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HomeMy WebLinkAboutItem No. 08 1st Amend to Agrmnt Harrington & Sons Rosetta CAnyon SP Ph II CIP Z40004Text File City of Lake Elsinore 130 South Main Street Lake Elsinore, CA 92530 www.lake-elsinore.org File Number: ID# 16-351 Agenda Date: 8/23/2016 Status: Consent AgendaVersion: 1 File Type: ReportIn Control: City Council Agenda Number: 8) Page 1 City of Lake Elsinore Printed on 8/18/2016 REPORT TO CITY COUNCIL To:Honorable Mayor and Members of the City Council From:Grant Yates, City Manager Prepared by:Jason Simpson, Director of Administrative Services Date:August 23, 2016 Subject:First Amendment to Agreement with Harrington & Sons, Inc. dba Storyland Studios for the Rosetta Canyon Sports Park Phase II Project (CIP Project RDA Z40004)Vehicle Arch Way Fabrication, Lighting and Enhancements. Recommendation Staff recommends that the City Council: 1.Amend the Agreement with Storyland Studios for the Rosetta Canyon Sports Park Phase II Project (CIP Project RDA Z40004) Vehicle Arch Way Fabrication, Lighting and Enhancements 2.Approve and authorize the City Manager to execute the First Amendment in the not to exceed amount of $29,327.00 with Harrington & Sons, Inc. dba Storyland Studios in the form attached and in such final form as approved by the City Attorney. Background On August 2, 2016 Storyland Studios and the City entered into an agreement to design fabricate and install Sports Park Arch Way Columns from fiberglass molds utilizing a baseball theme and City Logo. Additional design opportunities have been further developed to enhance the vehicle arch way into the sports park both during the day and at night. The benefit of this design, fabrication and installation agreement will is in the creativity and uniqueness of the arch design elements. In the end the design and fabrication will make a strong and lasting statement about Rosetta Canyon Sports Park. This is a massive structure spanning the entire entry drive at over 61 feet wide and over 24 feet tall. This is the last item to take under contract for the completion of the arch way and will be the final elements to be installed on the arch. In order to proceed without delay the design and fabrication process was initiated with a less than $30,000 agreement. Storyland Studios is a local City of Lake Elsinore Firm and was selected for this work based on their superior professional design and fabrication abilities. Following a design interview process with Storyland Studios it was quickly realized the uniqueness of this firm and how difficult it is to replicate their work with Disneyland, Arch Way Design Fabricate and Install August 23, 2016 Page 2 major national theme parks throughout the United States, and the movie/broadcast industry; all highly reputable. Fiscal Impact Rosetta Canyon Sports Park Phase II Project is included in the Fiscal Year 16/17 – 19/20 Capital Improvement Plan (CIP) budget. The estimated cost is about $40,000 lower than original cost estimates for the archway. Exhibits A. First Amendment B. First Amendment - Estimate C. Original Agreement FIRST AMENDMENT to AGREEMENT WITH STORYLAND STUDIOS FOR ROSETTA CANYON SPORTS PARK PHASE-II PROJECT CIP PROJECT NO. Z40004 ARCH WAY THIS FIRST AMENDMENT is made and entered into as of August 23, 2016 by and between the City of Lake Elsinore, ("City"), and Storyland Studios.("Contractor”). In consideration of the mutual covenants and conditions set forth herein, the parties agree as follows: 1. This Amendment is made with respect to the following facts and purposes: a. On August 2, 2016 the City and Contractor entered into an agreement for Purchase of Goods and/or Services for the Rosetta Canyon Sports Park Phase II Arch Way (the “Agreement”). b. The parties now desire to increase the compensation amount an additional twenty-nine thousand three hundred and seventy dollars and no cents ($29,327.00) and amend the Agreement as set forth in this Amendment. 2. Compensation. Section 5 of the Agreement is hereby amended to increase the amount that the City agrees to pay the Contractor by an additional twenty-nine thousand three hundred and seventy dollars and no cents ($29,327.00) for a total compensation not-to-exceed fifty- eight thousand two hundred twenty-eight dollars and no cents. ($58,228.00). The technical detailed scope of these services are included in the attached proposals from Storyland Studios. 3. Except for the changes specifically set forth herein, all other terms and conditions of the Agreement shall remain in full force and effect. IN WITNESS WHEREOF, the parties hereto have caused this Amendment to be executed by and through their respective authorized officers, as of the date first above written. “CITY” CITY OF LAKE ELSINORE, a municipal corporation Grant Yates, City Manager ATTEST: _______ City Clerk APPROVED AS TO FORM: City Attorney “CONTRACTOR” Storyland Studios Tom Vogel, Account Manager Quotation . Client:160729-R3 8/11/2016 Tom Vogel Project: Contact:Gus Papagolos Phone:951-764-2417 Terms: Qty Unit Cost Total 1 Set $7,064.00 $7,064.00 1 Lot $12,570.00 $12,570.00 1 Lot $9,693.00 $9,693.00 Shipping/Recieving hours 8:00 AM - 2:00 PM Pickups/deliveries after hours are subject to additional charges Sales Tax %:Not Calculated $29,327.00 Date:_____________ 590 Crane Street Lake Elsinore, Ca 92530 Phone 951.674.0998 Fax 951.674.0245 Estimate Number: City of Lake Elsinore Estimate Date: 130 N. Main Street Account Executive: Lake Elsinore, CA 92530 Ballpark Arch Columns 50% / 50% Item / Description Master & Mold to make Bats • Molds to be disposed of after project is complete Installation @ Rosetta Park, Lake Elsinore Lighting add-on: (per meeting 8/5/16) "Rosetta Canyon Sports Park" lettering for Arch • (A) 1” Acrylic Face (face cap) • (B) 1⁄2” Clear Acrylic Backer • (C) 3mm Di-Bond Light Splash Back Plate One per each Word listed above • (D) White 12 VDC LED Hallow Illumination • (E) 12 Volt LED Driver (Dimming) • (F) Wiring with Junction Box Elsinore "E" Logo on bats • (A) Translucent White Face, With Translucent Printed Vinyl Graphic • (D) White 12 VDC LED Face Lit Illumination • (E) 12 Volt LED Driver (Dimming) • (F) Wiring with Junction Box • Dimensional curved acrylic like material on front of bats for illumination • Vinyl graphic logo on backside of bats sealed with clear coat (no illumination) Requirements: • Storyland Studios to provide rigid template to contractor to weld mounting studs to arch for letter placement • Arch should be powder-coated after welding of mounting studs is complete • Arch to be delivered to Storyland Studios to have lettering mounted/pre-installed/tested • Clients electrician to pre-wire to electrical junction boxes at designated location(s) on columns as deemed necessary • Installaton listed above does not include installing arch between columns 50% Deposit due to start project Not Included in estimate unless specifically listed above: • Associated Engineering/Drawings/stamps for approvals • Installation • Freight • Crate(s) • Sales Tax (if applicable) Prices subject to change after 30 days. All change requests must be submitted in writing TOTAL: Quote subject to all terms below unless stated otherwise above. Payment terms are 50% Deposit / 50% Balance Due upon completion, prior to shipping unless payment terms have been previously established. Packaging and freight not included unless listed. Sales tax will be charged on all orders shipped within California, unless resale or other proof of sales tax exemption is submitted prior to invoicing. Lead time is based upon receipt of deposit, signed PO or Quote and approved drawings. Quote is based on initial design and should be considered budgetary until final design has been approved. All drawings, samples and/or engineering required by client will incur extra charges. Orders cancelled once production has started incur labor & material charges for work done. Items are not returnable nor can they be cancelled after they have been produced. Quote is based on regular production schedule. Any additional production or rush requests will incur extra charges. To accept this quotation, Sign and return: _______________________________________________ SHORT FORM PURCHASE O The parties to this Short Form Purchase of Goods and/or Services Contract (Contract) do mutually agree and promise as follows: 1. Parties: The parties to this Contract are the CITY OF LAKE ELSINORE, a municipal corporation (City) and the following named Contractor: (Name) Storyland Studios (Street Address) 590 Crane Street (City/State/Zip) Lake Elsinore CA. 9253a (Telephone) (951) 674-0998 (Email) tomv@storylandstudios.com (Taxpayer ID #) (City Business License #) 2. Term: The effective date of this contract is and it terminates unless sooner terminated as provided herein. 3. Contractor's Obligations: (a) To the satisfaction of the City's Project Manager, Contractor shall provide the following goods and/or services: (Attach extra sheet/s if necessary) Design Construct and Install Sports Park Arch Columns from Fiberglass bat shape, Elsinore logo front and back of each bat. Top 24'6" tall and 32" diameter; Middle 141 tall 26" Diameter; Base 18"Diameter. Letters for "ROSETTA CANYON SPORTS PARK" DIMS 20" tall X 3/8" thick Trajan font (b) Contractor shall perform the above -referenced services or delivery the required goods at or to the following specified location/s: (Attach extra sheet/s if necessary) Rosetta Canyon Sports Park City of Lake Elsinore 4. Supplemental Conditions: This Contract is subject to the Supplemental Conditions attached hereto, which are incorporated herein by reference. 5. Compensation: Contractor's total compensation for the goods and/or services performed under this Contract is $28,901.00, to be paid as (check one): (1) © lump sum upon completion of all Contractor's Obligations; (2) lump sum per -task in the amounts indicated below, payable upon completion of each task; F SERVICE CONTRACT (3) ❑ lump sum per -task in the amounts indicated below, payable in monthly installments not to exceed the percentage completion of each task; (4) i7 per attached written quote, up to a guaranteed not -to - exceed amount of $28,901.00 Task To the satisfaction of the City's Project Manager, Contractor shall provide the following goods and/or services: (Attach extra sheet/s if necessary) Design Construct and Install Sports Park Arch Columns from Fiberglass bat shape, Elsinore logo front and back of each bat. Top 24'6" tall and 32" diameter; Middle 14" tall 26' Diameter; Base 18' Diameter. Letters for "ROSETTA CANYON SPORTS PARK" DIMS 20" tall X 3/8" thick Trajan font Amount $28,901.00 6. Signatures: These signatures attest the parties' agreement hereto: CON7!T-9 land Studios Print Name/Title Tom Vogel CITY OF LAKE ELSINORE, am 0 App r d as(ts�-f By: Ity Attorney Approved as to content/Insurance: By Cit Purchasing n?/Risk Manager SHORT FORM PURCHASE OF SERVICES CONTRACT I August 2, 2016 City of Lake Elsinore SUPPLEMENTAL CONDITIONS Independent Contractor. It is expressly agreed that Contractor is to perform or deliver the goods and/or services described herein as an independent contractor pursuant to California Labor Code Section 3353, under the control of the City as to the result of his work only but not as to the means by which such result is accomplished. Nothing contained herein shall in any way be construed to make Contractor or any of its agents or employees, an agent, employee or representative of the City. Contractor shall be entirely responsible for the compensation of any assistants, employees, and subcontractors used by Contractor in providing said goods and/or services. 2. Cancellation. Either the City or Contractor may cancel this Contract at any time upon giving the other party five (5) calendar days' written notice of such cancellation. In the event of cancellation, the City shall be liable only to pay to the Contractor compensation for services rendered up to the date of the Contract's cancellation. Under no circumstances shall City be responsible for payment of lost profits, or damages beyond the total amount of compensation set in this Contract. 3. Assignment. Contractor shall not assign this Contract, or any part thereof, or any right of the Contractor hereunder without the prior written consent of the City. 4. Indemnity. Contractor shall indemnify, defend and hold the City harmless from and against all claims, demands and causes of action for injury, death or damage to any person or property that may arise or result from Contractor's performance of this Contract or from acts or omissions of any person(s) employed by Contractor. 5. Anti -Discrimination. Contractor shall not discriminate against any employee or applicant for employment because of race, color, religious creed, age, sex, actual or perceived sexual orientation, national origin, disability as defined by the American with Disabilities Act (42 U.S.C. § 12010, et seq.) or veteran's status. To the extent applicable, Contractor shall comply with all federal, state, and local laws regarding non-discrimination, equal employment opportunity, affirmative action and occupational -safety -health concerns, shall comply with all applicable rules and regulations thereunder, and shall comply with same as each may be amended from time to time. 6. Legal Responsibilities. The Contractor shall keep itself informed of State, and Federal laws and regulations and the Lake Elsinore Municipal Code which in any manner affect those employed by it or in any way affect the performance of its service pursuant to this Agreement. The Contractor shall at all times observe and comply with all such laws and regulations. The City, and its officers and employees, shall not be liable at law or in equity occasioned by failure of the Contractor to comply with this section. 7. Insurance. During the entire term of this Contract and any extension or modification thereof, the Contractor shall keep in effect insurance policies meeting the following insurance requirements: 7.1 Commercial General and Automobile Liability Insurance. Contractor, at its own cost and expense, shall maintain commercial general insurance in an amount not less than ONE MILLION DOLLARS ($1,000,000.00) per occurrence, coverage and automobile liability insurance in an amount not less than ONE MILLION DOLLARS ($1,000,000.00) per occurrence for the term of this Agreement in an amount not less than ONE MILLION DOLLARS SHORT FORM PURCHASE OF SERVICES CONTRACT 2 August 2, 2016 City of Lake Elsinore ($1,000,000.00) per occurrence, combined single limit coverage for risks associated with the work contemplated by this Agreement. If a Commercial General Liability Insurance or an Automobile Liability 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. Such coverage shall include but shall not be limited to, protection against claims arising from bodily and personal injury, including death resulting therefore, and damage to property resulting from activities contemplated under this Agreement, including the use of owned and non -owned automobiles. The following endorsements shall be attached to the policy: 7.1.1 Policy shall cover on an "occurrence basis." 7.1.2 Policy must cover personal injuries as well as bodily injuries. Exclusion of contractual liability must be eliminated from personal injury endorsement. 7.1.3 Broad form property damage endorsement must be attached. 7.1.4 Policy must cover contractual liability by amending the definition of "incidental contract" to include any written contract. 7.1.5 The City, its officers and employees shall be named by endorsement as an additional insured, and the policy shall stipulate that this insurance will operate as primary insurance and that no other insurance effected by the City will be called upon to contribute to any loss suffered by Contractor hereunder. 7.2 Worker's Comoensation. The Contractor, at its own cost and expense shall carry and maintain statutory Worker's Compensation Insurance and Employer's Liability with limits of not less than One Million Dollars ($1,000,000) with an insurance carrier satisfactory to the City. In the event Contractor is self-insured, it shall furnish the City with a Certificate of Permission to Self -Insure signed by the Department of Industrial Relations Administration of Self -Insurance in Sacramento, California. If any injury occurs to any employee of Contractor for which the employee, or his dependents in the event of his death, is entitled to compensation from the City, the City may retain out of sums due the Contractor under this Contract an amount sufficient to cover such compensation as fixed by said Act, until such compensation is paid or until it is determined that no compensation is due and if the City is compelled to pay such compensation, it will deduct and retain from the sums due the Contractor the amount so paid. 7.3 Additional Insurance Provisions. Said policies shall constitute primary insurance as to the City, and its officers, agents, and employees, so that other insurance policies held by or for them or the City's self-insurance program shall not be required to contribute to any loss covered under the Contractor's insurance policy or policies. 7.4 Coverage Verification. SHORT FORM PURCHASE OF SERVICES CONTRACT 3 August 2, 2016 City of Lake Elsinore 8.4.1 Upon notification of receipt by the City of a notice of cancellation, major change in coverage or expiration, Contractor shall file with the City a certified copy of the required new or renewal policy. 8.4.1 If, at any time during the life of the Contract or any extension thereof, Contractor fails to maintain the required insurance in full force and effect, all work under the Contract shall be discontinued immediately and all payments due or that become due to the Contractor will be withheld until notice is received by the City that the required insurance has been restored to full force and effect and that the premiums therefore have been paid for a period satisfactory to the City. Any failure to maintain the required insurance will be sufficient cause for City to immediately terminate the Contract. 8. Payment of Prevailing Wades. Contractor is aware of the requirements of California Labor Code Section 1720, et seq., and 1770, et seq., as well as California Code of Regulations, Title 8, Section 1600, et seq., ("Prevailing Wage Laws"), which require the payment of prevailing wage rates and the performance of other requirements on "Public Works" and "Maintenance" projects. If the services are being performed as part of an applicable "Public Works" or "Maintenance" project, as defined by the Prevailing Wage Laws, and if the total compensation is $1,000 or more, Contractor agrees to fully comply with such Prevailing Wage Laws. Contractor shall determine the applicable prevailing rates and make copies of the prevailing rates of per diem wages for each craft, classification or type of worker needed to execute the services available to interested parties upon request, and shall post copies at the Contractor's principal place of business and at the project site. Contractor shall defend, indemnify and hold the City, its elected officials, officers, employees and agents free and harmless from any claim or liability arising out of any failure or alleged failure to comply with the Prevailing Wage Laws. The provisions of this Section may be waived in if inapplicable to the services provided hereunder. SHORT FORM PURCHASE OF SERVICES CONTRACT 4 August 2, 2016 City of Lake Elsinore ASTUDIOS Client: City of Lake Elsinore 130 N. Main Street Lake Elsinore, CA 92530 Contact: Gus Papagolos Phone: 951-764-2417 Quotation Ballpark Arch Columns • Fiberglass bat shape to be clad to existing columns (Client to supply bat for sample) • Qty 1 Bat per column / 2 columns total (as per rendering) • Dims per bat: • Top: 24-6" Tall x 32" Diameter approx per drawing) -Middle: 14' Tall x 26" Diameter approx per drawing) • Base: 18" Diameter?? (appprox per drawing) • Elsinore "E" logo on fron2ack of each bat (Art file supplied by client) • Painted to look like drawing • Lights to shine on bats (by others) "ROSETTA CANYON SPORTS PARK" Letters (attached to arch) • Dims: 20" Tall x 3/8" thick (approx)(Trajan Font) • Arch to be 16" square beam • Letters "Nan -illuminated" • Finish/color TBD • Cost currently listed as not to exceed for lettering pending final design approval 50% Deposit due to start project 590 Crane Street Lake Elsinore, Ca 92530 Phone 951.674.0998 Fax 951.674.0245 Estimate Number: 160729-R2 Estimate Date: 8/5/2016 Account Executive: Tom Vogel Project: Ballpark Arch Columns Terms: 50%/50% r Set $14,456.00 Set $14,445.00 Not Included in estimate unless specifically listed above: • Associated Engineering/Drawings/stamps for approvals • Installation • Freight • Crate(s) • Sales Tax (if applicable) $14,456.00 $14,445.00 Shipping/Recieving hours 8:00 AM - 2:00 PM Sales Tax %: Not Calculated Pickups/deliveries after hours are subject to additional charges Prices subject to change after 30 days. All change requests must be submitted in writing Quote subject to all terms below unless stated otherwise above. Payment terms are 50% Deposit 150% Balance Due upon completion, prior to shipping unless payment terms have been previously established. Packaging and freight not included unless listed. Sales tax will be charged on all orders shipped within California, unless resale or other proof of sales tax exemption is submitted prior to invoicing- Lead time is based upon receipt of deposit, signed PO or Quote and approved drawings. Quote is based on initial design and should be considered budgetary until final design has been approved. All drawings, samples and/or engineering required by client will incur extra charges. Orders cancelled once production has started incur labor & material charges for work done- Items are not returnable nor can they be cancelled after they have been produced. Quote is based on regular production schedule. Any additional production or rush requests will incur extra charges. To accept this quotation, Sign and return: Date: ACOR/J CERTIFICATE OF LIABILITY INSURANCE (MMIDDIYYYY) 64� 0810312016 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(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME;. Katie Baker Diamond Valley Insurance Services, Inc. PHO iso {951)553-7400 FAX �,; (951)298.6808 41856 Ivy Street, Suite 204 EYO, E-MAIL. ADDRESS: katio%oiamoncivallgins.com Murrieta, CA 92562 �m B ES E ToEs.",,r $ 100,000 MED EXP (Any one person) S 5,000 License#: OH94716 INSURERJS AFFORDING COVERAGE NAICk INSURERA: Tr eters nswrance CoMpany PERSONAL 8 ADV INJURY $ 1,000,000 INSURER B: INSURED HARRINGTON &SONS, INC DBA STORYLAND STUDIOS IN8 URER. C GEjjN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE S 2 000. 000 590 CRANE STREET INSURER D: LAKE ELSINORE, CA 92530 INSURER E: PRODUCTS - COMP/OP AGG $ INSURER F COVERAGES CERTIFICATE NUMBER: 00000000-0 REVISION NUMBER: 44 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. IN SR TYPE OF INSURANCE ADDL BURR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER DDIVYYY IDDIYYYY A X COMMERCIAL GENERAL LIABILITY LAKE ELSINORE, CA 92530 Y-630-4FO23468-TIL-16 0110112016 01/0112017 EACH OCCURRENCE $ 1.000,000 CLAIMS -MADE OCCUR n l �m B ES E ToEs.",,r $ 100,000 MED EXP (Any one person) S 5,000 PERSONAL 8 ADV INJURY $ 1,000,000 GEjjN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE S 2 000. 000 j P+7LIG'f JCI JE � H�l LOC PRODUCTS - COMP/OP AGG $ S Ij OTHER A AUTOMOBILE LIABILITY BA-4FO29092-16-CAG 01101/2016 01/01/2017 D SNQ UE WM s 0,1000 BODILY INJURY (Per person) $ X ANY AUTO OWNED SCHEDULED BODILY INJURY (Per acadenI) S AUTOS ONLY AUTOS-- HIRED NON -OWNED PROPERTYDAMAGE $ AUTOS ONLY AUTOS ONLY -JPer accident 1 UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS -MADE AGGREGATE S jI DED RETENTION S S A WORKERS COMPENSATIONYJ-UB-4FO20731-16 01101/2016 01101/2017 ER OTH- STATUTE L5 AND EMPLOYERS' LIABILITY Y❑ 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E -L EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? NIA 1,000,000 (Mandatory in NH) E L DISEASE - EA EMPLOYEE S E L DISEASE - POLICY LIMIT S 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below A Building Y-630-4FO23468-TIL-16 01101/2016 01/0112017 Ded $5000 $4,522,752 A Contents Y-630-4FO23468-TIL-16 0110112016 01101/2017 Ded $5000 $520,200 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate holder is named as additional insured regarding general liability per the attached endorsement. CERTIFICATE HOLDER CANCELLATION © 198 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks f AC D Printed by KNB on August 03, 2016 at 10:26AM SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Lake Elsinore THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 130 South Main AUTHORIZEDREPRESEMTATIVE LAKE ELSINORE, CA 92530 (KNB) © 198 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks f AC D Printed by KNB on August 03, 2016 at 10:26AM