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10-1029_CCD INTERIORS AND FLOORING_Personal Services AgreementPERSONAL. SERVICES AGREEMENT THIS AGREEMENT is made, entered into, and shall become effective this 2 -V- day of October, 2010, by and between the San Juan Capistrano Community Redevelopment Agency (hereinafter referred to as the "Agency") and CCD Interiors and Flooring (hereinafter referred to as the "Consultant"). RECITALS: WHEREAS, Agency desires to retain the services of Consultant regarding the Agency's proposal to Remove and replace carpet and Laminate for the flooring of 26592, 26611 and 26603 Mission Street San Juan Capistrano, CA 92675; 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 the Consultant shall consist of those tasks as set forth in Exhibit "A," attached and incorporated herein by reference. To the extent that there are any conflicts between the provisions described in Exhibit "A" and those provisions contained within this Agreement, the provisions in this Agreement shall control. Section 2. Term. This Agreement shall commence on the effective date of this Agreement and services required hereunder shall continue until notified that said services are no longer required, subject to 15 days notice of termination. Section 3. Compensation. 3.1 Amount. Total compensation for the services hereunder shall not exceed Seven Thousand Eight Hundred Sixty Six and 361100Dollars. ($7,866.36). 3.2 Method of Payment. Subject to Section 3.1, Consultant shall submit monthly invoices based on total services which have been satisfactorily completed for such monthly period. The Agency will pay monthly progress payments based on approved invoices in accordance with this Section. 3.3 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. Invoices shall be addressed as provided for in Section 16 below. 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 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. For extra work not park of this Agreement, a written authorization from Agency is required prior to Consultant undertaking any extra 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/or Construction Site. By executing this Agreement, Consultant warrants that: (1) it has investigated the work to be performed; (2) if applicable, it has investigated the work site(s), and is aware of all conditions there; and (3) it understands the facilities, difficulties and restrictions of the work to be performed 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 the Agency of this and shall not proceed with further work under this Agreement until written instructions are received from the Agency. 2 Section 8. Time of Essence. Time is of the essence in the performance of this. Agreement. Section 9. Compliance with Law; E -Verify. 9.1. Compliance with Lave. Consultant shall comply with all applicable laws, ordinances, codes and regulations of federal, state and local government. 9.2. E -Verify. If Consultant is not already enrolled in the U.S. Department of Homeland Security's E -Verify program, Consultant shall enroll in the E -Verify program within fifteen days of the effective date of this Agreement to verify the employment authorization of new employees assigned to perform work hereunder. Consultant shall verify employment authorization within three days of hiring a new employee to perform work under this Agreement. Information pertaining to the E -Verify program can be found at http://www.usets.gov, or access the registration page at https://e-verify.uscis.gov/enroll/. Consultant shall certify its registration with E -Verify and provide its registration number within sixteen days of the effective date of this Agreement. Failure to provide certification will result in withholding payment until full compliance is demonstrated. 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 work, Consultant shall have delivered to Agency at least one (1) copy of any final reports and/or notes or drawings containing Consultant's findings, conclusions, and recommendations with any support documentation. All reports submitted to the Agency shall be in reproducible format, or in the format otherwise approved by the Agency in writing. 3 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. Indemni To the fullest extent permitted by law, Consultant agrees to protect, defend, and hold harmless the Agency and its elective or appointive boards, officers, agents, 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 damages of any nature, including interference with use of property, arising out of, or in any way connected with the negligence, recklessness and/or intentional wrongful conduct of Consultant, Consultant's agents, officers, employees, subcontractors, or independent contractors hired by Consultant in the performance of the Agreement. The only exception to Consultant's responsibility to protect, defend, and hold harmless the Agency, is due to the negligence, recklessness and/or wrongful conduct of Agency, or any of its elective or appointive boards, officers, agents, or employees. This hold harmless agreement shall apply to all liability regardless of whether any insurance policies are applicable. The policy limits do not act as a limitation upon the amount of indemnification to be provided by Consultant. Section 14. Insurance. On or before beginning any of the services or work called for by any term of this Agreement, Consultant, at its own cost and expense, shall carry, maintain for the duration of the agreement, and provide proof thereof that is acceptable to the Agency, the insurance specified below with insurers and under forms of insurance satisfactory in all respects to the Agency. Consultant shall not allow any subcontractor to commence work on any subcontract until all insurance required of the Consultant has also been obtained for the subcontractor. Insurance required herein shall be provided by 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 an amount not less than one million dollars per occurrence ($1,000,00o.bo); combined single limit coverage for risks 12 associated with the work contemplated by this agreement. If a Commercial General Liability Insurance form or other form with a general aggregate limit is used; either the general aggregate limit shall apply separately to the work to be performed under this agreement or the general aggregate limit shall be at least twice the required occurrence limit. 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 an amount not less than one million dollars per occurrence ($1,000,000.00). 14.3 Worker's Compensation, If Consultant intends to employ employees to perform services under this Agreement, Consultant shall obtain and maintain, during the term of this Agreement, Worker's Compensation Employer's Liability Insurance in the statutory amount as required by state law. 14.4 Proof of Insurance Requirements/Endorsement. Prior to beginning any work under this Agreement, Consultant shall submit the insurance certificates, including the deductible or self -retention amount, and an additional insured endorsement naming Agency, its officers, employees, agents, and volunteers as additional insureds as respects each of the following: Liability arising out of activities performed by or on behalf of Consultant, including the insured's general supervision of Consultant; products and completed operations of Consultant; premises owned, occupied or used by Consultant; or automobiles owned, leased, hired, or borrowed by Consultant. The coverage shall contain no special limitations on the scope of protection afforded Agency, its officers, employees, agents, or volunteers. 14.5 Errors and Omission1s Coverage [FOR PROFESSIONSIWORK EXCLUDE© UNDER GENERAL LIABILITY COVERAGE] Throughout the term of this Agreement, Consultant shall maintain Errors and Omissions Coverage (professional liability coverage) in an amount of not less than One Million Dollars ($'1,000,000). Prior to beginningany`work under this Agreement, Consultant shall submit an insurance certificate to the Agency's General Counsel for certification that the insurance requirements of this Agreement' have been satisfied. 14.6 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. 5 14.7 Terms of Compensation. Consultant shall not receive any compensation until all insurance provisions have been satisfied. 14.8 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 shall have the right to terminate this Agreement without cause by giving thirty (30) days' advance written notice of termination to Consultant. In addition, this Agreement may be terminated by any party 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: Laura Stokes, Housing Coordinator To Consultant: CCD Interiors & Flooring 32039 Camino Capistrano San Juan Capistrano, CA 92675 Attn: Kellie Gonzales 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. 0 Section 1 8. 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"). 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. aria Morris ' e'hpy Secretary` f APPROVED AS TO FORM: Omar 6dov61, Agency Co nsel SAN JUAN CAPISTRANO COMMUNITY REDEVEOPMENT AGENCY By: Jo Tait, E cutive Director CONSULTANT By: Ke4fie Gonzales, Consultant 0 fI.ight tax l ,5—G DATE (MMIDD1YYYY) A�'ERTIFICATE OF LIABILITY INSURANCE 10122/2010 THIS CERTIFICATE S ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CER11FlCATE HOLDEN. THIS CERTIFICATE DOES AOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTENT] OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE }';> INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S). AUTHORIZED REPRESENTATIVE OR PRODUCER, AN'> THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed, If SUBROGATION is WAIVED, subject to the terms and conditiorr-5 of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in ilea of such endorsement(s). AON RISK SERVICES CENTRAL INC PO BOX 23004 GREEN BAY, W1 04301 (888)661-3938 X2251 382 INSURED CCD INTERIORS r<ND FLOORINO INC 32039 CAMINO ,.:;APISTRANO SAN JUAN CAP'�U T RANO, CA 92675 INSURER(s) AFFORDING COVERAGE RER A.TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA URER D: NAW # INSURER F: --- OVERAGES CERTIFICATE NUMBER: 373603415181592 REVISION NUMBER: THIS IS TO CFRTIF`' TI IA"r THE POLICES OF 1N8URANCE LISTED BELOW HAVE RFEN ISSUED TO THE. INSURED NAMED ABOVE FC)R THf. PCI ICY PERIOD ENOICATED, NOTWR iSTANDING ANY REQUIREMENT, TERM OR CONDtTiON OF ANY CONTRACT OR OTHEP DOCUMENT WITH RESPECT TO WHICH THIS CLRTIFI CAIE MAY BI:, €8SUED OR MAY PERI AIN, THE fNSURANCE AFFORDED 13Y -EHE POLICIES DESCRIBED HEREIN IS SUBJLt; T 3'O AL €.. THE TERMS, EXCLUSIONS AND CONDITIONS 0 SUCH POLICIES_ LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS - SR •R A FYPEOFIN:"INSR GENERAL K C3fthMIr RE,A B, LI FY ..:7A ADD )( SusR E'c71.�c:r yrr �•••�_,•� PuLICYNUMBER t,�Mrt3D/VYW N f76D�YVW 666-3214NA223-10 04107,2010 04/07/2011 LIMITS EA--HOCCLIRRENC t;000,Qf7© V D N' X300,000 AR°M rre °x`1 MEI)EX" /An' Ire escm' i5.C3C)0 AGGREGA+'c i'.AIVS V CCUR X o';1J11 'wL� 9L1 NT€ON' $1. j l PERSONAL&ADV`.NJUFiY '.0,000,000 WORKERS COMPF�%.SA'nON AW6EMP€.OYERS' -EAB€LITY YIN '%NY PFC7PRIETC)F::RAR"CN;•=A/F_X�%U flVE ❑ OFF'=CERIMEMBE€ -XCLL'--DED? IMandaiory in NH' it yas. 495cril0e vn.3:r SP r> Ik. PROViS:':`N5 t':g0'-W r1Rr-n PD co L XID .L.N`EASE-EAEMFlt- YFE E -L DISEASE - POLICY LIMIT' GFNERAi AGGR''',ATE W2,00C,000.PROG'JCTGEN'LAG��rI'cGAi'icRO- 6A -3214M597-10 04/07/20t0 04/07!2C11 K r;oNo�uuENnuT. FOL!CY LCLO 0p13B1 ED SAGLE UW1' A AUTOMOHILELIAB=JTv 5A-3214iV 597-10 04/0712010 04/07/2011 ;31,000,000 fEaa=denl) SOOl[Y INS URY (E'er person) Q ANY AUTO 130G!L Y IiSStJ€iY tPer ae�San?) `- X ALL OWNED r- T'OS � PRCPER'Tl'r'AMAGE ; rPc� accE6em:} SCHEDI.i ED, -`i3S 'rIREJ AIJTOS NC)N-n'NNED-.°JT^s A � uMBREL4A I„[,:3 X EXCESS LIA'3 orcuR C'�AI MS-MA3F.. WA CUF'w9825Y082-10 041071201 O 04I07l2011 a EAc;1 oCcuFRENcE 1,000 AGGREGA+'c 4. X o';1J11 'wL� 9L1 NT€ON' $1. WC STATU,- 1GTH iMiTS R AA WORKERS COMPF�%.SA'nON AW6EMP€.OYERS' -EAB€LITY YIN '%NY PFC7PRIETC)F::RAR"CN;•=A/F_X�%U flVE ❑ OFF'=CERIMEMBE€ -XCLL'--DED? IMandaiory in NH' it yas. 495cril0e vn.3:r SP r> Ik. PROViS:':`N5 t':g0'-W r1Rr-n PD co L T :�Y c tAI' ACCMEN€T '> .L.N`EASE-EAEMFlt- YFE E -L DISEASE - POLICY LIMIT' 6A -3214M597-10 04/07/20t0 04/07!2C11 $500 AGV $100 ACV HIr,ED PC -COML )ESC91PTEON OF OPEF•,",TIONS; LOCATIONS; VEHICLES (Attach ACORD 307, Addlior,al Remarks Sehedule, if more spaoe is required) AS EVELOPMENT AGENCY INSURED �(CON'I ACTORS)LCGI1-ITY. SAN D2 47. BUT ONILY ASIRESPECTST O PROJECT AT 32 00 ADELANTO, SAIZONAL N JUAN CAPISTRANO, CA 92675- ;.ERTIFICATE HOLDER SAN JUAN CAPISTRANO COMMUNI REDEVELOP'::TENT AGENCY 32400 ADELANTO SAN JUAN G APISTRANO, CA 92675 ACORD 25 (21109/09 (.A NI-r-L1.A 1 IMY F / SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANC -LIED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEI_IVEHEI; IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORlZPO REPRESENTATIVE L71988-2009 ACORD CORPORATION. All r?ghts reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: I -680 -3214M223 -TIT, -10 COMMERCIAL GENERAL LIABILITY ISSUE DATE: 11-D1-10 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE REAL) IT CAREFULLY. ADDITIONAL INSURED (CONTRACTORS) This endorsement modifies insurance provided under the following; COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE NAME OF PERSON(S) OR ORGANI7ATION(S): SAN JUAN CAPISTRANO REDEVELOPMENT AGENCY 32400 PASEO ADELANTO SAN JUAN CAPISTRANO, CA 92675 PROJECTILOCATION OF COVERED OPERATIONS: JOB: 26611. 26603 & 26592 MISSION, SAN JUAN CAPISTRANO CA 92675. 1. WHO IS AN INSURED— (Section 11) is amended b) The insurance provided to the additional In- to include the person or organization shown in the sured does not apply to "bodily injury" "prop - Schedule above, but: erty damage" or "personal injury" arising out a) Only with respect to liability for "bodily injury" of the rendering of, or failure to render, any "property damage" or "personal Injury"; and professional architectural, engineering or sur- veying services, including: b) If, and only to the extent that, the injury or damage is caused by acts. or omissions ofI. The preparing, approving; or failing to you or your subcontractor in the performance prepare or approve, maps, shop draw - of "your work" on or for the project, or at the Ings, opinions, reports, surveys, field or - location, shown in the Schedule. The person: dens or change orders, or the preparing, or organization does not qualify as an addi- approving, or failing to prepare or ap- tional insured with respect to the independent prove, drawings and specifications; and acts or omissions of such person or organiza- It. Supervisory, inspection, architectural or tion, engineering activities. 2, The insurance provided to the additional insured c) The insurance provided 10 the additional In - by this endorsement is limited as follows: sured does not apply to "bodily injury" or a) In the event that the Limits of Insurance of "property damage" caused by "your work" this Coverage Part shown in the Declarations and included €n the "products -completed op - exceed the limits of liability required by a erations hazard" unless a "written contract "written contract requiring insurance" for that requiring insurance" specifically requires you additional insured, the insurance provided to to provide such coverage for that additional the additional insured shall be limited to the insured, and then the insurance provided to limits of liability required by That "written con- the additional insured applies only to such "bocilly "property tract requiring insurance". This endorsement injury" or damage" that oc- shall not increase the limits of insurance de- curs before the end of the period of time for scribed in Section III — Limits Of Insurance. which the "written contract requiring insur- ance" requires you to provide such coverage CG D2 47 08 05 0 2005 The St. Paul Travelers Companies, Inc. Page 1 of 2 COMMERCIAL GENERAL LIABILITY 3. 4. or the end of the policy period, whichever Is earlier. The insurance provided to the additional insured by this endorsement is excess over any valid and collectible "other insurance", whether primary., excess, contingent or on any other basis, that is available to the additional Insured for a loss we cover under this endorsement. However, if a "written contract requiring insurance" for that ad- ditional insured speciticaliy requires that this in- surance apply on a primary basis or a'primary and non-contributory basis, this insurance is pri- mary to "other insurance" available to the addi- tional insured which covers that person or'organi- nation as a named insured for such loss, and we will not share with that "other insurance". But the insurance provided to the additions{ Insured by this endorsement stili is excess over any valid and collectible "other insurance", whether i mary, excess, contingent or on any other basis, that is available to the additional insured when that person or organization is an additional in- sured under such "other Insurance As a condition of coverage provided to the additional insured by this endorsement: a) The additional insured must give us written notice as soon as practicable of an "occur- rence" or an offense which may result in a claim. To the extent posslbie, such notice should include: i. How, when and where the "occurrence" or offense took place; IL The names and addresses of any injured persons and witnesses; and ill, The nature and location of any injury or ' damage arising out of the "occurrence" or offense b) It a claim is made or "suit" is brought.against the additional insured, the additional Insured must: I. Immediately record the specifics of the clafm or "sult" and the date received; and iii. Notify us as soon aspracticable. The additional insured must see to it that we receive written notice of the claim or "suit" as soon as practicable. c) The additional Insured 'must immediately send is copies of all legal papers received in connection with the claim or "suit", cooperate with us in the investigation or settlement of the claim or defense against the "suit", and otherwise comply with all policy conditions. d) The additional insured must tender the de- fense and indemnity of any claim or "suit" to any provider of "other insurance" which would cover the additional Insured for a loss we cover under this endorsement, However, this condition does not affect whether the insur- ance provided to the additional insured by this endorsement is primary to "other insur- ance' available to the additional insured which covers that person or organizat'€on as a named insured as described in paragraph 3. above. The following definition is added to SECTION V. DEFINITIONS: "Written contract requiring insurance" means that part of any written contract or agreement under which you are required to include a person or organization as an additional in- sured on this Coverage Part, provided that the "bodily injury" and "property damage" oc- curs and the "personal injury" is caused by an offense committed: a. After the signing and execution of the contractor agreement by you; b, While that part of the contract or agreement is in effact; and c. Before the end of the policy period Page 2 of 2 0 2045 The St. Paul Travelers Companies, Inc. CG D2 47 08 05 CNA iQ/'LG/zuiu ±;,L,± ers rr " - ------..... CERTIFICATE OF LIABILITY INSURANCE ]ATE(l'>71L1Y(YY} j1012212010 PRODUCER j CS&SIAON RISK SERVICES CENTRAL, INC. PO BOX 946580 MAITLAND, FL 32794-6550 Phone - 577-724-2669 Fax - 577-763-5122 IINsuREv CCD INTERIORS&FLOO RING, INC 32039 Camino Capistrano SAN JUAN CAPIST'RANO, CA 92675 THIS CERTIFICATE IS ISSUED QS A A9ATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIL # INSURER A: INSURER 5: - I NSU RER C: I INSURER D; INSURER E: Hartford nce E:ompany c:uvttcv,� �a THE POLICIES OF INSURANCE LISTEDBELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTvVITHSTANDING 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 9U9,IECTTO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS S'.OWN MAY HNIE BEEN REDUCED BY PAID CLAIMS, INSR I -TR ADO t- INSRD • "IYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE LJA-rF fNgwI)L3lYYYY) POLICY EXPIRATION DATE (MMFDDfYYYY) LIMnS I I ! GE!,, -RAL U66RLITY j OM iERGEAL GENERAL WABELIiY I ! eACHOCCURRENCE DREG E TO a Oc ED PREMISES (Ea 4cc;,r'ence) CEAWIS MATTE FOCCUR M EB EXP €Any one pa;'sor,) PERSONAL & ADV INJURY ., .......... AGGREGATE GE.VL AGGREGATE LIMIT APPLIES PER'GENERAI, PRODUC"1'S-COMPIOPAGG !I P'3LICY PROJECT LOC , [ ALf i'E;AO011_E k IANEI Y - ANY AUTO Cc NED SiNGLF: UMI i {EEaa accldarai)i ------'--^f. gpO LY IN.IURY �-.. (Per pBfSOrs) ,,LLOWNEI)AUT05 � :CHEIX. .ED AUTOS BODILY IN,URY orac-ident) - ;.RED AUTOS •;.OEN-OVMEDAUTOS PROPERTYDAMAGE {Peracx,'cen,} • GRACE LIABILCFY I AUTO ONLY - EA AGC€DENT i' NY AUTO - - 071JE R TliAi+l AUTO ON EA ACC AG(" E'XCE,,S f UMBRELLA UA€3II,.ITY EACH OCCURRENCE AGGREGATE J� �A,tiY AI.fT(: I!3CCiIR FICLAIMS,"TAOF f DEDUCTIBLE E RETFNYiON S Ai'ORKERS COMPENSATION AND YIN i E1�VRLOYERS' LfAEIUTY �--� J ALiY PROPRIETOR I PARTNER f I! EXI-QUT€VE OFFICE, MEMBER �4017337307 03101/2010 L"XCLUDED?(NlalGatory in NH 0310112011 " 4rfC OTHER ' ® STATUTORY LICAI'75 E L . EACH ACCIDENT _ 1 000 OOQ C-1. DISEASE - EA EMPLOYEE $1,000,000 11VeS, deSCrL^e antler SPCC€AL i1 PItOASIONS i a? w E.L. DISEASE POLICY UFS,T OIj j �tY'€PIER � } CERTIFICATE HOLDER AGENCY 32400 ADELANTO SAN JUAN CAPISTRANO, CA 92675 ACORD 25 (206011 0) CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEF ,DRE THE EXPtRATTONI THEREOF, TTAf)'LIITO TjECRlFCATCOLDiNAEDOT14ELEF7 BUTFAiLUETOOISHALMPOSSENO OBLI GAYION OR LIABILITY OF AHY KIND UPON THE INSURER. FTS AGE N! ti OP.. ©1988-2009 ACORD CORPORATION. Ail rights reserved. The ACORD name and logo are registered marks of ACORD CNA .L lf/ LG/ Gt11V �I -ice I—VI rn4.n .u. -1 ACORD 25 (2009 110) INN Company ID Number. 367379 The individuals whose signatures appear below represent that they are authorized to enter into this MOU on behalf of the E -Verify Employer Agent and DHS respectively. If you have any questions, contact E -Verify at 1-888-464-4218. Approved by: Employer CCD Interiors and Flooring,ine Company Narne-MD Kellie Gonzales Gore pan. acihty AddressP'--M 1� Name TWe S,g,n Juan Capist�anoCA �32675 Conipany Afternota Address, Department of Homeland Security — Verification Division USCIS Verification Division San Juan Capistrano, CA 92675 T-775 TMe F"Iectronically Sign&d' 10/25/2010 Signatup.ry Date information Required -for the E -Verify Program Information relating to your Company - Company Narne-MD lnter:ors and Flooring,iFic Gore pan. acihty AddressP'--M Cw-nfno capsb'ano S,g,n Juan Capist�anoCA �32675 Conipany Afternota Address, 32039 Camino Capstrand San Juan Capistrano, CA 92675 Page 13 of 15 1 E -Verify MOU for E -Verify Employer Agent) Revision Date 09/01/09 www.dhs.gov/E-Verify Company ID Number: 367379 County ar Rarjsh, ORANGE Emp�oyerleen fificafion 330801600 ___ ______2qwnber: Wofth Am�erican Industry Classlfication. Systems Code-, V53 Admirn"strator- Number. of Errkployees: 5 to 9 of Sites Verified for: i Are you verifying for more than I site? If yes, please provide the number of sites verified for in each State: CALIFORNIA I site($) Page 14 of 15 1 E -Verify MOU for E -Verify Employer Agentl Revision Date 09101/09 www.dhs.gov1E-Verify Company ID Number: 367379 ✓ 5i, � w.R Information relating to the Program Adm inistrator(s) for your Company on policy .questions or operational problems: Name: Kellie A Gonzales Telephone Number: (949) 493 - 1508 Fax Number: (949) 248 - 0544 -mail Address: ccdinterfors@aol.com Page 15 of 15 1 i= -Verify MOU for i= -Verify Ernpioyer Agentl Revision Date 09!01!09 www.dhs.gov/E-Verify Today's Date: 10-28-10 Transmittal Routing (Check All That Apply) ® City Attorney ® City Manager City Clerk CIP No. (if any): Project Manager's Last Name: Stokes Phone Extension: 6313 Council or CRA Meeting Date (if applicable): APPROVING AUTHORITY: (Check One) ❑ Mayor ❑ CRA Chair ❑ City Manager Provide (1) executed original contract for each signing party, including the City. If the agreement is to be recorded — only (1) original will be recorded with certified copies going to other parties. Please provide the mailing address of any party to receive an agreement — unless the mailing address is included within the body of the agreement: Name(s) _ Street City St Zi OTHER INSTRUCTIONS: E- '- t/-e,/LA lr� Is, Form ©ate: 41-2004 D-7 32400 PASEO ADELANTO MEMBERS OF THE C''rY COUNCIL -A 92675 SAN JUAN CAPISTRANo, r IV ti i SAM ALLEVATO sHts (949) 493-1171 11110WRRIED LAURAFPEL3E (949) 493-1053 FAX LARRY KRAMER www. ,5atijuancapi-5trano.org C1 7 776 DEREK REEVE, 0 — JOHN TAYLOR Im CCD Interiors & Flooring Attn: Kellie Gonzales 32039 Camino Capistrano San Juan Capistrano, CA 92675 DATE: March 23, 2011 FROM: Christy Jakl, Deputy City Clerk (949) 443-6310 RE: Personal Services Agreement— Remove and replace Carpet Enclosed for your records: (1) Original, Personal Services Agreement — Remove and replace Carpet If you have questions concerning the agreement, please contact Laura Stokes, Housing Coordinator at (949) 443-6331. Cc: Laura Stokes, Housing Coordinator San Aan Capistrano: Presen4rg the Past to Eiihance the Future Printed on 300% recvded caper