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Resolution No. 6964 . ' . . 1 RESOLUTION NO. 6964 3 A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF VERNON APPROVING AND AUTHORIZING THE EXECUTION OF ENCROACHMENT LICENSE AGREEMENT NO. 383 BY AND BETWEEN THE CITY OF VERNON AND U.S. FILTER CORPORATION 2 4 5 WHEREAS, U.S. Filter corporation has filed an application 6 for an encroachment license agreement pursuant to Vernon city Code section 22.66 for two vehicle detector loops in its driveway 212 ft. 7 8 and 228 ft. north of 54th on the west side of Boyle Avenue, Vernon, California; and 9 10 WHEREAS, the City Council is authorized to issue an 11 encroachment license pursuant to Chapter 22, Article VI, 12 Encroachments, of the Code of the city of Vernon which license shall 13 be valid for a period of twenty-five (25) years unless otherwise 14 stated; and 15 WHEREAS, the City Council adopted Resolution No. 5088 on 16 February 21, 1984, authorizing fees for encroachment licenses; and 17 WHEREAS, U.S. Filter Corporation has provided proof of the 18 required insurance, and has paid the issuance fee of $1,250.00 and 19 the first annual renewal fee of $181.40; and 20 WHEREAS, the Director of Communi ty Services has 21 recommended approval of Encroachment License Agreement No. 383. 22 NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE 23 CITY OF VERNON AS FOLLOWS: 24 SECTION 1: The City Council of the city of Vernon hereby 25 finds and determines that the recitals contained hereinabove are 26 true and correct. 27 SECTION 2: The City Council of the City of Vernon hereby 28 approves the Encroachment License Agreement No. 383, a copy of which . 1" l "" 1 has been presented to the City council concurrently with this 2 resolution, and the City council hereby orders said Agreement to be 3 received and filed by the City Clerk. 4 SECTION 3: The City Council of the City of Vernon hereby authorizes the Mayor and the City Clerk to execute said Agreement 5 for, and on behalf of, the City of Vernon. 6 7 8 certify to the passage of this resolution, and thereupon and SECTION 4: The City Clerk of the City of Vernon shall thereafter the same shall be in full force and effect. 9 10 11 12 13 ATTE~ ~- BRUCE V. 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 APPROVED AND ADOPTED this 3rd day of June, 1997. //~ ~~or' ,/~ MALKENHORST, City ClerK -2- , . .. 1 STATE OF CALIFORNIA ) ) ss COUNTY OF LOS ANGELES ) 2 3 I, BRUCE V. MALKENHORST, City Clerk of the City of 4 Vernon, do hereby certify that the foregoing Resolution, being 5 Resolution No. 6964, was duly adopted by the City Council of the city of Vernon at a regular meeting of the City Council duly held on Tuesday, June 3, 1997, and thereafter was duly signed by the Mayor 6 7 8 of the City of Vernon. 9 10 11 ( SEAL) 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 -3- 1 ENCROACHMENT LICENSE AGREEMENT NO. 383 2 THE CITY OF VERNON, a municipal corporation of the 3 State of California, as Licensor (hereinafter referred to as 4 "City") and U.S. Filter Corporation (hereinafter referred to 5 as "Licensee") do hereby agree as follows: 6 1. City hereby grants to Licensee a license, for a 7 term of twenty-five (25) years from and after the date 8 hereof, to place and maintain and operate two vehicle 9 detector loops in the City of Vernon, as shown on engineer's 10 drawing marked Exhibit "A" attached hereto and made a part 11 hereof as though fully set forth herein. 12 2. This license is granted subject to the terms and 13 conditions set forth in the Code of the City of Vernon, 14 Chapter 22, Article VI, and-the acceptance hereof shall 15 evidence the Licensee's agreement to all terms and 16 conditions herein. 17 3. Licensee shall during the. life of this License, 18 pay to the City of Vernon, the issuance fee of One Thousand 19 Two Hundred Fifty Dollars ($1,250.00), payable prior to the 20 granting of the license, and the annual renewal fee of One 21 hundred Eighty-one Dollars and Forty Cents ($181.40) 22 annually in advance of the 3,/~.~. day of 23 of each year hereafter during the .term of this License 24 Agreement. 25 This annual renewal fee shall be revised in accordance 26 with the changes in the Consumers Price Index published by 27 28 1 the United States Department of Labor, Bureau of Labor 2 Statistics for Urban Wage Earners and Clerical Workers - 3 Annual Average - Los Angeles - Anaheim - Riverside Area, 4 California - all items. In the event said Index as of the 5 anniversary date is higher than said Index for the issuance 6 date, the renewal fee shall be increased effective the ~ anniversary date by multiplying said renewal fee by a $ fraction, the numerator of which is the Index for the 9 current anniversary date and the denominator of which is the 10 Index existing on the issuance date. There shall be no 11 reduction in fees by operation of this provision. 12 If, in the future, said Index shall be changed so that 13 the base year differs from that used as of the date of 14 commencement of the term hereof, it shall be converted in 15 accordance with the conversion factor published by the 16 United States Department of Labor, Bureau of Labor 17 Statistics. In the event said Index is discontinued or 18 revised during the term of this Agreement, such other 19 governmental Index or computation with which it is replaced 20 shall be used in order to obtain substantially the same 21 result that would be obtained if said present Index had not 22 been discontinued or revised. 23 4. Licensee shall secure and keep in full force and 24 effect at all times during the term of this license general 25 liability insurance in the amounts determined by the City of 26 Vernon on an annual basis and shall file proof thereof with 27 the City Clerk, which. proof shall include the following: 2$ (1) A standard certificate of insurance. 2 1 (2) An endorsement naming the City of Vernon, its 2 officers, and employees as insureds under this policy. 3 (3) An endorsement providing the City of Vernon 4 thirty (30) days notice of cancellation or material 5 reduction of coverage. 6 (4) A notarized letter from the underwriter or ~ carrier certifying that the coverage and statements in the $ standard certificate of insurance (attached thereto) are 9 true and correct and that the signator is an officer 10 authorized to so certify. 11 5. Licensee shall maintain said vehicle detector 12 loops in first class condition to the satisfaction of the 13 City of Vernon and Licensee shall not construct any 14 encroachment pursuant to this license without having 15 received a permit therefor from the City of Vernon. 16 6. In the event that Licensee shall fail to utilize 17 -the vehicle detector loops covered by this license for a 1$ consecutive period of six (6) months during any period of 19 time after it has been placed in operation, the City Council 20 of-the City of Vernon shall have the right, at its sole 21 discretion, to declare this license terminated. 22 7. Licensee shall not sell, transfer, assign or 23 lease this license, or any part hereof, or any of the rights 24 or privileges granted hereby. Licensee may not assign its 25 duties hereunder, and may not assign its rights hereunder to 26 a public utility. 27 8. In the event Licensee shall fail to keep, fulfill 2$ or perform any of the terms or conditions of this license 3 1 and shall fail to .remedy such default within thirty (30) 2 days after written notice from the City, the City may 3 declare this license terminated. Upon such a declaration of 4 termination this license shall be canceled and all of the 5 rights and privileges of Licensee under this license shall 6 be surrendered, and the City may thereafter exclude Licensee ~ from further use of the street area under this license. $ 9. Licensee shall promptly repair at its own cost and 9 expense, to the satisfaction of the City of Vernon, .any 10 damage caused to any street, alley or other public property 11 in the City of Vernon by the facilities constructed, 12 maintained or operated under this license; and if Licensee 13 shall fail to comply with any instructions of the City 14 relative thereto within ten (10) days after the. service of 15 written notice upon Licensee requiring compliance therewith, 16 then the City may immediately do whatever work is necessary 17 to carry out said instructions at the cost and expense of 18 said Licensee, which costs by the acceptance of this 1J license, said Licensee agrees to pay upon demand. 20 10. In the event of the termination of this license 21 for any cause, Licensee shall at its own cost and expense, 22 upon City's request, remove or abandon in place the 23 encroachment facilities. This provision may be suspended by 24 the City of Vernon at its sole discretion during such period 25 as Licensee may be negotiating with the City of Vernon for 26 renewal of this license. If Licensee fails to remove or 2'] abandon in place the encroachment facilities, City shall 28 have the right to remove them at Licensor's sole expense. 4 1 11. Licensee shall preserve and save harmless the City 2 and each officer and employee thereof from any liability or 3 responsibility for any accident, loss or damage to persons 4 or property happening or occurring as a proximate result of 5 the encroachment or the construction thereof. s EXECUTED IN DUPLICATE this day of - , 199x6 7~ ~SI~ 7 CITY OF VERNON 8 9 A Municipal Corporation 10 By ` 11 L NIS C. MALBUR Mayor 12 ATTES 13 14 BRUCE V. MALKENHORST, City Clerk 15 APPROVED AS TO FORM: 16 17 D ID B. BREARLEY, Cit Attorney - 18 U.S. Filter Corporation 19 Licensee 20 By ~o~~ 21 Title Vice President & Gen. Mgr. 22 23 Signature shall be Notarized 24 25 26 27 28 5 { ~ 40 x x x x x. 37.5 VEf-IICLE ~ DETECTOR ~ ' boo ps lo'x 5 " o , r m D ~ m i N N N CA S, F~ L r E ~ ~ C~~t~o~~-~r~~t ~ 'ti t ~ t~ ` ~ l 1 ~ _ _ ~ 1 ~ ~ ~ 54 T" ST ~ ~ - ~ EXHIBIT «A,~ CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT No. 5907 i , ~ State of County of On ~ ~ before me, G,)/~ ~L~~ , DATE ` NAME, TITLE OF OFFICER - E.G., "JANE DOE, NOTARY PUBLIC" personally appeared /G" - ~ , NAME(S) O SIGNER(S) personally known to me - OR - ? proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and ac- knowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. P•~•.~< ALNIa ROSH Ri1610 ~ WITNESS my hand and official seal ~ a~ `U• Comm. S 987843 ~ ~ w ~ n Los Angeles Counly NOTARY PULLIC • CAl1FORNW C/~C~~~~~~ - ' Q• ~ von ~ My Comm. Expires Mar. 14, 1997 'a SIGNATURE OF NOTARY OPTIONAL Though the data below is not required by law, it may prove valuable to persons relying on the document and could prevent fraudulent reattachment of this form. CAPACITY CLAIMED BY SIGNER DESCRIPTION OF ATTACHED DOCUMENT ? INDIVIDUAL 1 t CO PORATE FFICER ~ ~ ~ TITLE OR TYPE 01 F~DOCUMENT TITLE(S) ? PARTNER(S) ? LIMITED- / _ ? GENERAL ? ATTORNEY-IN-FACT NUMBER OF PAGES ? TRUSTEE(S) ? GUARDIAN/CONSERVATOR ? OTHER: DATE OF DOCUMENT SIGNER IS REPRESENTING: NAME OF PERSON(S) OR ENTITY(IES) SIGNER(S) OTHER THAN NAMED ABOVE ©1993 NATIONAL NOTARY ASSOCIATION • 8236 Remmet Ave., P.O. Box 7184 • Canoga Park, CA 91309-7184 OFFICE OF THE CITY CLERK INTER-OFFICE MEMQRANDUM DATE: June 11, 1997 T0: Martha Valenzuela, -0ffice Manager - Finance FROM: Gloria J. Orosc~~ ief Deputy City Clerk SUBJECT: Encroachment License Agreement #383 - U.S. Filter Corp. Dear Martha: The. City Council at their meeting held June 3, 1997-,.approved the above referenced agreement. Attached hereto is a copy of said agreement for your records. Both the issuance fee ($1,250) and the initial annual fee ($181.40) have been paid. Please refer to page 1, item number 3 of the license agreement, which provides the. amount of the annual renewal fee.. This section also provides instructions for revising the annual renewal fee, if so warranted. With that in mind this agreement should be calendared for follow-up prior to the due date of the renewal fee and U.S. Filter should be properly notified (invoiced?) of the adjustment in their renewal fee. Martha this clause was only recently brought to my attention by the Community Services Department and I realize that the Finance Department may not have adhered to the practice of adjusting the fees in the past; however, don't you think we would be prudent if we began calculating any adjustments to the fees from here on? I too shall attempt to submit each agreement that calls for such adjustments directly to you for your review. Since each company signs the agreement they are well aware of this clause and we should certainly seek to obtain any fees that are due to the city. Thank you. ~gj® cc: BVM Encroachment File ~Uv Information to be entered when assigning new agreement# to system. CATEGORY. (circle one only) : L & R, GAS, GENERAL OR LICENSE AGREEMENTS # 1. Approval date: (Q ~ # 1 a. Agreement # $ ~z #2. Title of Agreement: C Q, u s ~1. ~ ~-2- r' #3. Effective Date: (if different from approval date) ~o ~a ~ ~i'7 #4. Expiration Date: (if applicable). (o ~ ~ v2 0 ~ ~ #5. Expiration Date: NONE I^ !j- :AgrmntData I CITY COUNCIL DA D B. BREARLEY LEONIS C. MALBURG ~ I ilj ity Attorney Ma or FAX: (818) 330-5818 Y / THOMAS A. YBARRA tV KE LSON irect o uni Services & Water Mayor Pro-Tern tY V/ FAX: (213) 588-2761 Wm. "BILL" DAMS Councilman ~ ~ KENNETH J. D~b~RIO for f L' ht Power H. "LARRY" GONZALES ' G F (21 ) 583-1983 Councilman i~ W. MICHAEL McCORMICK R Councilman Chief CITY HALL : c213) 5 -1 5 BRUCE V. MALKENHORST ` OUIS NTZ City Administrator/City Clerk 4305 SANTA FE AVENUE, VERNON, CALIFORNIA 0058 ~ olice 'ef FAX: (213) 581-7924 TELEPHONE (213) 583-8811 F 581-1178 May 28, 1997 City Council City of Vernon Honorable Members: U.S. Filter Corporation requested permission to place, maintain, and operate two vehicle detector loops in their driveway; one is 212 feet north and the other is 228 feet north of 54th Street on the west side of Boyle Avenue in the City of Vernon. The required insurance has been approved and the necessary fees have been deposited with the City. This has been reviewed by the Director of Community Services and the City Attorney, and it is hereby recommended that Encroachment License Agreement No. 383 be approved and executed. Very truly yours, Bruce V. Malkenhorst City Clerk BVM/hr May 21, 19 9 7 L-5 TO: Bruce V. Malkenhorst, -City Administrator FROM: Samuel "Kevin" Wilson, Directgr of Community Services & water SUBJECT: ENCROACHMENT LICENSE AGREEMENT N0.383 U.S. FILTER CORPORATION ~ U.S. Filter Corporation requested permission to place and maintain and operate two vehicle detector loops in their driveway, 212' and 228' north of 54th on the west side of Boyle Avenue in the City of Vernon. They have executed an Encroachment License Agreement and have provided the required insurance. The insurance was approved - by Risk Management. A check in the amount of $1,431.40 which includes the issuance fee of $1,250.00 and the first annual. renewal fee of $181.40, has been deposited with the City. It is recommended that Encroachment Permit No. 383 be approved and the Mayor and City Clerk be authorized to sign. /Ps Attachments cc: City Attorney Finance ~ ~ f r~ Y. f{:i ! t ~ ~F~ t q ! ~~j U.S. FILTER RECOVERY SERVICES ~CALIFORNIA~, INC. 5375 SOUTH BOYLE AVENUE TELEPHONE 213-277-1500 LOS ANGELES, CA 90058 FACSIMILE 213-582-6879 December 10, 1996 ~ ~ ~ ~ ~ ~ ~ D t t; 1 ~ 1gg6 Comr~~uri?~~y Services Mr. Kevin Wilson, PE . Director of Community Services & Water City of Vernon 4305 Santa Fe Avenue Vernon, CA 90058 Dear Mr. Wilson; Enclosed are the signed and notarized duplicate originals of the Encroachment License Agreement No. 383, to place and maintain two vehicle detector loops in the City of Vernon. Also included is the fee amount of $1431.40 as requested. Please return one agreement copy upon final execution. Should you have any questions please call Scott Simpson at 277-1516. Sincerely, Rick Henninger, Vice President and General Manager Memorandum Marsh & .McLennan California License No. 0437153- _ DATE: May 7, 1997 TO: Joan Francone, Risk Manager/City of Vernon FROM:.. Janice Nishi ~ wport Beach. 714/253-5849 SUBJECT: U.S. Filter Recover Services (California), Inca Dear Joan: . This message is a follow up to -your memo dated April 17, 1997. Attached for your records: is another original certificate of insurance, along with the General . Liability, Automobile Liability, Excess Liability and Workers' Compensation certification letters. Hopefully these documents will satisfy the requirements of the City. If you should have any further questions, please feel free to call: cc: Scott Simpson, U.S.-Filter CERTIFICATE .NUMBER::::::::::::. ~::~:?5 ~ ~:~:~:~:~::is~~~:~::?:::~:::2~~::'~~':::;::;:;:;:y':y'':%:;??.:':.. ~~~::.i:: ~~..~::::::~:::::::;:;::::y:;:«~i'5:~::::}:::::;::i':;:~.?::r:'~:::::::~:::::::::'::::::::::::::: :::::::is::::::::::::::::::::::: 7340 :.:.PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS Marsh & McLennan, IriCOTQOrated NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER?HANTHOSE PROVIDED IN 46.95 MacArthur COUrt THE POLICY. THISCERTIFICATEDOESNOTAMEND,EXTENDORALTERTHE Suite 550 COVERAGE AFFORDED BY THE POLICIES LISTED HEREIN. Newport Beach, CA 92660 COMPANIES AFFORDING COVERAGE coMPANY A COMMERCE AND INDUSTRY INS CO LETTER MISURED US Filter Recovery Servs(CA) CLEI7ER~ B AMER. INTEL SPECIALTY LINES IC United States Filter Corp. COMPANY 40-004 Cook Street DER C ARGONAUT INSURANCE CO Palm Desert, CA 92211 COMPANY D LETTER I~a~l~s o-:::,°THIS IS TO CERTI;<;:•;:THA:..~•:• FY T POLICIES ~OF~INSURANCE~LISTED HEREIN .HAVE.BEE IS.••• N SUED•TO~THE'INSURED~NAMEDHEREIN.FORTHE•POLICY~PERIOD•INDICATED...~~~ NOTWITHSTANDING ANYAEQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THE CERTIFICATE MAY BE ISSUED:OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES LISTED HEREIN IS SUBJECT TO ALL THE TERMS, CONDITIONS AND EXCLUSIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY ExPIRATION LIMITS LTR DATE (MM/DD/YY) DATE (MM/DD/YY) GENERAL LWBIUTY GLCM3 4 0 916 4 3/ 01/ 9 7 3 / 01/ 9 8 GENERAL AGGREGATE 5000000 X COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG $ 5000000 X~CLAIMS MADE?OCCUR. PERSONAL & ADV INJURY $ 1000000 OWNER'S CONTRACTOR'S PROT. EACH OCCURRENCE $ 1000000 FIRE DAMAGE (Any one }Ire) $ 50000 MED. EXPENSE (Any one person) $ 5000 AuTOMOBxE LweaTY CA5 0 5 3114 3/ O 1/ 9 7 3/ 01/ 9 8 COMBINED SINGLE LIMIT $ 1000000 ANY AUTO ALL OWNED AUTOS BODILY INJURY (Per person) $ SCHEDULED AUTOS HIRED AUTOS BODILY INJURY (Per accident) $ NON-OWNED AUTOS PROPERTY DAMAGE $ $ ,Physical Damage GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN AUTO ONLY EACH ACCIDENT $ AGGREGATE $ ExcESS LwBIUrY BE 819 0 3 3 3 3 / 01/ 9 7 3 / 01/ 9 8 EACH OCCURRENCE $ 5000000 UMBREUA FORM AGGREGATE $ 5000000 OTHERTHAN UMBRELLA FORM WORKERS'. caMPENSATION ANO frPC 6 2 5 8 4115 4 7 9 3 0 1 9 7 3 01 9 8 STATUTORY LIMITS X EMPLOYERSUABILITY / / / / EACH ACCIDENT $ 1000000 DISEASE -POLICY LIMIT $ 1000000 DISEASE -EACH EMPLOYEE $ 1000000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS (SEE REVERSE AND/OR ATTACHED). CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE POLICIES LISTED HEREIN BE CANCELLED BEFORE THE EXPIRATION DATE City O f Vernon THEREOF, THE INSURER AFFORDING COVERAGE WILL ENDEAVOR TO MAIL 3O DAYS WRITTEN Attn S KeV in Wil SOn NOTICE TO THE CERTIFICATE HOLDER NAMED HEREIN, BUT FAILURE TO MAIL SUCH NOTICE Director of Community Services SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON?HE INSURER AFFORDING .4305 Santa F@ Avenue COVERAGE, ITS AGENTS'OR REPRESENTATIVES, OR?HE ISSUER OF THIS CERTIFICATE. Vernon CA 9OO5S MARSH & MCLENNAN, INdORPORATE y i ~~',y?~ ' ~ ~1 BY: ~ d11•~ C~ r `~',`V@lfuh & IuIcLPnnan, If1Cy MMI 1 (8/95) VALID AS OF: 2/ 2 6/ 9 7 PAGE : 1 OF 2 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHLCLES/SPECIAL ITEMS CERTIFICATE #7340 (CONTINUED] INSURED US Filter Recovery Servs{CA) HOLDER Gty of Vernon Attn: Kevin Wilson- Director of Community Services 4305 Santa Fe Avenue Vernon, CA 90058 Re: U.S. Filter/Norris Environmental Services, Inc., 5375 S. Boyle Ave.,. Los Angeles., CA 90058. Encroachment License Agreement. No. 383 City: of Vernon; its officers and employees are named as additional insureds to-the General Liablity, Automobile Liability and Umbrella Liability policies as respects their interest in the-work performed by the-Named Insured. PAGE• 2 OF 2 American International Companies COSTA MESA OFFICE April 29, 1997 3090 Bristol Street Costa Mesa, Calif. 92626 (714) 435-6000 Fax: (714) 435-6688 City Clerk City Of Vernon 4305 Santa Fe Avenue Vernon, CA 90058 RE: Insurance requirements for City of Vernon concerning U.S. Filter Our Named Insured: U.S. Filter Corp. Policy Numbers: GLCM3409164 and CA5053114 City Clerk: I hereby certify that the certificate of insurance attached hereto and made a part hereof by reference truly and accurately represents the above cited insurance policies and the insurance coverage of each for the named insured issued by Commerce & Industry Insurance Company (A Division of American International Companies). The City of Vernon, it's officers and employees are included in said policies as additional insureds concerning the operations of U.S. Filter and the City of Vernon will be provided with thirty (30) days written notice of cancellation or material reduction of coverage. I certify that I am an authorized representative of the insurance carrier named herein and that I am authorized to sign this certificate on behalf of said insurance carrier. Sincerely: Ralph Molyneux, CPCU Branch Casualty Underwriting Manager CC: Shawn Doherty, Marsh & McLennan Commerce And Industry Insurance Company ~}~y~ State of California County of Orange On_May 5, 1997 before me, _Susan M. Carroll, Notary Public personally appeared Ralph Molyneux personally known to me c~~ ~„n~,Yd tc tko ~t,;a°~~.,r to be the person whose name is subscribed to the within instrument and acknowledged to me that he fsSl~th~executed the same in his authorized capacity and that by his ~'~°~rrth~ signature ~s} on the instrument the person { or the entity upon behalf of which'the person {-s} acted, ..executed the instrument. WITNESS my hand and official seal. SU~SIIN CARR..~.~ COMM. t7~oo2a~2 ~ Notary Public -California ORANGE COUN3Y ~ ; My Comm. Exp. Auqu~t 1_~`; Susan M. Carroll ~ v ~,l American International Companies COSTA MESA OFFICE Apri129, 1997 3090 Bristol Street Costa Mesa, Calif. 92626 (714) 435-6000 Fax: (714) 435-6688 City Clerk City Of Vernon 4305 Santa Fe Avenue Vernon, CA 90058 RE: Insurance requirements for City of Vernon concerning U.S. Filter Our Named Insured: U.S. Filter Corp. Policy Numbers: BE8190333 City Clerk: I hereby certify that the certificate of insurance attached hereto and made a part hereof by reference truly and accurately represents the above cited insurance policy and the insurance coverage of each for the named insured issued by American International Specialty Lines Insurance Company (A'Division of American International Companies). The City of Vernon, it's officers and employees are included in said policies as additional insureds concerning the operations of U.S. Filter and the City of Vernon will be provided with thirty (30) days written notice of cancellation or material reduction of coverage. I certify that I am an authorized representative of the insurance carrier named herein and that I am authorized to sign this certificate on behalf of said insurance carrier. Sincerely: Armand Peppin, President, American International Specialty Lines Insurance Company CC: Shawn Doherty, Marsh & McLennan Commerce And Industry Insurance Company ~ ~ `I~ti m ~GF. • 5~~~~ ~NIEGRITY ,M argonaut Insurance Company S O U T H E R N CALIFORNIA D I V I S I O N INSURANCE FORM LETTER Date: ~f City Clerk City of Vernon 4305 Santa Fe Avenue Vernon, CA 90058 Re: Insurance for City of Vernon U S Filter Recovery Services. Inc. (California) (description of permit or contract) Policy Number(s) WC-62-584-115479 City Clerk: I hereby certify that the certificate of insurance attached hereto and made a part hereof by reference truly and accurately represents the above cited insurance policies and the insurance coverage of each for the named insured issued by ARGONAUT INSURANCE COMPANY (Insurance Carrier). The City of Vernon, its officers, and employees are included in said policies as additional insureds and the City of Vernon will be provided with thirty (30) days written notice of cancellation or material reduction of coverage. I certify that I am an officer of the insurance carrier named herein and that I am authorized to sign this certification of behalf of said insurance carrier. ~N , Signature Title 120 South State College Boulevard /Suite 100 / Brea, California 92621 / 714.256.8800 /Fax 714.256.2294 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT State of ~a~lfOrnla county of Orange On ~-~~~i~~-- ~ ~ before me, hurray S. Sherman, Notary Public DATE NAME, TITLE OF OFFICER - E.G„ 'JANE DOE, NOTARY PUBLIC personally appeared ~ ~ ~-/'t NAME(S) OF SIGNER S) ? personally known to me - OR -proved to me on the basis of satisfactory evidence to be the person(s) whose name(s)r is/are m ~ ~ MURRAY S SHERMAN .subscribed to the within instrument and ac- '}rd~ ' CUMM #1097656 ~ knowledged to me that he/she/they executed ~ NOTARY PUBLIC-CALIFORNIA -~j v'r~n+",CL'e nD ~ ORANGECOUNTV c~ the same in his/her/their authorized My Comm. Expues July 9, 2000 capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted., executed. the instrument. WITNES ha official Y ' ~ ~ - ~ GNATURE OF NOTARY .OPTIONAL' Though the data below is not required by law, it may prove valuable to persons relying on the document and could prevent fraudulent reattachment of this form. CAPACITY CLAIMED BY SIGNER DESCRIPTION OF ATTACHED DOCUMENT INDIVIDUAL CORPORATE OFFICER f ~C~~~~` J~/1 / G~ TITLE OR TYPE OF DOCUMENt,Te !~~`O`~- rine, sI PARTNER(S) ~ LIMITED _ ? GENERAL r _ ,~,TTORNEY-IN-FACT NUMBER OF PAGES TRUSTEE(S) ~ GUARDIAN/CONSERVATOR ~,,.r• OTHER:. ~ ~ DATE OF DOCUMENT SIGNEA IS REPRESENTING: f~ •~aME ~F PERSONIS) OR ENTITYpES) - SIGNER(S) OTHER THAN NAMED ABOVE c01993 NATIONAL NOTARY ASSOCIATION • 8236 Remmet Ave., P.O. Box 7184 • Canoga Park, CA 91309-7t 84 ~~r)~ /I