HomeMy WebLinkAbout04991 - CARL WARREN & COMPANY CLAIMS ADJUSTING SERVICES RISK MANAGEMENT DOCUMENT TRACKING
Page: 1
Report: One Document Detail April 24, 2006
Condition: Document NumberA4991.
Document# Description Approval Date Expiration Date Closed Date
A4991 Claims Adjusting Services For Risk Management$18,000 11/08/2004 06/30/2005
Company Name: Carl Warren & Company
Address: P.O. Box 25180, Santa Ana, CA 92799-5180
Service: In File
xRef: HUMAN RESOURCES
Ins. Status: No Certificate on file.
Document Tracking Items: Due Completed Tracking Amount Amount
Code Item Description Date Date Date Added Paid
11-8-04 to CM for sigs
END OFREPORT* * `
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ECFIVED
C'b A 25 KN' 8: 03
HU4111AId RES0URCES
CITY Or PALM SPRINGS
Carl Warren & Company
Claims Adjusting Services
AGREEMENT#4991
CM signed 11-08-04
CITY OF PALM SPRINGS
CONTRACT SERVICES AGREEMENT FOR
Adjusting Services
��THIS CONTRACT SERVICES AGREEMENT(herein"Agreement")is made and entered into
this day of 9P, 2004, by and between the CITE'OF PALM SPRINGS, a municipal corporation
(herein "City") and Carl Warren & Company, (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 Eighteen Thousand Dollars ($18,000.00) ("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 Exhibit'B"Schedule of Compensation.
3.0 COORDINATION OF WORK
3.1 Representative of Contractor. DwightJ. Kunz, 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. Sue Mills, PHR 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.
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3.3 Prohibition Against Subcontractinq or Assiqnment. 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 AND INDEMNIFICATION
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 "C".
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.
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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 until June 30, 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
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the event of termination by the City, 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 City shall be entitled to reimbursement for
any compensation paid in excess of the services rendered.
6.0 MISCELLANEOUS
6.1 Covenant Aqainst 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-liabilitv of Citv Officers and Emplovees. No officer or 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
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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 Authoritv. 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.
SIGNATURES ON NEXT PAGE
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IN WITNESS WHEREOF, the parties have executed and entered into this Agreement as of the
date first written above.
CITY OF PALM SPRINGS
ATTEST: a municipal corporation
City Clerk Agreement oviin/under $25,000 City Manager -IENDIVE Wf WHIT
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Reviewed anntd approved by
CONTRACT(PRL o8a'rrgy#fAo ontraeting Check one:_Individual_Partnership_Corporation
P.O. Box 180
Inlitly I iAnl 27 I@0 ?�Gy
Corporations re�u7e•tWd� sty.. iba. 19ue hum 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).
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By: iL C' By: ��vyv✓v �—
Sig�ture(notarized) Signature\(n`otarizeed
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State of0\Y�f_lL � �\Ov State o � I I ""
Couuntyof Ise QQ � � \ County of e-v(isss
Oml - Ibefore me �,Y..V� �-t On`t 30-01 be me,\ ,� c,
personally appeared�� ,y\oh 4�• personally appeared
personally known to me (o roved to me on the basis of personally known to me (or proved 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 acknowledged is/are subscribed to the within instrument and acknowledged
to me that he/she/they executed the same in his/her/their to me that he/she/they executed the same in his/her/their
authorized capacity(ies), and that by his/her/their signature(s) authorized capacity(ies), and that by his/her/their signature(s)
on the instrument the person(s), or the entity upon behalf of on the instrument the person(s), or the entity upon behalf of
which the person(s)acted,executed the instrument. which the person(s)acted,executed the instrument.
WITNESS my hand and official seal. WITNESS my hand and official seal.
Notary Signature. \j\ ( � Notary Signaturre�— \�
Notary Seal: v ` Notary Seal: v \
` — — — — — — CINDYSELL
1 tim., CINDYSELL I Commission#1327717
Commission#7327717 Izz Notary Public-California
s n Notary Public-California 5 Orange County
VMYComm.
Orange county [[ ExpkesNov28_2005/
My Comm,Expires Nov 28,2005 - 1
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EXHIBIT "A"
SCOPE OF SERVICES
Contractor shall perform a variety of adjusting related services on an as-needed basis to
support the activities of the City's Risk Management Division.
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SCHEDULE B
SCHEDULE OF COMPENSATION
Total compensation for services and expenses provided hereunder shall not exceed $18,000.00.
Personnel:
Hourly Rate $49.00
Data Processing $25.00 per suffix
Office: $24.50 + 15%
Telephone 8%
Photographs $2.00 each
Stenographic $5.00
Index System $6.00 charge
Mileage $.40 per mile
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EXHIBIT "C"
SPECIAL CONDITIONS
Section 4.1 (d), "Additional Insurance" - A policy of professional liability insurance written on an
occurrence or claims made basis with limits of a minimum of$1,000,000 is required.
f
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FILE No.885 10/25 '04 14:12 ID:NEDIAPROFESIHNAL FAX:8162927920 PAGE 5i 5`
PROFESSIONALS'"
CERTIFICATE OF INSURANCE
This is to certify that the policy of insurance listed below has been issued to the Named Insured. This certificate is
issued as a matter of information only and confers no rights upon the Certificate Holder, This certificate does not
amend, extend or alter the coverage afforded by the policy listed below. Limits shown may have been reduced by
paid claims.
Named Insured and Mailing Address:
Carl Warren & Company
R.L. Gresham & Company, Inc.
dba R.L. Gresham/Carl Warren & Co.
750 The City Drive South, Suite 400
orange, California 92868
Company affording coverage: Gulf Insurance company
Type of insurance: Professional Liability and General Liability Policy
Policy No.: IGO948540
Policy Period: Effective date May 4, 2004 Expiration date _Kay A, 2005
12:01 A.M., Standard Time at the Mailing Address stated above,
Limits of Liability for ISPP Errors and Omissions Liability:
Each Wrongful Act $10,000,000
Policy Aggregate $10, 000, 000
Limits of Liability for ISPP-General Liability:
General Aggregate Limit $21 0001 000
Products-Completed Operations Aggregate Limit $2,000, 000
Advertising Injury Limit $2, 000,000
Each Occurrence Limit $2,000, 000
Fire Damage Limit $50, 000
Retroactive pate: See Endorsement
Schedule of Professional Services Insured:
Insurance claims adjusting services, insurance appraisal services and
insurance claims adminisfrat]on services.
Certificate Holder Name and Address:
City of Palm springs
Risk Management
P,O, sox 2743
Palm Springs, CA 92262
NOTE: If the Named Insured is the same as the above named Certificate Holder, written Notice )f Cancellation will be
provided to the Named Insured in accordanca with the provisions of the policy and any auplicable state law.
CANCELLATION: Should the above described policy be cancelled before the expiration date the,eof, the issuing
Company will endeavor to mad 30 days written notice to the above named Certificate Holder but
failure to mail such notice shall impose NO ohlioation or liability of any kind upon the Company,
Certificate Helder is also an Additional Insured
Date Certificate Issued: October 25, 2004
"CLAIMS MADE AND REPORTED POLICY"
FILE No.685 10/25 '04 14:12 ID:NEDIAPROFESIONAL FAX:8162927920 — PAGE 41 5
Gulf Insurance Company
One State Street Plaza, 9th Floor, New York, New York 10004
1888) 467-7767
Named Insured and Mailing Address:
Carl Warren & Company
R.L. Gresham & Co. , Inc.
dba R.L.Gresham\Carl Warren & Co,
750 The City Drive South
Suite 400
Orange, California 92858
Effective October 22 2004 12:01 a.m., at the Named Insureds address as snown on the
Declarations Page, this Endorsement No. 64 is part of Policy No. IG0648540
CH MGE 8NAOR$EMENT
In consideration of the premium charged it is hereby understood and 'agreed
that section V. GENERAL CONDITIONS, Item 6. NOTICE OF CANCELLATION )R
NON-RENEWAL, Item b, is amended to read:
(b) The Company may cancel or non-renew this Policy by mailing o,
delivering to the Named Insured written notice of cancellation or
non-renewal at least:
(1) 10 days before the effective date of cancellation if the Company
cancels for non-payment of premium; or
(2) 60 days before the effective date of cancellation if the Company
cancels for any other reason or non-renews
(3) 30 days notice shall be given to the City of Palm Springs if the
policy is cancelled before the expiration date of the policy, The
Company will mail or deliver its notice to the above Additional
Insured's last known mailing address. If the captioned policy is
cancelled prior to the expiration date by a premium finan„e
company this requirement will not apply and is not the
responsibility of the Company,
Except as stated above, this endorsement does not change any other provisions of the policy.
If the Company issued this endorsement to be part of the policy on the (effective Date, then tho countersignature on
the Declarations Page also applies to the endorsement. If this endorsement is effective after tics Effective Date of the
policy, the Company's authorized representative must countersign in the space below to (validiae the endorserne�nt. )
Countersigned by �� ` -',L{� �'l.r�-^ "
Authorized Represrnta
FILE No.885 10/25 '04 14:11 ID:MEDIAPROFESIONAL FAX:8162927920 PAGE 3i 5
Gulf Insurance Company
One State Street Plaza, 9th Floor, New York, New York 10004
(888) 467.7767
Named Insured and Mailing Address:
Carl Warren & Company
R.L, Gresham & Co. , Inc.
dba R.L.Gresham\Carl Warren & Co.
750 The City Drive South
Suite 400
Orange, California 92868
Effective October 22, 2004 12:01 a.m., at the Named Insured's address as shown on the
Declarations Page, this Endorsement No. 83 is part of Policy No. IG0648540
ADDITIONAL INSURED &NDOUNMBNT
In consideration of the premium charged, it is hereby understood anit agreed
that the person(s) or entity(ies) listed below is added as an Additional
Insured, but only for liability arising solely out of Wrongful Acts of the
Named Insured in the performance of Professional Services:
City of Palm Springs
Risk Management
P,O. Box 2743
Palm Springs, CA 82262
It is also understood and agreed that the Policy does not apply to any Claim:
(1) by an Additional Insured against any other Insured;
(2) which includes allegations or facts indicating actual or alleged
independent or direct liability on the part of an Additional Insured.
Except as stated above, this endorsement does not change any other provisions of the policy.
If the Company issued this endorsement to be part of the policy an the Effective Date, then th,: countersignature on
the Declarations Page also applies to the endorsement. If this endorsement is effective after the Effective Date of the
policy. the Company's authorized representative must countersign in the space below tovivalidwe the endorsement,
FORM: ISP-45061 Countersigned by
Authorized Represent e
09/07/2004 08:07 IFAH DRNG-FAX0CARLi1ARREN. 00M Dwight Kunz 1a 001/002
Gulf Insurance Company
One State Street PI028, Sth Floor, Now York, New York 10004
{888)467-7767
(herein called "the Company")
Insurance Services Professionals Errors and Omissions Liability Insurance Policy
Claims Made and Reported
OP-CLARATIONS PAGE 1 of 2
T NOTICE: THIS INSURANCE IS WRITTEN ON A CLAIMS MADE AND REPORTED BASIS AND PROVIDES COVERAGE FOR THOSE
CLAIMS WHICH ARE POST MADE AND REPORTED TO THE COMPANY WHILE THIS INSURANCE IS IN FORCE AND WHICH ARE
THP RESULT OF WRONGFUL ACTS COMMITTED ON 08 SU@Sr:OUENT TO THE RETROACTIVE DATE SPECIFIED IN ITEM 4 OF
THE DECLARATIONS. NO COVERAGE DQ$TS FOR CLAIMS FIRST MADE AFTER THE END OF THE POLICY PERIOD UNLESS
LAND N THE EXTENT
AN EXTENDED REPORTING PERIOD APPLIES. CLAIM EXPENSES SHALL RE APPLIED AGAINST THE
AMOUNT SPECIFIED IN ITEM S OF THE DECLARATIONS,PLEASE READ YOUR ENTIRE POLICY CAREFULLY,
TO..T .UN
Policy No, IG0648540_„,.._ Renewal of No. _j0j69>22
IN RETURN FDA PAYMENT OF THE PREMIUM, THE COMPANY AGREES WITH THE NAMED INSURED TO PROVIDE INSURANCE
UNDER THE PnOV1SIONS IN THIS POLICY,
Item 1. Named Insured and Mailing Address:
Carl WarreTl & Company
R.L, Gresham & Co. , Inc.
dba R.L-Greaham\C:arl Warren & Co.
750 The City Drive Sough
suite 400
Oratteje, California 92868
Item 2. Polley Period; From May 4, 2PO4 To May e. 2005,_,,.___
EffeCdVa DOTS ExPiration Date
14:01 A.M..Standard Tma 9t 1he Malang Address stated In Ram 1.
[torn 3, Limits at Liability for ISPP ET oTB and Omisalons Liability:
3a: Each Wrongful Act $ 10,000,000
3kr: Ppliay Aggregate $ 10,000,000
3c: Deductible - Each Wrongful Act
Limits of Liability for ISPP-Gencral Liability:
3d: General Aggregate Limit $ 2.000,000
Sec Products-Completed Operations Aggregate Limit $ 2,000,000
3t: Advertising Injury Limit $ 2,000,000
39: Each Occurrence Limit $ 2,000,000
3h, Fire Damage Limit $ 50,000
3i: Deductible- Each Claim $ 10,000
[tern A. Retroactive Date: see L"ndorsement
Items: Premium: $ 158,480.00
llncludea Terrorism Premium $ 1,569.00)
State SurchargeM3x: $Not. Applicable
iSP 4SO60 14I961 (Continued on next Ph9d)
Copyright 199Et
09/07/2004 00:07 IFAN 0RNG-FAH@0ARLWARREN. 00M 4 Dwight Kunz Z 002/002
Gulf Insurance Company
One State street Plaza, 9th Floor, New York, New York 10004
(8881467-7767
(herein called "the Company")
Insurance Services Professionals Errors and Omissions Liability Insurance Policy
Claims Made and Reported
DECLARATIONS PAGE 2 of 2
Named lnsurad : Cazl Warren & Company
Policy No- : IG0598540
from Y,: Schedule of Professidnal Services insured:
Insurance claims adjusting services, insurance appraisal services and
insurance cldime administration services.
Item 7, Form(s) and Endorsamontfsl made a part of this policy at time of issue:
Insurance Services Erofesal.onals Liability Srrers & Omissions - aSP 45052
ISee sndorsement
THIS DECLARATIONS PAGE, ALONG WITH YOUR SIGNED APPLICATION OR RENEWAL APPLICATION AND
ALL OF THE PARTS OF THE POLICY LISTED IN ITEM 7 ABOVE COMPLETE THE POLICY.(,��7,�
Countersigned at Eausaa_City, Missouri By �"�^" `-•ti-�
uth.dzed RRprecB'n
Data
ISP 45Q50(ores)
Copyright 1998
Client#: 10550 WARCA
ACORDa. CERTIFICATE OF LIABILITY INSURANCE 1DATE
0/22/04D )
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Ashbrook-Clevidence, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
575 Anton Blvd.#610 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
License#0188788
Costa Mesa, CA 92626 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: St. Paul Travelers
Carl Warren &Co. INSURER B. Granite State Insurance
P.O. Box 25161 HELPER C:
750 The City Drive South, Suite 400
INSURER D:
Santa Ana,CA 92799 INSURER E
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 ADVIL TYPE OFINSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
LTR NSRC DATE IMMIDD/YY) DATE(MMIDOIYY7
GENERAL LIABILITY EACH OCCURRENCE S
COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED
PREMISES(Ea occurrence) $
CLAIMS MADE OCCUR MED EXP(Any one person) $
PERSONAL&ADV INJURY $
GENERAL AGGREGATE $
GEN'L AGGREGATE LIMIT APPL�IES PER: PRODUCTS-COMP/OP AGG $
1 POLICY n JECT F LOC
A AUTOMOBILE LIABILITY 1810319H3322TIL04 07/01/04 07/01/05 COMBINED SINGLE LIMIT $1,000,000
_ ANY AUTO (Ea accident)
ALL OWNED AUTOS
BODILY INJURY $
_ SCHEDULED AUTOS (Per person)
X HIRED AUTOS
BODILY INJURY $
X NON-OWNED AUTOS (Per accident)
PROPERTY DAMAGE S
(Peraccident)
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGO $
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE S
OCCUR CLAIMS MADE AGGREGATE $
DEDUCTIBLE $
RETENTION $ $
B WORKERS COMPENSATION ANU_ - _WC3282739 03/01/04 03/01/05 X I WCST TU- OER
EMPLOYERS`LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000
OPFICERIMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $1,600,OQ0-,
IFyee,describe under ` -
SPECIAL PROVISIONS below EL DISEASE-POLICY LIMIT $1,060,000
OTHER
)
— l7
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
A)*10 days for non-payment of premium. B)*10 days for non-payment of premium and/or
non-reporting of payroll.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City of Palm Springs DATETHEREOF,THE ISSUING INSURER WILL XIIII) Ill MAIL *3Q, DAYS WRITTEN
Attn: Risk Management NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,XxXK%MXX)M7AK)*Q*k1XK
P.O. Box 2743 )AMKXR)PX)MXNAECRXXMKXX)W)OXXxINAX"XXK nYxM77x KX)4RRO(KD XX
Palm Springs, CA 92262 xylim"KKKNII x
AUTHORIZED REPRESENTATIVE
ACORD 25(2001/08)1 of 2 #10604 (;XO 0 ACORD CORPORATION 1981
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may
require an endorsement. A statement on this certificate does not confer rights to the certificate
holder in lieu of such endorsement(s).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
ACORD 25-S(2001108) 2 of 2 #10604
°CONTRACT ABSTRACT
Contract
Company Name: Carl Warren & Company
Company Contact: Dwight Kunz
Summary of Services: Claims Adjusting Services
Contract Price: $18,000.00 (revised amount)
Funding Source: 540-5904
Contract Term: 7/1/04 — 7/1/05
Contract Administration
Lead Department: Human Resources
Contract Administrator: Sue Mills
Contract Approvals
Council/Community Redevelopment 1%
Agency Approval Date:
Minute Order/Resolution Number:
Agreement Number:
Contract Compliance
Exhibits: ���������'
Signatures:
Insurance:
Bonds:
Contract prepared by: Dana Rascon
Re-Submitted on: 12/2/04 By: