HomeMy WebLinkAboutContracts & Agreements_105-99_CCv0001.pdf AGREEMENT
THIS AGREEMENT, made and entered into this 19th day of October, 1999, by and between the City
of Redlands, a Municipal Corporation, organized and existing under the laws of the State of California,
hereinafter referred to as the "City", and Holland-Lowe Construction, Inc. of the City of San Bernardino,
County of San Bernardino, State of California, hereinafter referred to as the "Contractor".
WITNESSETH: That the City and the Contractor, for the consideration hereinafter named, agree as follows:
1. SCOPE OF WORK: The Contractor will furnish all materials and will perform all of the work for the
following:
To perform construction of the the Herald Street Rehabilitation project, complete as shown, specified and
made a part of Contract No. 86-1917-4230.
2. THE CONTRACT SUM OF: $159,268.00
3. TIME FOR COMPLETION: The work shall be completed within forty-five(45)work days from and
after the date of the Notice to Proceed.
4. CONTRACT DOCUMENTS: The complete Contract includes all of the contract documents set forth
herein, to wit; Notice Inviting Bids, Instructions to Bidders, Proposal and Bid Forms, Bid Bond,
Agreement, Performance Bond, Payment Bond, Plans and Specifications,all referenced specifications,and
any Addenda thereto.
5. ATTORNEY FEES: In the event any legal action is commenced to enforce or interpret the terms or
conditions of this Contract the prevailing party shall, in addition to any costs and other relief, be entitled
to recovery of its reasonable attorney's fees.
6. DEFENSE OBLIGATION: The Contractor shall defend the City,its elected officials,officers, agents,
and employees from and against any and all claims,losses,damages, and causes of action,including death,
brought by any person or persons for or on account of any wrongful or negligent act or omission of the
Contractor,its employees or agents in connection with the performance of the Contractor's obligation under
this Contract.
7. INSURANCE: All policies of insurance required by this Contract shall name the City, its elected
officials, employees, and agents as additional insured, and such insurance shall be primary with respect
to such additional insured and non-contributing to any insurance or self-insurance maintained by the
additional insured.
IN WITNESS WHEREOF, the parties hereto have executed this Agreement in triplicate on the day
and year first written above.
CITY'S SEAL
By:
Mayor, CIty of REDL S
County of San Bernardino, Califo
L,
ATTEST:
Cit Jerk,Cit f EDLANDS
County of San Beriardino, California
Holland-Lowe Construction, Inc.
Name of Contra
l
1
CONTRACTOR'S SEAL By: `
Signature o u iz Agent
Signatory's Title
Signature of Authorized Agent (if necessary)
Signatory's Title (if necessary)
7090151 A, B and C-27
Contractor's License No.
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT
State of California
t
Ca of ' w } S <t
on before me,
Darc Nae and T'ak of'Offi=(e.g,'Jaw Doe-NotaY "}
personally appeared LTJ N
�(s)of s *>
Kye
rso
Wally known to me
proved to me on the basis of satisfactory
evidence
to be the person(4 whose name�o is/aP6 subscribed to the
within instrument and acknowledged to me that helswbK
executed the same in hislbeflthefr authorized
capacity(ied), and that by his/Jar/then' signatur*)on the
instrument the person(o, or the entity upon behalf of which
the person(4acted,executed the instrument.
S my d and;offici se
i
Ptsce Nota,scat Abocc
" N �Puttr
OPTIONAL
Though the m formation 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:
Document Date: Number of Pages:
Signer(s)Other Than Named Above:
Capacity(ies)Claimed by Signer
Signer's Name:
[]Individual
[]Corporate Officer-Title(s): Top of bem
Q Partner- []Limited 0 General
[] Attorney in Fact
[]Trustee
[]
Guardian or Conservator
[] Other:
Signer Is Representing:
WORKERS' COMPENSATION INSURANCE STATEMENT
1, the undersigned and authorized agent for the Contractor, am aware of the provisions of Section 3700
of the Labor Code which requires every employer to be insured against liability for workers'
compensation or to undertake self-insurance in accordance with the provisions of that code, and I will
comply with such provisions before commencing the performance of the work under the City's Contract
No. 86-19111-4230.
Holland-Lowe Construction, Inc.
Name of Contr or
By:
'Oriz�d Agent
Signature of
Signatory's Title
709051 A, B and C-27
Contractor's License No.
Executed in Triplicate Bond No. B99-115328
Premium: $2,093.00
PERFORMANCE BOND
WIEREAS, the City Council of the City of Redlands, State of California(hereinafter designated as "City"),axed
Holland-Lowe Construction, Inc. (hereinafter designated as "Principal")have entered into an agreement whereby
Principal agrees to install and complete certain designated public improvements, which by said agreement dated
October 19, 1999, and identified as Contract No. 86-1917-4230, is hereby referred to and made a part hereof; and
WHEREAS, under the terms of said agreement, Principal is required before entering upon the performance of
the work, to furnish a good and sufficient faithful performance bond with the City.
NOW, THEREFORE, said Principal and the undersigned as corporate surety, are held and firmly bound unto
the City in the sum of One Hundred Fif ty Nine Thousand Two Hundred Sixty Eight dollars
($ 15 9,268.00}_ ) for the payment of which sum well and truly to be made, we bind ourselves, our heirs,
successors, executors and administrators,jointly and severally, firmly by these presents.
The condition of this obligation is such that if the above bounded Principal, his or her heirs, executors,
administrators,successors or assigns, shall in all things stand to and abide by, and well and truly keep and perform
the covenants,conditions,and provisions in the said agreement and any alteration thereof made as therein provided,
or his or her pan, to be kept and performed at the time and in the manner therein specified, and in all respects
according to their true intent and meaning, and shall defend, indemnify and save harmless the City, its elected
officials, officers, agents, and employees, as therein stipulated, then this obligation shall become null and void;
otherwise it shall be and remain in full force and effect.
As a part of The obligation secured hereby and in addition the face amount specified therefor,there shall be included
costs and reasonable expenses and fees, including attorney's fees incurred by the City in successfully enforcing such
obligation, all to be taxed as costs and included in any judgement rendered.
The surety hereby stipulates and agrees that no change, extension of time, alteration or addition to the terms of the
agreement or to the work to be performed thereunder or the specifications accompanying the same shall in anywise
affect its obligations on this bond, and it does hereby waive notice of any such change, extension of time, alteration
or addition to the terms of the agreement or to the work or to the specifications.
IN WITNESS WHEREOF, this instrument has been duly executed by the Principal and surety named, on
October 22 - , 1999.
HOLLAND-LOWE CONS_TJRUCTION, INC.,' ULICO CASUALTY COMPANY
,SEAL) (SEAL)
Principal Surety
By: BV.
Signature 5isr,actarrc ames W. Moilanen, Attorney-in-Fact
Address: 14726 Ramona Ave.
Chino, CA 91710
1,NoUrW Arknowicdgrmuts of Contractor and Surety) Teiephone; (.209) 393-4712
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT
State of California
Count of
County } SS.
On before eDM ,
NMM aW Title off' (e,g.,'J,%w Ike,riotay j
personally appeared
N. x)of igm*s
personally known to me
proved to me on the basis of satisfactory
evidence
to be the persono whose name( isl
subscribed to the
within instrument and acknowledged to me that he/ 1t
-325
Cexecuted the same in hislbefl rr authorized
capacity(i s), and that by his/ tr signatur*)on the
instrument the person(,), or the entity upon behalf of which
e = _ the person( )acted, executed tl instrument.
I I SS hand andlo i
Dace No _e SM Above
Y
4\T
Though the information below is not required by law,it mqy prove valuable to persons relyoig on the document
and couldiereventJroudirletzf reinovaaand reattachment of this form to another dexwment
Description of Attached Document
Title or Type of Document:
Document Date: Number of Pages:
Signer(s)father Than Named Above:
C paeity(i )Claimed by Signer
Sign 's'Name: l III I q A
Individual P
[
Corporate Officer-Title(s : Top afft=L
Partner- [ Limited [)General
Attorney in fact
[ T 7Lv
Guardian or Co gator
Other
Signer Is Representing,
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT
State of California
County of Orange
On October 22, 1999 before me, Sheila K. McDonald, Notary Public
JATF ',AVE T_E Cr OVI'CEP-E G c.;ANC DOE NOTAR,J'�BL,C
personally appeared James W. Moilanen
%AME(Si OF S;G,EP,Si
personally known to me - OR - proved to me on the basis of satisfactory evidence
to be the person(s) whose name(s) is/are
subscribed to the within instrument and ac-
knowledged to me that he/she/they executed
the same in his/her/their authorized
S H F A K D 0D,N1 A,,L D capacity(ies), and that by his/her/their
Cq
C 0 kA i
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P,
j a I C A L 1F OR PA signature(s) on the instrument the person(s),
0 R A N G E 1 0'.J_i;11( or the entity upon behalf of which the
Y y '�ONIMISSION EXPIRESN1,Aft0H 1�" -2m) person(s) acted, executed the instrument.
WITNESS my hand and official seal,
SIGNATURE OF NOTARY
OPTIONAL
Though the data below is not required by law, it may prove valuable to persons relying on the document and could prevent
fraudulent reattachment of this form.
CAPACITY CLAIMED BY SIGNER DESCRIPTION OF ATTACHED DOCUMENT
7 INDIVIDUAL
CORPORATE OFFICER
TITLE OR TYPE OF DOCUMENT
TIT ESI
PARTNER(S) I____j LIMITED
GENERAL
ATTORNEY-IN-FACT NUMBER OF PAGES
TRUSTEE(S)
LGUARDIAN/CONSERVATOR
!_1 OTHER:
DATE OF DOCUMENT
SIGNER IS REPRESENTING:
NAME OF PERSOMS!094 ENTITY111ES)
SIGNER(S)OTHER THAN NAMED ABOVE
BD-1133 3194 C1993 NATIONAL NOTARY ASSOCIATION-8236 Rernmet Ave.,P.O Box 71EI4-Canoga Pa-k CA 9'.309-77+34
Executed in Triplicate Bond No. B99-115328
Premium Included in the
PA"MNT BOND Performance Bond
WHEREAS, the City COuIlcil Of the City Of Redlands. State of California(hereinafter designated as 'City"),and
Holland-Lowe Construction, Inc. (hereinafter designated as "Principal")have catered into an agreement whereby
Principal agrees to install and complete certain designated public improvements, which by said agreement dared
October 19, 1999,and identified as Contract No. 86-1917 4230, is hereby referred to and made a part hereof; and
WHIEREAS, under the terms of said agreement, Principal is required fore entering upon the performance of
Prin be erin erf rmance
the work, to furnish a good and sufficient labor and materials payment bond with the City to secure the claims to
which reference is made in Title 15 (commencing with Section 3082) of Part 4 of Division 3 of the Civil Code of
the State of California.
NOW, THEREFORE, said Principal and the undersigned as corporate surety, are held and firmly bound unto
the City and all contractors, subcontractors, laborers, materialmen, and any other persons employed in the
performance of the aforesaid agreement and referred to in the aforesaid Civil Code of the State of California in the
sum of One Hundred Fifty Nine ThousandTwoHundred Sixty Eight & no/100 dollars
($159,268.00 ) for materials furnished or labor thereon of any kind, or for amounts due under the
Unemployment Insurance Act with respect to such work or labor, that said surety will pay the same in an amount
not exceeding the amount hereinabove set forth, and also in case suit is brought upon this bond,will pay, in addition
to the face mount thereof, costs and reasonable expenses and fees, including reasonable attorney's fees, incurred
by the City in successfully enforcing such obligation,to be awarded and fixed by the court, and to be taxed as costs
and to be included in the judgement therein rendered.
It is hereby expressly stipulated and agreed that this bond shall inure to the benefit of any and all persons,
companies and corporations entitled to Me claims under Title 15 (commencing with Section 3082) of Part 4 of
Division 3 of the Civil Code, so as to give a right of action to them or their assigns in any suit brought upon this
bond.
Should the condition of this bond be My performed, then this obligation shall become null and void; otherwise it
shall be and remain in W force and effect.
The surety hereby stipulates and agrees that no change, extension of time, alteration or addition to the terms of the
agreement or to the work to be performed thereunder or the specifications accompanying the same shall in anywise
affect its obligations on this bond, and it does hereby waive notice of any such change, extension of time,alteration
or addition to the terms of the agreement or to the work or to the specifications.
IN WITNESS WHEREOF, this instrument has been duly executed by the Principal and surety named, on
- October 22 - , 1999.
HOLLAND-LOWS CONSTRUCTION, INC. (Sp_4L) ULICO CASUALTY COMPANY
(SEAL)
Principal Surety
-
13y, BY:
Signamre
Address: 14726 Ramona Ave.
- Chino, CA 91710
(Notarial Acknowledgnumts of Conazeror and Surety) Telephone- (209) 393-4712
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT
State of California
r �
CountV of S
tks
On
DaW Name and 11do of Offl=#. •3 N
personally appeared
ALA—
personally kno en to me
proved to the on the basis of satisfactory
evidence
to be the persons whose n subscribed to the
within instrument and acknowledged to me that he/s /4 y
executed the same in hi authorized
eapacity(i , and that by hi signature(s) on the
�w. . . erson
instrument the
vp- {, }, or the entity upon behalf of which
the perso acted,executed the instrument.
I S and and o ial.
A=N
t
OPTIONAL
7hough the information below is not required�y/arse,,it mqa y prove valuable to persons relying on the domment
asci ldlsrevent fraudulent removal wOreattachment of thin form to counher document.
]Description of Attached JDocument
Title or Type of Document:
east:
Document Date: Number of Pa
Signer(s)ulnar Than Named Above.
Capacity(ies}Clahned by Skner
Signet's
Individual
C
Corporate tiff -Title(s)- ��� �here
pat _ Limited [)General
C Attorneyi Fact
rustee
Guardian or Conservator
[)cath
Si Is Itepre
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT
State of California
County of Orange
On October 22, 1999 before me, Sheila K. McDonald, Notary Public
_A 7
� E OG OcPir_E� t C', _ANE DOE NOTAR-1 F`_:8L C
personally appeared James W. Moilanen
M, personally known to me - OR - proved to me on the basis of satisfactory evidence
to be the person(s) whose name(s) is/are
subscribed to the within instrument and ac-
knowledged to me that he/she/they executed
the same in his/her/their authorized
capacity(ies), and that by his/her/their
signature(s) on the instrument the person(s),
SHEI
"" F- P"�� I LD or the entity upon behalf of which the
r0 DON'A
A<
person(s) acted, executed the instrument.
J y
f MY ccop -�Ilsgi"N
2L
WITNESS my hand and official seal.
SIGNATURE OF NOTARY
OPTIONAL
Though the data below is not required by law, it may prove valuable to persons relying on the document and could prevent
fraudulent reattachment of this form,
CAPACITY CLAIMED BY SIGNER DESCRIPTION OF ATTACHED DOCUMENT
INDIVIDUAL
CORPORATE OFFICER
TITLE OR TYPE OF DOCUMENT
TITI-F;S)
PARTNER(S)
LIMITED
GENERAL
ATTORNEY-IN-FACT NUMBER OF PAGES
TRUSTEE(S)
L� GUARDIAN/CONSERVATOR
!� OTHER:
DATE OF DOCUMENT
SIGNER IS REPRESENTING:
NAME OF PFRSONfS'OR ENTIr-INES,
SIGNER(S) OTHER THAN NAMED ABOVE
..... .....
BD-1133 3/94 c01993 NATIONAL NOTARY ASSOCIATION-8236 Remmet Ave-P.O.Box 7184-Canoga Park CA 91309-7184
I-ALIC0
CASUALTY COMPANY R157
111 Massachusetts Avenue,N.W Washington,DC 20001
a ME 0 N 0
POWER OF ATTORNEY
Know All Men By These Presents: That Ulicir Casualty Company, A Delaware Corporation, having its principal office in Washington, DC, pursuant to the following
resolution,adopted by the Board of Directors of the Corporation effective on the 28th day of January,1993:
RESOLVED. "That the Chairman and Chief Executive Officer be,and hereby is,authorized to execute Powers-of-Attorney,qualifying the attorney named in the Powers-of-
Attorney to execute an behalf of the Corporation contract bonds and other related surety bonds,and to attach thereto the corporate sea]of the Corporation,in the transaction of its
surety business."
RESOLVED: 'That the signatures and attestiumfis of such officers and the seal of the Corporation may be affixed to any such Power-of-Attorney or to any certificate relating
thereto by facsimile,and any such Power-of Attorney or certificate bearing such facsimile signatures and facsimile seal shall be valid and binding upon the Corporation when so
affixed with respect to any contract bond or other related surety bond to which it is attached,'
This Power of Attorney is signed and sealed in facsimile under and by the authority of the above Resolution,
DOES IIEREBY MAKE,CONSITIUM AND APPOINT: Philip E.Vega,Mary J.Stelzer,Lourdes Landa,James W.Moilanen and Sheila K.McDonald,of Sullivan&Curtis
Insurance Brokers,of Irvine,in the State of California,its true and lawful Attorney(s)-in-Fact with full power and authority hereby conferred in its name,place and stead to sign,
execute,acknowledge and deliver in its behalf,and as its act and deed,without power of redelegation,as follows:
Contract bonds and other related surety bonds: IN AN AMOUNT NOT TO EXCEED TFIREE MILLION ($3,000,000.0(1)DOLLARS,to bind Utica Casualty Company
thereby as fully and to the same extent as if such bond was signed by the duly authorized officers of Ulico Casualty Company,and all the acts of said Attorneys)-in-Fact pursuant
to the authority herein given are hereby ratified and confirmed,
In Witness Whereof,Ulico Casualty Company of Dover, Delaware, has caused this Power of Attorney to be signed by its Chairman and Chief Executive Officer and its
Corporate seal to he affixed this 1st day of June,1999.
'-r&,,-Prover(A-Mtorne-je is void urfless the sea-)is readable,the text Is irt black h-jk-,the shp is n
"tureus are in black-ink,and tit' ofi-Ce—N hin red unk.
This Power of Arwro-ey is void!f attached to a dcong—mient evectred subsequent to Mwd,31,2001,
UHco Casualty Company
A Ty I"
District of Columbia ss: SEAL , By:
o IM , Obert A.Georgine, i Chief Executive Officer
AWS
On this Ist day of June,1999,before the subscriber,a Notary Public of the District of Coluntri duly commissioned and qualifj-�4 Robert A,Georgine of Ulico Casualty
.4 .t=pr��fi
Company to me personally known to be the individual and officer described therein,and who exec the preceding instrument,and &nowledged the execution of the same,and
being by me duly sworn,deposed and said,that he is the officer of the Company aforesaid,and that the seal affixed to the prvceding instrument is the Corporate Seal of the Company,
and the Corporate Seal and signature as an officer were duly affixed and subscribed to the said instrument by the authority and direction of the Corporation,and that the resolution of
the Company,referred to in the preceding instrument,is now in force,
In Testimony Whereof,I have hereunto set my hand,and affixed my official seal at Washington,DC the day and year above written.
T;
01
BJ.
(/�AOTARY y:
A N blic
UBLIG D.Y.biticeLea
CERTIFICATION My Commission Expires Match 31, 2001
1,Joseph A.Carabillo,Assistant Secretary of Ulico Casualty Company of Dover,Delaware,do hereby certify that the foregoing Resolution adopted by the Board of Directors of
this Corporation and the Powers of Attorney issued pursuant thereto,are true and correct,and that both the Resolution and the Powers of Attorney are in full force and effect,
In Witness Whereof,I have hermnto set my hand and affixed the seat of the corporation this 22nd day
October 1999.
By:
Joseph A. f Assistant secretary
EAL
,IS
UCB-102-REV.POA(06199) R,,SW 21
ACCRD-. CERTIFICATE OF LIABILITY SUIRANCECSR JUT DATE(MMMD/YY)
HQI.LIi-1 10/22/99
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Wood-Gutmann Insurance Brokers ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
License #0679263 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
14192 Franklin Ave. , Suite 200 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Tustin CA 92780-7044 COMPANIES AFFORDING COVERAGE
Scott M. Milne, CPA COMPANY
PnoneNo, 714-505-7000 Fax No. 714-573-1770 A Transportation Insurance Co.
INSURED
COMPANY
B Valley Forge Insurance Co.
COMPANY
Holland-Lowe Construction, Inc C Transportation Insurance Co.
427 S. Pershing Avenue Ste 150 COMPANY
San Bernardino CA 92408 i D
COVERAGES
THIS IS TO CERTIFY THAT 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
COI I (POLICY EFFECTIVE POLICY EXPIRATION -
LTR ( TYPE OF INSURANCE ( POLICY NUMBER DATE(MM/DDYY) DATE(MWDD1YY) LIMITS
i
NERAL LIABILITY GENERAL AGGREGATE 1$2,000,000
A I X I COMMERCIAL GENERAL LIABILITY 0143004459 10/10/99 10/10/00 PRODUCTS-COMP/OPAGG Ii$2,000,000
CLAIMS MADE [X I OCCUR PERSONAL&ADV INJURY 1$ 1,000,000
X OWNER'S&CONTRACTOR'S PROT EACH OCCURRENCE — $ 1F000,000
1! $2,500 Ded Per FIRE DAMAGE(Any one fire) I$ 50,000
!Occurrence MED EXP(Anyone person) $ 5 0 0 0
AUTOMOBILE LIABILITY r
B ANY AUTO 1036665379 10/10/99 1 10/10/00 COMBINED SINGLE LIMIT $ 1,000,000
ALL OWNED AUTOS --
BODILY INJURY $
X
SCHEDULED AUTOS (Per person)
Ix HIRED AUTOS
BODILY INJURY $
NON-OWNED AUTOS (Per a�deni)
PROPERTY DAMAGE I$
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT }$
ANY AUTO OTHER THAN AUTO ONLY:
EACH ACCIDENT -$
AGGREGATE ,$
EXCESS LIABILITY EACH OCCURRENCE $
UMBRELLA FORM AGGREGATE $
OTHER THAN UMBRELLA FORM ---
'°"ORKERS COMPENSATION AND ! I WC STATU- ((}TH_
EMPLOYERS'LIABILITY # I TORY UMTTS ER
EL EACH ACCIDENT1$ 1,000,000 POLICY LIMIT !$ 1,000,000
�THE PROPRIETOR!
C INCL ; WC175205065 01/01/99 { O1/01/00 EL DISEASE-
PARTNERSIEXECUTIVE s
4 OFFICERS ARE EXCL j EL DISEASE-EA EMPLOYEE $ 1 0 0 0 0 0 0
OTHER
A ! E i ment Floater-
; qu P 1043004459 10/10/99 10/10/00 ,
One Item $150,000
I (Rented & Leased) Max' $300,000
DESCRIPTION OF OPERATIONSILOCATIONS/VEHICLES/SPECIAL ITEMS
*10 Days Notice of Cancellation for Non Payment of Premium. CitV of
Redlands is named aladditional insured per attached G17957E. RE: herald
Street Rehab. Job 1057C.
CERTIFICATE HOLDER CANCELLATION
REDL00 4 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE T)4EREOF,TI-IE ISSUING COMPANY WILL ENDEAVOR TO MAIL
City of Redlands 3 0* DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
35 Cajon Street, #222 BUT FAILURE TO MAIL SUW NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
Redlands CA 92373 OF ANY KIND UPON OMPANY,MS A REPRESENTATIVES.
AUTHORIZED REPRES ATIVE
Scott Mi ne, CPA 2'`"f , !
ACORC}25-5(1198) ACO CORPORATION 1988
G-17S.57-�
(Ed.04;97)
IrHIS E-NOORSE-MEN T CHANGES THE POUCY. READ IT CAIR-E. LILLY.
CON-MAC T OR'S BLANKET ADOMONAL INSURED ENIOCRSEMENT
Thm endorse-nent mc-diff es litsumn— provided under*lie"cacwing.,
CCMMERC.'AL GENERAL UAelLr-iY=VERAGE PART
A. wHc is A4N iNsuR=- (sec!icn 11) is amended to a- *Eccily injury' or 'pr:psr7
f
Inetude as an itwured any ;erzcn or oG;anL=dcrz aifte-
(cane--4 addlitcnal ir=recl whcrn you are required to
add as an addlidonal insured on this pcilicl under. (11) A-4141 wcrk, can the protect (other tl= se!,4ic_-.
mair-mnarc-- ar re-,airs/l -- Ie ;erformed 1--y
1. A c--&,jac or asreerr.e-+.* or or cn lzel?aif of the adc-11,1crtai `insured at *.ie
2- An craf =ntm= or agre-ement where a site of the =vetmd cper-,-tlCr4 hZ'S teen
certificate of insur-ance showing that ;erzcn or
organization as an additional instxet has teen rotor, �f'your wcril-* =, :11 whic-, are
but Ir'lury, Cr damace 3e4es . as teen
the wr-,tar ar=rall ccntr-,,=or aqr:llerrerrt te: !:y ;arscr, ,.r :rg2,!izz-4c:!
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tn e c s p ca cf. and acera,"-crs c- a as ;:a:i of cta
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a- Yc-,;- ;:remLs= of C.- 1,211L.;re Ic -encer a,-.f prcfeszicnal serwiczzs
h- adt.-Renal or
a. 7,�e cr fairl:7g Ic ;r--car--
c- or --mLssic.-S-of *""e ad:t-,ticnz., `rlsun�dor a=*Clc,4e ma=s. -,4rawina:s, repz-,--s'
ir, ccmnec:.cr wit:l the garers! sucer,;is.-C.n. c�!ar;e C.ters4des,G:, c
of*ycur work*. and
2- The i ,r-its of in=rancz z;:-;ficat"!e to the b. S u=eri;scr,(, or escine--,4rg
add ucr.al inwured are trlcsa spec!"fied in the
wz an cccrtmr-- or agmem-ent or in tt-e
cec.larstucrz lfcc tris pclicf. whic. ever is less. S. Any coversge umler this em-4crsemer7t to
'T'In—te Urnits--f Insurance are inc!,;sive an,.4 lot an add�;cnai insreedsn2,',' be excess over ar.*y
in atc4fticrt to the Urr.iL- of Insurance s1mcwn in ct: er valid arc! =ffe--;bia irmursscz aysilaz:-- to
the Cleclaraticns. the ado'ticral instzmad wnether ;rmarl,
=n*.ir.gent or c:- any c:ltle!- t.,asi:s .r.!e-<z a
3. Excect whery req:Jred by =ntrac— =r s;e--;fl—ailly re-,"�;,res:ihat te ;..,4 mar4,.
the ccvera;e '-f-c"Aded tc the adcl!ticnal
bhis end-men. ent,does nct apply 1c:
y
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