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Home My WebLink About04513 - COURTESY VENDING SERVICE AIRPORT VENDING MO7085 DOCUMENT TRACKING Page: 1 Report: One Document Detail August 24, 2007 Condition: Document Numbera4513, Document# Description Approval Date Expiration Date Closed Date A4513 Vending Services,Airport 06/05/2002 04/30/2007 Company Name: Courtesy Vending Service Address: 83-616 Avenue 45, Suite 13, Indio, CA 92201 Group: AIRPORT Service: Lease Agreement xRef: AIRPORT Ins.Status: A policy has Expired Document Tracking Items: Due Completed Tracking Amount Amount Code Item Description Date Date Date Added Paid Converted from Fastrack v6.15 data. Distributed to Procurement 06/26/2002 per Janet Buck-changed to Airport as the lead dept called BG for option to be forwarded to our dept 08/01/2006 Option in File 09/12/2005 option in file 05/23/2006 END OF REPORT o�L1 t. DOCUMENT TRACKING Page: 15 Report: Expired Documents Summary August 3, 2007 Condition: Oldest Date= 1 !,ALL Groups,ALL Services,ALL XREFs D Des.rrption Approval Date Expiration Date Closed Date A4513 Vending Services,Airport 06/05/2002 04/30/2007 Company Name: ourtesy Vendin Servi a TL M� LvLa6;51 Address: 83-516 Avenue 45, Suite 13, Indio, CA 92201 Group: AIRPORT CNt` M Lt'�'[� 7alT Service: Lease Agreement , n �� xRef: AIRPORT I� Ins.Status: A policy has Expired. A4736 Reimbursement Agr For Providing Flexible Law Enforcement 07/23/2003 09/30/2006 ram" Company Name: Transportation Secure Administration �� Group: AIRPORT tic4-13(jq1 M o-79-7d1 1 Z1tO 160 71%w (,uku- C W5�� . Service: In Process xRef: AIRPORT Ins.Status: Certificate and Policies are OK ( l A4865 Lease Agreement For Office Space @ Airport$271,41 Mo W!3 1-yr... 04/07/2004 04/14/2007 1 1 I I IL, G(O C o Company Name: Coachella ValieV Address: P.O. Box 5451, Palm Springs, CA 92263-5451 �t.� Group: AIRPORT Service: Lease Agreement xRef: AIRPORT Ins.Status: INACTIVE eF PALM City of Palm Springs Department of Aviation Palen Springs International Airport f ':'ticoRl9aC RAT o\ Fri ; 3400 E Tahquitz Canyon Way,Suite OFC • Palm Springs, California 92262-6966 '1,, >: TEL (760) 318-3800 • FAX(760) 318-3815 • TDD(760)864-9527 �41 FO RNA �a May 22, 2006 Courtesy Vending Service 44 917 Golf Center Parkway, Suite 13 , Indio, CA 92201 - c RE: Agreement 4513 — Option c Dear Mr. Lazalde: The request to exercise the final option of Agreement 4513 with the City of Palm Springs at Palm Springs International Airport has been approved. This option will cover the period May 1, 2006 through April 30, 2007 Sincerely, J J`an t Buck Airport Asset Manager Cc: Steve Zehr, A.A.E., Assistant Director of Aviation City Clerk , Outgoing correspondence file Courtesy Vending file Post Office Box 2743 1 Palm Springs, California 92263-2743 May 16 06 oe: 03a Richard Lazalde (760) 347-4227 p. l M Q COURTESY VENDING SERVICE 44-917 Golf Center Parkway, Suite 13 Indio, CA 92201 May16,2006 City of Palm Springs Departmentof Aviation Palm Springs International Airport 3400 E.Tahquitz Canyon Way,Suite O'FC Palm Springs,CA.92262 DearJanetBuck I would like to exercise my option and extent my contractforvending service attire Palm - Springs Airport for an additional year. Sincerel Richa Lazalde Phone (760) 347-1607 • Fax (760) 347-4227 V4I COURTESY VENDING SERVICE '01 Courtesy Vending Service to 13 44-917 Golf Center Parkway# 13 Indio,CA.92201 i i March 30, 2005 Dear Lawrence Wedekind Nice to talk to you today, time really flies by when you enjoy what you do. I would like to exercise my option and extent my contract for vending service at the Palm Springs Airport for an additional year. Sincerely, Richard L Phone (760) 347-1607 9 Fax (760) 347-4227 Courtesy Vending Service • Airport Vending Machines AGREEMENT #4513 M07085, 6-5-02 CITY OF PALM SPRINGS CONTRACT SERVICES AGREEMENT FOR COURTESY VENDING SERVICE THIS CONTRACT SERVI ES AGREEMENT (herein "Agreement') is made and entered into this 55� day of , zvz z , by and between the CITY OF PALM SPRINGS, a municipal c poration (herein "City") and Courtesy Vending Service (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 PAYMENT OF PERCENTAGE FEES 2.1 ContractSum. For the services rendered pursuant to this Agreement, City shall be entitled to compensation from each vending transaction in accordance with the"Schedule of Payment'attached hereto as Exhibit"13"and incorporated herein by this reference. 2.2 Method of Payment. Contractor shall be solely responsible for payment of percentage fee pervending transaction by the fifteenth (151h)day of each month of the term, including the fifteenth (15`h) of the month following termination of this Agreement. Contractor shall pay to City all fees do City under "Schedule of Payment' for the preceding month, which payment shall be accompanied by an itemized statement showing the number of customer transactions and revenue generated from each machine. 3.0 COORDINATION OF WORK 3.1 Representative of Contractor. Richard Lazalde 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. Allen F. Smoot, A.A.E., Executive Director - Airports 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 Contractorshall 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 forcontractual 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 endorsementform CG2010(1185)orequivalent 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 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 -2- 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 forwhich 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) Contractorwill promptly pay anyjudgment 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. 4.4 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 -3- 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 (10) days of receipt of notice from the City Manager. 5.0 TERM 5.1 Term. Unless earlier terminated in accordance with Section 5.2 below, this Agreement shall continue in full force beginning May 1, 2002 and ending June 30, 2005 with two (2) one year renewal options available for lease extension. 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 forall 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 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 oremployee 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 Department of Aviation, Attn: Executive Director - Airports, 3400 E Tahquitz Canyon Way, Suite OFC, Palm Springs, CA 92262, and in the case of the Contractor, to the person at the address designated on the execution page of this Agreement. -4- 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. -5- • • IN WITNESS WHEREOF, the parties have executed and entered into this Agreement as of the date first written above. ATT T: CITY OF PALM SPRINGS, a municipal corporation By City C erk By City Manage- // APPROVED AS TO FORM: �i� CONTRACTOR: ByIWAttorney Signature-(Notarized) Corporations require two notarized signatures:one from each /1�� a"'i ��C° �� !.'��— f1E'�"> ',: ��'.S �,r_,�^'•' of the following.A.Chairman of Board,President,or any Vice Print Name & Title �\ President; and B. Secretary,Assistant Secretary, Treasurer, Assistant Treasurer,or Chief Financial Officer By Signature (Notarized) Print Name & title Mailing Address: -6- EXHIBIT "A" SCOPE OF WORK Courtesy Vending Services presently has a seperate contract with Anton Airfood, Inc. to provide vending services in public areas of the Airport. For reference, these locations are shown in order to alleviate any confusion ofwhatvending machines belong underthe City's agreement(i.e."Airport Terminal") versus the agreement with Anton Airfood, Inc. Vending machines for the "Airport Terminal" include: 2 snack and 2 soda machines , 1 coffee machine and 1 pool table. Contractor agrees to install at specific locations approved by the City and service on a weekly basis the following Food & Beverage machines and Pool Table: CITY OF PALM SPRINGS, DEPARTMENT OF AVIATION VENDING MACHINES AND PERCENTAGES (i.e. "AIRPORT TERMINAL") City Employee Lounge: 1 Snack machine 5% to City of Palm Springs 1 Soda machine 5% to City of Palm Springs GTC - Ground Transportation Center 1 Snack machine 10% to City of Palm Springs 1 Soda machine 12% to City of Palm Springs 1 Coffee machine 10% to City of Palm Springs 1 Pool Table 30% to City of Palm Springs ANTON AIRFOOD, INC. VENDING MACHINE LOCATIONS AND PERCENTAGES Airport Terminal (located by Security Checkpoint) 1 Snack machine 26% to Anton 1 Soda machine 40% to Anton Airport Terminal Gate 2: 1 Snack machine 26% to Anton 1 Soda machine 40% to Anton Airport Terminal Gate 3: 1 Soda machine 40% to Anton Airport Terminal Gate 19: 1 Snack machine 26% to Anton 1 Soda machine 40% to Anton The number and type of machines, percentage amounts or cost per item shall not be changed unless Contractor receives prior written approval from the Executive Director- Airports. -7- EXHIBIT "B" Schedule of Payment As previously listed in Section 2.2 Method of Payment. Contractor shall be solely responsible for payment of percentage fee per vending transaction by the fifteenth (151h) day of each month of the term, including the fifteenth (151h)of the month following termination of this Agreement. Contractor shall pay to City all fees do City under"Schedule of Payment"for the preceding month, which payment shall be accompanied by an itemized statement showing the number of customer transactions and revenue generated from each machine. Vending machines specified as "Airport Terminal' ( 2 snack and 2 soda machines , 1 coffee machine and 1 pool table as also shown in Exhibit A) Snack machines located in the Ground Transportation Center: 10% percentage fee to City Soda machines located in Ground Transportation Center: 12% percentage fee to City Coffee machine located in the Ground Transportation Center: 10% percentage fee to City Pool table located in the Ground Transportation Center: 30% percentage fee to City Snack machine located in the City Employee Lounge: 5% percentage fee to City Soda machine located in the City Employee Lounge: 5% percentage fee to City The number and type of machines, percentage amounts or cost per item shall not be changed unless Contractor receives prior written approval from the Executive Director- Airports. -8- CALIFORNIA ALL-PURPO CKNOWLEDGMENT s �,c(`,c�lzc=l`,c:C`.c�`,c-:!>c.�`,cro;'Y� I� 5 Cll CC State of 1,�v 0 n County of On 14Cku9Dit before me, BNq C V ill? ice �J1 LIP, Date n Name and Title g,"J{ne Doe,Notary Poblier personally appeared K%C ]r,12J tco—, r,4 AC --— ------- $ Name(s)of cigner(s) I ❑personally known to me-OR-Xproved to me on the basis of satisfactory evidence to be the person(s)• whose name(s) is/are-subscribed to the within instrument and acknowledged to me that he/sbeFtIctey-executed the same in his/ha4heir authorized capacity(ies);and that by his/ber ltreir signature(s) on the instrument the person(s), MAURA RODRIGUEZ or the entity upon behalf of which the person(4acted, Commission 0 12506F. executed the instrument. ti Notary Public-Colifomia a Riverside County WITNESS hand and official seal. My Comm,Wires Jon 21,200z, 4 ( h elute of Notary Pvbl;c OPTIONAL Though the information below is not required by law, it may prove valuable to persons relying on the document and could prevent fraudulent removal and reattachment of this form to another document. Description of Attached Document Title or Type of Document: (,_�Ara"A_ C,,li .0 i cr- Coop j( 12AJ nr ,01 Document Date: �1Qzt C>4 �D6�, Number of Pages: �-S t, � 7 1' Signer(s) Other Than Named Above: - — -' '--- --- Capacity(ies) Claimed by Signer&) I i Signer's Name: PldcC,-j drk2o,J�V- Signer's Name: [Plndividual ❑ Individual ❑ Corporate ificer [ICorporate Officer ) Title(s): /2�fK) 0 r Title(s): ❑ Partner—❑ Limited ❑ General ❑ Partner—❑ Limited General ❑ Attorney-in-Fact ❑ Attorney-in-Fact ❑ Trustee ❑ Trustee ❑ Guardian or Conservator ❑ Guardian or Conservator ❑ Other: Top of thumb here ❑ Other: / Top of thumb here h � � Signer Is Representing: _- Signer Is epresenting: t � 0 1995 National Notary Association•8236 Remmet Ave,PO Box 7184•Canoga Park,CA 91309-7184 Prod No 5907 Reorder:Call Tall-Free 1-800-876-6827 Jun 17 20 10: 20a Phil Cothran State Farm 9098298070 P. 2 This certifies thatUfo SIPSWFR N i rtearm waV ................................®...STATE•FARM•GEINAL IN5URAN Y•;Bloomington;•844nois...............--.............._............... ❑ STATE FARM FIRE AND CASUALTY COMPANY, Scarborough, Ontario ❑ STATE FARM FLORIDA INSURANCE COMPANY,Winter Haven, Florida ❑ STATE FARM LLOYDS, Dallas, Texas insures the following policyholder for the coverages Indicated below: Name of policyholder LAZALDE, RICHARD D., PDA COURTESY VENDING SERVICE Address of policyholder 44917 GOLF CENTER PRWY, STE 13 Location of operations SAME Description of operations VENDING MACHINE SERVICE The policies listed below have been issued to the policyholder for the policy periods shown. The insurance described in these policies is subject to all the terms exclusions, and conditions of those policies. The limits of liability shown may have been reduced by any paid claims. POLICY PERIOD LOFFS OF LUWILffY POLICY NUMBER TYPE OF INSURANCE Efilec*w Date „ 6Vrian DoW (at beat w&R of ply f�) Comprebe isive - BODILY INJURY AND 92-WL-2742-7 G Business Liabffty 04 15_02 04-Il5_03 PROPERTY DAMAGE — - This inSUwance indudes: ❑F'roduds-Completed Operations ®Contractual Liability ❑Underground hazard Coverage Each Occurrence ❑Personal Injury ❑Advertising Injury General Aggregate S 2.000,G00O 00 ❑Expkmon Hazard Coverage ❑Collapse Hazard Coverage Products—Completed $ ❑ Operations Aggregate POLICY PERIOD BODILY INJURY AND PROPERTY DAMAGE EXCESS LIABILITY Effective Date ; EviinfatrDaft (Combined Single Limit) ❑UmbeOa Each Oaasrence S ❑Dow Aggregate S Part 1 STATUTORY Part 2 BODILY INJURY Workers'Compensation and Employers Liability Each Accident Y Disease Each Employee i Disease-Po&y Limit 5 POLICY PERIOD LJNM OF LIABII.fIlY POLICY NUMBER TYPE OF INSULUIMCE HfWive Dale eryirgianr Deb (at begininkm of pa"perkKQ THE CERTIFICATE OF INSURANCE IS NOT A CONTRACT OF INSURANCE AND NEITHER AFFIRMATIVELY NOR NEGATIVELY AMENDS,EXTENDS OR ALTERS THE COVERAGE APPROVED BY ANY POLICY DESCRIBED HEREIN. If any of the described policies are canceled before its expiration date, State Farm will try to mail a written notice to the certificate holder 3 o days before Name and Address of Certificate Holder cancellation. If however, we fail to mail such notice, no obligation or liability will be imposed on State CITY OF PALM SPRINGS, DEPT OF AVIATION Farm or its agents or representatives. PALM SPRINGS INTERNATIONAL AIRPORT ,n /� � 340D E. TARQUITZ CANYON WAY, SUITE OFC r lgh). I �'Bvl�d.ILnlFol��-' PALM SPRINGS, CA 92262 Sgn lure of Aulho a epr ntalive STATE FARM AGENT 06-12-02 Title hdilip-Aganills Code Stan Date 8253 Siena Ave, AFO Cade P421 (Across from Pum Office) 558-994 a.3 04-1999 Pdntad In U.S.A. Fonrena, CAC 9035 (909)822-3545 6-20-202 8:33AM FROM COURTESY VENDING SRV 760 347 4227 P- 1 Cr COVRTESY VENDING SERVICE 83-616 Avenue 45, Suite 13 Indio, CA 92201 .Tune 20, 2002 Janet Buck Dear Janet, Courtesy Vending Service is a sole proprietor business owned by Richard Lazalde and operated with the help of my sons and grandsons.I have checked with nay insurance company regarding workers comp.And have been advised that because we are a family run business we are not required to have workers Comp. Hope this clears this up .If I can be of further help,please call Sincerely, Richard Lazalde i Phone (760) 347-1607 • Fax (760) 347-4227 Jun 21 20 10: 25a Ph' Cothran State Farm 9096298070 P. 2 CERTIFICATE OF INSURANCLO SUCH INSURANCE AS RESPECTS THE INTEREST OF THE CERTIFICATE HOLDER WILL NOT BE CANCELED OR OTHERWISE TERMINATED WITHOUT GIVING 10 DAYS PRIOR WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED BELOW, BUT IN NO EVENT SHALL THIS CERTIFICATE BE VALID MORE THAN 30 DAYS FROM THE DATE WRITTEN. THIS CERTIFICATE OF INSURANCE DOES NOT CHANGE THE COVERAGE PROVIDED BY ANY POLICY DESCRIBED BELOW. This Certifies that: [,NJ STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY of Bloomington, Illinois, or STATE FARM FIRE AND CASUALTY COMPANY of Bloomington, Illinois has coverage in force for the following Named Insured as shown below: Namedlnsured LAZALDR, RTruARn, TnaA (-.nTYRTE91-10ENDyrgr. Address of Named Insured 44917 Golf center Ru .y Ste , 3 - Indio , CA g22DI -73f)t POLICY NUMBER R40 0829-C20-75 R400864-EO6-75E R40 1061-EO6-75D EFFECTIVE DATE OF POLICY DESCRIPTION OF VEHICLE 98 Chev C2500PU 92 Nissan UD Trk 90 Dodge DakotaP LIABIITY COVERAGE ® YES Q NO ® YES 0 NO YES 0 NO 0 YES 0 NO UM[rS OF LIABILITY a. Bodily Injury Each Person Each Accident b. Property Damage Each Accident C. Badly 11-y R Ropeny 0-0- ----.-----_—_-- Damage Sin-*Unit Each Accident PHYSICAL DAMAGE ® YES NO YES NO YES ONO � YES F NO COVERAGES a. Comprehensive $ Deductible $ Deductible $ Deductible $ Deductible YES NO Z]YES ONO El YES 0 NO 0 YES [::] NO b. CUllis''on $ 500 Deductible $ 500 Deductible 5 � EMPLOYER'S $--9_ Deductible $ Deductible NON-OWNERSHIP Q YES ® NO 0 YES p NO Q YES Q NO 0 YES 0 NO HIRED CAR COVERAGE Q YES ® NO Q YES ® NO Lj E::] YES Q ND Agent 8820/F421 06/20/02 Signature of Authorized Representative Title Agent's Code Number Date Name and Address of Certificate Holder Name and Address of Agent CITY OF PAL SPRINGS, DEPT. OF AVIATION, PALM SPRINGS INTERNATIONAL STATE P W. INSUCOTHRANCE AGENT AIRPORT 8253 STATE FARM INSURANCE 3400 E. Tahquitz Canyon Way, Suite OFC Sierra Avenue, Ste 101 Font Palm Springs , CA 92262 Fontana, CA 92335 L J L J