HomeMy WebLinkAboutMOORE IACOFANO GOLTSMAN (MIG) - 2002-09-04%Su fity\ Contracts Checklist for Submittal to
} City Clerk's Office
Hunt 'go Bea ch-�
(Please transmit this form when your contract is ready to be filed in the City Clerk's office)
To: Connie Brockway, City Clerk
x5404
1. Name of Contractor: Moore lacofano Goltsman (MIG)
2. Purpose of Contract: For Example: Audit Services or Water Quality Testing Huntington Lake — Huntington Central Park
Economic Planning — Consensus Building Meeting With Property Owners
3. Expiration Date: If no expiration date, please put a tentative expiration date so the City Clerk's office can inquire of your
department if the file is ready to inactivate.
October 1, 2002
4. Amount of Contract: $ 2,140.00
A. Is the attached contract RELATED to a PREVIOUSLY SUBMITTED contract (renewal/amendment/etc)? x❑ YES ❑ NO
B. Did you attach the LIST OF CONSULTANTS from whom proposals were requested — pursuant to HBMC 3.03.100? ❑ YES ❑x
N/A
OR Is the attached contract a SOLE SOURCE?Continuation of Contract Approved on 7-17-00,ltem E-19 ❑ YES ❑x N/A
C. Did you attach a COPY of the insurance certificate/waiver and send the ORIGINAL to Risk Management? ❑x YES
PLEASEINCLUDE:
10 w, fl-wA Pkv s� x 1 0
Name/Extension
Department
9- q - o �--
Date
g:lforms/city clerk contract checklist.doc
CITY CLERK'S OFFICE USE ONLY: `
• 0
su v I► . PROFESSIONAL SERVICE CONTRACTS
PURCHASING. CERTIFICATION
1. Requested by: D auJ f1. bLI ti s Aco lA • t�Au.
. Istvf� C0,4t t tswA-v.�µ,.s1,7 x►S30
2. Date: <6, Z Z -0 v
3. Name of consultant: 'NA scr-c
4. Description of work to be performed: ow AeNs
5. Amount of the contract: BEd
6. Are sufficient funds available to fund this contract?' b] Yes, ❑ No
7. Company number and object code where funds are budgeted: 1 o
r_c ow.e,4n,.'c- t�a�`�+�P w►P — �cew.e►w� � ;, 4-4, c.s '70 5 Sq o I - (ay. 32 S
8. Is this contract generally described on the list of professional service contracts
approved by the City Council'? FA Yes, ❑ No
9. Is this contract within $25,000 or 25% .(whichever is less) of the amount stated on
the list of professional service contracts approved by the City Council?' C 04 w
® Yes, ❑ No Tl%i5 Cd m..t �4c.k L5 a Co b%4- %4- : -%�,^ CPrr fi
�-!; a- P f o, o tj *-J &VI I - t * 1- o 0 / "et w E l q. 5 AL& Nai e.
10. Were (at least) informal written proposals requested of three consultants?
❑ Yes, ® No
11. Attach list of consultants from whom proposals were requested (including a
contact telephone number). A Vs J, t.J t^ e... 'cam 604w
Wa-S C.. PP ej.
12. Attach proposed scope of work. P t-e-a s e See a +-c, �-� r +�� •� •+
13. Attach proposed payment schedule. -� Qk��t 6
so S �'��'``�
I HARD MADRIL, Manager
Purchasing/Central Services
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' If the answer to any these questions is "No," the contract will require approval from the City Council.
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PROFESSIONAL SERVICES CONTRACT BETWEEN THE
REDEVELOPMENT AGENCY OF THE CITY OF HUNTINGTON BEACH
AND
Maov.c Tgce fame G (+s04cm(MI C,Tv,C ,
FOR rr Q
Q+1pAc�w I.�QI:E�dIAAeut+
Table of Contents
Scopeof Services.....................................................................................................1
Agency Staff Assistance..........................................................................................2
Term; Time of Performance.....................................................................................2
Compensation..........................................................................................................2
ExtraWork...............................................................................................................2
Methodof Payment..................................................................................................3
Disposition of Plans, Estimates and Other Documents...........................................3
HoldHarmless.........................................................................................................3
Professional Liability Insurance.............................................................................4
Certificate of Insurance............................................................................................5
Independent Contractor............................................................................................6
Termination of Agreement.......................................................................................6
Assignment and Delegation.....................................................................................6
Copyrights/Patents...................................................................................................7
Agency Employees and Officials.............................................................................7
Notices.........................................................................................7
Consent....................................................................................................................8
Modification.............................................................................................................
8
SectionHeadings.....................................................................................................8
Interpretation of this Agreement..............................................................................8
DuplicateOriginal........................................................................:...........................9
Immigration...............................................................................................................9
Legal Services Subcontracting Prohibited................................................................9
Attorney's Fees..........................................................................................................10
Survival.....................................................................................................................10
GoverningLaw.........................................................................................................10
Entirety......................................................................................................................10
jmp/contracts group/intematl sample/3/14/02
PROFESSIONAL SERVICES CONTRACT BETWEEN THE
REDEVELOPMENT AGENCY OF THE CITY OF HUNTINGTON BEACH
AND _
j aeb %p a r a ce !&H a Ga [-Fc v%a H CM r
t���AQN-�.� uetopr►,e�t �°oyt�pHSus t� iKc�JV1t�+-iH,�
THIS AGREEMENT ("Agreement") is made and entered into this �4-116 day of
5{�A2r' , 20 M , by and between the Redevelopment Agency of the City of
JF
Huntington Beach, a municipal corporation of the State of California, hereinafter referred
to as "AGENCY," and M00 ae Za co f a vte (j!$ W.c—jL v�M� ). a
C4 t, �or w; �v �o�,�: e 1 , hereinafter referred to as "CONSULTANT."
WHEREAS, AGENCY desires to engage the services of a consultant to
�Io�ac�Qvosp,��ti nQuetbDwtev►t Cs�se,�e�,c Moc4-jk,r; and
Pursuant to documentation on file in the office of the Agency Clerk, the provisions
of the Huntington Beach Municipal Code, Chapter 3.03, relating to procurement of
professional service contracts have been complied with; and
CONSULTANT has been selected to perform these services,
NOW, THEREFORE, it is agreed by AGENCY and CONSULTANT as follows:
1. SCOPE OF SERVICES
CONSULTANT shall provide all services as described in Exhibit "A"
which is attached hereto and incorporated into this Agreement by this reference. These
services shall sometimes hereinafter be referred to as the "PROJECT."
CONSULTANT hereby designates I, ruhtE' S. ZaCofoKowho shall
represent it and be its sole contact and agent in all consultations with AGENCY during the
performance of this Agreement.
agree/forms/agency profserv/3/ 14/02 1
2. AGENCY STAFF ASSISTANCE
AGENCY shall assign a staff coordinator to work directly with
CONSULTANT in the performance of this Agreement.
3. TERM; TIME OF PERFORMANCE
Time is of the essence of this Agreement. The services of CONSULTANT
are to commence as soon as practicable after the execution of this Agreement by AGENCY
(the "Commencement Date"). This Agreement shall expire on 0C 01,&y r. i ,loot. unless
sooner terminated as provided herein. All tasks specified in Exhibit "A" shall be
completed no later than Afe t l _ Two :from the Commencement Date of this
Agreement. These times may be extended with the written permission of AGENCY. The
time for performance of the tasks identified in Exhibit "A" are generally to be shown in
Exhibit "A." This schedule may be amended to benefit the PROJECT if mutually agreed
to in writing by AGENCY and CONSULTANT.
4. COMPENSATION
In consideration of the performance of the services described herein,
AGENCY agrees to pay CONSULTANT on a time and materials basis at the rates
specified in Exhibit "B," a fee, including all costs and expenses, not to exceed
TWb T�o"c6%b -0%e 4%A u&trj Dollars ($ % 1 1 10, 00 ).
5. EXTRA WORK
In the event AGENCY requires additional services not included in Exhibit
"A" or changes in the scope of services described in Exhibit "A," CONSULTANT will
undertake such work only after receiving written authorization from AGENCY.
agree/forms/agency profserv/3/14/02 2
Additional compensation for such extra work shall be allowed only if the prior written
approval of AGENCY is obtained.
6. METHOD OF PAYMENT
CONSULTANT shall be paid pursuant to the terms of Exhibit "B," which
is attached hereto and incorporated by reference into this Agreement.
7. DISPOSITION OF PLANS, ESTIMATES AND OTHER DOCUMENTS
CONSULTANT agrees that title to all materials prepared hereunder,
including, without limitation, all original drawings, designs, reports, both field and office
notices, calculations, computer code, language, data or programs, maps, memoranda,
letters and other documents, shall belong to AGENCY, and CONSULTANT shall turn
these materials over to AGENCY upon expiration or termination of this Agreement or
upon PROJECT completion, whichever shall occur first. These materials may be used by
AGENCY as it sees fit.
8. HOLD HARMLESS
CONSULTANT hereby agrees to protect, defend, indemnify and hold
harmless AGENCY, its officers, elected or appointed officials, employees, agents and
volunteers from and against any and all claims, damages, losses, expenses, judgments,
demands and defense costs (including, without limitation, costs and fees of litigation of
every nature or liability of any kind or nature) arising out of or in connection with
CONSULTANT's (or CONSULTANT's subcontractors, if any) negligent performance of
this Agreement or its failure to comply with any of its obligations contained in this
Agreement by CONSULTANT, its officers, agents or employees except such loss or
damage which was caused by the sole negligence or willful misconduct of AGENCY.
agree/forms/agency profserv/3/ l4/02 3
AGENCY shall be reimbursed by CONSULTANT for all costs and attorney's fees incurred
by AGENCY in enforcing this obligation. CONSULTANT will conduct all defense at its
sole cost and expense and AGENCY shall approve selection of CONSULTANT's counsel.
This indemnity shall apply to all claims and liability regardless of whether any insurance
policies are applicable. The policy limits do not act as limitation upon the amount of
indemnification to be provided by CONSULTANT.
9. PROFESSIONAL LIABILITY INSURANCE
CONSULTANT shall obtain and furnish to AGENCY a professional
liability insurance policy covering the work performed by it hereunder. This policy shall
provide coverage for CONSULTANT's professional liability in an amount not less than
One Million Dollars ($1,000,000.00) per occurrence and in the aggregate. The above -
mentioned insurance shall not contain a self -insured retention, "deductible" or any other
similar form of limitation on the required coverage except with the express written consent
of AGENCY. A claims -made policy shall be acceptable if the policy further provides that:
A. The policy retroactive date coincides with or precedes the initiation
of the scope of work (including subsequent policies purchased as
renewals or replacements).
B. CONSULTANT shall notify AGENCY of circumstances or
incidents that might give rise to future claims.
CONSULTANT will make every effort to maintain similar insurance during
the required extended period of coverage following PROJECT completion. If insurance is
terminated for any reason, CONSULTANT agrees to purchase an extended reporting
agree/forms/agency profserv/3/14/02 4
provision of at least two (2) years to report claims arising from work performed in
connection with this Agreement.
10. CERTIFICATE OF INSURANCE
Prior to commencing performance of the work hereunder, CONSULTANT
shall furnish to AGENCY a certificate of insurance subject to approval of the Agency
Counsel evidencing the foregoing insurance coverage as required by this Agreement; the
certificate shall:
A. provide the name and policy number of each carrier and policy;
B. shall state that the policy is currently in force; and
C. shall promise that such policy shall not be suspended, voided or
canceled by either party, reduced in coverage or in limits except
after thirty (30) days' prior written notice; however, ten (10) days'
prior written notice in the event of cancellation for nonpayment of
premium.
CONSULTANT shall maintain the foregoing insurance coverage in force
until the work under this Agreement is fully completed and accepted by AGENCY.
The requirement for carrying the foregoing insurance coverage shall not
derogate from CONSULTANT's defense, hold harmless and indemnification obligations as
set forth in this Agreement. AGENCY or its representative shall at all times have the right
to demand the original or a copy of the policy of insurance. CONSULTANT shall pay, in
a prompt and timely manner, the premiums on the insurance hereinabove required.
agree/forms/agency profserv/3/14/02 5
11. INDEPENDENT CONTRACTOR
CONSULTANT is, and shall be, acting at all times in the performance of
this Agreement as an independent contractor herein and not as an employee of AGENCY.
CONSULTANT shall secure at its own cost and expense, and be responsible for any and
all payment of all taxes, social security, state disability insurance compensation,
unemployment compensation and other payroll deductions for CONSULTANT and its
officers, agents and employees and all business licenses, if any, in connection with the
PROJECT and/or the services to be performed hereunder.
12. TERMINATION OF AGREEMENT
All work required hereunder shall be performed in a good and workmanlike
manner. AGENCY may terminate CONSULTANT's services hereunder at any time with
or without cause, and whether or not the PROJECT is fully complete. Any termination of
this Agreement by AGENCY shall be made in writing, notice of which shall be delivered
to CONSULTANT as provided herein. In the event of termination, all finished and
unfinished documents, exhibits, report, and evidence shall, at the option of AGENCY,
become its property and shall be promptly delivered to it by CONSULTANT.
13. ASSIGNMENT AND DELEGATION
This Agreement is a personal service contract and the work hereunder shall
not be assigned, delegated or subcontracted by CONSULTANT to any other person or
entity without the prior express written consent of AGENCY. If an assignment, delegation
or subcontract is approved, all approved assignees, delegates and subconsultants must
satisfy the insurance requirements as set forth in Sections 9 and 10 hereinabove.
agree/forms/agency profserv/3/ l4/02 6
0 .
14. COPYRIGHTS/PATENTS
AGENCY shall own all rights to any patent or copyright on any work, item
or material produced as a result of this Agreement.
15. AGENCY EMPLOYEES AND OFFICIALS
CONSULTANT shall employ no AGENCY official nor any regular
AGENCY employee in the work performed pursuant to this Agreement. No officer or
employee of AGENCY shall have any financial interest in this Agreement in violation of
the applicable provisions of the California Government Code.
16. NOTICES
Any notices, certificates, or other communications hereunder shall be given
either by personal delivery to CONSULTANT's agent (as designated in Section 1
hereinabove) or to AGENCY as the situation shall warrant, or by enclosing the same in a
sealed envelope, postage prepaid, and depositing the same in the United States Postal
Service, to the addresses specified below. AGENCY and CONSULTANT may designate
different addresses to which subsequent notices, certificates or other communications will
be sent by notifying the other party via personal delivery, a reputable overnight carrier or
U. S. certified mail -return receipt requested:
TO AGENCY:
Redevelopment Agency of the City of
Huntington Beach
ATTN: '0 4 u 1c) 4 S r
2000 Main Street
Huntington Beach, CA 92648
agree/forms/agency profserv/3/ l4/02 7
TO CONSULTANT:
�4►��e� S. ZaCo�-a.NO
Moour (tAr&)
�loa eg%-s f Ao #-,%u.e
ie�k a lei , CA C14110
17. CONSENT
When AGENCY's consent/approval is required under this Agreement, its
consent/approval for one transaction or event shall not be deemed to be a consent/approval
to any subsequent occurrence of the same or any other transaction or event.
18. MODIFICATION
No waiver or modification of any language in this Agreement shall be valid
unless in writing and duly executed by both parties.
19. SECTION HEADINGS
The titles, captions, section, paragraph and subject headings, and descriptive
phrases at the beginning of the various sections in this Agreement are merely descriptive
and are included solely for convenience of reference only and are not representative of
matters included or excluded from such provisions, and do not interpret, define, limit or
describe, or construe the intent of the parties or affect the construction or interpretation of
any provision of this Agreement.
20. INTERPRETATION OF THIS AGREEMENT
The language of all parts of this Agreement shall in all cases be construed
as a whole, according to its fair meaning, and not strictly for or against any of the parties.
If any provision of this Agreement is held by an arbitrator or court of competent
jurisdiction to be unenforceable, void, illegal or invalid, such holding shall not invalidate
or affect the remaining covenants and provisions of this Agreement. No covenant or
provision shall be deemed dependent upon any other unless so expressly provided here.
As used in this Agreement, the masculine or neuter gender and singular or plural number
shall be deemed to include the other whenever the context so indicates or requires.
agree/forms/agency profserv/3/14/02 8
Nothing contained herein shall be construed so as to require the commission of any act
contrary to law, and wherever there is any conflict between any provision contained herein
and any present or future statute, law, ordinance or regulation contrary to which the parties
have no right to contract, then the latter shall prevail, and the provision of this Agreement
which is hereby affected shall be curtailed and limited only to the extent necessary to bring
it within the requirements of the law.
21. DUPLICATE ORIGINAL
The original of this Agreement and one or more copies hereto have been
prepared and signed in counterparts as duplicate originals, each of which so executed shall,
irrespective of the date of its execution and delivery, be deemed an original. Each
duplicate original shall be deemed an original instrument as against any party who has
signed it.
22. IMMIGRATION
CONSULTANT shall be responsible for full compliance with the
immigration and naturalization laws of the United States and shall, in particular, comply
with the provisions of the United States Code regarding employment verification.
23. LEGAL SERVICES SUBCONTRACTING PROHIBITED
CONSULTANT and AGENCY agree that AGENCY is not liable for
payment of any subcontractor work involving legal services, and that such legal services
are expressly outside the scope of services contemplated hereunder. CONSULTANT
understands that pursuant to Huntington Beach City Charter Section 309, the Agency
Counsel is the exclusive legal counsel for AGENCY; and AGENCY shall not be liable for
payment of any legal services expenses incurred by CONSULTANT.
agree/forms/agency profserv/3/ l4/02 9
0 •
24. ATTORNEY'S FEES
Except as expressly set forth in Section 8 of this Agreement, in the event
suit is brought by either party to construe, interpret and/or enforce the terms and/or
provisions of this Agreement or to secure the performance hereof, each party shall bear its
own attorney's fees, such that the prevailing party shall not be entitled to recover its
attorney's fees from the non -prevailing party.
25. SURVIVAL
Terms and conditions of this Agreement, which by their sense and context
survive the expiration or termination of this Agreement shall so survive.
26. GOVERNING LAW
This Agreement shall be governed and construed in accordance with the
laws of the State of California.
27. ENTIRETY
The parties acknowledge and agree that they are entering into this
Agreement freely and voluntarily following extensive arm's length negotiation, and that
each has had the opportunity to consult with legal counsel prior to executing this
Agreement. The parties also acknowledge and agree that no representations, inducements,
promises, agreements or warranties, oral or otherwise, have been made by that party or
anyone acting on that parry's behalf, which are not embodied in this Agreement, and that
that party has not executed this Agreement in reliance on any representation, inducement,
promise, agreement, warranty, fact or circumstance not expressly set forth in this
Agreement. This Agreement, and the attached exhibits, contain the entire agreement
between the parties respecting the subject matter of this Agreement, and supercede all prior
agree/forms/agency profserv/3/14/02 10
0 •
understandings and agreements whether oral or in writing between the parties respecting
the subject matter hereof.
IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be
executed by and through their authorized offices the day, month and year first above
written.
CONSULTANT,
W WAA 25
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' WA—' �� •
pr
ITS: (circle on hairma esident/Vice President
=IckN Ge cTC MZ n
print name
ITS: (circle one) Secretary hief Financial Office sst.
Secretary — Treasurer
agree/forms/agency profserv/3/14/02 11
REDEVELOPMENT AGENCY OF THE
CITY OF HUNTINGTON BEACH, a public
body, co orate and politic
' 0,
Deputy Exec tive Director
APPROVED AS TO FORM:
— "Li
1-36 - DZ. Agency Counsel
REVIEWED AND APPROVED:
Executive Director
(only for contracts over $50, 000.00)
August 1, 2002
Gus Duran
Housing and Redevelopment Manager
City of Huntington Beach
Department of Economic Development
200 Main Street
Huntington Beach, CA 92648
, Via e-mail: gduran@surfcity-hb.org
Dear Gus:
Moore Iacofano Goltsman (MIG), Inc., is pleased to submit this letter of engagement to provide
meeting facilitation services in connection with a property development consensus building meeting
for the City of Huntington Beach.
As we discussed, MIG will provide the services as outlined in the tasks below.
City of Huntington Beach: Property Development Consensus BuildingMeeting
MIG Preliminary Scope of Services S t, 4 o a- I-r a {*� -
$ e Pt e Na,. t % , L o 01
TASK 1: MEETING PREPARATION
MIG will meet with Gus Duran of the City of Huntington Beach by telephone to discuss the
strategy and structure for the meeting, including key objectives and issues. The discussion will
include an agenda, logistics coordination, and any background materials to be used or presented at
the meeting. The time budget also provides for review and preparation of materials before the
meeting and coordination with City staff.
TASK 2: MEETING FACILITATION
MIG will provide facilitation and graphic recording services to support a property development
consensus -building meeting in Huntington Beach, California.
Professional Time for Tasks 1 and 2:
Daniel Iacofano, Principal: 8.0 Hours @ $195.00/Hour........................................ $1,560.00
Project Assistant: 2.0 Hours @ $65.00/Hour.................... $130.00
.........................
Professional Time Subtotal.......................................................................................... 51,690.00
•
Cif- of I luntiaq Beach
Property Development Consensus Building Meeting
Direct Costs for Tasks 1 and 2:
Airfare........................................................................................... $300.00
Rental Car/Taxis/Parking Fees............................................................................................ $100.00
MeetingSupplies............................................................................................... $50.00
Direct Costs Subtotal............................................................................................. $450.00
TASK1-2 Estimated Cost............................................................................$2?140.00
MIG, Inc.
Page 2
The maximum total for both tasks outlined above is $2,140.00. This is a maximum amount not to
be exceeded unless you authorize a change to the scope of work. Reimbursable expenses are based
on cost plus 10%.
If you should have any questions, please feel free to contact me at (510) 845-7549.
Sincerely,
MOORE IACOFANO GOLTSMAN, Inc.
1 j
Daniel S. Iacofano, Ph.D., AICP
Principal
DSI:zr
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Will 60
Authorized by:
Signature
Date
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�.M CERTIFICAW' OF LIABILITY INSU , NCE 0882DTE 6102°"�'
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Dealey, Renton 8r Associates ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
P. O. Box 12675 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Oakland, CA 94604-2675
510 465-3090 INSURERS AFFORDING COVERAGE
INSURED INSURER A: Security Ins. Co. Of Hartford
Moore lacofano Goltsman, Inc. INSURER B:
800 Hearst Ave.
INSURER C:
Berkeley, CA 94710 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.
NSR
LTRAEMMDD
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
POLICY EXPIRATION
DATE (MMI D
LIMITS
GENERAL LIABILITY
COMM ERCIAL GENERAL LIAB ILITY
CLAIMS MADE DOCCUR
EACH OCCURRENCE
$
FIRE DAMAGE (Any one fire)
$
MED EXP (Any one person)
$
PERSONAL & ADV INJURY
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GENERAL AGGREGATE
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GEN'L AGGREGATE LIM IT APPL IES PER:
POLICY PRO LOC
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$
GARAGE LIABILITY
ANY AUTO
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OTHER Professional
Liability Ins.
AEE0700949
07/01/02
07/01/03
$1,000,000 per claim
$1,000,000 annl aggr.
DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES!EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Re: Job # 8075-City of Huntington Beach Property Development Consensus Building Meeting.
R
City of Huntington Beach
Attn: Tom Andrusky
Dept. of Economic Development
2000 Main St.
Huntington Beach, CA 92648
SHOULD ANYOF TH E ABOVE DESCRIBED POLICIES BE CANCELLED B EFORE TH E EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL J9)(R=xPMAIL-Itl DAYSWRITTEN
NOTICETOTHE CERTIFICATE HOLDERNAMEDTOTHELEFT, BKR5ALj=)TAjDVM I(AIi)0
AUTH IZED
AGUKU 25-J (//91)1 Of 1 #M61257 ARH Q AGUKU GOKPURATION 195U