Loading...
Proposal - Service First - Qualificationsta Co"it ALIFORNIA - REQUEST FOR QUALIFICATIONS SUMMARY (Use additional pages if needed) Company Name: G� �V 1 c� ' Address: VAS O VJ, &YIfIWPI At� Sr " S19vL418 A$J-f eA 11,703— Representative: _ 130!0 Worn %w 5 Phone: — IC-�[ ��� Email: b WovrnnU 5 c S^rvt t4 - t 5 f• L-crYh Mission Statement: V%,(,g �` (�U12 NAN�t✓ \ S OJT c OwV.V^; Statement of Values: V.+ ,, o*ANrsrr-c' in � wu l -�� � � � �G rn u /'�,� �'t C � w• ct= r,�., i -c, -�o I I v �,- tevaiKra CALIFORNIA Work Schedule (Use additional pages or an alternate format if needed) Provide a proposed detailed schedule of work that identifies the aspects of the work required. The proposed schedule should address issues such as daily, weekly maintenance times, water clarity, algae removal, odors, and types of chemicals used. Also include weekly/monthly strategies to maintain the pool and water features to a high standard. Proposed weekly schedule of work: a 151 (3 WA S IN L Av�C /0,0 L tD\f ife &�( c.L:;' 14 Li ` 7 4KL7t AA d5 T4 't Ia -vt %'L. NEct-'�" k %-q Lo L i,L So A-f-tAcoe,>at op-ge, •e lkonI-e- 4- 44c rv4-o,,- C&A -d Lj 4t-4, :hA-c;&c,4 Service V lqpw" - Pa EXHIBIT A SPECIFICATIONS TASKS PERFORMED AT EACH SCHEDULED VISIT PER BODY OF WATER 1. Vacuum the bottom surface of each pool. 2. Skim debris from surface of each pool. 3. Clean all water line tiles as necessary. 4. Brush sides of each pool to remove dirt and debris as needed. 5. Remove accumulated debris from all pool skimmers and drains. 6. Remove accumulated debris from all pump strainers. 7. Backwash pool filters as necessary to maintain proper pressure differential. 8. Refill all chemical feed equipment containers as necessary. 9. Maintain a clean and organized equipment room. 10. Check and record the following in the supplied commercial log book: a. Free chlorine b. pH level c. Flow rate d. Influent Pressure e. Effluent Pressure f. Pool Temperature g. Chemicals Added h. Services Performed 11. Check for safety hazards and conditions in and around the pool area. 2510 N. Grand Avenue, Suite 110 • Santa Ana, California 92705 • (714) 573-2200 • FAX(714)573-2297 • License #556812 Service 11-T EXHIBIT B SPECIFICATIONS TASKS PERFORMED AT EACH SCHEDULED VISIT PER BODY OF WATER I. Check and adjust all automatic and manual water chemistry control systems. 2. Maintain and adjust all company owned equipment. 3. Maintain a proper residual of chemical stock on hand for all automatic and manual water chemistry control systems. 4. Place in use chlorine and pH neutralizer necessary to maintain the water balance in accordance with local and state health department codes and regulations regarding the sanitation of commercial pool and spas. 5. Maintain water levels in all bodies of water and adjust all automatic water level equipment. 6. Provide secondary containment for all chemical stocks in accordance with all local fire and safety codes. 7. Maintain pool records charts in accordance with local health authority quidelines. 8. Drain all pools and spas as necessary. 9. Check all pool equipment for proper operation. 10. Check pool area for obvious hazards. 11. Check pool and spa lighting for proper operation. END OF MONTH INSPECTION REPORT COMPLETED AT THE END OF EACH MONTH 12. Check and Record the following: a. Free Chlorine b. Total Chlorine c. Combined Chlorine d. pH level e. Total Alkalinity f. Calcium Hardness g. Total Dissolved Solids h. Phosphate Levels i. Temperature 2510 N. Grand Avenue, Suite 110 • Santa Ana, California 92705 • (714) 573-2200 • FAX (714) 573-2297 • License #556812 13. Perform a site survey for all pools and spas to check and record the condition of the following: a. Check all required safety signage b. Check all required safety equipment c. Check for missing or damaged main drain covers d. Check for safety hazards in and around pool area e. Check for missing or damaged deck lids f. Check spa emergency shut off switch operation g. Check all pool circulation, filtration, and heating systems. h. Check all pool lighting and lighting GFCls for proper operation. Check all pool access gates and perimeter barriers Service �ST COP.QIvS_EitC3AL POOL SYBT$Ms manual test results from controller Daily Pool Log January Day I Tech FAC TAC pH ORP pH Flow Influent Effluent TA Drain Temp Products nnme P. PM Em fnrlrr ronhdi r eontrJw 2W 231 osl E a/Pod doqF Services 1 2 3 4 5 6 7 8 9 ' 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 24 HOUR EMERGENCY PHONE NUMBER Service 19t Commercial Pool Systems (714) 573-2253 Your pool, spa and fountain experts Swimming Poo]VSpa Service Inspection Report Nance of Facility: Date Service of Inspection: Inspected By: Body of Water # l : Body of Water u2: COMMERCIALPOOL SYSTEMS #1 #2 Pool Water Quality Analysis FAC TAC pH TA CH CyA TDS Temp PPM PPM Factor nnm _ ___ Flow Rate Influent Effluent Vacuum 9Am PS' psi vac #1 #2 Pool Signs Pool Rules: CPR: Pool Occupancy: No Diving: No Lifeguard: "911": M Plumbing and Equipment Leak Backwash Valy Flow Meters and Guage Filter Condition Pump Room Condition Electrical Connections Heater Condition Automated Chemical Feed System Weir Blades, baskets and covers Pool Area Safety Check Spa Signs Spa Rules: Spa Occupancy: Emerg, Shut Off: Good Fair Poor s e s ORP pH controller controller #1 #2 Safety Apparatus and Equipment #1 #2 Life Rinc Life Line Life Pole w/ Hool, Emergency Spa Shut Off Switch Lighting CGFI Time Clock and/or Controls Time Set on Time Clocks for pool and lighting Pool/Spa Lighting Pool/Spa Safety Signs Pool/Spa Safety Equipment. Pool/Spa Hand Rails: Pool/Spa Steps and Rungs: Pool/Spa Main Drain Covers: Deck Covers: Pool Barrier: PLEASE EXPLAIN POOR CONDITIONS OR SAFETY VIOLATIONS, taaa�tra CALIFORNIA EQUIPMENT TO BE USED (Use additional pages or an alternate format if needed) List equipment to be used on this project and include any specialized equipment used for water feature maintenance, do you have a preventative maintenance program, and how often equipment maintenance is performed!. Equipment List: Vt C� 'Y iAl•,S eeLn 'Pro V, Ate_ 1900 1,- VS . L�3c oseK Ott, rlec-ess veru 'te AAm�o �c. v Vof i*Vr r -s • �- c�1S C`�rCul�{,zv�'pc�,,f' LA - tag Tae ✓js, hQ- e fr Pa, c GL v t t t at S AW CA,01 At ta Qwkra CAI IPORMA CERTIFICATION OF PROPOSER'S EXPERIENCE AND QUALIFICATIONS The undersigned Proposer certifies that he is, at the time of proposing, and shall be, throughout the period of the Contract, licensed under the provisions of Chapter 9, Division 3, of the Business and Professions Code of the State of California, to do the type of work contemplated in the Contract Documents. Proposer shall further certify that it is skilled and regularly engaged in the general class and type of work called for in the Contract Documents. The Proposer represents that it is competent, knowledgeable, and has special skills on the nature, extent, and inherent conditions of the work to be performed. Proposer further acknowledges that there are certain peculiar and inherent conditions existent in the maintenance of the facilities, which may create, during the water feature maintenance contract, unusual or peculiar unsafe conditions hazardous to persons and property. Proposer expressly acknowledges that it is aware of such peculiar risks and that it has the skill and experience to foresee and to adopt protective measures to adequately, and safely, perform the work with respect to such hazards. The Proposer shall list below three (3) contracts completed in the last seven (7) years of similar size and complexity that indicate the Proposer's experience in water feature maintenance. The projects must be similar in scope of work (i.e. commercial and/or municipal). Please indicate on additional paper if a quality control program was implemented, and managed, as part of the work efforts, and if written proof of the quality control program can be provided to the City of La Quinta prior to the award of proposal for this previous assignment. A. Project Name: df Q%VS��-�i C ,r��•w+ YOJ�-S Owner: I• �� A%Vakr% 4—A Contract Amount:$ rT i Contract Time: Calendar Days Owner's Representative: SitP— Owner's Telephone No: 1ST' V�3— Duration of Contract: _ Years from _ Po Z -V to Lo 7,3 Prevailing Wage: Yes _ No 4Y L"T ( WW 14 atm �+1 a -tlM S ` ta �a CALIFORNIA B. Project Name: VWw, lewr V�7iVS%g uy-Il�ol Owner: AA irIef (— w Contract Amount: $ 1Sq, 4ZiA Contract Time: '1% Yr&lendar Days S Owner's Representative: d Gil: Owner's Telephone No: Duration of Contract: Years from to ?AL2 Prevailing Wage: Ves _ No C. Project Name: _LA. oy !L�- ProIP`,,++ C Owner: Contract Amount: $ Contract Time: �alendar Days Owner's Representative:5° Owner's Telephone No: 5 67, Duration of Contract: _� Years from __,;;-r+I to 2dZ Prevailing Wage:p&Yes _ No Signed this _ ?� day of 2020. Name of Proposer T-00 N- CACU- 19 Address of Proposer A4 -<_s c SSM►► C 9 L.7��� / 0000 / a 613 DIR Number (Prevailing Wage) Contractor's License No. -;I-f % ) zoz. License Expiration Date &2-1 Expiration Date It ,40kewZ1 LAAVI D SCA Pe 14i,%kuwLa4Q� vi(vMS C 5,wN I it — I St • Go d DIR Classification Email address 7, - 7YJr- q:r$l -7/ V -Y73- V -S3 Cell Pone Office Phone *Have you or your sub -contractors been debarred: Yes ❑ No bK If yes, provide additional information on a separate sheet of paper. taQUI�tra CM IFORNIA - CERTIFICATIONS List any certifications that apply to this project held by your company and/or staff, and how many staff members have those certifications. Certification: 5 Py l Cea4 F+ed VOL DPaf�/f) ! Certification:_ SP r COV Certification: L - Pr CO�"�Ga h �Fc, t MA q So" 1 0 y -*05 Certification: Certification: Certification: Certification: Certification: Certification: Certification: Certification: Additional Comments: J—' 4'4' t,4 NSJO;7 XKSjIry Owl- ..A- d ta �W CHEMICALS List any and all chemicals to be used for this project, and their purpose. Additional Com-mennts: Clecck-r- v— PROPOSED PERSONNEL Provide a list of proposed personnel to be assigned specifically for this project, include any details as to what would make your staff more qualified than anyone else. Include the size of the assigned Supervisor's and Foreman's territory and other Munis, Businesses, and HOA's. Occupation/Title: Occupation/Title: _1&22 VoteA.'Z wil tCV& Zr po � s L4 ttr-ff C� ZwSf��vf' 254 cpo Occupatio n/Title:_ C—CW 4-C Svp��� - ern..,. LA 4" is if aws C 1PI) Occupation/Title: 6arcjr+4 es _- .e - RIS *edL1 Occu ation TTV itle:' ,s IJP, Occupation/Title: Occupation/Title: Occupation/Title: Occupation/Title: Occupation/Title: Occupation/Title: Additional Comments: tot m6er-�V iJAuA - eSvfl- 9004`. S Llow�'c%Jt So e " _4� 50 S+�✓ Com$ , G V.KM1 t (AKrAo LA5 (24(U45 12--S-Me-t. rbcut -T t, db V t �y -P cl u`j , .,- IF&I UA. ta �a ADDITIONAL SERVICES Provide a detailed explanation of any additional services and costs provided by your company that pertain to maintenance and repair work, such as heater and pump repairs, main water line, and/or valve repairs. �. M F �'�/► Rtl Q rbJ . A -at Ai -L,- S eir wi t• S ks s oci;o44 M y, L4 -eA�t!i C )c ao r I -u, 4.e a are Pei I Ire � )i:�L`IL 1 t)he4 . Ue, V-- CS L,13 .SSb.rl Z e.—,53Cj,[ 1.a -4; PovL s r_ Gl 0 C -ILO C3 M tevQ"tra - CALIFORNIA - NON -COLLUSION AFFIDAVIT TO BE EXECUTED BY PROPOSER AND SUBMITTED WITH PROPOSAL State of California ) )ss. County of ) ,being first duly sworn, deposes and says that he/she is a of serkit CC - the party making the foregoing proposal that the proposal is not made in the interest of, or on behalf of, any undisclosed person, partnership, company, association, organization, or corporation; that the proposal is genuine and not collusive or sham; that the proposer has not directly or indirectly induced or solicited any other proposer to put in a false or sham proposal, and has not directly or indirectly colluded, conspired, connived, or agreed with any proposer or anyone else to put in a sham proposal, or that anyone shall refrain from proposing; that the proposer has not in any manner, directly or indirectly sought by agreement, communication, or conference with anyone to fix the proposal price of the proposer or any other proposer, or to fix any overhead, profit, or cost element of the proposal price, or of that of any other proposer, or to secure any advantage against the public body awarding the contract of anyone interested in the proposed contract; that all statements contained in the proposal are true; and, further, that the proposer has not, directly indirectly, submitted his or her proposal price of any breakdown thereof, or the content t of, or divulged information or data relative thereto, or paid, and will not pay, an(y, an corporation, partnership, company association, organization, proposal deposit ry. t�n member of agent thereof to effectuate a collusive or sham proposal. gn Name of Proposer Title % 3 a� Datel CALIFORNIA ACKNOWLEDGMENT CIVIL CODE § 1189 A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California 1 County of A Pk J} On L0 before me, K6.V Date Here Insert Name and Title of the dfficer personally appeared Name(s) of who 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 acknowledged 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), or the entity upon behalf of which the person(s) acted, executed the instrument. KATRINA E. RIC€ 4 Notary Public • Cali1nr.Aid < = = orange [aunty Commission ✓f 2296618 L'� •�'" My Comm. Expires Jul 12, 2023 Place Notary Seal and/or Stamp Above I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my ha and/ 1 Signatul� Signature of Notary Public Completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: Document Date: Signer(s) Other Than Named Above: Capacity(les) Claimed by Signer(s) Signer's Name: ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Number of Pages: Signer's Name: - ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: .. Signer is Representing: Signer is Representing: ©2018 National Notary Association SERVICE FI JEAP CERTIFICATE OF LIABILITY INSURANCE DATE A E(MMI 019 ) 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 certificate holder is an ADDITIONAL INSURED, the policy(les) 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 ICONTACT NAME. le Wood itch Company Insurance Services, Inc. Park Plaza, Suite 400 vine, CA 92614 INSURED Service First Contractors Network 2510 North Grand Ave, Ste. 110 Santa Ana, CA 92705 INSURER F: 553-9800 11'M.Nut:(9a'9) 553-0670 United SDecialty Insu COVERAGES 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. INSRTypE OF INSURANCE �ADDL (SUER POLICY NUMBER POLICY EFF PJMhVDDffi= IMOLILTR CY EXP LIMITS A X GEN'LACWEGATE COMMERCIAL GENERAL LIABILITY CLAIMS-MADEC^ 1 OCCUR ILIG0019301 8/1/2019 8/1/2020 1,000,000 EACH OCCURRENCE _ DAMAGE TO RENTED $ 100,000 MED EXP (Any aneperson) $ 5,000 PERSONAL 4ADVINJURY $ 1,000,000 LIMIT APPLIES PER: 4 POLICY }Ci LOC OTHER: GENERIAL AGGREGATE $ 2,000,000 PRODUCTS - COMPIOP AGG $ 2'000'000 AUTOMOBILE LIABILITY ANY AUTO _ AUTOS ONLY �I AUUT�pOppSULED AUTOS ONLY __._� A17T05IN COMBINED SINGLE LIMIT $ BODILY INJURY Per person)$ BODILY INJURY Per accident $ PROPERTYDAMAGE UMBRELLA LIAR OCCUR EXCESS LIAR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE DED I , R TCNTION 2 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIEfOWPARTNER/EXECUTIVE YIN p�FICERW Mg�� EXCLUDED? O o�da[nry In NH] If yes, describe under DESCRIPTION OF OPERATIONS below NIA PER OTH- T E_LEACH ACCIDENT - EL DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) RE: Sample Certificate. CERTIFICATE HOLDER. _ Sample Certificate ACORD 25 (2016/03) CANCELLATION 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 � 1 © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ' 7 ACRO AGENCY POLICY NUMBER SEE PAGE 1 CARRIER EE PAGE 1 AGENCY CUSTOMER ID: SERVICE FI LOC #: 1 ADDITIONAL REMARKS SCHEDULE NAMED INSURED Service First Contractors Network 2510 North Grand Ave, Ste. 110 Santa Ana, CA 92705 NAIC CODE 3EE P 1 EFFECTIVE DATE: JEANA Page 1 of 1 THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORN 25 FORM TITLE: Certificate of Liability Insurance Cancellation: *Except for 10 days notice of cancellation for non payment of premium. *Should this policy be cancelled before the expiration date, The Wooditch Company will mail 30 (thirty) days written notice to those Certificate Holders which require such action per contract or agreement.* ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AC R�� CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 215i2020 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 certificate holder Is an ADDITIONAL INSURED, the policy(les) 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 Iieu of such endorsement(s). PRODUCER GIGA Solutions, Inc. 101 Plaza Real South ONTACT PHONE u 888-581-0807 arc N :954-252-142s Ste 201 Boca Raton FL 33432 Ea4fAIL ADD es : telt asotves.com INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: STATE NATL INS CO INC 12831 INSURER B : _ INSURED Service First 2510 North Grand Ave INSURER t:: INSURERD: Santa Ana CA 92705 INSURER E: INSURER F: COVERAGES r FRTIFI r ATF NHMRFR-1Ad177A14d 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. 1NSR ADD L S eR POLICY EFF POLICY EXP LIMITS 7 TYPE OF INSURANCE PpL.ICY NUMBER MMI M COMMERCIAL GENERALUABILITY EACH OCCURRENCE S CLAIMS -MADE 17-1 OCCUR PREMISES ma occufre S MED EXP (An one eraon S PERSONAL 8 ADV INJURY S GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S POLICY JEa � LOC PRODUCTS-COMPIOPAGG S is OTHER: AUTOMOBILE LIABILITY rOMBINED SINGLELIMI S E eddenl BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) S PROPERTY DAMAGE S r aceldanl HIRED NON -OWNED AUTOS ONLY AUTOS ONLY 5 UMBRELIALUIB OCCUR EACH OCCURRENCE S AGGREGATE S EXCESS LIAR CLAIMS -MADE DED I I RETENTION S S A WORKERS COMPENSATION ANDEMPLOYERS'LIABILnY ANYPROPRIETORIPARTNERIEXECUTIVE YIN OFFICERIMEMBEREXCLUDED? NIA AMX-082-0021-003 10/112010 10/112020 X I PER 0 - SIAIUIt 'K E.L EACH ACCIDENT S1.000.000 E.L. DISEASE - EA EMPLOYEE S1,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $1,000.000 DESCRIPTION OF OPERATIONS I LOCATIONS (VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached If more space Is required) :tat I iFIUAI t MULUEK CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Proof of Coverage Only AUTHORIZED REPRESENTATIVE e ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD '4ce�►��v� CERTIFICATE OF LIABILITY INSURANCE E° 06/0412019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 14OLOM THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, TFC CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORmEo REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the csrtif Rift h*ldor is an ADDITIONAL INSURED, the palicy(4s) must be +ndorseld. If SU8110GATION IS WAIVED, subim to the forms and conditions of the policy, certain policies may requite an endorsement A Statement on ttlis certificate does not confer rights to the eerdfaaats holder In lieu of such endomoment[s]. RRoouaR CONTAaJOEY MUNTUOMEW STATE FARM MUTUAL INSURANCE COMPANY. 714 528-7WS 1 y 734-536i3a�8 State�f,am 1370 BREA BLVD STE_ 150 JOEYIOJOEYMONTGOMERY_COM q;! FUL LERTON, CA 92$35 � ----- 3�a[Rss�N<s<amM►ecovrseAc� - - - — eu�r - - ISUMNA_SIM* Farm MhuW a Automobile Insurance Company T57TS ___�_– _ ,-- -- -- - _ -- wsuRm SERVICE FIRST CaNTRACTOWS— NECWaRK _ DBA' SERVICE FIRST e$„ 13 ; - 2510 N. GRAND AVENUE SUITE # 110 SANTA ANA, CA 92705 PMOKAL S ADY INJUeW 5 Gf$fLAGGRiGA7'ZL.WrrAPPLIES PER R u%jvr-R %2r- 1 CEERTIFICATE N UMHER- PFInCIew WINRFO- TH151S TO CER IIFY THAT THE POLICIES OF INSURANCE uSTED BELOW HAVE BEEN ISSUED TO THE INSURED kAAIED ABOVE FOR THE POLICY PERIOD INDICATED N0TVXrHSTAN0ING ANY REQUIRF-mENT. TERHI OR CONDmON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO IAHICH THIS CERTIFICATE MAY SE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN tS SUBJECT TO ALL THE TERMS. IXCLUSiONS AND CONDMOtNS OF SUCH POLICI1i5 UMITS SHOWN MAY HAVE BEEN R_ eOUCED BY PASO CLAMS. LTR TfPEOFIMPAKE Mw YDLiL7Ni14el7i iIp11;r PGIIc7E7fP L1MIiT5 GOMs1lPIcuL 0Elt[RAL Lu.sluTr 16AE-H0=UkWNL:E } S • CLAIMS MADE ' 0CCL% ILk�CE R'grME p ra � • I_�+Iruls[s a axv>rn �31j 3 _ ' M�7E1[NUrn' aW�7vrxrp ! 3 PMOKAL S ADY INJUeW 5 Gf$fLAGGRiGA7'ZL.WrrAPPLIES PER GEM,RALAG E -AM S Pp ICY f LOG I I ` JC4T I ucrs .Cc PJcCl3 . S A AUTOMOftE X ""Y AWAUTO UTO 133 3423+09-75 061072019 0600712020 +amu .10— 5 1.000.000 . X Ali GVMR D SCMEDUL£D OMLY KAIRY (F*o zwj E L---- —�-- -- -- ----- . - S OWLY a� AWY (Pw eppanoj X HIRER AUTOS X KIN S UMRMIA Wa SUR C&CH CkX.711RAENCE S lxCRti UAej CLAIM�YIA6E ..T -._- l4GtaRf(S1TE - ---- S - . DM i [f�,7 s - - I Is MtlORI(1Ra CtA1PB15At70It I.i AfpEllRtfT[RSSTA wI e AW PROPR!["ORPaVE OFFlfirICMU BER MLLOC1aJ E N f A i L EACs#EACs# ACCsAEAif i Ir vlrcxkh� vrdx c E 1 :%SE� • E:+11r1fFi0YE # fYe•T nATI WOW F W,FA.^,En5V LWIT S j DE7CRIPTHM OF OPQtATKM f LOCATms f vwAcus IACOna iel, A8011a of PMI094 50lIM►i0. 1W b, ~1d R Iwo. lv.W u 16e191.dl -- $-Amtal_L -A I ICJrr FOR BUDDING AND INFORMATION PURPOSES SHOULD ANY OF THE ABOVE DESCRIBED POLK3M BE CANCELLED BEFORE THE WNtATION DATE T1I4REDF, UOTICE WILL 1119 DELIVERM IN ACCORDANCE VJrrH TNF POLICY PRQV=ONS. F1i.Ir, �_ ACORD CORPO"TIOIII_ All tiohts reserved. ACORD 25 (2014!01) The ACORD name and logo aro rllgistemd maters of ACORD 1001488 1328A9.9 02-04-2014