HomeMy WebLinkAboutGONG ENTERPRISES, INC.City of Santa Ana
Clerk of the Council
AGREEMENT TERMINATION FORM
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N-2019-029
CLERK OF COUNCIL
® DATE: FEB 0 4 2019
N%-) AGREEMENT WITH GONG ENTERPRISES FOR PLAN CHECK SERVICES
THIS AGREEMENT is made and entered into this 22nd day of January 2019, by and between Gong
Enterprises, Inc. ("Consultant'), and the City of Santa Ana, a charter city and municipal corporation
organized and existing under the Constitution and laws of the State of California ("City").
RECITALS
A. The City desires to retain a consultant having special skill and knowledge in the field of
professional plan checking services to be performed for the Water Resources Division of the Public
Works Agency.
B. Consultant represents that Consultant is able and willing to provide such services to the City.
C. In undertaking the performance of this Agreement, Consultant represents that it is knowledgeable
in its field and that any services performed by Consultant under this Agreement will be performed
in compliance with such standards as may reasonably be expected from a professional consulting
firm in the field.
NOW THEREFORE, in consideration of the mutual and respective promises, and subject to the terms
and conditions hereinafter set forth, the parties agree as follows:
SCOPE OF SERVICES
Consultant shall perform during the term of this Agreement, the tasks and obligations including
all labor, materials, tools, equipment, and incidental customary work required to fully and adequately
complete the services described and set forth in Exhibit A, attached hereto and incorporated by reference.
2. COMPENSATION
a. City agrees to pay, and Consultant agrees to accept as total payment for its services for City,
the rates and charges identified in Exhibit A. The total amount to be expended under this
Agreement shall not exceed $25,000, during the term of this Agreement, including any
extension periods exercised under Section 3.
b. Payment by City shall be made within 45 days (forty-five) days following receipt of proper
invoice evidencing work performed, subject to City accounting procedures. Payment need not
be made for work that fails to meet the standards of performance set forth in the Recitals which
may reasonably be expected by City.
3. TERM
This Agreement shall commence on the date first written and terminate on January 21, 2020, unless
terminated earlier in accordance with Section 16, below. The term of this Agreement may be extended
for one 1 -year period upon a writing executed by the City Manager and City Attorney.
Page 1 of 8
4. PREVAILING WAGES
Consultant is aware of the requirements of California Labor Code Section 1720, et seq., and 1770,
et seq., as well as California Code of Regulations, Title 8, Section 16000, et seq., ("Prevailing Wage
Laws'), which require the payment of prevailing wage rates and the performance of other requirements
on "public works" and "maintenance" projects. If the services being performed are part of an applicable
"public works" or "maintenance" project, as defined by the Prevailing Wage Laws, and the total
compensation is $1,000 or more, Consultant agrees to fully comply with such Prevailing Wage Laws.
Consultant shall defend, indemnify and hold the City, its elected officials, officers, employees and agents
free and harmless from any claim or liability arising out of any failure or alleged failure to comply with
the Prevailing Wage Laws,
5. INDEPENDENT CONSULTANT
Consultant shall, during the entire term of this Agreement, be construed to be an independent
contractor and not an employee of the City. This Agreement is not intended nor shall it be construed to
create an employer-employee relationship, a joint venture relationship, or to allow the City to exercise
discretion or control over the professional manner in which Consultant performs the services which are
the subject matter of this Agreement; however, the services to be provided by Consultant shall be provided
in a manner consistent with all applicable standards and regulations governing such services. Consultant
shall pay all salaries and wages, employer's social security taxes, unemployment insurance and similar
taxes relating to employees and shall be responsible for all applicable withholding taxes.
6, OWNERSHIP OF MATERIALS
This Agreement creates a non-exclusive and perpetual license for City to copy, use, modify, rouse,
or sublicense any and all copyrights, designs, and other intellectual property embodied in plans,
specifications, studies, drawings, estimates, and other documents or works of authorship fixed in any
tangible medium of expression, including but not limited to, physical drawings or data magnetically or
otherwise recorded on computer diskettes, which are prepared or caused to he prepared by Consultant
under this Agreement ("Documents & Data'). Consultant shall require all subconsultants to agree in
writing that City is granted a non-exclusive and perpetual license for any Documents & Data the
subconsultant prepares under this Agreement. Consultant represents and warrants that Consultant has the
legal right to license any and all Documents & Data. Consultant makes no such representation and
warranty in regard to Documents & Data which were provided to Consultant by the City, City shall not
be limited in any way in its use of the Documents and Data at any time, provided that any such use not
within the purposes intended by this Agreement shall be at City's sole risk.
7. INSURANCE
Prior to undertaking performance of work under this Agreement, Consultant shall maintain and
shall require its subconsultants, if any, to obtain and maintain insurance as described below;
a. Commercial General Liability Insurance, Consultant shall maintain commercial general
liability insurance naming the City, its officers, employees, agents, volunteers and
representatives as additional insured(s) and shall include, but not be limited to protection
against claims arising from bodily and personal injury, including death resulting therefrom
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and damage to property, resulting from any act or occurrence arising out of Consultant's
operations in the performance of this Agreement, including, without limitation, acts
involving vehicles. The amounts of insurance shall be not less than the following: single
limit coverage applying to bodily and personal injury, including death resulting therefrom,
and property damage, in the total amount of $1,000,000 per occurrence, with $2,000,000
in the aggregate. Such insurance shall (a) name the City, its officers, employees, agents,
and representatives as additional insured(s); (b) be primary and not contributory with
respect to insurance or self-insurance programs maintained by the City; and (c) contain
standard separation of insureds provisions.
b. Business automobile liability insurance, or equivalent form, with a combined single limit
of not less than $1,000,000 per occurrence. Such insurance shall include coverage for
owned, hired and non -owned automobiles.
C. Worker's Compensation Insurance. In accordance with the provisions of Section 3700 0£
the Labor Code, Consultant, if Consultant has any employees, is required to be insured
against liability for worker's compensation or to undertake self-insurance. Prior to
commencing the performance of the work under this Agreement, Consultant agrees to
obtain and maintain any employer's liability insurance with limits not less than $1,000,000
per accident.
d. If Consultant is or employs a licensed professional such as an architect or engineer:
Professional liability (errors and omissions) insurance, with a combined single limit of not
less than $1,000,000 per claim with $2,000,000 in the aggregate.
Z. The following requirements apply to the insurance to be provided by Consultant pursuant
to this section:
i. Consultant shall maintain all insurance required above in full force and effect for
the entire period covered by this Agreement.
ii. Certificates of insurance shall be furnished to the City upon execution of this
Agreement and shall be approved by the City.
iii. Certificates and policies shall state that the policies shall not be canceled or reduced .
in coverage or changed in any other material aspect without thirty (30) days prior
written notice to the City,
iv. Consultant shall supply City with a fully executed additional insured endorsement.
f. If Consultant fails or refuses to produce or maintain the insurance required by this section
or fails or refuses to famish the City with required proof that insurance has been procured
and is in force and paid for, the City shall have the right, at the City's election, to forthwith
terminate this Agreement. Such termination shall not affect Consultant's right to be paid
For its time and materials expended prior to notification of termination. Consultant waives
the right to receive compensation and agrees to indemnify the City for any work performed
prior to approval of insurance by the City.
8, INDEMNIFICATION
Consultant agrees to defend, and shall indemnify and hold harmless the City, its officers, agents,
employees, consultants, special counsel, and representatives from liability: (1) for personal injury,
damages, just compensation, restitution, judicial or equitable relief arising out of claims for personal
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injury, including death, and claims for property damage, which may arise from the negligent operations
of the Consultant, its subconsultants, agents, employees, or other persons acting on its behalf which relates
to the services described in section I of this Agreement; and (2) from any claim that personal injury,
damages, just compensation, restitution, judicial or equitable relief is due by reason of the terms of or
effects arising from this Agreement. This indemnity and hold harmless agreement applies to all claims for
damages, just compensation, restitution, judicial or equitable relief suffered, or alleged to have been
suffered, by reason of the events referred to in this Section or by reason of the terms of, or effects, arising
from this Agreement. The Consultant further agrees to indemnify, hold harmless, and pay all costs for the
defense of the City, including fees and costs for special counsel to be selected by the City, regarding any
action by a third party challenging the validity of this Agreement, or asserting that personal injury,
damages, just compensation, restitution, judicial or equitable relief due to personal or property rights arises
by reason of the terms of, or effects arising from this Agreement. City may make all reasonable decisions
with respect to its representation in any legal proceeding. Notwithstanding the foregoing, to the extent
Consultant's services are subject to Civil Code Section 2782.8, the above indemnity shall be limited, to
the extent required by Civil Code Section 2782.8, to claims that arise out of, pertain to, or relate to the
negligence, recklessness, or willful misconduct of the Consultant.
9. INTELLECTUAL PROPERTY INDEMNIFICATION
Consultant shall defend and indemnify the City, its officers, agents, representatives, and employees
against any and all liability, including costs, for infringement of any United States' letters patent,
trademark, or copyright infringement, including costs, contained in the work product or documents
provided by Consultant to the City pursuant to this Agreement.
10. .RECORDS
Consultant shall keep records and invoices in connection with the work to be performed under this
Agreement, Consultant shall maintain complete and accurate records with respect to the costs incurred
ander this Agreement and any services, expenditures, and disbursements charged to the City for a
minimum period of three (3) years, or for any longer period required, by law, from the date of final payment
to Consultant under this Agreement. All such records and invoices shall be clearly identifiable.
Consultant shall allow a representative of the City to examine, audit, and make transcripts or copies of
such records and any other documents created pursuant to this Agreement during regular business hours.
Consultant shall allow inspection of all work, data, docurnents, proceedings, and activities related to this
Agreement for a period of three (3) years from the date of final payment to Consultant under this
Agreement.
11. CONFIDENTIALITY
If Consultant receives from the City information which due to the nature of such information is
reasonably understood to be confidential and/or proprietary, Consultant agrees that it shall not use or
disclose such information except in the perfornumce of this Agreement, and failher agrees to exercise the
same degree of care it uses to protect its own information of like importance, but in no event less than
reasonable care. "Confidential Information" shall include all nonpublic information. Confidential
information includes not only written information, but also information transferred orally, visually,
electronically, or by other means. Confidential information disclosed to either party by any subsidiary
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and/or agent of the other party is covered by this Agreement. The foregoing obligations of non-use and
nondisclosure shall not apply to any information that (a) has been disclosed in publicly available sources;
(b) is, through no fault of the Consultant disclosed in a publicly available source; (c) is in rightful
possession of the Consultant without an obligation of confidentiality; (d) is required to be disclosed by
operation of law; or (e) is independently developed by the Consultant without reference to information
disclosed by the City.
12. CONFLICT OF INTEREST CLAUSE
Consultant covenants that it presently has no interests and shall not have interests, direct or
indirect, which would conflict in any manner with performance of services specified under this
Agreement.
13. DISCRIMINATION
Consultant shall not discriminate because of race, color, creed, religion, sex, marital status, sexual
orientation, age, national origin, ancestry, or disability, as defined and prohibited by applicable law, in the
recruitment, selection, training, utilization, promotion, termination or other employment related activities.
Consultant affirms that it is an equal opportunity employer and shall comply with all applicable federal,
state and local laws and regulations.
14. EXCLUSIVITY AND AMENDMENT
This Agreement represents the complete and exclusive statement between the City and Consultant,
and supersedes any and all other agreements, oral or written, between the parties. In the event of a conflict
between the terms of this Agreement and any attachments hereto, the terms of this Agreement shall prevail.
This Agreoment may not be modified except by written instrument signed by City and by an authorized
representative of Consultant. The parties agree that any terms or conditions of any purchase order or other
instrument that are inconsistent with, or in addition to, the terns and conditions hercof, shall not bind or
obligate Consultant or the City. Each party to this Agreement acknowledges that no representations,
inducements, promises or agreements, orally or otherwise, have been made by any party, or anyone acting
on behalf of any party, which is not embodied herein..
15. ASSIGNMENT
Inasmuch as this Agreement is intended to secure the specialized services of Consultant,
Consultant may not assign, transfer, delegate, or subcontract any interest heroin without the prior written
consent of the City and any such assignment, transfer, delegation or subcontract without the City's prior
written consent shall be considered null and void. Nothing in this Agreement shall be construed to limit
the City's ability to have any of the services which are the subject to this Agreement performed by City
personnel or by other Consultants retained by City.
16. TERMINATION
This Agreement maybe terminated by the City upon thirty (30) days written notice of termination.
In such event, Consultant shall be entitled to receive and the City shall pay Consultant compensation for
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all services performed by Consultant prior to receipt of such notice of termination, subject to the following
conditions:
a. As a condition of such payment, the .Executive Director may require Consultant to deliver
to the City all work product(s) completed as of such date, and in such case such work
product shall be the property of the City unless prohibited by law, and Consultant consents
to the City's use thereof for such purposes as the City deems appropriate.
b, Payment need not be made for work which fails to meet the standard of performance
specified in the Recitals of this Agreement.
17. WAIVER
No waiver of breach, failure of any condition, or any right or remedy contained in or granted by
the provisions of this Agreement shall be effective unless it is in writing and signed by the party waiving
the breach, failure, right or remedy, No waiver of any breach, failure or right, or remedy shall be deemed
a waiver of any other breach, failure, right or remedy, whether or not similar, nor shall any waiver
constitute a continuing waiver unless the writing so specifies.
18. JURISDICTION - VENUE
This Agreement has been executed and delivered in the State of California and the validity,
interpretation, performance, and enforcement of any of the clauses of this Agreement shall be determined
and governed by the laws of the State of California, Both parties further agree that Orange County,
California, shall be the venue for any action or proceeding that may be brought or arise out of, in
connection with or by reason of this Agreement.
19. PROFESSIONAL LICENSES
Consultant shall, throughout the term of this Agreement, maintain all necessary licenses, permits,
approvals, waivers, and exemptions necessary for the provision of the services hereunder and required by
the laws and regulations of the United States, the State of California, the City of Santa Ana and all other
governmental agencies, Consultant shall notify the City immediately and in writing of its inability to
obtain or maintain such pormits, licenses, approvals, waivers, and exemptions, Said inability shall be
cause for tennination of this Agreement.
20, MISCELLANEOUS PROVISIONS
a. Each undersigned represents and warrants that its signature herein below has the power,
authority and right to bind their respective parties to each of the terms of this Agreement,
and shall indemnify Cityfully, including reasonable costs and attorney's fees, for any
injuries or damages to City in the event that such authority or power is not, in fact, held by
the signatory or is withdrawn.
b. All Exhibits referenced herein and attached hereto shall be incorporated as if fully set forth
in the body of this Agreement.
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21. NOTICE
Any notice, tender, demand, delivery, or other commimieation pursuant to this Agreement shall be
in writing and shall be deemed to be properly given if delivered in person or mailed by first class or
certified mail, postage prepaid, or sent by fax or other telegraphic communication in the manner provided
in this Section, to the following persons:
To City:
Clerk of the City Council
City of Santa Ana
20 Civic Center Plaza (M-30)
P.O. Box 1988
Santa Ana, CA 92702-1988
Fax: 714- 64.7-6956
With copy to:
Executive Director, Public Works Agency
City of Santa Ana
20 Civic Center Plaza (M-21)
P.O. Box 1988
Santa Ana, California 92702
To Consultant:
Gong Enterprises, Inc.
Attn: Ken Gong, PE
7755 Center Avenue, Suite 1100
Huntington Beach, CA 92647
A party may change its address by giving notice in writing to the other party. Thereafter, any
communication shall be addressed and transmitted to the new address. If sent by mail, communication
shall be effective or deemed to have been given three (3) days after it has been deposited in the United
States mail, duly registered or certified, with postage prepaid, and addressed as set forth above. If sent by
fax, communication shall be effective or deemed to have been given twenty-four (24) hours after the time
set forth on the transmission report issued by the transmitting facsimile machine, addressed as set forth
above. For purposes of calculating these time frames, weekends, federal, state, County or City holidays
shall be excluded.
Page 7 of
IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first above
written.
.SN'.,
Norma Mitre
Acting Clerk of the Council
APPROVED AS TO FORM:
SONIA R. CARVALHO
City Attorney
By: 1 N.
John hyFunk
Assistant City Attorney
Fuad S. S)
Executive
Public We
FOR APPROVAL:
PE, PLS
Agency
CITY OF SANTA ANA
Steven A. Mendoza
Acting City Manager
CONSULTANT:
(name) Chao�of/
(title) Ar ri Q'ee�
Tax ID# -�' 00/Zo2¢
Page 8 of 8
STATE OF CALIFORNIA
GONG. ENTERPRISES
Incorporated Mar. 8, 1983
EXHIBIT A
GoNG Nl RPEt.CSES, INC.
December 1g, 2018
Mr. Brian Ige, Assistant Civil Engineer
City of Santa Ana Public Works Agency — Water Resources Division
City Corporation Yard
220 S. Daisy Avenue, Mm85
Santa Ana, CA 92703
Re: Proposal for Professional Plan Check Services
Gong Enterprises, Ino (GEI) is pleased to provide this proposal to offer professional
Plan checking services for City of Santa Ana Public Works Agency — Water Resources
Division,
Based on our discussions and email correspondence, pian check would include the
review of main line water Improvements, water lateral sarvloes, sewer main lin®
improvements, and sewer laterals as they relate to various types of
develapment/redevelopment projects such as single family, multi -family, commercia,l
industrial, and subdivisions (parcel or tract maps},
Related Prnlem
1, GEI has reviewed numerous projects that involve water and sewer improvements
for the City of San Clemente and San Juan Capistrano for over 29 years on a
consistent basis. The projects include domestic and non — domestic water lines,
fire lines, sewer lines, and associated appurtenances such as backflow devices,
Pressure regulators, Fire Department connections, fire hydrants, etc. Projects
include Single Family homes, duplexes, commercial buildings, industrial
buildings, condominiums, and tract homes, This includes new and remodel
projects.
Svnor►sis of F�tan Checking and Pian check aalroach°
1. Mr. Kan Gong will personally be involved In the plan check process and will
review and/or oversee every technical map, report, or improvement plan. Since
(SEI provides civil engineering services solely to municipalities, there are no
Professional conflicts of h the private sector.
2. GEI plan checking Interest
services include both Quality Assurance (QA) and Quality
Control (QC). QA is to ensure that the plans have been evaluated in a technical
standpoint; to be in substantial compliance with CITY codes, standards, policies,
and criteria. QC is to ensure the improvement plans are cross-referenced and
coordinated with other plans or plan sheets to ensure consistency and a well
thought-out project.
7755 Center Avenue, Suite 11 oo / Ihantington Beach, CA 92647/ Ph: (7J4)372-4959/Fax (714) 372-4968
43mail: GONGENTERPRIS ,S@yA4.1pp.CoM Plan Check 1 %ousulting
3. GEN philosophy of the role of consultant is to support, provide advice, and to be
an "extension" of In-house personnel.
4. GEI is easily accessible to answer questions and communicate professionally
with CITY staff. Emalls and Voice mails are typically returned within hours on
the same day upon receipt of the message.
5. Ken Gong Is also a licensed General Contractor-- 8 classification. The
combination of civil engineering and construction knowledge and over 88 years
of experience provides valuable insight to real world practicality and engineering
principles.
Atandards and iteria
All pians will be reviewed for substantial compliance with CITY format, codes, criteria,
standards, and typical general engineering practices.
A kick off meeting will be scheduled with CITY staff to familiarize GEI with expectations
by CITY and to discuss standards, format, and criteria that projects will require.
Samrala Procedures°
The following represents a sample of pian check procedures. (subject to change):
4. Client contacts GEI that a project is ready for pickup. A designated location is
provided Q CITY for courier service to pickup,
2. Client shall provide GEI (2) sets of plans and 4 copy of all research information
such as as builts, CITY"s atlas maps, and other information that will be required
to adequately plan check.
3. GEI will have the plans picked up and project will be logged into GEI's schedule.
4. Goal Is to review and complete the plan check review within 2 weeks upon
receipt of the plans.
5. GEI will review the plans to ensure compliance with CITY requirements.
6, GEI will write a pian check letter,
7. GEI will return the completed review along with the plan check letter to CITY.
H urI ate 3c ed la E tiv em ar 2078 -- J e 2 g
Classification: Hrly Rate:
Principal/Professional Engineer 8435.00
Clerical/Administration $ 85,00
Blueprints, courier service, mise Cost plus 40%
GEI shall invoice on a time and materials basis In accordance with the hourly rate
schedule presented hereon on a monthly basis. All incidentalloverhead costs that
Include travel, printing, telephone, photographs, and postage are included within the
hourly rate,
The hourly rates include all associated administrative, tracking, and coordination efforts
Involved for the plan check of that particular plan,
G®rtifieats of Insure! w
GPI maintains general Liability, Worker's compensation, and Professional Liability
(errors and omission) Insurance. A copy of the various certificates of insurance will be
provided to CITY as part of the agreement.
Thank you for your consideration. We are looking forward to providing the very best
plan checking service for you and the City of Santa Ana.
If any questions arlse, do not hesitate to call.
Thank you,
Sincerely,
uhf
Ken Gong, P
6AProposa1 San1(80ia)
RESUME OF PRINCIPAL„ OWNER
KENNETH CHC! GONG, PE
Prssident/Owner
EDUCATION:
REGISTRATION:
EMPLOYMENT
HISTORY,
B.S. Engineering
University of California, Irvine (1980)
Professional Engineer, 1983, CA (#36494)
General Contractor, B-HIC
1989 to present:
1986-1989:
President/Owner Gong Enterprises, Inc.
Civil Engineer, EIVIA/Regulationtsubdivislon
Streets/Drainage sections
1982-1988:
Civil Engineer, Orange County Flood Control
1980-1982:
District
Assistant Civil Engineer, EMA/ConstiMaterials
Lab
Gang Enterprises, Inc.
a. Design of master plan of drainage facility J01PO3, Foothill Ranch Community
b. Design of Galen Ranch Storm drain, Foothill Ranch Community
o. Preliminary design for Storm drain Improvements along Amaganset Way, City of
Tustin.
d, Design of Civic Center rehabllltaticn projects, City of Santa Ana m Partes.
e, Plan checked numerous street and storrid
drain plans within the development of
the MCAS -Tustin naval base, City of Tustin.
f. Plan checked numerous plans for the City of Irvine as a sub consultant to
Johnson -Frank, Inc.
9. Plan checked Runoff management plan for Serrano Heights, City of Orange.
h. Plan checked numerous Improvement plans for the City of Change.
i. Plan check services for City of San Clemente — ongoing 0989 -- present).
j. Plan check services for City of San Juan Capistrano — ongoing (1991— present).
k. Pian check services for City of Morena Valley -- ongoing (2003 to present).
1. Plan check services for City of Brea — ongoing (2017 w present)
M. Plan check services for Clty of Mission Viejo — ongoing (2014 -.. present)
EMA/REGU ATiC?Iy_'igi LannnaiONS
Reviewed numerous street, grading, and drainage plans within:
a. (love Canyon Planned Community.
b. Rancho Santa Margarita Planned Community.
C. Also Viejo Planned Community.
d. City of Mission Viejo (formerly unincorporated territory),
0. City of f, Foothill Ranch Pluna anneuel d Community (nounincorw part of lake territory).
rest).
9. Baker Manch.
h. City of Laguna Hills (formerly unincorporated territory.
i. Coto De Caza,
j. City of EI Toro (formerly unincorporated territory).
Plan checked numerous drainage projects, regional In nature. Prepared
County/Developer agreements for:
a, Borrego Channel (box culvert, vertical wall channel)
b, Ill Modena Channel (box culverytrapezoidai concrete lined)
c. Bee Canyon (box culvert, vertical wall channel)
d. Garden Grove-WIntersburg Channel (box culvert)
e• San Diego Creek Channel (Soil cement(trapezoidal channel)
f. Marshburn Channel (box culvert, vertical wall channel)
9• Allso Viejo Channel (natural, concrete -lined)
Total lineal footage reviewed: Approximately 20 miles.
ORANGECOUNTY 91 Ann GO TRot I T C
Designed/reviewed the following;
a. San Juan Creek.
b. Oso Creek.
C. Carbon Creek Channel.
d. Aliso Creek Channel.
Responsible for all aspects of design such as: Budget analysis, right of way acquisition,
agreement preparation, hydrologic analysis, hydraulic analysis, soil report acquisition
and review, surveys, structures, plan preparation, contract administration, permit
acquisition, and pre construction attendance.
POLICYHOLDER COPY
P.O. BOX 8192, PLEASANTON, CA 94588
CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
ISSUE DATE: 01-22-2019
CITY OF SANTA ANA, PWA, WRD - BRIAN IGE
220 S DAISY AVE
SANTA ANA CA 92703-4334
SP
GROUP:
POLICY NUMBER: 1258757-2018
CERTIFICATE ID: 47
CERTIFICATE EXPIRES: 07-01-2019
07-01-2018/07-01-2019
This is to certify that we have issued a valid Workers' Compensationinsurance policy in a form approved by the
California Insurance Commissioner to the employer named below for the policy period indicated.
This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer.
We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration.
This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded
byith the policy to which this listed herein. Notwithstanding any requirement, term or condition of any contract or other document
respect certificate finsurance e
in, the insurance
afforded by the herein is subject toab
all the termsueds exclusir to ons, ich �a daconditions, of such policy.
Authorized Representative /V I
EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: Prsi ent and
CEO
00 PER OCCURRENCE. v/
ENDORSEMENT #2085 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 07-01-1994 IS
ATTACHED TO AND FORMS A PART OF THIS POLICY.
EMPLOYER
GONG ENTERPRISES, INC
7755 CENTER AVE STE 1100
HUNTINGTON BEACH CA 92947
(REV.7-2014)
SP
irb,
IP11,SGj
PRINTED : 01-22-2019
SP
AC" d CERTIFICATE OF LIABILITY INSURANCE
DATE
A E 3/M 9YY)
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(iss) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WANED, 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 endomement(s).
PRODUCER
CONTACT
NAME:
WILLIS OF ILLINOIS, INC.
PHONE 888)780.5381 FAX P; (866 828-2424
EA UNESS: CertiBcate@Hanover.com
INSURER(S) AFFORDING COVERAGE NAIC R
233 S. WACKER DR, STE 2000
CHICAGO IL 60606
INSURERA: Citizens ins Co of America 31534
INSURED
INSURER B: Hanover Insurance Cc 22292
INSURERC:
MED EXP (Any one Person) $ 10,000
INSURER D:
GONG ENTERPRISES INC
7755 CENTER AVENUE STE 1100
INSURER E:
HUNTINGTON BEACH CA 92647
INSURER F:
COVERAGES CERTIFICATE NUMBER: RPVLCInIU MIUMPOR.
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.
ILTR
TYPE OF INSURANCE
ADOL
UBft
POUCYNUMBER
POLICY EFF
MWDD
POLICY EXP
N
LIMITS
�I COMMERCIALGENERALUABIUTY
CLMS-MADE IV]OCCURE
AI
FACHOCCURRENCE $ 2,000,000
RENT 1,000,000
PREMISES Ea occurrence $
MED EXP (Any one Person) $ 10,000
PERSONAL 8 ADV INJURY $ 2,000,000
A
Y
N
OBC A361099 04
03/25/2018
03/25/2019
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY Z JEa 1-1 LOC
GENERALAGGREGATE $ 4,000,000
PRODUCTS-COMP/OPAGG $ 4,000,000
$
OTHER:
AUTOMOBILEUABRJTY
COMBINE SINGLE LIMB $ 2,000,000
a accident
ANYAUTO
BODILY INJURY (Per Person) $
A
AUUTTOSDONLv AUTOSULED
HIRED✓ NON -OWNED
AUTOS ONLY AUTOS ONLY
Y
N
OBC A36109904
03/25/2018
03/25/2019
BODILY INJURY (Per accident) $
PROPERWDAMAGE $
Per accident
UMBRELLA UAB
OCCUR
EACH OCCURRENCE $
EXCESS LIAB
CLAIMS -MADE
AGGREGATE $
DEC) I I RETENTION$
Is
WORKERS COMPENSATIONPER
ANDEMPLOYERS'LIABILITY YIN
ANYPROPRIETORIPARTNERIEXECUTIVE
OFFICERIMEMBEREXCLUDED?
NIA
O -
STATUTE ER
E.L. EACHACCIDENT $
E.L. DISEASE -EA EMPLOYEE $
(Mandatory In NH)
describe under
DESCRIPTION un OPERATIONS below
WE.L.
DISEASE - POLICY LIMB $
B
Architects 8 Engineers Prof Llab
N
N
LHC 988479106
03/25/2018
03/25/2019
Claims -Made: $1M Ea Claim/$2M Agg
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Ramarx9 Schetlule, may be attached H more space Is requlred)
The City of Santa Ana, its officers, employees, agents, volunteers, and representatives
Certificate Holder is an Additional Insured on the General Liability pursuant to the terms and conditions by form 391-1586. Additional Insured is Primary and
Noncontributory to the extent provided by form 391-1003 (pg 79 of 81). Separation of Insureds provided to the extent allowed by form 391-1003 (pg 73 of 81).
Cancellation Notice will be provided to the Certificate Holder pursuant to endorsements: 401-1235 and 910-0296. Such notice is solely for the purpose of informing the
Certificate Holder of the effective date of cancellation and does not grant, alter, or extend any rights or obligations under these policies.
CITY OF SANTA ANA
PUBLIC WORKS AGENCY WATER RESOURCES DIV
220 S DAISY AVENUE - BLDG A
SANTA ANA CA 92703
ATTN: BRIAN I GE PE
V7
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORVUH) REPRESENTATIVE
1988-2015 ACORD CORPORATION. All riohts reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
PI