Loading...
HomeMy WebLinkAbout2016 CON Geraldo Cortez dba National City Electric - Electrical ServicesSHORT FORM SERVICES AGREEMENT BY AND BETWEEN THE CITY OF NATIONAL CITY AND NATIONAL CITY ELECTRIC THIS AGREEMENT is entered into this l3th day of October, 2016, by and between the CITY OF NATIONAL CITY, a municipal corporation (the "CITY"), and GERALDO CORTEZ, an individual, DBA NATIONAL CITY ELECTRIC, (the "CONTRACTOR"). NOW, THEREFORE, CITY agrees to engage CONTRACTOR to perform the services set forth herein in accordance with the following terms and conditions: 1. Description of Services. CONTRACTOR shall provide City-wide, on -site electrical maintenance, including, but not limited to repairs and remodeling as -needed and as directed by Arturo Gonzalez, Facilities Supervisor. 2. Length of Agreement. The duration of this Agreement is from October 13, 2016 through January 31, 2017. 3. Compensation. The total compensation to CONTRACTOR for providing the services set forth herein shall not exceed an annual total cost of $10,000. The compensation for CONTRACTOR'S work shall be based upon and not exceed the rates given in Exhibit "A" (the labor rates) without prior written authorization from CITY. 4. Payment Schedule. CITY will make payment within thirty (30) days of receiving and approving a billing statement for the satisfactorily completed services of CONTRACTOR. 5. Termination. CITY may terminate this Agreement at any time by providing a one (1) day written notice to CONTRACTOR. 6. Independent Contractor. It is agreed that CONTRACTOR is an independent Contractor, and all persons working for or under the direction of CONTRACTOR are CONTRACTOR'S agents, servants and employees, and said persons shall not be deemed agents, servants, or employees of CITY. 7. Insurance. CONTRACTOR shall obtain: A. ❑ If checked, Professional Liability Insurance (errors and omissions) with minimum limits of $1,000,000 per occurrence. B. Automobile insurance covering all bodily injury and property damage incurred during the performance of this Agreement, with a minimum coverage of $1,000,000 combined single limit per accident. Such automobile insurance shall include owned, non -owned, and hired vehicles ("any auto"). C. Commercial General Liability Insurance, with minimum limits of either $2,000,000 per occurrence and $4,000,000 aggregate, or $1,000,000 per occurrence and $2,000,000 aggregate with a $2,000,000 umbrella policy, covering all bodily injury and property damage arising out of its operations, work, or performance under this Agreement. The policy shall name the CITY and its officers, agents, employees, and volunteers as additional insureds, and a separate additional insured endorsement shall be provided. The general aggregate limit must apply solely to this "project" or "location". The general aggregate limit must apply solely to this "project" or "location". The "project" or "location" should be noted with specificity on an endorsement that shall be incorporated into the policy. D. Workers' compensation insurance in an amount sufficient to meet statutory requirements covering all of CONTRACTOR'S employees and employers' liability insurance with limits of at least $1,000,000 per accident. In addition, the policy shall be endorsed with a waiver of subrogation in favor of the City. Said endorsement shall be provided prior to commencement of work under this Agreement. E. The aforesaid policies shall constitute primary insurance as to the CITY, its officers, employees, and volunteers, so that any other policies held by the CITY shall not contribute to any loss under said insurance. Said policies shall provide for thirty (30) days prior written notice to the CITY of cancellation or material change. F. Said policies, except for the professional liability and workers' compensation policies, shall name the CITY and its officers, agents, employees, and volunteers as additional insureds, and separate additional insured endorsements shall be provided. G. If required insurance coverage is provided on a "claims made" rather than "occurrence" form, the CONTRACTOR shall maintain such insurance coverage for three years after expiration of the term (and any extensions) of this Agreement. In addition, the "retro" date must be on or before the date of this Agreement. H. Insurance shall be written with only California admitted companies which hold a current policy holder's alphabetic and financial size category rating of not less than A:VII according to the current Best's Key Rating Guide, or a company equal financial stability that is approved by the City's Risk Manager. In the event coverage is provided by non -admitted "surplus lines" carriers, they must be included on the most recent California List of Eligible Surplus Lines Insurers (LESLI list) and otherwise meet rating requirements. I. This Agreement shall not take effect until certificate(s) or other sufficient proof that these insurance provisions have been complied with, are filed with, and approved by the CITY's Risk Manager. If the CONTRACTOR does not keep all of such insurance policies in full force and effect at all times during the terms of this Agreement, the CITY may elect to treat the failure to maintain the requisite insurance as a breach of this Agreement and terminate the Agreement as provided herein. J. All deductibles and self -insured retentions in excess of $10,000 must be disclosed to and approved by the CITY. K. Insurance certificates must specify certificate holder as: City of National City ATTN: Risk Manager 1243 National City Blvd National City, CA 91950-4301 Revised May 2016 2 8. INDEMNIFICATION AND HOLD HARMLESS. The CONSULTANT agrees to defend, indemnify and hold harmless the City of National City, its officers, officials, agents, employees, and volunteers against and from any and all liability, loss, damages to property, injuries to, or death of any person or persons, and all claims, demands, suits, actions, proceedings, reasonable attorneys' fees, and defense costs, of any kind or nature, including workers' compensation claims, of or by anyone whomsoever, resulting from or arising out of the CONSULTANT'S performance or other obligations under this Agreement; provided, however, that this indemnification and hold harmless shall not include any claims or liability arising from the established sole negligence or willful misconduct of the City, its agents, officers, employees, or volunteers. CITY will cooperate reasonably in the defense of any action, and CONSULTANT shall employ competent counsel, reasonably acceptable to the City Attorney. The indemnity, defense, and hold harmless obligations contained herein shall survive the termination of this Agreement for any alleged or actual omission, act, or negligence under this Agreement that occurred during the term of this Agreement. 9. Acceptability of Work. The City shall, with reasonable diligence, determine the quality or acceptability of the work, the manner of performance, and/or the compensation payable to the CONTRACTOR. 10. Business License. CONTRACTOR must possess or shall obtain business license from National City Finance Department before beginning work. 11. Miscellaneous Provisions. A. Counterparts. This Agreement may be executed in multiple counterparts, each of which shall be deemed an original, but all of which, together, shall constitute but one and the same instrument. B. Captions. Any captions to, or headings of, the sections or subsections of this Agreement are solely for the convenience of the parties hereto, are not a part of this Agreement, and shall not be used for the interpretation or determination of the validity of this Agreement or any provision hereof. C. No Obligations to Third Parties. Except as otherwise expressly provided herein, the execution and delivery of this Agreement shall not be deemed to confer any rights upon, or obligate any of the parties hereto, to any person or entity other than the parties hereto. D. Exhibits and Schedules. The Exhibits and Schedules attached hereto are hereby incorporated herein by this reference for all purposes. To the extent any exhibits or schedules or provisions thereof conflict or are inconsistent with the terms and conditions contained in this Agreement, the terms and conditions of this Agreement will control. E. Amendment to this Agreement. The terms of this Agreement may not be modified or amended except by an instrument in writing executed by each of the parties hereto. F. Waiver. The waiver or failure to enforce any provision of this Agreement shall not operate as a waiver of any future breach of any such provision or any other provision hereof. G. Applicable Law. This Agreement shall be governed by and construed in accordance with the laws of the State of California. The CONTRACTOR shall comply with all laws, including federal, state, and local laws, whether now in force or subsequently enacted. Revised May 2016 3 H. Entire Agreement. This Agreement supersedes any prior agreements, negotiations and communications, oral or written, and contains the entire agreement between the parties as to the subject matter hereof. No subsequent agreement, representation, or promise made by either party hereto, or by or to an employee, officer, agent, or representative of any party hereto shall be of any effect unless it is in writing and executed by the party to be bound thereby. I. Successors and Assigns. This Agreement shall be binding upon and shall inure to the benefit of the successors and assigns of the parties hereto. J. Subcontractors or Subconsultants. The City is engaging the services of the CONTRACTOR identified in this Agreement. The CONTRACTOR shall not subcontract any portion of the work, unless such subcontracting was part of the original proposal or is allowed by the City. In the event any portion of the work under this Agreement is subcontracted, the subcontractor(s) shall be required to comply with and agree to, for the benefit of and in favor of the City, both the insurance provisions in Section 7 and the indemnification and hold harmless provision of Section 8 of this Agreement. K. Construction. The parties acknowledge and agree that (i) each party is of equal bargaining strength, (ii) each party has actively participated in the drafting, preparation and negotiation of this Agreement, (iii) each such party has consulted with or has had the opportunity to consult with its own, independent counsel and such other professional advisors as such party has deemed appropriate, relative to any and all matters contemplated under this Agreement, (iv) any rule or construction to the effect that ambiguities are to be resolved against the drafting party shall not apply in the interpretation of this Agreement, or any portions hereof, or any amendments hereto. IN WITNESS WHEREOF, this Agreement is executed by CITY and by CONTRACTOR on the date and year first above written. CITY OF NATIONAL CITY NATIONAL CITY ELECTRIC Leslie Deese, City Manager APPROVED AS TO FORM: George H. Eiser, III Interim City Attorney Revised May 2016 4 By: Ger do Cortez O CONTACT INFORMATION CITY OF NATIONAL CITY 1243 National City Boulevard National City, CA 91950-4397 Phone: Fax: Contact: Title: Dep.: Email: (619) 336-4585 (619) 336-4397 Arturo Gonzalez Facilities Supervisor Public Works/Engineering arturog(a nationalcityca.gov Revised May 2016 5 NATIONAL CITY ELECTRIC P.O. Box 1375 National City, CA 91950 Phone: (619) 857-0397 Fax: (619) 651-8881 Contact: Geraldo Cortez Title: Owner Email: ncelectric(agmail.com Taxpayer I.D. No.: 556-19-3730 Exhibit A Tuesday, March 1, 2016 10:40 PM National City Electric PO Box 1375 National City, CA 91951 Phone (619) 857-0397 Fax (619) 651-8881 Email: ncelectricl@gmail.com License C-10 #843770 07/20/2016 City of National City 1243 National City Blvd. National City, CA 9150 Att: Arturo Gonzalez In reference to our service we provide to the city of National City. Our hourly rates are as follows: $95 Per Man Hour ( These rates are for normal business hours: 8:OOAM-4:30PM ) Monday -Friday $125 Per Man Hour ( Overtime Rate: After 4:30PM Monday -Friday, Weekends, and Holidays) These rates are portal to portal, An electrical contractor places, installs, erects or connects any electrical wires, fixtures, appliances, apparatus, raceways, conduits, solar photovoltaic cells or any part thereof, which generate, trap mit, transform or utilize electrical energy in any form or for any purpose. • We appreciate your business and•Iook forward to serving you. Sincerely, Ger., do Cortez, 0r ner TO/TO 3E d City of Nations( City Page i 610313 AHD J 1 NOI1VN yLTTTtr66T9 LE:90 9T0Z/OZ/L0 Legal Name Registration Number County City Registration Date Expiration Date GERALDO CORTEZ 1000040894 SAN DIEGO NATIONAL CITY 07/27/2016 06/30/2017 A(C RO ��® PVC DATE (MM/DD/YYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 07/29/2016 HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEE( THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITDNAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies mapr require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorserrient(s). PRODUCER StateFarm Joaquin Alvarez, Agent Q 0•0 INSURED 240 F St Chula Vista CA 91910 Geraldo Cortez dba National City Electric PO Box 1375 National City CERTIFICATE OF LIABILITY INSURANCE CA 91951 COVERAGES CERTIFICATE NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSU INDICATED. NOTWITHSTANDING ANY REQUIREM CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES INSR ADDL SUBR LTR TYPE OF INSURANCE XCOMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR INSD WVD POLICY NUMBER GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- JECT LOC OTHER: AUTOMOBILE LIABILITY _1 ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY -- UMBRELLA UAB EXCESS UAB DED NON TACT Rudy De La Mora PHONE 619-425-1216 INC. No. Extl• ADDRESS: rudy.delamora.p4b statefarm.com FAX 619-425-1290 (A/C, No): INSURER(S) AFFORDING COVERAGE INSURER A State Farm Genera Insurance Company INSURER B : INSURER C : INSURER D : INSURER E : INSURER F: NAIC # 25151 REVISION NUMBER: RANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSU kED NAMED ABOVE FOR THE POLICY PERIOD ENT, TERM OR CONDITION OF ANY CONTRACT OR OTHEF DOCUMENT WITH RESPECT TO WHICH THIS THE INSURANCE AFFORDED BY THE POLICIES DESCRID HEREIN IS SUBJECT TO ALL THE TERMS, . LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIM POLICY EFF POLICY EXP (MM/DD/YYYY) (MMIDD/YYYY 90-CH-J557-2 03/01/2016 03/01/2017 UNITS EACH OCCURRENCE $ 2,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP/OP AGG $ 4,000,000 $ 4,000,000 (SCHEDULED J AUTOS NON -OWNED AUTOS ONLY [, OCCUR CLAIMS -MADE RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below COMBINED SINGLE LIMIT $ (Ea accident) BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) EACH OCCURRENCE $ AGGREGATE Y/N N/A DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is requ Additional Insureds: The City of National City, its elected officials, officers, agents, and employee CERTIFICATE HOLDER PER OTH- STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ d) City of National City c/o Risk Manager 1243 National City Blvd National City CA 91950 CANCELLATION SHOULD ANY OF THE ABOVE THE EXPIRATION DATE TH ACCORDANCE WITH THE POLI SCRIBED POLICIES BE CANCELLED BEFORE REOF, NOTICE WILL BE DELIVERED IN PROVISIONS. AUTHORIZED REPRESENTATIVE © 1988-2015 AC RD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Policy No. 90-CH-J557-2 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CMP-4786.1 ADDITIONAL INSURED — OWNERS, LESSEES, OR CONTRACTORS (Scheduled) CMP-4786.1 Page 1 of 2 This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number: 90-CH-J557-2 Named Insured: CORTEZ, GERALDO DBA NATIONAL CITY ELECTRIC PO BOX 1375 NATIONAL CITY CA 91951-1375 Name And Address Of Additional Insured Person Or Organization: CITY OF NATIONAL CITY ITS ELECTED OFFICIALS, OFFICERS, AGENTS, EMPLOYEES & VOLUNTEERS 1243 NATIONAL CITY BLVD NATIONAL CITY CA 91950-4397 1. SECTION II — WHO IS AN INSURED of SECTION II — LIABILITY is amended to in- clude, as an additional insured, any person or organization shown in the Schedule, but only with respect to liability for "bodily injury", "property damage", or "personal and advertis- ing injury" caused, in whole or in part, by: a. Ongoing Operations (1) Your acts or omissions; or (2) The acts or omissions of those acting on your behalf; in the performance of your ongoing opera- tions for that additional insured; or b. Products — Completed Operations "Your work" performed for that additional insured and included in the "products - completed operations hazard". However, Paragraph 1. above is subject to the following: a. The insurance afforded to the additional insured only applies to the extent permit- ted by law; b. If coverage provided to the additional in- sured is required by a contract or agree- ment, the insurance provided to the additional insured will not be broader than that which you are required by the contract or agreement to provide for such addition- al insured; and c. If the contract or agreement between you and the additional insured is governed by California Civil Code Section 2782 or 2782.05, the insurance provided to the additional insured is the lesser of that which: (1) Is allowed for the satisfaction of a de- fense or indemnity obligation by Cali- fornia Civil Code Section 2782 or 2782.05 for your sole liability; or (2) You are required by contract or agreement to provide for such addi- tional insured. We have no duty to defend or indemnify the additional insured under this endorsement un- til a claim or "suit" is tendered to us. O, Copyright, State Farm Mutual Automobile Insurance Company, 2013 Includes copyrighted material of Insurance Services Office, Inc., with its permission. CONTINUED 2. Any insurance provided to the additional in- sured shall only apply with respect to a claim made or a "suit" brought for damages for which you are provided coverage. 3. With respect to the insurance afforded to the additional insured, the following is added to SECTION II — LIMITS OF INSURANCE: If coverage provided to the additional insured is required by contract or agreement, the most we will pay on behalf of the additional insured will be the lesser of the amount of insurance: a. Required by the contract or agreement; or b. Available under the applicable Limits Of Insurance shown in the Declarations. This endorsement shall not increase the ap- plicable Limits Of Insurance shown in the Declarations. 4. With respect to the insurance afforded to the additional insured, the following is added to Paragraph 3. Duties In The Event Of Occur- rence, Offense, Claim Or Suit of SECTION II — GENERAL CONDITIONS: The additional insured must: a. See to it that we are notified as soon as practicable of an "occurrence" or an of- fense which may result in a claim. To the extent possible, notice should include: (1) How, when and where the "occur- rence" or offense took place; (2) The names and addresses of any in- jured persons and witnesses; and CMP-4786.1 CMP-4786.1 Page 2 of 2 (3) The nature and location of any injury or damage arising out of the "occur- rence" or offense; b. Tender the defense and indemnity of any claim or "suit" to us and to all other insur- ers who may have insurance potentially available to the additional insured; and c. Agree to make available any other insur- ance the additional insured has for de- fense or damages for which we would provide coverage under SECTION II — LIABILITY. 5. With respect to the insurance afforded the ad- ditional insured, the following replaces SEC- TION II —LIABILITY of Paragraph 7. Other Insurance of SECTION I AND SECTION II — COMMON POLICY CONDITIONS: a. This insurance is primary to and will not seek contribution from any other insurance available to the additional insured, provided that the additional insured is a named in- sured under such other insurance. b. Regardless of any agreement between you and the additional insured, this insur- ance is excess over any other insurance whether primary, excess, contingent or on any other basis for which the additional in- sured has been added as an additional in- sured on other policies. There will be no refund of premium in the event this endorsement is cancelled. All other policy provisions apply. 1007033 148011 08-21-2014 0, Copyright, State Farm Mutual Automobile Insurance Company, 2013 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Policy No. 90—Cx—J557-2 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY CMP-4787 WAIVER OF TRANSFER OF RIGHTS OR RECOVERY AGAINST OTHERS TO US CMP-4787 Page 1 of 1 This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number: 90—CH—J557-2 Named Insured: CORTEZ, GERALDO DBA NATIONAL CITY ELECTRIC PO BOX 1375 NATIONAL CITY CA 91951-1375 Name And Address Of Person Or Organization: CITY OF NATIONAL CITY ITS ELECTED OFFICIALS, OFFICERS, AGENTS, EMPLOYEES & VOLUNTEERS 1243 NATIONAL CITY BLVD NATIONAL CITY CA 91950-4397 The following is added to Paragraph 10.b. of SECTION I AND SECTION II — COMMON POLICY CONDITIONS: We waive any right of recovery we may have against the person or organization shown in the Schedule because of payments we make for injury or damage arising out of: a. Your ongoing operations; or b. "Your work" done under contract with that person or organization and included in the "products - completed operations hazard". This waiver applies only to the person or organization shown in the Schedule. All other policy provisions apply. CMP-4787 ©, Copyright, State Farm Mutual Automobile Insurance Company, 2008 1006225 137715.1 11-19-2013 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 'ACORD® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS/16 CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER INSURED CSS INSURANCE SERVICES 40 THIRD AVENUE CHULA VISTA, CA 91910 License #: 0181019 GERALDO CORTEZ dba: National City Electric PO BOX 1375 NATIONAL CITY, CA 91951-1375 COVERAGES CERTIFICATE NUMBER: 00000000-0 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED N INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOC CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEP EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR LTR TYPE OF INSURANCE ADDL SUER INSD I POLICY EFF [-PPOLICY EXP MD POLICY NUMBER 1 (MM/DO/YYYY) I (MM/DD/YYYY) INSURER B : INSURER_C : INSURER D : INSURER E : INSURER F : CONTACT NAME: Daniel E. McKent)a PHONE (kg_ No Ext): (619)427-2662 _ Tr" EMAIL . No): (619)427-0468 —'— ADDRESS: dan@californiaspecialservices.com INSURER(S) AFFORDING COVERAGE NAIL # INSURER A: California Auto Insurance Company —. 38342 rt COMMERCIAL GENERAL LIABILITY CLAIMS -MADE r .j OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: PRO - POLICY 1,1 JECT L_LOC OTHER: AUTOMOBILE LIABILITY X ANY AUTO OWNED _ AUTOS ONLY HIRED _ — AUTOS ONLY r-- SCHEDULED AUTOS NON -OWNED AUTOS ONLY BA040000018556 10/29/2015 110/29/2016 UMBRELLA LIAB EXCESS LIAB DED j RETENTION $ OCCUR CLAIMS -MADE WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVF OFFICER/MEMBER EXCLUDED? (Mandatory in NH) It yes, describe under DESCRIPTION OF OPERATIONS below Y/N N/AI 1 REVISION NUMBER: 1 MED ABOVE FOR THE POLICY PERIOD JMENT WITH RESPECT TO WHICH THIS EIN IS SUBJECT TO ALL THE TERMS, LIMITS EACH OCCURRENCE $ bAMAGE TO RENTED — — PREMISES (Ea occurrences $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERALAGGREGATE $ 1PRODUCTS - COMP/OP AGG $ COMBINED SINGLE LIMIT (Ea accident) $ _ 1 000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE — $ jper accidentL EACH OCCURRENCE AGGREGATE_ $ _I STATUTE ,L _ ERH _ — _ _ _ _ I .L. EACH ACCIDENT $ L. DISEASE - EA EMPLOYEE $— E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is require CERTIFICATE HOLDER CITY OF NATIONAL CITY 1243 NATIONAL CITY BLVD. NATIONAL CITY, CA 91950 ACORD 25 (2016/03) CANCELLATION SHOULD ANY OF THE ABOVE DE THE EXPIRATION DATE THEREOF ACCORDANCE WITH THE POLICY CRIBED POLICIES BE CANCELLED BEFORE NOTICE WILL BE DELIVERED IN ROVISIONS. AUTHORIZED REPRESENTATIVE e- "-'- (DEM) Husit The ACORD name and logo are registered )MICOIID CORPORATION. All rights reserved. marks of ACORD Printed by DEM on June 30, 2016 at 10:36AM GERALDO CORTEZ '�OLJCY # BA040000018556 10/29/2,015-10/29/2016 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE RE D IT CAREFULLY. BLANKET ADDITIONAL INSU ' ED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Cover modified by the endorsement. The following is added to the Section II — Liability Coverage, Paragraph A.1. Who Any person or organization that you are required to include as additional insured on written contract or agreement that is signed and executed by you before the "bodily. occurs and that is in effect during the policy period is an "insured" for Liability Cover. which this insurance applies and only to the extent that person or organization quail Who Is An Insured provision contained in Section II. MCA20480711 ge Form apply unless An Insured Provision: he Coverage Form in a jury" or "property damage" ge, but only for damages to -s as an "insured" under the D'pcuSign Envelope ID: 327A10E4-FBD5-4B10-9824-5149846E2299 2. Lower Limit(s) For Bodily Injury Uninsured Motorists Coverage The California Insurance Code requires that we provide you with the following information: "The California Insurance Code requires an insurer to provide uninsured motorists coverage in each bodily injury liability insurance policy it issues covering liability arising out of the ownership, maintenance, or use of a motor vehicle. Those provisions also permit the insurer and the applicant to agree to provide the coverage in an amount less than that required by subdivision (m) of Section 11580,2 of the Insurance Code but not less than the financial responsibility requirements. Uninsured motorists coverage insures the insured, his or her heirs, or legal representatives for all sums within the limits established by law, which the person or per- sons are legally entitled to recover as damages for bodily injury, including any resulting sickness, disease, or death, to the insured from the owner or operator of an uninsured motor vehicle not owned or operated by the insured or a resident of the same household. An uninsured motor vehicle includes an underinsured mo- tor vehicle as defined in subdivision (p) of Section 11580.2 of the Insurance Code." I reject Bodily Injury Uninsured Motorists Coverage at limits equal t my Combined Single Limit for Liability Coverage and I select the following lower combined sin le limits: $35,000 CSL $300,000 CSL $50,000 CSL $350,000 CSL $75,000 CSL $500,000 CSL $100,000 CSL $750,000 jCSL $250,000 CSL $1,000,000 CSL DOcuSigned by: 7735EFD84756447 Applicant's/Named Insured's Signature Date MCAU010112i01 Copyright 2011, Mercury Insurance Services, LLC (Includes copyright Page 2 Of 2 2012 material of ISO Properties, Inc., with its permissions) Policy Number: BA040000018556 'Effective Date: 06/30/2016 1J1$t MERCURY INSURANCE GROUP Amended Declarations: Change Coverage Symbol This policy change has resulted in an additional premium of $0.00 This declarations supersedes any previous declarations bearing the same number for this policy period BUSINESS AUTO DECLARATIONS Issued By: California Automobile Insurance Company P.O. Box 10730 Santa Ana, CA 92711-0730 Billing: (800) 503-3724 Claims: (800) 503-3724 Agent: CALIF SPECIAL SVCS 40 THIRD AVE CHULA VISTA, CA 919101712 Agent Number: 043279 Agent Phone: (619) 427-2662 ITEM ONE GENERAL INFORMATION Named Insured: GERALDO CORTEZ DBA NATIONAL CITY ELECTRIC Mailing Address: PO Box 1375, National City, CA 91951-1375 Policy Period: From 10/29/2015 to 10/29/2016 at 12:01 AM Standard Time at your mailing address Form of Business: Individual/Sole Proprietorship Total Policy Premium: $4,027.28 This policy may be subject to final audit. In return for the payment of the premium, and subject to all the terms of this policy, we agree with you to provide the insurance as stated in this policy. ENDORSEMENTS ATTACHED TO THIS POLICY IL 00 17 11 98 - Common Policy Conditions IL 00 2109 08 - Nuclear Energy Liability Exclusion IL 00 03 09 08 - Calculation of Premium CA 00 01 03 10 - Business Auto Coverage Form CA 01 21 02 99 - Limited Mexico Coverage CA 0143 05 07 - California Changes IL 02 70 09 12 - California Changes - Cancellation and CA 23 94 03 06 - Silica or Silica Related Dust Exclusion U-245 - Auto Body Repair Consumer Bill of Rights MCA85101213-CA - Broadening Endorsement CA 04 25 05 07 - California Individual Named Insured CA 21 54 09 09 - California Uninsured Motorists - Bodily CA 21 55 06 10 - California Uninsured Motorists - Physical CA 03 05 02 97 - California Changes Waiver of CDW MCADS030112-CA Page 1 of 4 06/30/2016 PT Policy Number: BA040000018556 'Effective Date: 06/30/2016 MERCURY INSURANCE GROUP ITEM TWO SCHEDULE OF COVERAGES AND COVERED AUTOS This policy provides only those coverages where a charge is shown in the premium column below. Each of these coverages will apply only to those "autos" shown as covered "autos". "Autos" are shown as covered "autos" for a particular coverage by the entry of one or more of the symbols from the Covered Autos Section of the Business Auto Coverage Form next to the name of the coverage. Covera es g Coverage Symbol Limit The Most We Will Pay For Any One Accident Or Loss Premium Liability 1 $1,000,000 CSL $2,438 Medical Payments Uninsured Motorists Bodily Injury 2 $300,000 CSL $282 Uninsured Motorists Property Damage 2 $3,500 with $250 deductible $21 Comprehensive 7 Actual Cash Value Or Cost Of Repair, Whichever Is Less, Minus Deductible Shown in ITEM THREE For Each Covered Auto, But No Deductible Applies To Loss Caused By Fire Or Lightning. See ITEM FOUR For Hired Or Borrowed Autos. $123 Specified Causes of Loss Actual Cash Value Or Cost Of Repair, Whichever Is Less, Minus Deductible Shown in ITEM THREE For Each Covered Auto For Loss Caused By Mischief Or Vandalism. See ITEM FOUR For Hired Or Borrowed Autos. Collision 7 Actual Cash Value Or Cost Of Repair, Whichever Is Less, Minus Deductible Shown in ITEM THREE For Each Covered Auto. See ITEM FOUR For Hired Or Borrowed Autos. $751 Towing and Labor See ITEM THREE LIMIT Shown For Each Disablement of An Auto. Premium For ITEM FOUR (Hired Auto Coverage) $75.00 Premium For ITEM FIVE (Non -Ownership Liability) $141.00 Premium For Endorsements $191.00 Miscellaneous Fees and Expense California Consumer Services and Fraud Program Fees $5.28 Total Policy Premium $4,027.28 MCADS030112-CA Page 2 of 4 Policy Number: BA040000018556 Effective Date: 06/30/2016 MERCURY INSURANCE GROUP ITEM THREE SCHEDULE OF COVERED AUTOS YOU OWN Covered Auto No. Description VIN Garaging Cost New City ST Zip Code Vehicle Equip. 1 2003 FORD RANGER 1FTYR14V13PA39082 National City CA 91950 $20,110 2 2013 TOYOTA RAV4 UTILITY 2T3WFREVXDW027788 National City CA 91950 $24,290 3 2006 CHEVROLET MEDIUM DUTY 1GBHG31U861194981 National City CA 91950 $25,480 Covered Auto No. Radius (In Miles) Usage Special Industry Class Loss Payee 1 Up to 50 Personal 2 Up to 50 Personal 3 Up to 50 Service Use Contractors COVERAGES, PREMIUMS, LIMITS, AND DEDUCTIBLES (Absence of a deductible or limit entry in any column below means that the limit or deductible entry in the corresponding ITEM TWO column applies instead.) Covered Auto No. Liability Premium Auto Medical Payments Premium UM Bodily Injury Premium UM Property Damage Premium Comprehensive Deductible Premium 1 $757 $100 $21 2 $757 $100 $500 $55 3 $924 $82 $500 $68 Covered Auto No. Specified Causes Of Loss Collision CDW Premium Towing & Labor Deductible Premium Deductible Premium Limit Per Disablement Premium 1 2 $500 $483 $8 3 $500 $268 $8 Covered Auto No. Rental Reimbursement Auto Loan/Lease Gap Premium Audio, Visual, & Data Equipment Total Vehicle Premium Maximum Payment Each Covered Auto Premium Limit Premium 1 $878 2 $1,403 3 $1,350 MCADS030112-CA Page 3 of 4 Policy Number: Effectk'e Date: BA040000018556 06/30/2016 MERCURY INSURANCE GROUP TOTAL PREMIUMS Liability $2,438 Medical Payments Uninsured Motorists Bodily Injury $282 Uninsured Motorists Property Damage $21 Collision Deductible Waiver $16 Comprehensive $123 Specified Causes of Loss Collision $751 Rental Reimbursement Loan/Lease Gap Audio, Visual and Data Electronic Equipment ITEM FOUR SCHEDULE OF HIRED OR BORROWED COVERED AUTO COVERAGE AND PREMIUMS Cost of hire means the total amount you incur for the hire of "autos" you don't own (not including "autos" you borrow or rent from your partners or "employees" or their family members). Cost of hire does not include charges for services performed by motor carriers of property or passengers. Estimated Annual Cost Of Hire Liability Coverage Physical Damage Coverage Total ITEM FOUR Premium Premium Limit Of Insurance Premium If Any $75 Actual Cash Value Or Cost Of Repair, Whichever Is Less, Minus $500 Deductible For Each Covered Auto. $75 ITEM FIVE SCHEDULE FOR NON -OWNERSHIP LIABILITY Number Of Employees (Including Volunteers) Total ITEM FIVE Premium 0-10 $141 ADDITIONAL INFORMATION Discounts • Multi -Line • Years In Business • Auto Pay - EFT Discount Driver Information Listed Drivers Excluded Drivers GERALDO CORTEZ LUCAS ARIASCORTEZ Other Endorsements Premium Broadening Endorsement $175 MCADS030112-CA Page 4 of 4 BA040000018556 Effective 06/30/2016 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. The following is added to the Section II— Liability Coverage, Paragraph A.1. Who Is An Insured Provision: Any person or organization that you are required to include as additional insured on the Coverage Form in a written contract or agreement that is signed and executed by you before the "bodily injury" or "property damage" occurs and that is in effect during the policy period is an "insured" for Liability Coverage, but only for damages to which this insurance applies and only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Section II. MCA20480711 BA040000018556 Effective 06/30/2016 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET WAIVER OF SUBROGATION This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. SECTION IV — BUSINESSS AUTO CONDITIONS, A. Loss Conditions, 5. Transfer of Rights Of Recovery Against Others To Us, the following is added: We waive any right of recovery we may have against any person or organization to the extent required of you by a written contract executed prior to any "accident" or "loss", provided that the "accident" or "loss" arises out of the operations contemplated by such contract. The waiver applies only to the person or organization designated in such contract. MCA04440913 CER HOLDER COPY STATE N❑ ISSUE DATE: 06-23-2016 P.O. BOX 8192, CERTIFICATE OF CITY OF NATIONAL CITY 1243 NATIONAL CITY BLVD NATIONAL CITY CA 91950-4301 PLEASANTON, CA 94588 WORKERS' COMPENSATION INSU';ANCE SC GROUP: POLICY NUMBER: CERTIFICATE ID: CERTIFICATE EXPIRES: 04-19-2016/ 157220-2016 2 4-19-2017 4-19-2017 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 indica -d. This policy is not subject to cancellation by the Fund except upon t0 days advance written i otice to the employer. We will also give you 10 days advance notice should this policy be cancelled prior to its n.` mal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter by the policy listed herein. Notwithstanding any requirement, term or condition of any contra. with respect to which this certificate of insurance may be issued or to which it may pertain afforded by the policy described herein is subject to all the terms, exclusions, and conditio Authorized Representative President and CEO UNLESS INDICATED OTHERWISE BY ENDORSEMENT, COVERAGE UNDER THIS POLICY THOSE NAMED IN THE POLICY DECLARATIONS AS AN INDIVIDUAL EMPLOYER OR A EMPLOYEES COVERED ON A COMPREHENSIVE PERSONAL LIABILITY INSURANCE POL CALIFORNIA WORKERS' COMPENSATION BENEFITS; EMPLOYEES EXCLUDED UNDER C COMPENSATION LAW. EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER 0 ENDORSEMENT #2570 ENTITLED WAIVER OF SUBROGATION EFFECTIVE 2016-06-23 ATTACHED TO AND FORMS A PART OF THIS POLICY. THIRD PARTY NAME: CITY OF NATIONAL CITY EMPLOYER CORTEZ, GERALDO DBA: NATIONAL CITY ELECTRIC PO BOX 1375 NATIONAL CITY CA 91951 he coverage afforded t or other document the insurance of such policy. EXCLUDES THE FOLLOWING: HUSBAND AND WIFE EMPLOYER; CY ALSO AFFORDING LIFORNIA WORKERS' CURRENCE. IS [BOO,CN] (REV.7-2014) PRIN ED : 06-23-2016 PO ICYHOLDER COPY sc S'rATE I�NJD ISSUE DATE: 06-23-2016 P.O. BOX 8192, CERTIFICATE OF CITY OF NATIONAL CITY 1243 NATIONAL CITY BLVD NATIONAL CITY CA 91950-4301 PLEASANTON, CA 94588 WORKERS' COMPENSATION INS SC GROUP: POLICY NUMBER: CERTIFICATE ID: CERTIFICATE EXPIRES 04-19-2016 ANCE 9157220-2016 2 04-19-2017 04-19-2017 This is to certify that we have issued a valid Workers' Compensation insurance policy in a )orm approved by the California Insurance Commissioner to the employer named below for the policy period indicted. This policy is not subject to cancellation by the Fund except upon 10 days advance written) notice to the employer. We will also give you 10 days advance notice should this policy be cancelled prior to its n),rrnal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alte by the policy listed herein. Notwithstanding any requirement, term or condition of any contr with respect to which this certificate of insurance may be issued or to which it may pertai afforded by the policy described herein is subject to all the terms, exclusions, and conditi. Authorized Representative President and CEO UNLESS INDICATED OTHERWISE BY ENDORSEMENT, COVERAGE UNDER THIS POLIC THOSE NAMED IN THE POLICY DECLARATIONS AS AN INDIVIDUAL EMPLOYER OR EMPLOYEES COVERED ON A COMPREHENSIVE PERSONAL LIABILITY INSURANCE PO CALIFORNIA WORKERS' COMPENSATION BENEFITS; EMPLOYEES EXCLUDED UNDER COMPENSATION LAW. EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER ENDORSEMENT #2570 ENTITLED WAIVER OF SUBROGATION EFFECTIVE 2016-06-2 ATTACHED TO AND FORMS A PART OF THIS POLICY. THIRD PARTY NAME: CITY OF NATIONAL CITY EMPLOYER CORTEZ, GERALDO DBA: NATIONAL CITY ELECTRIC PO BOX 1375 NATIONAL CITY CA 91951 the coverage afforded t or other document the insurance s, of such policy. EXCLUDES THE FOLLOWING: HUSBAND AND WIFE EMPLOYER; CY ALSO AFFORDING LIFORNIA WORKERS' CURRENCE. IS [BOO,CN] (REV.7-2014) PRIN. ED : 06-23-2016 WAIVER OF SUBROGATION N Enclosed is your copy of a certificate of insurance on which t e certificate holder required a waiver of subrogation: 1. Please be advised that a waiver of subrogation requires t :t a 3% surcharge will be applied by State Fund ONLY to the premium asses•.ed on the payroll of your employees earned while engaged in work for that certificate holder who requested the waiver. (Note: if you have no employe payroll on that job, then there is no charge.) 2. To apply the 3% surcharge, you must also agree to maintin accurately segregated payroll records for employees engaged in wort on job/s for the certificate holder who has the waiver. The payroll records re subject to verification by an auditor. Example: Payroll for job: Sample Rate: Regular Premium equals: Surcharge: $5,000.00 13 . 30 0 $ 665.00 3.000 Additional Waiver charge: $ 19.95 Total premium equals $ 684.95 (665.00 + 19.95) CITY OF NATIONAL CITY Office of the City Clerk 1243 National City Blvd., National City, California 91950-4397 619-336-4228 Michael R. Dalla, CMC - City Clerk October 26, 2016 Mr. Geraldo Cortez National City Electric P.O. Box 1375 National City, CA 91950 Dear Mr. Cortez, On October 13th, 2016, an Agreement was entered into between the City of National City and National City Electric. We are enclosing for your records a fully executed original Agreement. Sincerely, Michael R. Dalla, CMC City Clerk Enclosure