HomeMy WebLinkAboutItem No. 03 First Amendment to Service Contract Golden State BaitText File
City of Lake Elsinore 130 South Main Street
Lake Elsinore, CA 92530
www.lake-elsinore.org
File Number: ID# 17-136
Agenda Date: 4/11/2017 Status: Consent AgendaVersion: 1
File Type: ReportIn Control: City Council
Agenda Number: 3)
Page 1 City of Lake Elsinore Printed on 4/6/2017
Page 1 of 1
REPORT TO CITY COUNCIL
To:Honorable Mayor and Members of the City Council
From:Grant Yates, City Manager
Prepared by: Audrey Young, Management Analyst
Approved by:Johnathan O. Skinner, Community Services Director
Date:April 11, 2017
Subject:Golden State Bait – First Amendment to Service Contract
Recommendation
Approve the First Amendment to Service Contract for Golden State Bait for fish stocking
services.
Background
In February of 2017, the City entered into a Short Form Purchase of Service Contract with
Golden State Bait, Inc. to provide fish stocking services including Largemouth Bass, Bluegill,
and Black Crappie.
Discussion
Initially, City staff intended to work with an alternative vendor for Catfish stocking services.
However, the vendor in which we intended to utilize for Catfish stocking services, was not able
to obtain the Catfish supply necessary provide the appropriate services. As a result, City staff
reached out to several vendors regarding their ability to supply services. Golden State Bait, Inc.
has agreed to meet the requested Catfish stocking supply services. By increasing the scope of
the original contract, the City will exceeded the City Manager’s signing authority. As a result, we
hereby present to you the First Amendment to the Service Contract for Golden State Bait, Inc. to
add the additional Catfish stocking services.
Fiscal Impact
The First Amendment increases the original not-to-exceed amount from $30,000 to $50,000 and
is covered under the Community Services Department budget.
Exhibits
A -First Amendment
B -Short Form Purchase Service Contract
FIRST AMENDMENT TO SERVICE CONTRACT
f.I 1l MW
This FIRST AMENDMENT TO SERVICE CONTRACT is made effective 2017
by and between the CITY OF LAKE ELSINORE (herein after referred to as "City"), and
GOLDEN STATE BAIT, INC. (herein after referred to as "CONTRACTOR").
RECITALS
This First Amendment is made with reference to the following facts which are a substantive part
hereof:
A. City and Contractor have entered into that certain agreement entitled "Short
Form Service Contract" originally dated as of February 22, 2017.
B. In accordance with Section 5, the original agreement shall not exceed $30,000.
NOW, THEREFORE, in consideration of the mutual promises, covenants and conditions set
forth herein, the parties hereto agree as follows:
1. Section 5, Compensation, in addition to the tasks identified in the Original
Contract, the Contractor shall also provide $12,000 worth of Catfish stocking services in April
2017 and $8,000 worth of Catfish stocking services in May 2017. The total contract amount
shall not exceed $50,000.
2. Except for the changes specifically set forth herein, all other terms and conditions
of the Amended Contract shall remain in full force and effect.
3. Each individual signing below represents and warrants that he/she has the
authority to execute this First Amendment on behalf of and bind the party he/she purports to
represent.
First Amendment to Service Contract
Golden State Bait, Inc.
IN WITNESS WHEREOF, the parties have executed this First Amendment on the
respective dates set forth below.
DATE: /�I� -12M
DATE:
3/ // 2 �10 1
ATTEST:
Susan M. Domen, MMC
City Clerk
APPROVED AS TO FORM:
iw
Ba ara l_eibold
City Attorney
2
First Amendment to Service Contract
Golden State Bait, Inc.
GOLDEN STATE BAIT, INC.
By:
CITY OF LAKE ELSINORE, a municipal
corporation
By: go NZ
Grant Yat
City Man4r
'4 � CERTIFICATE OF LIABILITY INSURANCE 2/115/2017 n
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: N the certScate holder Is an ADDITIONAL INSURED, the polloy(Iss) must be endorsed. N SUBROGATION 13 WAIVED, subject to
the terror and conditions of the policy, certain Polidss may require an endorowneft A statement on this cer0cate does not confer rights to the
Barlocker Insurance Agency, Inc. PHONE Be.(209)383-0220 •ww .(909)383-5124
License #0580438 .ajuradosibarlocker.ccm
1164 Olivewood Dr. wau s AFFORDING COVERAGE NA
Merced CA 95348 wsaRERANationwide Agribusiness 0282
INSURED msums:State Compensation Insurance 3507
Brad & Stefani Saylor INSURER C:
dba: Golden State Bait, Inc. WSUREIo:
6554 South Healy Road INSURER E;
__—_-___ ����.�.�.. ........�...n• n v a• a n• uv n RMRInidNIIMRER-
GVYCRMWCA .,r -n nrrvn,
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.
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TYPE OF INSURANCE
YNUMBER POUC
PmICYEFF
��
UBITS
GENERAL LL409JTY
EACH OCCURRENCE $ 1,000,000
PREMISES (E. $ 50,000
A
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE T OCCUR
X
FPX7802565836
/28/2017
/28/2018
MED EXP (my one person) $ 5,000
PERSONAL A ADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREGATE LIMIT PPPUES PER:
T POLICY PR0. LOC
AUTOYOELE LIABILITYE
PRODUCTS - COMP/OP AGO $ 11000,000
$
M ELIMIT 1000000
BODILY INJURY (Per parson) $
A
X ANY AUTO
UTOSNED HEDULED
WNED
HIREDAUTOSPSCLOITTNOO
X
PKBAN7802565836
/28/2017
/28/2018
BODILY INJURY (Per acddent) $
PaOetle i AMAGE $
Uninsured MotodstcomCinetl $ 11000,000
UYBREUAUAB
OCCUR
EACH OCCURRENCE $
AGGREGATE $
EXCESS UAB
CLAIMSMADE
DED I I RETENTION
IIIONI09ffi COMPENSATION
AND EMPLOYE IP LIABILITY
ANY PROPRIETOR/PARTNERIEXECUTIVE YIN
OFFICER/MEMMBMER NI EXCLUDED? LiNIA
iMovidory In
ifes,RIPTION OF OPERATIONS W.d"Under
DESC
4YO STATU- OTM-
8
075610-16
10/14/201610/14/2017
E.L. EACH ACCIDENT $ 1,000,00 0
E.L. DISEASE - EA EMPLOYE $ 1,000,00
E.L. DISEASE - POLICY LIMIT $ 1,000,00
DEICPoPIION of OPE Al10NS I LOCATIONB /VBUCLPB (A1Mdr ACOFM 707, Atl68md Rsmsda BdedW, Imm spas M 11 "heed)
The City of Lake Elsinore , its officers and employees shall be named as additonal insured in regards to
project: Fish stocking services for Lake Elsinore at La Laguna Resort and Boat Launch, 32040 Riverside
Drive, Lake Elsinore, CA 92530 effective dates 02/22/2017 to 06/30/2017
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
City of Lake Elsinore _
130 S. Main St. AUTHOROW REPRP.BENTATTVE
Lake Elsinore, CA 92530
Socorro 3urado/SOJIIRA ��'r''�"�'ti-'"b' L711 p'T"r •"
ACORD 25 (2010106) ®1988.2010 ACORD CORPORATION. All rights reserve
INS02S(2oloos).oI The ACORD name and logo are registered marks of ACORD
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SHORT FORM PURCHASE OF SERVICE CONTRACT
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: Golden State Bait. Inc.
Street Address: 6554 S. Healy Road
City/State/Zip: Merced, CA 95340
Telephone: M-5) 963.9/�7
Email: goldenstatebaitOaol.com
Taxpayer ID #: 2i -- Kf �P 34-S I
City Business License #:
o► Ts
2. Term: The effective date of this contrac/27_/2 17
and it terminates 6/30/2017 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)
Provide fish stocking services for Lake
Elsinore in accordance with the attached
quote.
(b) Contractor shall perform the above -referenced
services at or to the following specified
location/s: (Attach extra sheet/s if necessary)
La Laguna Resort and Boat Launch
32040 Riverside Drive
Lake Elsinore, CA 92530
4. Supplemental Conditions: This Contract is subject
to the Supplemental Conditions attached hereto, which
are incorporated herein by reference.
Golden State Bait, Inc.
February 22, 2017
City of Lake Elsinore
5. Compensation: Contractor's total compensation for
the goods and/or services performed under this
Contract is $30,000, 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;
(3) 1 1 lump sum per -task in the amounts indicated below,
payable in monthly installments not to exceed the
percentage completion of each task; (4) Z✓ per attached
written quote, up to a guaranteed not -to -exceed amount
of $30,000.00.
Task Amount
1. Supply fish stocking services for $30,000
Lake Elsinore including Largemouth
Bass, Bluegill, Black and Black
Crappie
2-
3.
6. Signatures: These signatures attest the parties'
agreement hereto:
CONTRACTOR:
Golden S -tate Bait, Inc...
"MOIL��ALA .
CITY OF L&KE ELSINO
By:.,
C
Ap ved as to con tll surance:
B.
C Purc asfng gent/Risk Ma ger
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 Liabilily 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 ($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
Golden State Bait, Inc.
February 22, 2017 2
City of Lake Elsinore
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 Comcensation.
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.
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.
Golden State Bait, Inc.
February 22, 2017 3
City of Lake Elsinore
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 Wages.
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.
Golden State Bait, Inc.
February 22, 2017 4
City of Lake Elsinore
DISPLAY CONSPICUOUSLY AT PLACE OF BUSINESS FOR WHICH ISSUED
CALIFORNIA STATE BOARD OF EQUALIZATION
SELLER'S PERMIT
ACCOUNTNUMBER
1/1/2007 SR KH 100-908847
GOLDEN STATE BAIT INC.
6554 HEALY RD
MERCED, CA 95340-8953
NOTICE TO PERMITTEE:
yoU are required to obey aR
Federal and State fates that
regulate or contrnf your
&mlriess_ This permrf does
not allow you to do
otherwise.
IS HEREBY AUTHORIZED PURSUANT TO"' AND UBETAX LAW TO ENGAGE IN THE
BusINEss of SELLING TANGIBLE PERSONAL PROPEpTY AT THE ABOVE LOCATION.
THIS PERMIT 15 VALID ONLY AT THE ABOVE ADDRESS -
THIS PEFIMrr IS VALID UFfnL RpgOKED OR CANCELED AND IS NOT TRANSFERABLE. IF YOU SELL YOUR BUSINESS Not valid at any other address
OR DROP OUT OFA PARTNERSHIP. NOTIFY Us OR YOU COULD BE RESPONSIBLE FOR SALES AND USE TAXES
OWED BY THE NEW OPERATOR OF THE BUSINESS.
For general tax questions, please call our Information Center at 800-400-7115.
For Information on your rights, contact the Taxpayers' Rights Advocate Office at 888-324-2798 or 916-324-2798.
BOE-442-R.REV.15 (2-06)
A MESSAGE TO OUR NEW PERMIT HOLDER
As a seller, you have rights and responsibilities under the Sales and Use Tax Law. In order to assist you In your
endeavor and to better understand the law, we offer the following sources of help.
• Visiting our website at www.boe.ca.gov
• Visiting a district office
• Attending a Basic Sales and Use Tax Law class offered atone of our district offices
• . Sending your questions in writing to any one of our offices
• Calling our toll-free Information Center at 800-400-7115
have the respoPo resoleu have the right to issue merchandise
n iblilty a# not misusing resalaO"ficates. VVhlle the sales tax is imposed upon the etaileronversely, you
• You have the right to seek reimbursement of the tax from your -customer
• You are responsible for filing and paying your sales and use tax returns timely
• You have the right to be treated in a fair and equitable manner by the employees of the Board
• You are responsible for following the regulations set forth by the Board
As a seller, you are expected to maintain the normal books and records of a prudent businessperson. You are required to
maintain these books and records for no less than four years, and make there available for inspection by a Board representative busine
when requested. You are also expected to notify us if you are buying, selling, adding a location, or discontinuing y
adding or dropping a partner, officer, or member, or when you are moving any or all of your business locations. If it becomes
necessary to surrenderthis permit, you should only do so by mailing it to a Board office, or giving it to a Board representative.
If you would like to know more about your rights as a taxpayer, or if you are unable to resolve an issue with the Board, please
contact the Taxpayers' Rights Advocate Office for help by calling toll-free, 888-324-2798 or 916-324-2798. Their fax number is
916-323-3319.
Please post this permitat the address for which it was issued and at a location visible to your customers.
STATE BOARD OF EQUALIZATION
Sales and Use Tax Department
-� Q7 DATE (MMIDONYYY)
A� n CERTIFICATE OF LIABILITY INSURANCE 2/14/2017
THIS CERTIFICATE 18 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 eertifleate holder In an ADDITIONAL INSURE, the policy(los) must be endorsed. If SUBROGATION IS WAIVED, subject to
the twn 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 NAME: CT $OCOrrO Jurado
Barlocker Insurance Agency, Inc. PHONE (209) 383-0220 FAX (209)383-5124
License #0580438
E'MASL ajurado@barlocker.com
1164 Olivewood Dr. atau a AFFORDING OVERAGIE hA[C
Merced CA 95348 WSURERANationwide Agribusiness 028223
INSURED INSURERB:State Co ensation Insurance 35076
Brad & Stefani Saylor INSURERC,
dba: Golden State Bait,Inc. INSURER
6554 South Healy Road INSURERS:
Merced CA 95340 1NSURERF:
COVERAGES CERTIFICATE NUMBER:CL1721401963 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INBR TYPEOFINSURANCE
LIR
POWCYNUMBER IO t:FF PDupYE%P
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
X COMMERCIAL GENERAL LIABILITY
PREMISE a ncnirro
$ 50,000
A CLAIMS -MADE OCCUR X
FPK7892565836 /28/2016 2 /28/2017
MED FXP(AnYone peraon)
$ 5,000/25
PERSONAL &ADV INJURY
5 1,000,000
GENERAL AGGREGATE
$ 2,000,00
GEN,L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COWIPIOPAGG
S 1,000,000
X POLICY PRO LOG
$
AUTOMOBILE LIABILITY
EDacolont LELIMI
11000,000
X
BODILY INJURY (Per person)
$
ANY AUTO
A ALL OWNED SCHEDULED X
PPKBAN7892565836 '/28/2016 /28/2017
BODILY INJURY (Per accident) $
AUTOS AUTOS
NON-OWNED
PROPERTYRAMAGE
$
HIRED AUTOS
P dent
Unlnsuredmotorlatcombined
$ 11000,000
UMBRELLA LIAB OCCUR
EACH OCCURRENCE
$
EXCESSLIAB CLAIMS -MADE
AGGREGATE
$
DEp RETENT[ON
IM1IC OTH-
$
B WORIMRS COMPENSATION
"j'IT- I
AND EMPLOYERS' LIABILITY YIN
E L. EACH ACCIDENT
$ 11000,000
ANY PROPRiETCR;PARTNERIEKECUTIVE
❑FFICEWMEMBEREXCLUDED? ❑ NIA
075610-16 0/14/2016 0/14/2017
E. L. DISEASE - EA EMPLOYEE
$ 1,000 000
(Mandatory In NH)
II yyes, desc,Ibe under
E.L. DISEASE - POLICY LIMIT
$ 1 Q 0 0 0 0 0
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES IAtUch ACORD 101, Addldonel Remade Sch"ulo, H mon epace la requlnd)
The City of Lake Elsinore , its officers and amployeea shall be named as additonal insured in regards to
project: Fish stocking services
for Lake Elsinore at La Laguna Resort and
Boat Launch, 32040 Riverside
Drive, Lake Elsinore, CA 92530 effective dates 02/22/2017 to 06/30/2017
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
City of Lake Elsinore
130 S. Main St.
Lake Elsinore, CA 92530 AUTHORI2EDREPRESENTATIVE
Jurado, Socorro
ACORD 25 (2010105) ®1958-2010 ACORD CORPORATION. All rights reserved.
INS025 (201005).01 The ACORD name and logo are registered marks of ACORD