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Drainage Pipe #1 Poppy TrailBOLTON Engineering. Corporation 707 Silver Spur Road - Suite 201 Rolling Hills Estates, CA 90274 tel: (310) 544-6010 fax: (310) 544-0458 BILL TO City of Rolling Hills #2 Portuguese Bend Rd. Rolling Hills, CA 90274 Invoice DATE INVOICE NO. 2/29/2008 6949 TERMS PROJECT Due on recpt 5019 D DESCRIPTION QTY RATE AMOUNT Drainage plan for drain for from #1 Poppy Trail. Reg Chief Engineer Drafting Adjustment per Ross Bolton 8.5 15.5 145.00 85.00 -1,050.00 1,232.50 1,317.50 -1,050.00 /-4,' \[ r ,_\ By ? CITY 5.,....„." L MAR C OF ROLLING 7 --:(1$ 200$ HILLS . 'Q =R:. 1 so0.ca Di:. :_3 ----2-1/ -0 i _ :___ I/ s5 Thank you for your business. Total $1,500.00 Bolton Engineering Corporation 707 Silver Spur Road, Suite 201 Rolling Hills Estates, CA 90274 tel (310) 544-6010 fax (310) 544-0458 January 8, 2008 Anton Dahlerbruch City of Rolling Hills #2 Portuguese Bend Road Rolling Hills, CA 90274 Subject: Scope of Work — Drainage Pipe #1 Poppy Trail Dear Anton: We are proposing to provide Civil Engineering at #1 Poppy Trail for the drainage from the pad area between the tennis court and the house down the recently cut slope to the paved access road. Specifically, we are providing a plan and detail for a temporary 6" drainage pipe to replace the plastic lined swale that was originally designed to provide drainage from this pad down to the paved access road per the original repair plan. We are not providing any other engineering services or reviewing any other areas than this specific drainage improvement. We estimate this plan will cost $1,500.00 to complete. If you have any questions or need additional information, please call. Sincerely, Ross N. Bolton, RCE 26120 President 1411 Tel: (310) 544-6010 ' To: _,l 1 1 Bolton (Engineering Corp. Civil/Structural Engineering & Surveying ■ 707 Silver Spur Road Suite 201 Rolling Hiills Estates, CA 90274 Fax: (310) 544-0458 r72:, nit z i .1 s.,.: .,{ IT <°�.trt" i5i:._,_ii':;G H_1 LS At 4 (4-1 C. * PO f a 'Ts-) Cl v es 9 B074 —LP 11-0 12,E r ` f t a_ 5 Cn� c=li 0 7:7 y ATTENTION:! N Tc> D76., Cj R. <-4+ SUBJECT: Po PR -7/ D 1/ We are sending you herewith: Tentative Map ' Topographic Map Tract Map These are: prints of Street Plans transparencies of BEC JOB NO. DATE I Z ��' % �� v9 D originals of copies of other CZ.r=e'S.S r'o A -IA L._ c_e S Grading Plans Storm Drain Plans As noted As requested For your approval A 1 "7- 1 ik.( tjc..,t1, rD-tC-n v12i-1 For your files For your use For your information other Remarks: Copy to: Very truly yours, BOLTON ENGINEERING CORPORATION By Ross N. Bolton, RCE 26120 President PROFESSIONAL SERVICES AGREEMENT THIS AGREEMENT, made and entered into this 15-n" day of Oc_-rosise1 2007 at City of Rolling Hills, County of Los Angeles, State of California, by and between the CITY OF ROLLING HILLS, a California municipal corporation (hereinafter the "CITY"), and Bolton Engineering, a California corporation (hereinafter the "CONSULTANT"). 1. RECITALS: A. The CITY retained the CONSULTANT to evaluate and recommend temporary, remedial repairs to the Poppy Trail Drain, located as described in Exhibit A attached hereto and incorporated herein by reference. B. The CITY desires to retain the CONSULTANT for project management for temporary, remedial repairs to the Poppy Trail Drain. C. CONSULTANT is well qualified by reason of education and experience to perform such services; and D. CONSULTANT is willing to render such professional services as hereinafter defined. Now, therefore, for and in consideration of the mutual covenants and conditions herein contained, CITY hereby engages CONSULTANT and CONSULTANT agrees to perform the services set forth in this Agreement. 2. SCOPE OF WORK CONSULTANT shall perform project management in connection with the temporary, remedial repair of the Poppy Trail Drain, inclusive of project oversight and management direction to the City's contractor. 3. COST The CITY agrees to pay CONSULTANT for all the work or any part of the work performed under this Agreement an amount not to exceed $1,000 on an. hourly basis. The hourly rate shall be $ 145 . Any increase in contract amount or scope shall be by express written amendment approved by the CITY and CONSULTANT. 4. METHOD OF PAYMENT CONSULTANT shall be reimbursed monthly in arrears based upon the hourly services provided. CONSULTANT shall submit invoices in duplicate and addressed to the CITY, c/o the Planning Department, 2 Portuguese Bend Road, Rolling Hills, CA 90274. 5. SUBCONTRACTING CONSULTANT shall not be permitted to subcontract any portion of this contract without the express written consent of the CITY. 6. COMMENCEMENT OF WORK CONSULTANT shall commence work under this agreement upon receipt of a notice to proceed from the CITY. 7. ACCOUNTING RECORDS CONSULTANT must maintain accounting records and other evidence pertaining to costs incurred which records and documents shall be kept available at the CONSULTANT's California office during the contract period and thereafter for five years from the date of final payment. 8. OWNERSHIP OF DATA All data, maps, photographs, and other material collected or prepared under the contract shall become the property of the CITY. 9. TERM OF CONTRACT This contract shall be valid until the earlier of December 31, 2007 or completion of the repair project. 10. TERMINATION This contract may be terminated at any time for breach and the CITY may terminate unilaterally and without cause upon seven (7) days written notice to the CONSULTANT. All work satisfactorily ;performed pursuant to the contract and prior to the date of termination may be claimed for reimbursement. 11. ASSIGNABILITY CONSULTANT shall not assign or transfer interest in this contract without the prior written consent of the CITY. 12. AMENDMENT It is mutually understood and agreed that no alteration or variation of the terms of this contract, or any subcontract requiring the approval of the CITY, shall be valid unless made in writing, signed by the parties hereto, and approved by all necessary parties. 13. NON -SOLICITATION CLAUSE The CONSULTANT warrants that he or she has not employed or retained any company or persons, other than a bona fide employee working solely for the CONSULTANT, any fee, commission, percentage, brokerage fee, gifts,or any other consideration, contingent upon or resulting from the award or making of this contract. For breach or violation of this warranty, the CITY shall have the right to annul this contract without liability, or, in its discretion to deduct from the contract price or consideration, or otherwise recover, the full amount of such fee, commission, percentage, brokerage fee, gift, or contingent fee. 14. INDEMNITY CONSULTANT agrees to .indemnify the CITY, its officers, employees and agents against, and will hold and save each of them harmless from, any and all actions, claims, damages to persons or property, penalties, obligations or liabilities that may be asserted or claimed by any person, firm, entity, corporation, political subdivision or other organization arising out of the negligent acts or intentional tortious acts, errors or omissions of CONSULTANT, its agents, employees, subcontractors, or invitees, provided for herein. CONSULTANT will defend any action or actions filed in connection with any of said claims, damages, penalties, obligations or liabilities and will pay all costs and expenses, including attorneys' fees incurred in connection herewith. CONSULTANT will promptly pay any judgment rendered against. CITY, its officers, agents or employees for any such claims: damages, penalties, obligations or liabilities. In the event CITY, its officers, agents or employees is made a party to any action or proceeding filed or prosecuted against CONSULTANT for such damages or other claims arising out of or in connection with the sole negligence of CONSULTANT hereunder, CONSULTANT agrees to pay CITY, its officers, agents, or employees, any and all costs and expenses incurred by CITY, its officers, agents or employees in such action or proceeding, including but . not limited to reasonable attorney's fees. 15. INSURANCE A. Without limiting CONSULTANT'S obligations arising under paragraph 14 - Indemnity, CONSULTANT shall not begin work under this Agreement until it obtains policies of insurance required under this section. The insurance shall cover CONSULTANT, its agents, representatives and employees in connection with the performance of work under this Agreement, and shall be maintained throughout the term of this Agreement. Insurance coverage shall be as follows: i. Automobile Liability Insurance -with minimum coverage of $300,000 for property damage, $300,000 for injury toone person/single occurrence, and $300,000 for injury to more than one person/single occurrence. ii. Public Liability and Property Damage Insurance, insuring CITY its elected and appointed officers, agents, and employees from claims for damages for personal injury, including death, as well as from claims for property damage which may arise from CONSULTANT'S actions under this Agreement, whether or not done by CONSULTANT or anyone directly or indirectly employed by CONSULTANT. Such insurance shall have a combined single limit of not less than $500,000. iii. Worker's Compensation Insurance for all. CONSULTANT'S employees to the extent required by the State of California. B. Deductibility Limits for policies referred to in subparagraphs A (i) (ii) and (iii) shall not exceed $5,000 per occurrence. • C. Additional Insured. City, its elected and appointed officers, agents, and employees shall be named as additional insured on policies referred to in subparagraphs A (i) and (ii). D. Primary Insurance. The insurance required in paragraphs A (i) (ii) and (iv) shall be primary and not excess coverage. E. Evidence of Insurance. Consultant shall furnish CITY, prior to the execution of this Agreement, satisfactory evidence of the insurance required, issued by an insurer authorized to do business in California, and an endorsement to each such policy of insurance evidencing that each carrier is required to give CITY at leasj.-3-0days prior written notice of the cancellation of any policy during the effective period of the Agreement. All required insurance policies are subject to approval of the City Attorney. Failure on the part of CONSULTANT to procure or maintain said insurance in full force and effect shall constitute a material breach of this Agreement or procure or renew such insurance, and pay any premiums therefore at CONSULTANT'S expense. 16. ENFORCEMENT OF AGREEMENT In the event that legal action is commenced to enforce or declare the rights created under this Agreement, the prevailing party shall be entitled to an award of costs and reasonable attorney's fees in the amount to be determined by the court. 17. CONFLICTS OF INTEREST No member of the governing body of the CITY and no other officer, employee, or agent of the CITY who exercises any functions or responsibilities in connection with the planning and carrying out of the program, shall have any personal financial interest, direct or indirect, in this Agreement; and the CONSULTANT further covenants that in the performance of this Agreement, no person having any such interest shall be employed. 18. INDEPENDENT CONSULTANT The CONSULTANT is and shall at all times remain as to the CITY a wholly independent consultant. Neither the CITY nor any of its agents shall have control over the conduct of the CONSULTANT or any of the CONSULTANT's employees, except as herein set forth. The CONSULTANT shall not at any time or in any manner represent that it or any of its agents or employees are in any manner agents or employees of the CITY. 19. ENTIRE AGREEMENT OF THE PARTIES This Agreement supersedes any and all other agreements, either oral or in writing, between the parties hereto with respect to the employment of CONSULTANT by CITY and contains. all the covenants and agreements between the parties with respect such employment in any manner whatsoever. Each party to this Agreement acknowledges that no representations, inducements, promises or agreements, orally or otherwise, have been made by any party, or anyone acting on behalf of any party, which are not embodied herein, and that no other agreement or amendment hereto shall be effective unless executed in writing and signed by both CITY and CONSULTANT. 20. GOVERNING LAW This Agreement shall be governed by and construed in accordance with the laws of the State of California, and all applicable federal statutes and regulations as amended. IN WITNESS WHEREOF, the parties hereto have executed this Agreement on the date and year first above written. CITY OF ROLLING HILLS CONSULTANT CITY MANAGER: BOLTON ENGINEERING LftRBRUCH DATE: I O I i g I .� ATTEST: k d- MARILYN KERN, DEPUTY CITY CLERK APPROVED ASS TO FORM: MICHAEL JENKI CITY ATTORNEY ROSS BOLTON, P.E. DATE: Oc- r I5 Z ' 7 10/15/2007 11:50 FAX lj 001/001 STATE COMPENSATION INSURANCR' FUND POLICYHOLDER COPY P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 10-15-2007 THE CITY OF ROLLING HILLS 2 PORTUGUESE BEND RD ROLLING HILLS CA 50274-5171 SG GROUP: POLICY NUMBER: 1500831-2007 CERTIFICATE ID: 8 CERTIFICATE EXPIRES: 04-01-2008 04-01-2007/04-01-2008 This is to certify that we have issued a valid Workers' 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 10 days advance written notice tothe employer. We will also give you 10 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. HORIZED REPRESENTATIVE PRESIDENT EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: 51,000.000 PER OCCURRENCE. ENDORSEMENT #0016 ENTITLED ADDITIONAL INSURED EMPLOYER EFFECTIVE 2007-10-15 IS ATTACHED TO AND FORMS A PART OF THIS POLICY, NAME OF ADDITIONAL INSURED: THE CITY OF ROLLING HILLS ENDORSEMENT #1600 — ROSS BOLTON PRES,TREAS - EXCLUDED. ENDORSEMENT #1600 - JENNIFER Q BOLTON, SECRETARY - EXCLUDED. ENDORSEMENT #1600 - JESSILEA H BQLTQN,VP - EXCLUDED. ENDORSEMENT #1600 - KATRINA A BOLTON,VP — EXCLUDED. ENDORSEMENT #1600 - DANIEL J. BOLTON BOARD OF DIRECTORS - EXCLUDED. EMPLOYER BOLTON ENGINEERING CORP. 707 SILVER SPUR RD STE 201 ROLLING HILLS ESTATES CA 80274 IFteV.z-05) SG IJS6,CS] PRINTED : 10-15-2007 SG Date: 10/15/2007 Time: 2:57 PM To: 1-310-544-0458 @ 9,1-310-544-0458 James G Parker Page: 002 ACORD TM CERTIFICATE OF LIABILITY INSURANCE 0/15/ PRODUCER (559)222-7722 FAX (559)222-1724 James G Parker Insurance Associates License #0554959 P 0 Box 3947 Fresno, CA 93650 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 NAIL #I JNsueao Bolton Engineering Corp. 707 Silver Spur Ste 20),., Rolling Hills, CA 90274-7613 INSURERA Maryland Casualty INSURER B: INSURER C: INSURER 0: .INSURER E: COVERAGES 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. MISR LTR ALKYL aL AN TYPE OF INSURANCE - POUCYNUMBER EFFELIIVE Wh In DATPPOLICY EXPIRATION M ri uwa A GENERAI-LIABILITY COMMERCIAL GENERAL LIABILITY PAS38592367 08/03/2007 08/03/2008 EACHOCCURRENCE s 1,000,000 X DAMAGE T(FR RENTED wl PRFISFCCLAIMS S 11000,000 8 10,000 MADE ii OCCUR MED EXP (Any one Person) PERSONAL a ADV INJURY ' $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: —I POLICY n jT n LOC PRODUCTS- COMP/OP AGG $ 2,000,000 - AUTOMOBILE UABIUrr ANY AUTO ALL OWNED AUTOS • SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS - -. . COMBINED SINGLE LIMIT (Ea ecddenq S BODILY INJURY (Pet PQ +) S — BODILY INJURY ) S PROPERTY DAMAGE (Pm aeadenl) , S GARAGE IJAbLITY � ANY AUTO AUTO ONLY- EA ACCIDENT E OTHER THAN EA ACC S AUTO ONLY. AGG S -- -. ._ EXCEESIUMBRELUI LIABILITY OCCUR 1 1 CLAIMS MADE RETENTION S - - EACH OCCURRENCE 8 - .. 1 AGGREGATE 3 s 'DEDUCTIBLE S s WORKERS COMPENSATION AND EMPLOYERS' LUtMLITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/ANEMBER EXCLUDED? If yes, de,lribe Lodi SPECIAL PROVISIONS below - WC sTATU- I OTH- TORY LIMITS ER EL EACH ACCIDENT S EL DISEASE- EA EMPLOYEE,$ S E.L DISEASE - POUCY LIMIT OTHER *10 Day Notice of Cancellation IF Cancelled for Non Payment of Premium. DESCRIPTION OF OPERATIONS / LOCA110N3 A VEHICLES 1 EXCLUSIONS ADDED nY ENDORSEMENT/ SPECIAL PROVISIONS Re: Engineering/Consultants. City of Rolling Hills, its elected and appointed officers, agents, and employees named as Additional Insured per form CG2010 7/04 attached CERTIFICATE HOLDER City of Rolling Hills #2 Portuguese Bend Rd. Rolling Hills, CA 90274 ACORD 25 (2001/08) FAX: (310)377-7288 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL. ENDEAVOR TO MAIL • *30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION ORLIABIUTY OF ANY KIND UPON THE INSURER ITS AGENT'S OR REPRESENTATIVES._ AUTHORIZED REPRESENTATTVE James Parker III/JDW ©ACORD CORPORATION 1988 Date: 10/15/2007 Time: 2:57 PM To: 1-310-544-0458 @ 9,1-310-544-0458 James G Parker Page: 003 POLICY NUMBER: PAS38592367 COMMERCIAL GENERAL LIABILITY CG 2010 07 D4 . THIS ENDORSEMENT CHANGES THE POUCY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement mom insurance provided under the fdiowing: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Location(s) Of Covered Operations City of Rolling Hills, its elected and appointed officers, ,agents and employees California Operations Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section If - Who Is An Insured is amended to include as an additional. insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) desig- nated•above. CO 20 10 07 04 B. With respect to the insurance afforded to these additional insureds, the following additional exciu- • slons apply: This Insurance does not apply to "bodily injury" or "property damage" occurring after. 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations'has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its in- tended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project ® ISO Properties, Inc., 2004 Page 1 of 1 0 Date, 10/15/2007 Time: 2:57 PM Toi 1-310-544-0458 0 9,1-310-544-0458 James G Parker Pages 004 IMPORTANT If the certificate holder is an AEC mONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). tf SUBROGATION IS•WAIVED. subject to the terms and c ondiitions of the policy, certain policies may .require an °Aes ft on this certificate does not confer rights to the certificate holder in lieu of:auch ' _ • ` .• DI8CLAtMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the Issuing Insurer(s), authorized representative or producer; and the certificate holder, nor does it affirmatively or negatively amend, extend or atter the coverage afforded by the policies fisted thereon. •ACORD 25 (20011081 ACORD, CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 10/15/2007 PRODUCER (310) 792-1850 C&S Insurance Services. Insurance. Center Associates 3460 Torrance Blvd., #200 Torrance, CA 90510 INSURED Bol ton Engineering Corporation • 707 Silver Spur Rd, #201 Rolling Hills Estat, CA 90274 FAX (310)792-1858 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERT FICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURER A: _Mercury Casual ty INSURER B: INSURER C: INSURER D: INSURER E: COVERAGES 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 LTR ADD'L INSRD TYPE OF INSURANCE POLICY NUMBER - - POLICY EFFECTIVE DATE IMM/DDIYYI POLICY EXPIRATION DATE IMM/DD/YY1 _ LIMITS ' GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY • EACH OCCURRENCE $ DAMAGE TO RENTED PRFMISFS (Fa nrrurenrP) $ 1 CLAIMS MADE OCCUR MED EXP (Any one person) $ PERSONAL 8 ADV INJURY $ GENERAL AGGREGATE $- GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ POLICY PRO- JECT LOC A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS - ' NON -OWNED AUTOS AC 11037729 07/01/2007 - - 07/01/2008 • COMBINED SINGLE LIMIT (Ea accident) - . $ BODILY INJURY (Per person) $ 500,000 X BODILY INJURY (Per accident) $ X PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY - EACH OCCURRENCE $ OCCUR CLAIMS MADE DEDUCTIBLE RETENTION $ AGGREGATE $ $ $ - WORKERS COMPENSATION AND • EMPLOYERS' LIABILITY - ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? If yes. describe under SPECIAL PROVISIONS below - _ - - - WC STATU- - OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT - $ ' OTHER - - DESCRIPTION OF OPERATIONS / LOCATIONS 1 VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER The City of Rolling Hills 2 Portugese Bend Rolling Hills , CA 90274 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE. Linda Goodyear/LINDA ACORD 25 (2001/08) ©ACORD CORPORATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement. on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, -nor does it - affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2001108)