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iWorQ Systems Inc. A2013-27 A 13-z.7 Services Agreement VENDOR' ! r'"b Y 62 �jV9itht S 374 C, DATE MAILED: IO/51t° 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 11 85 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. Such insurance must be on an "occurrence," not a "claims made," basis and will not 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 purchase 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. ❑ 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. (Not needed if Self-employed with no employees and CONTRACTOR signs statement to this effect.) ❑ Business License: The VENDOR 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). ❑ Permits: Plans must be approved and permit(s) issued (no fee) by the Planning and Building Safety if appropriate. Call the Planning Manager @(909)364-2600 if you have questions. ❑ Coov of valid picture I.D. (Drivers license etc.) PLEASE NOTE: ALL APPLICABLE INFORMATION LISTED ABOVE MUST BE OBTAINED AND ON FILE, PRIOR TO THE ISSUANCE OF A CITY PURCHASE ORDER BEING SENT TO YOU (VIA FAX OR HARD COPY) BY THE RISK MANAGERIPURCHASING AGENT, THUS AUTHORIZING COMMENCEMENT OF WORK FOR THE CITY. Submitted by(complete all blanks): COLOR COPY REQUIRED BACK TO THE CITY Company Name: r By(Print name&title): L L l �r71 GC SrS�err2S 3 Nc, 4 aru n )+(red: - Pcotadeir,'j' Company Street Address: Vendor's Autl orizpp((d Si u e required: 1125 W you ni 5'ctl'Jt 1 u z 4-3/1..vm�{ City,State,Zip: Dare signed: I ' /oa,rn of /5/zroi3 Phone: J FAX: LAA - 75C- ,926) (886703.71 - 32113 Vendor's Email address: Vendor's Web site: QPet ra 0 Oorq ,Lan Ww J. ; L4trQ, cony Mail original agreement and insurance to:City of Chino Hills-City Clerk 14000 City Center Drive,Chino Hills,CA 91709 OriginatoriDepadment Contact P PA9PRS Date initiated: 6-t- I3 City Manager Approval: Date Approved: G ^r'2-"'t� inarxzApprcval: '(Z1 C7CL�jfN•-.—, Date Approved: 6'IZ- 13 / cc:Business License;City Clerk;Purchasing Agent;Requesting Dept.Ile•