HomeMy WebLinkAbout2012 Pacific West Industries - Civic Ctr CompressorC.i
CONTRACT
THIS CONTRACT, by and between the CITY OF LA QUINTA, a municipal
corporation, herein referred to as "City," and Pacific West Industries, Inc. herein referred to
as "Contractor."
WITNESSETH:
In consideration of their mutual covenants, the parties hereto agree as follows:
1. Contractor shall furnish all necessary labor, material, equipment, transportation and
services for Compressor Replacement at La Quinta Civic Center 78-495 Calle Tampico in
the City of La Quinta, California pursuant to the attached proposal listed as Exhibit A.
2. Contractor will comply with all Federal, State, County, and La Quinta Municipal
Code, which are, as amended from time to time, incorporated herein by reference.
3. All work shall be done in a manner satisfactory to the ,Director of Building and
Safety.
4. Contractor shall commence work after the issuance of a written Notice to Proceed
and agrees to have all work completed within 30 days from the date of Notification to
Proceed.
5. In consideration of said work, City agrees to pay Contractor such sums as shall be
approved by the Director of Building and Safety at lump sums and/or unit prices stated in
the Contractor's Bid, the base consideration of Six ThousandDollars ($6,000.00). All
payments shall be subject to approval by the Director of Building and Safety.
6. Prevailing Wage is not required for this project.
7. Except for the gross negligence or willful misconduct of an Indemnified Party (as
hereinafter defined), the Contractor hereby assumes liability for and agrees to defend (at
Indemnified Parties' option), indemnify, protect and hold harmless City and its Project
Consultants, and Engineers, officers, agents, and employees ("Indemnified Parties") from
and against any and all claims, charges, damages, demands, actions, proceedings, losses,
stop notices, costs, expenses (including counsel fees), judgments, civil fines and penalties,
liabilities of any kind or nature whatsoever, which may be sustained or suffered by or
secured against the Indemnified Parties arising out of or encountered in connection with
this Contract or the performance of the Work including, but not limited to, death of or
bodily or personal injury to persons or damage to property, including property owned by or
under the care and custody of City, and for civil fines and penalties, that may arise from or
be caused, in whole or in part, by any negligent or other'act or omission of Contractor, its
officers, agents, employees or Subcontractors including, but not limited to, liability arising
from:
Revised 5-29-12
a. Any dangerous, hazardous, unsafe or defective condition of, in or on the
premises, of any nature whatsoever, which may exist by reason of any act,
omission, neglect, or any use or occupation of the premises by Contractor,
its officers, agents, employees, or subcontractors;
b. Any operation conducted upon or any use or occupation of the premises by
Contractor, its officers, agents, employees, or subcontractors under or
pursuant to the provisions of this contract or otherwise;
c. Any act, omission or negligence of Contractor, its officers, agents,
employees, or Subcontractors;
d. Any failure of Contractor, its officers, agents or employees to comply with
any of the terms or conditions of this Contract or any applicable federal,
state, regional, or municipal law, ordinance, rule or regulation; and
e. The conditions, operations, uses, occupations, acts, omissions or negligence
referred to in Sub -subsections (1), (2), (3), and (4), existing or conducted
upon or arising from the use or occupation by Contractor on any other
premises in the care, custody and control of City.
The Contractor also agrees to indemnify City and pay for all damages or loss suffered by
City including but not limited to damage to or loss of City property, to the extent not
insured by City and loss of City revenue from any source, caused by or arising out of the
conditions, operations, uses, occupations, acts, omissions or negligence referred to in Sub -
subsections (a), (b), (c), (d) and (a).
Contractor's obligations under this Section applyregardless of whether or not such claim,
charge, damage, demand, action, proceeding, loss, stop notice, cost expense, judgment,
civil fine or penalty, or liability was caused in part or contributed to by an Indemnified
Party. However, without affecting the rights of City under any provision of this contract,
Contractor shall not be required to indemnify and hold harmless City for liability attributable
to the active negligence of City, provided such active negligence is determined by
agreement between the parties or by the findings of a court of competent jurisdiction. In
instances where City is shown to have been actively negligent and where City's active
negligence accounts for only a percentage of the liability involved, the obligation of
Contractor will be for that entire portion or percentage of liability not attributable to the
active negligence of City.
Contractor agrees to obtain executed indemnity agreements with provisions identical to
those set forth here in this section from each and every subcontractor or any other person
or entity involved by, for, with or on behalf of Contractor in the performance of this
contract. In the event Contractor fails to obtain such indemnity obligations from others as
required here, Contractor agrees to be fully responsible according to the terms of this
section.
Failure of City to monitor compliance with these requirements imposes no additional
obligations on City and will in no way act as a waiver of any rights hereunder. This
obligation to indemnify and defend City as set forth here is binding on the successors,
assigns or heirs of Contractor and shall survive the termination of this contract or this
section.
Revised: 5-29-12 2
This indemnity shall survive termination of the Contract or Final Payment hereunder. This
Indemnity is in addition to any other rights or remedies that the Indemnified Parties may
have under the law or under any other Contract Documents or Agreements. In the event
of any claim or demand made against any party which is entitled to be indemnified
hereunder, City may, in its sole discretion, reserve, retain or apply any monies to the
Contractor under this Contract for the purpose of resolving such claims; provided,
however, City may release such funds if the Contractor provides City with reasonable
assurance of protection of the Indemnified Parties' interests. City shall, in its sole
discretion, determine whether such assurances are reasonable.
The City will not be liable for any accident, loss, or damage to the work prior to its
completion and acceptance.
8. Except as otherwise required, Contractor shall concurrently with the execution of
this contract, furnish the City satisfactory evidence of insurance of the kinds and in
the amounts as follows:
Commercial General Liability Policy
Commercial General Liability Insurance using Insurance Services Office "Commercial
General Liability" policy form CG 00 01 or the equivalent. Defense costs must be
paid in addition to limits. There shall be no cross liability exclusion for claims or
suits by one insured against another. Limits shall be no less than One Million
Dollars ($1,000,000) per occurrence for all covered losses and no less than Two
Million Dollars ($2,000,000) general aggregate.
Contractor's policy shall contain no endorsements limiting coverage beyond the
basic policy coverage grant for any of the following:
a. Explosion, Collapse or Underground Hazard(X CU)•
b. Products and Completed Operations.
C. Pollution liability.
d. Contractual liability.
Coverage shall be applicable to City for injury to employees of: contractors,
subcontractors or others involved in the project. Policy shall be endorsed to provide
a separate limit applicable to this project.
Workers' Compensation Insurance
Workers' Compensation on a state -approved policy form providing statutory
benefits as required by law with employer's liability limits no less than $1,000,000
per accident for all covered losses.
Revised: 5-29-12 3
Business Auto Policy
Business Auto Coverage on ISO Business Auto Coverage form CA 00 01 06 92
including symbol 1 (Any Auto) or the exact equivalent. Limits shall be no less than
$1,000,000 per accident, combined single limit. If Contractor owns no vehicles,
this requirement may be satisfied by a non -owned auto endorsement to the general
liability policy described above.
Excess or Umbrella Liability Insurance
Excess or Umbrella Liability Insurance (Over Primary) if used to meet limit
requirements, shall provide coverage at least as broad as specified for the
underlying coverage. Any such coverage provided under an umbrella liability policy
shall include a drop down provisions providing primary coverage for liability not
covered by primary but covered by the umbrella. Self -insured retentions are not
permitted. Coverage shall be provided on a "pay on behalf" basis, with defense
costs payable in addition to policy limits. There shall be no cross liability exclusion
precluding coverage for claims or suits by one insured against another. Coverage
shall be applicable to City for injury to employees of Contractor, subcontractors or
others involved in the Work. The scope of coverage provided is subject to approval
of City following receipt of proof of insurance as required herein. Limits are subject
to review but in no event less than $1,000,000 per occurrence and aggregate.
This insurance shall be kept in full force and effect by Contractor during this entire contract
and all premiums thereon shall be promptly paid by it. Each policy shall further state that it
cannot be canceled without written notice to the City and shall name the City as an
additional insured. Failure to maintain the required amounts and types of coverage
throughout the duration of this Contract shall constitute a material breach of this Contract.
a. Contractor agrees to endorse the Commercial General Liability coverage required
herein to include as additional insureds City, its officials, employees and agents,
using standard ISO endorsement No. CG 2010 with an edition date of 1985 or
equivalent. Contractor also agrees to require all contractors, subcontractors, and
anyone else involved in any way with the project contemplated by this Contract to
do likewise.
b. Any waiver of subrogation express or implied on the part of City to any party
involved in this Contract or related documents applies only to the extent of
insurance proceeds actually paid. City, having required that it be named as an
additional insured to all insurance coverage required herein, expressly retains the
right to subrogate against any party for sums not paid by insurance. For its part,
Contractor agrees to waive subrogation rights against City regardless of the
applicability of any insurance proceeds, and to require all contractors,
subcontractors or others involved in any way with the project(s) contemplated by
this Contract, to do likewise.
c. All insurance coverage maintained or procured by Contractor or required of others
by Contractor pursuant to this Contract shall be endorsed to delete the subrogation
Revised: 5-29-12 4
condition as to City, or to specifically allow Contractors or others providing
insurance herein to waive subrogation prior to a loss. This endorsement shall be
obtained regardless of existing policy wording that may appear to allow such
waivers.
d. It is agreed by Contractor and City that insurance provided pursuant to these
requirements is not intended by any party to be limited to providing coverage for the
vicarious liability of City, or to the supervisory role, if any, of City. All insurance
coverage provided pursuant to this or any other Contract (express or implied) in any
way relating to City is intended to apply to the full extent of the policies involved.
Nothing referred to here or contained in any Contract involving City in relation to
the project(s) contemplated by this Contract is intended to be construed to limit the
application of insurance coverage in any way.
e. None of the coverages required herein will be in compliance with these requirements
if they include any limiting endorsement of any kind that has not been first
submitted to City and approved of in writing.
f. All coverage types and limits required are subject to approval, modification and
additional requirements by the City, as the need arises. Contractor shall not make
any reductions in scope of coverage (e.g. elimination of contractual liability or
reduction of discovery period) that may affect City's protection without City's prior,
written consent.
g. Proof of compliance with these insurance requirements, consisting of binders of
coverage, or endorsements, or certificates of insurance, at the option of City, shall
be delivered to City at or prior to the execution of this Contract. In the event such
proof of any insurance is not delivered as required, or in the event such insurance is
canceled at any time and no replacement coverage is provided, City has the right,
but not the duty, to obtain any insurance it deems necessary to protect its interests
under this or any other agreement and to pay the premium. Any premium so paid
by City shall be charged to and promptly paid by Contractor or deducted from sums
due Contractor, at City option.
h. Contractor agrees to endorse, and to require others to endorse, the insurance
provided pursuant to these requirements, to require written notice to City and the
appropriate tender prior to cancellation of such liability coverage and notice of any
material alteration of non -renewal of any such coverage, and to require contractors,
subcontractors, and any other party in any way involved with the project
contemplated by this Contract to do likewise.
i. It is acknowledged by the parties of this Contract that all insurance coverage .
required to be provided by Contractor or any subcontractor, is intended to apply
first and on a primary non-contributing basis in relation to any other insurance
available to the City.
j. Contractor agrees to ensure that subcontractors, and any other party involved with
the project that is brought onto or involved in the project by contractor, provide the
Revised: 5-29-12 5
same minimum insurance coverage required of Contractor. Contractor agrees to
monitor and review all such coverage and assumes all responsibility for ensuring
that such coverage is provided in conformity with the requirements of this section.
Contractor agrees that upon request, all agreements with subcontractors and others
engaged in the project will be submitted to City for review.
k. Contractor agrees not to self -insure or to use any self -insured retentions or
deductibles on any portion of the insurance required herein and further agrees that it
will not allow any contractor, subcontractor, Architect, Engineer or other entity or
person in any way involved in the performance of work on the project contemplated
by this Contract to self -insure its obligations to City. If contractor's existing
coverage includes a deductible or self -insured retention, the deductible or self -
insured retention must be declared to the City. At that time the City shall review
options with the contractor, which may include reduction or elimination of the
deductible or self -insured retention, substitution of other coverage, or other
solutions.
I. The City reserves the right at any time during the term of the contract to change
the amounts and types of insurance required by giving the Contractor ninety (90)
days advance written notice of such change. If such change results in substantial
additional cost to the Contractor, the City will negotiate additional compensation
proportional to the increased benefit to City.
m. For purposes of applying insurance coverage only, all contracts pertaining to the
project will be deemed to be executed when finalized and any activity commences
in furtherance of performance under this Contract.
n. Contractor acknowledges and agrees that any actual or alleged failure on the part of
City to inform Contractor of non-compliance with any insurance requirement in no
way imposes any additional obligations on City nor does it waive any rights
hereunder in this or any other regard.
o. Contractor will renew the required coverage annually as long as City, or its
employees or agents face an exposure from operations of any type pursuant to this
Contract. This obligation applies whether or not the Contract is canceled or
terminated for any reason. The insurance shall include but not be limited to
products and completed operations and discontinued operations, where applicable.
Termination of this obligation is not effective until City executes a written
statement to that effect.
p. Contractor agrees to waive its statutory immunity under any workers' compensation
statute or similar statute, in relation to the city, and to require all subcontractors
and any other person or entity involved in the project contemplated by this Contract
to do likewise.
q. Requirements of specific coverage features are not intended as limitations on other
requirements or as a waiver of any coverage normally provided by any given policy.
Specific reference to a given coverage feature is for purposes of clarification only as
Revised., 5-29-12 6
it pertains to a given issue, and is not intended by any party or insured to be all-
inclusive.
r. Any provision in any of the construction documents dealing with the insurance
coverage provided pursuant to these requirements is subordinate to and superseded
by the requirements contained herein. These insurance requirements are intended
to be separate and distinct from any other provision in this Contract and are
intended by the parties here to be interpreted as such.
s. All liability coverage provided according to these requirements must be endorsed to
provide a separate aggregate limit for the project that is the subject of this Contract
and evidencing products and completed operations coverage for not less than two
years after issuance of a final certificate of occupancy by all appropriate
government agencies or acceptance of the completed work by City.
t. Contractor agrees to be responsible for ensuring that no contract used by any party
involved in any way with the project reserves the right to charge City or Contractor
for the cost of additional insurance coverage required by this Contract. Any such
provisions are to be deleted with reference to City. It is not the intent of City to
reimburse any third party for the cost of complying with these requirements. There
shall be no recourse against City for payment of premiums or other amounts with
respect thereto.
U. Contractor agrees to obtain and provide to City a copy of Professional Liability
coverage for Architects or Engineers, if any are working on this project through
Contractor. City shall determine the liability limit.
9. In accepting this Contract, Contractor certifies that in the conduct of its business it
does not deny the right of any individual to seek, obtain and hold employment without
discrimination because of race, religious creed, color, national origin, ancestry, physical
handicap, medical condition, marital status, sex or age as provided in the California Fair
Employment Practice Act (Government Code Sections 12900, at seq.) Contractor agrees
that a finding by the State Fair Employment Practices Commission that Contractor has
engaged during the term of this Contract in any unlawful employment practice shall be
deemed a breach of this Contract and Contractor shall pay to City $1,607.00 liquidated
damages for each such breach committed under this contract.
10. This Contract shall not be assignable by Contractor without the written consent of
City.
11. Contractor shall notify the Director of Building and Safety forthwith when the
Contract is deemed completed.
12. In accepting this Contract, Contractor certifies that no member or officer of the firm
or corporation is an officer or employee of the City except to the extent permitted by law.
13. Contractor certifies that it is the holder of any necessary California State
Contractor's License and authorized to undertake the above work.
Revis&& 5-29-r2 7
14. The City, or its authorized auditors or reprasentatives, shall have access to and the
right to audit and reproduce any of the Contractor records to the extent the City deems
necessary to insure it is receiving all money iu which it is entitled under the contract
and/or is paying only the amounts to t- 1licl, Contractor is properly entitled under the
Contract or for other purposes relating to the Collir,_�ct.
15. The Contractor shall maintain and (xes:,rvo, all such records for a period of at least
three years after termination of the contract.
16. The Contractor shall maintain all such recerc's in the City of La Quinta. If not, the
Contractor shall, upon request, prornptly deliver the records to the City or reimburse the
City for all reasonable and extra costs incurred in conducting the audit at a location: other
than at City offices including, but not lirnitecf tc-, mich additional lout of the City) expenses
for personnel, salaries, private audiwrs, travellodging, meals and overhead.
IN WITNESS WHEREOF, the parties have execsmd this Agreement as of the dates stated
below.
^ITV.
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APPROVED AS TO FORM:
i y ttorney
r' A QUINTA
uiiiou?ia municipal corporation
F;ant:. .I. Sp ac , City Manager
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"CONTRACTOR"
(if wrporation, 34fiz seal)
Dated: �� /� (y: ✓ nature) — ---
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Revised: 5-29-12
L.
test Industries
r r ostag. knee • Buiidisg Automaiwo
To: City of La Quinta
78.495 Calle Tampico
La Quints, CA 92247
Reference: City Hall Cond 1 Compressor 2
Pacific West Industries, Inc.
4085 E. La Palma Ave. Unit B
Anaheim, CA 92807
Tel 866.328.2129
Fax 714.630.4049
Date: 6/7/2012
Number: 303LQQK12
Payment Terms: Net 30 Days
During a recent service call, our service technician found a bad compressor in condenser 1. The hermetic
compressor appears to be scrambled internally and needs to be replaced. Below is a scope of work outlining the
replacement.
Scope of Work:
1. Recover the existing refrigerant.
2. Remove and replace compressor #2
3. Provide and install'a Trane OEM compressor (lead tune Ito 10 working days)
4. Replace the liquid line drier
S. Replace the high pressure. service port (existing will not open)
6. Leak test circuit and evacuate.
7. Charge system R22 refrigerant
8. Start up and test.
9. Will provide written notice of operations and any quote any necessary fitither repairs
Total Price (Labor, Material and Sales Tax) »:»»...... .... ».................... » .... ............. »»... $6,000.00
Alternate Price: Substitute OEM Trane compressor for Danfoss compressor.
Same spec is Trane $5,400 lead time 3 days
Excluding: Any work not detailed above. Warranty of any device other then the compressor
Warranty: Manufacture warranty on compressor 1 year
Acceptance
This'proposal is subject to acceptance within 30 days from date of issuance. Pacific West Industries thanks you
for the opportunity to be of service.
If you should have any questions, please feel free to call on me. My phone number is (714) 322-0691(Cell)
Respectfully submitted,
Kevin Marquardt, President
Pacific West Industries, Inc.
ACCEPTANCE: Please sign and return one copy.
Sign Date
Print Title
Terms and conditions are part hereof
Page 1 of 2
Revised: 5-29-12 9
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A� & CERTIFICATE OF LIABILITY INSURANCE
mYE(MuDDMYYY)
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 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 BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certlficate holder Is an ADDITIONAL INSURED, the poilcy(les) must 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
Pynn Insurance Agency, LLC
24910 Washington Ave Suite 205
Munieta CA 92562
ON
NAMEAcY Mad Drewry
PPHONl_E Eat): (951) 239.0038 1V Ne : (951) 239-1916
ADDRESS: Mad@pynninsumnoeagency.com
INSURER(S) AFFORDING COVERAGE
MAIC9
INSURERA: Navigators Insurance. Company
INSURED
PACIFIC WEST INDUSTRIES, INC
4085 E LA PALMA AVE STE 8
ANAHEIM CA 92807-1702
INSURER B:
INSURERC: Navigators Insurance Company
INSURER D:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMRFR-
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 REOUIREMENT, 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.
I
LTRR
TYPE OF INSURANCE
ADDLSUBR
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PO NUMBER R
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UNITS
A
GENERALLIABWTY
X COMMERCIAL GENERAL LIABILIABILITY100,000
CLAIMS -MADE rvi
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04-NO027985
11/1/11
1111/12
EACH OCCURRENCE
$ 1,000,000
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$
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$ 5,000
PERSONAL a ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
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GENLAGGREGATEUMn
X POLICY
APPIJFS PER:
PRO• LOC
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AUTOMOBILE
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AUTOS AUTOS
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EACH OCCURRENCE
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AGGREGATE
$ 1,000,000
DED I
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AND EMPLOYERS' LIABILITY YTN
ANY PROPRIETORMARTNERIEXECITIVE
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DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Atl®Ional Remarks Schedule, if mom apace Is required)
City of La Quints Is named Additional Insured per the attached endorsement.
B
City of La Quinta
PO Box 1504
La Quinta, CA 92247
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE. WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
c,r✓1�.tr: C ��-
The ACORD name and logo are registered marks of ACORD
BLANKET. ADDITIONAL INSUREDS -
OWNERS, LESSEES OR CONTRACTORS
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Policy Number. 04.Nu027985
Endorsement Effective: 11/1/2011 12:01 a.m.
Named Insured
PACIFIC WEST INDUSTRIES INC, DBA: PACIFIC WEST mDUS7AIES INC
Countersigned By:
IV-+M'r •p r t
Name of Person or Organization:
Any person or organization that the named insured is obligated by virtue of a written contract or
agreement to provide insurance such as is afforded by this policy.
(If no entry appears above, Information required to complete this endorsement will be shown in the Declarations
as applicable to this endorsement.)
A. Section li — Who Is An Insured is amended to include as an insured the person or
organization shown in the Schedule, but only to the extent that the person or organization
shown in the Schedule is held liable foryour acts or omissions arising out of your ongoing
operations performed for that insured.
B. With respect to the insurance afforded to these additional insureds, the following exclusion is
added:
2. Exclusions
This insurance does not apply to "bodily injury" or "property damage" occurring after:
(1) All work, including materials, parts or equipment furnished in connection with such
work, on the project (other than service, maintenance or repairs) to be performed by
or on behalf of the additional insured(s) at the site of the covered operations has
been completed; or
(2) That portion of "your work" out of which the injury or damage arises has been put to
Its intended use by any person or organization other than another contractor or
subcontractor engaged in performing operations for a principal as a part of the same
project:
C. The words "you" and "your" refer to the Named Insured shown in the Declarations.
D. "Your work" means work or operations performed by you or on your behalf; and materials, parts
or equipment furnished in connection with such work or operations.
Primary Wording
If required by wdtten contract or agreement: Such insurance as is afforded by this policy shall be
primary Insurance, and'any Insurance or selfinsurance maintained by the above additional
insured(s) shall be excess of the insurance afforded to the named insured and shall not contribute
to it.
Waiver of Subrocallon '
If required by mitten contract or agreement: We waive any right of recovery we may have against an entity
that Is an additional insured per the terms of this endorsement because of payments we make for Injury or
damage arising out of "your work" done under a contract with that person or organization.
ANF- ES 043 (5/2006)
UCKIINUAIC VI' LIA61LII T IIVJVKAIV4C 1 6/5/2012
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 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 BETWEEN THE ISSUING INSURER($), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must 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).
GOUGER
kOTHSTEIN INSURANCE AGENCY
L833 Portola Road, Suite A
CONTACT
NAME:
ac°HOE (805)648-6595 FAXacND:(805)435-1599
,
I
AooREss: barry@ rinsurance .net
7entura, CA 93003
)E68747
INSURER(S) AFFORDING COVERAGE
NAICt
INSURERA Hartford Casualty Ins. Co.
WIRED Kevin Marquardt
INSURER B
INSURER C'.
Pacific West Industries, Inc.
NSURERD
4085 E. L Palma Ave., .Suite B
Anaheim, CA 92807
INSURER E
(714) 630-4440
INSURER F
)VERAGES CERTIFICATE NUMBER: REVISION NUMBER:
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.
R
r TYPE OF INSURANCE
ADDL
INSR
SUBR
We
POLICY NUMBER
POLICY EFF
MMIDDIYYYY
POLICY EXP
MMIDDNYYY
LIMITS
GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE CI OCCUR
EACH OCCURRENCE
$
RENTED —
PREMISES Ea occurrence
$
MED EXP(Any one person)
$
PERSONAL& ADV INJURY
$
GENERAL AGGREGATE
$
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY PEOT LOC
PRODUCTS - COMPIOP AGG
$
$
AUTOMOBILE LIABILITY
ANYAUTO �
ALL OWNED SCHEDULED
AUTOS AUTOS
NON -OWNED
HIRED AUTOS qAUTOS
Ea accident
$
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
lPer accident
$
UMBRELLA LAB
EXCESS LIAB
OCCUR
CLAIMS -MADE
EACH OCCURRENCE
$
AGGREGATE
$
DED I I RETENTION $
$
WORKERS COMPENSATION
ANDEMPLOYERS! LIABILITY YIN
ANY PROPRIETORIPARTNERIEXECI I
L OFFICEreMEMBER EXCLUDED? 1
(Mandatory In NN) `
If yes, describe under
DESCRIPTION OF OPERATIONS belo,Y
NIA
72WECEQ3302
11/17/2011
11/17/2012
WC STATU- I OTH-
X TO RV LIMITS ER
E.L. EACH ACCIDENT
$ 1 , 000 , 000
E.L. DISEASE - EA EMPLOYEE
$ 1,000,000
E.L. DISEASE -POLICY LIMIT
s 1,000,000
SCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, a more apace is required)
roof of Insurance.
City of La Quints.
P.O. Box 1504
La Quints, CA 92247
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
C 1988-2010 ACORD CUnruKA I IUN. AB rights reservea.
,ORD25(2010105) The ACORD name and logo are registered marks of ACORD
CERTIFICATE OF INSURANCE
Tffiscefftes,ttY 0. STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY of Bloomington, [Ifinois
0 STATE FARM FIRE AND CASUALTY COMPANY of Bloomington, Illinois
0 STATE FARM COUNTY MUTUAL INSURANCE COMPANY OF TEXAS of'Datlas, Texas, or
C
NAMEDINSURED: Fac-;fic West
Industries 1tic
ADDRESS OF NAMED INSURED: 4085 9 1A P ' airta Ave Ste 8 Anaheim, CA 92807
POLICY NUMBER
245 8-189-FOI-55
224 6785
E01 bS
EFFECTIVE DATE
OF POLICY
05/01/12-11/01/12
DESCRIPTION OF
VEHICLE (lncluding VN)
11 Chevy
Silverad
06 Chevy
Express
1GBOCVCG413FIS9634
IGCGC25KX81229162
LIABILITY COVERAGE
0 YES
0 NO
0 YES
0 NO
0 YES
0 NO
[I YES
0 NO
LIMITS,OF LIABILITY
0. Bodily Injury
Each Person
$1000000
$1000000
Each Accident
$1000000
$1000000.
b., Property Damage
Each Accident
$1000000
$100000
r. Soddy Injury &
Property Damage
Single Limit
Each Accident
PHYSICAL DAMAGE
COVERAGES
YES
0 NO
0 YES
0 NO
D YES
0 NO
0 YES
0, NO
a. Comhens ive
*1000
Deductiole
$ 1000
Deductible
Deductible
$
Deductible
0 YES
ONO
0 YES
ONO
-$
El YES
0 NO
[J YES
0 No
- b. Collision
$ 1000
Deductible
$ IGQ6
Deductible
$
Deductioie
Deductible
Eli;UOY61S NON47awo
CAR LIABILITY COVERAGE
M YES
0 NO
YES
0 NO
El YES
0 NO
[:1 YES
0 No
HIRED CAR LIABILITY
COVERAGE
YES
0 NO
-fE]
T'"
0 YES
0 NO
LJ
-
0 YES
0 NO
0 YES
0 NO
F LEET
ALLM =ANDL=
MOTOR VEHICLES,
0 YES
0 NO
YES
0 NO
0 YES
0 NO
❑ O"YES
ONO
City of La 'Quinta
PO Box 1504
La Ouinti, CA 9224*7
INTERNAL STATE FARM.USE ONLY: ORequest
1224202 Rev, deiG-2004 0 Request
AGENT 55-8317 W18/12
State Farm Insurance
Marty Miller
2667 Camino Del Rio So # 112
San Diego, Ca 92108