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Home My WebLink AboutOC SAFETY, INC. - 2018INSURANCE ON FILE: WORK MAY PROCEED TIL INSURANCE EXPIRES py� CLERK OF COUNCIL DATE: AGREEMENT WITH OC SAFETY TO PROVIDE CPR/AED TRAINING N-2018-030 THIS AGREEMENT is made and entered into this 17th day of January, 2018 by and between OC Safety, Inc., a California Corporation ("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 ("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 Consultant 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 compliance with such standards as may reasonably be expected from a professional consulting firm in the field, 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: 1. SCOPE OF SERVICES Consultant shall perform during the term of this Agreement, the tasks and obligations including all labor, materials, tools, equipment, and incidental customary work required to fully and adequately complete the emergency first aid and CPR/AED training described and set forth in Exhibit A, attached hereto and incorporated by reference. 2. COMPENSATION a. City agrees to pay, and Consultant agrees to accept as total payment for its services for City, 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 45 days (forty-five), days following receipt of proper invoice evidencing work performed, subject to City accounting procedures. Payment need not be made for work which fails 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 for a one (1) year term, unless terminated earlier in accordance with Section 13, below, The term of this Agreement may be extended upon a writing executed by the City Manager and the City Attorney. Pagel of 7 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 naming the City, its officers, employees, agents, volunteers and representatives as additional insured(s) and shall include, but not be limited to protection against claims arising from bodily and personal injury, including death resulting therefrom and damage to property, resulting from any act or occurrence arising out of 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, with $2,000,000 in the aggregate. Such insurance shall (a) name the City, its officers, employees, agents, 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. Business automobile liability insurance, or equivalent form, with a combined single limit of not less than $1,000,000 per occurrence. Such insurance shall include coverage for owned, hired and non -owned automobiles. C. Worker's Compensation Insurances 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. d. If Consultant is or employs a licensed, professional such as an architect or engineer: Professional liability (errors and omissions) insurance, with a combined single limit of not less than $1,000,000 per claim with $2,000,000 in the aggregate. e. The following requirements apply to the insurance to be provided by Consultant pursuant to this section: Page 2 of 7 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 by the City. 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. iv. Consultant shall supply City with a fully executed additional insured endorsement, 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 affect 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 defend, and shall indemnify and hold harmless the City, its officers, agents, employees, contractors, 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 negligent operations of the Consultant, its subcontractors, agents, employees, or other persons acting on its 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- --"d goats for Special counsel to he 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. Notwithstanding the foregoing, to the extent Consultant's services are subject to Civil Code Section 2782,8, the above indemnity shall be limited, to the extent required by Civil Code Section 2782.8, to claims that arise out of, pertain to, or relate to the negligence, recklessness, or willful misconduct of the Consultant. 7. RECORDS Consultant shall keep records and invoices in connection with the work to be performed under this Agreement. Consultant shall maintain complete and accurate records with respect to the costs incurred under this Agreement and any services, expenditures, and disbursements Page 3 of 7 charged to the City for a minimum period of three (3) years, or for any longer period required by law, from the date of final payment to Consultant under this Agreement. All such records and invoices shall be clearly identifiable, Consultant shall allow a representative of the City to examine, audit, and make transcripts or copies of such records and any other documents created pursuant to this Agreement during regular business hours. Consultant shall allow inspection of all work, data, documents, proceedings, and activities related to this Agreement for a period of three (3) years from the date of final payment to Consultant under this Agreement. 8. 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 farther 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. 9. 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. 10. 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. 11. 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. In 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 Page 4 of 7 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 or 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 is not embodied herein. 12. 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. 13. 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(s) 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. 14. WAIVER No waiver of breach, failure of any condition, or any right or remedy contained in or granted by the provisions of this Agreement shall be effective unless it is in writing and signed by the party waiving the breach, failure, right or remedy. No waiver of any breach, failure or right, or remedy shall be deemed a waiver of any other breach, failure, right or remedy, whether or not similar, nor shall any waiver constitute a continuing waiver unless the writing so specifies. 15. 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. Page 5 of 7 16. 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. 17. MISCELLANEOUS PROVISIONS a. Each undersigned represents and warrants that its signature herein below 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. 18. 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 fax or other telegraphic communication in the manner provided in this Section, to the following persons: To City: Cleric of the City Council City of Santa Ana 20 Civic Center Plaza (M-30) P.O. Box 1988 Santa Ana, CA 92702-1988 Fax: 714- 647-6956 With courtesy copies to: Executive Director, Personnel Services Agency City of Santa Ana 20 Civic Center Plaza (M-28) P.O. Box 1988 Santa Ana, California 92702 Fax: 714-647-6930 Sonia R. Carvalho City Attorney City of Santa Ana 20 Civic Center Plaza (M-29) P.O. Box 1988 Santa Ana, California 92702 Fax: 714- 647-6515 Page 6 of 7 N-2018-030 To Consultant: OC Safety, Inc. 1940 N. Tustin Street, Suite 130 Orange, CA 92865 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 fax, 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. IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first above written. Maria D. Huizar Raul C,odinez II Clerk -of the Council SONIA R. CARVALHO City Attorney Laura A. Rossini Senior Assistant City Attorney 1tILiC�7Ti�Tii!jf �s� 1�7�171t7�i�tt'#rfilR ELLE , . SMILEY Acting Executive Directo Personnel Services Agenc CITY OF SANTA ANA City Manager CONSULTANT: Title VlGe" f' s/'✓ "'f".. Page 7 of 7 EXHIBIT A SCOPE OF SERVICES EXMBIT A SCOPE OF SERVICES Hearts aver ® 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 AC RH CERTIFICATE OF LIABILITY INSURANCE aposos2a, THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFER$ 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 IN$URER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder la an ADDITIONAL INSURED, the poHcy(los) must have ADDITIONAL INSURED provisions or be endorsed. H SUBROGATION IS WAIVED, Subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement an this Certificate does not confer rights to the certificate holder in lieu of such endorsement a . PRODUCER ,S$atsftfi RIC VVEISSINGER,AGENT - LIC #OC89161 WEISSINGER INSURANCE AGENCY INC 5922WARNERAVE HUNTINGTON BEACH, CA 92649 NONE CT CAROLE COOK PNHONE 714377-1111 yC.N .714377-1611 EMAIL iij INSUREP431 AFFORDING COVERAGE NAIC0 INSURERA a State Farm General Insurance Company 25151 INSURED OC SAFETY INC 1940 N TUSTIN ST, STE 103 ORANGE, CA 928664642 N-2018-030 INSURERE: INSURER C : INSU R ' INSURE'RE: INSURER F: COVERAGE$ CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN 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 'PERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I SR TYPE of INSURANCEXj APLUBR P NUM OLICYEACH D CY EPP P LIMITS ORNERAL UAahITY OCCURRENCE S 1.000.000 ®OCCUR _ M=mCLAIMS-MADE �ylaal g-160,098 4 —` MCCEXP A bna areon $ 5,000 x A A 92-EA4145.9 07/01/2017 0710V2018 -RY "S 11000.000 PERSONAL ADVINJURY 8 GEN'LAGGREGATE LIMIT APPLIES PER; GENERALAGGREGATE S 2,000.000 POLICY ❑ jE� ® LOC PRODUCTS.DOMPIOPAGG 5 2,000,000 s OTHER: AUTOMOBILE LIAMILTY MRI EG IN LPAI s ANYAUTO BODILY INJURY (Per PeroW S 0ANRD sCMEWLED AUTOS ONLY Aur aODIY INJURY(Psraccldmt) S HIRED NONXIWTIEO AUTOS ONLY AUTOS ONLY PROPERTY OAMAGE S e s UMBRELLA WeOCCUR I EACHOCCUR ENCE AGGREGATE S EXCESS MECWIMSMADC ED I I RETENTION" S WORKERS COMPENSATION BIND EMPLOYERE'LWBWTY YIN ANY PROPRIETORIPARTNERIEXECUTIVE �I OPPICERNMedai EXCLUDED? F NIA tRT E RH— __—' E.L. EACH ACCIDENTmm$� E.L. DISEASE -EA EMPLOYE S (Mandatory In NH) IP M tlBBtlI0N 540' D ORIPTION OF OPERATIONS below _...__ - POLICY E.L. tlI5EA9E�M0LIOY LIMIT S _ BUSINESS PROPERTY _ I X 92 -EA -V145.9 07/01f2017 0710,12018 bESCMPRGN OP OPERAnON6 f LCCATION6 / VEHICLE6 iACORD tsi, Atltlltlsnsi Ra1naH16 6ehatlule, maybe atlsebed N mo,c spans is reg4lretll LCC 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 CITY OF SANTA ANA ATTN: PURCHASING DEPARTMENT 20 CIVIC CENTER PLATA SANTA ANA, CA 92701 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 0 ACORD 26 (2016103) The ACORD name and logo are registered marks of ACORD All ITQhts reserved. 1001460 iS284e.d2 Ub18id014 1 � Policy No. 92 EAV145 9 RIC WEISSINGER INS AGCY GMP -4788.1 Page 1 of 2 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CMP -4766.1 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 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 92701 SECTION 11 — WHO IS AN INSURED of SECTION II — LIABILITY is amended to in- clude, as an addltlonal 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 ofyour 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 Offioe, Ino., 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 11— 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 It. Available under the applicable Limits Of Insurance shown in the Declarations. This endorsement shall not Increase the ap- pllcable 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 11— 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 -4768.9 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 it — 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 11— 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. 0, Copyright, State Farm Mutual Automoblie Insurance Company. 2813 includes mpyrighted material of Insurance SaMoss Office, Ino., with Its permisslon. 1007433 148019 68-21-2014 1�\v\ N-2018-030 WORKERS' COMPENSATION DECLARATION I Craig Robson/Vice President hereby affirm under penalty of perjury, the (Name/Title) following declaration: I certify on behalf of OC Safety INC. that during the term of my (Consultant/Company Name) contract for CPR/AED Training services with the City of Santa Aria, I will not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions and provide proof of workers' compensation coverage. DATE: 02/06/16 By: CC�'iPo6aavG V Name: CRAIG ROBSON Title: VICE PRESIDENT Telephone: (714) 960-1911 WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. I Lv� �OAF I tjj GEICO, California Evidence of Liability Insurance 1-800-841-3000 geioo.00m GEICO GENERAL INSURANCE COMPANY PO BOX 509090 SAN DIEGO, CA 92150-! NAIC Code: 35882 Policy Number Effective 4458126424 04-10-1. Year Make M 2010 FORD TR, Insured: CRAIG JEFFREY AND JANET CANCILLER ROBSON 1940 N TUSTIN ST STE 103 ORANGE, CA 92865-4642 ----- Expiration Date 10-10-18 Vehicle ID No. NMOLS7AN8AT026563 Evidence of Insurance Here are your Evidence of Liability Insurance Cards. One card must be carried in the proper insured vehicle. Proof of insurance is required to register or renew the registration of your vehicle. A law enforcement officer can ask you to prove that you have liability insurance meeting the basic requirements of California law. A violation of these requirements can result in a fine of up to: $1,000 for the first time $2,000 for additional times Also, a judge can have your vehicle impounded. False proof of insurance may result in a fine up to $750 and 30 days in prison. The coverage provided by this policy meets the minimum requirements of sections 16056816500.5 of the California Due to space limitations on the ID card, only the Vehicle code, minimum nabilitylimitsprescribed by1. Named Insured and the Co-insured are listed. Fora full list of drivers covered under this policy, please reference the Drivers section of your Declarations Page,which is included with your insurance packet. If you would like additional ID cards you can go online to geico.com or call us at 1-800-841-3000. What to do at the time of an accident. • Do not admit fault. • Do not reveal the limits of your liability coverage to anyone. • Exchange contact information; get year, make, model, plate number, insurance carrier and policy number of all involved. Also, identify witnesses and collect contact information. • Contact the police or 911 if applicable. • Contact GEICO by calling 1-800-841-3000 or visit geico.com to report the accident. U -4 -CA (11-09) Agreement No.: N-2018-030 Reviewed by Briza Morales 04/05/18 GEICO, California Evidence of Liability Insurance 1-800-841-3000 geioo.00m GEICO GENERAL INSURANCE COMPANY PO BOX 509090 SAN DIEGO, CA 92150-! NAIC Code: 35882 Policy Number Effective 4458126424 04-10-1. Year Make M 2010 FORD TR, Insured: CRAIG JEFFREY AND JANET CANCILLER ROBSON 1940 N TUSTIN ST STE 103 ORANGE, CA 92865-4642 ----- Expiration Date 10-10-18 Vehicle ID No. NMOLS7AN8AT026563 Evidence of Insurance Here are your Evidence of Liability Insurance Cards. One card must be carried in the proper insured vehicle. Proof of insurance is required to register or renew the registration of your vehicle. A law enforcement officer can ask you to prove that you have liability insurance meeting the basic requirements of California law. A violation of these requirements can result in a fine of up to: $1,000 for the first time $2,000 for additional times Also, a judge can have your vehicle impounded. False proof of insurance may result in a fine up to $750 and 30 days in prison. The coverage provided by this policy meets the minimum requirements of sections 16056816500.5 of the California Due to space limitations on the ID card, only the Vehicle code, minimum nabilitylimitsprescribed by1. Named Insured and the Co-insured are listed. Fora full list of drivers covered under this policy, please reference the Drivers section of your Declarations Page,which is included with your insurance packet. If you would like additional ID cards you can go online to geico.com or call us at 1-800-841-3000. What to do at the time of an accident. • Do not admit fault. • Do not reveal the limits of your liability coverage to anyone. • Exchange contact information; get year, make, model, plate number, insurance carrier and policy number of all involved. Also, identify witnesses and collect contact information. • Contact the police or 911 if applicable. • Contact GEICO by calling 1-800-841-3000 or visit geico.com to report the accident. U -4 -CA (11-09) Agreement No.: N-2018-030 Reviewed by Briza Morales 04/05/18