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HomeMy WebLinkAbout2004-3931 2 3 4 5 6 7 8 9 10 ill 1 1 RESOLUTION NO. 2004-393 RESOLUTION OF THE CITY OF SAN BERNARDINO AUTHORIZING AND DIRECTING EXECUTION OF A LICENSE AND AGREEMENT WITH LOCKHEED MARTIN CORPORATION (LMC) FOR ENCROACHMENT OF A GROUNDWATER MONITORING WELL IN THE PUBLIC RIGHT-OF-WAY LOCATED ON SAN JACINTO STREET, EAST OF GIFFORD AVENUE, SOUTH OF MILL STREET. BE IT RESOLVED BY THE MAYOR AND COMMON COUNCIL OF THE CITY OF SAN BERNARDINO AS FOLLOWS: SECTION 1. That the Mayor and Common Council of the City of San Bernardino is hereby authorized and directed to execute, on behalf of said City, a license and agreement with Lockheed Martin Corporation (LMC) for encroachment of a groundwater monitoring well in the public right-of-way located on San Jacinto Street, east of Gifford Avenue, south of Mill Street, a copy of which is attached hereto and incorporated herein as Exhibit "A". SECTION 2. The authorization to execute the above referenced license and agreement is rescinded if the parties fail to execute it within sixty (60) days of the passage of this 15 Resolution. 16 17 18 19 20 21 12/14/04 2004-393 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 19 20 21 22 23 24 25 271 RESOLUTION .... AUTHORIZING AND DIRECTING EXECUTION OF A LICENSE AND AGREEMENT WITH LOCKHEED MARTIN CORPORATION (LMC) FOR ENCROACHMENT OF A GROUNDWATER MONITORING WELL IN THE PUBLIC RIGHT-OF-WAY LOCATED ON SAN JACINTO STREET, EAST OF GIFFORD AVENUE, SOUTH OF MILL STREET. I HEREBY CERTIFY that the foregoing resolution was duly adopted by the Mayor and Common Council of the City of San Bernardino at a Joint regular meeting thereof held on the 20th day of December 20 04 , by the following vote, to wit: Council Members: AYES ESTRADA x LONGVILLE x x MCGINNIS x DERRY KELLEY x JOHNSON x MCCAMMACK x NAYES ABSTAIN ABSENT L l City derk n The foregoing resolution is hereby approved this day of(e/1rw�� 20 Approved as to form and legal content: JAMES F. PENMAN City Attorney By: 0 12/14/04 Rikke Van Johnson Mayor Pro Tem City of San Bernardino I 2004-393 EXHIBIT "A" LICENSE AND AGREEMENT THIS LICENSE AND AGREEMENT is made and entered into this 20th day of December 20 04 by and between LOCKHEED MARTIN CORPORATION (LMC) hereinafter referred to as "Licensee," and the CITY OF SAN BERNARDINO, a municipal corporation hereafter referred to as "City." WITNESSETH: For and in consideration of the mutual promises and covenants herein contained, the parties hereto do hereby agree as follows: 1. City hereby gives permission, removable and terminable as hereinafter provided, to Licensee to install, use and maintain in conformance with existing laws on a certain portion of the City's public right-of-way for San Jacinto Street, east of Gifford Avenue and south of Mill Street, a groundwater monitoring well at such location indicated in Attachment "1 ", and in accordance with that letter dated September 10, 2004, from Licensee (Attachment "2"), both attached and made a part hereof, and subject to any requirements or conditions as may be imposed by the Director of Development Services of City. 2. This permission is given to Licensee as an accommodation to Licensee and shall be subject to an annual fee of $150.00, payable in advance to the Development Services Department Real Property Section for each year that this License and Agreement remains in effect. 2004-393 EXHIBIT "A" 3. Licensee hereby acknowledges the title and paramount interest of City to the public right-of-way and agrees never to assail or resist said title or interest and to observe present or future set -back requirements relating thereto. 4. City reserves the right to terminate the permission hereby given at any time by giving Licensee at least thirty (30) days written notice of such termination, except that City may, at its election, terminate said permission forthwith at any time if Licensee shall fail to comply with or abide by each and all of the provisions hereof or keep each and all of the Licensee's promises herein. Waiver by City of any breach of any term or provision hereof shall not be deemed a waiver of any subsequent breach of the same or any other term or provision hereof. 5. Licensee agrees to install, use and maintain said groundwater monitoring well as required by this Agreement. Said groundwater monitoring well shall be maintained at all times in a safe, neat, sightly and good physical condition. City shall be the sole judge of the quality of maintenance, and upon written notice by City, through its Director of Development Services, stating in general terms how and in what manner the maintenance is required, Licensee shall be required to perform such required maintenance. If Licensee fails to do so, then City shall have the right to perform this maintenance, the cost of which shall be borne by Licensee. Licensee further agrees to install, use and maintain said groundwater monitoring well in conformity with applicable Federal, State, and local laws, rules and regulations. Licensee shall at its own responsibility and expense obtain and keep in effect all licenses, bonds and permits necessary for the installation and existence of said groundwater monitoring well. 2 2004-393 EXHIBIT "A" 6. Upon termination of this Agreement, Licensee agrees to immediately remove said groundwater monitoring well from the public right-of-way and to restore the public right-of-way to the satisfaction of the Director of Development Services. If Licensee fails to exercise its duties under this paragraph, City shall have the right to remove said groundwater monitoring well and to restore the premises at no cost or liability to the City. Licensee covenants and agrees to reimburse City for such removal and/or restoration. 7. City shall in no way be responsible for loss of or damage to said groundwater monitoring well or for any property belonging to or leased by Licensee, its officers, servants, agents or employees, that may be stolen, destroyed or in any way damaged during the installation, use or maintenance of said groundwater monitoring well. 8. Licensee shall exercise its privileges under this license at its own risk. Licensee shall indemnify, defend and hold harmless City, its elective and appointive boards, commissions, officers, agents and employees from any costs, claims, damages, injuries, and liability resulting from, arising out of, or in any way connected with, the construction, installation, use and maintenance of said groundwater monitoring, well the occupation or use of the public areas of such structure, both during and after the installation thereof, including but not limited to any costs, claims, damages, injuries, and liability resulting from the conduct of Licensee or the employees, invitees, guests or agents of Licensee, or Licensee's failure to perform its promises in connection herewith. 9. The Licensee's attention is directed to Section 7-3, "Liability Insurance", of the Standard Specifications for Public Works Construction, 2003 Edition, providing 3 2004-393 EXHIBIT "A" that the Licensee shall furnish the City with a policy or certificate of liability insurance prior to execution of the contract. All of the Insurance Policy shall name the City of San Bernardino as additionally insured. The endorsement shall be provided by/or agent of the insurance company and shall be notarized to that affect. ACCORD Forms are not acceptable nor forms signed by the broker, unless they have Power of Attorney to bind the insurance provider. (See attached Attachment " Y) Licensee shall maintain minimum limits of insurance no less than: A) General Liability: $1,000,000.00 per occurrence for bodily injury, personal injury and property damage. If Commercial General Liability Insurance or other form with a general aggregate limit shall apply separately to this project/location or the general aggregate limit shall be twice the required occurrence limit. B) Products/Completed: $1,000,000.00 C) Automobile Liability: $1,000,000.00 per accident for bodily injury and property damage. E) Employer's Liability: $1,000,000.00 per accident for bodily injury or disease. E) Course of Construction: Completed value of the project. F) A combined single limit policy with aggregate limits in an amount of not less than TWO MILLION DOLLARS ($2,000,000.00) shall be considered equivalent to the said required minimum limits set forth hereinabove. G) The Licensee's attention is directed to Section 7-4, "Worker's Compensation Insurance", of Standard Specifications for Public Works 4 2004-393 EXHIBIT "A" Construction, 2003 Edition, providing that the Licensee shall file a signed certification Certificate of Worker's Compensation Insurance before start of work under terms of this Agreement. 10. This license is personal to Licensee. It is nonassignable and any attempt to assign this license will terminate the license privileges granted to Licensee under this Agreement. 11. Licensee agrees that should any action, whether real or asserted, at law or in equity, arise out of the terms of this Agreement, or by Licensee's operations on the premises, venue for that action shall lie in San Bernardino County, California. 12. Licensee hereby certifies that it will not discriminate against any employee or applicant for employment because of race, color, religion, sex, marital status, national origin or disability. Licensee's hiring practices and employee policies shall comply with applicable Federal, State and local laws. Such action shall include, but not be limited to, the following: Recruitment and recruitment advertising, employment, upgrading and promotion. 13. The prevailing party in any legal action to enforce or interpret any provision(s) of this Agreement shall be entitled to recover from the losing party all attorney's fees, court costs and necessary disbursements in connection with that action. The costs, salary and expenses of the City Attorney and members of his office in connection with that action, shall be considered as attorney's fees for the purposes of this Agreement. 5 2004-393 EXHIBIT "A" 14. All official notices relative to this Agreement shall be in writing and addressed to the following representatives of Licensee and City: Licensee Mr. Chris Ingalls Lockheed Martin Corp. (LMC) Shared Services, Engineering Environmental and Health 2550 N. Hollywood Way, Su. 301 Burbank, CA 91505 Ph: (818)847-9901 Fax: (818) 847-0256 Mr. James Funk, Director Development Services Department City of San Bernardino 300 North "D" Street San Bernardino, CA 92418 Ph: (909) 384-5357 Fax: (909) 384-5155 6 2004-393 EXHIBIT "A" LICENSE AND AGREEMENT: INSTALLATION, MAINTENANCE AND MONITORING OF A GROUNDWATER MONITORING WELL IN THE PUBLIC RIGHT-OF-WAY OF SAN JACINTO STREET EAST OF GIFFORD AVENUE AND SOUTH OF MILL STREET. IN WITNESS, the parties have executed this Agreement on the -2,xr—j- day of LII Apl- 200 L. ATTEST: Rachel Clark, City Clerk Approved as to form And legal content: James F. Penman City Attorney By Rikke Van Johnson, Mayor Pro Tem City of San Bernardino LOCKHEED MARTIN CORP. (LMC) ` I • t,I , 1 Clef S\O �� 1n a\\5 S n, r Al Printed Name ancT Title 7 2004-393 ATTACHMENT "1" 0 M a n Z a U) U Q O U p 00 Lv j L U Ln 00 <� CD ���XJ�wz p m N U Z Q Z W V n W Z Q H 0 0 o0 O 04 Z N Of p z J J 4 Z LLJ O W Z I n a_ 0 0 IIl O p 0 J LJ LLJ <0000� a- wo N O NCO ~ Z li I Z � X U Q: Q Z pLLJ U OQz O =) W C� LZ J Z ow jw l� pa N 1 O i d. rn C7: N W O O 01 i rn <D 00 00 z 00 O � M � w an o m O i' o) 00 z I JL�H Q O co Z J O Y U d Z U Z CWj LLJ < Q Q Q p Q� Z � Q i ii - - -7nN-7/1 e a(�IOJWD W HLLHOy W � O o 0 00 U r� O o�w�w LLI Of Z_ _ y J w - j \ Wm(n00 Z of atZ � Z W O AlU 1O O 0 O U. W Z O O m OQEw?r Ul 0 li ¢ w W LLJ ((~ZzmW �K m c¢n ¢ d LJ N LL. O z O F U W 0 n w W 0 z 0 W ¢ IL W Ir Q. M O d N N I 0 0 LLJ V) (n oC)� oLO No ofo� 0 of U � O � Zwcn —00) (50'X z ¢ a U- a� LEI U � <Or 00 Om0 maw woo o¢^ 2004-393 ATTACHMENT 11211 fi3 TETRA TECH, INC. 17770 Cartwright Road, Suite 500 Irvine, CA 92614 Telephone (949) 253-2958 FAX (949) 250-6776 September 10, 2004 City of San Bernardino Department of Public Works "D" Street- 3rd Floor San Bernardino, California 92418 Attention: Mr. Les Fogassy Subject: Application for an Encroachment Permit Groundwater Monitoring Well Dear Mr. Fogassy: Tetra Tech, Inc, on behalf of our client, Lockheed Martin Corporation (LMC), is requesting an encroachment permit for the drilling, installation, and sampling of a groundwater monitoring well (LMW-12). The purpose of this monitoring well is to characterize water quality in the Bunker Hill groundwater basin. Well Location Siting As we discussed in our telephone conversation on September 3, 2004, the preferred location of the proposed multi -port monitoring well is at the east end of the cul de sac, at the eastern terminus of San Jacinto Street. The proposed monitoring well location is shown on the enclosed map, aerial photograph, and tax map (Figures 1, 2 and 3). A photograph of the proposed well site is shown on Figure 4. • JAockheetll2004\mont well instalREncroachmenlPermittloc 2004-393 Mr. Les Fogassy September 9, 2004 0 Page 2 In the event that the location of the proposed monitoring well is not acceptable, an alternate site has been selected for consideration. The alternate potential well site is located at the east end of Santa Fe Street as shown on Figures 1, 2 and 3. Regulatory Oversight A Work Plan is being developed for the installation of this and other monitoring wells in the area. The Work Plan will be submitted and approved by the RWQCB prior to the commencement of drilling. Well Design The well design will consist of one 12-inch boring that will be advanced to a depth of approximately 900 feet below ground surface (bgs) using conventional mud -rotary drilling techniques. A schematic of the mud rotary system is included as Figure 5. Upon reaching total depth a suite of geophysical logs will be run to obtain lithologic data, which will be analyzed and used in the design of the multi -port monitoring well. The well will discretely monitor five groundwater zones within the aquifer system. A typical multi -port well design is provided on Figure 6. The surface completion of the multi -port well will be within a traffic -rated, below -grade well vault. Prior to commencement of invasive work, Tetra Tech will mark the location of the proposed well and contact Underground Services Alert to clear underground utilities. Wastes generated during drilling (i.e., water, drilling fluids and soil cuttings) will be temporarily stored in appropriate vessels adjacent to the drill site pending sampling and receipt of analytical results. The temporary holding tanks/drums and/or water -tight roll -off bins will be labeled indicating contents, date and source. Following receipt of analytical results, the wastes will be transported from the drill site and disposed of in accordance with state and federal requirements. Following the initial drilling and well construction activities, groundwater samples will be collected from the multi -port well on a regular sampling schedule. The periodic sampling will be •non -intrusive and requires minimal equipment or disruption to the neighborhood. J'4mkheedk2004VmM well innsUlIkEnmoach"nWa mit.doc TETRA TECH, 2004-393 Mr. Les Fogassy September 9, 2004 .Page 3 Schedule Drilling is tentatively scheduled to commence as early as September 27, 2004, depending on whether site access is available at that time. It is currently planned that drilling will be conducted during daylight hours between the hours of 7AM and 7PM. If, however, the stability of the borehole is in jeopardy, drilling may continue on a 24-hour per day schedule. Estimated duration of drilling and well installation at this site is approximately four to six weeks. Subsequent sampling will require less than one day to complete. Because of our compressed schedule, your expedited review and processing of this request is greatly appreciated. In the meantime, should you have any questions or comments regarding this application for an encroachment permit, please call either Mr. Roy Marroquin or myself at 949 253-2958. Sincerely, Tetra T ch Inc. 1 Brendan Shine, P.E. Senior Engineer Attachments cc: Mr. Roy Marroquin, Tetra Tech Inc. Mr. Bill Bath, Lockheed Martin Corporation • J1OCkhee&"4VWnt well instalnEmmachMntPe=it.d= TETRA TECH, INC. 2004-393 U FIGURES • • 2004-393 w] 0 • ' It � tion He)r ort AVEall �> - � - .3r t r'I ��. S � • A J. J 0 art► 1�� G fl . r .1 SH -4 Proposed Well f t7I.. LMW-12 Site 5q oR o Tower1ML M Is .'' • _..Mru / '!., wl. eR 1 • 5 Hi. I A I • !A A Wel I .a �~CI Hefi, 1 d r� I yk lOT/ cewrRS If Alternate Proposed Site h yp 1 r aM °. �1■ ,. a. �1 r� D p r T T {� Well 0"7 101055 IOIY �� On • >( J - II t j1i I �n 1_ n ♦. ����/ a �Y■ � .t5m•r er I, •' I _ 5 ■Zr r II ■ $o _ r :• 1 y P Y Well r i i i ri curs ant _ �u �. m i n SebSt;tsOn I I� Wet. Course `` 1 y / THE M135/OW 7RNJa RaClo .y \IS 1 .Yr BM t� Towers° f / (KFXMB _._ '_A _ A CreeR ,r t._-. p�� �1Ni�. s2m2 ✓q,,¢¢ �,, '.I -i. !Golf CourS! "' Vt I Wills �` i IV Well - � ` i�Pu IM 101 / I r _ . _ II 1 gw.. ,✓ oil ry -.- _ g 1 FEMAN rrnoteol r I V ,e, WT n' __ _ _ o d..j�: rw, ro - M 1023 !Sewage 4 ryQg� ■ .. .� t.J �( "y'.."_ eM 1 sourH£ f s.Y/ qi� — � I �k Scale TITLE: Lockheed Martin Corporation - Monitoring Well LMW-12 Location Q 1 mile LOCATION: San Bernardino, California N CHECKED. R. MarrO uin FIGURE: I Source: USGS 7.5 Minute San Bernardino South TETRA TECH INC. DRAPRFFTED: B. Shine Quadrangle(1980). Wre.r� M14 DATE 09/09105.01 ') DATE 09I09/04 2004-393 Y W 99 a I ® O O I O 0 p O -�33tl1S- -3.4 Y1NY3 - ® ® ® o � 7 as to ♦a A sa to � f 1 a S ♦ S a O O O!® ®°i O D 0 -J33N1$--QIAMAI' NYS—R- p s I I I la i oa I I I I � I@ ' I O O O© 0 0 I ("JtlAI 1 CL a 0 a J -- b£ 9£ 0 e • �4 0 O O cM 0 R my 0 9 £ m o CDR L O r L C R iu�uoim O O. C m o 0 L d 0 � o — x w 0 w 0 Rdy� C �i � R d3 4) z B ea O U) F U) IZ a' G 3 R ui x i w � i (a) U U) iJ 2004-393 cu cu aa) 0 Y 0 0 O a3 75 cn c W V� O as W co a> U) 0 a 0 d m C - O tv tv V c O J o t y C� ^ v OOOP� GGG co O O O W O V w a— w<o� u a o 0 3. C C O R N l6 2 O a o m z 8 w = s o J O (q V F C Q F Y {V ~ O L a o gLEJt H J 2004-393 Top Head Rotary Drive Cuttings Discharge 11 Most II II II !3 4 C II ,IJ II Drilling Fluid Tank I° Drilling Fluid o Return e loner: Pipe e , '_.Cut ings ,Return ss m Outer Pipe -- _ e _ c _ e Is ss a - Drilling:. s i _ Operation Bit e Open Center It Carbide Bit e, ME FLUID REVERSE —CIRCULATION MUD —ROTARY DRILLING METHOD LOCAMN: LOCKHEED MARTIN CORPORATION REDLANDS CALIFORNIA CHECKED: RJM FlGURE TETRA TECH I N C °RAF1EDo ADM PRQI.: OSO7.065 5 11r10 tAR1rIWprt M SUITE 5M eVSE 04i M14 r:\R.dhna eso-ow. C�7E: 8 16 04 I 2004-393 Inflatable Pacluor Monitoring Well Filter Pack Port Coupling Borehole Wall Silainlew, St�OW Well Screen Caving segm.no SCH 80 PVC Pumping Port r - r Monitoring Well Annular seal Monitoring Well cosing/scree. Unit I pper Less Transmissive Unit Unit 2 per Primary Water —Bearing Unit Unit 3 liddle Less Transmissive Unit Unit 4 Idle Primary Water —Bearing Unit Unit 5 pper Less Transmissive Unit Unit 6 wer Primary Woter—Bearing Unit EXPLANATION Ej Cement Grout Bentonite Grout Eg Bentonite Slurry ❑ Sand Pack Filter Sand Stainless Steel Slotted Screen NOT TO SCALE ACORD,. CERTIFICATE OF LIABILITY INSURANCE 0510112005 01/06/2005l PRODUCER Lockton Companies P 444 W.47th Street, Suite 900 Kansas City Mo 64112-1906 (816) 960-9000 THIS CERTIFICATE IS ISSUED AS A MATTER 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 INSURED LAYNE CHRSTENSEN COMPANY 426 11001 ETIWANDA AVENUE PHONE: (909) 390-2833 FONTANA, CA 92337 INSURER A'. OLD REPUBLIC INSURANCE COMPANY INSURER B. INSURER INSURER D COVERAGES LAYINOI FK THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE IMMIDD/YY POLICY EXPIRATION DATE MMIDDMI_ LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 FIRE DAMAGE (My one fire) $ 250000 A X COMMERCIAL GENERAL LIABILITY MWL.Y56323 05/01/2004 05/01/2005 CLAIMS MADE [XI OCCUR MED EXP (My one arson $ 5,000 PERSONAL S ADV INJURY $ 2,000,000 X CONTRACTUAL GENERAL AGGREGATE $ 5,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGO 2,000,000 X I POLICY JECT LOC A AUTOMOBILE LIABILITY ANY AUTO MWTB 18973 05/01/2004 05/01/2005 COMBINED(Ea accitlennt) LE LIMIT U $ 2,OOQ000 X BODILY INJURY (Par person) $ XXXXXXX ALL OWNED AUTOS SCHEDULED AUTOS X BODILY INJURY (Per accident) $ XXXXXXX HIRED AUTOS NON -OWNED AUTOS X PROPERTY DAMAGE (Per awitlent) $ XXXXXXX GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ XXXXXXX OTHE0. THAN EA ACC XXXXXXX ANYAUTO NOT APPLICABLE $ XXXXXXX AUTO ONLY. AGO EXCESS LIABILITY EACH OCCURRENCE $ XXXXXXX OCCUR CLAIMS MADE NOT APPLICABLE AGGREGATE $ XXXXXXX XXXXXXX UMBRELLA 1:1FORM S XXXXXXX DEDUCTIBLE $ XXXXXXX RETENTION $ A WORKERS COMPENSATION AND MWC 10898300 05/01/2004 05/01/2005 DTH- X WCSTATU- ER EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $ 2,000,000 E. L. DISEASE EA EMPLOYEE $ 2000000 E. L. DISEASE -POLICY LIMIT $ 2000000 OTHER DESCRIPTION OF OPERATIONSILOCATIONSNEHICLEWEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS RE: LMW-12, SAN BERNADINO, CA. LOCKHEED MARTIN CORP., GEO TRANS, TETRA TECIL AND CITY OF SAN BERNADINO ARE ADDITIONAL INSUREDS AS RESPECTS LIABILITY COVERAGE, ONLY AS REQUIRED BY CONTRACT. The f r R.^.. 2205275 GEO TRANS 17770 CARTWRIGHT ROAD SUITE 500 IRVINE CA 92614 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3_ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,✓UFFAILUR€TO-DO 90 RNA CENTSIMPOSE NO ORL 'KIND UPON THE INSURER, ITS 0 eR Acnan94.sY/I07I For owstionsrewNinathis ce,tiecea AUTHORIZED REPRESENTATIVE Proaoceesemua mow end swan the client code •LAY111e1'. as ACORD CORPORATION 1988