HomeMy WebLinkAbout04488 - NICKERSON & ASSOCIATES 2002-03 DBE PROGRAM DISADVANTAGED BUSINESS DBE Nickerson & Associates
DBE Program 2002-03
AGREEMENT #4488
CITY OF PALM SPRINGS CM signed 5-3-02
CONTRACT SERVICES AGREEMENT FOR
PREPARATION OF THE CITY OF PALM SPRINGS
FEDERAL FISCAL YEAR 2002/2003
DISADVANTAGED BUSINESS ENTERPRISE (DBE) PROGRAM
THIS CONTRACT SERVICES AGREEMENT (herein "Agreement') is made and
entered into this.BOrl day of ° ^.e.. P by and between the CITY OF
PALM SPRINGS, a municipal corporatiol (herein "City") and Nickerson & Associates,
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 Dollars ($5,000.00) ("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 in Exhibit "B" Schedule
of Compensation.
3.0 COORDINATION OF WORK
3.1 Representative of Contractor. Lloyd "Nick" Nickerson,Jr. 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.
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3.2 Contract Officer. Marcus Fuller 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 costand
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
accordancewith standard ISO additional insured endorsementform CG2010(1185)
or equivalent language.
(b) Worker's Compensation Insurance. A policy of worker's
compensation insurance in an amount which fully complies with the statutory
requirements of the State of California and which includes $1,000,000 employer's
liability.
(c) Business Automobile Insurance. A policy of business
automobile liability insurance written on a per occurrence basis with a single limit
liability in the amount of$1,000,000 bodily injury and property damage. Said policy
shall include coverage for owned, non-owned, leased and hired cars.
(d) Additional Insurance. Additional limits and coverages, which may
include professional liability insurance, will be specified in Exhibit B.
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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 Agreementthe 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 orwillful 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 againstthe
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.
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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 (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 until December 31, 2002.
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
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0
Contractor or to its successor, or for breach of any obligation of the terms of this
Agreement.
6.3 Conflict of Interest. No officer or employee of the City shall have any
financial interest, direct or indirect, in this Agreement nor shall any such officer or employee
participate in any decision relating to the Agreement which effects his financial interest or
the financial interest of any corporation, partnership or association in which he is, directly
or indirectly interested, in violation of any State statute or regulation. The Contractor
warrants that it has not paid or given and will not pay or give any third party any money or
other consideration for obtaining this Agreement.
6.4 Notice. Any notice, demand, request, document, consent, approval,
or communication either party desires or is required to give to the other party or any other
person shall be in writing and either served personally or sent by prepaid, first-class mail,
in the case of the City, to the City Manager and to the attention of the Contract Officer,
CITY OF PALM SPRINGS, P.O. Box 2743, Palm Springs, California 92263, and in the
case of the Contractor, to the person at the address designated on the execution page of
this Agreement.
6.5 Interpretation. The terms of this Agreement shall be construed in
accordance with the meaning of the language used and shall not be construed for or
against either party by reason of the authorship of this Agreement or any other rule of
construction which might otherwise apply.
6.6 Integration: Amendment. It is understood that there are no oral
agreements between the parties hereto affecting this Agreement and this Agreement
supersedes and cancels any and all previous negotiations, arrangements, agreements and
understandings, if any, between the parties, and none shall be used to interpret this
Agreement. This Agreement may be amended at any time by the mutual consent of the
parties by an instrument in writing.
6.7 Severability. In the event that part of this Agreement shall be declared
invalid or unenforceable by a valid judgment or decree of a court of competent jurisdiction,
such invalidity or unenforceability shall not affect any of the remaining portions of this
Agreement which are hereby declared as severable and shall be interpreted to carry out
the intent of the parties hereunder unless the invalid provision is so material that its
invalidity deprives either party of the basic benefit of their bargain or renders this
Agreement meaningless.
6.8 Waiver. No delay or omission in the exercise of any right or remedy
by a nondefaulting party on any default shall impair such right or remedy or be construed
as a waiver. A party's consent to or approval of any act by the other party requiring the
party's consent or approval shall not be deemed to waive or render unnecessary the other
party's consent to or approval of any subsequent act. Any waiver by either party of any
default must be in writing and shall not be a waiver of any other default concerning the
same or any other provision of this Agreement.
6.9 Attorneys' Fees. If either party to this Agreement is required to initiate
or defend or made a party to any action or proceeding in any way connected with this
Agreement, the prevailing party in such action or proceeding, in addition to any other relief
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i
which maybe granted,whether legal or equitable, shall be entitled to reasonable attorney's
fees, whether or not the matter proceeds to judgment.
6.10 Corporate Authority. The persons executing this Agreement on behalf
of the parties hereto warrant that (i) such party is duly organized and existing, (ii) they are
duly authorized to execute and deliver this Agreement on behalf of said party, (iii) by so
executing this Agreement, such party is formally bound to the provisions of this Agreement,
and (iv) the entering into this Agreement does not violate any provision of any other
Agreement to which said party is bound.
IN WITNESS WHEREOF, the parties have executed and entered into this
Agreement as of the date first written above.
ATTEST: CITY OF PALM SPRINGS,
a municipal corporation
City Cler y: .�
City Manage
CONTRACTOR:
Corporations require two notarized signatures:one from each
of the following:A.Chairman of Board,President,or any Vice
President; and B. Secretary, Assistant Secretary, Treasurer,
Assistant Treasurer,or Chief Financial Officer
LXL'� 6 �
�Igna//ture d(Notarized)—� Print Name & Title '
By: "I�,,� a- ���c1�.r� c�
Agreement ove - bnde $25,000
Signature (Notarized)
Cz (=C) Reviewed and approved by
Print Name & Title Procurement& Contracting
r
Mailing Address: Initials Date Wta,, Z
P.O.Number
68955 Adelina Road
Cathedral City, CA 92234
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ALL-PURPOSE ACKNOWLEDGMENT
State of California CAPACITY CLAIMED BY SIGNER
County of Riverside ❑ INDIVIDUAL(S)
❑ CORPORATE
On April 24, 2002 before me, Elaine L. Wedekind, Notary Public OFFICER(S)
Date Name, Title of Officer TITLE(S)
personally appeared Lloyd & Lisa A. Nickerson, Jr. ------------ ❑ PARTNER(S)
NAME(S) OF SIGNER(S) ❑ ATTORNEY-IN-FACT
❑ TRUSTEE(S)
i`dpersonally known to me-UW- ❑ SUBSCRIBING WITNESS
❑ GUARDIAN/CONSERVATOR
❑ proved to me on the basis of satisfactory evidence to be the persons whose name(s) ❑ OTHER
Xic/are subscribed to the within instrument and acknowledged to me that haWffi/they executed
the same in bis/$IrnMeir authorized capacity(ies), and that by kb dhxktheir signature(s) on
the instrument the person(s)or the entity upon behalf of which the persons(s)acted,executed
the instrument. SIGNER IS REPRESENTING:
Witness my hand and official seal �ar'>;�u FLAME L.INFDEMND
{ ,r' (? ° COMM.a 1206984
"NOTARY PUBLIC-CALIFORNII
RIVERSIDE COUNTY 0
4<ran, COMM.EXP.FEB.3,2003
Signature of Notary r���ti-�-�>��vo.PPo..!<
ATTENTION NOTARY: Although the information requested below is OPTIONAL, it could prevent fraudulent attachment of this
certificate to unauthorized document.
THIS CERTIFICATE Title or Type of Document
MUST BE ATTACHED
TO THE DOCUMENT Number of Pages DATE of DOCUMENT
DESCRIBED AT RIGHT:
Signer(s) Other Than Named Above
EXHIBIT "A"
SCOPE OF WORK
Task 1 - Research and Investigation
Contractor shall meet with City staff to identify City of Palm Springs projected Federal Highway
Administration (FHWA) funded projects, contracts and expenditures. Contractor shall use the
information provided by the City in its Request for Proposals dated April 15, 2002, and shall obtain
a copy of the City's 2001/2002 Disadvantaged Business Enterprise (DBE) Program and support
information as required from City staff.
Task 2 - Development of Methodology
A. Contractor shall summarize the information gathered in Task 1 by category of work,
standard industry classification, estimated Federal dollar value, and percent of Federal
funding.
B. Contractor shall perform calculations based upon the Caltrans DBE directory of certified
firms (filtered to represent DBE's within the Riverside/San Bernardino Counties) and the
Census Bureau's Business Pattern Data Base (CBP's) for the same areas.
C. Contractorshall use the results(base figure)established in Task 2B to establish a breakout
of estimated race-neutral and race-conscious participation goals.
Task 3 - Preparation of DBE Program
Contractorshall use the information from Task 2 to complete the DBE Model Program provided by
Caltrans, and shall prepare the required transmittal/reporting letter outlining the City's projects,
funding, methodology, and goals for Federal Fiscal Year 2002/2003.
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October 30, 2001
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EXHIBIT "B"
SCHEDULE OF COMPENSATION
Lump Sum Fee not to exceed $5,000.00 payable upon completion of the work outlined as Tasks
1, 2, and 3 in Exhibit "A", Scope of Work.
Section 4.1shall be revised as follows:
The insurer shall not be required to waive all rights of subrogation and contribution it may have
against the City, its officers, employees and agents, and their respective insurers.
The requirement for a performance bond in Section 4.3 is hereby waived.
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M E M O R A N D U M
DATE: May 20, 2002
TO: Procurement - Bruce Johnson
FROM: Office of the City Clerk
RE: Nickerson & Associates, Inc., A4488:
CC: File
Attached please find three copies of the above-mentioned agreement,
between Nickerson & Associates, Inc. and the City of Palm Springs, for
Preparation of DBE Program Federal Fiscal Year 2002-03, approved by the
City Manager, on May 3, 2002. Please make the necessary distribution.
have retained an original agreement, including the insurance certificates for
our records.
If you
have any questions, please let me know.
Barb
Apr-30-02 07 : 38A P - Ol
Ask Ah
ACORD CER_TIFIC OF LIABILITY INS 'INCH OPID PS DATE(MMIDDNY)
_-, ICKE 1 04/25/02
PRODUCER THIS CERTIFICATE IS ISSu_J AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Desert Southwest Ins Br'oker5 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
74-785 Highway Ill Suite 209 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Indian Wells CA 92210
Phone: 760-773-5955 Fax:760-776-4205 INSURERS AFFORDING COVERAGE
INSURED ------- INSURER A: Northern Ina. Co. of New York
INSURERS. Gul£ Insurance COIf,�9�- -
Nickeraon 4 AsAoRRiates, Inc. INSUHER C, American Sta_te_s Ins. Co.
68-955 Adel1na, 5200 INSURER D.
Cathedral City CA 92234 IN --- -------- -
INSURER F.'
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 CONE)ITION 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 "' ------"'-' POC 'UL'Y EXPIRATIDNI --- ---
LTR TYPE OF INSURANCE POLICY NUMBER DATE MMIDDIYY DATE MMIOWY, LIMITS
GENERALLIAWLITY EACH OGCHRRFNCE t2 ,000,000
A X COMMERCIAL GENERAL LIABILITY PAS 39757423 02/28/02 , 02/26/03 FIRE DAMAGE(Any unc ine) $2,000_000
ICLAIMS MADE 4]GGCUH MED EXP(Any nve pmxnnJ 5 10,000
X ADD'L INSURED PERSONAL&ADV INJURY $ 2,000,000
X EXCL, PROF. TAB. GENERAL AGGREGATE y 4,000,000
GENL ACOREGATE LIMIT APPLIES PER', PRODUCTS COMP/OP AGG 94,000,000
X POLICY PFCOI IOC
AUTOMOBILE LIABILITY COMNINELI SINGLE LIMIT
C XI ANY AUTO 01—CE-953237-2 11/20/01 11/20/02 IEa+caarnn
All OWNED AUTOS ♦)DOILY INJURY
SCHEDULED AUTOS [Fey Peron) S
X I TIRED AUTOS ROM Y IN.IUHy
X NON-OWNED AUTOS (vm nrn,lellp S
L --
-._ PROPERTY DAMAGEti
S
(Pn uccidentl
GARAGE,LIA91LITY --. AUTOONLY FA ACCIDENT T
ANY AUTO 1�? OTHEN THAN EA ACC 5
Al.)IT)ONLY AGG y
EXCESS LIABILITY EACI I OCCURRENCE S
�� OCCUR CLAIMS MADE AGGRFCiAIF 5 -
S
DEDUCTIRI F S
RETENTION 5 T S
WORKERS COMPENSATION AND I TORY LAIMITc —v CR
1 EMPLOYERS'LIABILITY GRDYRCD FRON STATE ]RRID E L EACH ACCIDENT S
E L.DISEASE EA EMPLOYE 9
CL,DISGSE POLICILIMIT _ — -----
OTHER
8 PROFESSIONAL GAE062 963 11/01/01 11/01/021 EachClaim $1,000,000.
LIABILITY p'g.9?'e ate $1,000,tl00.
DESCRIPTION OF OPERATIONSA.00A11oNSNFHICLES/E%CLUSION5 ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
*10 DAY NOTICE OF CANCELLATION APPLIES FOR NON-PAYMENT OF PREMIUM
CERTIFICATE HOLDER Y I ADDITIONAL INSURDOi INSURER LETTER: A CANCELLATION
PSCITYO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF,THE ISSUING INSUR ILL ENOEAVORTOMAIL 90A DAYS WRITTEN
NOTICE TO THE CERTIPICATE HC ER MED TO THE LEFT,BUT FAI LIRE TO DO SO SHALL
CITY OF PALM SPRINGS IMPOSE NO OBLIGATION OR LI ILITV F ANY KI UPON THE 1 REP,ITS AGENTS OR
3200 E. TARQUITZ CANYON WAY REPRESENTATIVES.,
PALM SPRINGS CA 92292 AUTHORI=REP RESENT
Penn J. Sa
ACORD 25-3(T/97( COAPORDC r1PORATjON TSRB
Apr-30-02 07t39A
P _ 02
CUSTOMER NAMF. ' NICKERS099 ASSOCIATES, INC, IaOLIoNUMBER: PAS39757423
EFFECTIVE DATE 04-25-02
WHO IS ,AN INSURED
Name Of Persan or Organization: CitY Of Palm Springs
1. if you preldesignated in the Declanfions as:
a, An indibidual, you and your spouse are insureds,but only with respect to the conduct of a businesa of"ich you are the sole owner.
In, A partnership or-joint venture,you are an insurcei Your members,your partners,and their spouses arc also Insureds,hot only with
respect to the conduct of your business.
c. A limited liability company,you ore an insured. Your members are also insureds,but only with respect to the conduct oryour husrness
Your managers we insures, but Only with respect to their duties as your managers.
d An organ=lon other than a partnership,joint verini a or limiaed liability company,you are art insured, Your esecodve ofticerc and
direcmrs we insumdie,but only with respect to their dulias as your nfAeers or i ireetnr&. Your stockholders are also Insureds,but Only
with respect to their liability an stockholders- Your subsidlorlts,and subsidiaries of your aubsidtnrirs,are insureds if.
(I) They tin legally incorporated entities;and
(2) You own more than 50%of the voting crock in them as of the a rectiva date of this policy,
If such subsidiaries we nor shown in the Declarations,you must repon them mug within 180 days Of the inception of this policy.
2. Psch of the ronowtng is also an insured:
a- Your emptoyeoa,other than eitho your Cxetutive officers(if you are an organimtion Other than a parmership,juint venture or
limlttel liability company) or your managers(if you are a limited Ifahfliry aempany),but only for ins within ibe,scope of ther employment
by you or while performing duties related to the Conduct Of yoev brrsinems. 11owevrs,no tnnployee is as insured for:
(7) "Bodily injury"or"personal Injury":
(a) To you, to your partners or members(if you am a partnership ar joint vsriture),to your members(if you err a limited liability
company),or to a co-"employee"while in the course of his Or her emplOY"Wt orwhlle performing duties related to the conduct of
your business;
(b) To the spouse.child,parent,brother or sister of the:eo-"employoo"as acOnsoquartce ofparagrapli (1)(a)above.
(e) For which there IF any obligation to share damages with or repay someone rise who must pay damages brsause of the injury
described in paragraphs(I xa)or(b)above;or
(d) Arising out of hit or her providing or failing to provide proftulOnal health care services.
(2) "property,Damage"to property:
(a) Owned,occupied or used by,
(b) Reined to,in the cure, custody or control of,or over which physical central Is being exercised for any purpose by you,any of your
"err+pJoytxs"Or by may pvmer Or member(if you art a partnership or joint venture),or any member(if you arc a limited liability
company).
b. Any person(other than your"employee"),a any organir�tiuu while acting as your real estate mwtoger.
c. Any person or OfMir200n having proper temporary custody of your property if you die,but only;
(1) With respect W liability arising out of the maintenance or use of that property,and
(2) Unril your legal represcntntive has been appointed.
d. Your legal represnntativc If you die,hue only wirh respect to dudes as such. That rcpremixelvo will have all your rights and duties under
this Coverage Pan,
C. Any person or orgtuiizittlon with whom you agree,because of written eontna,to provide insurance such as is afforded under lithe policy,
but only with respect to liability arising out of your Operations,"your work'or facilities owned or used by you.
This provision don nor apply;
(1) To any vendor,concess miatre, lessor of leased egltipenent,grantor of is franchise.eirgincer,arctlieet Or surveyor;or
(2) Unlrss the eonmut has beer signed prior to the date of"bodily injury',"properrydnmage",personal injury^or"adverrtsing
injury".
r. Any person or organization to whom you are Obligated by virtue of wrine0"insured contrast"to provide inaunmce such its is afforded by
this policy,but Only with respect in liability arising Out of the ownership,mainsemunte,or use of that part of any premises leased to you,
This does not applyro:
(1) Any"Occurrence"that takes place after you cease to be a tenant on these premicea.
(2) Structural alterarianm,new ronstmation or dianolirion operations performed by or on behalf of such insured.
g. Any slue or political subdivision, but only as respects legaf hahifity incurred by the state or polit)eal subdivision solely Ixeause n has
issued i permit In connection will premises you won,rent or control for one of the hiiaards listed below:
(1) The existence,maintenance,repair,canabuction,etecrion,or removed of advertising signs,awnings,eanopirs,cellar entrances,
coal holes,driveways,manholes,marquees,hoiFtaway aponings,sidewalk voulln.street banners or decorwinng and similar expogures;
(2) The construction,crcclion or removal of elevators;or
(3) 'Tie ownershlp,maintcnant or use Of any elevators covered by this insuriacc.
S2001 Includes copyrighted mnteriol of insurance Services Office,lna,with ise permltsion. Cipyright 1995
insurance Services OfTice,Inc. Copyright, 199a,Maryland Casualty Company,as to additional lest and revisions
STATE P.O:BOX 420807, SAN FRANCISCO, CA 941d220807
COMPENSATION -
1NSU RAN GE
FUND CERTIFICATE OF WORKERS'tCOMPENSATION INSURANCE
POLICY NUMBER.
CERTIFICATE EXPIRES: _';.11.1 02
7
�If-E J .
EI ,r Itl 1.+`' f�le:'f _
This Is to certify that we have issued a valid Workers' Compensation Insurance policy In a form approved by the California
Insurance Commissioner to the employer named below for the policy period Indicated.
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This policy Is not subject to cancellation by the Fund except upon,.ten days'advance written notice to the employer.
We will also give yoLMN.days'advance notice should this policy be cancelled prior to its normal expiration.
This certificate of:insurance is not an irisuranoe policy and does not amend, extend'or;alter the coverage afforded by the
policies listed herein. Notwithstanding any requirement. term, or condition of any contract or other document with
respect to.:which [his certificate of Insurance may be Issued or may pertain,.the Insurance afforded by,the policies
described foram is subject to all the terms,'exclusions and donditlons of such polices. _
AUTHORIZED REPR ES EN7ATIVL [ - - PRESIDENT
IHf.F'L f _hiF f �f 4.0.,
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4!<'.:it =Li f; I ,- F , 03`.t c`Y=^iv?TL T IEIFt � is{L ' RN : - POLICYJL "
-
EMPLOYER
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