CONTRACT 5435 One Page Service Agreement CLOSED Agreement No. 5435
Services Agreement
CONTRACTOR: A': DATE MAILED:
Below you Wit find a checklist relating to Insurance and other requirements that are required for doing business with the City of El
Segundo, Only those items checked-off are MANDATORY, however if your standard policies exceed the minimum requirements please
include. Commercial generat liability Insurance must meet or exceed the requirements of ISO-CGL Form No.CG 201411 85 or
equivalent. The amount of insurance set forth below will be a combined single limit per occurrence for bodily injury, personal injury, and
property, damage for the policy coverage. Liability policies will be endorsed to name the City, its officials, and employees as
"additional Insured's" under said insurance coverage andl to state that such insurance Will be deemed "primary" such that any
other Insurance that may be carried by the City will be excess thereto. Such insurance must be on an "occurrence," not a
"claims made," basis and will not be cancelable or subject to reduction except upon thirty(30)days prior written notice to the
City. Please find additional Terms and Conditions on the reverse side of this Services Agreement, This is not a purchase order or
an authorization to begin work.
Comorehengive General Liability, including coverage for premises, products and completed operations, independent contractors,
personal injury and contractual obligations with combined single limits of coverage of at least$1.000,000 per occurrence.
Auto Liabilitv,including owned, non-owned and hired vehicles with at least:
ED $1,000.000 per occurrence,
F-1 $100,000-300.0O0 per occurrence.
F-1 As required by State Statutes. A copy of your current policy must be submitted naming yourself and or your company.
Workers'Compensation Insurance: as required by State Statutes with Waiver of Subrogation. (Not needed if Self-employed with
no employees and CONTRACTOR signs statement to this effect.)
Business License: The CONTRACTOR shall agree to have a current City of El Segundo license on file at City Hall or purchase
said license(at no cost to the City).
El Permits: Plans must be approved and pernnit(s) issued (no fee) by the Planning and Building Safety if appropriate. Call the
Planning Manager @(310)524-2340 if you have questions,
❑ gopy of valid victure I.D..(Drivers license etc.)
PLEASE NOTE: ALL APPLICABLE INFORMATION LISTED ABOVE MUST BE OBTAINED AND ON FILE, PRIOR TO THE ISSUANCE OF A CITY
PURCHASE ORDER BEING SENT TO YOU lVIA FAX OR HARD COPY)BY THE PURCHASING AGENT,THUS AUTHORIZING COMMENCEMENT OF
WORK FOR THE CITY.
&bmitted by(complete all blanksl: COLOR COPY REQUIRED BACK TO THE CITY
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Phone: FAX:
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Vendor's Ernafl address: Vendor's Web site:
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Mail original agreement and Insurance to,C of El Se�Urr 350 Main Street,Room 5,El Segundo,CA 90245' 813
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Orl�iinator/Departrnsnt Contact: J h"
�'P� I A, Dateinifiated�
Department Head Approval: 0 Date Approyed: '2—
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Finance Approval: e Date Approved:
cc:Business License;City Clerk;Purchasing Agent;Requesting Dept name-
AR `4vp.
_(1)Page Services Agreement with check boxes 4 5
AS TO FORM. �V
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C1 VYAT RN ` City of El Segundo
Agreement No. 5435
B&B Window Coverings Date 11/30/17
575 Mary Ann Dr Estimate No. 561
Redondo Beach, CA 90278
310-376-3555
Ship To
Esti mate City of EI Segundo
Fire Department
314 Main St
EI Segundo, CA 90245
Description Quantity Total
Installation of Shades and Blinds 8 720.00
I'm the Sole Proprietor and I will be doing the installation
CA Sales Tax 0.00
I
,Signature:
Total $720.00