HomeMy WebLinkAbout04660 - INFOTOX ASBESTOS LEAD MONITORING Infotox
Asbestos CP02-16
FIRST AMENDMENT TO CONTRACT SERVICES AGREEM AGREEMENT #4660 Amend 1
CM signed 7-9-03
WITH INFOTOX, INC. FOR
ASBESTOS AND LEAD MONITORING SERVICES-
400 AVENIDA CERCA DEMOLITION
CITY PROJECT NO. 02-16
The following articles of Agreement No. 4660 are hereby amended to read as follows:
SECTION 2.1 Maximum contract amount is amended to Eight Thousand Eight Hundred
Fifteen Dollars ($8,815.00).
EXHIBIT C is amended as follows:
Amend Asbestos Management Services, Task 1 to read:
Task 1: $65.00 per hour, not to exceed $6,500.00
Amend Asbestos Management Services, Subtotal to: $7,400.00
Amend Total Not to Exceed to: $8,815.00
Except as specifically amended by this Amendment No. 1, all terms and provisions of
Agreement No. 4660 remain in full force and effect.
ATTEST: CITY OF PALM SPRINGS,
a municipal corporation
City Clerk 11tV105 City ager
Agreementomervunder $25,000
Reviewed and approved by
Procurement & Contracting
Initials V�� Date 7103
P.O. Number
>i�I�.0G�1CdI.. I:�Sisa
CONTRACTOR: .Check one: Individual Partnership X Corporation
Si kure (notarized) Sign ft, r (notarized)
Name: Michael A. Nieuwlandt Name: Pamela J. Nieuwlandt
Title: President Title: Secretarv/Treasurer
(This Agreement must be signed in the above space by one of This Agreement must be signed in the above space by one of
the following:Chairman of the Board,President or any Vice the following:Secretary,Chief Financial Officer or any
President) Assistant Treasurer)
Stateof 0 fxk State of � V� f county oC �/,,�ll t1�(/�•^�}tS ¢b�1'Q:✓�°wb. County
On r�(,.f`t Ii^— t��B- f,C17L,, before me, On '�O"V�0 ��� r=����` ;� before
-M 4'..� fir? ) r
,)e�� ,Fi•aa.e d �.� t' �; �pp a �.� me, 4` ,
.
personally appeared Ayt'i ' .iij.0 ��(, , iAQ�C7H�Hth`1�.fi!A Cn�—personally appeared 'itl'4A��P.:9
.persQadty known to me "pm'ed to uie on the basis of satsfactory -personaH7^lmotvttZet`n'm (or proved to me on the basis of satisfactory
evidence) to be the persou(fr�whose name is�re subscribed to the evidence) to be the persoriKwhose mmnr' Cie'ts74fcssubscribed to the
within instrument and acknowledged to me tha?ie'he/ehey executed within instrument and acknowledged to me thatlrZWIrc�S�4'ey executed
!/r' ��
the sane nr( yw?h r/their authorized rapacity^sf, and that by the same m lets aer'/titer authorized capacity(}"+i�,, at d that by
his/[ r/their signaturo�on the instrument the persot or the bQLap i/tlii<ic signatuce� on the instrument rite personAd,, or the
cnnry upon behalf of which the person$.f,'acted, executed the entity upon behalf of which the person( acted, executed the
instrument I instrument.
WITNESS my hand and official scat WITN S n�nd a`,', offlciol
J ` P/ /
NotarySi natur i p// p/�' , 4
g 4��_�'C�-ia�� IAZ..-- Notary Signa ure:Notary Seal;Seal: r� Notary Seal: l�
i�ELLA J. SMITH Y
Lam. COMM.#1376285 d' ) /jam -"-fie - t� Y+NhI{VIrA,� C�
�U NOTARY PUBLIC CALIFORNIA U �` 'c`fis CONIIJi 112f3S583 xl`
O lA�? `r.ki NOTARY PUBLIC-CALIFORNIA
SAN RERNARDINO COUNTY W
p p I'"2yl SAN BERNARDINO COUNTY 51
My Comm Ex irea Se L23,2006 �,^ .n
I�,... ;__ `My,Comm Expims Cc-c^7,200A J�
v p
Infotox
Asbestos Monitoring
AGREEMENT #4660
CM signed 3-7-03
CITY OF PALM SPRINGS -- -- -
DEPARTMENT OF PUBLIC WORKS AND ENGINEERING
CONTRACT SERVICES AGREEMENT FOR
ASBESTOS AND LEAD MONITORING SERVICES
at
400 AVENIDA CERCA IN PALM SPRINGS, CALIFORNIA.
THIS CONTRACT SERVICES AGREEMENT (herein "Agreement") is
made and entered into this`'L-day of° 7r"✓d.4�L ' 2003, by and between the
CITY OF PALM SPRINGS, a municipal corporation (herein "City") 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 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
Five Thousand Five Hundred Sixty Five Dollars ($5,565.00) ("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.
H:\USERS\ENG\CONTR.AGREEMENTS\CP.02.16 AVE.CERCA\CONTRACT SERV.AGR.2 WITH INFOTOX.DOC
,I-
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 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 anytime 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 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 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.
I-I:\USERS\ENG\CORRESPONDENCE\CP02-16 400 AVE.CERCA DEMOIITION\CONTRACT SERV.AGR.2 WITH INFOTOX.DCC
,2,
(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 B.
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 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, endorsements or appropriate insurance binders evidencing the
above insurance coverages and said Certificates of Insurance, endorsements,
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
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 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:
I-I:\USERS\ENO\CORRESPONDENCE\CP02-I6 400 AVE.CERCA DEMOLMON\CONTRACT SERV.AGR.2 WITH INPOTOX.DOC
-3-
(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.
4.3 Performance Bond. Concurrently with execution of this
Agreement, Contractor shall deliver to City a performance bond in the sum of
the amount of this Agreement, in the form provided by the City, 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 City Manager or designee of the City Manager due to unique
circumstances. In the event the City Manager determines that the work or
services to be performed under this Agreement creates an increased or
decreased risk of loss to the City, the Contractor agrees that the 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
City Manager or designee; provided that the Contractor shall have the right to
appeal a determination of increased coverage by the City Manager to the City
Council of City within ten (1 O) days of receipt of notice from the City Manager.
H\USERS\ENG\CORRESPONDENCE\CP02-I6 400 AVE.CERCA DEMOLMOMOONTRACT SERV.ACR 2 WM I INPOTOX DOC
-4-
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, 2003.
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 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 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 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
H\USERS\ENG\CORRESPONDENCE\CP02-I6 400 AVE CERCA DEMOLMON\CONTRACT SERV.AGR.2 WITH INPOTOX.DOC
,5,
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.
SIGNATURES ON NEXT PAGE
I-I\USERS\ENG\C0RRE9P0NDENCE\CP02.16 400 AVE.CERCA DEMOLITION\CONTRACT SERV.AGR1 WITH INPOTOX.DOC
,6,
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 corporationCEB y: BY:
y Clerk �g� /� �e City Mina per
d-
,-..' r, 'c+.�,i.L,.n''li���ii i� 11 )i")•,r yn"}n{rt rv�"-da
�I�ItLd�V�t9J 11,1 1111,E e�
CONTRACTOR: Check one: _Individual Partnershi L'Corporatio
By: GG/, / ���
Signature (notarized) By.
g ) Sig (notarized)
Name:GJdaGIlil�l fr x1i SiWll �4 ]t�"d Name: T'/4 I'll GL-t- ,:J KAki _IAW dI kJ
Title: cy-e6i pel"i a Title:
. e
(This Agreement must be signed in the above space by one of This Agreement must be signed in the above space by one of
the following: Chairman of the Board,President or any Vice the following:Secretary, Chief Financial Officer or any
President) t� Assistant Treasurer)
State of C,q)(.\y7ryrtg-, 't
Sate o{('nL!%J12Aie%n1 �ll
Countyof kWets4e, )ss Counryofsn- ).a r'rLrV itVUs3Ii�+Q'
On,Ton2 2op � No}w Powxc.3beforeme, rrio-Rein p
—1 On
before me, J"�I �iy d�}ty- L[' 4�"_9 r'�Apersonal y appeared i"U'))o.VXCLI' personally appeamd �y e,-11 1 kJ '11'. . ,,iPn7P-crsonally
pmtcraaH7+ t-te-me+(or proved to the on the basis of satisfactory known to me(or proved to me on the basis of satisfactory evidence)to be
evidence) to be the pcuon(e) whose name(, is/are subscribed to the the person(s)whose name(s)is/are subscribed to the within instrument
withininstrument and acknowledged tome that he/sltehhey executed the and acknowledged to me that he/she/they executed the same in
same in his/bet/their authorized capacity(ies},and that by his/herfeheir his/her/their authorized capaciry(ies), and that by his/her/their
signatureH on the instrument the persono),or the entity upon behalf of signatures)on the instrument the person(s),or the entity upon behalf of
which the person(e)acted,executed the insaumenc which the person(s)acted,executed the instrument.
WITNESS my hand and official seal. WITNESS my hand and official seal. 1�
Notary Signature:_(��LL�A, � Notary Signature:-1,;��j�J
Notaryl
Sea "� ' Notary Seal:
CARRIE RO U� MA:'.R-I A E..
OJq�Commission 7
Notary Public-California COMM.#1319038
U NOTARYPUSUC-CALIFORNIA U
Riverside County '� ORANGECOUNTY U
My Cocoon.Expires Mark' �^.�-" My Comm.Explres Aug,27,2005"
Agreement __. . 5,000
Reviewed and approved by
H:\USERS\ENG\CONTR.AGREEMENTS\CP.02-l6 AVE.CERCA\CONTRACTSERV.AGR.2 WITH INFOTOX.DOProeurement & Contracting
Initials Date h
P.O. Number
��,,..:M
�� _ ., _ _ � 1 .,. ����, . , ,�.�,
EXHIBIT "A"
SCOPE OF SERVICES
Contractor shall provide professional services to the Agency for City Project
No. 02-16, 400 Avenida Cerca Demolition Project, as follows:
Provide oversight services for the removal of asbestos and lead containing
materials from structures located at 400 Avenida Cerca in Palm Springs,
California, and compliance monitoring in accordance with the Specifications for
City Project No. 02-16 (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" and Section 3.3 "
Prohibition Against Subcontracting or Assignment" of this Agreement are
waived.
H\USERS\ENE\CONTR.AGREEMENTS\CP 02-I6 AVE.CERCA\CONTRACT SERV.AGR.2 WITH INFOTOX.DOC
,8,
EXHIBIT "B"
SCHEDULE OF COMPENSATION
Based on the attached Exhibit "A", Scope of Services, the fees necessary to
provide the required professional services for the City Project No. 02-16 shall
not exceed the amounts listed per tasks identified below:
Asbestos Management Services:
Task 1 : $65.00 per hour, not to exceed $3,250.00
Task 2: $16.00 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 $ 75.00
-------------------------------------------------------
Subtotal: $4,150.00
Lead Based Paint Management Services:
Task 1 : $65.00 per hour, not to exceed $1 ,040.00
Task 2: $25.00 per sample, not to exceed $ 75.00
Task 3: $25.00 per sample, not to exceed $ 150.00
Task 4: $15.00 per sample, not to exceed $ 150.00
-------------------------------------------------------
Subtotal: $1,415.00
TOTAL NOT TO EXCEED: $5,566.00
Payment shall be made after completion of each task, or portion thereof, and
within 30 days after invoicing therefore, up to the maximum amounts indicated
herein.
H:\USERS\ENG\CONTR,AGREEMENTS\CP.02.16 AVE.CERCA\CONTRACT SERV.AGR.2 WITH INFOTOX.DOC
-9-
FROM : INFOTOX, INC FAX NO. : 909 597 0993 Mar. 03 2003 06:24PM P3
ACpRD- CERTIFICATE OF LIABILITY INSURANCF.,oT is D= °"oi,24;o3
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
8renkel Of California ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Environmental Risk services HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
725 S. Figueroa Blvd, ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Los Angeles CA 90017 INSURERS AFFORDINGCOVt:RAGE
Phcnef213-787-1100 8axs213-787-1164
INSUR -- � INSU0.FgA American SafgtY Casu
._alt Ina
Y
INsuRERE: State Gompensation ins, Fund
InfOCOX, LAC. INSURER C:
9451 O; o Pdrkwa Ste. J INSURP;
Riversl�a CA 925� FR
L-0906 —
INsuRER E:
COVERAGES
fHE POLICIES OF INSURANCE LISTED DELOW HAVE BEEN ISSUED TO THE INSURED HAMM ABOVE EORTHEPOLICY PERIOD INDICATED.NOTWITHSTANDING
ANY REOUIRETAQ4T,TERM ORCONDMON 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 SUWWT TO ALONE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN MOWED BY PAID CLAIMS.
ILT FI TYPEOFW0URANCE POLICYNUMSER A MMOW ➢ATE MMIpOf/1' LIMITS
GENERAL LIABILITY EACH OCCURRENCE i2,000 O,LOO
A X cOMMERcuLGENEMLLIABIuTY PCL 03-1422-003 01123/03 01/23/05 RRED,MAOE(AnYonefic) $50,000 _
DIAIMG MADE OOCCUR MEO E7SP I,AMX rneprc.gT) $5,000
X Contr.Poll.Liab. PERSONAL&ADVINURY 42 000,000
GENERALAGGREGATE i21000,000_
GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMNOPAGG i2 OOO,OOO
X POLICY JETT Lac
AUTOMOIILE LIABILITY COMEINEO SINGLE LIMIT
ANYAUTO (F =rloo $1,000,000
ALL OWNED AUTOS BODILY INJURY —
SCHEW=AUTOS (Pa pe*son) S
A X HIRED AUTOS PCL 03-1422-003 01/23/03 Di/23/05 BODILY INJURI• i
X NON-OWNEO AUTOS (Pav eoaaenq
PROPERTY DAMAGE S
(Peramaanq
GARAGE UABILIT'( AUTO ONLY-EA ACCIDENT i
ANY AUTO OUTFIER THAN PJIACC $
A ODIO AGE S
EXCESS LIABILITY GACH OCCURRENCE i
OCCUR CWMS MADE AGGREGATE i
DEDUOTLOLE _
RETENTION $ S
WORKERS COMPENSATION AND 7L TOR ..-I ER
B 9MPLOYERS'LuauTY 1424268-02 03/01/02 03/01/03 E.LEACHACODENT _ il 000,000
EL.DISEASE-EA EMPLOYEE i 1,000,000
L—D-ISIASE.PODOYLIMIT P1,000 000
OTHER
A CLASH$ MADE: RA.CLATM $1,000,000
PROP►,,.9SICNAL L7AB. PCL 03-1422-003 01/23 03 01423/05 AGGREGATE $2 000 000
DCSSORRI(N1 OF OPERATIONSILOCATIONSNENICLFSIIXCL W IONB A W ED OY ENDORSEMENTISPECIAL PROVISIONS
General Information Only.
CERTIFICATE HOLDER N I ADDNI,oNAL INSURED:INSURER LETTER: CANCELLATION
C;)Imo SHOULD ANYOFTHEABOVE DESCRIDED POLICIES BECANCEµED DEFORETHE EXPIRATION
DATETHEREOF,THE155UING 1Ni:V1MERWILL ENDEAVOR TO MAR .ZI&➢AYSWLRTfFN
NOTICE TO THE CERTIFICATE NOLDER NAMED TO THE UEFr,5UT FNLURETO OOSO SHALL
GrMIJI.L 1HFORDLATiON ONLY IMPOSE NO OBUGATION OR LNe1UTY OFANY KIND UPON THE INSURER,ITS AGENTS OR
REPRESENTATNEB.
AUTHOR)=REPRESS
ACORn 25S(7197) CORPORATION 1984
SK .
'�1 C,ERTHQ pEFf COPY -
■�TS PQ BOX $07, SAN ISC,FRANCO;C4 941'4 O807
! WMPBN�ATkOM
RAN , CERTIFICATE OF-WORKERS'' COMPNSATiQN 'IN&UEtAhCCE '
',-I$SUE ]ATE, 02 61-2003 _ - GROUPe'
- PgLI Y,NUMBED 142'42B8;-3003�
CEf#,T,IFICA, E lb :29,
CERV]FIQATR;E'XPIRES Ib) -01-2004„
03=01.-2002/03=0"1;-2004,'
C'I,TY pF PALM SPRINGS , SK, JOB,"ALL:oPERaTIDNs
AT.TN JUD14H S,'UMICH, CITY CLERK
P A BOX 2743
PALM SPR.INGS GA "92263 2743';
This is to,certify that we haVer issued a„valid Workers' Compensation insurance pohoy.in, a forrn'ap{,�roved by the
Cahfornia i'surabee Commissioner to the, employer named below.-for the 1p cy per,iod',indrpated. -
This pollcy,,i!S riot subject to cancellations by,the Fund except upon 1pday5'.advance �i+Fitfeh!nbGice to the employer,.
We.will�also give you,10 d9ys'-advance notice should this policy be cancelled prior to,,ifs.normal expiration.
This Certificate of;inSurance Is not an insurance policy and does not amend, extenol,or alter, the Coverage afforded
by the pgl'icies-listed herein'N,otwithstandi69 any requirement,-term, or condition of any contract or,'other document
with respect to which this certificate of insurance inay^be issued or may,pertain=thednsurande,afforded;by. the
policies described herein is subject to all ';the terms; exclusion's and conditions of such;polieies.
AUTHOR IZEp REPRE5ENTATIVE PRESIDENT� '
EMPLOYER'S4LIABILI'TY LIMIT INCLUDING DEFENSE CtlSTS;. $1 OOb,p,00.00 PER OCCURRENCE.
. EMPLOYER
!l LEGAL NAME - -
r;
I NFQTOX, INC - INFOTOX INC.
` 92-51 ORCO PKWY. $TE J
;R I V'ERS'I DE_`f A 92509
- •• 02. 14-20.03
- _ PRl_NTED P0408' -.,