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Home My WebLink AboutE. G. AND SONIA MITTELSTEDT - 1980-02-19LEASE AGREEMENT THIS AGREEMENT is entered into this day of 1980, by and between the City of Huntington Beach, a municipal corporation, as Lessor, hereinafter referred to as "CITY" and E. G. and Sonia Mittelstedt , as Lessee, hereinafter referred to as "TENANT." WHEREAS, CITY owns and is in possession of that certain offlie building known as, and located at 220 Main Street, Hunt- ington Beach, California, the interior of which consists of approximate?,y 1,200 square feet and includes five parking spaces in the rear the. eof, and WHEREAS, CITY has no present use or need of said building, and WHEREAS, s(4d building is in a desirable location for the purposes of the coznercial use thereof and represents a poten- tial Source, of revenue, and CITY is desirous of entering into a c=mercial lease therefor; NOW, THEREFORA, the parries hetveby agree as follows: 1. DESCRIPTION OF PREMISES: CITY hereby leases under terms and conditions set forth herein the office building located at 220 lnain Street, Huntington Beach, California, to TENANT and TENANT accepts premises 2. TERM: The term of this lease shall be for a period of one (1) year from the date set forth here:i<nabove. 1.. CM/bc 2/7/80 Ask Upon. thirty (30) days written notice by TENANT to CITY, prior to the end of the lease term, the tenancy may ccntinue on a month to month basis from and after the date of termination of this lease. Any month <.o month tenancy ahall be subject to all the provisions of this'{ Agreement. Either panty uo this Agreement may terminate this tenancy upon thirty (30) days prior written _notice to the other party. 3 RENT: Monthly rental shall be $600 due and payable in advance on the first day of each month. If rent is not paid on or before the tenth day of each month, a ten percent (10%) penalty sliall be applicable. TENANT will pay any possessory interest tax assessed. 4. SECURITY DEPOSITS: TE-NANT shall pay the first and last months' rent upon execution of this lease. In addition + ereto, TENANT sht.�ll pay the sum of $300 as a security deposit for the performance of the conditions of this lease. If at any time during the term hereof, TENANT fails to perform any of the conditions of the lease or causes damage to the premises o2• falls to leave the dwelling in a reasonably clean condl.tion upon termination, than CITY may appropriate and apply any portion of the security neces- sary to make the repairs or clean the premises. 5. MAINTENANCE: TENANT shall, maintain premises including landscaping in good condition. If TENANT fai).s to maintain the premises, CITY, may at its option, perform necessary maintenance and bill. TENANT for the cost of services rendered, and TENANT shall reimburse CITY for the cost thereof within ,.an (10) days 2 s a .. after receipt of billing. 6. UTILITIES CITY shall pay for water, only at the leased premises. TENANT shall pay for all other utilities at the sub- ject premises. 7. INDEMNIFICATION.: During the term of this tenancy, TENANT agrees to indemnify, defend, and save CITY harmless from any and all claims arising from any act, omission or negligence of TENANT or his agents or employees arising from any accident, injury or damage whatsoever caused to any person or propenty occurring in on or about the leased premises, and from am `end all cost, expense, or liability incurred in connection with any such claim or proceeding. 8. ALTERATIONS DURING TERM OF TENANCY: TENANT shall not make any alterations to the premises without the written consent of CITYa 9. ASSIGNMENT; REENTRY: TENANT shale not assign the lease or sublet the premises ertcept with the written permission of CITY, and CITY expressly reserves the right of reentry for any violation of this section or other conditions of this lease, and CITY reserves t,e right ti reenter and inspect the premises at all reasonable times. 10. INSURANCE: TENAI4T agrees to furnish to CITY and maintain in force unt'.l ter ,'a,tion of this tenancy a general liability certificate of insurance in which CITY is named as an additional insured. Such certificate of insurance shall indicate insurance coverage for TENANT, its officers and employees, while acting 3, AIL within the scope of their duties, against all claims arising out of or in connection with TENANT'S activities on or about the 'cased premises. The policy shall provide for not less than the following amounts Combined single limit bodily injury and/or property damage of $30rr,000 per occurrence. IN WITNESS WHEREOF, the parties have caused this lease to be executed on the day first above written. T TZayo r ATTEST APPROVED AS TO FORM: t 47,or.M�. " erk Citt�rney ,` APPROVED AS TO CONTENT INITIATED ACID APPROVED: ty Adminstrator ctor f Community Services �: Tenanti .. _" Ten-dnt flnun a Pr'el And tMa e4 04 ,i'd�01i oanPlsttod tenihcaha to: saPi att huuen:.. a, prw,n,r. CERTIFICATE OF INSUpA�f AllotApvrorM V rs,w: RW MA_Q. Cny of 4htnimgton broth f 1.� V BY f, rt AP i.Gaw . City k Tt� ryprH lter t,ahh - City Fararnr Pass CITY OF HUNTINGTON BEACH/,I Cpnr Hurn•••aton MsY., Cdilornie +s?Sa5 AMUNICIPAL Cy�IPOfP �, _Q �p�,, { T.hit n to satiny that the policies of Insurance at Ui ed below fT((av issued to that insured by the under, ;hgned and are in force at this time, If thaw pptieim a a cancdlad,�q`1'�`''` `",`� j�js , a ltrannej,•that vnlb affect this certificate, tba insurance atim4my a rcrn to give 30 days Prior written notice, by snail. t�p�iiYbtiF�e�igUAlisach. P 0 Box 190, Huntlnpto Beach. California 0 8�.`EACH `SU0�11E,.S 16 APR 33 19 Name of InstuedQA?J4 ;JY F/1de/AR® /II i /%FL ,)'7— 2 4 00 — \AddrowofInswei ,,,�.Q.,QVAI,t- rS)".C�'�( 7;.-:frA•✓Ti vfi /P.tJI.�t',.>:eN 2iJ L 3 Loeaf;ets d Welk or to be perAoetae+i 126 fr7s f ; (71 OoKaiTHirsA at>? mark w t�goaacfeo+e R! .01 ile .5 c. R ! r Owner 'I Owners y POLICIES IN FORCE Nt LICY -EFfEQTtlr EIfPIRATIO LIMITSOP LIABI. ITY warhersflgfrdli"tltl sv r 'if I f S� Ft/nrD StatJtory Public Obbliit : iladily Iaµefy Mmufac4urwtt-t-a�nal Contractors 13 S Each Person t Ekws policy cover: IPlaase check at Inn one) a All owned outomolsiles I I Yes ( i No Non owned automobiles ( ,i Yes ( i No Hired atdo tebiies d 1 Yet f 1 No At I..rA argil bAA muar by ehsand yEe it awomebila kawama oppli ,. o•,^r•n....,....�-•..:,....n....,.r......rm.......nt...,,�.....m..r....r:»..,.,..........r.t..�..ar�....r��........,.ea.... .,.v ' Additional Insured Ersdarsavttenf: - The insurer West that the City of Huntington Beech ar.d its City Council, and/or all City Council appointed groups, Committees,. aommlasiurn,. boards and any other City Council appointed body, and/or dectivo and appointive offices, sarvatrte or employs" a! the CRy of Huminfitors Beach, when Acting As such are additionat inaureds hereunder, for the t, AcH of 04 insured, and such insures" sbebfba primary to any Insurance of the City of Huntington Beach, • , nl r r., v., - ,,raw. rat . .. ti•.".r, yet t•.t... r'.. �. a.. �. a rt,.x , a ! Hold Hatinlao Agreament: eyinsused 161pnetwsl The insured &great to protect. defend, indemnify and tare harmlats She City of Huntington Booth against loss, damage or ,xponto by reason of any suits, ciniern, danvsruis, judgments and eautasof action caused by insured, hie employees, agents. or any subtopvaetos at * any third pasty arising out of or in caneocluenoe of ,le parforminea of Ali or anyoperotilem covered by the cartitiasto of invsuarscv, rtemerke:Thit tertitwats Is raj an snswynee aahey and doe nor r '. y " APPROVED AS TO FORM! An"r 1, nalewl er &lie. hke eevarePa &"*Nled by the Pokey. OAI L HUTTON City My Not withstanding any rogukomaM, farm, ee 6oedStion of carry contract or other kaued Of may p.irtatn, the ussurrnse Atfordad 5y the Pogdas dea , N*4 hualn r cc to &I Me VVIVIC, p, ; t. Oo y GtyAttorney A_ .J I ' rYr + +,.aw.Yrr♦ f.r , •,r r to ..fa • t i aaY Y.nM.•.��•"...". Data 4tr24/80 nrAU` 5 REPRESENTATIVE OF IP42URANCE COMPANY r INSURANCE. COMPAAY . y ianrtweot AahorHM Rw�.M•n.f,ti` /H«+r .-. ,N&Ma (i 011t Southaaif>f Mro "Tnata]lAU Co. Addfen P.0. Boz 2g421 lutdrstt 10221 Slater Ave 2Q �4 i r,,ry 3cottgdalgr, .Lr�.fA23k 852tx1 STATE ycC3MPEIVSATION P.O. BOX 807, SAN FRANCISCO, CALIFORNIA 94101 /Eo INSURANCE FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE This is to certify that we have issued a valid Workers' Compensation insurance policy in a torm approved by the California Insurance Commissioner to the employer named belovv for the policy period indicated. This policy is not subject to cancellation by the Fund except upon ten days' advance written notice to the employer. We will also give you TEN days' advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance City and does not amend, extend or alter the coverage afforded by the policies listed herein,_' Notwithstanding any rer iement, term, or condition of any contract or other document with respect to which this certificate of Insurance; may be issued or may pertain, the insurance afforded by the policies described hereir is subject to all the terms, exclusions and conditions of such policies. EMPLOYER SCIF FORM 262A (REV. 8-78) OLI I'LKIATE NR.tur, �rrpinal and t.uce copim of Dist rit uiron. t inul�pcl(jina riK corripirried candtcata ta: CERTIFICATE OF IitISURj {� After Apllrovhi - Yatln�v Rich Minapur City of Huntington ►,3rranh T( ry. Qry i� RY City AtiorneY Pink - C1ty Clgl` Q^ �r ppl OIj(y� Gold - d�,y Attornoy Dept - -{ CITY OF HUNTINGTON BEACH, C Cif0W5 Y P.O. Box 1" n�i Huntington 13wh.California r926" A MUNICIPAL C iPQfi+�.l�O �y �! This is to certify that the policies of insurance as i ed ba7oW ffav t issued to the insured by the under- :ignad and are in force at this time. If these policies are c3ncellacM"Ir �P�jC)) ��s%} ch a rnanne chat will affect this certificate, the insurance company agrees to give 30 days prior written notice, by mail, tr� C,Sy;,q '11each, P. O. [lox 190, Huntington Beach, California 92648. - DF'- UDn J S APR 2 3 1990 Name of Insured r _ a� . lr J?ut//}Jt _r.LLT ,l7' 57. U2 Address of insured -2,2 0 /%)ti'l .A.) _ _ C_S �/A?��,1��•✓ Ti �✓('s I`D �t 1 ✓i �,-s2C /,+ �+� G y � Location of Work of *Dperations to be crforttled C`sscription of :Work or Operations A, t�� - CLa ;r;��, r r ��" l?.� fl Owne3 POLICIES IN FnRCE f 4' orkcrs f:o vtion if1 Nums R ` r..i•FFgtFivr EXPIRATION LIMITS OF L1AalLtTY r F "vL7 Statutory Emplovers' Liability S el-. -. . a . _ __. _. _... _ ., ...,- - -.., ....x- .�._._. -� k .� - _.__. _ _ .,Public Liability* (3odily ln)ury: Man if,rtiturers-a-}nd Coritracta�s J 5 Each Person �S l , andlords t & Tenants' Comprehensive MP 20651E ! y�o?.f) / $300, 000 each occurrence $300,000 aggregate General S Each Accident Including products completed iperetions) Property damage $ —Each Each Accident Automobile Liability: (whore ariptimble) Bodily injury $ [et h !�oratzn $ Each Accident PrWirty Damage ` 1 i S " Each Accident Does policy Lover; IPlmse chixk at bass# one) All owned automobiles ( ) Yes ( ) No Non -owned automobiles i ) Yes ( ) No Hired automobiles i ) 'Yes { l No At Iriesi ona tiox must by cbacked YESif autornq.bilo insurrnre appliaa, V Additional Insured Endotserrierifr The ini.urer agree, that the City of Huntington b:ach and its City Council, and/or all City Council' @+,sprinted groups, committers, commissions, boardv and any other City Council appointed body; and/or elective and appointivir officgro,: servants or wriployees of the City of Huntington Beach, when acting as such are additional insureds heroundor, for Ow acts of the insured, .and sach insurance shall be primary to any lnsurancr� J the City of Huntington aaacb. Hold Harmless Agreerriont. By Insured: 4 (Signature) The insured agref.s to protect, defend, indemnify and save harmless the City of Huntington Beach against lots, damage or nxponse by reason of any suits, chits, demands, juc gmants and causes of action caused by iMurcd, Wit employees, agents or any subcontractor or by city third party arising ,^ it of or in consequence of tho performance of all or any, operations ` covered by the certificate of insurance. itxn.arks. 'ibis cwtif icate is not an msuronce policy and dons not amend. extend or alto, lhreMvirracgeafivrd6J by the prrlicY. GALL Ht!'TT A$ TO FORM'. "fOhl City A flrney Not withstanding any requirement, term, or contrition of any contract or whir -17=11=17 Whit I 511130,fty WIXIcirthIs cur',tTitlti 01 fttSiitif issued ar may pertain. the insurance al(orded by the pollcles descrlbed herein is_ BY: u15i�ct ro atrmzlarlrt ercrst:; rs xrrtrrt�ltait psi t pe y City Attorney Date 4/24/80 AUTHORIZED REPARSENTk7'11/E OF INSURANCE COMPANY IrdSURANCI curirpANY t1i J.- pzl�� , y 5i+t,iature of Auttiarizad Rapresentatrvo/Agent Name Grea'�_Southwest Fare Insurance.Co. r..rldrissS ?.Us :Box 29421 �irltiress 10221 Slater Ave., Ste,, 22Q� _,. _ m w ..-wFountai.7r�ia3h'Y� r,ity Scottsdale, Arizona 85260 Tclrllhone 71 96 `5711 r r Return original and ihree copies of Distribution: txmpleted eertifieaWto: Original — Originating Dept. r. CERTIFiCATE OF INSURANCE After Approval Y Ifaw —Risk Manager S TO " BY City Attorney Pink — City Clerk City of Hunnington Beach „0. Gold- City Attorney CITY OF HUNTINGTON BEACH, CALIFORNIA P, 0; Box 190 Huntingtdn Beach, California 92648 A'MUNICIPAL CORPORATION This is to cartify that the policies of insurance as described below have been issued to the insured by the under- ';'rgned and are in force at this time. If these policies are cancelled or changed in such a manner that will affect this certificate, the insurance company agrees to give 30 days prior written notice, by mail, to City of Huntington Beach, P. 0, Box 190, Huntington Leach, California 92648. Name'of Insured s r Address of Insured ' , ! to a 4 1 Location of Work or Operations to be performed Description of Work or Operations g'; r 7 , t:� r 'c Does policy cover: (Please check at least one) All owned automobiles ( ) Yes ( ) No Non-ovinef automobiles { j Yes ( ) Na Hired aut",inobiies { I Yes ( 1 No At least one box must be chocked YES if automobile insurance applies. D. Additional Insured Endorsement: The insurer agrees that tho City of Huntington Beach and its City Council, andfor-all City Council appointed groups, committees, commissions, boards and any other City Council appointed body, and/or elective and appointive offir-as, servants or ,employees of the City of Huntington Beach, when acting as such are additional insureds hereunder, for tiie acts of the insured and such insurance shall be primary to any insurance of the City of Huntington Beach, E. Hold Harmless Agreement: By Insured,»�,;i°`ar� & 4 .. (Signature) The insured agrees to protect, defend, indemnify and save harmless, the City of Huntington Beach against loss, damage or expense by reason of any suits, claims, demands, judgments and causes of action caused by insured, his employees, agents or any subcontractor or by any third party arising out of or in consequence of the performance of all or any operations covered by the certificate of insurance: Remarks; This certificate is not an insurance policy and dges not F. emend, extend or alter the ceuirn_ « forded by the policy. APPROVED AS TO FORM: GAIL HUTTON —"-- City Attorney Not withstanding any requirement, term, or conclifon of any contract or othsr . fir, Issued or may pertain, the insurance afforded the poilcles described herein is Y, subject to all the t, [ H.° "" 'Deputy City Attorney Date AUTHORIZED REPRESENTATIVE OF INSURANCE COMPANY INSURANCE COMPANY y B � Name Signature of ,Authorized Representative/Agant Address r 'Address City L Telephone POLICY POLICIES' IN FORCE NUMBEI:'-EFFECTt�JE EXPIRATION LIMITS OF LIABILITY A. Workers Compensation Statutory Emplovers'Lia6ility i�flt,>43� �jp/�:�+t/�+°+I �r��7 $ (where applicable) B. Public Liability: Bodily Injury: � Manufacturers and. Contractors- �- $ ;�i,` Each, Person Comprehensive General Each Accident (including products completed. operations) Property Damage $ Each Accident C. Automobile Liability: (where app'licabie) Bodily, Injury $ * Each Person ' Property Darhege �,� $ � Each Accident SfNTINEl,R(aC*OcrPOLICY _t (PREFERRED) (STANDARD) - I , ow Bus ochg; 0 Chg, Name Q Chg. 0Chg. ❑ Crime _ jl Reinsl•DATe ANGEL (Addf (Show former name Car Coy. Fite liab, ❑ _ In Remarks) DECLARATIONS Add Po 1. Name of COT. . JEIGIASS"AuI o 1. PP Gam.—.-..:�'_)�%„T � . s^ �. / t /%i / (USE CAPITAL, LETTERS) Premalic DBA, If any—C fy f•? �... — Acct. No., Count F' Address- ..r2� '`� �„i /�1 NO, r71..j_�.•. j'1 L,y:V ,%� A_ ---�•pT_ Sul)- ISTATE o15T AGENT r STREET milled ['A G r I _ _.? L5� by 2. Locion, if other CITY at STATE XIPCODE Than Address Above 3. EFFECTIVE DATE r �1_ ' r�—f ,,t TOKind of Dcsiness. ?i_ ^. 774t 4. The applicant is R' Individual MONTH DAY, YEAR MONTN DAY YEAR ❑ Co -Partnership (Name all partners above) ❑ Corporation ❑ Other.. II (FIRE AND TULIED LINES Cord or Rat, Reference ___., _ .. �, Lfne � __... _ _ -Pogo ❑ Sprinklered _Q Non•Sprinklered 1. Deductible. Clause AMOUNT OF Avg. or Rates Replacement Cost Premium rtl 0 #2 INSURANCE Coins Clause Fnm Building S ❑ Ye ❑ No s Fixtures and Equip $ w �_ - Stock (Non-Reporling) C c I., v` _ ) . C•� _ Stock (Reporting) Specify amt. of ins, for Amot.nt of insurance must equal or exceed highest ❑ Yes new acquired locations potential value X ❑ No S Contents (Midwest) ❑ Earnings Fi 33�s%� Me, Limit 25eo 1b% ❑ Gross Earnings (Submit W/S 3i-0044) ❑ Loss of Rents ❑ Exhn Expense l 2. List all other occupancies Total fire and square footage of each __._ , _ _. �. -- - - Pre�mium'nes 4 v r _ 3,W Mortgage iewn ; Name, Clause f +oltw a ElBfdp. Address s.No..............�.,....W._..a. irecl .,... - ....._..�_...-.- :...,..., -. `-... fode No - VP 1 loan IHtnn, only). ❑ Port. Clly ._..- « - ..,.,-_•-_._....,.......State....._..._,«..«.... ___.r_:..._Code„__„ ..,.1 No,, _.. n- of Ural tt--tI only] or Motel L-1 Prop. Name— R1,do AddressrNo .. - Street.__... _ ZIP- - .. ..,...,. - . .., ___Slate..,..-... �.. .. N ...r�.,.....Cod Loan Per%• City_..._...»."....,...._..I No_ .......... „ Prop. 4. Complete. only when "All Risk" Policy is wr;llon on Conlents (Rel. 4 or 6) a. Reporting Form —Specify Amount of Insurance $.. , ».:. _al any other mercanlile or warehouse location declared at the inception, of this insurance. b. Applicable for Reporting or Non -Reporting Forms —Property at locations not ownad, leased, operated or regularly used by the insured, except properly listed above $ ..... _...• ' _ ._,,...,.,....-....,min the aggeegale at all (acaifons, not to exceed 5 _ .. _. _ ._ at <any one location, (Maximum limit permlitee. at one location is $10,000.) IiI GLASS The Company's Ilzbility for noon skins and lettering foe which values are statod by specific ,item, shall be determined as follows; THE LIMIT Or THE COMPANY'S LIABILITY IS THE ACTUAL CASH VALUE OF THE PROPERTY AT THE TIME ANY LOSS OR DAMAGE OCCURS. THE LOSS OR DAM. AGE SHALL BE ASCERTAINED OR ESTIMATED ACCORDING TO SUCH ACTUAL CASH VALUE WITH PROPER DEDUCTION FOR DEPRECIATION, HOWEVER CAUSED, AND SHALL IN NO EVENT EXCEED WHAT IT WOULD THEN COST TO REPAIR OR RE;?LACE THE SAME WITH MATERIAL OF LIKE KIND ,AND QUALITY NOR EX- r1911 TUr IIA:IT nt slAnIIITV CTATtn im TLtt ADD1trayinfi. WwirHFVFD 114 Tt4F t;itSFrt AMOUNT. I No of tosser Dint. Greater Dim_, Plales I, III inches in Inches Description of eaeh plate »,._. 1. �,-, _.....�...-. �K r......,_.. »,.,..... .: :....... :..�:.. «,. . „ ,.. _ „..... Iv position ...._,.._�.�..�.,-.......... iv The building _.....,........,,. »_,....„, Class ., .p ,...,.... Rate per i)lo .,. p Premium _._ -,,,,,. _ «..mom. w...._�..ri... ..._,. ....»,„, . ..� .. ,�.. .F ,... ......�,. , ..,.,.. ,-... ..... .........»..,.._...._ Lcllcring—Describe Value 4 Territory Code.---- .. Territorial Mulliplier, . ,% Manual Prem Modified Glass Prom. 2. is repairing and replacing of frames to be insured for more than $7S? j,i Yes ( No if Yes show amount $� 3. It removing and replacing of obstructions' to be insured for more than $75? ❑ Yes ❑ No If Yes show amount $ A. Are Temporary repair% to be Insured for more than $75? 0 Yes [_1 No If Yes show amount $ 5. Glass Dcducl(bio? Q Ycs � No iI Yes show amount S 6, Noon Signs —Describe ❑ Deductible Value ) 31,e4ee 3 YL, 1151 a,*Z#- aX «w. To'tl: Glass Pram, t� .. _1 '��R Rt6Y (For Garage'lrahility, use 31.0377 Apo.) s I. tLimits $_ /$ ,` !S ® or Limit $ �� v C? -^r? C �e� dl: Prem. Basis Rate i Premium S. 1. G %��/l4/G s.°/T 61'•ti %yyi/M`- /�✓'/.''hc'I.— �r %"liJ+r.�[.+°/r%% / r �1�.� t./� ,j.l... l� t; cs 7 Parking Area r op El Piro Legal ,0 0 Swimming Pool [j Escalators No. of Landings ❑ Personal Injury 0 Broad Form Liability Cl Broad Form Property Damage 2. Owners and Contractors Protective If applicant sublets any work to sub-contraclor'give esnmated total aeb•conhaet cost fornext policy period S Code - - 3. Contractual Liability — Has applicant assumed: liability under any type of contract or agreement other than a Lease of Promiseso Easement not in Connectionwilltrailroad grade crossings, Municipal Ordinance not in connection with work for the municipality, Elevator or Escalator Maintenance, or Railroad Sidetrack Agreements? If so, a copy of the contract or agreement must be submitted to the pOicywriting office for rating, (if orfg, contract is f% varded, it will be returned,) Single I Code A, Products or Completed Operations Llab,: Limits or Limit��j7rf/�rr%� Sales or ReceiFIs �7> �. Single Lbrats $ /$ —. /$— or limit $ 5. Personal or Firm and Ranch Liability ---show locations; Guest Med. limits; 0 $300 0 $1000 Occupancies (1) (2) a, Names of Co -Partners desiring coverage b, How many acran of farm properly? c, Any boats 0 Yes ❑ No Describes Length H.P. Speed-- d. Family Members Residence Medical Payments>(aflach 01) LimFlss ❑ $500 ❑ $1000 to Agent's Manual e. Private Residence for Employees Coverage inscrvants (Class 0913) Oufservants (Class 0912) occasional Em• 1 for oxptanatlon at rjcovorage and (California Only) O Number of Emp(aYeess... [ ] Number of Ent toyces. _. _: 0110 cos (Class 0910)1 tiassificalion codes, Total Premises & Operations Liability Pram, $ 6. Business Premises ModicA,A $ _ _per personi $10000 per accident ($ �/ [AUTO COVERAGE Limits $ Limit ..,/$.... ,/$.._._ ... or Limit $ <.., ...< .._ 1 NON OWNERSHIP — these Premium 1« hou' nsaTty entplD) ees does h. Ii#tw usany of these are regularly= contiiscnsnt(ci for the applicant employ? use of their personi( cars on company business? 2, PARTNERSHIP NON-OWNERS111P �+ Rated �premiUni _ a. Nuniber'of partners? - f 3. Hired Autos • rj' y Pass. Role [ Premium if applicant hires or rents autos or trucks estimate i,osf of hire for next 12 months. Carr S Trucks $ f 4. Owned Autos Y Pass. Carst COMMERCIAL VEHICLE INFORMATION taFARM PASSENGER CAR INFORMATION „_..-.-..... - ..,-.._....,....... ...,.,,., .,_.,:,.....�... <_ . .. �+,... H.P. Cu in ,...«. .»,. ... .. ,. ..,,.__.._«.....�,..:_..._.._ Trade Name f)ispl BUSINESS USE CLASS Used Any Miles To and Unit Ygar Typo of Body Full identification Commercials iShhow %) Mileage commoditie! for Farm gust From Work Picas Annual Laad Capacity in Tons Number GVW Grass '" '""'_ '"" "" Radius Hauled Hit*? Per, nest : One Per are Mileage if Trlr , Tyll. or Semi and Lonn'.h. Vahiete WJ) Service Retail Comm') Yes/No Pgser Use, Way Week Onfy i 2 3 4 _- ( PREMIUM Caro°—lAed 7oW Unit . Cost Carr Apo Palo .,..,. ,. . .. _.. ,.. ,,... _..., ..,. . �...., ... <......., -,. _._ . ,..._ Ka,,..w Tort F $ i Show Loy. Registered'. Owner s Now CfaaO Class« Fire ik. a • Camp Car Camp, Coll BI+Pd UM 8 CAC ColHston and Limit of Premium ( Theft CAC Ded Damage Aqd. Dud i,lablilly t $ $ 3 $ 2 $ $ $ 5 3 $ s s $ $ Total Auto Prom. 1 $ $ $ S $ $ 1 It `<f75 DEDUCTIBLE APPLIES TO LOSS BY MALICIOUS. MISCHIEF OR VANDALISM ONLY UNLESS A HIGHER DEDUCTIBLE IS SHOWN, COMPLETt L)NLY IF PASSENGER, RATEb. VEHICLES ARE COVERED. 5, indicate if applicant or any driver of a passenger rated vehicle was i,tvolyed 1n d, Hit by a "Hit and Run" driver if the octldent is reported to PATE any accident curing past 24 months under cite followinil circumstaticost DATE the proper police authorities within 24 hours, Yes a.[awfully parked. ❑ Yct ---�^-��- e. Not convicted of a moving traffic violation in iannectlan b. Reimbursed by, or on behalf of, a person responsible f% the accident or has juegment against such "rton, [] yes—_.— _._ with the In such but the operator of the other ling traffic c. Struck by another vehicle while )dually stopped for traffic involved in such accident was convicted of a movin9 fraffk or traffic tonirof device and hat not been tonvicfod of a violation. [] Yes moving traffic violation in tonlutivion with the acdclen1, j Yes....,.......,,__ (idunllly driver of oath 11 " answer under "Remark.-") 1 .. y , i 6, a List names and actresses of Morlgogacs, Additional ds or Certificate Holders (Specify which oro) Unif No'$. Other Interest 'Ad res ess Amoun; Owed [ ; i � C i` .rr�.�,�':re,��'s•t`C� � 3r:;rr c �r 7. Location of all premises owned, ranted or controlled on the inception dolor r ` Localfoe I Locatior, of Premi:as (or 5;racf, Number Owrsr, City and State) Tenant, Lasser„ Lessor, Part O.c tpsa4 by .4ppticant x ,,ifb'AlT,NrJ-v xyJ�J� ate _ C. VI I BOiILER AND MACHINERY vi DO 140 BI&J-}-Subrn4 Suppi. App. 31-G'150 Amount ( Dad '— '"err, t v)) isubmt FLD-MC(31.0365) for Fidelity and other 3•D Crime Coverage) of Insure�ca I Aml• + Rafe I Mull, `Class. Premium CR6ME 1. ❑ Storokeepers B a R O Office B& R r] Retailers Crime X X X a If Farmers Agcnis 0 Tires and Tubas 19 Outside Cuntainers b [ Gasoline and Qil ut Gulstdrz Conlamcrs X ry 2. Robbery Qdlsido ❑ essongor without nuard [3 Messenger with at least guards _ m ' t 3. Homo of Cuslodnn (lava name and address of each person covered to remarksp .� 4, 2obbnry Inside ❑ AI least one custodian on duly at all limes _W — ❑ A custodian znd at least another employee or, duly 5. Safe Burglary Class sf S:dc 6. Marc, O en Slock Coin&. o/a, Coins. Limit $ Excess aver other ❑ Yes [ ] No P !.I.G. policies 7, Church Theft ❑ Blanket ❑ Specific a. Loss of Money & Socurities from Alms Boxes { » X X X 1 « X b. Personal Religious • Proporty of Ciergymon ( , K X X i X Manual Pram, 8. Description of Safe, ff any Total Crimp Prom. S ..... �..... 4, Protective Services a' Devices (Complete aso it "All Risk" an contents is wrillon). lacalton of Protected Promises Underwriters kaboratory Carlilicaio No, f Watch Control I X� Area. „. ,,..,...,_,w_„�.,«_, -. .,,„:.„._) local Central Class Install Kays With Whop Station 1 ch,'k Proloctoil Grade Floor Ai"JI f Gary Station lA BorC), (r 2 or Jf Al+rm t:.o. Nureb•r ffniralion Promises Hourly Hourly and liplow Grado Floor J 1 t x } Data Closed » ..I Promises � { — j .to ! } T } 10. Will more than one messenger have custody of proFaay outside the promises? ❑ Yes ❑ No If "Yes'', describo 11, Has any employee committed any fraudulent or dishonest act In the service of the insured or otherwise? L] Yes ("ei Flo II "Ye;'', n.Rola1 1n Remarks 12, Is this risk located in a shopping condor (dotined as a location with r4 least five stores and at [east 25,000 sq. ff. of area for aufomoblle parking)? [ Yes Q No REMAltKSr PREMIUM SUMMARY AND COMPUTATiON OF PACKAGE DISCOUNT 1. Fire, Allied Lines $ �. ?.. 10, Auto BI:Pb $_...,._k-...,_ 2. Gtas $ . _...„.: ,.. 1, 1. tJuinsured hloforfsft S, _ , 3. pf 3misos E Opins. tiab, S,. ,,3 0-7- , 'Sr , _ 12, Auto Medical, $ - . 4, Promises Medical$ $:.. w.. 13. Fire & Theft 5.._.:..... 5, Crime $' .. 14, Comprehensive 6, Boiler is Machinery 5:.,.. 15, Collision 7. Other Non•Vehlcla $_:_ . 16, Towing 8. Total tines ( through 7 5.„ ... 17. Other Auto $ ., Lass _., �. V. Pkg. Alscounf $ ,. .. 18, Total (Lines 10 lhru 17) $....h.., .:. .. 4: Nal Discounted Premium Total Premium (Lines 4 & 181 i O^ nay �i 1 . is •. i3 7 Membership Fees (Chargod on ,n smiurrs shown on Lines 3 & d (lass Pkg, 0isc.)+14 $ ,. �.. ,— Total including lees M .� Cesh. Receiver! $«...,..._�.......�.. Olhat Credits $,.,,,,. „ Balance Due Maker's Name Numbary Style or lollop S+tn H Burptarnroo(r ar Eath Door is Equipped Fireproof only; or ,Phn, Thickness of Steel in ' wipe a CombinsSan or Name or Rnlq[k• $raip Cast to Insured, he Salc is � proof with DurAlarnrpof Fach Door Exdusiva of Tisnu' lock ar Kay sac;r ton Dnviss an Ya. Purehcsad, and if Within a Vault "Us "a Chest (state vrhichl Boh Yhsk (n Inches) lslato whlihl each poor Naw or (5'or or Net Outer ; Outer ' .Outer Cos) S Middle "Middle 'Middle Year Chest � Chas) ' Chest NPw or Used ri SljgfiCl2 PTION AG4dEEK6iQi' APPLIES 1Cl 'f''uo( INSURANCl EXCHANGE OR FARfl1FRS INSURANCE EXCHANGE ONLY Por!an-.1 in considerallon'of ilia benn'ils to be derirc ' therefrom The Subscri,Jer ,ovenanls and agrees wi!h 'Ilia Exchange Indicated on the front of this app;ica• Tlon had other subscribers Ihercl6 through their and r f (i,^1r atlorney.in•facl, the Truck Underwriters Asso n .'or ilia Truck Insurance Exchange and Farmers Underwrllen Association for ha Farmers Insurance .Ex e, so ascrange with all other subscribers' polh,'os a ranee or reinsurance containing such terms and con- r_., ditions' therein as may be, specified by ,-aid attorney -in- act ,m, •;pproycd by Ilia .e.lard of Governors or its Ex Tail Committee for any loss insured against, and sub• scriber hereby designatps, constitutes and appoints said Associalic•, to F= attorney-in•fact for subscriber,, granting to it power to substitute another in its place, and in subscriber's name, place and stead to do all things which the subst %cr or subscribers might or could do severally or jointly wish reference to all policies issued, in• _tud(nq cancetlallon, thereof, collection and re;aipf of all m.sries due the Ef change front whatever source and disbursement of all loss and expense t,nyments, effect reinsuranto and all other. acts incidental to Ili,) managamc,.0 of the Exchange and 1im business of inter-insurancei subscriber further agrees that there sball be paid to said Association, as compensation for its becoming and ,cling as attorpeyin•fact, the tnembershin fees and 'twenty per canlum of the Premium Deposit far !Ise insurance provided and twenty per septum of the premiums required for continuance thereof. The remaining potion of ilia Premium Deposit and of additional term payments made by or an bt 'If of the subscriber shall be applied to the payment of losses And expenses and to Pie establishment of reserves and eocral surplus. Such reserves and surplus may be invested and rr,invested by a Board of Governots duty elected by and from subscribers in accordance with provisions of policli s issued, which Board ar its Executive Committee or an agent or agency appointed by written au!hority of said Executive Committee shall have full powers to hogotiate purchases, sales, trades, exchanges and transfers of investments, properties, litles and socurhies, iogelhor with full powers to execute all necessary instruments. The expenses above referred to shall include all taxes, license leer, attorneys' fees and adjustment expenses and charges, 'expenses of members' and governors' meetings, agents' commissions, and such other specified fees, dues and expenses as may be aufhortrad by ilia Board of Governorsi, All other expenses incurred in connection with the conduct of the Exchange and such of ;he above expenses as shall from time to time be agreed upon by and between the Association and the Board of Governors or its Executive Committee shall be borne by the Arsecialton, The principal office of the Exchange and Ill,'Alorneylo-fact shall be malniained in $he City of Los Angeles, County of Los Angeles, State of California. This agreemont can be signal upon any rt; e_hpr of counterparts with Ilia same effect as if ilia sianatures of of; subscribers were upon one and the same lnsirument, and shal.' be binding upon the parties (1,creto, severally and ratably as provided in policies issued. Wherever the word `subscriber' is used IF,o same shall mean members of the Exchange, the subscriber hereto, and all other subscribers to this or any other like agreement. Any policy issued hereon shall be non -assessable. No Company has declinedr cancelled, dacliroO to snow o• refused insurance of the type applied for or served notice of Its intention to do so, except as stated horaln: I have read all ilia pages of this application and declare ilia fact> sword to be true and request the Exdhango to Issue ilia insurance applied for and any renewals ther", In reliance thereon, i authorize the driving record of all drivers to be checked through the St."e Mclar Vehicle Department. This is my authority to cancel Polley #_.._�..�...._,.,_ of the Farmers, Fire or Truck Insurance Exchange or Mid -Century Insv;ancs Company ,� r� - ,� rj effective on the effective dent of the new polic applied for and any crest should Subscribed lei N.e _ _L be applied io the new poj1-yam / ( 9 rIMtC MONTH epv YEAR �.. U �� SIGNIGGt PHONEt Busit.ass.....�.._......_.__. Rasldorcc.s�� 4�'_s�'�:_, HERE � pps.lcnNr ANo suoscnioF.n ,�... Vill AGENT'S 1 Last all drivers by Bir hdale I Unil °/n of Married Pall 3 Years REPORT rvname (first middle Iasi) Operator's Licenss No., Stale y f No, Mifaayo Relationship _ Mc I Da yr. , _� Yerj No ,ArddenitCilalfars 2. Any physical impairments?...... . .F .. ( Ypt (7 No 12, a. Buildings Size,,._.__,.__, -off. by� if. ,! 4' C S Srtuare Ff. 3. Ever' had license suspended or revoked?.,..,.. .. ......................... Yos 0 No b. Typo of Roofi LJ Ap roved Q Unapproved t. No. of stotet la. Hcatin4: a, Typoi [,f Central jJ Space r,. O r 4. How many Trucks, Cars or Trailers owned by Insured? _ W — b. Fuels („'� Gs 0(I EIaCIrF- [� n F1 Coll Other , Which gntls have. dual rear axle?...w ._.._..-.,�_..... . .. .. . ... .. td, Approx. age of BTdgs.?,,....,....,._. , . yeast. Year rcinodcled / ? 5. Have you Inspected equipment? El Yes C3 No List Any Damage in Remarks 15. a, fire Protection Dist. 11, not in Lily!1(m11s? 6, RISE ISt a. located on_ -,»...._,._—,,-.-.Boor of>,.«...,_ --story building, b• Distance In (sotto nearest fire hydrant 16, Condition of Premisess V4 vood ❑ Fair [`' floor b, well lighted at night? 0 YES Q NO tfousekeepingt tn' Gaod Fair [.I Poor c, on main arterial highway leading, out of city? [J YES Q NO 17. Consf. of Bldg, [j Frame L Brick (-7 Block 0 Refill. Cone, [I Other—_ ar d, under city police protection'? El YES d NO 18, How locg, (a) has current mgmt, owned this bus_�_yrs, (b) at this locrtl4es. 7. Are ilia following grill or bar covered? Windows jJ YES 0 NO 19. Applicant-s aslimafa of current value oft Buildings) excltding value of land Skylights 0 YES D NO Doors [] YES C) NO Fixtures and Equlpo $. — Stocks 8a. Type of lock(s) on rxtevior doorst [f f adtock [I Cifhor (doscrlbc) 20, Structures and occupancies within 50 feeh 0 Double cyl. 0 Single cyl, 0 Single cyl, North . Deadlock Deadlock Spring lock EastWest 8b, Describe lock detvica on lubo enclosure.._ „-»...x. ,. .„..... South,.,.- 9. Are windowt and roof openings easily accessible? C1 YES 0 NO 21, On d(agiamt 10, Loss ezperlencc last 5 yrs, (Show test each claim and dascribot Fire, Glass, a. F,irnish names of all streets and Burglary—descrlbo circumstances of foss also) indicate location of risk, yit}o Description Amount b. if Apartrienl Building, Metal or Court, also glue distance be, ... iwacn buildings and number of untts in each building, 22. Does Insured have any exposures ! on which coverage is not desired? C) Yes 0 No. if "'Yes". describe In Remarks. 23, Aia $here any special or unusual hAzsres in connection with this business? I' If. a. Have you inspected pramises? � � � Yes No 0 Yes [x No 11 "Yes' describe in " Ro orks" It, Does dmurcd own Building?,, Yes 171 No 24, Does appikiint carry Workmen's Compensalfon Insurance? 0 Yes t3 No. 9S I:.. AI: .,aid,.... 1w m116 n11.e. rn niet tnr An rnunrane anntidd 1— Name of Company Policy Number Kind of Coverago Limht Explr. pate Localities b Equipment Covered NonAnlo Auto 26. List All FARMERS MCA TRICK FIRE MCNA FNWI, - Curri nl end Prior Policy Not. AGENT'S This Application Is complete and I recommend Its acceptance. ARA No, Dafe SIGNATURE STATE r COMPENSATION P, ,BOX 807, SAN F`RANCISCO, CALIFORNIA*01 INIsURANCE FUND January 29, 1980 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE City of Huntington Beach Building Department P. 0. Box 190 Huntington Beach, California 92648 This is to cert;fy that we have issued a valid Workers' Compensation insurance poiley 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 ten days' advarn;e written notice to the employer. We will also give you TEN 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;:fforded by the policies listed herein. Notwithstanding any requirement, term, or condition of any contract or other document with respect to whicl this certificate of insurance 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, New Application-80 1-29-80/1-1-81 d EMPLOYER - PRESIDENT Beach Buddies 220 Main Street Huntington BEach, California 92649 AZL OPBRATXONS SCIF FORM 2e2A (REV, 8.78) de P. O. BOX 291f2e \UINOMM \j Scatt 4®, AtizorRa 65268 Date 4 February 1981 London West Surpluo Lines Bkrs., Inc. 7380 Clairmont Mesa Blvd. Suite 204CE San niego, CA 92111 6 RECEIVED ' � EQ FEE 8 '3 RE Named Insured & Edward Mittelstedt DBAO leach Buddies 1 K.8, Policy Number 14P 20654 UjQA OFFICc ,. Property Location 2,20 Main Street Huntington Beach CA 92649 Loan Number YOU ARE HEREBY NOTIFIED THM VG "AVE RECVAD El Captioned odginal policy wNh a request to cancel effeeltva k Jxa" h-l!"h V . 1I Y and that we have pt vm avtHti rr tiatbn InOnwilons. This teller is to further advise you that all coverage protecting your Interest on the property covered under this policy has been cancelled and you should proceed =ordingiy. Ureda wffing Gruel Southwest Isle Insurance Co. P.O. Box 294M Scoltsocle, Arizona 85258 C' City of Huntington Beecee P � 0. Box 190 Huntington Beach, CA 92648 l i sw�r4r��,»r U84 ROOM sal RISK MANAGER CITY OF HUNTINGTON BEACH P.O. BOX 711 HUNTINGTON BEACH, CA.92648 CERTIFICATE OF INSURANCE REQUIREMENTS TO: Sonia & Edward Mittelstedt DATE; February 9, 1981 DHA Beach Buddies 220 Main Street Huntington Beach, CA 92648 I� Proof of 'porkers Com;�ensation required, ov- present a certificate of consent to self -ins _^e issued by the Director of Industrial Relations. (See City form, Parragraph A.) [ Pubtic Liability limits Minimum acceptable is combined single limit per occurrence including prop- er t�damage. —TSee City form, Paragraph B.) Automobile Liability is required. Minimum acceptable is F1 combined single limit per occurrence including property damage (See City form, Paragraph C.) Additional insured endorsement required. Insurance company must name F] the City as additional insured for the acts or omissions to act of the insured and not of the City. (See City torm, Paragraph D ) Hold Harmless Agreement not signed by insured and title not given. The insured must hold the City harmless. (See City form, Paragraph E. f— Policy number and effective/expiration date missing. --� insurance company not licensed to do business in California. :she Certificate of Insurance must be issued by a surplus line broker admitted in California or by an insurance company licensed to do business ir. California. F] Telephone number for insurance broker missing Automobile liability, Paragraph C, does policy cover: Lj All owned automobiles ( )yes ( )no Non --owned automobiles ( )yes ( )no Hired automobiles ( )yes ( )no Al least one box must be checked YES. _z9I•/ f � ./' Z;% a, �' _ I x a City of Huntington Beach ° P.O. BOX 18O CAL1FORN1A 92648 OFFICE O,' CHE CITY CLERK 1 r tfj t February 20, 1980 Mr. Paul de Phyffer Orange County Assessor P. 0. Box 149 Santa Ana, CA 92702 Dear Mr. de Phyffer: The City Council of the City of Huntington Beach at its regular meeting held Tuesday, February 19, 1980 approved an agreement to allow Mr. & Mrs. F, G. Mittelstedt the lease of city -owned property located at 220 Main Street. Enclosed is a copy of said agreement for your records. Sincerely, Alicia M. Wentworth City Clerk AMW:cd ` Enclosure City of Huntington Beach ( P.O. BOX 190 , CALIFORNIA 92640 OFFICE OF THE CITY CLERK February 20, 1980 Mr. & Mrs. E. G. Mitt-eistedt 220 Main Street Huntington Beach, CA 92648 Dear Mr. & Mrs. Mittelstedt; The City Council of the City of Huntington Beach at its regular meeting' W d Tuesday, February 19, 1980 approved an agreement to allow you the lease of city -owned property at 220 Main .Street, Enclosed is a duly executed copy of said agreement together with a copy of your insurance certificate. Sincerely, Al' i c; a M. Wentworth City Clerk AMW: cd' Enclosure RWS rFOR CITY COUNUL At"TION Sutmitted by _VINCENT G. MOORHOUSE Department -COMMUNITY SERVICES Date Prepared February 1 , 19 80 Backup Material Attached Fx� Yes No Subject Uease Agreement for 220 Main Street City Administrator's Comments TY c'DUN �YE1? gY 19 Approve as recommended. ..---- CITY C �8 l Statement of Issue, Recommendation, Analysis, Funding Source, Alternative Actions: STATEMENT OF ISSUE On February 5,'1979';, the City Council approved of leasing the city -owned building at 220 Maio Street, for. $600 per month. RE.COMMENDATION Approve agreement with E. G. and Sonia Mittelstedt and authorize execution by Mayor ANALYSIS The subject building has been vacant for over two years. Recently, we ru. ceived a request from Mr. & Mrs-. E. G. Mittelstedt to rent the building Ior the purpose of retail selling of women's sportswear. The City Attorney's Office has prepared the attached lease agreement and the proposed tenants have met all insurance requirements. In that'execution of the agreement is only a formality since Council had already authorized leasing of the property, we have accepted first and last month's rent and security deposit from the tenants and allowed them to occupy the premises-. FUNDING SOURCE None required. ALTERNATIVE ACTIONS Leave building for city use.