HomeMy WebLinkAbout2004-2471
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RESOLUTION NO. 2004-247
RESOLUTION OF THE MAYOR AND COMMON COUNCIL OF THE CITY
OF SAN BERNARDINO AUTHORIZING THE EXECUTION OF A
CONTRACT WITH AND ISSUANCE OF A PURCHASE ORDER TO
INDUSTRIAL AIR INNOVATIONS, INC. FOR THE REPLACEMENT OF
TWO COOLING TOWERS AT CAROUSEL MALL IN THE CITY OF SAN
BERNARDINO.
BE IT RESOLVED BY THE MAYOR AND COMMON COUNCIL OF
THE CITY OF SAN BERNARDINO AS FOLLOWS:
SECTION 1. Industrial Air Innovations, Inc. is the lowest responsive bidder
for the replacement of two cooling towers at Carousel Mall in the City of San
Bernardino. A contract is awarded accordingly to said Contractor in a total amount of
$83,644.00, with a contingency amount of $8,356.00. Such award shall be effective
only upon said contract being fully executed by both parties. The Mayor is hereby
authorized and directed to execute said contract on behalf of the City; a copy of the
contract is attached hereto as Exhibit A and incorporated herein. The Purchasing
Manager is hereby authorized and directed to issue a Purchase Order which references
this resolution to said Contractor in the amount of $83,644.00.
SECTION 2. Any amendment or modification thereto shall not take effect or
become operative until fully signed and executed by the parties and no party shall be
obligated hereunder until the time of such full execution. No oral agreements,
amendments, modifications or waivers are intended or authorized and shall not be
implied from any act or course of conduct of any party. This resolution is rescinded if
the parties to the contract fail to execute it within sixty (60) days of the passage of this
resolution.
2004-247
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RESOLUTION OF THE MAYOR AND COMMON COUNCIL OF THE CITY
OF SAN BERNARDINO AUTHORIZING THE EXECUTION OF A
CONTRACT WITH AND ISSUANCE OF A PURCHASE ORDER TO
INDUSTRIAL AIR INNOVATIONS, INC. FOR THE REPLACEMENT OF
TWO COOLING TOWERS AT CAROUSEL MALL IN THE CITY OF SAN
BERNARDINO.
I HEREBY CERTIFY that the foregoing resolution was duly adopted by the
Mayor and Common
Council of the City of San Bernardino at a
j t . regular
meeting thereof, held on the 2nd day of
August
, 2004, by the following vote, to wit:
Council Members:
AYES NAYS ABSTAIN ABSENT
ESTRADA
x
LONGVILLE
x
MCGINNIS
x
DERRY
x
KELLEY
x
JOHNSON
x
NmcCAMMAC:K
x
Ra hel G. Clark, City Clerk
The foregoing resolution is hereby approved this,,,( day of August
2004.
Approved as to form and legal content:
F. Penman, City Attorney
�10L `
Susan Longville, Mayor Pro Tern
City of San Bernardino
2004-247 Exhibit "A"
AGREEMENT FOR SERVICES
This AGREEMENT is made and entered into this 2nd of August 2004, by and
between the CITY OF SAN BERNARDINO, California, a municipal corporation, hereinafter referred to as the
"CITY" and Industrial Air Innovations, Inc., hereinafter referred to as "CONTRACTOR".
WITNESSETH
WHEREAS, City desires to engage a mechanical contractor for the replacement of two cooling towers at
Carousel Mall in the City of San Bernardino, California; and
WHEREAS, Contractor is a licensed mechanical contractor qualified to provide said services; and
WHEREAS, San Bernardino City Council has elected to engage the services of Contractor upon the
terms and conditions as hereinafter set forth; and
NOW, THEREFORE, it is mutually agreed, as follows:
1. SCOPE OF SERVICES
Contractor shall perform those services specified in the attached quotation, dated June 23, 2004,
and proposed costs, a copy of which is attached hereto as Exhibit "1", and all of which are
incorporated herein as though set forth in full.
2. TERM OF AGREEMENT
Contractor shall commence within five (5) days after the City has authorized work to start by
issuance of a Notice to Proceed.
3. STANDARD OF PERFORMANCE
Contractor shall complete all work in conformance with Federal, State, and local regulations and
industry standards.
4. CHANGES/EXTRA SERVICES
A. Performance of the work specified in the attached quotation are made an obligation of Contractor
under this Agreement, subject to any changes made subsequently upon mutual agreement of the
parties. All such changes shall be considered as additional tasks and shall be incorporated by
written amendments to this Agreement and include any increase or decrease in the amount of
compensation due Contractor for the change in scope. Any change, which has not been so
incorporated, shall not be binding on either party.
B. Contractor shall render no extra services under this Agreement unless City authorizes such extra
services in writing prior to performance of such work. Authorized extra services shall be
invoiced based on the authorized additional task amounts.
5. COMPENSATION
2004-247 Exhibit "A"
A. Upon satisfactory completion of the work, the Contractor will be paid time and material
not to exceed $83,644.00 in arrears, for all work and services performed under this
contract and upon receipt of itemized invoices, submitted in triplicate to the contract
manager. The invoice amount will be based on the actual work performed by task.
Contractor will submit an invoice to the City upon completion of each building or at the
completion of the project.
B. Said compensation shall not be altered unless there is significant alteration in the scope,
complexity or character of the work to be performed. City and Contractor shall agree
upon any such significant alteration in writing before commencement of performance of
such significant alteration by Contractor.
Any adjustment of the total cost of services will only be permitted when the Contractor
establishes and City has agreed in writing that there has been, or is to be, a significant
change in:
1. Scope, complexity, or character of the services to be performed;
2. Conditions under which the work is required to be performed; and
3. Duration of work if the change from the time period specified in the Agreement
for completion of the work warrants such adjustment.
C. The Contractor is required to comply with all Federal, State and local laws and
ordinances applicable to the work. The Contractor is required to comply with prevailing
wage rates in accordance with California Labor Code Section 1770.
6. PAYMENT BY CITY
A. The billings for all services rendered pursuant to this Agreement shall be submitted by
Contractor to City and shall be paid by City within twenty (20) days after receipt of same,
excepting any amounts disputed by City. Dispute over any invoiced amount shall be
noticed to the Contractor within ten (10) days of billing and a meet and confer meeting
for purposes of resolution of such dispute shall be initiated by the City within (10) days
of notice of such dispute. All tasks as specified in Exhibit "1" shall be completed prior to
final payment.
B. No payment will be made for any work performed prior to approval of this contract by
City and Notification to Proceed.
SUPERVISION AND ACCEPTANCE OF SERVICES
A. The Director of Facilities Management of City, or his designee, shall have the right of
general supervision over all work performed by Contractor and shall be City's agent with
respect to obtaining Contractor's compliance hereunder. No payment for any services
2004-247 Exhibit "A"
rendered under this Agreement shall be made without prior approval of the Director of
Facilities Management or his designee.
8. COMPLIANCE WITH CIVIL RIGHTS LAWS
Contractor hereby certifies that it will not discriminate against any employee or applicant for
employment because of race, color, religion, sex, marital status, age, handicap or national origin.
Contractor shall comply with all State and Federal Civil Rights Laws in its hiring practices and
employee policies. Such action shall include, but not be limited to, the following: recruitment
and recruitment advertising, employment, upgrading, and promotion.
9. TERMINATION OF AGREEMENT
A. This Agreement may be terminated by either party upon thirty (30) days' written notice
in the event of substantial failure of the other party to perform in accordance with the
terms of this Agreement. Each party shall have twenty (20) days following the date of
such notice within which to correct the substantial failure, giving rise to such notice. In
the event of termination of this Agreement, City shall within thirty (30) days pay
Contractor for all the fees, charges and services performed to City's satisfaction by
Contractor, which finding of satisfaction shall not be unreasonably withheld. Contractor
hereby covenants and agrees that upon termination of this Agreement for any reason,
Contractor will preserve and make immediately available to the City, or its designated
representatives, maps, notes, correspondence, or records related to work paid for by the
City and required for its timely completion, and to fully cooperate with City so that the
work to be accomplished under this Agreement may continue within forty-five (45) days
of termination. Any subsequent use of such incomplete documents, other than their
originally intended use, shall be at the sole risk of the City, and the City agrees to hold
harmless and indemnify Contractor from any claims, losses, costs, including attorney's
fees and liability arising out of such use. Contractor shall be compensated for such
services in accordance with Exhibit "1".
B. This Agreement may be terminated for the convenience of the City upon thirty (30) days
written notice to Contractor. Upon such notice, Contractor shall provide work product to
City, and City shall compensate Contractor in the manner set forth above.
C. Following the effective date of termination of this Agreement pursuant to this section, the
Agreement shall continue until all obligations arising from such termination are satisfied.
10. CONTINGENCIES
In the event that, due to causes beyond the control of and without the fault or negligence of
Contractor, Contractor fails to meet any of its obligations under this Agreement, and such failure
shall not constitute a default in performance, the City may grant to Contractor such extensions of
time and make other arrangements or additions, excepting any increase in payment, as may be
reasonable under the circumstances. Increases in payment shall be made only under the
"changes" provision of this Agreement. Contractor shall notify City within three (3) days in
3
2004-247 Exhibit "A"
11.
12.
writing when it becomes aware of any event or circumstances for which it claims or may claim
an extension.
Contractor shall act as an independent contractor and shall not be considered an employee of the
City in the performance of the services provided for under this Agreement. Contractor shall
furnish such services in its own manner. This Agreement is not intended and shall not be
construed to create the relationship of agent, servant, employee, partnership, joint venture, or
association between Contractor and the City.
ASSIGNMENT OR SUBCONTRACTING
Contractor shall not assign this Agreement, or any portion thereof without the written consent of
City. Any attempt by Contractor to assign or subcontract any performance of this Agreement
without the written consent of the City shall be null and void and shall constitute a breach of this
Agreement. All subcontracts exceeding $10,000 shall contain all provisions of this contract.
13. NOTICES
All official notices relative to this Agreement shall be in writing and addressed to the following
representatives of Contractor and City:
CONTRACTOR
Jim Carter
Industrial Air Innovations, Inc.
323 South Sierra Way
San Bernardino, CA 92412
14. RESPONSIBILITIES OF PARTIES
CITY
Jim Sharer
Director of Facilities Management
300 N. "D" Street
San Bernardino, CA 92418
A. The Contractor may reasonably rely upon the accuracy of data provided by the City or its
agents.
B. Upon completion of all work under this contract, ownership and title to all reports,
documents, plans, specifications, and estimates produced as part of this contract will
automatically be vested in the City and no further agreement will be necessary to transfer
ownership to the City.
C. For the purpose of determining compliance with Public Contract Code Section 10115, et.
seq. and Title 21, California Code of Regulations, Chapter 21, Section 2500 et. seq.,
when applicable, and other matters connected with the performance of the contract
pursuant to Government Code Section 8546.7, the Contractor, subconsultant, and the City
shall maintain all the books, documents, papers, accounting records, and other evidence
pertaining to the performance of the contract, including but not limited to, the costs of
administering the contract.
4
2004-247 Exhibit "A"
All parties shall make such materials available at their respective offices at all
reasonable times during the contract period and for three years from the date of final
payment under the contract. The State, the State Auditor, or any duly authorized
representative of the Federal government having jurisdiction under Federal laws or
regulations (including the basis of Federal funding in whole or in part) shall have
access to any books, records, and documents of the Contractor that are pertinent to
the contract for audits, examinations, excerpts, and transactions, and copies thereof
shall be furnished if requested.
15. HOLD HARMLESS CLAUSE
A. Contractor shall indemnify, defend and hold free and harmless the City, its officers, and
its employees from all claims, damages, costs, expenses, and liability, including, but not
limited to attorney's fees, imposed upon them for any alleged infringement of patent
rights or copyrights of any person or persons in consequence of the use by City, its
officers, employees, agents, and other duly authorized representatives, of programs or
processes supplied to City by Contractor under this Agreement.
B. The prevailing party in any legal action to enforce or interpret any provision of this
Agreement will be entitled to recover from the losing party all reasonable attorneys' fees,
court costs, and necessary disbursements in connection with that action. The costs,
salary, and expense of the City Attorney and members of his office, in connection with
that action shall be considered as attorneys' fees for the purposes of this Agreement.
16. INDEMNITY
Contractor shall indemnify, defend and hold harmless City from and against any and all claims,
demands, suits, actions, proceedings, judgments, losses, damages, injuries, penalties, costs,
expenses (including reasonable attorney's fees), and liabilities, of, by, or with respect to third
parties, which arise from Contractor's negligent performance of services under this Agreement.
Contractor shall not be responsible for, and City shall indemnify, defend, and hold harmless
Contractor from and against, any and all claims, demands, suits, actions, proceedings, judgments,
losses, damages, injuries, penalties, costs, expenses (including reasonable attorney's fees) and
liabilities of, by or with respect to third parties, which arise from the City's negligent
performance under this Agreement. With respect to any and all claims, demands, suits, actions,
proceedings, judgments, losses, damages, injuries, penalties, costs, expenses (including
reasonable attorney's fees) and liabilities of, by or with respect to third parties, which arise from
the joint or concurrent negligence of Contractor and City, each party shall assume responsibility
in proportion to the degree of its respective fault.
17. LIABILITY/INSURANCE
Contractor shall maintain insurance policies meeting the minimum requirements set forth herein. All
insurance maintained by the Contractor shall be provided by insurers satisfactory to the City.
Certificates evidencing all insurance coverage required herein shall be delivered to the City prior to
the Contractor performing any of the services under this Agreement. All insurance certificates
required herein shall name the City as an additional insured and provide for thirty-(30) days written
5
2004-247 Exhibit "A"
notice from the insurer to the City prior to any change or cancellation of any insurance policy of the
Contractor.
A. Comprehensive General Liability and Automobile Insurance. The Contractor shall
maintain comprehensive general liability and automobile liability insurance with a combined
single limit of not less than One Million Dollars ($1,000,000.00) per occurrence.
B. Worker's Compensation Insurance. The Contractor shall maintain worker's
compensation insurance in accordance with the laws of the State of California for all
workers employed by the Contractor.
18. VALIDITY
Should any provision herein be found or deemed to be invalid, this Agreement shall be construed as
not containing such provision, and all other provisions which are otherwise lawful shall remain in
full force and affect, and to this end the provisions of this Agreement are declared to be severable.
19 ENTIRE AGREEMENT
This Agreement represents the entire and integrated agreement between the parties hereto and
supersedes all prior and contemporaneous negotiations, representations, understandings, and
agreements, whether written or oral, with respect to the subject matter thereof. This Agreement may
be amended only by written instrument signed by both parties.
IUI
1H
2004-247
Exhibit "A"
AGREEMENT FOR Services with Industrial Air Innovations, Inc.
IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be executed on the date
written above by their duly authorized officers on their behalf.
ATTEST:
BY: 2,,,4u /b. Q,&k,
Raeftel Clark, City Clerk
City of San Bernardino
Approved as to form
and legal content:
JAMES F. PENMAN
City Attorney
I:
CITY OF SAN BERNARDINO
BY: ,
Susan Longville, Mayor Pro Tern
City of San Bernardino
Industrial Air Innovations, Inc.
TITLE:
President
W
2004-247
---__�\ EXHIBIT 1
IAI Industrial Air Innovations
Mechanical Contractors
HVAC • Retrofit • Central Plant • Chillers • Boilers • Energy Controls • Design Build • Refrigeration
June 23, 2004
City of San Bernardino
300 North D Street
San Bernardino, Ca. 92418
Attn: Rick Moreno, Facilities
Subj: Carousel Mall
Ref: Evap Condenser Change Outs
Dear Sir:
Thank you for an opportunity to serve you. Upon our most recent survey this past month
and reviewing the scope to change out the east and west Baltimore Air Coil evap
condenser -towers; our proposal description is as follows:
(A) Remove and replace with new, two (2) Evapco Model LSCB-155 forced draft
counter flow evaporative condensers, nominal 150 tons at 40 degree suction and
105 degree condensing with a entering wet bulb temperature.
(B) Pump down existing Carrier 30HXA186 chillers and store/salvage existing
refrigerant.
(C) Utilize Bragg Crane to remove and rig in place, new evap condenser -towers.
(D) New galvanized iron platform covers complete with I-beam supports.
(E) Extend water lines to new external floats.
(F) Extend refrigeration piping and electrical to new points of connection.
(G) Includes start-up and test of new equipment and (e)xisting chillers.
(H) (1) one-year warranty and labor guarantee on new work tasks.
(I) Delivery is 6 to 8 weeks.
(J) Pricing is good for thirty days and can be protected thru October 2004 if ordered
within 30 days.
Price including tax is $76,740.00
Add: Seismic rail isolation; by M.W. Sausse $6,904.00.
Add: Bond @ 1 %%.
Very truly yours,
James S. Carter
Vice President
323 S. SIERRA WAY • PO. BOX 5302 • SAN BERNARDINO, CA 92412-5302
(909) 884-6276 • FAX (909) 889-6936
LIC. # 405281
2004-247
Qv co
Jim Carter
Industrial Air Innovations
323 S. Sierra Way PO Box 5302
San Bernardino, CA, 91412
Phone, (909) 884.6276
Fax: (909) 889�936
Project: Carousel Mall
Location:
Gentlemen:
Thank you for requesting a quotation for EVAPCO equipment We are pleased to submit our offer as follows-
(2) EVAPCO Model LSCB 155 forced draft counterflow evaporative condensers, each unit having the condensing
capacity of 150 Tons with R22 at 40°F suction, 105°F condensing and 78OF entering wet bulb temperature.
Technical Data for each unit.
# Fan Motors (HP):
# Pump Motors (HP),
Air Flow (CFM):
Spray Water Flow (gpm):
Evaporated Water Rate (gpm):
Operating Weight (lbs):
Shipping Weight (lbs)-
Accessories included with offer:
Copper sweat fittings
Total Net Price including accessories:
excluding tax, including freight
(1) 10..00
(1) 1.50
23 300
245
3.6
8,410
6,500
FOB factory with full freight allowed to Los Angeles Area,CA.
Shipment: 6-8 weeks after receipt of purchase order and release for fabrication.
Quotation is Valid for purchase within 30 days and shipment within eight months from date of this quotation.
Terms of payment Net 30 Days
All purchase orders must be addressed to EVAPCO, Inc. Go the undersigned.
JU[l-z4- CLU4 J14Jf'NI
Vr;'!t,?_ JfJ'2004-247
No•3'b4
P. 2
Evaporative Condenser Data Sheet
Jim Carter
Industrial Air Innovations
(909) 884-6276 Fax: (909) 889-6936
Project: Carousel Mall
Location:
Product Type: LSCB Evaporative Condenser
Selection Criteria
Mark Comstock
Vertical Systems
1508 Cotner Avenue
Los Angeles, CA, 90025, U S A.
(310) 451-0630 Fax: (310) 458-1036
Date: 06/22/04 Page: 1
Capacity (Tons)'
30000
Refrigerant:
R22
Condensing Temp (Fg
105.0
Suction Temp (F)
400
Wet Bulb (F):
78.0
Selection
LSCS Capacity
Percent
Qty Model (Tons)
Capacity
2 155 155
103.3
All Weights,
Dimensions and Technical Data are Shown per Unit
# Fans: 4
# Fan Motors Q HP: (1)
Q 10 00(460/3/60) Overall Length
11' 11.75"
# Pump Motors @ HP, (1)
Qa 150 Overall Width :
4' 0.63"
Overall Height -
8' 7.00'
Air Flow (CFM):
23,300
Spray Water Flow (gpm):
245 Operating Weight (Ibsy
8,410
Shipping Weight (lbs):
6,500
Evaporated Water Rate (gpm):
36 Heaviest Section (lbs)-
4,750
Recommended Bleed Rate (gpm),
36
Options Selected
Copper sweat fittings
Sound Data (Sound Pressure Level)
Conn End Fan Side Opp End Back
Top
S P L dB(A) at 5' 73
78 73 73
77
S.P.L. dB(A) at 50' 59
62 59 58
61
Note 1: Sound Data shown is for 1 cell operating at full speed
Note 2: The use of frequency inverters (Variable Frequency Drives) can increase sound levels.
Note 3, Sound options) selected None
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Evaporative Condenser Data Sheet Page- 2
Layout Criteria
Recommended Clearances Around Units (Feet)
Elevation
0 Distance From Wall to Unit With Air Inlet Facing Wall:
5
Distance Between Units Wnh Air Inlets Facing Each Other.
10
Refer to the Equipment Layout Manual or contact your Sales Representative for more details on layout criteria.
Shipping Data
Description
Domestic Skidded Dimensions (inTotal
) Cubic Feet Cubic Feet
Gross
Wt (Ibs)
Total
Gross
Section
Length Width Height
Basin:
Casing-
1 163 50 48 226 226
1 161
1,760
Wt (Iba)
1,750
45 64 268 268
4,750
4,750
Totals
2 494 495
6.500
6,500
Shipping Notes:
Can ship as (1) piece
2004-247
M.W. 5AU55E' & CO., INC.
25590 Avenue Stanford Valencia, Ca. 91355-1199
Phone:661-257-3311 llawrom@mwcaurse.com FAX:661-257-7673
Quotation
To: Industrial Air Innovations Date: June 22, 2004
Fax No.: 909-68946936 No. Pages Including
Transmittal Sheet:l
Attn: Jim Carter
From: Lisa Lawson
Subject: Carousel Mall — City of San Bernardino
2 only DAC Towers 'RML5-58-EQ" structural steel full perimeter
support frame with 2' deflection spring earthquake
isolators.
'Nate:
1) Above price Is net and F.0.13. factory Valenela, with fr t allowed to the jolseu.
Lisa Lawson, Inside Sales Manager
I
I
ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID L
DATE (MMIDDM ,
INACO-1
4
OB/16 04
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Austin Cooper 6 Price
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Ins Agency Inc (Lic-0546677)
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P O Box 3280
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
San Bernardino CA 92413-3280
1
Phone:909-886-9861 Fax:909-886-2013
INSURERS AFFORDING COVERAGE
NAIC#
INSURED Inland Acoustics Inc,
Industrial Air Innovations dba
INSURER A. NIC Insurance Compan /PTN
Inland Interior Contractingdba
INSURER B: Netherlands Ins Co/GOE
Clements Heating & Air
Conditioning Service DBA
IINSURER c: Peerless Ins Co/GOE
P O Box 5302
San Bernardino CA 92412
INSURER D. Mt Hawley Ins Co/PTN
K.ria:i_1191*-y
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
NSR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE MM/DOIYY
POLICY EXPIRATION
DATE MMIDD/YY
LIMITS
LIABILITY
li EACH OCCURRENCE
$ 1,000,000
A
X
$GENERAL
MMERCIAL GENERAL LIABILITY
CLAIMS MADELK OCCUR
GS308784
11/27/03
11/27/04
NILU
PREMISESOEaoccurence
S50,000
MED EXP(Any one person)
$5,000
PERSOrvALflADVINJURY
S1,000,000
U INC/BFPD
PER JOB AGG INCL
X
Contractual Liab
GENERAL AGGREGATE
$2,000,000
DED $2,500 PD PER CCC
GENT AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMPIOP AGG
$2,000,000
POLICY X PRO LOC
JECT
B
AUTOMOBILE
LIABILITY
ANY AUTO
BA9797334
11/27/03
11/27/04
(Ea accident) COMBident) LE LIMIT
$1r 000r 000
X
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
$
OTHERTHAN EA ACC
$
ANY AUTO
$
AUTO ONLY: AGG
EXCESSIUM13RELL.A LIABILITY
EACH OCCURRENCE
$6,000,000
D
X OCCUR �CLAIMSMADE
NXL0360064
11/27/03
11/27/04
AGGREGATE
$6,000,000
$
$
DEDUCTIBLE
$
RETENTION $
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
ANY PROPRIETORIPARTNEWEXECUTIVE
OFFICER/MEMBER EXCLUDED'
A yes, Runder
TORV LIAUS ER
.
E.LEACH ACCIDENT
$
EL. DISEASE -EA EMPLOYE
$
SPECIALAL PROVISIONS below
EL DISEASE -POLICY LIMIT
$
OTHER
C
Property
CBP9651351
11/27/03
11/27/04
see below if applies
C
Install Floater
CBP9651351
11/27/03
11/27/04
Per Occ $250,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
Job: Carousel Mall, San Bernardino CA #9923-SH-79081
Certholder is add'1 ins/prim wrdg as respects gen'l liab per ANF160 0903
30 days N 0 C except 10 days for nonpayment
2
CERTIFICATE HOLDER CANCELLATION
City Of San Bernardino
Michelle Taylor
300 North I'D" Street
San Bernardino CA 92418
CISBE'+01 I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIO
DATE THEREOF, THE ISSUING INSURER WILL MAIL 30 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
ACORD 25 (2001108)
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
BLANKET ADDITIONAL INSURED ENDORSEMENT
(EXCLUDING RESIDENTIAL AND HABITATIONAL)
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
ADDITIONAL INSURED — OWNERS, LESSEES OR CONTRACTORS (FORM B)
CG 20 10 1185
SCHEDULE
Name of Person or Organization:
City of San Bernardino
Job: Carousel Mall, San Bernardino CA
Any person or organization that the named insured is obligated by virtue of a written
contract or agreement to provide insurance such as is afforded by this policy. Provided
the Company is notified in writing within 30 days of inception of the contract or
agreement, or the inception of this policy, whichever is later.
WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization
shown in the Schedule, but only with respect to liability arising out of "your work" for that insured
by or for you.
The following additional provisions apply to any entity that is an insured by the terms of this
endorsement:
1. Primary Wording
If required by written contract or agreement: Such insurance as is afforded by this policy
shall be primary insurance, and any insurance or self-insurance maintained by the above
additional insured(s) shall be excess of the insurance afforded to the named insured and
shall not contribute to it.
2. Waiver of Subrogation
If required by written contract or agreement: We waive any right of recovery we may have
against an entity that is an additional insured per the terms of this endorsement because
of payments we make for injury or damage arising out of "your work" done under a
contract with that person or organization.
3. Neither the coverages provided by this insurance policy nor the provisions of this
endorsement shall apply to any claim arising out of the sole negligence of any additional
insured or any of their agents/employees.
4. This endorsement does not apply to any work involving or related to properties intended
for permanent residential or habitational occupancy.
The words "you" and "your" refer to the Named Insured shown in the Declarations.
"Your work" means work or operations performed by you or on your behalf; and materials, parts
or equipment furnished in connection with such work or operations.
Insured: Inland Acoustics Inc
Policy Number: GS308784
ANF 160 (9/2003)
CERTHOLDER COPY
STATE P.O. BOX 420807, SAN FRANCISCO, CA 94142-0807
COMPENSATION
INSURANC E
FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
ISSUE DATE: 08-16-2004 GROUP: 000044
POLICY NUMBER: 21556-2003
CERTIFICATE ID: 1298
CERTIFICATE EXPIRES: 11-27-2004
11-27-2003/11-27-2004
CITY OF SAN BERNARDINO
300 N."Da STREET
SAN BERNARDINO CA 92418
JOB: CAROUSEL MALL
SAN BERNARDINO CA #9923-5H-7981
This is to certify that we have issued a valid Worker's 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
policy 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 to which it may pertain, the insurance afforded by the policy
described herein is subject to all the terms, exclusions, and conditions, of such policy.
AUTHORIZED REPRESENTATIVE
PRESIDENT
EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE.
ENDORSEMENT #1600 - LARRY HYDER, PRES, SEC, TRES - EXCLUDED.
ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 11-27-2002 IS
ATTACHED TO AND FORMS A PART OF THIS POLICY.
EMPLOYER
INLAND ACOUSTICS, INC.
PO BOX 5302
SN BERNRDNO CA 92412
[6,NH]
PRINTED. 06-16-2004
SCIF 10262E Accept this cerllcate only if you see a faint watermark that reads STATE FUND DOCUMENT PAGE 1 OF 1