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HomeMy WebLinkAboutFOUNTAIN VALLEY MUSIC CENTER, INC - 1981-01-19Return Original and Copy JC coml�Ie�egS%r?ificate to: 0 CERT)FICAtE GFI ISURANCE Approved as to Form. ( f City of Huntington Beach to Gail Hutton, City Attorney`0 ,/Z , 2 l City A`,trrnsy F. O. Box Iad^ CITY OF HUNf0313TOK BEACH, CALIFORNIA Huntington 9 .c... CA 92646 golly go Risk'Managw afterapproval A MUNICIPAL CORPORATION This is to certify that the policies of insurance as described below have been issued to the insured by the undersigned and are in force at this tine. it those policies are cancelled or changed in such a manner that will affect this certificate, the insurance company egress to give 90 days prior written notice, by mail, to City of Huntington Beach-P. Q. Box 719, Huntington Beach, California 92648. ALL ITEMS MUST BE COMPLETED, ANY DELETION Oil CHANGE 1N THIS FORM SHALL BE SIGNED AND DATED BY Ar'v AUTHORIZED REPRESENTA71VE OF THE INSURANCE COMPANY AND MUST BE APPROVED IN WRITING E Y THE CITY .ATTORNEY, Name of Insured �int)-AIIA, V ' 4"r V Alfc^ !L � C ! l"7�-� c/ 7 ' %� F. U • j �, y+ f i � �^/L.y�"./ Address of Insured% Location of Work or Operations to be performed L t Description of Work or Operatiotrs e (a—� e) I.I. jiI -e0 iy-e S POLICY DATES LIMITS OF LIABILITY NAME OF COMPANY _ Effective Expirt`1iol POLICIES IN FORCE POLICY NO. In 'Thousands (CQC) (INS.) GENERAI- LIABILITY I I CithlPREH£NSIVE FORM De $ � CSL Each Occurance I I PREMISES - OPERATIONS I IEXPLOSION AND COLLAPS-E HAZARD I I UNDERGROUND HAZARD J t PRODUCTS COMPLETED r OPERATIONS HAZARD ( J CONTRACTUAL INSURANCE, BROAD FORM PROPERTY DAMAGE ( J INDEPENDENT CONTRACTORS ( ) PERSONAL INJURY AUTOMOBILE LIABILITY I I COMPREHENSIVE FORM I 1 4" NEn S CSL ( 1 HIRED Each Occurance I I NON-OwNCO EXCESS LIABILITY { I UMBRELLA .FORM I OTH=R THAN S UMBRELLA FORM WORKERS' COMPENSATION �) L 3 a;nd EMPLOYERS' LIABILITY }n� %/, %�-( 16- fry Additional Insured Endorse'n "nt: The insueer agrees that the IL4ty of Huntington 134a h and its City Councii, and/or all City Countcil appelva—ad groups, � Ommittees, conlmisetons, boards and any other City Council appointed body, and/or ttlective and appointive officers, servants or employees of the City of Huntington Bead', when hcting as such are additional insureds hereunder, for the acts tit tea insured, and such insurance shall be primary to any insurance of the Vitt) of Huntington Beach, as their interest may appear. onto Leo 2 52— AUTHORIZED REPRESENTATIVE OF INSURANCE COMPANY INSURANCE SCIMPANY nfy , c _ t3y —7i " s �-t it7—k f 1. yr s Nanw _. /3 c'Address -2--2-1 3 Q CAdcfCi C I - S 2 P& C. 0 G--�` Cityr�a Z— C [' , City ram! �l r� t) f Telephone " 7 1 Li S� Icj_7C HOLD K-AMLESS AGREEMENT d l ijr Ito L-4 exmited by irlslr,red) The insured r'" .. fill j. rk aVeels to protvot, defend, indemnify,save and hold harmless the City of Huntington Beach its officers, agents, and empiriyed against any liability, loss, damage, cost, or expanse by reason of any and all liability, suits, claims, demands, judgment& .nd causes of action +,aused by insured, his employees, agents or any subcontractor or by any third pasty arising riot at or in consequence of the performanc^ of all or any operations or activity or which this certificate of insurance is fur fished. w. ('11 Soles Proprietorship i2) Panrwrshtp ((3) Corporation` ` (4) Itdaty} 0017 HOLD 14ARMLESS SIGNED, ley Insured: I Title (All nanumshal, printvdor tyPki By Insu sd: b ow each vynattl a If Corporation, '(WO Officers must sigh, or present evidencq of authorization to bind Corporation. JIM PLEI IEL PLEM L NSURACE, INC. 22132 ?AVODA LAGUNA HILLS, :r, 9285*3 RECF.IVF I CITY ATT01:1 ` Y CIP, nr HUNTING - ' -•,1 OCT26 l� �a AK `�? TELEPHONE: 714-588-7033 . Oct. 25, 1982 City of Huntington Beach P . 0. Box 190 2000 Main St. 4th Floor Huntington Beach CA. 92643 Attn: City Attorney's office Re: Fountain Valley Music Store dba.; Arcade Certificate of Insurance On Oct. 18., 1982 I delivered a Certificate of Insurance on behalf of the insured at your r- uest. While at your office 1 mis asked to shot a 3.0 day cancellation notice and delete the words "endeavor" and the last portion of the sentence, The company -ailed me on Got. 2j, 1982 to ad, se me that I cannot change the wording. Therefore, we respectfully request you dierega.rd the 'ce'ctificato dated Cot. 1.8, 1982 and accept in its place the Certificate of Insurance attached to this letter which, changes the notice of cancellations to 1-1, days and males no changes to the wording of the document. The cancellation --acted on the document is the only one, recognized by Comstock Insurance Co. Sincerely yours, PLEMEL INSL AG CY, INC. JEPfdp YOUR.ndependenf" fnsurunreAG>N-r S ■ x i 26 October 1982 1. Aquapride Pools Corporation - State Comp Insur',.nce Fund 2. Creative Building Specialists Inc. State Comp .,_oarance Fund 3. Earl's Plumbing, Inc. GriffithjSincock Insurance Brokers 4. Jim Lee, Inc, - Beissel. Ins. ServLce, Inc. 5. J. Herman Company, Inc. Frank B. H:all. L, Co. of Calif. f 6. Bauserman Air Conditioning - State Farm 7. United Installers - Alexander & Alexander of California, Inc. 8. Robert Payne C�_poration - Plumbing Contractors Insurance Program 9. Duke Timber Construction Co., Inc. - Western Employers Insurance 10. Mel Smith Electric, Inc. -- Leisurecraft Ins. Agency Ill L.C.L. Sheet Metals Inc. - LPL Insurance Agency, Inc, 12. Better Built Fence Company/Better Built masonry - Plather•s and Assoc. 13. Tne Pipe Surgeon, Inc. - Coast Valley Insurance Agency, Inc. 14. J. K. Harrison Excavation, Inc. - Tipton & Compa,.xy 15. Beat_; Construction Corporation - Carroll Associates Insurance, Inc. N.B.- As of today Fountain Valley Musle Store, inc./Arcade has no'- insurance - Gee attached letter. Community .Services has been notified to instruct the assured to seek insurance with another company to meet city's requirements. R � EQUIPMENT LEASE AGREEMENT THIS AGREEMENT is enterer into this ,'2p�` day of 1981 by and 'bet.veen FOUNTAIN VALLEY MUSIC -- _7 CENTER, INC., a California corporation, hereinafter referred to as "LESSEE", and the CITY OF HUNTINGTON BEACH, a municipal corpora- tion existing under and by virtue of the laws of the State of California, hereinafter referred to as "LESSOR". RECITALS - WHEREAS, LESSON desires to provide coin -operated video and other amusement games to secure additional revenue as well as provide an 4dditional source of ,recreation for its citizens; and, LESSEE J,slocated in the County of Orange and has knowl-� edge and experience in furnishing electronic video and other amusement games; and No official or employee of LESSOR has any financial interest in the subject matter of this agreement, contemplated within the provisions of California Government Code sections 1090 and 1092 NOW, THEREFORE, in consideration of the promisee' herein- after contained, it is agreed by and between the parties., a follows SECTION I. CONSIDERATION. LESSEE accepts as full CM., iF : lm l0/ 2fl/80 compensation for the services provide a percentage of the gross receipts collected from the equipment in the amount of fifty percent (50%). LESSOR and LESSEE shall inspect machines once per week, and gross income shall be counted in the presence of both parties. LESSEE shall thereupon render written, weekly accountings of the gross receipts collected for the previous week, which shall be signed by both parties; and payment on such weekly accountings shall be made to LESSOR who shall issue to LEI`SEE a cash receipt for the total amount received. SECTION 2. TERI4. The term of this agreement shall be for one (1) year, commencing on the date first above written. At the end of the first year, this agreement shall continue on a month to month basis. SECTION 3• EQUIPMENT. LESSEE agrees to lease space for coin -operated video and other amusement Eames from LESSOR to be installedatMurdy Community Center and. Edison Community Center; and other locations in the city as determined by the Community Services Director. SECTION 4. RENEGIAL AND TERMINATION This lease shall renew itself automatically at the same terms and conditions except as otherwise provided in section 2, above, unle6s either party gives to the other party -s notice of.' termination by registered mail not less than thirty 30) days prior to said termination. SECTION 5. EXCLUSIVITY. LESSOR agrees to accept, and by these presents does accept said rental of equipment to be prominently displayed in its business locat.Lons above mentioned. H L? v I LESSOR agrees that it will not rent, install, permit to be installed, or to be used in its business locations above mentioned, equipment of its own or of any other person, firm or corporation, of a like or competitive description or d=sign, during tie term of this agreement. SECTION 6. CARE >-)-F F LESSOR, further agrees that it will not itself damage, interfere with, injure or tamper with said equipment, and that it will imzriedie tely notify LESSEE when any of said equipment is found to be -),nt of order. LESSEE will provide any necessary maintenance at its sole expense within a forty-eight (48) hour time period after notifica- tion 1,Ny LESSEE that the equipment requires such maintenance. LESSEE shall bear any and all expense for replacement of said equipment which may be lost or stolen while at the lccations above mentioned. SECTION 7 CHARGES, REFUNDS, REMOVAL. The charges made by LESSEE for use of its equipment shall be subject to the approval of LESSOR. All refunds claimed by users of equipment shall be the responsibility of and paid for by LESSEE. Removal of the egv pment shall be the responsibility of LESSEE.. Upon removal LESSEE shall restore the leased preiii3es. to their oendition prior to the installation of the equipment SECTION B. PAYMENT OF ELECTRICITY LESSOR agrees to pay for all electricity used in conjunction with the operation and maintenance of the described leased equipment. 3. 11 0 SECTION 9. LICENSES z TAXES. LESSEE shall bear any cost or expanse resulting from, but not limited to, licenses, royalties, Federal, state and local taxes and assessments. SECTION 10. ASSIGNMENT. This agreement shall bind the parties and their assigns, and the LESSOR further agrees that in the event of sale or change of ownership of its business location above mention: d, this agreement shall be binding upon its assigns or successors, and that said successors or assigns will be notified of the existence of this agreement, and this agreement willbeincluded in the escrow agreement, and LESSOR shall forth- with procure assigns' or successors' signatures to this ag,.,eement within five (5) lays of the opening of escrow or application for any license. LESSEE further agrees that it shall not assign this lease without the prior written consent of LESSOR. SECTION 11. INDEMNIFICATION, DEFENSE, HOLD HARMLESS, LESSEE agrees to defend, inder.raify and hold harmless L,,SSOR, its officers, agents and employees, from and against any and all liability, damages, casts, losses, claims and expenses, however caused resulting directly or indirectly form or connected with LESSEE'S performance of this agreement, except where such liability, damages, costs, losses, claims, or expenses are caused solely by the negligent or wrongful acts of LESSOR or any of its agents or employees. SECTION 12. INSURANCE. LESSEE agrees to furnish 0 0 LESSOR and maintain in force for the term of this agreement, a general liability insurance policy in which LESSOR is named as an additional insured. The policy shall provide for not less ,han Three Hundred Thousand Dollars ($300,000) of insurance against bodily injury or property damage per occurrence. Such insurance shall specifically provide that any other insurance carried by Lh3SOR which may be applicable shall be deemed excess and LESSEE'S insurance primary despite any conflicting provisions of LESSEE'S policy to the contrary. LESSEE further agrees to provide Workers' Compensation insurance for its agents, officers and employees, and to submit proof of such insurance to LESSOR within ten (10) days after execution of this agree,.tient. SECTION 13. INDEPENDENT CONTRACTOR. It is further understood and agreed that LESSEE is, and shall be a.ctinh at all times as an independent contractor herein and not as an employee of LESSOR. LESSEE skull secure at its expense, and be responsible for any and all payments of social security, state disability insurance compensation, unemployment compensat'.on, and other payroll deductions for LESSEE and its officers, agents anw employees izt connection with the services performed hereunder. SECTION 111. NOTICES. All notices pursuant to this agreements unless otherwise specified, shall be made by depositing same in the united States postal service, first class postage prepaid and addressed as follows 0 To LESSOR: City Clerk City of Iiuntingtuil Beach 2000 Main Street Huntington Beach, California 92648 i To LESSEE: Fountain Valley Music Center, Inc. 18934 Brookhurst Street Huntington Beach, California 92'703 SECTION 15. ADDITIONAL PROVISIONS. In the event any of the terms of this lease agreement are breached by LESSOR or LESSEE, all sums then due or to become due and payable shall I immediately become due and payable at the time of the breach. If Legal action shall be instituted by LESSOR or LESSEE to enforce the terms and ,- nditions contained herein, then, and a.7 that event, the party found to have breached this agreement, or its successors in interest, agrees to pay reasonable attorney fees plus court costs. SECTION 16. ENTIRETY, this agreement contains the entire agreement between the parties hereto. IN WITNESS WHEREOF the parties hereto have caused this agreement to be executed by and trough their authorized, officers the day, month and year first above written. CITY OF HUNTINGTON BEACH a municipal corporation By Mayor ATTEST: APPROVED AS TO FORM: s City Clerk 6, wrvs ., 1 REVIEWED AND APPROVED: INITIATED AND APPROVED: T A e City Admini rater -- on—Lmunit-,<V Services Director FOUNTAIN VALLEY MUSIC CENTER, INC. res �n � 6ecretayy -STATE COMPENSATION IN S t_/ RANC E FUND 0 P.O. BOX 807, SAN FRANCISCO, CALIFORNIA 94101 i CERTIFICATE OF WORKERS' COMPENSATION INSURANCE r „a,_ :' ?NIBER: . .. � i CERTIFICATt. 'IES: y .3rtwe` t1 . I' o x r 1 1 Mgt s< Yez;r rz —1 This is to certify that we have issued a valid Workers' Compensation insurance policy 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' 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 :n instrance policy and does not amend, extend or alter the coverage afforded pry the policies listed herein. Notwithstanding any requirement, 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 herein is subject to all the terms, exclusions and conditions of such policies. c EMPLOYER rsESID n Ur � 1 �G '?Jerl iga t s own" t fir.; .�...�, o _ :�dllili I ® S - SAFECO ANCE COMPANY OF AI'4ERICA E11i T G = GENERA vRANCE COMPANY OF AMERICA t F =FIRST NA NAL INSURANCE COMPANY OF AMERICA 'gOME OFFICE: 4333 BROOKLYN AVE, N.E., SEA:[ C7l�F� , LE, WASNIN9818b r' HEAD OFFICE FOR CANADA• MISSISSAUGA ONTARIO (Coverage is provided by the compony designated by imt'-it, a stock Insurance compcny herein called the com Policy Period: CertificaRe of Insurance The company certifies that the insurance policies indicated below arc in effect on the dote of this certificate. Name of Insured and Mailing Address (Street, City, State or Province, ZIP or Postal Code) l� F- FOUNTAIN VALLEY MUSIC STORE INC. � ')' -1 DBA: ARCADE 18934 BROOKHURST ST., FOtNTAIN VALLEY, CALIFORNIA 92708 Dj 12:01 A.M. ❑ Noon Stondard Time. of the address of the insured. For each policy the following schedule indicates the basic type of insurance provided with the limit of the icsurer's liability or moxi- mum amount payable for loss. This certificate is only a statement of the existence of the policy or policies of insurance herein referred to and neither affirmatively nor negatively amends, extends or alters the coverage afforded by any policy described herein. urr his of Lrob,l,'s• ea Amcu- of Co teroge Policy N�wber Fypeof tnsu;once Coverage One Person One Ots mence F�gp?p—.e Lcab,l%ty ESod,ty tny;rry S 5 Other Than Property Damage S $ CP 806119 A;rt�;rrabiy a Corrbtnel S 300,000 $ i 8ad4y Injury S $ t Automobte Prepeov Damage l S CP 806119 11o1;a".dry l Carr+A ned 5 300,000 ^t�tY�11HSr/..+'s'`�a\'tFr.�l%�'Ei+�ER'.T,aER.� 9t IX"r`f"ar+31!C1;lEuf t.1iFC,"e!:p"•tA�l GI3+fFr , EM1CliIONT WITH 4t7t.Ct ID WNICK 1HE Cf RilrkCATE IS 4SJED. ItiE WOOED BY It'! POUDES LISTED D.'a IHECtV r1GT£ IS i1;9i£&I Id AEE 1Hi t F.�S $1 y � p S1�t f'txtCiES:' tl a Fer,«S Irsceed A-mrst C 1 n Er^" cf L-ui; ' - Prcpe"y ,yB';:OO' qtS Tns4'ranfe S �frS'Ji;L" R'tL`rN`+'.'y Easiness tr,'emip!: ra -- tocul m 3r t � �f r ra 1w qF, r ntn, Wct7€men s rrrpensu Wta-v* . huk4v�iczeroge Location w risk zovered, or description of ouIor c&1,e or control covered, L't .z"', and �Ocattcn of ccp?r ;+Icns of Hark col - n ibe event of any rriateriolchange in, Cr can:ea"'atron o#, sold poltctes. the udders°fined cormpon y° vnil erideava^ 4'o—F' ,� .tter. to the patty to whom this certificote is issued but foaiureto g� -4 t such raotr.ze st-c& mpase no d�Fr's�ot.�n r�.. Certificate °s tsseea for flame and Address - t .-, � J c riCtaB �l cc, h ti CI- OF H i43 i IKTONI r BEACf CA. IN A MUNICIPAL CORPORATIO�. P. O. BOX 19.0 �. HLWTtWrON BEACH, CA. 9264$ ff a: a x Ira ba°'+, rnrtef�sed oily? NO rA>rwe Any statement on revers Voted FOLMAIN VALLEY,CA. l4kRcH 10, 1981 G �t �f1 gy • ��"? `��' � �` �aF�cq 8t+i5LRAYtE CK� BRNIf� Pl-a4EL INSttq e side is void. ICIY R C , 17--4 64`c C6F AVERiCk y CP AyAEaali:A. Aid A%*Y OF AMCAIC4 1'. , f t..i �'� ~ � y t2 � -� . ,� � rt { � � �" 4: r � { i c �r ♦ , � "r'� � err , s; °^ � � "s; b 1+•S �.�.f:.li.� � �1`,! �%�•.•�+ • �'l/ �. A ty��c�� Y..,t �+ a r.S �b Ae rY�. . ,. i{ }.f, t.1 ., ',•,Y.if i♦.-" r 1 .y,. 1 d• «t..r atr. �'� t;..f a a�F�fa �{1,r f' w.'!1 1 3!}17 t �, Irr1Ax ♦r �f'f�4, :1.+ �i.�.�d>`"a.t.{.Rg•.�, ! ._. ♦p., e1.=•I.1.^ 1. , if :,a+ f.1 _.,f. •t rl;i .S I•`, ff. rj�l 1't erael Insurance Agency, Inc. f'r)t ll.r,, r r ems'" 4 t 22192 Padova Lagu,�a Hills, Ca. 9?6K3 1 r Safr:co Insurance Co. j •` 71�-586-7033 t•1.1 Valley Fountain Music Storm, Inc; dha,: Arcade 18934 Broolchu:st Sty 4•, Fountain Valley, Ca. 92708 ; - 1" rills t, 1 • _ 15,1., ro 'I f ••1 Ia1-111jot ^- If ,.liotl 1,. ; . If ,. ni.. I;t .. i ,l rr,,. ! 14 f, •, x r , 1.... l II.1. f r I •>t)t)1 • t rl,, I—_ � Lf 'Itt�. n i.=ht1)ly 1 i 1 ltplltands t {{� TRT 1l tall «Y f9 CI !^t•1a7.'•. I" v • "••1 ' 1 .. , , .., •' j.. : Ii HERAL IIAU t II Y ' 1 ` A XI wo61to 3-28-8t 1: t �. a 300,000 CSL � A A : x 0806119 3-28-81 300,0001 i �•ITt .. 'I Q F I I V'i IT,` tia•rsxx� . [N•p fy j A a X 0806119 �- 28-81 - 300,00C. ' tt ! r � + _ • , ��yyS 9" t f!IIH 1 } d "at y q '�` t i.•—. /� GTE « ,t'` �..,�....,•,....;--�,.--.—.a �. • '"..w.,. «y r .....—, r •,v r+ Y � �,• / NyI' ,.... .. «♦ S'•yn+-w..�. Iw+_.'t _ . m n Insured Provides electronic game machines at various city of flunti 1 recreational facilities, S_ 9 JA N 21 96 It, iLl7 r �. (". •r(lr4i..Sn,. ) 1... t'a ,. !, • IS a, ... a„ ° • l 8 ! ,. 1 o b >�.. r ! •. tI 30, ,i e f rl tlq � )� d. ('� t+ i,yf.�. U. �,r� �. C443UI{ER GKFI�� �';'. It 53. .na, 'Y'I t3a... '+r l.s. t. Ia, ,a,a 1, ;t ;. t�+=I#!+ ,' tI,;1 t.•S: r!j� 1 City of Huntington Beech, Calif. C:'t^ 13, 1980 :> a I3unicipal Corporation F . t; . H c-x 190 41 ��� S Huntington Beach Ca. 92-648 STATE COMPENSATION P. O. BOX 807, SAN FRANCISCO, CALIFORNIA 94101 C FUND 0 �7 A L pU Ev' uRllv� 121)7A7- E ryj E N� JANUARY 8, 1981 FOUNTAIN VALLEY MUSIC CENTER, INC. 18942 BROOKHURST AVE FOUNTAIN VALLEY, CA 92708 POLICY NUMBER. AND YEAR � �P�OLICY DA�7 ES � 375678-80 10-1-80/81 SR F-76 PREMIUFA ©U1_ $t i 51 , 00 DUE DATE JANUARY, 23, 1981 IF PAYMENT IS NOT AEG-,'/ED BY THE DUE DATE SHOWN FL ABOVE, T141S POLICY 1S SUBJECT TO CANCELLATION:--' PLEASE RETURN BLUE COPY WITH YOUR PAYMENT SCIF FORM 511 (NEW 5.78) ' huad cs+ l„•t �,• • � rra' �' Mr r,�, • � M1, �, �Y , +•,., Y "�.' r � •a. ,�,a�.y. h i} ."! Ft ,�� �,,�� w�.«L"`a+!`r1r14"' " `L- t".r. `�. «• . ,.—. . rn•. , t, *-.r�`•+.5. Y ,. � �� rX s.�," 5 +4 �m!*••i� `f 4 �` {� •.vim: a a%`'r �" � r•.r{ a + �: � �, t!! ,�" �` .r."1 `.. nYt' ..c t' ' ti� rs :" an. ti.,M x ., , ...t r Y f "�'. i'ar .�!„�v. dirt r. y a •� � T yF �!/� ~�f'Y• f�' ...i t.+.,'�la.a 'tI.,.14* i r. �1�;" '"� /i :..~� a v .,1 C •.s ,. r> raffia ^i•..+ n wr41.K +..•'t r ..!, 1••a �. 1...•-ri r ...i�. r' t �'� .✓.!•«..ap": u.`� Y. � 1 i/ R a.. ,,� .,.1+f,s' .rC ..�G'J!fs.^vr"A"'.t'Y�..N✓ � " 3.J c ✓. a.• ;„ " `c a•r:{too•,i,..•,;r%:.,rii'r:�,f+'%wr.:'...r„4i�..'r:�,c�-,,,.�G.�l;.:.}.�'..,^'Ll..r�'t•It',,S",}:i,�a" � f ' ^iY yry,.,,,,��+d,x CX �ay��ltttJ.t .�a ra•,� M"�64•'i„r'7 �+..Sa f.a ,r "k•.� �4'«s. ...J ..,. ��J• � q.y� `�,',' ' �..r.'..��_._,.�`�. n'.,•t-i. t .�+�+.. i�l`.rW'A�:�:y'. ,rt ;.r+_},-•ae.,,. ✓�'t,.et...n�vk�r'�J..v + h+ ��1+7+..{. r1+,.��G.il:...�*;A:�• *.�: 1Ty-t.:, C:+' y £ ..• �?� .��,,."` '?" . *'�, � � �"s1"" �?a••' r ... � -Yn a.:4.t r %•.Y..r�.ti,+r/r..w .r iLh' .arty 1 ¢ �... wn,a, `i•�.. 'Y .vim+'*sL'd; .� r rty4'h��i fi iM:�'�' �.t rx"�raw wy��5...a�-���`o"� wy'4r. ya/`-,.f/a.'��r.. ,i '.." n �1 � "'.' r+�. -..�•r :s,«, a i ,,. �� •� " w ,�'r �,s i� i � •.,�1t�+T'r a,�y v"y}Y. tl "!" !.l ..'�Y. ,s/ l .c "•.'L i 'S�/ ,,,t, !T r r. ,.ir .t :+^. e I r "•„ �vter.} +}✓ .�' FDept.,� n original and three copies of0aeiJ certificate to: istribution: Original — Oriqinating Dept. CEhThi=ICATE OF INSURANCE After ApprovalYellow R,sk Manager f Huntington Beach ToBy City Attorney Plnk —City Clerk �, .rGold — Clty Attorney P. 0. Bart 190 CiTY OF HUNTINGTO.N BEACH, CALIFORNIA Huntington Beach, California 92648 A MUNICIPAL CORPORATION This is to ce-tify that the policies of insurance as described below have been issued to the insured by the under- :igned 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. O. Box 190, Huntington Beach, California 92648. :dame of Insured — Address of Insured Location of Insured Operations Description of Operations ' POLICIES IN FORCE POLICY NUMBER EFFECTIVE EXPIRATION LIMITS OF LIABILITY A. Workers Compensation Statutory .Employers' Liability $ B. Public Liability: 5300,000 combined single F - FIRST NAT ONAL'NSUIiANCE GOI. � ANY OF AMERIGA f� HOME OFFICE: 4333 BROOKLYN AVE, N,E., SEATTLE, WASH I TON 98185 HEAD OFPIt CANADA: MISSiSSAUGA, ONTARIO (Coverage is ded by the company designn'ed by initial, o stock ins a company herein called the company) Certificate of Insurance X�a The company certifies that the insurance policies indicated below are in eff ect on the dote of this certificate. Name of Insured and Mailing Address (Street, City, State or Province, ZiP or Postal Code) Policy Period: r FOUNTAIN VALLEY MUSIC STORE INC. from MA R CH 28, 19 1 DBA; ARCADE 18934 BROOKHURST ST., to_ MARCH 96, 11182 FOUNTAIN VALLEY, CALIFORNIA 92708 L 12:01 A.M. Noon Standard Time, at the address of the insured For each policy the following schedule indicates the basic type of insurance provided with the limit of the insurers habi"ty or maxi mum omui,nt payable for loss, This certificate is only a statement of the existence of the policy or policies of insurance herein referred to and neither affirmatively nor negatively amends, extends or alters the coverage afforded by any policy described herein. Limits of Liability or Amount of Coverage ry Numaer Type of insurance Coverage One Fersoa On Occurrence Aggregate Lability I*arii'.y Ir.;vey Other Than Property Damage S S CP 806119 Autorr#abt:e Crmbined S 300,000 _ Bodily ►nlury S S Autamob ie Lwbiloy Property Do -age S Combined S" 300,000 CP 806119 t+01W114$f0-*D;0+CAtyPOUiHEW.11 KRUO 47q -TO OIHER DOCU1:cNf WITH kESPECE TO WHICH ]HE CE TIFICJfr is ISSUED, THE R: RMCE AFTORDEO BY FHE FOLiCIES uSfEO ON THr CERT FfCA1E lSSUBJECI TO ALL FHET RMS OF SUCHFIXIVES" Pests insured Agocnst Cans Limit of Lrobrl,ly Property &)u Wmg,s, i insurance Personal Property Locot;wh �� s�+'arkinen s 5LI:'ect'o'F^e (err-$ rF , , 'aXcr6men s fCompensotran %r Ca pensatrcn'aws of r �e stc!e in wh,ch 0:^IfCy afi.wrds ra 3 ition of risk covered, or description of out( mobile or contract covered, or descr,pfacrr and locciion of orF.ratmns or wort, :ow -red I In the event of any material chonge in, or cancellation of, said 7*1-ties, the r-ndersigned tortypany -w4l endeav�s'T� �'�7e�rlttH n notice io tht* to this certificate is issued, but fotluteto flit 1 �I�_` porgy whom give Such notice shall impose no cbligatiori in , mpony Certificate is Issued to. Nome grid Address 1— _ ;rior notice of Ca pit tort to Ix' t cerfi.Jcate holder has e endRPM E.0 ` ' CITY OF HUNTINGTON BEACH, CA. �'� MAR A MUNICIPAL CORPORATION 2 7 10 1 P. O BCX 190 t HUNTINGTON BEACH, CA. 92648 If on x in be ;-t,I�iisbraz3>7r[fTAv� er' increased only ions or warp c39�'a oborre. r . & • 3 Any statement on reverse side is void. Doted : F004TAIN VALLEY, CA, MARCH 10, 1981 G. E'NdHC PLE1,4EL INSURAN E It+.'=, #17-4642 F "� " , " ..--, / of -- on G�. .,�' .�//' f SAFECO 1160RANCE Co1J,PANY aF AlAERICA GEfJERAL ItiSURAIMF CO74PANY or AIAERICA '- FIRST NATIMAL J14SURAIOCE.COIA ANY OF Ai.1ERiCA Cr r& : ' K; ty, r � ./ a :rr;My�e�,✓ S 'tr * h Aft Return original and three copies of distribution' completed certificate to: Original Originating Dept. CERTIFICATE OF INSURANCE After Approval fellow — Risk Manager City of Huntington Bead TO By City Attorney Pink City Clerk Dept/t?1tYi1;y F?fa# Gold- City Attorney P. O. Box 190 CITY OF HUNTINGTON BEACH, CALIFORNIA Huntington Beac°i, California 92648 A MUNICIPAL CORPORATION 1� This is to certify that the policies of insurance as described h0ow have been issued to the insured by the under- .igned and are in force at this time. If these policies are cancelled or changed in such a manner that wi i affect this certificate, the insurance company agrees to give 30 days prior written notice, by mail, to City of iiuntington Beach, P. 0. Box 190, Huntington Beach, Uifurnia 921A8. N me of I Address .of Insured .Li719'J8' I'Tl! 1-41,194 r0017-hMr;; `; St:P€?pt. Poi;tin n ��l�. `v Location of Insured Operations ' 8 1 and 11, 91 'Ttr0t.01,r't22rt''L. "?'r . e ,aa'1tp i.rx ""^3 i `l r�ur. . tr-- ilescription of Operations POLICIES IN FOP POLICY NUMBER LIMIT'S OF LIABILITY EFFECTIVE EXPIRATION A. Workers Compensation Statutory Employers' Liability $ B. Public Liability: * $300,000 combined single "dily Injury: lirriit per occurrence. Manufacturers and Contractors 0 $ each Person Comprehensive General S Eaco Accident (Including products completed operations! Property Damage_ * Each Accident C. Automobile Liability: Bodily Injury S_ Each Person $ Each Accident Property Damage S * Each Accident Does policy cover: (Please check at least one) All owned automobiles ( ? Yes { 1 No (Von -owned automobiles { ) Yes C 1 No Hired automobiles ( ) Yes ( ) No D. Additional insured Endorsement: The insurer agrees that the City of Huntington Beach and iris City Council, and/or all City Council appointed groups, committees, commissions, boards and any other City Council appointed body, and or elective and appointive officers, servants or employees of the City of Huntington reach, when acting as such are additional insureds hereunder, fa the 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:' w. 1SNnatur`el' The insured agrees to protect, defend, indemnify and save harmless the City of Huntington Beach against loss, damage or u 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 theperformanceof all or any operations covered by the certificate of insurance. F. Remarks: APPROVED AS TO FORM: GALL HUTTON City Attorney By: Deputy City Attorney Date AUTHORIZED REPRESENTATIVE OF rNSURANCE COMPANY INSUfMNCE COMPANY By Name Signature of Autfrorited Re,preiantative/Agent w Address Address city Telephone rP,AfAfI AND ADDRESS OF AQ%NCY ti Y��.q� /e COMPANIES AFFORDING COVERAGES 2213M sae v -,COMPANY �g yg 7, guna Hills, 59653 � ,� LETTER r'3feco Insurance 00. COMPANY _Ca. 714_586-7033. I ,. "'CET)ER WR NAME AND ADDRESS OF INSURED G C Fountain Valley Music r�etoxv ; Inc . LETTCOMjER dba: Arcade - COMPANY,+ 18934 Brotikhurat Ste 1ETTER �� ry Fountain Valley, Ca, 92f08 COMPANY �o LETTER Mr T his is to certify that policies of insurance listed below have be -a- ;ssued'to the insured named above and are in force at this time, �..._ — Limits of L 8bl ty ID T OUSa1T S (OUT-- COMPANY irTIER TVP:0FINSURANCE POLICY NUMBER POLICY EXPIRATION DATE EACH OCCURRENCE AWREGATE CiENERAL LIABILITY BODILY INJURY $ f .A. COMPREHENSIVE FORM 0ad6li9 3-28-81 ❑ PREMISES -OPERATIONS PROPEPiYDAMAGE $ i EXPLOSION AND COLLAPSE 7 HAZARD ❑ UNDERGROUND HAZARD PRODUCTSICOMPL ET ED OPERATIONS HAZARD ❑ CONTRACTUAL INSURANCE BODILY INJURY AND PROPERTY DAMAGE i 300 , 000 f 08L BROAD FORM PROPERTY COMBINED DAMAGE ❑ A INDEPENDENT CONTRACTORS PrRSONA( INJURY o3O6119 3-28-81 PIPS -( INJURY $300,000 3 AliiaMOBILE LIABILITY Bo0iLY1NJURY $ ^7 C(-J� (EACH PERSOH-i Y t OMPREHENSIVE FORM C LJ OtYNLO BODILYINJURY (EACH OCCURRENCE) I'R-PEFaYDAMAGE A i �J D 0806119 3-28-81 t BO�DILYINJJUURRYYAND a�" NON OWNED f 3OO p 00O P" ROPERTY DAMAGE EXCESS LIABILITY�� BODILY INJURY AND UMBRELLA FORM PROPERTY DAMAGE t ( _I 0THERTHAN UMBRELLA COMBINED !!!!! FORM IWORKERS' COMPENSATION SlXTUTURY and 1 EMPLOYERS' LIABILITY ; nx r,K iiMwr� OTHER F A hIPTION OF OPERATMS&OCATIONSNEHICLES Insured provides electronic game machines at various city of Huntington Beach recreational facilities. Cancellation: Should any of the above des policies be cancelled before the exti 'late thereof. the Issuing Corr,* pang will endeavor to snail Abed days written notice to Vie below - °tificate, holder, but failure to mail such notice shall impose no obligation or liabilft of any kind upon ray, NAME AND ADDRESS OF CERTIFICATE R%DER City of Huntington Beach, Calif. a Municipal Corporation t P . 0. Box 190 Huntington Beach, Ca. 9264 DATE 4 CITY OF HUNTINGTON P. O. DOX 711 CALIFORNIA 92648 CITY TREASURER —WARREN G. HALL August 18, 1982 'rt James Plemei 7, 22132 Padova m Laguna Hills, Ca. Dear Mr.. Plemel Reference is made to ;your telephone conversation with Mr.,Moorhouse's secretary regarding the liability insurance for The Fountain Valley Music Center - D.B.A.. Arcade, K The policy has been expires since March and we are most: anxious to show renewal. As you requested, enclosed please find our insurance form to be made out by you as their agent. Your prompt attention in this matter is appreciated. Please refer to Comstock Insurance #711-000-070. Thanks again for your help. Si'rel. , c Jacki rredenburg Risk Managar's Office encl. cc: Vince Moorhouso, Community Services A CITY OF HUNTINGTON 8 EACH 20QO!MAIN STREET CALIFORNIA 92648 OFFICE OF THE CATY CLERK January 20, 1981 Mr. Allan A. Niccola Fountain Valley Music Center, Inc, 18932 B'rookhurst Street Fountain Valley, CA 92708 The City Council of the City of Huntington Beach at its regular meeting held Monday, January 19, 1981, approved an agreement with your company for the installation of coin -operated video and other amusement games in the community centers. Enclosed is a duly executedcopy of said agreement and a copy of the insurance which you Submitted. Alicia K. Wentworth City Clerk AMW:CB j enclosure i T 'I 21000 STAIN STREET CALIFORNIA 92648 OFFICE OF V H9 r4 tY CLERK y January 20, 1981 Paul de Pfyffer Assessor's Office P. 0. Box 149 Santa Ana, CA 92702 The City Council of the City of Siuntingtcn Beach, on January 19, 1981 approved an agreement between. the City ,end Fountain Valley Music Center for the installation .of coin -operated video and other amusement g&mes in the cmi unity centers in the City. We are providing your office a copy in the event possessory interest tax applies to this type of agreemenF. Alicia M, Wentworth City Clerk AMW-,CB:js Enclosure REQUEST FOR CITY COU IL ACTION Submitted by Vincent G. Moorhouse Department Community Services Date PreparedDecember 3 , 1980 Backup Materisl Attached [ Yes 0 No Subject Agreement with Fountain Valley Music Center for the Provis%.on of Coin -Operated Video Games at Jommunity Centers City Administrator's Comments Approve as Rec Statement of issue, Recommendation, Analysis, Funding Source, Alternative Actions:'✓ STATEMENT OF ISSUE The Community Services Department desires to provide an additional source of recreation for the community, as well as secure additional revenue, by installing coin -operated video and other amusement games in the community centers. RECOMMENDATION Approve attached agreement with Founta�r Valley Music Center. Inc. and authorize Mayor to execute same. ANALYSIS Fountain Valley Music Center agrees to install and maintain woin-- operated video games at Murdy and Edison Community Centers in return for 50 percent of the gross receipts collected from such equipment. The City will also receive 50 percent of the gross receipts. The agreement is for- one year with automatic renewal if agreeable to both parties The Community Services Commission, at its June 11, 1980, meeting., approved the concept of installing coin -operated video games in Edison and Murdy Community Centers. Estimated yearly revenue is $6,000. FUNDINO SOURCE None ALTERNATIVE ACTION RECEIVED Do not approve agreement. r.-., CITY ATTORNEY VrM:VB: cs DEC 03 1980 AM FA4 718191M1Hjt2l1l2l :i4J5i6 i