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HomeMy WebLinkAbout00502C - INFOTOX INC DESERT HOTEL ASBESTOS-LEAD MONITORING Infotox, Inc. Asbestos/Lead Monitoring AGREEMENT #0502C COMMUNTY REDEVELOPMENT AGENCY CM signed, 10-20-05 CITY OF PALM SPRINGS CONTRACT SERVICES AGREEMENT FOR ASBESTOS AND LEAD MONITORING SERVICES at THE DESERT HOTEL -285 N. INDIAN CANYON DRIVE, PALM SPRINGS, CALIFORNIA. THIS CONTRACT SERVICES AGREEMENT(herein"Agreement")is made and entered into this �9 day of Or-7-66EG� , 2005, by and between the COMMUNITY REDEVELOPMENT AGENCY OF THE CITY OF PALM SPRINGS,a public body,corporate and politic,(herein"Agency")and INFOTOX,INC.(herein "Contractor"). NOW, THEREFORE, the parties hereto agree as follows: 1.0 SERVICES OF CONTRACTOR 1.1 Scope of Services. In compliance with all of the terms and conditions of this Agreement, the Contractor shall perform the work or services set forth in the "Scope of Services"attached hereto as Exhibit"A"and incorporated herein by reference. Contractor warrants that all work and services set forth in the Scope of Services will be performed in a competent, professional and satisfactory manner. 1.2 Compliance with Law. All work and services rendered hereunder shall be provided in accordance with all ordinances, resolutions,statutes,rules,and regulations of the City and any Federal,State or local governmental of competent jurisdiction. 1.3 Licenses, Permits. Fees and Assessments. Contractor shall obtain at its sole cost and expense such licenses, permits and approvals as may be required by law for the performance of the services required by this Agreement. 2.0 COMPENSATION 2.1 Contract Sum. For the services rendered pursuant to this Agreement, Contractor shall be compensated in accordance with the"Schedule of Compensation"attached hereto as Exhibit"B"and incorporated herein by this reference, but not exceeding the maximum contract amount of Eight Thousand Five Hundred Fifty Five Dollars ($8,555.00) ("Contract Sum"). 2.2 Method of Payment. Provided that Contractor is not in default under the terms of this Agreement, Contractor shall be paid as outlined in "Exhibit B" Schedule of Compensation. 3.0 COORDINATION OF WORK 3.1 Representative of Contractor.Michael A.Nieuwlandt is hereby designated as being the principal and representative of Contractor authorized to act in its behalf with respect to the work and services specified herein and make all decisions in connection therewith. 3.2 Contract Officer. George F.Farago is hereby designated as being the representative the Agency authorized to act in its behalf with respect to the work and services specified herein and make all decisions in connection therewith("Contract Officer"). The Executive Director of Agency shall have the right to designate another Contract Officer by providing written notice to Contractor. i 3.3 Prohibition Against Subcontracting or Assignment. Contractor shall not contract with any entity to perform in whole or in part the work or services required hereunder without the express written I approval of the Agency. Neither this Agreement nor any interest herein may be assigned or transferred, j Page I of 8 i Q\DOCUMENTS AND S=NGS\OWNER\LOCAL SETTINGS\TEMPORARY INTERNET FILES\CONTENT.IE5\ERiTIVZ6\CONTRACT_SERV[i].AGR._MONITORING_WITH-INFOTOX.DOC i i voluntarily or by operation of law,without the prior written approval of Agency.Any such prohibited assignment or transfer shall be void. I 3.4 Independent Contractor. Neither the Agency nor any of its employees shall have any control over the manner, mode or means by which Contractor, its agents or employees,perform the services required herein, except as otherwise set forth. Contractor shall perform all services required herein as an independent contractor of Agency and shall remain under only such obligations as are consistent with that role. Contractor shall not at anytime or in any manner represent that it,or any of its agents or employees,are agents or employees of Agency. 4.0 INSURANCE, INDEMNIFICATION AND BONDS 4.1 Insurance, The Contractor shall procure and maintain, at its sole cost and expense,in a form and content satisfactory to Agency,during the entire term of this Agreement including any extension thereof, the following policies of insurance: (a) Commercial General Liability Insurance. A policy of commercial general liability insurance written on a per occurrence basis with a combined single limit of at least$1,000,000 bodily injury and property damage including coverages for contractual liability,personal injury, independent contractors, broad form property damage, products and completed operations. The Commercial General Liability Policy shall name the Agency and City of Palm Springs as an additional insured in accordance with standard ISO additional insured endorsement form CG2010(1185) or equivalent language. (b) Worker's Compensation Insurance. A policy of worker's compensation insurance in an amount which fully complies with the statutory requirements of the State of California and which includes $1,000,000 employer's liability. (c) Business Automobile Insurance. A policy of business automobile liability insurance written on a per occurrence basis with a single limit liability in the amount of$1,000,000 bodily injury and property damage. Said policy shall include coverage for owned, non-owned,leased and hired cars. (d) Additional Insurance. Additional limits and coverages, which may include professional liability insurance, will be specified in "Exhibit A". All of the above policies of insurance shall be primary insurance. (Reference Section 4.4 regarding sufficiency.) The insurer shall waive all rights of subrogation and contribution it may have against the Agency and City, its officers,employees and agents,and their respective insurers. In the event any of said policies of insurance are canceled,the Contractor shall,prior to the cancellation date,submit new evidence of insurance in conformance with this Section 4.1 to the Contract Officer. No work or services under this Agreement shall commence until the Contractor has provided the Agency with Certificates of Insurance, endorsements or appropriate insurance binders evidencing the above insurance coverages and said Certificates of Insurance, endorsements, or binders are approved by the Agency. The contractor agrees that the provisions of this Section 4.1 shall not be construed as limiting in any waythe extent to which the Contractor may be held responsible forthe payment of damages to anypersons or property resulting from the Contractor's activities or the activities of any person or persons for which the Contractor is otherwise responsible. In the event the Contractor subcontracts any portion of the work in compliance with Section 3.3 of this Agreement the contract between the Contractor and such subcontractor shall require the subcontractor to maintain the same polices of insurance that the Contractor is required to maintain pursuant to this Section. 4.2 Indemnification. Contractor agrees to indemnify the Agency and City, its officers, agents and employees against, and will hold and save them and each of them harmless from, any and all actions,suits,claims,damages to persons or property,losses,costs,penalties,obligations,errors,omissions or liabilities,(herein"claims or liabilities")that may be asserted or claimed by any person,firm or entityarising Page 2 of S C:\DOCUMENTS AND SETTINGS\OWNER\LOCAL SETTINGS\TEMPORARY INTERNET FILES\CONTENT.IE5\ERi1TVZ6\CONTRACT_SERV[v].AGR._MONITORING WITH_INFOTOX.DOC out of or in connection with the negligent performance of the work, operations or activities of Contractor, its agents, employees, subcontractors, or invitees, provided for herein, or arising from the negligent acts or omissions of Contractor hereunder,or arising from Contractor's negligent performance of orfailure to perform any term, provision, covenant or condition of this Agreement, whether or not there is concurrent passive or active negligence on the part of the Agency or City, its officers, agents or employees but excluding such claims or liabilities arising from the sole negligence or willful misconduct of the Agency or City, its officers, agents or employees, who are directly responsible to the Agency or City, and in connection therewith: (a) Contractor will defend any action or actions filed in connection with any of said claims or liabilities and will pay all costs and expenses,including legal costs and attorneys'fees incurred in connection therewith; (b) Contractor will promptly pay any judgment rendered against the Agency or City, its officers, agents or employees for any such claims or liabilities arising out of or in connection with the negligent performance of or failure to perform such work,operations or activities of Contractor hereunder;and Contractor agrees to save and hold the Agency and City, its officers, agents, and employees harmless therefrom; (c) In the event the Agency or City, its officers, agents or employees is made a party to any action or proceeding filed or prosecuted against Contractor for such damages or other claims arising out of or in connection with the negligent performance of or failure to perform the work, operation or activities of Contractor hereunder, Contractor agrees to pay to the Agency or City, its officers, agents or employees,any and all costs and expenses incurred bythe Agency or City,its officers,agents or employees in such action or proceeding, including but not limited to, legal costs and attorneys'fees. 4.3 Performance Bond. Concurrently with execution of this Agreement,Contractor shall deliver to Agency a performance bond in the sum of the amount of this Agreement, in the form provided by the Agency,which secures the faithful performance of this Agreement,unless such requirement is waived by the Contract Officer. The bond shall contain the original notarized signature of an authorized officer of the surety and affixed thereto shall be a certified and current copy of his power of attorney. The bond shall be unconditional and remain in force during the entire term of the Agreement and shall be null and void only if the Contractor promptly and faithfully performs all terms and conditions of this Agreement. 4.4 Sufficiency of Insurer or Surety. Insurance or bonds required by this Agreement shall be satisfactory only if issued by companies qualified to do business in California,rated"A"or better in the most recent edition of Best's Key Rating Guide or in the Federal Register, unless such requirements are waived by the Executive Director or designee of the Executive Director due to unique circumstances. In the event the Executive Director determines that the work or services to be performed under this Agreement creates an increased or decreased risk of loss to the Agency or City,the Contractor agrees thatthe minimum limits of the insurance policies and the performance bond required by this Section 4 may be changed accordingly upon receipt of written notice from the Executive Director or designee; provided that the Contractor shall have the right to appeal a determination of increased coverage by the Executive Director to the Agencywithin ten (10) days of receipt of notice from the Executive Director. 5.0 TERM 5.1 Term. Unless earlier terminated in accordance with Section 5.2 below, this .Agreement shall continue in full force until December 31, 2005. 5.2 Termination Prior to Expiration of Term. Either party may terminate this Agreement at any time, with or without cause, upon thirty(30) days written notice to the other party. Upon receipt of the notice of termination,the Contractor shall immediately cease all work or services hereunder except as may be specifically approved by the Contract Officer. In the event of termination by the Agency, Contractor shall be entitled to compensation for all services rendered prior to the effectiveness of the notice of termination and for such additional services specifically authorized by the Contract Officer and Agency shall be entitled to reimbursement for any compensation paid in excess of the services rendered. Page 3 of 8 C:\DOCUMENTS AND SETTINGS\OWNER\LOCAL SETTINGS\TEMPORARY INTERNET FILES\CONTENT.IE5\ERiTIVZ6\CONTRACT_SERV[1].AGR_MONITORING WITH_INFOTOX.DOC i 6.0 MISCELLANEOUS 6.1 Covenant Against Discrimination. Contractor covenants that, by and for itself, its heirs,executors,assigns and all persons claiming under or through them,that there shall be no discrimination against or segregation of, any person or group of persons on account of race, color, creed, religion, sex, marital status, national origin, or ancestry in the performance of this Agreement. Contractor shall take affirmative action to ensure that applicants are employed and that employees are treated during employment without regard to their race, color, creed, religion, sex, marital status, national origin or ancestry. 6.2 Non-liability of City Officers and Employees. No officer or employee of the Agency or City shall be personally liable to the Contractor, or any successor in interest, in the event of any default or breach by the Agency or City or for any amount which may become due to the Contractor or to its successor, or for breach of any obligation of the terms of this Agreement. 6.3 Conflict of Interest. No officer or employee of the Agency or City shall have any financial interest,direct or indirect, in this Agreement nor shall any such officer or employee participate in any decision relating to the Agreement which effects his financial interest or the financial interest of any corporation,partnership or association in which he is,directly or indirectly interested, in violation of any State statute or regulation. The Contractor warrants that it has not paid or given and will not pay or give any third party any money or other consideration for obtaining this Agreement. 6.4 Notice. Any notice, demand, request, document, consent, approval, or communication either party desires or is required to give to the other party or any other person shall be in writing and either served personally or sent by prepaid, first-class mail, in the case of the Agency, to the Executive Director and to the attention of the Contract Officer, CITY OF PALM SPRINGS, P.O. Box 2743, Palm Springs,California 92263,and in the case of the Contractor,to the person at the address designated on the execution page of this Agreement. 6.5 Interpretation. The terms of this Agreement shall be construed in accordance with the meaning of the language used and shall not be construed for or against either party by reason of the authorship of this Agreement or any other rule of construction which might otherwise apply. 6.6 Integration;Amendment. It is understood that there are no oral agreements between the parties hereto affecting this Agreement and this Agreement supersedes and cancels any and all previous negotiations,arrangements, agreements and understandings, if any, between the parties,and none shall be used to interpret this Agreement. This Agreement maybe amended at anytime by the mutual consent of the parties by an instrument in writing. 6.7 Severability. In the event that part of this Agreement shall be declared invalid or unenforceable by a valid judgment or decree of a court of competent jurisdiction, such invalidity or unenforceability shall not affect any of the remaining portions of this Agreement which are herebydeclared as severable and shall be interpreted to carry out the intent of the parties hereunder unless the invalid provision is so material that its invalidity deprives either party of the basic benefit of their bargain or renders this Agreement meaningless. 6.8 Waiver. No delay or omission in the exercise of any right or remedy by a nondefaulting party on any default shall impair such right or remedy or be construed as a waiver. A party's consent to or approval of any act by the other party requiring the party's consent or approval shall not be deemed to waive or render unnecessary the other party's consent to or approval of any subsequent act. Any waiver by either party of any default must be in writing and shall not be a waiver of any other default concerning the same or any other provision of this Agreement. 6.9 Attorneys' Fees. If either party to this Agreement is required to initiate or defend or made a party to any action or proceeding in any way connected with this Agreement, the prevailing party in :such action or proceeding, in addition to any other relief which may be granted, whether legal or equitable, shall be entitled to reasonable attorney's fees,whether or not the matter proceeds to judgment. Page 4 of 8 C:\DOCUMENTS AND SETTINGS\OWNER\LOCAL SETTINGS\TEMPORARY INTERNET PILES\CONTENT.IE5\ERITIVZ6\CONTRACT_SERV[1].AGR._M0NIT0RING_WITH_INF0T0X.D0C 6.10 Corporate Authority. The persons executing this Agreement on behalf of the parties hereto warrant that(i)such party is duly organized and existing, (ii)they are duly authorized to execute and j deliver this Agreement on behalf of said party, (iii) by so executing this Agreement, such party is formally bound to the provisions of this Agreement, and (iv) the entering into this Agreement does not violate any provision of any other Agreement to which said party is bound. SIGNATURES ON NEXT PAGE Page 5 of 8 Q\DOCUMENTS AND SETTINGS\OWNER\LOCAL SETTINGS\TEMPORARY INTERNET FILES\CONTENT.IE5\ERITNZ6\CONTRACT_SERV[i].AGR._MONITORING_WITH_INFOTOX.DOC i . IN WITNESS WHEREOF, the parties have executed and entered into this Agreement as of the date first written above COMMUNITY REDEVELOPMENT AGENCY OF THE CITY OF PALM SPRINGS ATTEST: = a public body, corporate and politic >qDl © — Assistant Secretary ffMUVLU by VNRMNNWRCW Executive for 'Corporations require two notarized signatures:: One signature must be from the Chairman of Board, President, or any Vice President. The second signature must be from the Secretary, Assistant Secretary, Treasurer, Assistant Treasurer, or Chief Financial Officer. CONTRACTOR: INFOTOX, INC. Check One:_Individual_Partnership_Corporation 9251 Orco Parkway, Suite J Riverside, CA 9 609 Ey Air ry: /ki�WL Signature(not rized) Signature(notarized) Name:m le-H-4EG- .4. Awl�'EU CV4 olAeO; Name: .a. fAI GNU UV LAN lr`'"r Title: Title: hGGyfz�s5 (This Agreement must be signed in the above space by one of (This Agreement must be signed in the above space by one the following:Chairman of the Board,President or any Vice of the following: Secretary,Assistant Secretary,Treasurer, President) ,[/r� Assistant Treasure(Atir,,C-hief Financial Officer) State of Coll XT rliI State of 0(,(Jl m p county of 1ver County of I .S 1)� `-.- On LJ Y�C6kO- QM eOeaf0.SL-on oC '� . before me, before me, � personally appeared YJ qyr '� personally appeared o (or proved to me on the basis of .pecseraakF}+-lenewe-te-tne (or proved to me on the bass of satisfactory evidence)to be the person(*whose name(s)is * satisfactory evidence)to be the persou(6)whose name is/ subscribed to the within instrument and acknowledged to me that subscribed to the within instrument and acknowledged to me that hr// ktefthey-executed the same in Se49t authorized sh tfiep executed the same in-las eir authorized capacity(ies), and that by ns ree4heir signat re(s)-on the capacity(las), and that by-4i /her wir siguature(e on the instrument the person(.4 or the entity upon behalf of wh t e instrument the person(a),or the entity upon behalf ofwhi i tli personfe)acted,exe to nstnment. person( acted,ex d the instrument. WITNESS my hand a of i i se WITNESS my hand id cial seal. Notary Signat re: Notary Signature: Notary Seal: Notary Seal: SNEENA LEOPARD " SHEENA LEOPARD Comm,#1413i15 Comm.#1413115 NOTARY ersi 0 C oanlY RNIA �1!fls Riverside County NOTARY PUBLIC CALIFORNIA My Comm.Eeplres April 22,2007'i " ; Rlverside County My Lamm,Eaplres April 22,20D7`µ Agreement owgr/under $2 000 Page 6 of S Procurement& Contracting C:\DOCUMENTS AND SETTINGS\OWNER\LOCAL SETTINGS\TEMPORARY INTERNET " FILES\CONTENT.IE5\ERxTIVZ6\CONTRACT_SERV[i].AGR._MONITORING_WITH_INFOTOX.DO q Initfa2s �date /0 •..ww.�wrwwwu+��r.,r�wwvy,�v,y�yvY�.w, - ','5A 41 ''. EXHIBIT "A" SCOPE OF SERVICES Contractor shall provide professional services to the for The Desert Hotel Demolition Project, City Project No. 05-14 as follows: Provide oversight services for the removal of asbestos and lead containing materials from structures located at 285 N. Indian Canyon Drive in Palm Springs, California, and compliance monitoring in accordance with the Specifications for City Project No. 05-14 (Section 02080 and Section 02090). The services shall include: Asbestos Management Services: Task 1 - Project oversight,Contractor's document review,compliance monitoring and final inspection. Task 2 - Background air samples collection and analyses. Task 3 - Compliance air samples collection and analyses. Task 4 - Clearance air samples collection and analyses. All air samples shall be analyzed by Phase Contrast Microscopy, utilizing the NIOSH 582 Method. Lead Based Paint Management Services: Task 1 - Project oversight, Contractor's document review,final inspection and complete report with data interpretation. Task 2 - Background samples collection and analyses. Task 3 - Compliance samples collection and analyses. Task 4 - Clearance samples collection and analyses. Services shall be provided to the Agency within 48 hours of advance notice. The requirements of Section 4.3 "Performance Bond"are waived. Page 7 of 8 C:\DOCUMENTS AND SEMNGS\OWNER\LOCAL SETTINGS\TEMPORARYINTERNET RILES\CONTENT.IE5\ERiTrVZ6\CONTRACf_SERV[i].AGR._MONrrORING_WPPH_INFOTOX.DOC , I . i i EXHIBIT "B" SCHEDULE OF COMPENSATION Based on the attached Exhibit"A",Scope of Services,the fees necessaryto provide the required professional services for City Project No. 05-14 shall not exceed the amounts listed per tasks identified below: Asbestos Management Services: Task 1: $68.00 per hour, not to exceed $4,080.00 Task 2: $15.00 per sample, not to exceed $ 75.00 Task 3: $15.00 per sample, not to exceed $ 750.00 Task 4: $15.00 per sample, not to exceed $ 300.00 ------------------------------------------------ ------ Subtotal: $5,205.00 Lead Based Paint Management Services: Task 1: $65.00 per hour, not to exceed $2,600.00 Task 2: $25.00 per sample, not to exceed $ 125.00 Task 3: $25.00 per sample, not to exceed $ 375,00 Task 4: $25.00 per sample, not to exceed $ 250.00 ------------------------------------------------------- Subtotal: $3,350.00 TOTAL NOT TO EXCEED: $8,555.00 Payment shall be made after completion of each task, or portion thereof, and within 30 days after invoicing. The cost will be adjusted to reflect the number of project oversight hours and number of samples collected and analyzed, not to exceed the total contract amount of Eight Thousand Five Hundred Fifty Five Dollars ($8,555.00). Page 8 of 8 C:\DOCUMENTS AND SETTINGS\OWNER\LOCAL SETTINGS\TEMPORARYINTERNET PILES\CONTENT.IE5\ERITIVZ6\CONTRACr_SERV[11 AGR._MONITORING_WITH_INFOTOX.DOC ACORD,„ CERTIFICATE OF LIABILITY INSURANCE 3/18/2005 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Frenkel & Co, ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Environmental Risk Services HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 725 S. Figueroa St. , Ste. 2200 AL ER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Los Angeles CA 90017 �� 'r"� INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA American Safety Casualty Insu 39969 In£otox, Inc. INSURERS. State Compensation Ins Fund 35076 9251 Orco Parkway, Ste. J INSURER C: Riverside CA 92509-09OG INSURER D. INSURER 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 IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR kDDII, POLICY NUMBER POLICYEFFECTIVE POLICYEXPIRATION LIMITS A GENERALLIAOILITY PCL 05-1422-004 1/23/2005 1/23/2007 EACH OCCURRENCE $ 2, 000, 000 X DA AG TO E E 50,000 COMMERCIAL GENERAL UADILITY PREMISES Ea occur n e $ CLAIMS MADE a OCCUR MEDEXP(Anycnepemon) $ 5,000 X Contr.Poll.Lld}J. PERSONALIADVINJURY $ 2,000,000 GENERALAGGREGATE $ 2, 000, 000 GEN'LAGGREGATE LIMITAPPLIEE PER PRODUCTS-OOMPIOPAGG $ 21 0OO, OOO X POLICY PE T LOC A AUTOMOBILE LIABILITY PCL 05-1422-004 1/23/2005 1/23/2007 COMBINED SINGLE LIMIT S 11000, 000 ANY AUTO lEa accident) ALL OWNED AUTOS BODILY INJURY SCHEDULEDAUTOS (Per person) $ }C HIREDAUTOS BODILY INJURY $ NON-OWNEDAUTOS (Peraccidenl) PROPERTY DAMAGE $ (Pera=de M) GARAGELIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHERTHAN EAACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE S OCCUR CLAIMS MADE AGGREGATE $ S DEDUCTIBLE $ RETENTION $ $ $ WORKERS COMPENSATION AND 1424268-05 3/1/2005 3/1/2006 x r"YHMu- OEH- EMPLOYEES'LIABILITY l 000,000 E.L.EACH ACCIDENT $ / ANY PROPRI R E/E%ECUTIVE 1,000,000 OFFICER/MEMBMB EXCLUDED? ER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ Ryes,descnbeantler SPECIALPROVISIONS below EL.DISEASE-POLICYLIMIT $ 1,000,000 A OTHER PCL 05-1422-004 1/23/2005 1/23/2007 Each Claim $2,000,000 Claims Made Aggregate $2,000,000 Professional Liability DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES[EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS The City of Palm Springs, its officers and employees are added as Additional Insured, Waiver of Subrogation applies to the General Liability but only as respects all covered operations of the Named Insured. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER City of Palm Springs WILLs ..Y4C' MAIL 30 DAYS WRITTEN NOTICE TO THE Attn: City Clerk-Patricia Sanders CERTIFICATE HOLDER NAMED TO THE LEFT (10-DAYS FOR P.O. Box 2743 NON-PAYMENT OF PREMIUM) , Palm Springs CA 92263-2743 AUTHORIZED REPRESENTATIVE n ACORD 25(2001/08) ©ACORD CORPORATION 1988 GERTHOLDER" COP Ys'- - STATE P.O BOX 807 SAN FRANCISCD CA 94142 0807 COMPEJd$ATI,ON _ j. � INSLiRAN-CE - FUND CERTIFICATE QF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 03-01-2005 - GROUP: - POLICY'NUMBER: -' '1424268,2005 -_ CERTIFICATE ID-,, 29 CERTIFICATE EXPIRES: 03701-200e 03-01�2005/03-01-2006' CITY OF PALM SPRINGS SK 'JOB:, ALLOPERATIONS ATTN - JUDITH SUMICH, CITY CLERK. P 0 BOX 2743 PALM SPRINGS CA 9226,�-2743 This is to certify that we have issued a valid Workers' Compensation insurance- policy in a -form approved by the" California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 30 days' advance written notice to the employer. We will also give you 30 days' advance notice should this policy be cancelled prior to its normal expiration. This certificate of msurapce.is not an insurance policy and does not amend, :extend or alter .the coverage afforded - by the policies listed herein. Notwithstanding; any requirement, term, or condition'of any contract or other- document with respect to which this certificate of ':insurance 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. AUTHORIZED REPRESENTATIVE PRESIDENT - EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS:- $1,000,000.00 PER OCCURRENCE. ENDORSEMENT X2065 ENTITLED CERTIFICATE•:HOLDERS' NOTICE EFFECTIVE 03-01-2005 -IS ATTACHED TO AND „ FORMS A PART OF THIS POLICY. - EMPLOYER. LEGAL NAME INFOTOX, INC. l� INFOTOX, INC.'. 9251 ORCO PKWY STE. J RIVERSIDE CA 9.2569 , (REV.3-W) P � TFf1 02/17/2;005 • ' �'�^ t