COMPLETED BOARD ORDER�"x��24
Before the Board of Supervisors in and for the
County of Monterey, State of California
Agreement No: A 11677
Authorize the Purchasing Manager for Nlatividad Medical Center NMC) to
execute Amendment No. 2 to the Agr~ement with Gallun Snow Associates
Inc. for Interior Design and Design Master Planning Services at NMC in an
amount not to exceed $198,500 an increase of $60,000) for the period March
1, 2010 to June 30, 2010.
Upon motion of Supervisor Parker, seconded by Supervisor Armenta, and carried by those
members present, the Board hereby:
Authorized the Purchasing Manager I for Natividad Medical Center NMC) to execute
Amendment No. 2 to the Agreement with Gallun Snow Associates Inc. for Interior Design and
Design Master Planning Services at NNC in an amount not to exceed $198,500 an increase of
$60,000) for the period March 1, 2010 tj June 30, 2010.
PASSED AND ADOPTED this 13th dayl of April, 2010, by the following vote, to wit:
AYES: Supervisors Armenta, Calcagno, Salinas, Parker, Potter
NOES: None
ABSENT: None
I, Gail T. Borkowski, Clerk of the Board of S pervisors of the County of Monterey, State of California, hereby
certify that the foregoing is a true copy of an original order of said Board of Supervisors duly made and entered in
the minutes thereof of Minute Book 75 for the eeting on April 13, 2010.
Dated: April 14, 2010 Gail T. Borkowski, Clerk of the Board of Supervisors
County of Monterey, State of California
By F~
Deputy
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SIGNED BOARD REPORTX��"x��MONTEREY COUNTY BOARD OF SUPERVISORS
MEETING: April 13, 2010
AGENDA NO.:
SUBJECT: Authorize the Purchasing Manager for Natividad Medical Center NMC)
to execute Amendment #2 to the Agreement with Gallun Snow Associates
Inc. for Interior Design and Design Master Planning Services at NMC in
an amount not to exceed $198,500 an increase of $60,000) for the period
March 1, 2010 to June 30, 2010.
DEPARTMENT: Natividad Medical Center
RECOMMENDATION:
It is recommended that the Board of Supervisors authorize the Purchasing Manager for Natividad
Medical Center NMC) to execute Amendment #2 to the Agreement with Gallun Snow Associates
Inc. for Interior Design and Design Master Planning Services at NMC in an amount not to exceed
$198,500 an increase of $60,000) for the period March 1, 2010 to June 30, 2010.
SUMMARY/DISCUSSION:
Gallun Snow Associates, Inc. is an interior design firm that specializes in hospital design; creating a
holistic, healing environment. NMC has had an agreement with Gallun Snow Associates, Inc. since
Fiscal Year 2009. Gallun Snow Associates, Inc. has helped the hospital develop a design master
plan for the facility to include a master color palette, finishes, floor patterns, and furniture standards.
Additionally, NMC is in the process of completing a much needed renovation of the hospital
cafeteria with the collaboration of this vendor. The current agreement is valid through the end of
June 2010. NMC desires to increase the existing contract with Gallun Snow Associates, Inc. by
$60,000 for design planning on the following projects:
Outpatient Specialty Clinic Expansion
Cafeteria Artwork
First Floor Flooring type and design
OTHER AGENCY INVOLVEMENT:
The Amendment has been reviewed and approved by County Counsel, the Auditor/Controller's
office and the Natividad Medical Center Board of Trustees.
FINANCING:
The cost for this Amendment is $60,000 and is included in the approved FY 2009-10 Budget. This
action will not require any additional General Fund subsidy.
Prepared by:
Andrea Rosenberg
Assistant Administrator
February 12, 2009
L
Harry Weis
Chief Executive Officer
Attachments: Agreement, Amendment #2, Board Order
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AGREEMENT�X��"x��Original Agreement No or PO#. BP0836)
AMENDMENT NO. 2
FOR PROFESSIONAL SERVICE AGREEMENT
BETWEEN Gallun Snow Associates Inc. AND
THE NATIVIDAD MEDICAL CENTER
FOR
Professional Internal Medicine/Hosaitalist SERVICES
The parties to Professional Service Agreement, dated November 1, 2008 between the County of
Monterey, on behalf of Natividad Medical Center NMC"), and Gallun Snow Associates Inc.
Contractor), hereby agree to amend their Agreement No. BP0836) on the following terms and
conditions:
1. Contractor will continue to provide NMC with the same scope of service as stated in the original
Agreement No. BP0836). Additionally, the scope of service will include the services described
on Attachment A of this Amendment.
2. This Renewal Amendment shall become effective on March 1, 2010 and shall continue in full
force and extending the term date until June 30, 2010.
3. The total amount payable by County to Contractor under Agreement No. BP0836) shall not
exceed the total sum of $198, 500 for the full term of the Agreement and $158,322 for fiscal year
2009-2010.
4. All other terms and conditions of the Agreement shall continue in full force and effect.
5. A copy of this Amendment shall be attached to the original Agreement No. BP0836).
IN WITNESS WHEREOF, the parties hereto are in agreement with this Amendment and
Professional Service Agreement on the basis set forth in this document and have executed this
amendment on the day and year set forth herein.
CONTRACTOR
Signature
Printed Name 4S,4 GALL
NATIVIDAD MEDICAL CENTER
Signature
Signature
Dated /2 /7
Title /'Z',~~. 00d
Dated
Dated V l jl
NMC CEO
Approved as to Legal Form:
Charles J. McKee, County Counsel
Stacy Saetta, Depu
Attorneys for Countt and NMC
Dated: 2010
A t Controller
Coun of Monterey
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AGREEMENT�X��"x��0 k-"AAw-f
February 4, 2010 GALLUN SNOW
Ms. Andrea J. Rosenberg
Administrator Operations and Support Services
Natividad Medical Center
1441 Constitution Blvd.
Salinas, CA 93906
RE: INTERIOR DESIGN SERVICES PROPOSAL- Amendment Request NATIVIDAD MEDICAL CENTER
Dear Andrea:
We are pleased to submit the following proposal to amend our existing agreement with Natividad Medical
Center NMC) for the 2009-2010 fiscal year by $60,000.00
PROJECT DESCRIPTION
Our scope of services is anticipated to include additional scope of work for the Natividad Medical Center
NMC) in Salinas, CA. Below is a menu of identified additional projects and services we anticipate
providing for NMC before the end of this fiscal year. We will continue services on an hourly basis up to
approximately 500 hours of additional project work. Below are estimates of scope of services for each
project. Note that these are only estimates and will be further clarified as the scope of each project is further
defined. Actual hours could vary from those identified below depending on scope of work.
INTERIORS SERVICES
To be billed hourly)
Outpatient Expansion 2"d floor) Specialty Clinics- approximately 270 hours)
Remodel and Build out of approximately 10,745 sf of space approximately 5,700 sf of reconfigured
space and the remainder of refresh space.)
Interior finish selection and documentation including feature floor patterning and accent
feature design elements non-architectural)
Interior Furnishings planning, selections, specification and dealer coordination; including
furnishings, related finishes, and fabrics.
Selection of options and recommendation for accent lighting in feature spaces
Consultation, sketches, and recommendation for feature finishes on casework / walls
documentation and detailing by Reel Grobman). Assume 3-4 computer Photo/renderings
to illustrate concept and design similar to those produced for cafeteria project.
Art selection review and coordination with Natividad Medical Center curator
Additional weekly coordination meetings Re: art package Via GoTo meeting).
Contract documents documenting finishes and furnishings. Generated from Architect
provided AutoCAD base drawings.
Cafeteria Remodel- Art and Expanded Construction Administration Services approximately 130
hours)
Additional scope for art services for cafeteria project including surrounding corridors.
Addition of evaluation and recommendations for lighting in surrounding corridors.
Review and evaluation of selection of donated artwork. Coordination with owner, donor &
Photo studio, regarding budgets, processes for execution of artwork, enlargement size of
photographic artwork, matting, framing, placement, and installation. Includes all framed
artwork, Mural, and chalkboard art/menu boards
Expanded Construction Administration services for cafeteria remodel including weekly
owner/Interiors/Contractor coordination meetings Via GoTo meeting) and additional
Contractor coordination.
Additional material selection,for finish materials due to added scope for remodel including
custom designed trash receptacles, clock and accessory selections, partial height wall and
booth wall laminate finish change request.
1920 Market Street, Suite 201 Denver, Colorado 80202 303) 433-9500 0 Fax 303) 433-5624
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AGREEMENT�X��"x��Ms. Andrea Rosenberg
February 4, 2010
Page Two
On site services approximately 50 hours per person for 2 designers)
3 day site visit to provide the following additional interior design services
Site walk, coordination, and evaluation of Outpatient Expansion 2"d floor) Specialty
Clinics with Owner and Architect
On site walk and punch of cafeteria project construction and completion
On site walk and assessment of facility to prioritize projects and need for next fiscal year
On site walk and evaluation of Lobby flooring mockup
Standards binder on site review and work session
Coordination meeting with Jatividad medical center's new Facilities manager
On site walk and evaluation of implemented interiors work to date.
Follow-up documentation and coordination
HOURLY RATES
Principal $150.00
Project Manager $ 120.00
Project Designer $ 85.00
Design Support / Administration $ 65.00 $75.00
PAYMENT SCHEDULE / REIMBURSABLE EXPENSES
Invoices shall be sent to the Owner monthly and payment shall be in accordance with the original Monterey
County Professional Services Agreement PSA)
Reimbursable expenses will be billed in accordance with the stipulations of the existing contract with the
County of Monterey. Expenditures made are to be in the direct interest of the project including, but not
limited to expense of reproductions, postage and handling of drawings and documents, long distance
telephone calls, and mileage. All reimbursable expenses will be charged at direct expense, with mileage
chargeable in accordance with the Monterey County Travel Policy. Computer plots will be charged at $6.50
per sheet. Airfare, lodging, and meals alcohol excluded) while traveling will be billed in accordance with the
County of Monterey Travel Policy plus the hourly rate. Approximately One 1) to Two 2) trips are
anticipated
EXTENT OF THE AGREEMENT
This agreement represents the entire and integrated agreement between the Owner and the Designer and
may be amended only by written instrument signed by both Owner and Designer. This agreement may be
terminated by either party upon seven days written notice. In the event of termination, the Designer shall be
paid for services performed to the termination date, including reimbursable expenses and additional
services.
Andrea, we are excited about amending our services with Natividad Medical Center for the 2009-2010 fiscal
year. If the aforementioned meets with your approval, please sign one copy of this letter and return it to me
for our files. Thank you again, for allowing Gaflun Snow Associates, Inc. to propose services to amend our
contract. We look forward to our continued relationship with Natividad Medical Center. Should you have
any questions or if you need any additional information, please do not hesitate to contact me.
Sincerely,
Christie Philopoulos
NATIVIDAD MEDICAL CENTER ACCEPTED BY:
Signed: Date:
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AGREEMENT�X��"x��Original Agreement No or PO#. BPO #836)
RENEWAL AMENDMENT NO. I
FOR PROFESSIONAL SERVICE AGREEMENT
BETWEEN Gallun Snow Associates Inc. AND
THE NATIVIDAD MEDICAL CENTER
FOR
Interior Design and Design Master Planning Services
The parties to Professional Service Agreement, dated November 1, 2008 between the County of
Monterey, on behalf of Natividad Medical Center NMC"), and Gallun Snow Associates Inc.
Contractor), hereby agree to renew their Agreement No. BPO #836) on the following amended terms
and conditions:
1. Contractor will continue to provide NMC with the same scope of service as stated in the original
Agreement No. BPO #836). In addition, the scope of service will be modified to include the
services described on Attachment A of this Amendment #1.
2. This Renewal Amendment shall become effective on November 1, 2009 and shall continue in full
force and extending the term date until June 30, 2010.
3. The total amount payable by County to Contractor under Agreement No. BPO #83 6) shall not
exceed the total sum of $138,500 for the full term of the Agreement and $98,322 for fiscal year
2009-2010.
4. All other terms and conditions of the Agreement shall continue in full force and effect.
5. A copy of this Amendment shall be attached to the original Agreement No. BPO #836).
IN WITNESS WHEREOF, the parties hereto are in agreement with this Amendment and
Professional Service Agreement on the basis set forth in this document and have executed this
amendment on the day and year set forth herein.
CONTRACTO
Signature
PrintedNaine4ijE}(L,0',pS
NATIVIDAD ED' C L CENTER
Dated 2
Title 5"11L K,it M
Dated
/' c/--of
Signature /
17
Purc sing Manager
Signature
NMC CEO
Approved as to Legal Form:
Charles J. McKee, County Couns,
Wien Litt, Deputy
Attorneys for County and NMC
S c~e~ evlew�d
Dated
1JOARd: V lj 2009
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AGREEMENT�X��"x��I
14Triq_41 M 67
*"Ap P Of 14
September 25, 2009 G.ALLLJN SNOW
Ms. Andrea J. Rosenberg
Administrator Operations and Support Services
Natividad Medical Center
1441 Constitution Blvd.
Salinas, CA 93906
RE: INTERIOR DESIGN SERVICES PROPOSAL NATIVIDAD MEDICAL CENTER
Dear Andrea:
We are pleased to submit the following proposal to amend our existing agreement with Natividad Medical
Center NMC) for the 2009-2010 fiscal year by $40,000.00
PROJECT DESCRIPTION
Our scope of services is anticipated to include the continued development of interior design master planning
services for the Natividad Medical Center NMC) in Salinas, CA as well as Interior design services for
NMC's interior design priorities for the year. Below is a menu of possible projects and services we could
provide for NMC. We propose consultation services on an hourly basis up to approximately 300 hours of
project work. Below are some rough estimates of fee ranges for each project. Note that these are only
estimates and will be further clarified as the scope of each project is defined. Actual hours could vary
considerably from those identified below depending on scope of work.
INTERIOR FINISHES- MENU OF SERVICES
To be billed hourly up to $30,000.00)
Miscellaneous projects
Wayfinding / signage-Design consultation to assist signage consultant's efforts. 20-50
hours)
Radiology Waiting Interior finish Upgrades 10-20 hours)
Second floor Public area Interior finish upgrades 40-70 hours)
Coffee cart redesign 20-4d hours)
Second floor ARU/Med. Surg. flooring replacement project 40-80 hours)
Nurse Station outside postpartum rooms on 3'd floor Interior finish Upgrades 20-40 hours)
Comprehensive remodel of 2nd floor Labor and Delivery 50-90 hours)
ED- Coordination and finish work with Architectural team Remodel 80-100 hours)
Construction Administration for ongoing projects Cafeteria, lobby, Postpartum, Lobby
upgrade projects) 30-80 hours)
Standards
Further develop basic standards binder to include typical materials/color use and floor
patterns, and integration with Furniture standards. 15-30 hours)
Finishes type and suitability matrix, finishes by area 8 hours)
Furniture: Develop Furniture standards for facility including standards document 100-170
hours)
o Initial selections to review
o Furniture tour
o Furniture standards presentation including finishes and upholstery)
o Furniture refinement and final documentation not including inventory of existing
furniture)
o Create final furniture standards binder
Standards book- containing factual samples 10-20 hours)
Trip to review standards with facilities Department 1 trip-1 project designer)
1920 Market Street, Suite 201 Denver, Colorado 80202 303) 433-9500 0 Fax 303) 433-5624
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AGREEMENT�X��"x��Ms. Andrea Rosenberg
September 25, 2009
Page Two
ART COORDINATION- MENU OF SERVE ES
To be billed hourly up to $10,000.00. unused portion may be used for interior finish services as well)
Art planning and visioning
Coordination of poster arm purchasing, framing, & installation for ongoing projects and new.
Any purchasing services would offer our direct design discount with an a 20% markup.
Coordination with foundation for original art and consulting on location options.
Foundation work render images for Foundation to market to potential donors.
Estimated Hours TBD)
HOURLY RATES
Principal $150.00
Project Manager $ 120.00
Project Designer $ 85.00
Design Support / Administration $ 65.00 $75.00
PAYMENT SCHEDULE/ REIMBURSABLE' EXPENSES
Invoices shall be sent to the Owner monthly and payment shall be in accordance with the original Monterey
County Professional Services Agreement PSA)
Reimbursable expenses will be billed in accordance with the stipulations of the existing contract with the
County of Monterey. Expenditures made are to be in the direct interest of the project including, but not
limited to expense of reproductions, postage and handling of drawings and documents, long distance
telephone calls, and mileage. All reimbursable expenses will be charged at direct expense, with mileage
chargeable in accordance with the Monterey'' County Travel Policy. Computer plots will be charged at $6.50
per sheet. Airfare, lodging, and meals alcohbl excluded) while traveling will be billed in accordance with the
County of Monterey Travel Policy plus the hourly rate. Approximately One 1) to Two 2) trips are
anticipated
EXTENT OF THE AGREEMENT
This agreement represents the entire and integrated agreement between the Owner and the Designer and
may be amended only by written instrument signed by both Owner and Designer. This agreement may be
terminated by either party upon seven days written notice. In the event of termination, the Designer shall be
paid for services performed to the termination date, including reimbursable expenses and additional
services.
Andrea, we are excited about continuing our services with Natividad Medical Center for the 2009-2010 fiscal
year. If the aforementioned meets with your approval, please sign one copy of this letter and return it to me
for our files. Thank you again, for allowing G0I1un Snow Associates, Inc. to propose services to amend our
contract. We look forward to our continued relationship with Natividad Medical Center. Should you have
any questions or if you need any additional information, please do not hesitate to contact me.
Christie Philopoulos
NATIVIDAD MEDICAL CENTER ACCEPTED BY:
Signed: Date:
1920 Market Street, Suite 201 Denver, Colorado 80202 303) 433-9500 0 Fax 303) 433-5624
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AGREEMENT�X��"x��i
ACTION: R SCREEN: OPPH USERID: SIDC
07/22/09 12:12:01 PM
O P E N P O H E A D E R I N Q U I R Y
VENDOR= GALLU SNOW TRANSACTION ID= PD B960975027
NAME: GALLUN SNOW ASSOCIATES INC CONTACT: ***CHANGE ORDER***
TERMS: ADDRESS IND: A RESP PERSON: SID CATO
BUYER:
PO DATE: 01 02 09 BLANKET NO: COMMENTS:
RESP AGENCY: 960 ORGANIZATION: 96100 ORG NAME: NATIVIDAD HOSPITAL
PO HOLD: ORDER TYPE: S CONFIRMING ORDER: NOTE PAD IND:
BUDGET FY: 09 OFFSET RESV ACCT: 3010 OUTSTANDING APRV: 000 LINKING IND: Y
DELIVERY DATE: 06 30 09 WAREHOUSE: SHIP/BILL:
RECEIPT IND: N FOB POINT: D
TAX CODE: TOTAL QTY:
FREIGHT IND: FREIGHT AMT:
DISC CODE: DISCOUNT ANT:
3W MATCH IND: N LAST PRINT DATE: 04 17
MOD NUMBER: 01 MOD DATE: 04 16
PARTIAL IND: CLOSED DATE: 06 25
BUILDING/ROOM:
110 / 021
1.000 TOTAL ORDER AMT: 88,500.00
0.00 RECEIVED AMT: 0.00
0.00 INVOICED AMT: 0.00
09 OUTSTANDING AMT: 0.00
09 EXPENDED AMT: 40,177.06
09 CLOSED AMT: 88,500.00
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AGREEMENT�X��"x��h1 Natividad MEDICAL CENTER
COUNTY OF MONTEREY A(REEMENT FOR PROFESSIONAL SERVICES
NOT TO EXCEED $100,000)
This Professional Services Agreement hereinafter Agreement") is made by and between Natividad Medical
Center NMC"), a general acute care teaching hospital wholly owned and operated by the County of
Monterey, which is a political subdivision of the State of California and Gallun Snow Associates Inc.
hereinafter CONTRACTOR").
In consideration of the mutual covenants and conditions set forth in this Agreement, the parties agree as
follows:
SERVICES TO BE PROVIDED. NMC hereby engages CONTRACTOR to perform, and
CONTRACTOR hereby agrees to perform, the services described in Exhibit A in conformity with the
terms of the Agreement. The services are generally described as follows: Provide interior design
services to include interior design master planning services.
1. PAYMENTS BY NMC. NMC shall pay the CONTRACTOR in accordance with the payment provisions
set forth in Exhibit A, subject to the limitations set forth in this Agreement. The total amount payable by
NMC to CONTRACTOR under this Agreement shall not exceed the sum of $98,500.
2. TERM OF AGREEMENT. The term of this Agreement is from November 1, 2008 to June 30, 2010
unless sooner terminated pursuant to the terms of this Agreement. This Agreement is of no force or effect
until signed by both CONTRACTOR and NMC and with NMC signing last and CONTRACTOR may not
commence work before NMC signs this Agreement.
3. ADDITIONAL PRO VISIONS/EXHIBITS. The following attached exhibits are incorporated herein by
reference and constitute a part of this Agreement:
Exhibit A & Schedule A Scope of Services/Payment Provisions
4. PERFORMANCE STANDARDS.
4.1. CONTRACTOR warrants that CONTRACTOR and Contractor's agents, employees, and
subcontractors performing services under this Agreement are specially trained, experienced,
competent, and appropriately licensed to perform the work and deliver the services required under
this Agreement and are not employees of NMC, or immediate family of an employee of NMC.
4.2. CONTRACTOR, its agents, employees, and subcontractors shall perform all work in a safe and
skillful manner and in compliance with all applicable laws and regulations. All work performed under
this Agreement that is required by law to be performed or supervised by licensed personnel shall be
performed in accordance with such licensing requirements.
4.3. CONTRACTOR shall furnish, at its own expense, all materials, equipment, and personnel necessary
to carry out the terms of this Agreenlient, except as other wise specified in this Agreement,
CONTRACTOR shall not use NMC premises, property including equipment, instruments, or
supplies) or personnel for any purpose Other than in the performance of its obligations under this
Agreement.
Revised NMC PSA Form $100,000 or Less 1 10-1-08
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AGREEMENT�X��"x� �5. PAYMENT CONDITIONS.
5.1. CONTRACTOR shall submit to the Contract Administrator an invoice on a form acceptable to NMC.
If not otherwise specified, the CONTRACTOR may submit such invoice periodically or at the
completion of services, but in any event, not later than 30 days after completion of services. The
invoice shall set forth the amounts claimed by CONTRACTOR for the previous period, together with
an itemized basis for Administrator or his or her designee shall certify the invoice, either in the
requested amount or in such other amount as NMC approves in conformity with this Agreement, and
shall promptly submit such invoice to the County Auditor-Controller for payment. The County
Auditor-Controller shall pay the amount certified within 30 days of receiving the certified invoice.
5.2. CONTRACTOR shall not receive reimbursement for travel expenses unless set forth in this
Agreement.
6. TERMINATION.
6.1. During the term of this Agreement, NMC may terminate the Agreement for any reason by giving
written notice of termination to the CONTRACTOR at least thirty 30) days prior to the effective date
of termination. Such notice shall set forth the effective date of termination. In the event of such
termination, the amount payable under this Agreement shall be reduced in proportion to the services
provided prior to the date of termination,
6.2. NMC may cancel and terminate this Agreement for good cause effective immediately upon written
notice to Contractor, Good cause" includes the failure of CONTRACTOR to perform the required
services at the time and in the manner provided under this Agreement. If NMC terminates this
Agreement for good cause, NMC may be relieved of the payment of any consideration to Contractor,
and NMC may proceed with the work in any manner, which NMC deems proper. The cost to NMC
shall be deducted from any sum due the CONTRACTOR under this Agreement.
7. INDEMNIFICATION: CONTRACTOR shall indemnify, defend and hold harmless. NMC and the
County of Monterey hereinafter County"), it officers, agents and employees from any claim, liability,
loss, injury or damage arising out of, or in connection with, performance of this Agreement by
CONTRACTOR and/or its agent, employees or sub-contractors, excepting only low, injury or damage
caused by the negligence or willful misconduct of personnel employed by NMC. It is the intent of the
parties to this Agreement to provide the broadest possible coverage for NMC, The CONTRACTOR shall
reimburse NMC for all costs, attorneys' fees, expenses and liabilities incurred with respect to any
litigation in which the CONTRACTOR is obligated to indemnify, defend and hold harmless NMC and the
County under this Agreement.
8. INSURANCE.
8.1. Evidence of Coverage:
Prior to commencement of this Agreement, the CONTRACTOR shall provide a Certificate of
Insurance" certifying that coverage as required herein has been obtained. Individual endorsements
executed by the insurance carrier shall accompany the certificate. In addition, the CONTRACTOR
upon request shall provide a certified copy of the policy or policies.
Revised NMC PSA Form $100,000 or Less 2 10-1.08
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AGREEMENT�X��"x�
�Executed by the insurance carrier shall accompany the certificate. In addition, the CONTRACTOR
upon request shall provide a certified copy of the policy or policies.
This verification of coverage shall be sent to NMC's Contracts/Purchasing Department, unless
otherwise directed. The CONTRACTOR shall not receive a Notice to Proceed" with the work under
this Agreement until it has obtained all insurance required and NMC has approved such insurance.
This approval of insurance shall neither relieve nor decrease the liability of the Contractor.
8.2. Oualifying Insurers: All coverage's except surety, shall be issued by companies which hold a current
policy holder's alphabetic and financial size category rating of not less that A-VII, according to the
current Best's Key Rating Guide or a company of equal financial stability that is approved by NMC's
Contracts/Purchasing Director.
8.3. Insurance Coverage Requirements: Without limiting Contractor's duty to indemnify, CONTRACTOR
shall maintain in effect throughout the term of this Agreement a policy or policies of insurance with
the following minimum limits of liability:
Commercial general liability insurance, including but not limited to premises and operations, including
coverage for Bodily Injury and Property Damage, Personal Injury, Contractual Liability, Broad form
Property Damage, Independent Contractors, Products and Completed Operations, with a combined
single limit for Bodily Injury and Property Damage of not less than $1,000,000 per occurrence.
Exemption/Modification Justification attached; subject to approval).
Business automobile liability insurance, covering all motor vehicles, including owned, leased, non-
owned, and hired vehicles, used in providing services under this Agreement, with a combined single
limit for Bodily Injury and Property Damage of not less than $500,000 per occurrence.
Exemption/Modification Justification attached; subject to approval).
Workers' Compensation Insurance. If CONTRACTOR employs other in the performance of this
Agreement, in accordance with California Labor Code section 3700 and with Employer's Liability
limits not less than $1,000,000 each person, $1,000,000 each accident and $1,000,000 each disease.
Exemption/Modification Justification attached; subject to approval),
Professional liability insurance, if required for the professional services being provided, e.g., those
persons authorized by a license to engage in a business or profession regulated by the California
Business and Professions Code), in the amount of not less than $1,000,000 per claim and $2,000,000
in the aggregate, to cover liability for malpractice or errors or omissions made in the course of
rendering professional services. If professional liability insurance is written on a claims-made" basis
rather than an occurrence basis, the CONTRACTOR shall, upon the expiration or earlier termination
of this Agreement, obtain extended reporting coverage tail coverage") with the same liability limits.
Any such tail coverage shall continue fpr at least three years following the expiration or earlier
termination of this Agreement.
Exemption/Modification Justifications attached; subject to approval).
Revised NMC PSA Form $100,000 or Less 3 10-1-08
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�8.4. Other Insurance Requirements:
All insurance required by this Agreement shall be with a company acceptable to NMC and issued and
executed by an admitted insurer authorized to transact insurance business in the State of California.
Unless otherwise specified by this Agreement, all such insurance shall be written on an occurrence
basis, or, if the policy is not written an an occurrence basis, such policy with the coverage required
herein shall continue in effect for is period of three years following the date CONTRACTOR
completes its performance of services finder this Agreement.
Each liability policy shall provide that NMC shall be given notice in writing at least thirty days in
advance of any endorsed reduction in coverage or limit, cancellation, or intended non-renewal thereof.
Each policy shall provide coverage for CONTRACTOR and additional insured with respect to claims
arising from each subcontractor, if any, performing work under this Agreement, or be accompanied by
a certificate of insurance from each subcontractor showing each subcontractor has identical insurance
coverage to the above requirements.
Commercial general liability and automobile liability policies shall provide an endorsement naming
the County of Monterey, its officers, agents, and employees as Additional insureds with respect to
liability arising out of the Contractor's work, including ongoing and completed operations, and shall
further provide that such insurance ris primary insurance to any insurance or self insurance
maintained by the County and that the i surance o the Additional Insureds shall not be called upon to
contribute to a loss covered by the ontractor's insurance. The required endorsement from or
Commercial General Liabili Addition I Insured is ISO Form CG 20 10 11-85 or CG 20 10 10 01 in
tandem with CG 20 37 10 01 2000. The re uired endorsement from for Automobile Additional
Insured Endorsement is ISO Form CA 20 48 02 99.
Prior to the execution of this Agreement by NMC, CONTRACTOR shall file certificates of insurance
with NMC's Contracts/Purchasing Department, showing that the CONTRACTOR has in effect the
insurance required by this Agreement. The CONTRACTOR shall file a new or amended certificate of
insurance within five calendar days aftek any change is made in any insurance policy, which would
alter the information on the certificate then on file. Acceptance or approval of insurance shall in no
way modify or change the indemnification clause in this Agreement, which shall continue in full force
and effect.
CONTRACTOR shall at all times during the term of this Agreement maintain in force the insurance
coverage required under this Agreement and shall send, without demand by NMC, annual certificates
to NMC's Contracts/Purchasing Department. If the certificate is not received by the expiration date,
NMC shall notify CONTRACTOR and CONTRACTOR shall have five calendar days to send in the
certificate, evidencing no lapse in coverage during the interim. Failure by CONTRACTOR to maintain
such insurance is a default of this Agreerrtent, which entitles NMC, at its sole discretion, to terminate
the Agreement immediately.
9. RECORDS AND CONFIDENTIALITY.
9.1. Confidentiality, CONTRACTOR and its officers, employees, agents and subcontractors shall comply
with any and all federal, state, and local laws, which provide for the confidentiality of records and
other information. CONTRACTOR shall not disclose any confidential records or other confidential
information received from NMC or prepared in connection with the performance of this Agreement,
unless NMC specifically permits CO1 TRACTOR to disclose such records or information.
Revised NMC PSA Form $100,000 or Less 4 10-1-08
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AGREEMENT�X��"x�
�CONTRACTOR shall promptly transmit to NMC any and all requests for disclosure of any such
confidential records or information. CONTRACTOR shall not use any confidential information
gained by CONTRACTOR in the performance of this Agreement except for the sole purpose of
carrying out Contractor's obligations under this Agreement.
9.2. NMC Records. When this Agreement expires or terminates, CONTRACTOR shall return to NMC
and NMC records which CONTRACTOR used or received from NMC to perform services under
this Agreement.
9.3. Maintenance of Records. CONTRACTOR shall prepare, maintain, and preserve all reports and
records that may be required by federal state, and County rules and regulations related to services
performed under this Agreement. CONTRACTOR shall maintain such records for a period of at
least three years after receipt of final payment under this Agreement. If any litigation, claim,
negotiation, audit exception, or other action relating to this Agreement is pending at the end of the
three year period, then CONTRACTOR shall retain said records until such action is resolved.
9.4. Access to and Audit of Records. NMC shall have the right to examine, monitor and audit all records,
documents, conditions, and activities of the CONTRACTOR and its subcontractors related to
services provided under this Agreement. Pursuant to Government Code section 8546.7, if this
Agreement involves the expenditure of public funds in excess or $10,000, the parties to this
Agreement may be subject, at the request of NMC or as part of any audit of NMC, to the
examination and audit of the State Auditor pertaining to matters connected with the performance of
this Agreement for a period of three years after final payment under the Agreement.
9.5. Royalties and Inventions. NMC shall have a royalty-free, exclusive and irrevocable license to
reproduce, publish, and use, and authorize other to do so, all original computer programs, writings,
sound recordings, pictorial reproductions, drawings, and other works of similar nature produced in
the course of or under this Agreement.: CONTRACTOR shall not publish any such material without
the prior written approval of NMC.
10. NON-DISCRIMINATION. During the performance of this Agreement, Contractor, and its
subcontractors, shall not unlawfully discriminate against any person because of race, religious creed,
color, sex, national origin, ancestry, physical disability, mental disability, medical condition, marital
status, age over 40), or sexual orientation, either in Contractor's employment practices or in the
furnishing of services to recipients. CONTRACTOR shall ensure that the evaluation and treatment of its
employees and applicants for employment and all persons receiving and requesting services are free of
such discrimination. CONTRACTOR and any subcontractor shall, in the performance of this Agreement,
full comply with all federal, sate, and local laws and regulations which prohibit discrimination. The
provision of services primarily or exclusively to such target population as may be designated in this
Agreement shall not be deemed to be prohibited discrimination.
11. COMPLIANCE WITH TERMS OF STAVE OR FEDERAL GRANT. If this Agreement has been or
will be funded with monies received by NMC pursuant to a contract with the state or federal government
in which NMC is the grantee, CONTRACTOR will comply with all the provisions of said contract, and
said provisions shall be deemed a part of this, Agreement, as though fully set forth herein. Upon request,
NMC will deliver a copy of said contract to Contractor, at no cost to Contractor.
12. INDEPENDENT CONTRACTOR. In the performance of work, duties, and obligations under this
Agreement, CONTRACTOR is at all times acting and performing as an independent CONTRACTOR and
Revised NMC PSA Form $100,000 or Less 5 10-1-08
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$198,500-U012
AN-U012
INCREASE-U012
OF-U012
$60,000)-U012
PERIOD-U012
MARCH-U012
1,-U012
2010-U012
TO-U012
JUNE-U012
30,-U012
2010.-U012
AGREEMENT�X��"x�
�not as an employee of NMC. No offer or obligation of permanent employment with NMC or particular
County department or agency is intended in any manner, and CONTRACTOR shall not become entitled
by virtue of this Agreement to receive from NMC any form of employee benefits including but not limited
to sick leave, vacation, retirement benefits, workers' compensation coverage, insurance or disability
benefits. CONTRACTOR shall be solely liable for an obligated to pay directly all applicable taxes,
including federal and state income taxes and social security, arising out of Contractor's performance of
this Agreement. In connection therewith, CONTRACTOR shall defend, indemnify, and hold NMC and
the County of Monterey harmless from any and all liability, which NMC may incur because of
Contractor's failure to pay such taxes.
13. NOTICES. Notices required under this Agreement shall be delivered personally or by first-class, postage
per-paid mail to NMC and Contractor's contract administrators at the addresses listed below.
FOR NATIVIDAD MEDICAL CENTER:'
Contracts/Purchasing Manager
Name and Title
1441 Constitution Blvd. Salinas, CA. 93906
831.755.4111
Address
Phone
14. MISCELLANEOUS PROVISIONS.
FOR CONTRACTOR:
Lh t wu
Name and Title
V SNQ) A_'TOD_1 7r.7111 c-.
ivo mA6dti' r S--, sum Yo 1
I N ye'~L, ro 702 02
Address
o3143 gr;oo
Phone
14.1. Conflict of Interest. CONTRACTOR represents that it presently has no interest and agrees not to
acquire any interest during the term of this Agreement, which would directly, or indirectly conflict
in any manner or to any degree with the full and complete performance of the professional services
required to be rendered under this Agreement.
14.2. Amendment. This Agreement may be amended or modified only by an instrument in writing signed
by NMC and the Contractor.
14.3. Waiver. Any waiver of any terms and conditions of this Agreement must be in writing and signed by
NMC and the Contractor. A waiver of any of the terms and conditions of this Agreement shall not be
construed as a waiver of any other terms or conditions in this Agreement.
14.4. Contractor. The term Contractor" as used in this Agreement includes Contractor's officers, agents,
and employees acting on Contractor's behalf in the performance of this Agreement.
14.5. Disputes. CONTRACTOR shall continue Ito perform under this Agreement during any dispute.
Revised NMC PSA Fonn $100,000 or Less 10-1-08
BIB]
40284-U01
AGREEMENT-U02
LI21329-U03
FO21330-U03
FO85769-U03
FO86069-U03
MG86107-U03
AS86133-U03
AS86134-U03
AI88995-U03
DO90609-U03
C1-U03
GENERAL-U03
DOCUMENTS-U03
4/16/2010-U04
RIVASR-U04
14739-U05
1-U06
AUTHORIZE-U07
PURCHASING-U07
MANAGER-U07
NATIVIDAD-U07
MEDICAL-U07
CENTER-U07
NMC)-U07
TO-U07
EXECUTE-U07
AMENDMENT-U07
NO.-U07
2-U07
TO-U07
960-NMC-U08
RUIZ-IGNACIO-U09
MAEGAN-U09
RUIZ-IGNACIOM-U10
3/15/2010-U011
AGREEMENT-U012
GALLUN-U012
SNOW-U012
ASSOCIATES-U012
INC.-U012
INTERIOR-U012
DESIGN-U012
DESIGN-U012
MASTER-U012
PLANNING-U012
SERVICES-U012
AT-U012
NMC-U012
IN-U012
AN-U012
AMOUNT-U012
TO-U012
EXCEED-U012
$198,500-U012
AN-U012
INCREASE-U012
OF-U012
$60,000)-U012
PERIOD-U012
MARCH-U012
1,-U012
2010-U012
TO-U012
JUNE-U012
30,-U012
2010.-U012
AGREEMENT�X��"x��14.6. Assignment and Subcontracting. The CONTRACTOR shall not assign, sell, or otherwise transfer its
interest or obligations in this Agreement without the prior written consent of NMC. None of the
services covered by this Agreement shall be subcontracted without the prior written approval of
NMC. Notwithstanding any such subcontract, CONTRACTOR shall continue to be liable for the
performance of all requirements of this Agreement.
14.7. Successors and Assigns. This Agreement and the rights, privileges, duties, and obligations of NMC
and CONTRACTOR under this Agreement, to the extent assignable or delegable, shall be binding
upon and inure to the benefit of the parties and their respective successors, permitted assigns, and
heirs.
14.8. Compliance with Applicable Law. The parties shall comply with all applicable federal, state, and
local laws and regulations in performing this Agreement.
14.9. Headings. The headings are for convenience only and shall not be used to interpret the terms of this
Agreement.
14.10. Time is of the Essence. Time is of the essence in each and all of the provisions of this Agreement
14.11. Governing Law. This Agreement shall be governed by and interpreted under the laws of the State
of California.
14.12. Non-exclusive Agreement. This Agreement is non-exclusive and both NMC and CONTRACTOR
expressly reserve the right to contract with other entities for the same or similar services.
14.13. Construction of Agreement. NMC and CONTRACTOR agree that each party has fully participated
in the review and revision of this Agreement and that any rule of construction to the effect that
ambiguities are to be resolved against the drafting party shall not apply in the interpretation of this
Agreement or any amendment to this Agreement.
14.14. Counterparts. This Agreement may be executed in two or more counterparts, each of which shall
be deemed an original, but all of which together shall constitute one and the same Agreement.
14.15. Inte rg ation. This Agreement, including the exhibits, represents the entire Agreement between
NMC and the CONTRACTOR with respect to the subject matter of this Agreement and shall
supersede all prior negotiations. Representations, or agreements, either written or oral, between
NMC and CONTRACTOR as of the effective date of this Agreement, which is the date that NMC
signs the Agreement.
14.16. Interpretation of Conflicting Provisions. In the event of any conflict or inconsistency between the
provisions of this Agreement and the Provisions of any exhibit or other attachment to this
Agreement, the provisions of this Agreement shall prevail and control.
Revised NMC PSA Foim $100,000 or Less 7 10-1.08
BIB]
40284-U01
AGREEMENT-U02
LI21329-U03
FO21330-U03
FO85769-U03
FO86069-U03
MG86107-U03
AS86133-U03
AS86134-U03
AI88995-U03
DO90609-U03
C1-U03
GENERAL-U03
DOCUMENTS-U03
4/16/2010-U04
RIVASR-U04
14739-U05
1-U06
AUTHORIZE-U07
PURCHASING-U07
MANAGER-U07
NATIVIDAD-U07
MEDICAL-U07
CENTER-U07
NMC)-U07
TO-U07
EXECUTE-U07
AMENDMENT-U07
NO.-U07
2-U07
TO-U07
960-NMC-U08
RUIZ-IGNACIO-U09
MAEGAN-U09
RUIZ-IGNACIOM-U10
3/15/2010-U011
AGREEMENT-U012
GALLUN-U012
SNOW-U012
ASSOCIATES-U012
INC.-U012
INTERIOR-U012
DESIGN-U012
DESIGN-U012
MASTER-U012
PLANNING-U012
SERVICES-U012
AT-U012
NMC-U012
IN-U012
AN-U012
AMOUNT-U012
TO-U012
EXCEED-U012
$198,500-U012
AN-U012
INCREASE-U012
OF-U012
$60,000)-U012
PERIOD-U012
MARCH-U012
1,-U012
2010-U012
TO-U012
JUNE-U012
30,-U012
2010.-U012
AGREEMENT�X��"x��NATIVIDAD MEDICAL CENTER
Contracts/Purchasing Agent
Date: nDG 9 5I'"` 9
C-1 EE
By:
Date:
By
NMY ty Co
A& 1'1r14
Date: /O~
LP i T
CONTRACTOR
Contractor's Business Name***
Signature of Chair, President, or Vice-President
L'% GAjLL)M P 5-v T
Name and Title
Date: 11. 5-0p)
Secretary, Asst. Secretary, CFO, Treasurer
or Asst. Treasurer)
a k 1 Z 1 s N.g W \(
Name and Title
Date:
1
5~~2,~-~p.Yzy
***INSTRUCTIONS: If CONTRACTOR is a corporation,
including limited liability and non-profit corporations,
the fall legal name of the corporation shall be set forth
above together with the signatures of two specified
officers. If CONTRACTOR is a partnership, the name of
the partnership shall be set forth above together with the
signature of a partner who has authority to execute this
Agreement on behalf of the partnership. If
CONTRACTOR is contracting in and individual
capacity, the individual shall set forth the name of the
business, if any and shall personally sign the Agreement.
Revised NMC PSA Form $100,000 or Less 10-1-08
BIB]
40284-U01
AGREEMENT-U02
LI21329-U03
FO21330-U03
FO85769-U03
FO86069-U03
MG86107-U03
AS86133-U03
AS86134-U03
AI88995-U03
DO90609-U03
C1-U03
GENERAL-U03
DOCUMENTS-U03
4/16/2010-U04
RIVASR-U04
14739-U05
1-U06
AUTHORIZE-U07
PURCHASING-U07
MANAGER-U07
NATIVIDAD-U07
MEDICAL-U07
CENTER-U07
NMC)-U07
TO-U07
EXECUTE-U07
AMENDMENT-U07
NO.-U07
2-U07
TO-U07
960-NMC-U08
RUIZ-IGNACIO-U09
MAEGAN-U09
RUIZ-IGNACIOM-U10
3/15/2010-U011
AGREEMENT-U012
GALLUN-U012
SNOW-U012
ASSOCIATES-U012
INC.-U012
INTERIOR-U012
DESIGN-U012
DESIGN-U012
MASTER-U012
PLANNING-U012
SERVICES-U012
AT-U012
NMC-U012
IN-U012
AN-U012
AMOUNT-U012
TO-U012
EXCEED-U012
$198,500-U012
AN-U012
INCREASE-U012
OF-U012
$60,000)-U012
PERIOD-U012
MARCH-U012
1,-U012
2010-U012
TO-U012
JUNE-U012
30,-U012
2010.-U012
AGREEMENT�X��"x��Exhibit A
Scope of Services / Payment Provisions
PROJECT DESCRIPTION
This project is anticipated to include interior design master planning services and Additional
Projects as outlined below for the Natividad Medical Center in Salinas, CA. We highly
recommend the Master Planning services, to establish a set of standards on which to base future
design efforts, whether major additions for minimal remodel. This will give us a basis to achieve a
consistent look and quality throughout the facility.
MASTER PLANNING / STANDARDS PROGRAM
1. Walk-through of facility identifying all departments, general condition of existing finishes
and furniture. Review existing interiors and recommend elements of the existing interior
finishes in the hospital that should be maintained. For this project, we recommend not
conducting a detailed evaluation of each material in each space, but focusing on
general conditions in each department, as departments may shift based on the
architectural planning.
2. Materials suitability matrix basled on site evaluation.
3. One day intensive workshop dovering mission, vision, philosophy, demographics, and
initial discussion of design direction with administration, foundation, and selected user
groups.
4. Present basic visual slides including concept photos, implemented designs, etc.
5. Revision of documents to fit injiividualized design goals. Power point format including
inspiration photos, as well as implemented healthcare samples.
6. Matrix template, flooring comparisons, material support documentation, and samples to
show quality of materials.
7. Review of design concepts anti suitability matrix.
8. Revise matrix, document sample selections, finalize design concept.
9. Based on finishes identified in uitability matrix, provide color palette options 2-4 total.
10. Informal presentation boards ir ciuding finishes and upholstery.
1 1 Presentation of finishes and p lettes, feedback.
12. Create master finish binder, standards boards.
13. Present furniture options for fajnily, patient, and staff areas.
14. Furniture review/final selection Does not include inventory of existing furniture.
15. Create furniture specifications binder
16. Artwork guidelines to include art theory for healing environments, framing, application
and location guidelines, samplo styles, implementation recommendation for 2 and 3
dimensional art.
ART CONSULTATION SERVICES Gallun Snow will act as NMC's rep for art consulting
services. We propose providing artwork consultation services on an hourly basis for public
lobbies and corridors. Note: actual costslof art, framing, and installation are additional.
1. Meet with Owner to determine needs, budget, and goals for artwork.
2. Work with art committee to select and recommend poster art and/or original art pieces to
fit the budget.
3. Select appropriate art for public and patient areas.
4. Present art to committee based on decisions made.
5. If requested we will coordinate purchasing, framing, and installation of art.
The following options can be implemented or combined, based on availability of funds, donor
opportunities, and Natividad's preference.
Option A Work with local artists, galleries, donors, to select and procure art
Option B Select commercially available combination of original and reproduction art
Option C Coordinate employee-submittal program, selection, printing, and framing
BIB]
40284-U01
AGREEMENT-U02
LI21329-U03
FO21330-U03
FO85769-U03
FO86069-U03
MG86107-U03
AS86133-U03
AS86134-U03
AI88995-U03
DO90609-U03
C1-U03
GENERAL-U03
DOCUMENTS-U03
4/16/2010-U04
RIVASR-U04
14739-U05
1-U06
AUTHORIZE-U07
PURCHASING-U07
MANAGER-U07
NATIVIDAD-U07
MEDICAL-U07
CENTER-U07
NMC)-U07
TO-U07
EXECUTE-U07
AMENDMENT-U07
NO.-U07
2-U07
TO-U07
960-NMC-U08
RUIZ-IGNACIO-U09
MAEGAN-U09
RUIZ-IGNACIOM-U10
3/15/2010-U011
AGREEMENT-U012
GALLUN-U012
SNOW-U012
ASSOCIATES-U012
INC.-U012
INTERIOR-U012
DESIGN-U012
DESIGN-U012
MASTER-U012
PLANNING-U012
SERVICES-U012
AT-U012
NMC-U012
IN-U012
AN-U012
AMOUNT-U012
TO-U012
EXCEED-U012
$198,500-U012
AN-U012
INCREASE-U012
OF-U012
$60,000)-U012
PERIOD-U012
MARCH-U012
1,-U012
2010-U012
TO-U012
JUNE-U012
30,-U012
2010.-U012
AGREEMENT�X��"x��DATE 111111111IDDIn-M
CERTIFICATE OF L ILITY INSURANCE P,I,II 1 01420 110
PRODUCER
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
PUI Agency of Colorado, Inc HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
5445 OTC Parkway Penthouse 4 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW
Greenwood Village CO 80111
Phone:303-488-3418 Fax:303-486-6843 INSURERS AFFORDING COVERAGE NAIL #
INSURED
INaIRERA: r.....+,.....a, Casualty CaW-V,
20443
INSURERS Hartford Casual Ins. Co. 29424
isaon
Snow Associates, Inc.
Lisa
Gal nn
L INSUR13t C sentenial Iasnrame co, SLID 11000
1920 Market Street, Suite 200 INSURER D.
Denver CO 80202
INSURER E
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO INSURED NAIED ABOME POR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OT HER DOC(JNENF WITH RESPECT TO WHICH TITS CERTIFICATE WAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICES DESCRA IEDFIEREIN IS SUBJECT TO ALL TIE TERMS, OCCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED PAE CLAW.
LTR NER TYPE OF INSURANCE POLICY NUUBM y t7R UNITS
GENERAL LIABILITY EACH OCCURRENCE $$1,000,000
B X X COMMERCLALGENERAL LIABILITY 353BARU9261 03/24/10 03/24/11 PREMLSES aawmnce s$300,000
CLA(MS MADE Li OCCUR MED SXP Any one person) $$10,000
PERSONAL&ADVINJURY S$1',000,000
GENERAL AGGREGATE $$2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER
PRODUCTS COMPIDP AGG s$2,000,000
POLICY TEC-T F
1 LOC
AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT $$1000
000
X ANY AUTO Ea accldent)
L
ALL OWNED AUTOS BODILY INJURY
SO-IEDULED AUTOS
Per Person) $
B HIREDAUTOS 35SBARU9261 03/24/10 03/24/11
BODILYINjURY $
B NON-OWNEDAUTOS 35SBARU9261 03/24/10 03/24/11
PROPERTY DAMAGE
Per aa:ident)
GARAGE LIABILITY AUTO ONLY EA ACCIDENT $
ANY AUTO EA ACC
OTHER THAN $
AUTO ONLY: AGG $
EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE S$2,000,000
S OCCUR CUUMSMADE 3S5nARD9261 03/24/10 03/24/11 AGGREGATE S
DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION
W
M
AND EMPLOYIRE LIABILITY YIN TO
9
UM FS ER
C ORIPARTNERIEXEC
A FICRE PRIET ER EXCEUDEm YJ 35WEcRE6980 08/26/09 08/26/10 EL EACH ACCDENT $ $1, 000 000
Mandatory in NH)
IT yyeess describe under ELDISEASE-EAEMPLO $ $1,000,000
SPEG~IAL PROVISIONS below EL DISEASE- POLICY LIMIT $ $1 0 0 0 000
OTHER
A Professional Liab MCH114131208 08/15/09 08/15/10 Ea Claim $1,000,000
Aggx ate $1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONSI VEIBCLES I E[CLUMNS ADDED BY ISPECISL PROVISIONS
County of Monterey, its officers, agents a nd employees are additional
insured on general and automobile liabilit y endorsement forthcoming). Such
insurance is primary and non-contributory.
CERTIFICATE HOLDER
County of Monterey
Contracts/Purchasing Dept
168 West Alisal St, 3rd Floor
Salinas CA 93901
ACORD 251(2009101)
The ACORD name and
CANCELLATION
SHOULD ANY OF TILE ABOVE OP,SCR�ED POLICIES BE GANCeLL� BEFORE THE EXPIRATIOL
DATE TNEREOF, THE ISSUING BISURBt WLL ENDEAVOR To MAIL 30 DAYS WRITTEN
NOTICE TO THE CERTIRGATE HOLDER MASSED TO THE LEFT, BUT FAILURE TO DO SO SHALL
NO OBLIGATION OR LIABILITY OF ANY KM UPON THE INSURER. ITS AGENTS OR
RET RESBRTATJVES
IA[HWBZED ATIVE
IS19
ACORD CORPORATION. All rights reserved.
logo are registered marks of ACORD
BIB]
40284-U01
AGREEMENT-U02
LI21329-U03
FO21330-U03
FO85769-U03
FO86069-U03
MG86107-U03
AS86133-U03
AS86134-U03
AI88995-U03
DO90609-U03
C1-U03
GENERAL-U03
DOCUMENTS-U03
4/16/2010-U04
RIVASR-U04
14739-U05
1-U06
AUTHORIZE-U07
PURCHASING-U07
MANAGER-U07
NATIVIDAD-U07
MEDICAL-U07
CENTER-U07
NMC)-U07
TO-U07
EXECUTE-U07
AMENDMENT-U07
NO.-U07
2-U07
TO-U07
960-NMC-U08
RUIZ-IGNACIO-U09
MAEGAN-U09
RUIZ-IGNACIOM-U10
3/15/2010-U011
AGREEMENT-U012
GALLUN-U012
SNOW-U012
ASSOCIATES-U012
INC.-U012
INTERIOR-U012
DESIGN-U012
DESIGN-U012
MASTER-U012
PLANNING-U012
SERVICES-U012
AT-U012
NMC-U012
IN-U012
AN-U012
AMOUNT-U012
TO-U012
EXCEED-U012
$198,500-U012
AN-U012
INCREASE-U012
OF-U012
$60,000)-U012
PERIOD-U012
MARCH-U012
1,-U012
2010-U012
TO-U012
JUNE-U012
30,-U012
2010.-U012
AGREEMENT�X��"x��THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
POLICY CHANGE
N'
N
0
PRO RATA FACTOR: 0.397'
THIS ENDORSEMENT DOES NOT
Form SS 12 11 04 05 T
Process Date: 10/31/08
This endorsement changes the policy effective on the Inception Date of the policy unless another date is Indicated
below:
Policy Number: 35 SBA RU9261 SA
Named Insured and Mailing Address; GALLUP SNOW
Agent Name: PROFESSIONAL UNDERWRITERS INC
Code: 355036
Policy Change Effective Date: 10/30/08 Effective hour is the same as stated in the.
Declarations Page of the Policy.
M
Policy Change Number:. 002
N
1i DENVER CO 80202
0
COPY
M 1920 MARKET. ST STE 200
rn
0
POLICY CHANGES:
HARTFORD CASUALTY INSURANCE COMPANY
ANY CHANGES IN YOUR PREMIUM WILL BE REFLECTED IN YOUR NEXT BILLING
STATEMENT.
THIS IS NOT A BILL.
NO PREMIUM DUE AS OF POLICY CHANGE EFIFECTIVE DATE
RATES AND PREMIUMS ARE:CHANGED.:
FORM, NUMBERS OF ENDORSEMENTS REVISED T ENDORSEMENT ISSUE.:
IH12001185 ADDITIONAL INSURED PERSO
CHANGE THE PJLICY EXCEPT AS' SHOWN.
Page 001
UW COPY
Pol icy Effective Date:. 10 / 3 0 / 0 8
Policy Expiration Date: 03/24/09
BIB]
40284-U01
AGREEMENT-U02
LI21329-U03
FO21330-U03
FO85769-U03
FO86069-U03
MG86107-U03
AS86133-U03
AS86134-U03
AI88995-U03
DO90609-U03
C1-U03
GENERAL-U03
DOCUMENTS-U03
4/16/2010-U04
RIVASR-U04
14739-U05
1-U06
AUTHORIZE-U07
PURCHASING-U07
MANAGER-U07
NATIVIDAD-U07
MEDICAL-U07
CENTER-U07
NMC)-U07
TO-U07
EXECUTE-U07
AMENDMENT-U07
NO.-U07
2-U07
TO-U07
960-NMC-U08
RUIZ-IGNACIO-U09
MAEGAN-U09
RUIZ-IGNACIOM-U10
3/15/2010-U011
AGREEMENT-U012
GALLUN-U012
SNOW-U012
ASSOCIATES-U012
INC.-U012
INTERIOR-U012
DESIGN-U012
DESIGN-U012
MASTER-U012
PLANNING-U012
SERVICES-U012
AT-U012
NMC-U012
IN-U012
AN-U012
AMOUNT-U012
TO-U012
EXCEED-U012
$198,500-U012
AN-U012
INCREASE-U012
OF-U012
$60,000)-U012
PERIOD-U012
MARCH-U012
1,-U012
2010-U012
TO-U012
JUNE-U012
30,-U012
2010.-U012
AGREEMENT�X��"x��POLICY NUMBER: 35 SBA RU9261
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED PERSON-ORGANIZATION
ANDERSON MASON DALE ARCHITECTS
1615 SEVENTEENTH STREET
DENVER, CO 80202
M+O+A
1900 WAZEE STREET, SUITE 100
DENVER, CO 80202
UNIVERSITY OF COLORADO HOSPITAL
4200 E. 9TH AVENUE
DENVER, CO 80262
BARKER RINKER SEACAT ARCHITECTURE
2300 FIFTEENTH STREET SUITE 100
DENVER, CO 80202
FENTRESS BADBURN ARCHITECTS
421 BROADWAY
DENVER, CO 80203
HLM DESIGN
820 16TH STREET MALL
DENVER, CO 80202
ASPEN VALLEY
0401 CASTLE CREEK ROAD
ASPEN, CO 81611
MEMORIAL HOSPITAL
1400 BOULDER. STREET
COLORADO SPRINGS, CO 80909
MEDICAL CENTER OF THE ROCKIES
2500 ROCKY MOUNTAIN AVENUE
LOVELAND, CO.80538
COUNTY OF, MONTEREY, ITS OFFICERS, AGENTS AND EMPLOYEES
CONTRACTS/ PURCHASING DEPT.
168 WEST ALISAL ST, 3RD`IFLOOR
SALINAS, CA 93901
Form IH 12 00 11 85 T SEQ. NO. 003 Printed in U.$.A. Page 001 CONTINUED ON NEXT PAGE)
Process Date: 10/31/08 Expiration Date: 03/24/09
UW COPY
BIB]
40284-U01
AGREEMENT-U02
LI21329-U03
FO21330-U03
FO85769-U03
FO86069-U03
MG86107-U03
AS86133-U03
AS86134-U03
AI88995-U03
DO90609-U03
C1-U03
GENERAL-U03
DOCUMENTS-U03
4/16/2010-U04
RIVASR-U04
14739-U05
1-U06
AUTHORIZE-U07
PURCHASING-U07
MANAGER-U07
NATIVIDAD-U07
MEDICAL-U07
CENTER-U07
NMC)-U07
TO-U07
EXECUTE-U07
AMENDMENT-U07
NO.-U07
2-U07
TO-U07
960-NMC-U08
RUIZ-IGNACIO-U09
MAEGAN-U09
RUIZ-IGNACIOM-U10
3/15/2010-U011
AGREEMENT-U012
GALLUN-U012
SNOW-U012
ASSOCIATES-U012
INC.-U012
INTERIOR-U012
DESIGN-U012
DESIGN-U012
MASTER-U012
PLANNING-U012
SERVICES-U012
AT-U012
NMC-U012
IN-U012
AN-U012
AMOUNT-U012
TO-U012
EXCEED-U012
$198,500-U012
AN-U012
INCREASE-U012
OF-U012
$60,000)-U012
PERIOD-U012
MARCH-U012
1,-U012
2010-U012
TO-U012
JUNE-U012
30,-U012
2010.-U012
AGREEMENT�X��"x��6) When You Are Added As An
7)
RACOW-P
pct(
tA 0,P)
Additional Insured To Other
Insurance
That is other insurance available to
you covering liability for d mages
arising out of the premises or
operations, or products and completed
operations, for which you have been
added as an additional insure by that
insurance; or
When You Add Others As An
Additional Insured To This
Insurance
That is other insurance available to an
additional insured.
However, the following provisions
apply to other insurance available to
any person or organization who is an
additional insured under this Co erage
Part:
a) Primary Insurance When
Required By Contract
This insurance is primary f you
have agreed in a written contract,
written agreement or perm t that
this insurance be primary. I other
insurance is also primary, we will
share with all that other insu ance
by the method described in c.
below.
b Prime An Ngri` Gont~rlb; t d
fiarywr
To Other Insurance When
Required By Contract
if you have agreed in a w itten
contract, written agreement or
permit that this insurance is
primary and non-contributory with
the additional insured's own
insurance, this insurance is
primary and we will not seek
contribution from that other
insurance.
Paragraphs a) and b) do not app y to
other insurance to which the additi nal
insured has been added as an
additional insured.
When this insurance is excess, we will
have no duty under this Coverage Pa to
defend the insured against any suit" if any
other insurer has a duty to defend he
insured against that suit". If no of er
insurer defends, we will undertake to do
so, but we will be entitled to the insure s
rights against all those other insurers.
Form SS 00 08 04 05
BUSINESS LIABILITY COVERAGE FORM
When this insurance is excess over other
insurance, we will pay only our share of
the amount of the loss, If any, that
exceeds the sum of:
1)
The total amount that all such other
insurance would pay for the loss in the
absence of this Insurance; and
2) The total of all deductible and self-
insured amounts under all that other
insurance.
We will share the remaining loss, if any, with
any other insurance that is not described in
this Excess Insurance provision and was not
bought specifically to apply in excess of the
Limits of Insurance shown in the
Declarations of this Coverage Part.
c. Method Of Sharing
If all the other insurance permits
contribution by equal shares, we will follow
this method also. Under this approach,
each insurer contributes equal amounts
until it has paid its applicable limit of.
insurance or none of the loss remains,
whichever comes first.
if any of the other insurance does not permit
contribution by equal shares, we will
contribute by limits. Under this method, each
insurer's share is based on the ratio of its
applicable limit of insurance to the total
applicable limits of insurance of all insurers.
8. Transfer Of Rights Of Recovery Against
Others To Us
a. Transfer Of Rights Of Recovery
If the insured has rights to recover all or
part of any payment, including
Supplementary Payments, we have made
under this Coverage Part, those rights are
transferred to us. The insured must do
nothing after loss to impair them. At our
request, the insured will bring suit" or
transfer those rights to us and help us
enforce them. This condition does not
apply to Medical Expenses Coverage.
Waiver Of Rights Of Recovery Waiver
Of Subrogation).
If the insured has waived any rights of
recovery against any person or
organization for all or part of any payment,
including Supplementary Payments, we
have made under this Coverage Part; we
also waive that right, provided the insured
waived their rights of recovery against
such person or organization- in a contract,
agreement or permit that was executed
prior to the Injury or damage.
Page 17 of 24
BIB]
40284-U01
AGREEMENT-U02
LI21329-U03
FO21330-U03
FO85769-U03
FO86069-U03
MG86107-U03
AS86133-U03
AS86134-U03
AI88995-U03
DO90609-U03
C1-U03
GENERAL-U03
DOCUMENTS-U03
4/16/2010-U04
RIVASR-U04
14739-U05
1-U06
AUTHORIZE-U07
PURCHASING-U07
MANAGER-U07
NATIVIDAD-U07
MEDICAL-U07
CENTER-U07
NMC)-U07
TO-U07
EXECUTE-U07
AMENDMENT-U07
NO.-U07
2-U07
TO-U07
960-NMC-U08
RUIZ-IGNACIO-U09
MAEGAN-U09
RUIZ-IGNACIOM-U10
3/15/2010-U011
AGREEMENT-U012
GALLUN-U012
SNOW-U012
ASSOCIATES-U012
INC.-U012
INTERIOR-U012
DESIGN-U012
DESIGN-U012
MASTER-U012
PLANNING-U012
SERVICES-U012
AT-U012
NMC-U012
IN-U012
AN-U012
AMOUNT-U012
TO-U012
EXCEED-U012
$198,500-U012
AN-U012
INCREASE-U012
OF-U012
$60,000)-U012
PERIOD-U012
MARCH-U012
1,-U012
2010-U012
TO-U012
JUNE-U012
30,-U012
2010.-U012
AGREEMENT�X��"x��R~ CERTIFICATE OF UABILITY INSURANCE cro c
PRODUCER MATTER INFORMATIO1
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
PUI Agency of Colorado, Inc HOLDER. THIS CERTIFICATE DOES NOT AMEND
EXTEND OR
5445 DTC Parkway Penthouse 4
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW
Greenwood Village CO 80111
Phone: 303-488-3418 Fan: 303-486-6843 INSURERS AFFORDING COVERAGE NAIC #
INSURED INSSURE k sentinel Insurance Co, Ltd. 11000
G
ll
S
A
t
i INSURER B:
a
un
now
ssoc
a
es, Inc.
Lisa Gal un INSURER C:
1920 Mar et Street Suite 200 INSURER a.
Denver CO 80202
INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO P BURED N/aEDABOVE FOR TM POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR Orr *R DOCUIYBIT WITH RESPECT TO WHICH TI�IS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIE ED HEREIl IS SUB.ECT TO ALL THE TERMS. EXCLUSIONS AND COMXTIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAL) CLAMS.
LTR NOR TYPE OF INSURANCE POLICY NUMBBI BITE DATE L RWM
GENERAL LIABILITY EACH OCCURRENCE $
COMMERCIAL GENERAL LIABILITY PREMISES Ea occurence $
CLAIMS MADE DOCCUR
ME) EXP Any one person) $
PERSONAL B ADV INJURY $
GENERAL AGGREGATE $
GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS COMP/OP AGO $
POLICY JEG T LOC
AUT OMOBILE LIABILITY
COMBINED SINGLE LIMB
$
ANY AUTO accident)
ALL OWNED AUTOS
BODILY eWURT $
SCHEDULED AUTOS Per pence)
HIRED AUTOS
BODILY INJURY
NON-OWNED AUTOS
I
Per acident) S
CI PROPERTY D
E
AMAG $
Per acc dent)
GARAGE LIABILITY AUTO ONLY EA ACCIDENT S
ANY AUTO EA ACC
OTHER THAN S
AUTO ONLY: AUG $
EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE $
OCCUR F1 CLAIMS MADE
ATE
AOGRi S
3 DEDUCTIBLE
RETENTION
OR ERS COIN SATION
AND EMPLOYERS' LIABILITY
X TORY[INKS f
R V
A ANY PROPRIETOR/PARTNER/EXECUTIVED 35RECRE6980 08/26/09 08/26/10 EL EACHACCIDENT 000
000
da
AS
f]2 IXCLUDED7
tory in In
Mantlatory U
NHJ
Mandatory
ribe under
LP
EL DISEASE EA EMPLO
SPEG~IAL
PROVISIONS below EL DISEASE-POLICY LIMIT s$1,000,000
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS! VEHICLES I EXCLUSIONS ADDED BY EM! /SPECIAL PROVNnONS
CERTIFICATE HOLDER
County of Monterey
Contracts/Purchasing Dept
168 West Alisal St, 3rd Floor
Salinas CA 93901
I
ACORD 25 2009/01)
The ACORD name and
ATIVE
giiap
I AC CORPORATION. All rights reserved.
logo are registered marks of ACORD
CANCELLATION
SHOULD ANY OF THE ABOVE DE.SCIDHEDPOLICBI3 BE CANCELLED BEFORE THE EXPIRATIOI
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAR. 30 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER. ITS AGENTS OR
REFR�ITATIVES.
BIB]
40284-U01
AGREEMENT-U02
LI21329-U03
FO21330-U03
FO85769-U03
FO86069-U03
MG86107-U03
AS86133-U03
AS86134-U03
AI88995-U03
DO90609-U03
C1-U03
GENERAL-U03
DOCUMENTS-U03
4/16/2010-U04
RIVASR-U04
14739-U05
1-U06
AUTHORIZE-U07
PURCHASING-U07
MANAGER-U07
NATIVIDAD-U07
MEDICAL-U07
CENTER-U07
NMC)-U07
TO-U07
EXECUTE-U07
AMENDMENT-U07
NO.-U07
2-U07
TO-U07
960-NMC-U08
RUIZ-IGNACIO-U09
MAEGAN-U09
RUIZ-IGNACIOM-U10
3/15/2010-U011
AGREEMENT-U012
GALLUN-U012
SNOW-U012
ASSOCIATES-U012
INC.-U012
INTERIOR-U012
DESIGN-U012
DESIGN-U012
MASTER-U012
PLANNING-U012
SERVICES-U012
AT-U012
NMC-U012
IN-U012
AN-U012
AMOUNT-U012
TO-U012
EXCEED-U012
$198,500-U012
AN-U012
INCREASE-U012
OF-U012
$60,000)-U012
PERIOD-U012
MARCH-U012
1,-U012
2010-U012
TO-U012
JUNE-U012
30,-U012
2010.-U012
AGREEMENT�X��"x��MONTEREY OUNTY
VENDOR REGISTRATION FORM
RETURN THIS FOR TO,
Contracts. Purchasing Division 168 W, Allsel S 3rd Floor Salinas CA 93901
PH(831)766-4990 FAX 8 1) 755-4969
BUSINESS NAME Name
C
I an' 6 ra o 1J- G 55.o Gi Dr, c,
DBA
TAXPAYER IDENTIFICATION Federal Employer ID No I or Social Security No'
Enter Applicable Number) z.o D5
BUSINESS ORGANIZATION 0 Corporation
Check one and follow
the Instructions)
7 I Cy'
L i 5 q ri-l I L�n, inc r q E Jnou
resident Vice President
gi Snow- C_i L'` rrAAQ Il U.l.
ecretary Treasurer
Subsidiary f
Parent Comp ny)
a Partnership
arlner Name Partner Name
riner Name Partner Name
Sole Proprietorship
Owner Name
dba if applicable):
BUSINESS LOCATION Street Address
Must be Completed)
1 c a a P r f / t Si r-p- 2 i- 4 i
City L~V C'rG
State Zip Code
CID
PO Box If applicable). E-mail address
Telephone No Fax No
3~ /33-q5ap y3
PAYMENT TERMS Discounts Offered,
BUSINESS TYPE
Check applicable boxes
Retail
Wholesale
Distributor
Manufacturer
LICENSES Contractor's License No
Revised 2/28/2006
56 47-4
M� Minority /Woman Owned
Veteran Owned
Ycl Small Business
1
BIB]
40284-U01
AGREEMENT-U02
LI21329-U03
FO21330-U03
FO85769-U03
FO86069-U03
MG86107-U03
AS86133-U03
AS86134-U03
AI88995-U03
DO90609-U03
C1-U03
GENERAL-U03
DOCUMENTS-U03
4/16/2010-U04
RIVASR-U04
14739-U05
1-U06
AUTHORIZE-U07
PURCHASING-U07
MANAGER-U07
NATIVIDAD-U07
MEDICAL-U07
CENTER-U07
NMC)-U07
TO-U07
EXECUTE-U07
AMENDMENT-U07
NO.-U07
2-U07
TO-U07
960-NMC-U08
RUIZ-IGNACIO-U09
MAEGAN-U09
RUIZ-IGNACIOM-U10
3/15/2010-U011
AGREEMENT-U012
GALLUN-U012
SNOW-U012
ASSOCIATES-U012
INC.-U012
INTERIOR-U012
DESIGN-U012
DESIGN-U012
MASTER-U012
PLANNING-U012
SERVICES-U012
AT-U012
NMC-U012
IN-U012
AN-U012
AMOUNT-U012
TO-U012
EXCEED-U012
$198,500-U012
AN-U012
INCREASE-U012
OF-U012
$60,000)-U012
PERIOD-U012
MARCH-U012
1,-U012
2010-U012
TO-U012
JUNE-U012
30,-U012
2010.-U012
AGREEMENT�X��"x��MONTEREY BOUNTY
VENDOR REGISTR~TION FORM
RETURN THIS FOR T0:
Contracts Purchasing Division 16B W. Alisal L3rd Floor Salinas CA 93901
PH 831) 756 4990 FAX 31) 766-4969
Carefully examine the List of Commodities",. List the DESCRIPTION and NUMERIC CODE of each Commodity
product &/or Servlce(s)) that you wish to provide the unty. See attached list.)
Numeric Code Des rlption
Dr"t~n
2 2
3 3
4 4
6 6
7 7
8 6
9 9
10 10
Use the spaces below for Commodities / Merchandise no listed OR to clarify a commodity you have already selected
Please feel free to attach any additional information you ould like us to have. ie Brochures, Line Cards, etc
PREPARED BY; Prtnte / Typed Name Printed i Typed Tille
L /.JQ Cl~ rJ/
Signature
Telephone No.
303) Ll 3 3 q
Date
itIC~~~o~or
Revised 2128/2006 2
BIB]
40284-U01
AGREEMENT-U02
LI21329-U03
FO21330-U03
FO85769-U03
FO86069-U03
MG86107-U03
AS86133-U03
AS86134-U03
AI88995-U03
DO90609-U03
C1-U03
GENERAL-U03
DOCUMENTS-U03
4/16/2010-U04
RIVASR-U04
14739-U05
1-U06
AUTHORIZE-U07
PURCHASING-U07
MANAGER-U07
NATIVIDAD-U07
MEDICAL-U07
CENTER-U07
NMC)-U07
TO-U07
EXECUTE-U07
AMENDMENT-U07
NO.-U07
2-U07
TO-U07
960-NMC-U08
RUIZ-IGNACIO-U09
MAEGAN-U09
RUIZ-IGNACIOM-U10
3/15/2010-U011
AGREEMENT-U012
GALLUN-U012
SNOW-U012
ASSOCIATES-U012
INC.-U012
INTERIOR-U012
DESIGN-U012
DESIGN-U012
MASTER-U012
PLANNING-U012
SERVICES-U012
AT-U012
NMC-U012
IN-U012
AN-U012
AMOUNT-U012
TO-U012
EXCEED-U012
$198,500-U012
AN-U012
INCREASE-U012
OF-U012
$60,000)-U012
PERIOD-U012
MARCH-U012
1,-U012
2010-U012
TO-U012
JUNE-U012
30,-U012
2010.-U012
AGREEMENT�X��"x��Form W-9
Rev October 2007)
Dopnrimanl of the Treseury
Internal Rovonuo Service
0)
Request for Taxpayer
Identification Number and Certification
Name lees n on your Income tax return)
G).- I I ur, bt D LAr G5 Gf Gt-~t S 1-'~ L
Business name. If different from above
Give form to the
requester. Do not
send to the IRS.
Check appropriate box: Individual/Sole proprietor Corporation Partnership
Limited tinblllly company Enter the In) alossfllcafion O+c
lsragarded entity, 0=corporation. Papartnership) Exempt
a
ee
Other sea lnalnx:liors) p
y
AddIres number street. and apt or eullo'no)
to mc~izK~+ 5F Requester's name and address optional)
eef-2p.i
City, state. and ZIP code
7r1
List account number(s) here optional)
Taxpayer Identification Number TIN
Enter your TIN in the appropriate box. The TIN provided must etch the name given on Line 1 to avoid Social security number
backup withholding For Individuals. this is your social security number SSN). However, for a resident
alien, sole proprietor, or disregarded entity, see the Part I instr ctlons on page 3 For other entitles, It Is
your employer Identificatlon number EIN) If you do' not have a number. see How to get a TIN on page 3 or
Note. if the account Is In more than one name. see the chart. c
number to enter r' page 4 for guidelines on whose Employer Identification numb Ier
2 U 5e>
Certification
Under penalties of perjury. I certify that:
1 The number shown on this form is my correct taxpayer ids tiffcation number or I am waiting for a number to be issued to me), and
2. 1 am not subject to backup withholding because: a) I am a ampt from backup withholding, or b) I have not been notified by the Internal
Revenue Service IRS) that I am subject to backup withholdi ng as a result of a failure to report all interest or dividends, or c) the IRS has
notified me that I am no longer subject to backup withholdin g, and
3. 1 am a U S. citizen or other U S. person defined below),
Certification Instructions. You must cross out Item 2 above If y ou have been notified by the IRS that you are currently subject to backup
withholding because you have failed to report all interest and di idends on your tax return For real estate transactions, Item 2 does not apply.
For mortgage Interest paid, acquisition or abandonment of secur ed property, cancellation of debt, contributions to an individual retirement
arrangement IRA). and generally. payments other than interest a nd dividends. you are not required to sign the Certification but you must
provide your correct TIN See the instructions on page 4
Sign Signature of
1
I
Hers US. person
l
Data)'
c,LCU
General Instructions,
Section references.are to the Internal Revenue Code unless
otherwise noted
Purpose of Form
A person who'is required to'flle an information refurn�With th
IRS must obtain your correct taxpayer identification number iIN)
to report, for example, Income paid-to you, real estate
transactions, mortgage interest you paid, acquisition or
abandonment of secured property, cancellation of debt. or
contributions you made to an IRA
Use Form W-9 only if you are a U S person including a
resident alien), to provide your correct TIN"to the person
requesting it the requester) and. when applicable, to:
1 Certlfy.lhat the TIN you are giving is correct or you are
waiting for a number to be Issued).
2. Certify that you are not subject to backup withholding,'or.
3 Claim exemption from backup withholding If you are a U
exempt payee. If applicable, you are also certifying that as a
U S' person. your aliooabie share'of any partnership Income fr4m
a U S trade or business is not subject to the withholding tax on
foreign partners' share of effectively connected income
Note. If a requester gives you a form other than Form W-9 to
request your TIN, you must use the requester's form If It is
substantially similar to this Form W-9
Definition of a U.S. person. For federal tax purposes, you are
considered a U S person if you are:
An individual who Is a U S. citizen or U.S resident alien,
e A partnership, corporation, company. or association created or
organized In the United States or under the laws of the United
States,
An estate other than a foreign estate), or
A domestic trust as defined in Regulations-section
301 7701-7)
Special rules for partnerships. Partnerships that conduct a
trade or business in the United States are generally required to
pay a. withholding tax on any Joreign partners' share of income
from such business Further, in oertaln.oases'where a Form W-2
has not been received, a partnership Is required to presume that
a partner Is a foreign person,. and. pay the withholding tax.,
Therefore, If you are a U S person that Is a partner in a
partnership conducting a trade or business In the United States.
provide Form W-9 to the partnership to establish your U.S
status and avoid withholding on your share of partnership
income
The person who gives Form W-9 to the partnership for
purposes of establishing Its U.S. status and avoiding withholding
on its allocable share of net' Income from the partnership
conducting a trade or business In the United States.is in the
following cases:
The U S. owner of a disregarded entity and not the entity,
Cat No 10231X Form W-9 Rev 10-2007)
BIB]
40284-U01
AGREEMENT-U02
LI21329-U03
FO21330-U03
FO85769-U03
FO86069-U03
MG86107-U03
AS86133-U03
AS86134-U03
AI88995-U03
DO90609-U03
C1-U03
GENERAL-U03
DOCUMENTS-U03
4/16/2010-U04
RIVASR-U04
14739-U05
1-U06
AUTHORIZE-U07
PURCHASING-U07
MANAGER-U07
NATIVIDAD-U07
MEDICAL-U07
CENTER-U07
NMC)-U07
TO-U07
EXECUTE-U07
AMENDMENT-U07
NO.-U07
2-U07
TO-U07
960-NMC-U08
RUIZ-IGNACIO-U09
MAEGAN-U09
RUIZ-IGNACIOM-U10
3/15/2010-U011
AGREEMENT-U012
GALLUN-U012
SNOW-U012
ASSOCIATES-U012
INC.-U012
INTERIOR-U012
DESIGN-U012
DESIGN-U012
MASTER-U012
PLANNING-U012
SERVICES-U012
AT-U012
NMC-U012
IN-U012
AN-U012
AMOUNT-U012
TO-U012
EXCEED-U012
$198,500-U012
AN-U012
INCREASE-U012
OF-U012
$60,000)-U012
PERIOD-U012
MARCH-U012
1,-U012
2010-U012
TO-U012
JUNE-U012
30,-U012
2010.-U012