00-0615_MOBILE HOME INSPECTORS_Personal Services Agreement0 4
PERSONAL SERVICES AGREEMENT
THIS AGREEMENT is made and entered into this 1�5 day of June, 2000, by
and between the San Juan Capistrano Community Redevelopment Agency (hereinafter
referred to as the "Agency") and Mobile Home Inspectors, (hereinafter referred to as
"Consultant"), whose Corporate Office is located at 16932 Gothard Street Huntington
Beach, Unit N California. 92647.
RECITALS:
WHEREAS, Agency desires to retain the services of Consultant for the inspection
of mobile homes and mobile home parks throughout the City; and
WHEREAS, Consultant is qualified by virtue of experience, training, education and
expertise to accomplish such services.
NOW, THEREFORE, Agency and Consultant mutually agree as follows:
Section 1. Scope of Work.
The scope of work to be performed by Consultant shall consist of those tasks as set
forth in Exhibit 'A" attached and incorporated herein by reference.
Consultant warrants that all of its services shall be performed in a competent,
professional and satisfactory manner and in accordance with the prevalent standards of
its profession.
Section 2. Term.
This Agreement shall commence on the effective date of this Agreement and
services required hereunder shall be completed by no later than May 20, 2001. If services
are not completed by the expiration date of the agreement, the Executive Director,
at his discretion, may amend the agreement to extend the expiration date for up to
an additional three months if the Consultant has performed the tasks described in
the scope of work satisfactorily. Any extensions granted by the Executive Director
will not affect the total compensation specified in Section 3.1 of this Agreement.
Section 3. Compensation.
3.1 Amount.
Total compensation for the scope of services for this Project shall not exceed
Forty -Seven Thousand, Six Hundred Fifty Dollars ($ 47.650), as set forth in Exhibit "B,"
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attached and incorporated herein by reference.
3.2 Rate Schedule.
The services shall be billed to the Agency at the rates set forth in Exhibit "C,"
attached and incorporated herein by reference. Included within the compensation are all
the Consultant's ordinary office and overhead expenses incurred by it, its agents and
employees, including meetings with the Agency representatives and incidental costs to
perform the stipulated services. Submittals shall be in accordance with Consultant's
proposal.
3.3 Method of Payment.
Consultant shall submit monthly invoices based on total services which have
been satisfactorily completed and specifying a percentage of projected completion for
approval by the Agency. The Agency will pay monthly progress payments based on
approved invoices in accordance with this Section.
For extra work not part of this Agreement, a written authorization from Agency
is required prior to Consultant undertaking any extra work.
3.4 Records of Expenses.
Consultant shall keep complete and accurate records of all costs and
expenses incidental to services covered by this Agreement. These records will be made
available at reasonable times to Agency.
Section 4. Independent Contractor.
It is agreed that Consultant shall act and be an independent contractor and not an
agent or employee of Agency, and shall obtain no rights to any benefits which accrue to
Agency's employees.
Section 5. Limitations Upon Subcontracting and Assignment.
The experience, knowledge, capability and reputation of Consultant, its principals
and employees were a substantial inducement for Agency to enter into this Agreement.
Consultant shall not contract with any other entity to perform the services required without
written approval of the Agency. This Agreement may not be assigned, voluntarily or by
operation of law, without the prior written approval of the Agency. If Consultant is permitted
to subcontract any part of this Agreement by Agency, Consultant shall be responsible to
Agency for the acts and omissions of its subcontractor as it is for persons directly
employed. Nothing contained in this Agreement shall create any contractual relationships
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between any subcontractor and Agency. All persons engaged in the work will be
considered employees of Consultant. Agency will deal directly with and will make all
payments to Consultant.
Section 6. Changes to Scope of Work.
In the event of a change in the Scope of Work provided for in the contract
documents as requested by the Agency, the Parties hereto shall execute an addendum to
this Agreement setting forth with particularity all terms of the new agreement, including but
not limited to any additional Consultant's fees.
Section 7. Familiarity with Work and Construction Site.
By executing this Agreement, Consultant warrants that: (1) it has investigated the
work to be performed; (2) it has investigated the proposed construction site, including the
location of all utilities, and is aware of all conditions there; and (3) it understands the
facilities, difficulties and restrictions of the work under this Agreement. Should Consultant
discover any latent or unknown conditions materially differing from those inherent in the
work or as represented by Agency, it shall immediately inform Agency of this and shall not
proceed with further work under this Agreement until written instructions are received from
the Agency.
Section 8. Time of Essence.
Time is of the essence in the performance of this Agreement.
Section 9. Compliance with Law.
Consultant shall comply with all applicable laws, ordinances, codes and regulations
of federal, state and local government.
Section 10. Conflicts of Interest.
Consultant covenants that it presently has no interest and shall not acquire any
interest, direct or indirect, which would conflict in any manner or degree with the
performance of the services contemplated by this Agreement. No person having such
interest shall be employed by or associated with Consultant.
Section 11. Copies of Work Product.
At the completion of the contract period, Consultant shall have delivered to Agency
at least one (1) copy of any final reports and architectural drawings containing Consultant's
findings, conclusions, and recommendations with any support documentation. All reports
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submitted to the Agency shall be in reproducible format.
E
All services to be rendered hereunder shall be subject to the direction and approval
of the Agency.
Section 12. Ownership of Documents.
All reports, information, data and exhibits prepared or assembled by Consultant in
connection with the performance of its services pursuant to this Agreement are confidential
to the extent permitted by law, and Consultant agrees that they shall not be made available
to any individual or organization without prior written consent of the Agency. All such
reports, information, data, and exhibits shall be the property of the Agency and shall be
delivered to the Agency upon demand without additional costs or expense to the Agency.
The Agency acknowledges such documents are instruments of Consultant's professional
services.
Section 13. Indemnity.
Consultant agrees to protect, defend and hold harmless Agency, its elected and
appointed officials and employees from any and all claims, liabilities, expenses or damages
of any nature, including attorneys' fees, for injury or death of any person or damage to
property or interference with use of property and for errors and omissions committed by
Consultant arising out of or in connection with the work, operation or activities of
Consultant, its agents, employees and subcontractors in carrying out its obligations under
this Agreement.
Section 14. Insurance.
Insurance required herein shall be provided by Admitted Insurers in good standing
with the State of California and having a minimum Best's Guide Rating of A- Class VII or
better.
14.1 Comprehensive General Liability.
Throughout the term of this Agreement, Consultant shall maintain in full force
and effect Comprehensive General Liability coverage in the following minimum amounts:
$500,000 property damage;
$500,000 injury to one person/any one occurrence/not limited to contractual
period;
$1,000,000 injury to more than one person/any one occurrence/not limited
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to contractual period.
14.2 Comprehensive Automobile Liability.
Throughout the term of this Agreement, Consultant shall maintain in full force
and effect Comprehensive Automobile Liability coverage, including owned, hired and non -
owned vehicles in the following minimum amounts:
$100,000 property damage;
$100,000 injury to one person/any one occurrence/not limited to contractual
period;
$300,000 injury to more than one person/any one occurrence/not limited to
contractual period
14.3 Worker's Compensation.
If Consultant intends to employ employees to perform services under this
Agreement, Consultant shall obtain and maintain, during the term of this Agreement,
Worker's Compensation Employer's Liability Insurance in the statutory amount as required
by state law.
14.4 Proof of Insurance Requirements/Endorsement.
Prior to beginning any work under this Agreement, Consultant shall submit
the insurance certificates, including the deductible or self -retention amount, and an
additional insured endorsement to the Consultant's general liability and umbrella liability
policies using ISO form CG 20 10 11 85 (in no event with an edition date later than 1990)
to the Agency's General Counsel for certification that the insurance requirements of this
Agreement have been satisfied.
14.5 Notice of Cancellation/Termination of Insurance.
The above policy/policies shall not terminate, nor shall they be cancelled, nor
the coverages reduced, until after thirty (30) days' written notice is given to Agency, except
that ten (10) days' notice shall be given if there is a cancellation due to failure to pay a
premium.
14.6 Terms of Compensation.
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Consultant shall not receive any compensation until all insurance provisions
have been satisfied.
14.7 Notice to Proceed.
Consultant shall not proceed with any work under this Agreement until the
Agency has issued a written "Notice to Proceed" verifying that Consultant has complied
with all insurance requirements of this Agreement.
Section 15. Termination.
Agency and Consultant shall have the right to terminate this Agreement without
cause by giving thirty (30) days' advance written notice of termination to the other party
In addition, this Agreement may be terminated for cause by providing ten (10) days'
notice to the other party of a material breach of contract. If the other party does not cure
the breach of contract, then the agreement may be terminated subsequent to the ten (10)
day cure period.
Section 16. Notice.
All notices shall be personally delivered or mailed to the below listed addresses, or
to such other addresses as may be designated by written notice. These addresses shall
be used for delivery of service of process:
To Agency: San Juan Capistrano Community Redevelopment Agency
32400 Paseo Adelanto
San Juan Capistrano, CA 92675
Attn: Director of Administrative Services
To Consultant: Mobile Home Inspectors
16932 Gothard Street, Unit N
Huntington Beach, California, 92647.
Section 17. Attorneys' Fees.
If any action at law or in equity is necessary to enforce or interpret the terms of this
Agreement, the prevailing party shall be entitled to reasonable attorneys' fees, costs and
necessary disbursements in addition to any other relief to which he may be entitled.
Section 18. Dispute Resolution.
In the event of a dispute arising between the parties regarding performance or
interpretation of this Agreement, the dispute shall be resolved by binding arbitration under
the auspices of the Judicial Arbitration and Mediation Service ("JAMS").
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Section 19. Entire Agreement.
This Agreement constitutes the entire understanding and agreement between the
parties and supersedes all previous negotiations between them pertaining to the subject
matter thereof.
IN WITNESS WHEREOF, the parties hereto have executed this Agreement.
ATTEST:
II171..,I W .i/'i .i ... _
APPROVED AS TO FORM:
a �1-�
John R. 8haw, City Attorney
SAN JUAN CAPISTRANO COMMUNITY
REDEV,ELO.PMENT AGENCY
Executive Director
MOBILE HOME INSPECTORS
By: 14
Jt r Milan
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• •
EXHIBIT "A"
SCOPE OF TASKS
1. Prepare and distribute a letter to all mobile home PARK owners regarding the
date and time of the mobile home Title 25 inspection and the purpose of the
inspection.
2. Conduct the inspection of each mobile home park to conduct an inspection to
identify park owner Title 25 violations.
3. Provide a written inspection report identifying the Title 25 violations for each
PARK owner.
4. Prepare and distribute a letter to all mobile home residents regarding the date
and time of the mobile home Title 25 inspection and the purpose of the
inspection.
5. Conduct the inspection of each individual mobile home resident space to identify
resident Title 25 violations.
6. Provide a written inspection report identifying the Title 25 violations for each
individual resident mobile home space. This report may be a comprehensive
listing of all violations within the park by owner and resident as opposed to an
individual report for each space.
7. Prepare and distribute a letter notifying the park owner of any Title 25 violations.
The selected firm shall be responsible for preparing and distributing all letters.
8. Prepare and distribute a letter notifying each resident of any Title 25 violations.
City staff shall review the correspondence to ensure that all available city
programs are identified to assist in correcting the violations.
9. Conduct a follow-up inspection of each mobile home space, as necessary, and
each mobile home park to determine that all identified Title 25 violations have
been corrected. The follow-up inspection shall show (a) all items that have been
corrected by park name and space number and (b) all items that remain to be
corrected by park name and space number.
10. Coordinate with City staff to provide inspection approval information.
11. Coordinate with City staff and attend meetings between the City staff and/or park
owners and park residents, as necessary.
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AMENDATORY AGREEMENT*
0�
SiThis Amendatory Agreement is made this 71h day of August, 2001, by and
between the City of San Juan Capistrano, hereinafter referred to as "CITY", and MOBILE
HOME INSPECTORS. hereinafter referred to as "CONSULTANT'.
Whereas, CITY and CONSULTANT entered into an agreement dated June 15, 2000
for consultant services for inspection of mobile home parks throughout the City; and
Whereas, the term of the agreement between CITY and CONSULTANT expired
May 20, 2001; and
Whereas, the consultant has not yet completed two of the park follow-up
inspections, and the CITY and CONSULTANT hereby desire to extend the term of the
agreement to October 20, 2001.
NOW, THEREFORE, BE IT RESOLVED between CITY and CONSULTANT as
follows:
Section 1. Section 2 (Term) is hereby amended to read as follows:
"This Agreement shall commence on the effective date of this Agreement
and services required hereunder shall be completed by no later than
October 20, 2001."
Section 2. All other terms and conditions of said agreement shall remain in full
force and effect. A
L411MOMMU 'I[OL•17699:lei
L0
h, City Manager
MOBILE HOME INSPECTORS
In
ATTEST:
�2
R. Monahan, City
APPROVED AS TO FORM:
John R. Shaw,jCity Attorney
ce : ado 1. -sro ` ( vt
1—
Filian
ACORD . CERTIFIGWE OF
LIABILITY INS ANCEPID TS DATE (MMIDD/YY)
GREGO-6 09/22/99
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Powers & Company
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Insurance Agents & Brokers
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P. r. -Box 619043 Lic #OBO2564
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Roseville CA 95661-9043
COMPANIES AFFORDING COVERAGE
Richard Powers
Phone No. 916-630-8643 F..N., 800-783-0083
COMPANY
A Savers Property & Casualty
INSURED
COMPANY
B
COMPANY
Gregory K Filian Contracting &
Mobile Home Inspectors
C
16932 Gothard St Unit # N
Huntington Beach CA 92647
COMPANY
D
COVERAGES
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE
BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE
BEEN REDUCED BY PAID CLAIMS.
COPOLICYEFFECTIVE
LTR
IYPE OF INSURANCE
POLICY NUMBER
DATE (MM/DDM')
POLICY EXPIRATION
DATE (MM/DD/YY)
LIiNITS
GENERAL
LIABILITY
GENERAL AGGREGATE $1,000,000
A
X
COMMERCIAL GENERAL LI ABILITY
ACAM10007843CA9909
08/31/99
08/31/00
PRODUCTS - COMP/OP AGO $1,000,000
CLAIMS MADE OCCUR
PERSONAL B ADV INJURY $50,000
OWNER'S& CONTRACTOR'S PROT
.'I�
/ C.
� /1
1f//i_,-..-
EACH OCCURRENCE $500,000
FIRE DAMAGE (Any one fire) $50,OD0
X
modified occurenc
MED EXP (Any one person) $ 1 000
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOSi
SCHEDULED AUTOS
r j
� / jai• � �
C
L�� �•
�r •--` ( � � %
/�
i ..�.''�
COMBINED SINGLE LIMIT $
BODILY INJURY
(Per Person) $
BODILY INJURY $
(Per emident)
HIRED AUTOS
NON -OWNED AUTOS
PROPERTY DAMAGE $
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT $
OTHER THAN AUTO ONLY:
ANY AUTO
EACH ACCIDENT $
AGGREGATE $
EXCESS LIABILITY
EACH OCCURRENCE $
AGGREGATE $
UMBRELLA FORM
$
OTHER THAN UMBRELLA FORM
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
- OTH-
TO Y LIMITS
TORY LIMITS ER
EL EACH ACCIDENT E
THE PROPRIETOW INCL
PARTNERSIEXECUTIVE
EL DISEASE - POLICY LIMIT $
EL DISEASE - EA EMPLOYEE $
OFFICERS ARE. EXCL
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS
CERTIFICATE HOLDER IS SHOWN AS ADDITIONAL INSURED BUT ONLY WITH RESPECT TO
LIABILITY ARISING OUT OF OPERATIONS PERFORMED BY NAMED INSURED
ALL CA OPERATIONS
CERTIFICATE HOLDER
CANCELLATION
C/ SANJU
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
CITY OF SAN JUAN CAPISTRANO
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
C/O: LYNETTE ADOLPHSON
10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
FAX: 949-493-1053
32400 PASEO ADELANTO
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
SAN JUAN CAPI STRANO CA 92675
OF ANY KIND UPON THE COMPANY, ITS AGENTS OR R ESENTATIVES.
AUTHORIZED REPRESENTATIV ,,/
Richard Powers //( //
ARKO
ACORD 25-S (1/95)
l ���lll RA ION 1988
Policy Number ACAM10007843CA9909 Commercial General Liability
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
ADDITIONAL INSURED ----OWNERS, LESSEES OR
CONTRACTORS (FORM B)
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART.
SCHEDULE
NAME OF PERSON ORGANIZATION:
CITY OF SAN JUAN CAPISTRANO
32400 PASEO ADELANTO
SAN JUAN CAPISTRANO, CA 92675
ALL CA OPERATIONS
(If no entry appears above, information required to complete this endorsement will be shown in the
Declarations as applicable to this endorsement.)
WHO IS AN INSURED(Section II) is amended to include as an insured the person or organization shown
in the Schedule as an insured but only with respect to liability arising out of your ongoing operations
performed for that insured.
CG 20 10 10 93 Copyright, Insurance Services Office, Inc. 1992
0 • SO
STATE P.O. BOX 807, SAN FRANCISCO,CA 94101-0807
COMPENSATION
INSURANCE
FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
POLICY NUMBER: 1059203 - 99
ISSUE DATE: 12-01-99 CERTIFICATE EXPIRES: 12-01-00
CITY OF SAN JUAN CAPISTRANO JOB: ALL OPERATIONS
COMMUNITY REDEVELOPMENT AGENCY-LYNNETTE ADOLPHSON
32400 PASEO ADELANTO
SAN JUAN CAPISTRANO,
CA. 92675
This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the
California Insurance Commissioner to the employer named below for the policy period indicated.
This policy is not subject to cancellation by the Fund except upon 30 days'. advance written notice to the employer.
We will also give you 30 days' advance notice should this policy be cancelled prior to its normal expiration.
This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded
by the policies listed herein. Notwithstanding any requirement, term, or condition of any contract or other document
with respect to which this certificate of insurance 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.
2KRRESIDENT
EMPLOYER'S LIABILITY LIMIT INCLUDING"DEFENSE COSTS: $1_,.000,000.00 PER OCCURRENCE.
STANDARD EXCLUSION: INDIVIDUAL EMPLOYERS AND HUSBAND AND WIFE EMPLOYERS ARE NOT'ELIS14E
FOR BENEFITS AS EMPLOYEES UNDER THIS POLICY.
ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS'. NOTICE EFFECTIVE 12/01/99 IS ATTACHED TO AND
FORMS A PART OF THIS POLICY. "
EMPLOYER _ LEGAL NAME
F—.I�L IAN..CpNTRAC OBILE HOME 6M (�,� FILIAN, GREGORY AND
h pECTORS _ _ FILXAN, DEBORAH
18932 GOTHARD UNIT N
HUNTINGTON BEACH CA 92647
PRINTED: 0•
THIS DOCUMENT HAS A BLUE PATTERNED BACKGROUND ',I IF I'I s Ikev 2 ob,
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EMPLOYER _ LEGAL NAME
F—.I�L IAN..CpNTRAC OBILE HOME 6M (�,� FILIAN, GREGORY AND
h pECTORS _ _ FILXAN, DEBORAH
18932 GOTHARD UNIT N
HUNTINGTON BEACH CA 92647
PRINTED: 0•
THIS DOCUMENT HAS A BLUE PATTERNED BACKGROUND ',I IF I'I s Ikev 2 ob,
CERTI TE OF INSURANCE WECTIVE DATE
CERTIFICATE
ALLSTATE INSURANC COMPANY Home Office, Northbrook, JUN 30, 199`
Illinois, hereby certifies that the following insurance is in force:
POLICYHOLDER
POLICY NUMBER POLICY PERIOD
GREGORY & DEBBIE FILIAN
APT 101 0 24 743750 12/30
21851 NEWLAND AVE
HUNTINGTON BCH CA 92646
The person or oranization designated below is described in the policy as:
J
S C REDEVELOPMENT
32400 PASEO ADELANTO
SAN JUAN CAPISTRANO CA 92675-3603
At
1201 AM
Standard
JUN 30, 1999 Time
WITH NO FIXED DATE
OF EXPIRATION
UENHOLDER
(Loss Payable Clause)
X ADDITIONAL
INTERESTED PARTY
AGENT J GILES INS AGY
PHONE 714 963-6363
Coverages designated below are afforded for each described vehicle:
BI 100,000 EA.PERS.-300,000 EA.000. 95 CARVN 2B4GH25K5SR129354
PD 100,000 EA. OCC.
COLLISION -*250 DED. COMPREHENSIVE -9100 DED.
BI 100,000 EA.PERS.-300,000 EA.000. 86 FORDT 1FTCF15Y5GPB96132
PD 100,000 EA. OCC.
COLLISION -9250 DED. COMPREHENSIVE -9100 DED.
See reverse side for provisions concerning Loss Payable Clause and Additional Interested Party
Endorsements.
This Certificate of Insurance neither affirmatively nor negatively amends, extends or alters the cover-
age afforded by the policy referred to above.
U6673 -i PRINTED IN U.S.A.
The Loss Payable Clause of such policy provides:
"The company reserves the right to cancel such policy
at any time as provided by its
terms, but in such
case the company shall
notify the
Lienholder when not less than
ten days thereafter
such cancellation shall be
effective
as to the interest of said Lien -
holder therein and
the company shall have
the right,
on like notice, to cancel this
agreement."
The Additional Interest Endorsement of such policy, in part, provides:
1. . . such insurance as is afforded by the policy" for automobile liability insurance
listed on the reverse side hereof applies also to the person or organization named as
Additional Interested Party.
"As respects such . . . interest, no cancellation . . . and no endorsement . . . adversely
affecting such additional interest, shall be effective until ten (10) days following the
mailing of written notice (to the person or organization) of such cancellation or en-
dorsement ... "
r -I
a
ACI CERTIFI TE OF LIABILITY INSURANC ID SW I DATE(MMIDDIYY)
GO -6 09/22/00
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Powers & Company
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Insurance Agents & Brokers
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P. 0. Box 619043 Lic #OBO2564
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE
Roseville CA 95661-9043
Phone:916-630-8643 Fax:800-783-0083
INSURED
INSURER A: Certain Undwrs @ Lloyds London
INSURER B:
Gregory K Filian Contracting &
Mobile Home Inspectors
16932 Gothard St Unit N
Huntington Beach CA 9 647
INSURER C:
INSURER D.
INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR
TYPE OF INSURANCE
POLICY NUMBER
DATE MM/DD/YY
GATEMM/DD/YY
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE $500,000
A
X GENERALLIABILITY
ACAM10007843CAOOOS
08/31/00
08/31/01
FIRE DAMAGE (Any one fire) S 50,000
COMMERCIAL
CLAIMS MADE O OCCUR
MED EXP (Anyone person) $ 1,000
PERSONAL S ADV INJURY $50D, 000
X Owner/Cont Prot.
X I modified occurenc
GENERAL AGGREGATE $ 1,000,000
GENL AGGREGATE LIMIT APPLIES PER:
PRODUCTS m COMPIOP AGG $ 1,000,000
POLICY JrCT 7 LOC
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT $
ANY AUTO
(Ea accident)
BODILY INJURY $
ALL OWNED ALTOS
SCHEDULED AUTOS
(Per Person)
BODILY INJURY $
HIRED AUTOS
NON -OWNED AUTOS
(Per accident)
PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT $
OTHER THAN EA ACG $
ANY AUTO
AUTO ONLY: AGG $
EXCESS LIABILITY
EACH OCCURRENCE $
OCCUR CLAIMS MADE
AGGREGATE $
S
S
DEDUCTIBLE
1 S
RETENTION $
WORKERS COMPENSATION AND
TORY LIMITS ER
EMPLOYERS LIABILITY
E.L. EACH ACCIDENT $
E.L. DISEASE - EA EMPLOYEE $
E.L. DISEASE - POLICY LIMIT
OTHER
C
C -n
CJS
z tTo� .A
ti
DESCRIPTION OF OPERATIONS/LOCATIONSVEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS m a-< 1177
Certificate holder is shown as Additional Insured but only with respect
liability arising out of operations performed by named insured. N-1'^mm fA m
n=y� C7
i -cm I Irr�/ IC nu"ucR T I AQUI I IUNAL IY.UNt.; IIYDVRCRLCIICR: q MMIVVCLLN I IVIY
CITYSAN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City of San Juan Capistrano DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN
Redevelopment Agency NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
Fax: 949-493-1053/Dawn IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, I15 AGENTS OR
32400 Paseo Adelanto
San Juan Capistrano CA 92675 REPRESENTATIVES.
25-S(71971
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
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).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
0 0
Policy Number ACAM10007843CA0008 Commercial General Liability
THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY
ADDITIONAL INSURED ----OWNERS, LESSEES OR
CONTRACTORS (FORM B)
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART.
SCHEDULE
NAME OF PERSON ORGANIZATION:
City of San Juan Capistrano
Redevelopment Agency
32400 Paseo Adelanto
San Juan Capistrano, Ca. 92675
All Ca operations
(If no entry appears above, information required to complete this endorsement will be shown in the
Declarations as applicable to this endorsement.)
WHO IS AN INSURED(Section II) is amended to include as an insured the person or organization shown
in the Schedule as an insured but only with respect to liability arising out of your ongoing operations
performed for that insured.
CG 20 10 10 93 Copyright, Insurance Services Office, Inc. 1992
Sent by: POWERS & COMPANY
800 783 0083; 09/25/00 3:52PM;htFrc g218;Page 1/3
acoRv
CERTIFICAM OF LIABILITY INSU C IDSw DATE IMMODAYY)
GO -6 09/25/0.0
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Power, 6 company ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Insurance Agents S Brokers HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P. O. Box 619043 J is NOBO2564 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Roseville CA 95661-9043
Phone :916-630-B643 Fax:800-78y3r-0083 INSURERS AFFORDING COVERAGE
INSURED
Gregory 8 Filian Contracting &
mobile Rome Inspectors
16932 Gothard St UnitY N
Huntington Beach CA 92647
COVERAGES
INSLRER A Certain Undwrs- @
INSLRER B
INSLRER C _ -
INSLRERD_ -- ----_ _ ---_-_
INSLRER E
THE POLICIES OF INSURANCE LISTED BELOW WAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED- NOTWITHSTANDWG
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- AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAMS.
---' ------ POLICYEFFECYNE PDTfCYTOM-`TIOTI
TYPE OF INSURE PoDGYNUM8eA DATE MMIX11" DATE MMICI LIMITS
L R ANC
GENERAL LWBILITY
_
EACH OCCURRENCE 5 500 , 000
A
Y CDMMEROALGENERrALLIABILITY
ACAKI0007843CAO008
06/31/00
08/31/01
FIRE DAMAGE (AT, coo fim) $50,000
CLNMS MADE ` .I OCCUR
MED EXP (A,V— p--) $1,000
IX Owner/Cont Prot.
'
PERSONAL A ADV INJURY {500,000
X
modified OCCurene
GENERAL AGGREGATE 11,000,000
PRODUCTS-COMPIOP AGG S 1,000,000
DEF L AGGREGATE LIMIT APPLIES PER
P0.1Cv j� _ - Lac
- - -
AUTOMOBILE
LIABILITY
COMBINED SINGLE OMIT
:
--
AN'Y AUTO
(Fa
----
RIXXLY INJURY
-
ALL OWNED AUTOS
SCHEDULED AUTOS
(PGI peRe^)
s
B%=INJURY
HIRED AUTOS
W
NON-ONEO AUTOS
(Pb,&Sdbrp
5
PROPERTY DAMAGE
s
(P.,aDwdGM
GARAGE LIABILITY
AUTO ONLY EA ACCIDENT
5
ANY AUTO
OTHER THAN �_ ACC
'f
AUTO ONLY AGG
7
EXCESS LIABILITY
EACHOCCURRENCE
$
OCCUR �) CLAIMS PUDE
I
AGGREGATE
S
DEDUCTIBLE
f
REIENRON $
i
WORXERSOOMPBISATION AND
TORY U1014 ER
EMPLOYERS' LIAWL`O
EL EACH ACCIDENT S
E L DISEASE - EA EMPLOYE $
EL DISEASE -POLICY LIMB S
OTHER
DESCRIPTION OF OPERATIONS&OOATIW6NRfCLE&%XCLU510N5 ADDED BY ENDORSEMENTISPECLLL PRDIRSIONS
Certificate holder is shown as Additional Insured but only with respeot to
liability arising out of Operations performed by named insured. Form CG2010
11-85 is "Job Speca.£iC" per Carrier guidelines ••A11 Ca operations N/A"
CERTIFICATE HOLDER I I ADDITIONAL W6URED, INGUALR LETTER- A CANCELLATION
City of San Juan Capistrano
Redevelopment Agency
Fax: 949-493-1053/Dawn
32400 Paseo Adelanto
San Juan Capistrano CA 92675
CIT SAN OVE SHOULD ANY OF THE ABDESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATR
DATE THEREOF, THE ISSUING INSURER MILL L ENDEAVOR TO AL 10 DAYS WRITTEN
NOTICE TO THE cERT1FICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TOM SO SHALL
IM✓GSC NO OOLOAT,ON O" LOOKLIYY OT —T KIND UI ON TMC INSURER, ITS AGENTS OR
M
Sent by: POWERS & COMPANY 800 783 0083; 09/25/00 3:52PM;1ltFax /t218;Page 2/3
• Aft is
IMPORTANT
It the certificate holder is an ADDITIONAL INSURED, the poky(les) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
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).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or atter the coverage afforded by the policies listed thereon,
26S
Sent by: POWERS & COMPANY 800 783 0083;
0
Policy Number ACAN410007943CA0008
09/25/00 3:52PM;jejFia_g218;Page 3/3
0
Commercial General Liability
THIS ENDORSEMENT CHANGES THE POLICY, PLEASE. READ IT CAREFULLY
ADDITIONAL INSURED ----OWNERS, LESSEES OR
CONTRACTORS (FORM B)
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART.
SCHEDULE
NAME OF PERSON ORGANIZATION;
City of San Juan Capistrano
Redevelopment Agency
32400 Paseo Adelanto
San Juan Capistrano, Ca. 92675
All Ca operations
(if no entry appears above. information required to complete this endorsement will be showtt in the
Declarations as applicable to this endorsement.)
WHO IS AN INSURED(Section 11) is amended to include as an insured the person or organization shown
in the Schedule as an insured but only with respect to liability arising out of your ongoing operations
performed for that insured.
rt -9n In Inm -.
acoRv CERTIFIC E OF LIABILITY
INS NC ID SW
GO -6
DATE (MM DD YV)
09/25/00
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Powers S Company
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Insurance Agents 6 Brokers
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P. O. Box 619043 Lie $OB02564
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE
Roseville CA 95661-9043
Phone: 916-630-8643 Fax:800-783-0083
INSURED
INSURER A- Certain Undwrs @ Lloyds London
INSURER B.
Gregory K Filian Contracting &
Mobile Home Inspectors
16932 Gothard St Unit
Huntington Beach CA 916,47
INSURER C.
INSURER D.
INSURER E:
08/31/01
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR
TYPE OFINSURANCE
POLICY NUMBER
EFFECTIVE
DATE MM/DD/YY
POLICY EXPIRATION
DATE MPOLICY
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE $500,000
A
X COMMERCIAL GENERAL LIABILITY
ACAM10007843CAOOOS
08/31/00
08/31/01
FIRE DAMAGE (Any one fire) $50,000
CLAIMS MADE ❑ OCCUR
MED EXP (Any one person) $ 1,000
PERSONAL B ADV INJURY s500,000
X Owner/Cont Prot.
X modified occurenc
GENERAL AGGREGATE $ 1,000,000
GI AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGO $ 1,000,000
POLICY PRO- LOC
JECT
AUTOMOBILE
LIABILITY
ANY AUTO
COMBINED SINGLE LIMIT $
(Ea accident)
BODILY INJURY $
(Per person)
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY $
(Per accident)
HIRED AUTOS
NON -OWNED AUTOS
PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT $
OTHER THAN EA ACC $
ANY AUTO
AUTO ONLY. AGO $
EXCESS LIABILITY
EACH OCCURRENCE $
OCCUR CLAIMS MADE
AGGREGATE $
$
DEDUCTIBLE
$
RETENTION $
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
I TORY LIMITS ER
E.L. EACH ACCIDENT $
E.L. DISEASE -EA EMPLOYE $
E . DISEASE - POLICY LIMIT $
OTHER
i
DESCRIPTION OF OPERATIONS/LOCATIONB/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
Certificate holder is shown as Additional Insured but only with respect to z::;vap
liability arising out of operations performed by named insured. Form CG201m"`T� _ o
11-85 is "Job Specific" per carrier guidelines **All Ca operations N/A**� O <
oo m
2 =
VCRIIr1VI11G f1VLYLR j gVUI,IVrygL IryJVM1LV�IryJVM1CR LCIICR: !] MIYVCLLNIIVIY
CITYSAN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED B RE THE EXPIRATION
City of San Juan Capistrano DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN
Redevelopment Agency NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
Fax: 949-493-1053/Dawn IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
32400 Paseo Adelanto
San Juan Capistrano CA 92675 REPRESENTATIVES.
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
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).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
ACORD 25S (7187)
Policy Number ACAM10007843CA0008 Commercial General Liability
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
ADDITIONAL INSURED ----OWNERS, LESSEES OR
CONTRACTORS (FORM B)
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART.
SCHEDULE
NAME OF PERSON ORGANIZATION:
City of San Juan Capistrano
Redevelopment Agency
32400 Paseo Adelanto
San Juan Capistrano, Ca. 92675
All Ca operations
(If no entry appears above, information required to complete this endorsement will be shown in the
Declarations as applicable to this endorsement.)
WHO IS AN INSURED(Section II) is amended to include as an insured the person or organization shown
in the Schedule as an insured but only with respect to liability arising out of your ongoing operations
performed for that insured.
CG 20 10 10 93 Copyright, Insurance Services Office, Inc. 1992
• • SG
STATE P.O. BOX 807, SAN FRANCISCO,CA 94101-0807
COMPENSATION
INSURANCE
FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
POLICY NUMBER: 1058203 - 00
ISSUE DATE: 12-01-00 CERTIFICATE EXPIRES: 12-01-01
CITY OF SAN JUAN CAPISTRANO JOB: ALL OPERATIONS
COMMUNITY REDEVELOPMENT AGENCY-LYNNETTE ADOLPHSON
32400 PASEO AOELANTO
SAN JUAN CAPISTRANO,
CA. 92675
This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the
California Insurance Commissioner to the employer named below for the policy period indicated.
This policy is not subject to cancellation by the Fund except upon 30 days' advance written notice to the employer.
We will also give you 30 days' advance notice should this policy be cancelled prior to its normal expiration.
This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded
by the policies listed herein. Notwithstanding any requirement, term, or condition of any contract or other document
with respect to which this certificate of insurance 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.
RESIDENT
EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000.00 PER OCCURRENCE.
STANDARD EXCLUSION: INDIVIDUAL EMPLOYERS AND HUSBAND AND WIFE EMPLOYERS ARE NOT ELIGIBLE
FOR BENEFITS AS EMPLOYEES UNDER THIS POLICY.
ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 12/01/00 IS ATTACHED TO AND
FORMS A PART OF THIS POLICY.
EMPLOYER
FILIAN CONTRACTING & MOBILE NOME
INSPECTORS
16832 GOTHARD UNIT N
HUNTINGTON BEACH CA 92647
LEGAL NAME
FILIAN, GREGORY AND
FILIAN, DEBORAH
..
0'
THIS DOCUMENT HAS A BLUE PATTERNED BACKGROUND SCF 1026s iREV. 2-�sj
Cz
!V
Pl1
A�
<
Q
in
�
C2
O
LEGAL NAME
FILIAN, GREGORY AND
FILIAN, DEBORAH
..
0'
THIS DOCUMENT HAS A BLUE PATTERNED BACKGROUND SCF 1026s iREV. 2-�sj
STATE P.O. BOX 420807, SAN FRANCISCO, CA 94142-0807
COMPENSATION
INSURANCE
FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
NOVEMBER 27, 2000 POLICY NUMBER:
CERTIFICATE EXPIRES:
F -
CITY OF SAN JUAN CAPISTRANO
COMMUNITY REDEVELOPMENT AGENCY-LYNNETTE
32400 PASEO ADELANTO
SAN JUAN CAPISTRANO, CA 92675 JOB: ALL OPERATIONS
L
1058203 - 00
12-1-01
This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California
Insurance Commissioner to the employer named below for the policy period indicated.
30
This policy is not subject to cancellation by the Fund except upon teWyS advance written notice to the employer.
We will also give you T44 advance notice should this policy be cancelled prior to its normal expiration.
This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the
policies listed herein. Notwithstanding any requirement, term, or condition of any contract or other document with
respect to which this certificate of insurance 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.
—w �� IDr/
AUTHORIZED REPRESENTATIVE PRESIDENT
EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE.
ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE
12/01/00 IS ATTACHED TO AND FORMS A PART OF THIS POLICY.
THIS DOCUMENT HAS A BLUE PATTERNED BACKGROUND SCIF 10262 (REV. 3 95)
s
C
N
+vim
<
rn
ca
_
EMPLOYER
�j1�
J
0
z
3
1
F
O
O
FILIAN, GREGORY AND FILIAN, DEBORAH
DBA: FILIAN CONTRACTING & MOBILE HOME INSPECTORS
16932 GOTHARD UNIT N
HUNTINGTON BEACH CA 92647
THIS DOCUMENT HAS A BLUE PATTERNED BACKGROUND SCIF 10262 (REV. 3 95)
NOS • •
`x
3
z
't
z
8 a.r of snN i�nN uvisTn.,Nn'
San Juan Capistrano
Community
Redevelopment
Agency
November 20, 2000
Mr. Greg Filian
Mobile Home Inspectors
16932 Gothard Street Unit N
Huntington Beach, CA 92648
Re: Renewal of Workers' Compensation Certificate of Insurance (Inspection of Mobile
Homes and Mobile Home Parks throughout the City)
Dear Mr. Filian:
The Workers' Compensation Certificate of Insurance, regarding the above -referenced
service, is due to expire on December 1, 2000. In accordance with your agreement, the
insurance certificate needs to be renewed for an additional period of one year.
Please forward an updated certificate to the City of San Juan Capistrano, attention City
Clerk's office, by the above due date.
If you have any questions, please contact me at (949) 443-6310.
Thank you for your cooperation.
Very truly yours,
Dawn M. Schanderl
Deputy City Clerk
cc: Cheryl Johnson, City Clerk
Lynnette Adolphson, Management Analyst II
32400 Paseo Adelanto
San Juan Capistrano
California 92675
714 - 493-1171
F S/.A IIAA 1A11510.Ary 'I
.i CITY OF l� CAPL�1xA.u�i
San Juan Capistrano
Community
Redevelopment
Agency
August 30, 2000
Mr. Greg Filian
Mobile Home Inspectors
16932 Gothard Street, Unit N
Huntington Beach, California 92647
Re: Renewal of General Liability Certificate of Insurance and Endorsement Form
(Inspection of Mobile Homes and Mobile Home Parks throughout the City)
Dear Mr. Filian:
The General Liability Certificate of Insurance, regarding the above -referenced service, is
due to expire on August 31, 2000. In accordance with your agreement, the insurance
certificate needs to be renewed for an additional period of one year. The agreement
requires a general liability endorsement form (form CG 20 10 11 85 as per agreement)
naming the San Juan Capistrano Community Redevelopment Agency as an additional
insured.
Please forward the updated certificate and endorsement to the City, attention City Clerk's
office, by September 11, 2000.
If you have any questions, please contact me at (949) 443-6310.
Thank you for your cooperation.
jV�er�y truly yours,
Dawn M. Schanderl
Deputy City Clerk
cc: Cheryl Johnson, City Clerk
Lynnette Adolphson, Management Analyst I
32400 Paseo Adelanto
San Juan Capistrano
California 92675
714 - 493-1171
Sent by: POWERS 8 COMPANY 800 783 0083; 09122/00 11:28AM;]O[FMX # 41, ge 1/3
Adik
/-CORD__ , CERVI TE OF LIABILITY INS RANC IDS 6 °ATE'""°B°DD
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Powers E. Company ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Insurance Agents S Broker& HOLDER- THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P. O. Box 619043 Lia #01302564 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Roseville CA 95661-9043
Phone:916-630-8643 Fax:800-783-0083 INSURERS AFFORDING COVERAGE
INSURED ` INSURER Certain Undwra _Lloyds London _
INSURER B
Gregory Til liars Contracting G INSURER 1693 a Hoo mo Ina Unita
1693 Gothard ac CA 3Unit INSURER
Huntington Beach CA 9 647
INSURER E'
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR TME POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH TMS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWNMAYHAVE BEEN REDUCED BY PAID CLAIMS.
LTR TYPE OF INSURANCE I POLICY NUMBER I�bETCPEFFEC POLTCYEg - LIMITS
DATE MMIDpYV GATE MwDDIW
GENERAL LIABILITY
EACH OCCURRENCE _ S 500 , 000
AIX
COMMERCIAL 6E RENAL LIABILITY
ACAM10007843CAOOOB OB/31/00
08/31/01
FREOAMAGEN^yo 1,,,1 150,000___
_I GIAIMB MADE O OCCUR
-
RED EXP (Any enF We ) 51,000
4 X ORDet/COnt Prot._
—
PERSONAL& ADV INJURY 1 SOO,000
GENERAL AGGREGAYE $1,000,000
X modified ocommenc
LIMIT APS PER
GEN'L AGGREGATE PLIE
I
_
PRODUCTS . COMPATP AGO SO 0 , 000
POLICY jF19 I I LOG
AUTOMOBILE LABILITY
GOMMNEOSINGLE LIMIT
t
ANYAUTO
(ER AcclpenR
ALL OWNEDAUTOS
BDOILYINJURY
— _
SCHEDULED AUTOS
(PM PenRrl
1
HIRED AUTOS
BODILY INJURY
NON-0WNED AUTOS
— `— —
(PR, xc106471
PROPERTY DAMAGE
S
(Pw acdtlelO
S
GARAGE
LABILITY
AUTO ONLY. L. ACCICENIT $
--
ANY AUTO
OTHER THAN EA ACC 1
AUTO ONLY AGG 5 _
EXCESS
LABILITY
EACH OCCAINRENCE S
nC,AIMSMADEOCCLR
AGGREGATE S
1
DEIX6TIBLE
1
RETENTION S
S
WORNERS COMPENSATION AND
EMPLOYERS' LIABILITY
_
-
TORY LBAITS : ER
_
E L EACH ACCIDENT
i
EL DISEASE. EA EMPLOY1
EL DISEASE - POLICY LIMIT
OTHER
DESCRIPTION OF OPERATNNISUCATION&NEJRCLES*XCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
Certificate holder is shown as Additional Insured but only with respect to
liability arising out of operations performed by named inaured.
TIFICpTI_
City of San Juan Capistrano
Redevelopment Agency
Fax: 949-493-1053/Dawn
32400 Pasao AcLolanto
San Juan Capistrano CA 92675
Tune)
CITYSAN SHOIILG ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATN
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 BAYS WRITTEN
NOTICE TO THE CERTIFICATEHOLDER "MUD To THE LFTT. BUT FAILURE T3 DOW SHALL
�MPDAr uv OBI�u�iIDN OR LIACILDY OF ANY KIND UPON THE INSURER. ITS AGENTS OR
REPRESENTATIVES
M
800 783 0083; 09122/00 11:29AM;jeLfA 4l41;Page 2/3
;nt by:. POWERS &COMPANY ` _
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s)
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 endorsements)
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authored representative or producer, and the certificate holder, nor does d
affirmatively or negatively amend, extend or atter the coverage afforded by the policies listed thereon
(7107)
lent by: POWERS & COMPANY ODD 783 0083;
Policy Number ACAMI0007843CA0009
09/22/00 11t29AMjtLrya,_4141;Page 313
Commercial General Liability
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
ADDITIONAL INSURED ----OWNERS, LESSEES OR
CONTRACTORS (FORM B)
This endorsement modifies insurance provided under the following:
COMMERCIAL. GENERAL LIABILITY COVERAGE PART.
SCHEDULE
NAME OF PERSON ORGANIZATION.
City of San Juan Capistrano
Redevelopment Agency
32400 Paseo Adelanto
San Juan Capistrano, Ca. 92675
All Ca operations
(If no entty appears above, information required to complete this endorsement will be shown in the
Declarations as applicable to this endorsement.)
WHO IS AN INSLR2ED(Section ll) is amended to include as an insured the person or organization shown
in the Schedule as an insured but only with respect to liability arising out of your ongoing operations
performed for that insured.
CG 20 10 10 93 r ._- - -
Dawn Schanderl
To: Lynnette Adolphson
Subject: Mobile Home Inspectors D
I
Personal Services Agreement requires endorsement form
CC 20 10 11 85 and states in no event with an edition date later than 1990. Farm
provided was CC 20 10 10 93. This may be a point to bring to the attention of any
conSultants who will enter into a personal services agreement with the City/Agency.
Thanks.
0 • SG
STATE P.O. BOX 807, SAN FRANCISCO,CA 94101-0807
COMPENSATION
INSURANCE
FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
POLICY NUMBER: 1058203 - 01
ISSUE DATE: 12-01-01 CERTIFICATE EXPIRES: 12-01-02
CITY OF SAN JUAN CAPISTRANO
COMMUNITY REDEVELOPMENT AGENCY-LYNNETTE
32400 PASEO AOELANTO
SAN JUAN CAPISTRANO, CA 92675
JOB: ALL OPERATIONS
This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the
California Insurance Commissioner to the employer named below for the policy period indicated.
This policy is not subject to cancellation by the Fund except upon 30 days' advance written notice to the employer.
We will also give you 30 days' advance notice should this policy be cancelled prior to its normal expiration.
This certificate ofinsurance is not an insurance policy and does not amend, extend or alter the coverage afforded
by the policies listed herein. Notwithstanding any requirement, term, or condition of any contract or other document
with respect to which this certificate of insurance 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.
2/ PRESIDENT
EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000.00 PER OCCURRENCE.
STANDARD EXCLUSION: INDIVIDUAL EMPLOYERS AND HUSBAND AND WIFE EMPLOYERS ARE NOT ELIGIBLE
FOR BENEFITS AS EMPLOYEES UNDER THIS POLICY.
ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 12/01/01 IS ATTACHED TO AND
FORMS A PART OF THIS POLICY.
EMPLOYER
FILIAN CONTRACTING & MOBILE HOME
INSPECTORS -
16932 GOTHARD ST STE-N
HUNTINGTON BH CA92647
LEGAL NAME
FILIAN, GREGORY AND
FILIAN, DEBORAH
PRINTED:111-20-01
P040
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0
•
STATE P.O. BOX 807, SAN FRANCISCO,CA 94101-0807
COMPENSATION
INSURANCE
FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
POLICY NUMBER: 1058203 - 01
ISSUE DATE: 12-01-01 CERTIFICATE EXPIRES: 12-01-02
CITY OF SAN JUAN CAPISTRANO JOB: ALL OPERATIONS
COMMUNITY REDEVELOPMENT AGENCY-LYNNETTE ADOLPHSON
32400 PASEO ADELANTO
SAN JUAN CAPISTRANO,
CA. 92675
This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the
California Insurance Commissioner to the employer named below for the policy period indicated.
This policy is not subject to cancellation by the Fund except upon 30 days' advance written notice to the employer.
We will also give you 30 days' advance notice should this policy be cancelled prior to its normal expiration.
This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded
by the policies listed herein. Notwithstanding any requirement, term, or condition of any contract or other document
with respect to which this certificate of insurance maybe issued or may pertain; the insurance afforded by the
policies described herein is subject to all the terms, exclusions and conditions of such policies.
PRESIDENT
EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $,1,000,000.00 PER OCCURRENCE.
STANDARD EXCLUSION: INDIVIDUAL EMPLOYERS AND HUSBAND AND WIFE EMPLOYERS ARE NOT ELIGIBLE
FOR BENEFITS AS EMPLOYEES UNDER THIS POLICY. -
ENDORSEMENT #2055 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 12/01/01 IS ATTACHED TO AND
FORMS A PART OF THIS POLICY.
EMPLOYER
FILIAN CONTRACTING & MOBILE HOME
INSPECTORS _
15932 GOTHARD ST STE N.
HUNTINGTON SH CA 92547.,
FILIAN, GREGORY AND
FILIAN, DEBORAH
11-20-01
P0408
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FILIAN, GREGORY AND
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11-20-01
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E
32400 PASEO AD6LANTO
SAN JUAN CAPISTRANO, CA 92675
(949) 493-1171
(949) 493-1053 (FAX)
www.sanjuancapistrano.org
September 6, 2001
Mobile Home Inspectors
16932 Gothard Street, Unit N
Huntington Beach, CA 92647
Re: Amendatory Agreement
Dear Sir or Madam:
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BMRum 1961
1776
MEMBERS OF THE CITY COUNCIL
DIANE L. BATHGATE
JOHN S. GELFF
JOHN GREINER
MATT HART
DAMO M. SWERDUN
CITU MANAGER
GEORGE SCARBOROUGH
Enclosed for your records is an executed original Agreement related to Title 25 health
and safety inspections for mobile homes and mobile home parks.
Services under this agreement are to be provided for the sum of $7,452 and completed
by October 10, 2001.
Please be aware, that evidence of your General Liability Insurance has expired and we
have not received updated information regarding a current policy you may have in force.
No work under this agreement should be conducted, nor payments for work completed,
should proceed until we receive evidence of your insurance. If you have any questions
regarding insurance requirements, please contact Dawn Schanderl, Deputy City Clerk,
(949)443-6310.
If you have any questions regarding the agreement, please contact Lynette Adolphson,
Management Analyst II at (949) 443-6324.
Sincerely,
Meghan, CMC
City Jerk
as noted
cc: Lynette Adolphson, Management Analyst II
Thomas Tomlinson, Planning Director
Df1U6 USE
IS
San. Juan Capistrano: Preserving the Past to Enhance the Future
San Juan Capistrano
Community
Redevelopment
Agency
August 14, 2001
Mobile Home Inspectors
16932 Gothard Street, Unit N
Huntington Beach, California 92647
RE: Compliance with Insurance Requirements - Inspection of Mobile Home Parks
The following insurance document expired:
V General Liability Certificate 8/31/01 - please name the San Juan Capistrano
Community Redevelopment Agency as certificate holder.
V General Liability Endorsement CG 20 10 11 85 naming the San Juan
Capistrano Community Redevelopment Agency as additional insured.
Please submit updated documentation to the City of San Juan Capistrano, attention City
Clerk's office, 32400 Paseo Adelanto, San Juan Capistrano, CA 92675 by the above
expiration dates. If you have any questions, please contact me at (949) 443-6310.
Sincerely,
/QUyjA.
Dawn M. Schanderl
Deputy City Clerk
cc: Lynnette Adolphson
32400 Pasco Addanto
Sun .loan Capistrano
• •
Dawn Schanderl
'To: Lynnette Adolphson
Subject: Mobile Home Inspectors
Mobile Home Inspectors personal services agreement has a May 20, 2001 expiration
date unless a three (3) month extension is granted by the Executive director. What's
happening. Mobile Home Inspectors insurance id due. Thanks
I
Dawn Schanderl
From: Lynnette Adolphson
Sent: Tuesday, August 14, 2001 2:32 PM
To: Dawn Schanderl
Cc: Housing Consultant
Subject: RE: Mobile Home Inspectors
Hi Dawn,
Please contact and request new insurance certificates. Work is still ongoing. The park
inspections are not yet completed but should be done within the next month or so. I am
working on a contract extension. Thanks.
-----Original Message -----
From: Dawn Schanderl
Sent: Tuesday, August 14, 20012:28 PM
To: Lynnette Adolphson
Subject: Mobile Home Inspectors
Mobile Home Inspectors personal services agreement has a May 20, 2001
expiration date unless a three (3) month extension is granted by the Executive
director. What's happening. Mobile Home Inspectors insurance id due. Thanks
1
•
32400 PASEo ADELANTO
SAN JUAN CAFISTRANO. CA 92675
(949) 493-1 171
(949) 493-1053 (FAX)
June 15, 2000
Mr. Greg Filian
Mobile Home Inspectors
16932 Gothard Street, Unit N
Huntington Beach, CA 92647
Jean �,
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MEMBERS OF THE CITY COUNCIL
DIANE L. BATHGATE
COLLENE CAMPBELL
JOHN GREINER
WYATT HART
DAVID M. SWERDLIN
CITY MANAGER
GEORGE SCARAORGU6H
Re: Agreement for Personal Services - Inspection of Mobile Homes and Mobile Home
Parks throughout the City
Dear Mr. Filian:
Enclosed for your records is a fully -executed copy of the Personal Services Agreement to
provide mobile home inspection services for the City of San Juan Capistrano. Services
under this agreement are to be completed on or before May 20, 2001, at a cost not to
exceed $47,650. The City has received all required insurance.
Thank you for your cooperation. If we can be of any further assistance, please call.
Very truly yours,
Cheryl Johnson
City Clerk
Enclosure
cc: Lynnette Adolphson (with agreement)
Administrative Services (with agreement/purchase requisition)
DilUG USE
IS
B
San Juan Capisti-a)ur Prreserrin, the Pact to Enhance the Futuro
0 •
MEMORANDUM
TO: George Scarborough, City Manager
John Shaw, City Attorney
FROM: Thomas Tomlinson, Planning Director k6 -4e
May 9, 2000
SUBJECT: Request for Approval of Agreement with Mobile Home Inspectors
I have attached a revised agreement for your signature totaling $47,650.00 for the third
year of the Title 25 mobile home park inspections. The three-year program consisted of
inspecting the seven mobile home parks, with the third year ending in May 18, 2001. The
current agreement covers the second year of the program and expires May 18, 2000. The
agreement provided that the Executive Director may extend the agreement for one
additional year if the consultant is satisfactorily performing the duties of the agreement.
Staff finds that the consultant has performed per the terms of the contract and
recommends that the agreement be extended for the final third year.
The amount in the agreement represents $82,830 (approved by the Community
Redevelopment Agency on May 19, 1998) less payments made, or to be made, through
June 30, 2000 for work completed. Since May, 1998, four mobile home parks have been
inspected for Title 25 violations. During Fiscal Year 2000-2001 the last three parks will be
completed.
Please note that I have made two revisions to the standard contract at the request
of the consultant. First, I have added a provision allowing the Executive Director to
administratively extend the term of the agreement by an additional three months at
no additional cost, if necessary to complete the program, provided the consultant
is performing satisfactorily (see page one, Section 2). Second, I deleted the
requirement for errors and omissions insurance (previous agreements did not
require this insurance).
After signing the contracts, please forward them to the City Clerk's office, along with the
attached purchase requisition, for further processing. Please call Lynnette at extension
6324 if you have any questions. Thank you.
Ica
cc: Lynnette Adolphson
Attachments: Two original contracts
Purchase Requisition
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