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HomeMy WebLinkAboutUntitled (2) Client#: 14832 GUACL ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY)03/22/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: J.A.Price Agency,Inc. PHONE 952 944-8790 FAx (A/C No,Ext): (A)C,No): 952 944-0097 6640 Shady Oak Road E-MAIL ADDRESS: Suite 500 INSURER(S)AFFORDING COVERAGE NAIC# Eden Prairie,MN 55344-6176 INSURER A:Western National Insurance Grou INSURED INSURER B:Old Republic Surety Company 40444 Guaranteed Clean Maintenance,Inc. 1565 Como Ave INSURER c Suite 101 INSURER D INSURER E Saint Paul,MN 55108 : INSURER F: COVERAGES CERTIFICATE-NUMBER REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP W LIMITS LTR INSR VD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) A GENERAL LIABILITY CPP0016380 04/01/2013 04/01/2014 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY PRAEMISESO(Ea occunence) $100,000 CLAIMS-MADE X OCCUR MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY PRO LOG $ JECT A AUTOMOBILE LIABILITY CPP0016235 04/01/2013 04/01/2014 {Ea aE121eotSINGLE LIMIT 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS (Per accident) A x UMBRELLA LIAB X OCCUR UMB0010862 04/01/2013 04/01/2014 EACH OCCURRENCE $1,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $1,000,000 DED X RETENTION$10,000 - $ A WORKERS COMPENSATION WCV0010808 04/01/2013 04/01/2014 X WC STAT TS ER AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y I N E.L.EACH ACCIDENT $100,000 OFFICER/MEMBER EXCLUDED? N NIA (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1 00,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 B Empl Dishonesty RBS0600564 10/15/2012 10/15/2013 $10,000 bond amount DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) CERTIFICATE HOLDER CANCELLATION ANY OF City of Oak Park Heights THE SHOULD EXPIRA ONH DATE V THEREOF,E NOTTICEIEWILLL BAE CELLED DELIVERED O NE 14168 Oak Park Blvd North ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 2007 Oak Park Heights,MN 55082 AUTHORIZED REPRESENTATIVE 66C"'- (1144424446°1 O 1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S110715/M110697 EMC1 Client#: 14832 GUACL ACORDu CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDMlYY)04!02/2012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: J.A.Price Agency,Inc. PHONE 952 944-8790 FAX Shady Oak Road E-MAIL Ext). tA/C,No: 952 944-0097 Suite 500 ADDRESS: Eden Prairie,MN 55344-6176 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Western National Insurance Grou INSURED INSURER B:Old Republic Surety Company 40444 Guaranteed Clean Maintenance,Inc. 1565 Como Ave INSURER C Suite 101 INSURER D Saint Paul,MN 55108 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDLSUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) A GENERAL LIABILITY CPP0016380 04/01/2012 04/01/2013 EACH OCCURRENCE $1,000,000 EpEMISES X COMMERCIAL GENERAL LIABILITY PA (Ea occurrence) $100,000 CLAIMS-MADE X OCCUR MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GE 'I.AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 X POLICY PRO- JECT LOC $ A AUTOMOBILE LIABILITY CPP0016235 04/01/2012 04/01/2013 COMa acciBINdent) �ED SINGLE LIMIT 1,000,000 (E X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS J AUTOS PROPERTY DAMAGE X HIRED AUTOS X AUTOS EO eaccident) $ A X UMBRELLA LWB OCCUR UMB0010862 04/01/2012 04/01/2013 EACH OCCURRENCE $1,000,000 EXCESS UAB CLAIMS-MADE AGGREGATE $1,000,000 DED X RETENTION$10,000 $ A WORKERS COMPENSATION WCV001 0808 04/01/2012 04/01/2013 X TORY UMITS ERH AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $100,000 OFFICER/MEMBER EXCLUDED? NI N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $100,000 If yes,describe under DESCRIPTION OF OPERATIONS below _ E.L.DISEASE-POLICY LIMIT $500,000 B Empl Dishonesty RBS0600564 10/15/2011 10/15/2012 $10,000 bond amount DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If mom space Is required) RECEIVED APR 0 3 7 RECEIVED APR 0 3 2012 CERTIFICATE HOLDER CANCELLATION City of Oak Park Heights SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 14168 Oak Park Blvd North ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 2007 Oak Park Heights,MN 55082 AUTHORIZED REPRESENTATIVE Cis ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S91978/M91962 EMC1 Client#: 14832 GUACL ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYI') 04!05/2011 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: J.A.Price Agency,Inc. PHONE (AiC,No,Ext):952 944-8790 F°X (A/C,No): 952 944-0097 6640 Shady Oak Road E-MAIL Suite 500 ADDRESS: Eden Prairie, MN 55344-6176 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Western National Insurance Grou INSURED INSURER B:Old Republic Surety Company 40444 Guaranteed Clean Maintenance, Inc. 1565 Como Ave INSURER c Suite 101 INSURER D Saint Paul,MN 55108 ' 'r INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. lTR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS INSR WVD POLICY NUMBER (MM/DDIYYYY) (MM/DD/YYYY) A GENERAL LIABILITY CPP0016380 04/01/2011 04/01/2012 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES(EaEocccur ence) $100,000 CLAIMS-MADE X OCCUR MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY _$1,000,000 GENERAL AGGREGATE _$2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 * PPOLICY PRO- LOC — $ JEGT A AUTOMOBILE LIABILITY CPP0016235 04/01/2011 04/01/2012 (EOa all EO11 INGLE LIMIT j1,000,000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ X AUTOS RED AUTOS X NO OWNED PROPERTY DAMAGE AUTOS (Per accident) $ A X UMBRELLA LIAR OCCUR UMB0010862 04/01/2011 04/01/2012 EACH OCCURRENCE $1,000,000 EXCESS LIAR CLAIMS-MADE AGGREGATE $1,000,000 DED X RETENTION$10,000 $ A WORKERS COMPENSATION WCV0010808 04/01/2011 04/01/2012 X IVORY LMITS I IERH AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $100,000 OFFICER/MEMBER EXCLUDED? N 1 A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 B Empl Dishonesty RBS600564 10/15/2010 10/15/2011 $10,000 bond amount Bond DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION City of Oak Park Heights SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 14168 Oak Park Blvd North ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 2007 Oak Park Heights,MN 55082 AUTHORIZED REPRESENTATIVE 012<.' GILICAta444.1 ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S70760/M70732 EMC 1 Client#: 14832 GUACL ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE(MMlDD1YYYY)04/01/2010 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION J.A.Price Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 6640 Shad Oak Road HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR Shady ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Suite 500 • Eden Prairie,MN 55344-6176 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Western National Mutual Group Guaranteed Clean Maintenance, Inc. INSURER B: Old Republic Surety Company 40444 1565 Como Ave INSURER C: Suite 101 INSURER Saint Paul,MN 55108 APR . 2610 : INSURER E E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR INSRC DATE IMM/DD/YYI DATE(MM!DD/YY) A GENERAL LIABILITY CPP0016380 04/01/10 04/01/11 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $100,000 PREMIS_ESJEa occurrence! CLAIMS MADE X OCCUR MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY n PE a n LOC A AUTOMOBILE LIABILITY CPP0016235 04/01/10 04/01/11 COMBINED SINGLE LIMIT X ANY AUTO (Ea accident) $1,000,000 ', ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ X HIRED AUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ A EXCESS/UMBRELLA LIABILITY UMBOO10862 04/01/10 04/01/11 EACH OCCURRENCE $1,000,000 31 OCCUR CLAIMS MADE AGGREGATE $1,000,000 $ DEDUCTIBLE $ X RETENTION $10,000 $ A WORKERS COMPENSATION AND WCVOOI0808 04/01/10 04/01/11 X I OR STATUS I IOER TORY LIMITS EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $100,000 OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $100,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $500,000 B OTHER Employee RBS0600564 10/15/09 10/15/10 $10,000 bond amount Dishonesty Bond DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT!SPECIAL PROVISIONS • CERTIFICATE HOLDER CANCELLATION 10 Days for Non-Payment SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE City of Oak Park Heights DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS 14168 Oak Park Blvd North NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO PO Box 2007 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGI Oak Park Heights,MN 55082 REPRESENTATIVES. AUTHORIZED REPRESENTATIVE C10A14411 oN A4166 ACORD 25(2001/08)1 of 2 #S48896/M48869 EMC1 0 ACORD CORPO't` POLICE DEPARTMENT "` - CITY OF OAK PARK HEIGHTS °`44,01 14168 OAK PARK BLVD.NORTH•P.O.BOX 2007 OAK PARK HEIGHTS,MINNESOTA 55082 j=:d TELEPHONE:(651)439-4723 FAX:(651)439-3639 EMERGENCY:911 February 16,2011 To: Eric Johnson, City Administrator From: Brian DeRosier, Chief of Police Re: Employment Background Investigation—Cleaning Contractor I have completed the employment background check reference: Sarah Grace Rowe xx-xx-1977 Contract employee for: Guaranteed Clean and Maintenance Inc., St Paul MN 55108 Subject has no criminal history that would prevent his access to the non-public areas of City Hall. This would not to include secure areas such as the vault, or to the Police Dept. area without supervision or city personnel being present, or other areas deemed secure by you or other staff; as no finger prints have been taken for comparison and full investigation. This background check was completed with available computer research and did not consist of any personal interviews or physical background investigation. A copy of this investigation will be kept secured in the department background file and available only to those with a need to know basis,as required under data retention. Respectfully submitted for your review; Brian DeRosier Chief of Police w ,+ The following named individual has pmade application with the City of Oak Park Heights for employment: Last name of Applicant: �i .3 First Name: S CLr(J,\ Middle: C\la-- Maiden,Alias or Former: V} r\C O I 1 Date of Birth: Q— / 1 Gender(M or F): ge mat' Social Security Number(optional): 1-4-7 1 — 1 1 19 I authorize the City of Oak Park Heights to conduct a background investigation. I also authorize the Minnesota Bureau of Criminal Apprehension to disclose all criminal history record information to the City of Oak Park Heights Police Department for the purpose of employment with the City of Oak Park Heights. The expi .tion of this aut,on . s shall be one year from the date of my signature. Al • .l..u• a- r5- it Signature of Applicant Date *. . 1 • 4' • --,, *'�.4• - , =:i_ 2 .45_ 1/ Nota�� Signature .�� JULIE R. `I , N - ! NOTARY PUBLIC-MINNESOTA Date l�l .;"' My Commission Expires Jan.31,2015 BF X-9F `;.�fTr./.!l',/lJ't-r'.r"ilIll'r!.11./✓— If applicant is under 18,p: •r guardian must sign below authorizing the background check and criminal history. Parent/Guardian Signature Parent/Guardian Print Name Date lS POLICE DEPARTMENT �` `° ''' CITY OF OAK PARK HEIGHTS tii4� fN J� 14168 OAK PARK BLVD.NORTH • P,O. BOX 2007 f' ,'' ` OAK PARK HEIGHTS,MINNESOTA 55082 06 W t :r TELEPHONE:(651)439-4723 N?N it FAX:(651)439-3639 `` ,` EMERGENCY:911 February 11, 2011 To: Eric Johnson, City Administrator From: Brian DeRosier, Chief of Police Re: Employment Background Investigation—Cleaning Contractor I have completed the employment background check reference: Carol Susan Schroeder 10-05-1950 Contract employee for: Guaranteed Clean and Maintenance Inc., St Paul MN 55108 This subject has no criminal history that would prevent them from being in public or employee areas of the city hall. This individual would not be allowed into secure areas such as the vault, or to the Police Dept. area without direct supervision by city personnel being present, or other areas deemed secure by you or other staff; as no finger prints have been taken for comparison and full investigation. This background check was completed with available computer research and did not consist of any personal interviews or physical background investigation. A copy of this investigation will be kept secured in the department background file and available only to those with a need to know basis, as required under data retention. Respectfulbmitted for your review; Brian DeRosier Chief of Police POLICE DEPARTMENT CITY OF OAK PARK HEIGHTS 14168 OAK PARK BLVD.NORTH • P.O.BOX 2007 * OAK PARK HEIGHTS,MINNESOTA 55082 TELEPHONE:(651)439-4723 C ie,iskv, _ " FAX(651)439-3639 1-`0 EMERGENCY:911 February 16, 2011 To: Eric Johnson, City Administrator From: Brian DeRosier, Chief of Police Re: Employment Background Investigation—Cleaning Contractor I have completed the employment background check reference: Sarah Grace Rowe xx-xx-1977 Contract employee for: Guaranteed Clean and Maintenance Inc., St Paul MN 55108 Subject has no criminal history that would prevent his access to the non-public areas of City Hall. This would not to include secure areas such as the vault, or to the Police Dept. area without supervision or city personnel being present, or other areas deemed secure by you or other staff; as no finger prints have been taken for comparison and full investigation. This background check was completed with available computer research and did not consist of any personal interviews or physical background investigation. A copy of this investigation will be kept secured in the department background file and available only to those with a need to know basis, as required under data retention. Respectfully submitted for your review; Brian DeRosier Chief of Police POLICE DEPARTMENT CITY OF OAK PARK HEIGHTS 14168 OAK PARK BLVD,NORTH P.O.BOX 2007 st'�` .� ,.,'= � OAK PARK HEIGHTS,MINNESOTA 55082 Yy��` "� 0' TELEPHONE:(651)439-4723 NiN FAX:(651)439-3639 EMERGENCY:911 October 11, 2010 To: Eric Johnson, City Administrator From: Brian DeRosier, Chief of Police Re: Employment Background Investigation—Cleaning Contractor I have completed the employment background check reference: Amy Lee Schuman XXXX 1976 Contract employee for: Guaranteed Clean and Maintenance Inc., St Paul MN 55108 Subject has no criminal history that would prevent his access to the non-public areas of City Hall. This would not to include secure areas such as the vault, or to the Police Dept. area without supervision or city personnel being present, or other areas deemed secure by you or other staff; as no finger prints have been taken for comparison and full investigation. This background check was completed with available computer research and did not consist of any personal interviews or physical background investigation. A copy of this investigation will be kept secured in the department background file and available only to those with a need to know basis, as required under data retention. Respectfully submitted for your review; Brian DeRosier Chief of Police From:Guaranteed clean MTC 6516440900 10/11/2010 12:59 #688 P.002/002 T0'd "1hJ1Ol The following named individual has made application with the City of Oak Park Heights for employment. Last Name of Applicant:, SAVvvccti\-t---- First Name: kin Middle: -e_- .0 ,,,� Maiden, Alias or Former: 1 Date of Birth: I Sex(M or€) Social Security Number(optional): (44.1-2.A- I authorize the City of Oak Park Heights to conduct a background investigation. I also authorize the Minnesota Bureau of Criminal Apprehension to disclose all criminal history record Information to the Oak Park Heights Police Department for the purpose of employment with this agency. The expiration of this authorization shall be one year from the date of my sign re. � !s Sig ature • . . ._ _ - SUSANSANBURG '11 NOTARY PUBLIC . 4 Vii`• .; 4' MINNESOTA 10-ti-/b Notary Signature Date ***lf applicant is under 18, parent or guardian must sign below authorizing the background check and criminal history. Parent/Guardian Parent/Guardian Date Signature Print Name tth I TO/TO'd SZ:OT 6002-6T-1DO From:Guaranteed clean MTC 6516440900 10/11/2010 12:59 #688 P.001/002 Guaranteed Clean Maintenance, Inc. 1565 Como Avenue '° Suite #101 t St. Paul, MN 55108 (651) 644-9919 4 FAX (651) 644-0900 FAX COVER SHEET Attention: ILA-s-1,Ac" Company Name: 0. c QC4_,.0 z.e.,42) From: ., Number of pages. including cover: Date: lb-I/-JO Notes: \Cx-La J ) PLL. POLICE DEPARTMENT kh CITY OF OAK PARK HEIGHTS 14168 OAK PARK BLVD.NORTH • P.O.BOX 2007 '?'r 0` :<4w-ft:t OAK PARK HEIGHTS, MINNESOTA 55082 TELEPHONE:(651)439-4723 FAX:(651)439-3639 EMERGENCY:911 February 25, 2010 To: Eric Johnson, City Administrator From: Brian DeRosier, Chief of Police Re: Employment Background Investigation—Cleaning Contractor I have completed the employment background check reference: Ronald Dennis Udstuen 09-13-1957 Contract employee for: Guaranteed Clean and Maintenance Inc., St Paul MN 55108 Subject criminal history investigation shows 2 convictions: Misdemeanor Theft— 1992 Engaging in Prostitution— 1998 This individual would not be allowed into secure areas such as the vault, or to the Police Dept. area without direct supervision by city personnel being present, or other areas deemed secure by you or other staff; as no finger prints have been taken for comparison and full investigation. This background check was completed with available computer research and did not consist of any personal interviews or physical background investigation. A copy of this investigation will be kept secured in the department background file and available only to those with a need to know basis, as required under data retention. Respectfully submitted for your review; Brian DeRosier Chief of Police ;46 �Rte�� ; POLICE DEPARTMENT v.+ yll a444M CITY OF OAK PARK HEIGHTS .��--.fi' 14168 OAK PARK BLVD.NORTH �P.O.BOX 2007 x � .?.14,- .4 e OAK PARK HEIGHTS,MINNESOTA 55082 C W _, r' TELEPHONE:(651)439-4723 --- ' ` FAX:(651)439-3639 /'LI(,/� q''/g EMERGENCY:911 f� March 3, 2010 To: Eric Johnson, City Administrator From: Brian DeRosier, Chief of Police Re: Employment Background Investigation—Cleaning Contractor I have completed the employment background check reference: Deborah Jean Demulling XXXX1949 Contract employee for: Guaranteed Clean and Maintenance Inc., St Paul MN 55108 Subject has no criminal history that would prevent his access to the non-public areas of City Hall. This would not to include secure areas such as the vault, or to the Police Dept. area without supervision or city personnel being present, or other areas deemed secure by you or other staff; as no finger prints have been taken for comparison and full investigation. This background check was completed with available computer research and did not consist of any personal interviews or physical background investigation. A copy of this investigation will be kept secured in the department background file and available only to those with a need to know basis, as required under data retention. Respectfully submitted for your review; Brian DeRosier Chief of Police POLICE DEPARTMENT CITY OF OAK PARK HEIGHTS �` 14168 OAK PARK BLVD.NORTH • P.O.BOX 2007 ® OAK PARK HEIGHTS, MINNESOTA 55082 ■ Tr 41(-- -: TELEPHONE:(651)439-4723 FAX:(651)439-3639 yA (' I EMERGENCY:911 fItt December 15th, 2009 0401 To: Eric Johnson, City Administrator From: Brian DeRosier, Chief of Police Re: Employment Background Investigation—Cleaning Contractor I have completed the employment background check reference: William Edson Strauss 07-28-1951 Contract employee for: Guaranteed Clean and Maintenance Inc., St Paul MN 55108 Subject has no criminal history that would prevent his access to the non-public areas of City Hall. This would not to include secure areas such as the vault, or to the Police Dept. area without supervision or city personnel being present, or other areas deemed secure by you or other staff; as no finger prints have been taken for comparison and full investigation. This background check was completed with available computer research and did not consist of any personal interviews or physical background investigation. A copy of this investigation will be kept secured in the department background file and available only to those with a need to know basis, as required under data retention. Respectfully s mitted for your review; Brian DeRosier Chief of Police 4-4.4t\ POLICE DEPARTMENT rj. ,. CITY OF OAK PARK HEIGHTS 14168 OAK PARK BLVD.NORTH • P.O. BOX 2007 so r4 OAK PARK HEIGHTS, MINNESOTA 55082 (♦�✓� , `: kr'"? TELEPHONE:(651)439-4723 ti, � FAX:(651)439-3639 EMERGENCY:911 (.07,C4\1\7c c EC W April 14, 2009 To: Eric Johnson, City Administrator From: Brian DeRosier, Chief of Police Re: Employment Background Investigation—Cleaning Contractor I have completed the employment background check reference: Stephen Kelli Johnson 1984-09-08 Contract employee for: Guaranteed Clean and Maintenance Inc., St Paul MN 55108 Subject has no criminal history that would prevent his access to the non-public areas of City Hall. This would not to include secure areas such as the vault, or to the Police Dept. area without supervision or city personnel being present, or other areas deemed secure by you or other staff; as no finger prints have been taken for comparison and full investigation. This background check was completed with available computer research and did not consist of any personal interviews or physical background investigation. A copy of this investigation will be kept secured in the department background file and available only to those with a need to know basis, as required under data retention. Respectfully submitted for your review; Brian DeRosier Chief of Police Client#: 14832 G UAC L ACORD, CERTIFICATE OF LIABILITY INSURANCE 0325/20091 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION J.A.Price Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 6640 Shady Oak Road HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Suite 500 - Eden Prairie,MN 55344-6176 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Western National Mutual Group Guaranteed Clean Maintenance,Inc. INSURER B: Old Republic Surety Company 40444 1565 Como Ave; Suite 101 Saint Paul, MN 55108 RELEl INSURER C: INSURER D: INSURER E: COVERAGES tI u 2U09 THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADM POLICY EFFECTIVE POLICY EXPIRATION LTR INSRC TYPE OF INSURANCE POLICY NUMBER DATE(MM/DD/YY) DATE(MM/DD/YY) LIMITS A GENERAL LIABILITY CPP0016380 04/01/09 04/01/10 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES(Ea occurrence) $100,000 1 CLAIMS MADE X OCCUR MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY n E n LOC A AUTOMOBILE LIABILITY CPP0016235 04/01/09 04/01/10 COMBINED SINGLE LIMIT X ANY AUTO (Ea accident) $1,000,000 ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) X HIRED AUTOS BODILY INJURY X NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO EA ACC $ OTHER THAN _ AUTO ONLY: AGG $ A EXCESS/UMBRELLA LIABILITY UMB0010862 04/01/09 04/01/10 EACH OCCURRENCE $1,000,000 il OCCUR r CLAIMS MADE AGGREGATE $1 000 000 ' I $ DEDUCTIBLE $ X RETENTION $10,000 $ A WORKERS COMPENSATION AND WCV0010808 04/01/09 04/01/10 X I WC STATU- FOTH- EMPLOYERS'LIABILITY TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $100,000 OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $100,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT ,$500,000 B OTHER Business RBS0600564 10/15/08 10/15/09 $10,000 bond amount Service Bond DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS - CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION City of Oak Park Heights DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3(1 DAYS WRITTEN 14168 Oak Park Blvd North NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL PO Box 2007 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Oak Park Heights, MN 55082 REPRESENTATIVES. AUT-EDREPRESENTATIVE LAkt.. ACORD 25(2001/08)1 of 2 #S16798/M16771 EMC1 0 ACORD CORPORATION 1988 Client#: 14832 GUACL ACOROM CERTIFICATE OF LIABILITY INSURANCE DATE(MNUDD/YYYY) 04/09/08 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION J. A. Price Agency,Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 6640 Shady Oak Road Ar fit. ( 1 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Suite 500 Eden Prairie,MN 55344-6176 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Western National Mutual Group Guaranteed Clean Maintenance, Inc. INSURER B: 1565 Como Ave; Suite 101 INSURER C: Saint Paul,MN 55108 INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR INSRC DATE(MM/DD/YY) DATE(MWDD/YY) A GENERAL LIABILITY CP300008807 04/01/08 04/01/09 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY PR RENTED $100,000 PREMISES(Ea occurrence) _ CLAIMS MADE X OCCUR MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 Td POLICY JtT ]T LOC A AUTOMOBILE LIABILITY CA300009342 04/01/08 04/01/09 COMBINED SINGLE LIMIT 000 X ANY AUTO (Ea accident) $1 ,0 s 0 00 ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) X HIRED AUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ A EXCESS/UMBRELLA LIABILITY CU300003561 04/01/08 04/01/09 EACH OCCURRENCE $2,000,000 OCCUR CLAIMS MADE AGGREGATE $2,000,000 DEDUCTIBLE _ $ X RETENTION $10,000 $ A WORKERS COMPENSATION AND WC300003386 04/01/08 04/01/09 X TWMUS S I O - EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $100,000 OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $100,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $500,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT!SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION City of Oak Park Heights DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL an DAYS WRITTEN 14168 Oak Park Blvd North NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL PO Box 2007 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Oak Park Heights,MN 55082 REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2001/08)1 of 2 #M13785 EMC1 © ACORD CORPORATION 1988 e8/15/2087 14: 39 6516440900 GUARANTEED CLEAN MTC PAGE 01/02 Guaranteed Clean Maintenance Inc. Joi'tfir 1565 Como Avenue * Suite #101 * St. Paul, MN 55108 l4i (651) 644-9919 * FAX (651) 6440900 C(,�, t n I "Carib FAX COVER SHEET i Attention: E Y' Ji1 CL Company Name: j ilk' qb 411.4i A .► , a - y ,. From: Number of pages, including cover: a Dater f 1 cZDIa i Notes: _ _ Z C\ CX C.- jilel `S Y \U&. \ ' f-fl . _ 7,1,0 L • I -Ci (- VA(‘ o C Co„, uvic-- �juk„,) cu Pus- rt, J 08/15/2007 14:39 6516440900 GUARANTEED CLEAN MTC PAGE 02/02. jol • 11 ` ..a'.} .15 'yZ :rl���ij 0•� off ii °. lA�,or....J + t • . ..,,..,„ .:„. -,... . p;-‘\'.' f. ' 6 J , �. ap a y w '4' 'ge Y S c g w jii .. —1 wr a • • City of Oak Park Heights 14168 Oak Park Blvd. N•Box 2007•Oak Park Heights,MN 55082•Phone(651)439-4439•Fax(651)439-0574 May 10,2007 I, C f I R I s T i k r Fr H R, 1+ii ,have received the A3 key to the Oak Park Heights City Hall, on May 10,2007.I will be solely responsible for this key and how it is utilized. Should this key be lost,please immediately report that it has been lost to the City Administrator,Eric Johnson 651-439-4439. Should this key be lost and not found,Guaranteed Clean Maintenance will be responsible to re-key the entire City Hall facility. Signet. Signed: Date: '6 04/19/2007 11:21 6516440900 GUARANTEED CLEAN MTC PAGE 01/02 , 7' Guaranteed Clean Maintenance, Inc. 1565 Como Avenue * Suite #101 *St. Paul, MN 55108 (651) 644-9919 * FAX (651) 611 0900 '-_ FAX COVER SHEET Attention: ft. - Company Name: � I Ks I fit` From: ..i, • _ i . _ Number of pages, including cover: Notes: • 04119!2007 11:21 6516440900 GUARANTEED CLEAN MTC PAGE 02/02 + ' "I '1 • !''r' >,Z \LT ,.:Ry ',14. •,ri '� 1::5'.''''''''' r, ...r,,,11,,.i,..-..4i,a ' :•i-iv• •J:;?.4::.i• :;i 1".4 .^} •� ,�?, .� t� yr ''..,,,',......,',,q*"' . .1`i;:•, �1••.. �:t'�,-. .l`1� Mr�}s 4`ff. } . i'.a r x • 'to ty* t ", , r.� , 7 '• 3 n ..' t,. <: O t ! .. � a �°� saw• 4�mz �s �= = r a AmmN ra im Cao j `.��µ:�j�Ym�rn a) P y ' _ `. _. r, \_F ..• �.• Ni lat3 Client#: 14832 GUACL CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) Ar RD� 04/17/07 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION J.A. Price Agency,Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 6640 Shady Oak Road HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR y ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Suite 500 Eden Prairie,MN 55344-6176 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Western National Mutual Group Guaranteed Clean Maintenance,Inc. INSURER B: 1565 Como Ave; Suite 101 INSURER C: Saint Paul,MN 55108 INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L POLICY EFFECTIVE POLICY EXPIRATION LTR INSRL TYPE OF INSURANCE POLICY NUMBER DATE(MM/DD/YY) DATE(MM/DD/YY) LIMITS A GENERAL LIABILITY CP300008807 04/01/07 04/01/08 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE SO RENTED $100,000 PREMISES(Ea occurrence) CLAIMS MADE in OCCUR MED EXP(Any one person) $5,000 _ PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 TPOLICY n JEa n LOC A AUTOMOBILE LIABILITY CA300009342 04/01/07 04/01/08 COMBINED SINGLE LIMIT $1,000,000 ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ A EXCESS/UMBRELLA LIABILITY CU300003561 04/01/07 04/01/08 EACH OCCURRENCE $2,000,000 OCCUR n CLAIMS MADE AGGREGATE $2,000,000 $ DEDUCTIBLE _ $ RETENTION $10,000 _ $ A WORKERS COMPENSATION AND WC300003386 04/01/07 04/01/08 X I gl STATU-I IV- EMPLOYERS'LIABILITY TORY I IMITS I ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $100,000 OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $100,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $500,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS APR 1 8 2007 r CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION City of Oak Park Heights DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3n DAYS WRITTEN 14168 Oak Park Blvd North NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL PO Box 2007 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Oak Park Heights,MN 55082 REPRESENTATIVES. AUTHORIZED REPRESENTATIVE A°{- 02-06.40.444:101 ACORD 25(2001/08)1 of 2 #M12957 EMC1 © ACORD CORPORATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies)must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer,and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25-S(2001/08) 2 of 2 #M12957 Jun 15 06 11 : 42a p. 1 r Guaranteed Clean Maintenance, Inc. t 1565 Como Avenue * Suite #101 * St. Paul, MN 55108 C (651) 644-9919 * FAX (651) 644 0900 <0. 0 FAX COVER SHEET J Attention: yAkI i:9 fCom an Name: Oak CVL H J y d C L-1-39—Q 7 From: rri k -c /1 ,b(.44_6, Number of pages, including cover: J Date: Coj/S1(30& Notes: Lr1 U" J< � /0.-es t_. Lii—US- , tG q.- Lt y J wCt,-L4 , AtbrIK k_cyrul. 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"• tk.„3.0 M-260-1 os.a-ta-141 CARLTON MCCOY 9.95 FULLER AVE ST PAUL.MN 55104 viSLAI tel0; (.1r4 A IA" %.0 ;777 • 1 -n 1Cov 2 ,CCIA/yCL/P0f,VU1APEP -AG!,01,PE rs...ri 111111M !ill ji:41 rzi .11! 0;171 •" Mar 31 06 02: 29p p. 1 C4C Guaranteed Clean Maintenance, Inc. 1565 Como Avenue•Suite #101 • St. Paul, MN 55108 (651) 644-9919 • FAX(651) 644-0900 FAX COVER SHEET ATTN: Eck' vt Company Name: OGk W.,PL. F64,4 4139 -OS 74 From: 4 Number of pages, including cover: Z ;late: 3/3( /O Notes: U VVIN Gaei/C v■- 41,45 PL 0 Vvxou CA5 5-coti p ()OCC Li 64\t3r titvZ 1972- t998 Client#: 14832 GUACL ACORD„ CERTIFICATE OF LIABILITY INSURANCE DATE PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION J.A.Price Agency,Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 6640 Shady Oak Road HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR y ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Suite 500 Y Eden Prairie, MN 553444176-- .."° INSURERS AFFORDING COVERAG NAIL# X.. INSURED , INSURER r�+ ' Guaranteed Clean Maintenance, Inc. r-a�ir_31v ` Git3 i1 INSURER C 1565 Como Ave;Suite 101 \1!!l ����� Saint Paul, MN 55108 INSURER N, INSURER D im 1! aiti∎ y �,, INSURER E:"I„ W _ COVERAGES —,. .. , .„ . ",�, THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED A •VE FOR THE POLICY PERIOD ■D ' • D.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH R SPE • ' - - - IFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJEC 0 ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR AMYL TYPE OF INSURANCE POLICY NUMBER 'POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR/NSRO DATE(MM/DD/YY) DATE(MWDD/YY) A GENERAL LIABILITY S1747126 04/01/06 04/01/07 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY PRM S RENTED PREMISES(( $100,000 occurrence) 004 iCLAIMS MADE n OCCUR MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS•COMP/OP AGG $3,000,000 X POLICY n JE a n LOC A AUTOMOBILE LIABILITY S1747126 04/01/06 04/01/07 COMBINED SINGLE LIMIT $1,000,000 X ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY _ SCHEDULED AUTOS (Per person) $ X HIRED AUTOS BODILY INJURY X NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT y $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ A EXCESS/UMBRELLA LIABILITY S1747126 04/01/06 04/01/07 EACH OCCURRENCE $4,000,000 iiOCCUR E CLAIMS MADE AGGREGATE $4,000,000 $ DEDUCTIBLE _ $ _ X RETENTION $10000 $ A WORKERS COMPENSATION AND WC7252536 04/01/06 04/01/07 X I WC STATUS I IOTH- TORY LIMITS 1 ER EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $100,000 OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $100,000 If yes,describe under SPECIAL PROVISIONS below _ E.L.DISEASE-POLICY LIMIT ,$500,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION City of Oak Park Heights DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL an DAYS WRITTEN 14168 Oak Park Blvd North NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL PO Box 2007 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Oak Park Heights,MN 55082 REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2001/08)1 of 2 #M12195 EMC1 © ACORD CORPORATION 1988 Cleaning Contract 44- on t is made this 3 I —day of 411.5 k045 between the This C trac s ad , « „ y City of Oak Park Heights, ("City"),existing under the laws if the State of Minnesota, with offices at 14168 Oak Park Blvd, Oak Park Heights,MN 55082,and Contractor Guaranteed Clean Maintenance, Inc., "Contractor" Recitals The City desires to retain the services of the Contractor to provide cleaning services for the Oak Park Heights City Hall and Police Department as outlined in Section I and in Attachment 1. Should a conflict arise between this Contract and its Attachment 1,the Cleaning Contract shall take precedence and not Attachment 1. Contractor agrees perform these services for the City under the terms and conditions as � to P ty set forth in this Contract and in areas as shown during the Contractor's pre-bid walk-thru. In consideration of the mutual promises set forth herein, it is agreed between the City and the Contractor as follows: Section I.Nature of Work The Contractor will perform the cleaning services for the City Hall and Police Department. Such cleaning services include general cleaning of all public and office areas,bathrooms,meeting rooms,kitchens,break-rooms and offices,e.g.,dusting, vacuuming, sweeping,mopping,bathroom cleaning,etc. The City Hall and Police Department shall be jointly cleaned on Thursday mornings commencing at 7:30 AM,with the City Hall areas to be done first. The City Hall areas shall receive a second cleaning,but such second cleaning shall be either on Monday evening after 4:30 PM or Tuesday morning with cleaning complete by 8:00 AM. These dates and times may be amended by mutual,written agreement. Section II. Place of Work It is understood that the Contractor services will be rendered entirely at the Oak Park C s y Heights City Hall and Police Department, 14168 Oak Park Blvd, Oak Park Heights,MN, 55082. Section III. Compensation 1. The Contractor will charge the City as follows: $657.00 per month. Fees may only be increased by mutual and written agreement. There shall be no surcharges,taxes or other fees placed on invoices submitted to the City without prior written consent and agreement by both parties that such fees are valid and enforceable. ( r Section IV. Status of Contractor This Contract calls for the performance of services of the Contractor as an independent p pe contractor and the Contractor will not be considered as an employee or agent of the City for any reason. Section V. Indemnification and Insurance Any and all claims that arise, or may arise against the Contractor, its contractors, servants or employees as a consequence of any act or omission on the part of the Contractor or its contractors, servants or employees while engaged in the performance of this Contract shall in no way be the obligation or the responsibility of the City. Contractor shall indemnify,hold harmless and defend the City, its officers and employees against and all liability, loss, costs, damages, expenses, claims or actions, includin g attorney's fees, which the City, its officers or employees may hereafter sustain, incur or be inquired to pay, arising out of or by reason of any negligence or willful act or omission of the Contractor, its Contractors, servants or employees, in the execution,performance or failure to adequately perform Contractor's obligations under this Contract. The Contractor shall maintain in a general liability policy for not less than$500,000; such policies shall remain in effect,name the City as additionally insured and copies of such policy shall be provided to the City. The City provides no warranty or assurances to the Contractor as to the condition of the facilities where services are being provided.The Contractor provides all such services at their"own risk". For reasons other than willful negligence by the City,the Contractor acknowledges that the City is not responsible for loss, injury or other damages sustained by the Contractor while performing the terms of this Contract or while on City property. Section VI. Authority and Security The City hereby grants to the Contractor all authority reasonably necessary to pursue and achieve the objectives of this Contract. The City shall provide a key to the City Hall (not incl. the Police Department)to the Contractor for their purposes only and shall be utilized only for the purposes as outlined in this Contract. The Contractor,who has been provided keys to the City Hall shall return such keys to the City upon request or upon the termination of this Contract. Should the Contractor fail to return such keys to the City, the Contractor shall be responsible for the costs related to the re-keying of the City Hall. The Police Department shall be cleaned only during normal business hours—between 8:00 am and 4:30 pm, Monday to Friday and when Police staff are present, subject to Section I. above. The Contractor,their employees or sub-contractors shall be subject to a police background and security check. Prior to any person entering the City Hall and/or Police Department to provide cleaning services, such person must have been pre-approved by the City Police Department. The Contractor shall provide the City a copy of a valid f r Minnesota or Wisconsin Drivers License or Identification Card for pre-approval for all persons who will performing work under this Contract. The City shall have a minimum of 48 hours to perform a necessary background check. Should the Contractor not strictly comply with the terms of this Section(VI),the City may immediately terminate this Contract without further notification or action required and without penalty. Upon such termination the Contractor shall surrender to the City all provided keys, equipment,etc as may have been provided. Section VII.Duration k,,, tilt a This Contract will commence on 5 41'. I Z ,2005 and will be in effect until terminated or replaced by a new contract. This Contract may be terminated for any reason by either party,with no termination penalties,upon thirty(30)days written notice to terminate this Contract. IN WITNESS W KO OF,the parties have agreed to the above terms this 3 ' day ' ng U'cJ , 200 S • / ity of O Pa eights C Johns, City Administrator Contra f` 4r- JULIE R.JOHNSON Notary for Contractor: ' NOTARY PUBLIC-MINNESOTA ( hi,e- f]{ f( 1r oo ``�1 My Cpmmission Expires Jan.31,2010 1 Attachment 1 "Cleaning Specifications" and Language from Contractor as submitted with proposal. • CLEANING SPECIFICATIONS FOR OAK PARK HEIGHTS CITY HALL AND POLICE DEPARTMENT E. AREAS OF SERVICE Cleaning will be performed in entryway, lobby, corridors, conference rooms, Council Chambers,offices, break room,and rest rooms. F. CLEANING SPECIFICATIONS GENERAL CLEANING FREQUENCY * Dust flat surfaces such as desks,file cabinets, bookshelves, chairs, Each Service ledges,pictures and window sills. Papers and other personal items should not be moved. * Wash off desk tops when completely cleared. Each Service * Spot clean marks on woodwork, walls, partitions, door frames, hand Each Service and kick plates,doors, light switches, and glass. Pay special attention to kitchen cabinets by door handles. * Clean lunchroom,this to include all tables and chairs, Each Service microwaves inside and out, sinks and counter tops. * Spot clean entrance and partition glass. Each Service * Secure building doors and lights as required. Each Service * Maintain janitorial closets in a professional manner. Each Service FLOOR CARE: FREQUENCY * Vacuum entry matting. Each Service * Vacuum carpeted areas. Each Service * Dust-mop or sweep all hard surface floors and remove dirt from corners. Each Service * Damp-mop all tiled floors. Each Service * Spot clean carpeting to remove stains and spills. Each Service RESTROOM MAINTENANCE: FREQUENCY * Empty all waste receptacles,change liners as needed and place for Each Service disposal in designated area. * Dust horizontal surfaces. Each Service * Remove gum, tar and other foreign substances from floor. Each Service * Report any fixture not working properly. Each Service * Clean and polish dispensers,chrome, mirrors, and wash basins. Each Service * Check and refill towel, soap,and toilet dispensers. Each Service * Spot clean walls around sinks,towel dispensers, urinals, partitions and Each Service door frames. * Empty and clean sanitary napkin disposal units and replace liners. Each Service * Clean and disinfect toilets,toilet seats and urinals. Each Service * Wet mop all floors with detergent/disinfectant solution. Each Service MONTHLY DUTIES: FREQUENCY QU NCY * Dust or vacuum air return vents and grills. Each Month * Edge vacuum all carpeted areas. Each Month ' , G. SPECIALTY SERVICES GCM has fully trained specialty crews and equipment to provide the following specialty services. We would be pleased to submit a quotation for any of these services upon your request. * CARPET CLEANING * CARPET EXTRACTION(Hot Water) * CARPET MAINTENANCE PROGRAMS * UPHOLSTERY CLEANING AND PROTECTION * ANTI-STATIC CONTROL * WINDOW WASHING * DRAPERY AND VERTICAL OR HORIZONTAL BLIND CLEANING * FLOOR STRIPPING AND RESEALING * LIGHT FIXTURE LENS WASHING * EMERGENCY FIRE AND FLOOD CLEAN-UP H. GENERAL PROVISIONS CUSTOMER SATISFACTION Customer satisfaction is vital to our success. We offer a unique cleaning guarantee. Our "No Cleaning-No Payment Guarantee"assures you of satisfactory cleaning. "If you are not completely satisfied with the service we have provided,just call the next day to notify us and you will not pay for that particular aspect of the service." s • „ H. GENERAL PROVISIONS(CONT'D) SUPPLIES AND EQUIPMENT GCM will provide all equipment and cleaning supplies necessary to complete the cleaning as specified. These supplies and equipment will include(but are not limited to) the following: * Water tight transport carts for removing trash. * Vacuums of commercial quality with bumper pads to prevent chipping and damaging of furniture. * Brooms, dust mops, buckets and wringers, mops, wet vacuums, buffers and edge vacuums. * Floor soaps,germicidal,toilet cleansers, window cleaner, stainless steel cleaner,etc. INSURANCE COVERAGE We carry Property Damage Liability Insurance,Bodily Injury Liability Insurance, Business Service Fidelity Bond and Workman's Compensation Insurance. A Certificate of Insurance will be sent to you. OPERATING PROCEDURES 1. GCM will maintain neat and orderly storage rooms. 2. Lights shall not be turned on until required and turned off as soon as cleaning is finished. 3. GCM will provide a log book. The purpose of this log is for two way communication between you,the customer and the cleaner. 4. Upon completion of cleaning, GCM will properly arrange furniture, shut off designated lights, lock designated doors and comply with any alarm procedures. ADJUSTMENTS The price set forth in this proposal is based on the necessary labor, supplies,equipment and supervision necessary to maintain your facility properly as set forth in the specifications. In the event of any changes in conditions, such as an increase or decrease in the amount of space we are cleaning, or the addition or subtraction of days service is provided,the contract price may be increased or decreased accordingly with thirty(30) days written notification. This would be by mutual agreement. The cleaning up of excessive and abnormal debris caused either intentionally or unintentionally by construction contractors is not included in the cleaning specifications but will be completed upon request and billed separately. . ` Y ° r II. ilik I. TERMS Janitorial service shall be performed as outlined in this agreement,except for the following holidays: New Year's Day, Memorial Day,Independence Day, Labor Day, Thanksgiving Day and Christmas Day. Service can be provided on any of the above listed holidays if requested. There will be an additional charge for holiday service. It shall be understood and agreed upon by both parties that during the term of this agreement and for one(1)year from the termination date of said contract that either party(including organizations performing placement or hiring services on their behalf)will not hire either party's personnel, unless mutually agreed upon in writing by both parties. In the event that such mutual consent is not obtained,the hiring party hereby agrees to compensate the other party in the amount of thirty-five percent(35%)of the annualized wages of the person hired. The placement fee shall be immediately due and payable commensurate with the new employee date. Guaranteed Clean Maintenance, Inc. will perform all services required here under,except when prevented by strike, lockout, act of God, accident or other circumstances beyond our control. Should this proposal become accepted, it will form an agreement. It may be modified from time to time as set forth above and may be terminated in its entirety by either party at any time by giving written notice of their desire to do so thirty(30)days prior to the selected date of termination. A longer period may be effected should you require. A statement will be sent in the beginning of each month for that month's service. Payment is due no later than the last day of the month in which the services are performed. Guaranteed Clean Maintenance, Inc. charges 1.5% interest on past due accounts,and reserves the right to terminate services at any time after payment becomes delinquent. J. BUILDING SERVICE AGREEMENT Guaranteed Clean Maintenance, Inc. agrees to the services set forth in the specifications for the consideration set forth below: Service to be performed 2 Days per week in City Hall areas and 1 day per week in the Police Department areas. Contract price is $657.00 Per month,plus tax. Service to commen e t Of- 5 P I l� 200. GUARANTEED CLEAN MAINTENANCE, INC. By �L , .4, —,I As - Date 04 '2 ci—b S Raymond J ire me, f E CI r' OF e--K 1,/HEIGHTS By �� Date 31-0 ----0 iiier_ c4 Mar 23 06 03: 06p p. 2 4. F b\t`-10 \I KS r,._ . ......................„.......------ OV,i,tA t‘ G � �e, CtA GG g&i,02 -2' 93 . am_essigt.e„,.....,...._,..14.4.1am.....,_„...., . .. . .. U ;4\I/ems l • _:Q'. .' . .....,-;‘,.•.,L.).,',-.\ ': zt. r `'' 1I I1 "+ -I1�re IV •`'t 1,, . . - ;1,0/ . . ' 1(1], 11 1 /' `=' JOJ 1/11"1 MINNESOTA DRIVERS LICENSE $ i BIM nth+=7 1 < IIi , 0-150- :- -635 155KS TCO D NE f 0EAR MAPLEW000,MN 55109 Mar 23 06 03: 05p p• 1 1 ( c1C ua a Clean Maintenance, G teed r n C Inc. 1565 Como Avenue • Suite#101 • Sr. Paul, MN 55108 (651) 644-9919 • FAX(651) 644-0900 FAX COVER SHEET AITN: Er - -Okr∎50 Ey X139-057 Company Name: Ci Q(- O4 Po rk 146 314-5 14-5 From: 010 Number of pages, including cover: Z Date: 124106, Notes: � , w . (1972- 1998 I hereby acknowledge receipt of key # A3 from the City of Oak Park Heights on September 12, 2005. ViAir Signed • +:' JULIE R.JOHNSON - ,� NOTARY PUBUC-MINNESOTA uN ' Expires Jan.31,2010 �f�f�_-�Commission ExpRe 4c �l�t1d Guaranteed Clean Maintenance, Inc. 1565 Como Avenue • Suite I • St.Paul, MN 55108 (651) 644-9919 • 651,-644-0900 www.gcm- om 1 7;c4 September 13, 2005 Eric Johnson City of Oak Park Heights 14168 Oak Park Blvd. No PO Box 2007 Oak Park Heights, MN 55082 Dear Eric: It is a pleasure to welcome you as a new customer of Guaranteed Clean Maintenance,Inc. We shall try very hard to keep you a satisfied customer. We firmly believe that giving our valued customers something extra in the way of service and quality will insure a long and pleasant association. Please feel free to call me if you should have any questions regarding our current services or any additional services that you require. Thanks again, I'm looking forward to a good working relationship. Sincerely, A04v Ray(IeVine, CI3SE President RD/aly enclosures )1(il Since 1972 41 Client#: 14832 GUACL ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE( 05Dmrn PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION J.A.Price Agency,Itic. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 6640 Shady teak Road HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR y ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Suite 500 Eden Prairie,MN 55344-6176 INSURERS AFFORDING COVE- ' -G NAIL:# INSURED INSURER A: Selective Insurance v ale E ow s Ni, Guaranteed Clean Maintenance, Inc. INSURERS: 1 II 1565 Como Ave;Suite 101 INSURER C: lia It,r Saint Paul,MN 55108 , / INSURER D: I1,„1� ra M !1• IIII„f INSURER E: 11 I r COVERAGES QlryQ p, THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT UOR OTHER DOCUMENT WITH RESPECT TO WHICH OL THIS -•IFICAY B z ISSUED OR DING MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR INSRO DATE(MM/DD/YY) DATE IMMIDDY) A GENERAL LIABILITY S174712600 04/01/05 04/01/06 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE PREMISES(Ea occurrence) $100,000 CLAIMS MADE X OCCUR MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $3,000,000 _ X I POLICY n PRO JECT- LOC A AUTOMOBILE LIABILITY S174712600 04/01/05 04/01/06 COMBINED SINGLE LIMIT $1,000,ODU X ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ X HIRED AUTOS BODILY INJURY X NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ A EXCESS/UMBRELLA LIABILITY S174712600 04/01/05 04/01/06 EACH OCCURRENCE $4,000,000 X OCCUR CLAIMS MADE AGGREGATE $4,000,000 $ DEDUCTIBLE $ X RETENTION $10000 $ A WORKERS COMPENSATION AND WC725253600 04/01/05 04/01/06 X TOTMS- TV- EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $100,000 OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $100,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $500,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION City of Oak Park Heights DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN 14168 Oak Park Blvd North NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Oak Park Heights, MN 55082 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ‘414t4 ACORD 25(2001/08)1 of 2 #M11427 TLM 0 ACORD CORPORATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer,and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25-S(2001/08) 2 of 2 #M11427 Sep 08 05 03: 08p 2 SEP-0?-2085 14:46 OAK PARK HEIGHTS C:1IY r.ua P oi Guaranteed Clean Maintenance, Inc 1563 Como Avenue • Suite *101 •St,Paul,MN 55108 (651) 644-9919 • FAX(651) 644-0900 wwuugon-tnc tom September 6,2005 Eric A.Johnson,City Administrator City of Oak Park Heights 14168 Oak Park Boulevard Oak Park Heights,MN 55082 Dear Eric, As discussed,we would like to perform the cleaning of the City Hall and '' department on the following schedule. j0 Polio Department:Cleaning every Tuesday afternoon(complete by4110) City Hall:Cleaning every Tuesday and Thursday after business s, Please let me know if you have any questions,or if this schedule will not work for •u. ° If this schedule is acceptable please sign on the space provided below. 9 r Thank you for your business. Sincerely, f/44.t.Uh) Mark DeVine Vice President Sales and Marketing tv Mlw) Date 7#115 JFMCNAS 7)fE CeNTTZ*C7 Pfi j a u- A-at tar oily.. Ott OTWi2 p, ,wwrn S Remo fef q..�-O iftirtU 1972 TOTAL P.01 Sep 07 05 08: OSa p' 2 Guaranteed Clean Maintenance, Inc. 1565 Como Avenue • Suite #101 • St.Paul, MN 55108 (651) 644-9919 • FAX (651) 644-0900 September 6,2005 www.gcm-inc.com Eric A.Johnson, City Administrator City of Oak Park Heights 14168 Oak Park Boulevard Oak Park Heights,MN 55082 Dear Eric, As discussed,we would like to perform the cleaning of the City Hall and Police department on the following schedule. Police Department: Cleaning every Tuesday afternoon(completed by 4:30) City Hall: Cleaning every Tuesday and Thursday after business hours. Please let me know if you have any questions,or if this schedule will not work for you. If this schedule is acceptable please sign on the space provided below. Thank you for your business. Sincerely, Mark DeVine Vice President Sales and Marketing 5�►eJ_ (cl \\7' X '� R-1�os Date 1)(15 /}MCN b S Tifr 0/s/ GT PAIr or a-EA-Nbvt cw y. � 07710 PRow 'motc /lema rn "I Since 1972 (rc��4. INDEX TO PROPOSAL A. COVER LETTER B. INTRODUCTION C. QUALITY CONTROL D. PERSONNEL 1. SELECTING 2. TRAINING E. AREAS OF SERVICE F. CLEANING SPECIFICATIONS G. SPECIALTY SERVICES H. GENERAL PROVISIONS 1. CUSTOMER SATISFACTION 2. SUPPLIES AND EQUIPMENT 3. INSURANCE 4. OPERATING PROCEDURES 5. ADJUSTMENTS I. TERMS J. BUILDING SERVICE AGREEMENT CONFIDENTIAL The information contained in this proposal is confidential. No duplication or release of this information is permitted ff Without written authorization by GCM,Inc. cic Guaranteed Clean Maintenance, Inc. 1565 Como Avenue • Suite #101 • St.Paul, MN 55108 (651) 644-9919 • FAX (651) 644-0900 August 24,2005 www.gcm-inc.com Eric Johnson, City Administrator City of Oak Park Heights 14168 Oak Park Blvd.N. Oak Park Heights,MN 55082 Dear Eric: Guaranteed Clean Maintenance,Inc. is pleased to present this proposal for contract cleaning services to you for City of Oak Park Heights. We are submitting operational data,specific areas of responsibilities, specifications, general terms, and the value of our professional service. We at GCM are committed to providing you with a superior cleaning maintenance program. A program that is a cost effective solution that meets your highest expectations. We do whatever is necessary to provide you with a clean environment,thereby promoting effective facility management. If you have any questions about our service or need clarification on any point,please call me. We appreciate the opportunity to submit this proposal and look forward to working with you soon. Sincerely, +4IfJP Mark DeVine Vice President Sales&Marketing MD/aly Since 1972 ()j( B. INTRODUCTION Guaranteed Clean Maintenance,Inc.began operations on June 3, 1972. We have grown successfully year by year because of our total commitment to QUALITY SERVICE. Our goal is to provide our customers with a superior maintenance program that is designed to meet their exact needs and is cost effective. In order to accomplish our goals we hire quality employees,properly train them and continuously communicate with them. Because of this management philosophy,you can be assured that your facility is being handled by people who care! C. QUALITY CONTROL In order to maintain a consistently clean environment and trouble free service,GCM conducts regular inspections of your facility by an assigned supervisor. In addition,we schedule periodic, daytime walk throughs of your facility with our management. You can be assured that from our walk throughs, any requests that you make regarding your facilities needs will be implemented consistently and conscientiously. D. PERSONNEL SELECTION Aside from proper management and supervision,we feel the single most important part in any building maintenance program is the individuals that are actually doing the cleaning. GCM gives this part of our business all the attention it deserves. We begin our hiring process with individuals who we feel are conscientious and will be responsible for their actions within your facility. In order to assure we hire quality people,each applicant undergoes a thorough background check with prior employers, as well as a criminal history check. Our experience has shown that past work records are a very good indication of future performance. All new employees are put on a 30 day probation period. During this time their performance and attitude is monitored closely. If a customer finds an employee objectionable for any reason it is our policy to remove the employee immediately. T14 TRAINING Once a person has been hired we feel they deserve to be properly trained to do the required job. It has been our experience that the better trained an employee is the more satisfied they will be with their job,thus becoming a more valuable employee. All new employees begin their training through an orientation program. This orientation program gives the employee background information about the company. In addition, they are trained in chemicals and hazards,to comply with high OSHA standards. This information trains the employees in all aspects of the important Federal"Right to Know Act"regarding safety procedures. Employees are also given useful information on company policies,handling of equipment,emergency procedures,etc. We feel this provides an excellent base of communications. Training begins by working with an experienced manager. When we start a new building,we clean exclusively with experienced personnel, setting up complete routines. When the new employee starts they watch the trainer do the routine the first night. The second night they do the routine under constant supervision. The third night they do the routine themselves with their work being inspected. TIME KEEPING To keep accurate time of our employees,we track all of our employee's times in and out of each building, as well as nightly and weekly budgets reports through Express Time, a computer program which allows employees to call in and out their times,via the telephone,from a remote location. In addition,area supervisors are able to call into this system to ensure that all scheduled cleaning is being done through the Notification Schedule. Should the regular cleaner,for whatever reason,not check in at their regularly scheduled time, a supervisor will then investigate and make sure your building is properly cleaned. CLEANING SPECIFICATIONS FOR OAK PARK HEIGHTS CITY HALL AND POLICE DEPARTMENT E. AREAS OF SERVICE Cleaning will be performed in entryway, lobby, corridors,conference rooms, Council Chambers, offices, break room,and rest rooms. F. CLEANING SPECIFICATIONS GENERAL CLEANING FREQUENCY * Dust flat surfaces such as desks,file cabinets,bookshelves,chairs, Each Service ledges,pictures and window sills. Papers and other personal items should not be moved. * Wash off desk tops when completely cleared. Each Service * Spot clean marks on woodwork,walls,partitions,door frames,hand Each Service and kick plates, doors, light switches, and glass. Pay special attention to kitchen cabinets by door handles. * Clean lunchroom,this to include all tables and chairs, Each Service microwaves inside and out, sinks and counter tops. * Spot clean entrance and partition glass. Each Service * Secure building doors and lights as required. Each Service * Maintain janitorial closets in a professional manner. Each Service FLOOR CARE: FREQUENCY * Vacuum entry matting. Each Service * Vacuum carpeted areas. Each Service * Dust-mop or sweep all hard surface floors and remove dirt from corners. Each Service * Damp-mop all tiled floors. Each Service * Spot clean carpeting to remove stains and spills. Each Service RESTROOM MAINTENANCE: FREQUENCY * Empty all waste receptacles,change liners as needed and place for Each Service disposal in designated area. * Dust horizontal surfaces. Each Service * Remove gum,tar and other foreign substances from floor. Each Service * Report any fixture not working properly. Each Service * Clean and polish dispensers,chrome,mirrors,and wash basins. Each Service * Check and refill towel, soap, and toilet dispensers. Each Service * Spot clean walls around sinks,towel dispensers,urinals,partitions and Each Service door frames. * Empty and clean sanitary napkin disposal units and replace liners. Each Service * Clean and disinfect toilets,toilet seats and urinals. Each Service * Wet mop all floors with detergent/disinfectant solution. Each Service MONTHLY DUTIES: FREQUENCY * Dust or vacuum air return vents and grills. Each Month * Edge vacuum all carpeted areas. Each Month G. SPECIALTY SERVICES GCM has fully trained specialty crews and equipment to provide the following specialty services. We would be pleased to submit a quotation for any of these services upon your request. * CARPET CLEANING * CARPET EXTRACTION(Hot Water) * CARPET MAINTENANCE PROGRAMS * UPHOLSTERY CLEANING AND PROTECTION * ANTI-STATIC CONTROL * WINDOW WASHING * DRAPERY AND VERTICAL OR HORIZONTAL BLIND CLEANING * FLOOR STRIPPING AND RESEALING * LIGHT FIXTURE LENS WASHING * EMERGENCY FIRE AND FLOOD CLEAN-UP H. GENERAL PROVISIONS CUSTOMER SATISFACTION Customer satisfaction is vital to our success. We offer a unique cleaning guarantee. Our "No Cleaning-No Payment Guarantee"assures you of satisfactory cleaning. "If you are not completely satisfied with the service we have provided,just call the next day to notify us and you will not pay for that particular aspect of the service." H. GENERAL PROVISIONS(CONT'D) SUPPLIES AND EQUIPMENT GCM will provide all equipment and cleaning supplies necessary to complete the cleaning as specified. These supplies and equipment will include(but are not limited to) the following: * Water tight transport carts for removing trash. * Vacuums of commercial quality with bumper pads to prevent chipping and damaging of furniture. * Brooms, dust mops, buckets and wringers,mops,wet vacuums,buffers and edge vacuums. * Floor soaps,germicidal,toilet cleansers,window cleaner,stainless steel cleaner,etc. INSURANCE COVERAGE We carry Property Damage Liability Insurance,Bodily Injury Liability Insurance, Business Service Fidelity Bond and Workman's Compensation Insurance. A Certificate of Insurance will be sent to you. OPERATING PROCEDURES 1. GCM will maintain neat and orderly storage rooms. 2. Lights shall not be turned on until required and turned off as soon as cleaning is finished. 3. GCM will provide a log book. The purpose of this log is for two way communication between you,the customer and the cleaner. 4. Upon completion of cleaning,GCM will properly arrange furniture,shut off designated lights,lock designated doors and comply with any alarm procedures. ADJUSTMENTS The price set forth in this proposal is based on the necessary labor,supplies,equipment and supervision necessary to maintain your facility properly as set forth in the specifications. In the event of any changes in conditions, such as an increase or decrease in the amount of space we are cleaning,or the addition or subtraction of days service is provided,the contract price may be increased or decreased accordingly with thirty(30) days written notification. This would be by mutual agreement. The cleaning up of excessive and abnormal debris caused either intentionally or unintentionally by construction contractors is not included in the cleaning specifications but will be completed upon request and billed separately. TERMS Janitorial service shall be performed as outlined in this agreement,except for the following holidays:New Year's Day,Memorial Day,Independence Day,Labor Day, Thanksgiving Day and Christmas Day. Service can be provided on any of the above listed holidays if requested. There will be an additional charge for holiday service. It shall be understood and agreed upon by both parties that during the term of this agreement and for one(1)year from the termination date of said contract that either party(including organizations performing placement or hiring services on their behalf)will not hire either party's personnel,unless mutually agreed upon in writing by both parties. In the event that such mutual consent is not obtained,the hiring party hereby agrees to compensate the other party in the amount of thirty-five percent(35%)of the annualized wages of the person hired. The placement fee shall be immediately due and payable commensurate with the new employee date. Guaranteed Clean Maintenance,Inc. will perform all services required here under,except when prevented by strike, lockout,act of God,accident or other circumstances beyond our control. Should this proposal become accepted, it will form an agreement. It may be modified AHD- 54-1/r 6AV from time to time as set forth above and may be terminated in its entirety by either party •°4-.1 at any time by giving written notice of their desire to do so thirty(30)days prior to the #.• I 3 /4/ selected date of termination. A longer period may be effected should you require. Si vrFb� err ,,`- A statement will be sent in the beginning of each month for that month's service. Cc to r' Payment is due no later than the last day of the month in which the services are performed. Guaranteed Clean Maintenance,Inc. charges 1.5% interest on past due accounts,and reserves the right to terminate services at any time after payment becomes delinquent. J. BUILDING SERVICE AGREEMENT Guaranteed Clean Maintenance,Inc.agrees to the services set forth in the specifications for the consideration set forth below: Service to be performed 2 Days per week in City Hall areas and 1 day per week in the Police Department areas. Contract price is $657.00 Per month,plus tax. Service to commence GUARANTEED CLEAN MAINTENANCE,INC. By Al Date r'ezif -Q S Raymond J. deVine, t SE CITY OF OAK PARK HEIGHTS By Date I CBSE CBSE: Certified THE Building Service MARK Executive OF Our company has the executive leader- EXCELLENCE ship you expect in a building service contractor—leadership exemplified by the Certified Building Service Executive (CBSE)—leadership that delivers profes- sional, quality service. What does a CBSE mean to You? The Certified Building Service Executive is an expert building service executive.A minimum of five years in in the management of contract cleaning. He or she is the industry and three years in an executive policy- a professional executive with demonstrated knowl- making position is mandatory for consideration of edge and skill widely recognized in the building the CBSE designation. In order to maintain their service industry—the same knowledge and skill that designation, CBSEs must participate in ongoing, • can assure you a properly maintained building. educational activities. These activities keep them apprised of the latest industry developments with For the CBSE, state-of-the-art cleaning technology is respect to management techniques, financial and ` the key to maintaining your building at a peak level of strategic planning, risk management, and legal issues. appearance and cleanliness.And yet,an understand- The Certification Program is administered by the ing of cleaning technology is just one facet of the Building Service Contractors Association Intema- CBSE's credentials.The CBSE is an executive with tional(BSCAI),a non-profit organization which is broad business and management expertise—an dedicated to furthering the professionalism of the executive who ensures that your building's mainte- industry and whose membership is comprised of nance needs are met smoothly and cost-effectively building service companies worldwide. In short, placing your building in the hands of a CBSE means having the technical cleaning knowledge and CBSEs are professional executives who actively seek executive experience you expect. to further the image of the building service industry. These executives strive to provide your building with 1b achieve the CBSE designation, building service well-trained cleaning personnel and to use effective contractors must participate in a Certification Pro- techniques for estimating your building's supplies gram which requires their successful completion of and labor needs. CBSEs adhere to the BSCAI Code a rigorous, full-day examination. Additionally, they of Ethics,which advocates professionalism and fair must document their experience and tenure as a business practice among cleaning contractors. Professional, quality service with assurance. It's what BSCAI you've been looking for. And you'll find it by hiring the .456, _ company led by a Certified Building Service Executive. BSCAI's Certification Program is strictly voluntary.That a person is not Building Service Contractors certified does not indicate that he or she is unqualified as a building g service contract executive,only that the individual has not fulfilled the Association International requirements for the CBSE designation or has not applied for the 10201 LEE HIGHWAY•SUITE 225 program.BSCAI specifically disclaims any attempt to interfere with or FAIRFAX,VA 22030 limit,in any way,the professional activities of anyone in the practice 703-359-7090.800-368-3414 of building service management. FAX 703-352-0493 ©2003 Building Service Contractors Association International A Better Cleaning Service P.O. Box 129 Stillwater, MN 55082 651-442-1804 August 29, 2005 Mr. Eric Johnson City of Oak Park Heights 14168 Oak Park Boulevard Oak Park Heights, MN 55082 Re: Cleaning bid Dear Mr. Johnson, Thank you for taking the time to show me around the offices on Friday morning. After careful consideration I have come up with the following numbers for cleaning at Oak Park Heights City Hall and Police Department: CLEANING OF CITY HALL: $ 115.00 + tax per clean i w"`' CLEANING OF CITY HALL AND POLICE DEPT: $ 150.00 ± tax per clean '3" 70 ,217s(� 2 . sl 13,70 These prices are to include general cleaning as outlined in Section I of the cleaning contract, but more specifically: Dusting or cleaning of the , following areas: The front, top, and exposed sides of desks, chairs, y; \ tables, counters, cupboards, shelves, showers, toilets, sinks, vanities, built-ins, knickknacks, pictures, doors, trim, baseboards, and surfaces of electronic equipment and furniture that can easily be reached. The inside of the microwave. The inside of the windows and glass doors will be cleaned or spot-cleaned as needed. Floors will be washed with an appropriate cleaner, Carpets and rugs will be shaken and jor vacuumed. These prices do not include dishes, carpet steam cleaning, or cleaning walls. The inside of closets, pantries, cupboards, and containers are not included. Washing of upholstered furniture is not included in this bid. Books will not be removed from bookshelves, and items on desks and work areas will not be moved, but dusted around or over. City OPH bid August 29, 2005 Page 2 of 2 I have attached a copy of my insurance coverage. I am currently covered for $100,000. I spoke to my insurance agent on Friday and was told that changing this amount to $500,000 is as simple as a phone call to her and can be done the same day that the contract may be awarded. This can be verified by contacting 3anet 3ezior at State Farm Insurance 651-439-8600. I have also attached a copy of my driver's license for any background check that may be needed. I again want to thank you for your time and consideration, and I look forward to hearing from you. Sincerely, P J' (Th Quaderer 651-442-1804 Enclosures STATE FARM CERTIFICATE OF INSURANCE S th t ® STATE FARM FIRE AND CASUALTY COMPANY, Bloomington, Illinois ®O 0 STATE FARM GENERAL INSURANCE COMPANY, Bloomington, Illinois in uresttkrerf 4l ing policyholder for the coverages indicated below: Nam of policyholder SUSAN QUADERER DBA A BETTER CLEANING SERVICE Address of policyholder PO BOX 129 STILLWATER, MN 55082 Location of operations SAME Description of operations CLEANING SERVICE The policies listed below have been issued to the policyholder for the policy periods shown. The insurance described in these policies is sub'ect to all the terms exclusions,and conditions of those .•licies.The limits of Iiabili shown ma have been reduced b an 'aid claims. POLICY NUMBER TYPE OF INSURANCE POLICY PERIOD LIMITS OF LIABILITY Effective Date Expiration Date (at beginning of policy period) Comprehensive BODILY INJURY AND 93—KS-0829-4 Business Liability 05/04/05 05/04/06 PROPERTY DAMAGE This insurance includes: ►0 Products-Completed Operations ®Contractual Liability — ®Underground Hazard Coverage Each Occurrence $ 100000 ® Personal Injury ®Advertising Injury General Aggregate $ 200000 ❑ Explosion Hazard Coverage Products-Completed ❑Collapse Hazard Coverage Operations Aggregate $200000 ❑General Aggregate Limit applies to each project 0 ❑ _ EXCESS LIABILITY POLICY PERIOD BODILY INJURY AND PROPERTY DAMAGE Effective Date Expiration Date (Combined Single Limit) ❑Umbrella Each Occurrence $ ❑Other Aggregate $ Part 1 STATUTORY Part 2 BODILY INJURY 93—KU-9039-1 Workers'Compensation 07/01/05 0 7/01/0 6 and Employers Liability Each Accident $ Disease Each Employee $ Disease-Policy Limit $ POLICY NUMBER TYPE OF INSURANCE POLICY PERIOD LIMITS OF LIABILITY Effective Date Expiration Date (at beginning of policy period) If any of the described policies are canceled before its expiration date, State Farm will try to mail a written notice to the certificate holder 30 days before cancellation. If, however,we fail to mail such notice, no obligation or liability will be imposed on State Farm or its agents or representatives. Name and Address of Certificate Holder Signature of Authorized Representative Title 558-994 a 2-90 Printed in U.S.A. Date I 1 NESOT p DIANE-RS LICENSE M1N 104 r SUSAN 10.10014 QUADOESI 304 pM Rp 5T s1 .1...WTER,tat*55002 �3 /6,1si1 Sep 07 05 08: 09a p• 3 Guaranteed Clean Maintenance, Inc. 1565 Como Avenue • Suite #101 • St.Paul, MN 55108 (651) 644-9919 • FAX (651) 644-0900 wwwgcm-inc.corn ?A:74 tiA qr AUTHORIZATION FOR A CRIMINAL RECORD CHECK It is a requirement of our customer that a criminal record check be done for any GCM employee working in their building. By signing this form,you are authorizing Oak Park Heights to do their own criminal record check on you. I hear by give permission to Guaranteed Clean Maintenance, Inc. and Oak Park Heights to run a criminal record on me. c.rgun C, Scct+ PRINT NAME D.O.B. APPLICANTS SIGNATURE DATE 0:ince 1972 �r11� r A A Minnesota Department of Public Safety-Driver and Vehicle Services Page 1 of 1 Driver and Veil& -::'"72',-'-v •DVS Home •Online Services Search By Name/DOB(Enter one or more of the following) Batch#: Name(First/Last): DOB(M/D/Y): / / Find 1 DL#: Name DOB Ht Wt Sex Eye Address DL DARIAN ESCORT 111291908 500 148 M BRN 1445W JESSAMINE#312 ST PAUL 55108 DL Num Status CDL School Bus Class Endorsements Restrictions Issued Expires 0 DL Record E283135018901 VAUD N 1 A D 0412212003 11125120 , Printable/w/Photo Photo •Photo Only Entry Incident Requirements Other Date Date Info ME !No records of this type found for this person. (ii MV Lookup •INFO ) https://www.dvslesupport.org/dvsinfo/Mainframe.asp 9/8/2005 ____ Sep 07 05 08: 10a p. 4 • MINNESOTA DRIVER'S LICENSE ;;;;I 9p9g 1311.22.0. ;_ E fsRrf•54 4I :il(E 1Vfnk1�V1 - r E-263-135-018-901 DARIAN ESCORT 16=7 W JESSAMINE n312 ST PAUL,MN 55108 https://www.dvslesupport.org/dvsinfo/dvsnewdl/PicShowlmage.asp?DL=E263135018901 9/812005 Sep 09 05 03: 08p p' 1 Guaranteed Clean Maintenance Inc. 1565 Como Avenue *Suite #101 (651) 644-9919 '" FAX (651) 644--0900y� 55108 FAX COVER SHEET Attention: E'r G oLh5oy‘ Ccmcany Name: Oat( ?ack ei ki"S rem: 016. a@,vi et 0 65 o Keel 'S 3 0-68 -71150 ii(gc.ce 11 _n l t I