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Azusa Refinishing Co. A2015-171 Services Agreement N20IS- «� Below you will find a checklist relating to Insurance and other requirements that are required for doing business with the City of Chino Hills. Only those items checked-off are MANDATORY,however if your standard policies exceed the minimum requirements please include. Commercial general liability insurance must meet or exceed the requirements of ISO•CGL Form No. CG 00 01 1185 or 88. The amount of insurance set forth below will be a combined single limit per occurrence for bodily injury, personal Injury, and property damage for the policy coverage. Liability policies will be endorsed to name the City, Its officials,and employees as "additional insured's"under said insurance coverage and to state that such Insurance will be deemed "primary"such that any other Insurance that may be carried by the City will be excess thereto, Workers'Compensation policies shall waive all rights of subrogation against City,its officers, officials, employees and agents for losses arising from work performed by Consultant for City. Such insurance must be on an"occurrence," not a"claims made,"basis and will riot be cancelable or subject to reduction except upon thirty(30)days prior written notice to the City. Please find additional Terms and Conditions on the reverse side of this Services Agreement. This is not a Contract order or an authorization to begin work, ❑ Comprehensive General Liability, including coverage for premises, products and completed operations, independent contractors, personal injury and contractual obligations with combined single limits of coverage of at least $1,000,000 per occurrence, The City of Chino Hills is to be listed as an additionally insured party. ❑ Auto Liability,including owned, non-owned and hired vehicles with at least: ❑ $1,000,000 per occurrence. ❑ $100.000-300,000 per occurrence. ❑ As required by State Statutes. A copy of your current policy must be submitted naming yourself and or your company. ❑ Workers' Compensation Insurance: as required by State Statutes including Waiver of Subrogation. (Not needed if Self-employed with no employees and CONTRACTOR signs statement to this effect.) ❑ Business License: The SERVICE PROVIDER shall agree to have a current City of Chino Hills license on file at City Hall or purchase said license(at no cost to the City). El Scope of Services and/or Compensation Attachments ❑ Total Compensation Not-to-Exceed: $1.232.40 ® Expiration Date: September 30. 2015 PLEASE NOTE: ALL APPLICABLE INFORMATION LISTED ABOVE MUST BE OBTAINED AND ON FILE, PRIOR TO THE ISSUANCE OF A CITY CONTRACT BEING SENT TO YOU(VIA FAX OR HARD COPY)BY THE CONTRACT COMPLIANCE OFFICER,THUS AUTHORIZING COMMENCEMENT OF WORK FOR THE CITY. AGREEMENT IS EFFECTIVE AS OF DATE LAST SIGNED BELOW. Company Name: By(Print name&title): Azusa Refinishing Co. David Quintero Company Mailing Address: I City,State,Zip: I 844 N.Vernon Ave.,#11 Azusa,CA 91702 Phone: E-Mall Address: 626-334-1516 I azusarefinishingco a gmail.com Mail two copies of the original agreement along with proof of insurance to:City of Chino Hills—City Clerk,14000 City Center Drive,Chino Hills,CA 91709 Originator/Department Contact: _ Fe Rama - i Date Initiated: 7124/15 Vendor's Authorized Signature: i- 1 Date signed: 7 13° I 1 t c Contract Compliance Approval: �C . _L• Date Approved: g —37 tS Li Department Director/City Manager Approval: Date Approved: '�/Lr 3 • . _ 3 Sales Order iii:usA RRiq&J.§i G obmp iNy 1 Date I S.O. No. 844 N.VERNON AVE. #11 iI 1121115 AZUSA,CA 91702 (626)3341516 I Ship To CjiliQI M M • ILI°00 CIS C IER, NE 1,71,1K0 If-liiRS/CAT-10g . Cc-161) 364 -2276 . P.O. No. I Project I IDescription Ordered I Rate I Amount ( Q ) io L tfr I I !i2OD•01) -- — -- -- -- -------- -I - - - I I Po O2 O.r��rli\� I r � I Erni-i14 16ICE 1:734 I I I l I -- -- - IAl If; 3N.V11-; J I I I ICITY OF CHINO II7ILLS I I I I Subtotal Sales TaxES TitaIl4112.52).qo