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Emergency Medical Service
Coordination Services
CITY OF PALM SPRINGS AGREEMENT #A5193
CM 11-18-05
CONTRACT SERVICES AGREEMENT
for
Emergency Medical Service Coordination Services
HIS CON,JT�& CT SERVICES AGREEMENT(herein"Agreement") is made and entered into
this day of 4D2 �2005, by and between the CITY OF PALM SPRINGS, a municipal
corporation (herein "City') and Gigi Kramer, M.I.C.N., (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 agency 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 twenty thousand Dollars ($20,000.00) ("Contract Sum").
2.2 Method of Payment. Provided that Contractor is not in default underthe 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. GiGi Kramer, RN, M.I.C.N., 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. Fire Chief Blake Goetz is hereby designated as being the
representative the City 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 City Manager of City
shall have the right to designate another Contract Officer by providing written notice to Contractor.
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 approval of the City. Neither this Agreement nor any interest herein may be
assigned or transferred, voluntarily or by operation of law, without the prior written approval of City.
Any such prohibited assignment or transfer shall be void.
3.4 Independent Contractor. Neither the City 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 City and shall remain under only such obligations as
are consistent with that role. Contractor shall not at any time or in any manner represent that it or
any of its agents or employees are agents or employees of City.
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 City, 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 a least
$1,000,000 bodily injury and property damage including coverages for contractual liability,
personal injury, independent contractors, broadform property damage, products and
completed operations The General Liability Policy shall name the City of Palm Springs, its
officers, employees, and agents, as 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
such amount as will fully comply with the laws of the State of California and which will include
$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. Policies of such other insurance, including professional liability
insurance in a minimal amount of$1,000,000 if contract has professional liability exposure,
as may be required in Exhibit "A".
All of the above policies of insurance shall be primary insurance. The insurer shall waive all
rights of subrogation and contribution it may have against the 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 City with Certificates of Insurance or appropriate
insurance binders evidencing the above insurance coverages and said Certificates of Insurance or
binders are approved by the City.
The contractor agrees that the provisions of this Section 4.1 shall not be construed as limiting
in any way the extent to which the Contractor may be held responsible for the payment of damages
to any persons or property resulting from the Contractor=s activities or the activities of any person or
person 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 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 entity arising 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 or failure 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 City,
its officers, agents or employees but excluding such claims or liabilities arising from the sole
negligence or willful misconduct of the City, its officers, agents or employees, who are directly
responsible to the 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 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 City, its officers, agents, and employees
harmless therefrom;
(c) In the event the 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 City, its officers,
:agents or employees, any and all costs and expenses incurred by the City, its officers, agents or
employees in such action or proceeding, including but not limited to, legal costs and attorneys'fees.
5.0 TERM
5.1 Term. Unless earlier terminated in accordance with Section 5.2 below,
this Agreement shall continue in full force for 1 year.
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 City, Contractor shall be entitled to compensation for all services rendered priorto
the effectiveness of the notice of termination and for such additional services specifically authorized
by the Contract Officer and City shall be entitled to reimbursement for any compensation paid in
excess of the services rendered.
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 officeror employee of the City
shall be personally liable to the Contractor, or any successor in interest, in the event of any default or
breach by the 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 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 City,
to the City Manager 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 may be amended at
any time 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 hereby
declared 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.
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 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.
IN WITNESS WHEREOF, the parties have executed and entered into this Agreement as of the date
first written above.
CITY OF PALM SPRINGS,
a municipal corporation
ATTEST: --
,,By APPRO�b
City Clerk 9Y CITY 'age'
�
lr,s 11- SS-r1a ovo� P�,�s�cY��
CONTRACTOR: Gigi Kramer, M.I.C.N. Check one:_X Individual_Partnership_Corporation
Corporations require two notarized signatures One from each of the following: A. Chairman of Board, President,or any
Vice President:AND B. Secretary,Assistant Secretary,Treasurer,Assistant Treasurer, or Chief Financial Officer).
S' n ure(notarized) Signature(notarized)
1
Name: // Name:
��\
Title: I f V CVr j Title:
State of } State of }
County of }ss County of }ss
On before me, On_ before me,
personally appeared personally appeared
personally known to me(or proved to me on the basis of personally known to me(or proved to me on the basis of
satisfactory evidence)to be the person(s)whose name(s) satisfactory evidence)to be the person(s)whose name(s)
is/are subscribed to the within instrument and is/are subscribed to the within instrument and
acknowledged to me that he/shefthey executed the same acknowledged to me that he/shefthey executed the same
in his/herftheir authorized capacity(ies), and that by in his/her/their authorized capacity(ies), and that by
his/her/their signature(s)on the instrument the person(s), his/herftheir signature(s)on the instrument the person(s),
or the entity upon behalf of which the person(s) acted, or the entity upon behalf of which the person(s) acted,
executed the instrument. executed the instrument.
WITNESS my hand and official seal. WITNESS my hand and official seal.
Notary Signature: Notary Signature:
Notary Seal: Notary Seal:
EXHIBIT "A"
SCOPE OF SERVICES
Contractor shall serve as the City's Emergency Medical Service Coordinator for the Fire
Department's Advanced Life Support Program (ALS). Representative duties of the Emergency
Medical Services Coordinator include, but are not limited to, the following;
• Complete the orientation and accreditation process for all Fire Department personnel
entering the Palm Springs Fire Department first responder Advanced Life Support (ALS)
Program.
• Provide requested information to the Fire Department Administration regarding the progress
of all paramedic personnel involved with the Program.
• Maintain separate files on each Fire Department paramedic, as it relates to ALS.
• Review Patient Care Reports (PCR) forms for the purpose of maintaining Quality
Assurance/Improvement objectives as filed with the Riverside County EMS Agency.
• Maintain and audit all forms related to controlled substances (verification, usage, and
incident reports).
• Upon written request, provide the Riverside County EMS Agency any PCR or patient care
data for the purposes of data management quality improvement, or system issues.
Performance of this will be coordinated with the Fire Department Administration.
• Work in conjunction with the Pre-Hospital Liaison Nurse, and Clinical Manager for American
Medical Response(AMR)to provide field care audits, system changes,and protocol updates
for all Fire Department paramedics.
• Offer ALS and BLS continuing education classes, structured for Fire Department purposes,
but open to any EMS personnel.
• Provide field observation(ride-a-longs)with Fire Department paramedics. Observations will
be documented in writing, and maintained in personnel files.
• Provide skills refresher courses for Fire Department paramedics as needed,
• When requested, conduct quality assessment reviews as outlined in Policy *2200 of the
Riverside County EMS Agency Protocol, Policy, and Procedure manuals.
• Perform an annual audit on all sets of the Riverside County EMS Agency Protocol, Policy,
and Procedure manuals maintained by the Fire Department. This would include audits of the
manuals held by the paramedics.
• When requested, attend meetings, seminars, and continuing education classes that will
enhance delivery of EMS to Palm Springs.
• Perform other EMS related administrative services, not specifically contained herein, as
requested by the Fire Chief or his/her designee.
Special Requirements:
The requirement for Commercial General Liability Insurance is waived.
Worker's Compensation Insurance is not required for this Agreement as the Contractor does not
have any employees.
'The liability limit on Contractor's automobile policy is hereby changed from $1,000,000 to$300,000
Contractor shall procure and maintain for the entire term of this Agreement a policy of Professional
Liability Insurance in the amount of$1,000,000
Y
EXHIBIT"B"
SCHEDULE OF COMPENSATION
'Total compensation for services provide shall not exceed $20,000.00.
The Contractor shall be compensated for services rendered under Exhibit"A", Scope of Services,at
an hourly rate of$35.00 per hour.
Allowable Expenses: Certain fees and insurance premiums related to the requirements of Section
4.0 of this Agreement are eligible for reimbursement to the Contractor by the City. The Contractor
must invoice the City separately for reimbursement. Any cost differential claimed by Contractor for
increasing Contractor's automobile insurance coverage to the levels required by Section 4.1(C) must
be documented by Contractor's insurance agent and attached to the invoice.
City agrees to reimburse Contractor for supplies, travel cost, etc. on a case-by-case basis and with
prior written approval by the City's Contract Officer.
FROM FAX NO. :
Nov. 17 2005 34:21PM P3
RightFax Norcro5s 11/17/2005 7:07 PAGE 003/004 Fax bervel
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li the oertifiGate holder Is an ADDITIONAL INSURED, the policy(ies) must be endorsed_ A statement
on this eerxiflcate does not COnfeY rights SO the CBr[fflcate holder In lieu of Such endorsement(s),
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may
require on endorsement. A statement on this r..ertificate does not oonfer rights to the certificate �
holder in lieu of such endorsement(s)
DISCLAIMER
The Certificate of Insurance on the reverse sine of this'form does not constitute a contract between
the issuing Iuurer(s), authorized representative or producer end the cSrtificate holder, roi does it
affirmatively or negatively amend, extend or after the coverage afforded by the policies listed thersor.
I
I
i
I
ACORD 25(2001/08)
FROM : FAX NO.
RightVax Noroross 11/17/2005 7:07 PAGE 00'L/UU4 rNov.��7.�0a5 04:21Pf9 P2
We are happy to assist you with any questions,
St. Paul Travelers Service Center
71UVUM
FA5?AT;IADECLARATIONS -------------------------------------
ICoverage afforded by this policy is I
We will provide the ]provided by: I
insurance described in I I
this policy in return for the premium ISTATE FARM GENERAL INSURANCE COMPANY I
and compliance with all applicable 1900 OLD RIVER ROAD 1
provisions of this policy. IBAKERSFIELD CA 93311-0001 1
I I
77-UZ-5918-5 Policy Number I
---------------------------------------- IA Stock Company with Home Offices in I
Named Insured and Mailing Address IBloomington, Illinois. 1
KRAMER, CHRISTOPHER & GIGI -------------------------------------
3149 E VENTURA RD
PALM SPRINGS, CA 92262-3958
-------------------------------------------------------------------------------
The Policy Period begins and ends at [Automatic Renewal - If the Policy
12: 01 a.m. Standard Time at the residence ( Period is shown as 12 months, this
premises . (policy will be renewed auto-
Imatically subject to the premiums,
04-02-2005 Effective Date Irules and forms in effect each
12 months-Policy Period Isucceeding policy period. If this
04-02-2006 Expiration of Policy Period (policy is terminated, we will give
-------------------------------------------- [ you and the Mortgagee/Lienholder
Limit of Liability - Section 1 [written notice in compliance with
Ithe policy provisions or as
$ 220, 900 Coverage A. Dwelling Irequired by law.
$ 1 , 000 ,000 Liability Section II I -----------------------------------
------------------------------------------- IDeductibles - Section 1 $1000
Policy Type TALL LOSSES In case of loss under
Homeowners Policy Ithis policy, the deductible will be
Dwell Repl Cost - Similar Construction [ applied per occurrence and will be
Option ID - Increase Dwlg Up to $44, 180 Ideducted from the amount of the
------------------------------------------- [ loss . Other deductibles may apply
Location of Premises I - refer to your policy.
I
Same as mailing address I
I -----------------------------------
1Policy Premium $1, 215 . 00
--------------------------------------------------------------------------------
Forms & Endorsements
438-BFU.NS LNDR LOSS PAY FE-5257 NURSES PROF LIAB
FP-7955.CA HOMEOWNERS POL ( $1 ,000,000 limit)
LSP B1 LMT RPLC COST-B
OPT ID COV A-INCR DWLG
OPT OL BLD ORD/LAW-10%
---------------------------------------------------------------------------------
Mortgagee I Agent Name & Address
COUNTRYWIDE HOME LOANS INC I CYNTHIA L PIEPER INS
ATIMA-ISAOA I AGENCY, INC.
PO BOX 961206 FTWX-22 1 777 TAHQUITZ CANYON WAY
FORT WORTH, TX 76161-0206 1 SUITE 125
1 PALM SPRINGS, CA
1 92262-6784 (760) 416-3006
Loan Number: 032063182 1
--------------------------------------- .--- ---1 -- ------------ ------------
Countersigned: November 08, 2005 By 7033
Agent Agent ' s Code
559-916 CA Eff. 3-97 MORTGAGEE COPY
AUTO & HOME
INSURANCE PLUS
Coverage provided by: CALIFORNIA CASUALTY INDEMNITY EXCHANGE
Named Insured(s): Refer to page 1 Policy Period: 05/21/05 to 05/21/06
Policy Number: 3.06 1176676 0o o2
COVERAGE FOR: 01 CHRYS PT CRUISER VEHICLE ID NUMBER: 3C8FY4BB41T504045
LIENHOLDM PALM SPRINGS EFCJ
Class 388A20 Symbol: 12 Limit:
Coverage is provided where a premium is shown, See your Policy Contract for coverage details.
COVERAGE LIMITS DEDUCTIBLE PREMIUM
BODILY INJURY LIABILITY �'100, 000/5"0U, 000 $262.00
k�,ACH PERSOON/EACH ACCI➢ENT
PROPERTY DAMAGE LIABILTTY $300, 000 $202.00
EACH ACCIDENT
MEDICAL PAYMENTS 5, 000 $44 .00
RACH PERSON
UNINSURED AND UNDERINSURED MOTORISTS 5550 000/$100, 000 $50.00
EACh PER.SSON;EACH ACCIDENT
OTHER THAN COLLISION ACTUAL CASH VALUE $100 $177.00
dUBJEC'T TO DEDUCTIBLE
COLLISION ACTUAL CASH, VALUE $500 $286. 00
SUBJECT TO DEDUCTIBLE
TOWING AND LABOR COSTS APPLIES $10.00
REASONABLE COSTS
Total Premium: $1, 031.00
Your premium for this vehicle reflects the following discounts:
GOLD STAR PLUS LEVEL
SAFE/GOOD DRIVER DISCOUNT
PERSISTENCY DISCOUNT
MULTI-CAR DISCOUNT
PASSIVE RESTRAINT DISCOUNT
GROUP MEMBER DISCOUNT
COVERAGE FOR: 99 GMC YUKON VEHICLE ID NUMBER: 1GKEK13R7XJ807351
LIENHOLDER: PALM SPRINGS EFCU
Claiss: 388B20 Symbol: 12—`i- _Limit:_---_ --^—�__._�__
Coverage ;s provided where a premium is shown. See your Policy Contract for coverage details. T
COVERAGE LIMITS DEDUCTIBLE PREMIUM
BODILY INJURY LIABILITY $100' 000/$300'000 $289. 00
EACH PERSON/EACH ACCIDENT
PROPERTY DAMAGE LIABILITY $300, 000 $221.00
EACH ACCIDENT
MEDICAL PAYMENTS $5, coo $47 .00
EACH PERSON
UNINSURED AND UNDERINSURE➢ MOTORISTS $501000/$100, 000 $54 .00
EACH PERSON/EACH ACCIDENT
OTHER THAN COLLISION ACTUAL CASH VALUE $100 $178.00
SUBJECT TO DEDUCTIBLE;
COLLISION ACTUAL CASH VALUF $500 $286 .00
SUBJECT TC DEDUCTIBLE
TOWING AND LABOR COSTS APPLTES $10.00
REASONABLE COSTS
Total Premium: $1, 085 .00
Your premium for this vehicle reflects the rollowing discounts:
GOLD STAR PLUS LEVEL.
SAFE/GOOD DRIVER DISCOUNT
PERSISTENCY DISCOUNT
MULT1-CAR DISCOUNT
UP-1176 (08/99) INSURED COPY 06/07/05 Page: 2 of 4
lira AUTO & HOME Home Office;
INSURANCE PLUS San Mateo, CA
Coverage provided by: CALIFORNIA CASUALTY INDEMNITY EXCHANGE
NEW
Automobile Policy declarations
NAMED INSURED(S): For questions pan your policy, call THIS IS NOT A BILL
KRAMER, CHRISTOPHER M YOUR POLICY IS BILLED
3:1.49 VENTURA RD 800-800-9410 BY INSTALLMENTS.
PALM SPRINGS CA 92262 To report an accident or loan, call Billing information will be
000-800-9410 mailed s.aparately.
POLICY NUMBER POLICY PERIOD iNs of 12:0 1 a.m Standard time at rho Named Ineured's address of rocord.l
106 1176676 00 02 Effective Expiration
06/21/05 05/21/06
KRAMER, CHRISTOPHER PRINC�PAI. OPERATOR 99 GMC YUKON
KRAMER, GIGI PR1NCIpAL UPERATOR 01 CHRYS PT CRUISER
TOTAL POLICY PREMIUM $ 2, 1t6 . o0
Your Automobile policy consists of the Declarations and documents listed below. Please keep this information
for your records.
VEHICLE: FORM NUMBER: EDITION DATE:
ALL UP-1100 1186
ALL UA-1111 0690
ALL UA-1102 0690
ALL PCCA99 1104
01. CHRYS PT CRUISER 50A 0990
99 GMC YUKON 50A 0990
UP-1 176 (08/99) INSURED COPY 06/07/05 Page: I. of 4