaftue these services with Contractor,
C. Contractor mr me_.ts that Contractor is able; and willing to provide such sekviges to flac
City,.
D. In undertal;iiig the performance ofthis Agreement, Contractor represents that it is"
knowledgeable in its field and that any services performedby Contractor^ under this
Agreement will be performed in compliance with the State of California Department of
Justice,
NOW THER14rF0111, in consideration of the m4tual and respective promises, and subject to the
terms and conditions hereinafter set forth, the parties agree as follows:
11. SCOPE OF SERVICES
Contractor, agrees to provide fangerpriuting services tel: job applicants and volumeerss for
the City of Santa An& The fingerprinting will be done by Live Scan and will be sent to the
Deparinaent of Justico to chock for criminal records,
2, DELIVERY OF WORK PR43T)`[Z r
Any person providing services pursuant to this Agreement shall deliver to City any wort
product which results from the services provided pursuant to this Agreement. In regard to ail
eopyrightable material produced as a deliverable under this Agreement, including but not limited
to books, repoits, photographs, drawings, films, recordings, videotapes, and computer programs;
Contractor agrees for itself and its affected officers, employees, agents; contractors, and
volunteer workers that (a) other such material may not be copyrighted without prior review from
the City, and (b) the authors of all such material, whether copyrighted or not, will award to the
City, and to its` officers, agents and employees acting within the scope of their official duties, as a
condition of payment to the Contractor, a royalty - free, nonexolusive irrevocable license
throughout the world to disclose; publish, translate, reproduce; and use suohmaterials.
Page 1 of?
J. C olrkl MNSAUGN
a. The City agrees to pay, and Contraotor agrees to accept $10,00 per participant, The
total stair to be expanded under this Agreement shall not exceed Four Thousand Five
TTtundred Dollars ($4500.00) duffing the term of this Agreement; This agreement.
includes work done since August 20115,
b. Paynientby City ghallbemAdo within thirty (30) days followingroceipt of proper
invoice evidencing work perfarmed, subject to the City's accounting procedures.
Payment need not be made for work which fails to meet the standards of performance
set forth in the Recitala wlvoh. xmy reasonably ba expected by the City,
4, TERM
11HO Agreement shall oatnmence on October 16, 2015 and fetrairate on October 16,
2017, doss tortionatod earlier in accordance with Section 13, below, The term of. this
Agreement may be extended for (1) additional. year period upon a wilting executed by the City
Manager acrd City.Attoraaey:
5. INDEPENDENT CONTRACTOR
Contractor shall, during the entire term of this Agreement lie construed to be an,.
independent contractor and not an employee of the City, This Agreement is not untended nor
shall it be construed to create an ortnployer- employee relationship, a joint venture relatiotnship, or
to allow, the City to exercise discretion or control over the profosaional manner ii-i which
Oontraotor per OTTAs The services which are the subject matter of this Agreement; however, the
services to be provided by Contractor shall be provided iii a marmot consistent with all
applicable standards and regulations governing such services. Contractor shall pay all salaries and
wages, etnxployeris social sccurity tuxes,, unemployment insurance and similar taxes relating to
ontployees and shall be responsible for all applicable withholding taxes.
0. PMTRANC.14
Prior to tmdertalang performance of work under this Agreement, Contractor shall
maintain and shall regrtlre its subcontractors, if any, to obtain and maintain insmanoe as
described below:
a. Commercial General liability Insurance, Contractor 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 occurrenco arising out of Contractor's operations in the performance of
this Agreement, including, without !mutation, 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 and $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
Page 2 of
not contributory with respect to insurance or self-insurance programs maintained by the City,
and (c) contain standard separation of insured provisions.
b. Worker's Compensation Insurance; In acsordance with California State JaWV
Contractor, if Contractor has any employees, is required to be insured against liability for
worker's compensation or to undertake self-insurance. Prior to cominenciug the performance of
the work under this Agreement, Contractor agrees to obtain and maintain any employer's
liability insurance with lim iN not less than $1,000,000 per accident,
c. The follmNing.requirements apply to the insurance to be provided by Contractor
pursuant to this section:
(i) Contractor shall maintain all insurance. required above in fia force and
effect for the entire period cdvered by this Agreement. Certificates
of insurance shall be furnished to the City upon:, execution of this
Agreeozont and shall be approved in form by the City.
(u) Certificates and policies shall state that the policies shall not be canceled
Or reduced in oovmagd or cbauged in arty other mater%al aspect without
thirty (30) days prior written notice to the City,
d. If Ceirtzactor fails or refuses to produce or maintain the insurance required by this
section, or fails, or refries to famish the City with required proof tat isxsur-ance has bm procured
and is inform and paid for, the City shad have the. riglit, at the City's election, to terminate. this
Agreement. Such termination shall not affect Coutractorls right to be paid for its time and
materials exptended prior to notification of termination, Contractor waives the right to receive
compensation and agrees to indeaa r* the City for spy work perfoxtned prior to approval of
ipsnranoa by the City.
7, INDEMNIFICATION"
Contractor agrees to and shall indemnify,.def`ond and hold harmless the City, its officers,
agents, eMploye;es, Contractors„ special counsel, and xopresontatives from liability: (1) for
Personal injury, damages, just compensation, restitution, judicial or equitabloreliel' arising out of
claims forpersonal injury, Including deatb, and claims for property damage, which may arise
from the negligent operations of the Contractor 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
ar sing from this Agreement, to the extent that the Injury, damages, just compensation,
restitrtion, judicial or equitable relief is caused by the negligence of the Contractor. This
indonmity 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. City may make all reasonable decisions with respect to its representation in any legal
proceeding. In no case will Contractor be required to indemnify or hold harmless the City from
Page. 3 of 7
injury, damages, just compensation, restitution, judicial or equitable ralief; caused by the
negligence of the City:
8. CONFIDENTIALITY
If Contractor receives fiatm the City information which due to the nature of such
infrarmation is reasonably understood to be confidential and/or proprietary, Contractor agrees that
it shall notuse or disclose such information, except in the performance of this .Agreement, and
further agrees td exercise the sane 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 nonpublioinformation. Confidential information includes. not only written information, but
also information transferred orally, visually, elcctronically, ot• by other means. Confidential
infonnation disclosed to either party by any subsidiary and/or agent of t12e 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 Contractor disclosed in a publicly avai' fe, source; (o) is in rightful possession of the
Contractor without an obligation of co dontiality; (d) is required to be disclosed by oporat%on of
law; or (e) is independently devel oped by the Contractor without reference to inibri iatioxt
disclosed by the City,
9. CONFLICT OF ITTEE.E8T CLAUSE
Contractor covenants that itpresently has no interests and shall not have interests, dirt
or indirect, which would conflict in any" rmanmer with performance of services specified under
this Agreement-
W10010049 "01
Any notice; tender, demand, dellyery, or other eonnnunication pursuant: to'th is
Agreement shall be in miting 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 facsimile or other telegraphic
communication in the manner provided in this Section, to the following persons:.
To City; Clerk of the City Council
City of Sttgtu: Ana
20 Civic Center Plaza (M -30)
P.O B:ox 19$8
Santa Ana, CA 92702 -1988
Pax (714) 647 -6956
With col'utc,5Y copies to
Executive Director of the Personnel Services Department
City of Santa Ana
"r[ 0, Box 1988
Santa Ana, CA 92701 -1988
Page 4 of 7
Fax: 714 647 -6930
and
City Attorney
City of Santa Ana
20 Civic Center Plaza (IM -29)
P.0, 80X 1988
Santa Ana, California 92702
Fax (714) 647 -4515
To Contractor:. Teresa Arelland
1002 E. 17t' Street, Suite R
Santa Ana, CA 92701
(714) 245 -0050
A pally nay change its address by giving notice ini writing, to the other party,, Thereacer;
any coWManioation shall be addressed and transmitted to the new address, if sent by mail,
conrrnunioation shall be eff'eetive or deemed to have been given tht (8) hays after it has been
deposited in the United States avail, duly registered or certified, wit? postage prep?4d, and
addressed as set fordo above, If scat by facsimile, communication shall be effective or deemed to
have been given twenty, -.four (24) hours after the time set forth on the transmissioaa report issued,
by the traasmittiapfacsimile mwbixre;, addressed as set forth above. For purpose of caleuTati]ig
these tinge frames, weekends, federal, state, County or City holidays shall be excluded,
St. EXCLUS I IT AND ANWNDMENT
This Agreement represents the complete and exclusive statement betwom the City and
Contractor regarding the subject matter herein, and supersedes any and all other agrvoments; oral
or written, between the parties. In the event of a conflict between the terms of thi:s Agreement
and any attachments hereto, the terms of this Agreement shall prevail; This Agreement ruay not
be modified except by written instrument signed by the City and by an authorized representative.
of Contractor. The parties agree that any terms or conditions of atrypurchase order or other
instrument are ineonsisteut with, or in addition to, the terms and conditions .hereof, shall not
bind or obligate Contractor .= the City. Each paty to this Agreement acknowledges that no
representations; inducernents, 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.
12. ASSIGNMENT
Inasmuch as this Agreement is intended to secure the specialized services of Contractor,
Contractor may not assign, transfer, delegate, or subcontract any interest herein without the prior
written consent of the City and any such assiginment, 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 o'f the services which are the subj ect to
this Agreement performed by City personnel or by other Contractor s retained by City.
Page 5 of 7
13. TEId.14MATION
This Agreement may be terminated by the City with thirty (30) days written notice. to the
Contractor.
14. NON- IDISCRIADNATION
Contractor 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 or in connection with any activities wider this Agreement.
Contractor affirars that it is an equal opportunity employer and shall comply with all applicable
federal, state and local laws and regular ons.
is S DIC i C 1 I1 T
This Agreement and all questions relating to its validity, interpretation, perlonuanee and
enforooment shall be, governed and oottstrued in accordance wlth1he laws of the State of
California. This Agreement has been executed and delivered in the State of California and the
validity, interpretation, parformanee, arid, enforcement of any of the clauses of this Agreement
sliall bedetetrnirred and governed by the Paws of the of Califomia. Both parties further
491,00 that Osage C'aunty, California, shall be the venue for any actiga or proceeding that may
be brought or arlse out oi', in coviteciicat with om byreason ofthis Agreement,.
16. ]FOOFESSIONAL LICENSES
CamtMQtor shall, throughaut.the term of this ,Agroeanont, maintain all accessary licenses, .
permits„ approvals, waivers, continuing education, and exemptions neocssary for the provision of
the services hereunder and required by the laws ails xrgulaiious of the United States, the State of
California, the City of Santa Arta and all other govermnental agencies. Contractor shall notify
the City immediately and in writing of her inability to obtain or maintaia such permits, licenses;
approvals, waivers; and exemptions. Said inability shall be cause forteimination of this
Agreement,
17. MISCELLANEOUS PROVISIONS
a. Each undersigned represents and warrant that its signature hereiabelow has the power,
authority and right to bind their respective parties to each of the terms of this Agreement, and shall
inderwaify City fully, including reasonable costs and attorney's fees, for any injwies or damages to
City in the event that such authority or power° is not, in fact, hold 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.
Pine 6 of I
IN WITNESS WHEREOF, the parties hereto Have executed this Agreement the elate and year
first above written.
ATTEST:
MARIA D kTLiIZAR
Clerk of the Cou -nell
APPROVED AS TO FORM„
SONIA R. CARVALHO
City Attorney
LAURA A. ROSSINI
Senior Assistant City Attorney
RECOMMENDED FOR APPROVAL:
1MA AIR AYA
Executive Director of
Personnel Services Agency
CITY OF SANTA
City Manager
CONTRACTOR
Santa Ana Professional Services
I Lau—�
it
By:.
Title:
Pale 7 of 7
51
STATE FARM GENERAL INSURANCE COMPANY
A G POCK COMPAN Y wing HomE oFmc--s iN BL acmwc, ToN, xt iNols
R kaId
j�
Mfle
oo 3311-9501
R -23- 3036 -"=C16 F U
000502 3123
Named Insured
ARELLANO, TERESA
DBA SANTA ANA PROFESSIONAL
SERVICES
1082 "E' 17TH ST STE R
SANTA ANA CA 92701-2501
1 TqWTT-.7-'TiI4]Tk9
Policy Number 92.C7 �590-1
Policy Period Effectift Date Ex' fration Date
12 Months NOV 12 2015 12 20116
The il i" J bnIns and ends at 12:01 am standard
time NIC Rrellm"isds oraton,
Agent and Mailing Address
ROBERT R MACHADO INS AGCY INC
109 62 WARNI.R: AVg - – I
FOLJNTAIN. VLY CA-92768-3853
PHONE: (7145 964-1161
Office poflc�
Auk alk'6ijaWal_-...1flhq polici. period is shown as 12 months, thisppicywill be renewed automatically . subjeutth the premiums, rules and
forms � in off ectfor cz ig policy period. If this ternimpted, tte
icy s wewfli I uive you an4th-e Wo�6ageeklo-nfioldeirwrl nnoticein
Go.mplianz,e wl,tfi the poky prdvlislarmor as required Eby iaw.
Entity: Individual
NOTICE:: Information concerning changes in your policy Ian uage is included. Please call your agent
. ... ....... . .
If you ha�:e any ques . tio r,,,,
POLICYPREMIUM $ 500.00 "V W\
Minimum Premium
Discounts. Applied:
Renewal Year
Years in Business
Protective Disvioes
Sprinkler
claim Record
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E 0R,1 R,A1
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530-696a.2 q5.3i-7011 (O1P3231c)
M 11971
'DECLARATIONS (CONTINUED)
Office Policy for ARELLANO TERESA
Policy Number 92.6Y.55,90.1
SECTION I - PROPgRIJ 2CUEDULE
Location
Location of
Limit of Insurance*
Limit of InsuranoW
seasonal
Number
Described
Increase"
Premises
Coverape A -
C""'%'r! -
1,u,lness
r
Bull n9s
SUsiness onal
Personal
Prbpprt},
Piropdrty.
001
1002 -E I !TH ST. STE R
No Coverage
$ 15,4bO
V.
SANTA ANA CA 92701.2501
I
'As of the effective date of this policy) the Limit of insurance as shown includes any increase in the limit du6to Inflation Coverage,
SEQT.IOHI,- INFLATION COVERAGE INDE&E2)
Gov A - Inflation Coverage index: NIA
Cov B.- Consumer Price Index: 238.6
SECTION I - DEDUCTIBLES
Basic Deductible $1,00,0.
Special Deductibles:
Money and Securities $250 Employee Dishonesty $250
Equipment Breakdown $1,000
Other deductibles` may apply - refer to policy.
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CMP-4000 Includes ropv6ghted maternal of Insurance Services Office, lnc., vvith its permission.
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2aff?Farm
All, . DECLARATIONS (CONTINUED)
Office Pollog for ARELLANO TERESA
Policy Nulm or 92-CY-S5gol
M 111877
SECTION I - EXTENSIONS OF COVE—AGE - LIMIJ QF INSUEMCE - EACH DgScRII3EDPRr=mISEs
The d corresponding limits shown below apply separately to each described premises Q wn I these
coverages an ho
b4clarations, unless indicated by "'See "See Schedule." It a coverage does not have a corresponding limit shown below,
but has ' "Included "" indicated, please refer to that policy provision for an explanation of thatcovergge,
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011879 291 Continued on Reverse Side of Page Page 3 of 6
E
LIMIT OF
COVERAGE
INSURANCE
Accounts Receivable
On Premises
$50,000
Off Premises
$15,000, 1
Arson ReWa'rd
$5,000-
Baok-Up Of Sewer Or Drain
collapse
Included
DaMager To Non-Owned Buildings From Theft, Burglary Or Robbery
Coverage. B Limit
Debris Removal
26% of covered loss
Equipment Breakdown
Included
Fire Department Service CharRp
.$5,000
Fire Extinguisher Systems Recharge Expense
$6 000,
Forgery Or Alteration
$10,000'
Glass Expenses
Included
lnprdas0d CQBt-Of Construction And Demolition Costs (applies only when buildings are
10 °Ca
insured on a replacement cost basis)
Money And.Seourities (Of( Premises)
$5,000
Money And Seoprities (On Premises)
$10,000
Money Orders And Counterfeit Money
$1,000
Newly Acquired Business Personal Property (applies only if this policy provides
$100,000
Coverage 8 - Business Personal Property)
Newly Acquired Or Constructed Buildings (applies only if this policy provides
$250,000
Coverage A - Buildings)
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E
DECLARATIONS,(CONTINUED)
Office P011% for ARELLANO TERESA
Policy Num er 92 -CTS
Ordinance Cr Law - Equipment Coverage
Outdoor Property
Personal Effects (applies only to those premises provided Coverage 6 - Business
Personal Property)
Personal Property Off Premises
Pollutant Clean Up And fl6moval
Preservation: Of. Property
Property Of t'eth'ers (applies only to those promises provided Coverage B - Business
Personal Property)
Signs
Unauthorized Business Card Use
Valuable Papers And %cords
On Premises
Off Premises
Water Damagp, Other Liquids, Powder Or Molten Material Damage
M 11877
Included
$5,000
$5,000
$16,00o
$10,000
30 Days
$2,500
$2,500
$5,000
60,000
15,000
Included
§gQjj!2NJ-- gXTENSIONS OF COVeRAGg - LIMIT gE_INSUOANCE -PER POLICY
The coverages and coerespionding 1.1mits shown below are the most we will pay regardless of'tho'numberof
described premises shown In these Declarations.
COVERAGE
Dependent Property - Loss Of Income
Employee Dishonesty
Utility Interruption - Loss Of Income
Loss Of Income And Extra Expense
LIMIT OF
INSURANCE
$5,000
$1 0,00o
$10,000
Actual Loss Sustained -12 Months
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M 11$77
DECLARATIONS (CONTINUED)
Office P011% for ARELLANO TERESA
Policy NUM er 92.CY.S560.1
SEQjjQN
,LIMIT"OP
COVERAGE
INSURWCE,
Coverage L - Business Liability $1 100010(to
Coverage M - Medical Expenses (Any One Pet-son) $s'000'
Damage To Premises Rented To You $300,000
LIMIT OF
AGGREGATE LIMITS INSURANCE
ProdLJ0t81C0MpJ8t6d Operations Aggregate $2,000,000
' G4niirilAggregate ' I 1 11 $2,000,000'
Each paid claim for Liability Coverage reduces the amount of insurance we provide during die applicable
annual period, Please refer to Section II - Liability in the Coverage Form and an y attached endorsements,
Your policy consists of these Declarations, the BLISINESSOWNERS QOVERAGE FORM,shown below, and any other
forms an ' dendoirsernentsihat apply, includi.tig those sh6wri-b 9 i'o
was we as threw issued subsequenhothe
issuance of this policy-
FORMS AND EN MENTS
CMP-4101
*13usinessowners, Coverage Form
CMP-4705.1
*Lass of Income &E.xtra Expn se
OMP-471 0
*Employee Dishonesty
OMP-4704
*Dependent Prop Loss of Income
CMP-4668,
*136ok-Up' cif Sewer or b rah
OMP-4709
*Money and Seourifl6s
CIVIP-4703
*Utility interruption Loss Incur
FE-6999,2
"Terrorism Insurance Cov'Notice
OMP-4819.1
*Unauthorized Business Card Use
CMP-4786.1
*Add] Insd Owners Lessee Soh6o
FD-6007
*Inland Marine Attach Deo
* New Form Attached
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Page 5 of 6 .
M11871
Office Pollog for ARELLANO TERESA
Polidy Num or 92-CT-6;904
2CHED_UL_E OE AQ_QjTIQH& INTESgSTS
Interest Type: Addl Inslured-Section It
Endorsement OMP47861
Loan Number: NIA
COVERED OALIFORNIA
560 J ST STE ' 290
SACRAMENTO CA 958142339
Thi's policy is issued by the §tats Farm General insurance Company,
Participating Policy
You are entitled to partlolpate in adistrlbution,ref the earnings of'the company as, determined byaour Board of Directors in
accordance with the Company's Articles of Incorporation, as amended.
In Wltneiitgi Whereof, the 8t4te F�arm (�snaygal Insurairide Co"rnp 'he policy -to be signed by fts4Presl
. .�.T , - - — r . I .,any s caused this diaht and
Secretary at Bloomjhgtori, Ileinotu,
Secretary President
IMPORTANT NOTICE:
California law requires us to provide you. with information for filing complaints, with the State Insurance
Department regarding the coverage and service provided under this policy..
Complaints should be filed only after you and State: Farm or your agent or other company representative
have failed to reach a satisfactory agreement on a problem.
Please forward such complaints to: California Department of Insurance
Consum or Services Division
300 South Spring Street
Los Angeles, CA 90013
0
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011880 291 Page 6 of 6
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STATE FARM GENERAL INSURANCE COMPANY
A STOCK COMPANY WITH NObW OFF108S IN &00miNGToN, xuivois INLAND, MARINE ATTACHING DECLARATIONS
R. ,X,&,9CrA3311-9501
R-23-3038-FC1 8 F U
ARULAN0,.TERESA
W SANTA ANA P.POFESSIONAL,
SERVICES
10,02 E 17TH ST $TE,R
SANTA ANA CA 92701-2501
Policy Number 92-CT-S590-1
Policy Period Etfaective Date Expiration Date
12 Months NOV 12 2015 N9V 12 2016
The poll y period be?, ins and ends at 12:01 am standard
time aM premises calion.
ATTACHING INLAND MARINE
Automatic Renewal - If the policy period is shown as 112 months , this PD]iCywill be renewed automatically subject to the premiums, rules and
forms in effect for each succeeding policy period. If this policy is terminated, we will give you and the Mortgaged/Lienholder written notice in
compliance with the policy provisions or as required by law,
Annual Policy Premium Included
The above Premium Aniountis included in the Policy Premium shown an Me Declarations.
Your policy consists of these Declaratioris,the INLAND MARINE CONDITIONS shown below, and any oth&forms and end orsem ents that
apply, including those shown below as well as those issued subsequeritto the issuance of this policy.
Forms, Options, and Endorsements
FE-8745 *Inland Marine Computer Prop
FE-62,71 'Amendatory Endorsement
FE-6739 *Inland Marine Conditions
*New Form Attached
See Reverse for Schod'u,le Page with Limits
Prepared
AUG 19 2015 (0 Copyright State Farm MutuaP Automobb Insurance Company, 2B013
FD-6007 Includes cupyrighled mnlorW of Insurance Services Office, Inc, with Its permission.
011851
53 406 al 05-31-201110102320
92-CT-S590-1 M 11877
ATTAC141NO INIAND MARINE SCHEDULE PAGE
ATTACHING INLAND MARINE
ENDORSEMENT LIMIT OF DEDUCTIBLE ANNUAL
NUMBER COVERAGE INSURANCE AMOUNT PREMIUM
FE-8745 Inland Marine Computer Prop 25,000 $ EIU Included
Loss of Income and Extra Expense 25,000 Included
Prepared
AUG 19 2015
FID-6007
Mimi
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630-585a.2 05.31-2011 103239c1