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HomeMy WebLinkAboutDMS FACILITY SERVICES TO PROVIDE LANDSCAPING ' City of Santa A --.y �" :, �......._..............--COTC Office Use Only ` �, Clerk of the Cou��_.�I AGREEMENT TERMINATION FORM Please complete this form in its entirety when the attached agreement and VO APR 24 PM 3: 18 amendments (if any) are no longer in effect. Note: If your agreement is grant related, please ensure that all grant retention requirements C I T ' �e OF r `� i�� A N A have been satisfied prior to signing the termination form. C L i tj r COUNCIL Is the agreement(s)a permanent record?Yes No Return form to the Clerk of the Council Office (M-30). Call 647-1520 if you have any questions. The agreement with 1 '1Lr„S C!�� 1 *Vx C-(.3/y'V i CILS No. - , �; (� — (t( i:' was completed on 1' i lDZ and final payment has been made. (List all amendments. Use space below if needed.) l ( j -C O i Department: A--.) I�l.�a / attb�, Phone/Ext.: �r:..S 4 Signature: =.:E C.:, t(). r_ 7\jek,/) Date: - rl Revised: 10-18-16 A-2017-006.01 INSURANCE NE ON PILE WORK MAY f PROCEED MAYOR CLERK OF q�,lJUpl!!le��� Miguel R. PTE CLERK ���.V� �tVih MAYOR PRO s DATE: o Juan Villages COUNCILMEMSERS Cecilia Iglesias DavidRoma Rayne �7 A r t ` Roman Samm to R�—) Vicente Sartniento Jose Solodo S t\V %K CITY OF SANTA ANA PARKS, RECREATION AND COMMUNITY SERVICES AGENCY 20 Civic Center Plaza M-23 . P.O, Box 1988 Santa Ana, California 92702 WwWsanta-ana.orA January 28, 2019 DMS Facility Services Attn: Fred Gonzales„ General Manager 1040 Arroyo Drive South Pasadena, CA 91030 CITY MANAGER Raul Godlnez II CITY ATTORNEY Sonia R. Carvalho ACTING CLERK OF THE COUNCIL Norma Mitre -Ramirez Re: Extension of Agreement No. A-2017-006 to provide landscape maintenance services at City parks in Districts 2 and 3. Dear Mr. Gonzales: Pursuant to Section 3 ('Term") of Agreement No. A-2017-006, entered into by DMS Facility Services ("Contractor"), and the City of Santa Ana, dated January 17, 2017, The time period of the Agreement is hereby extended for an additional one (1) year period, from February 1, 2019 through January 31, 2020. The insurance certificates are required to be extended and/or renewed to cover this extension. All other terms and conditions of the Agreement remain unchanged and in full force and effect. Sine rely t 7 Lisdloff Ex Votive Director Parks, Recreation and Community Services Agency CITY OF SANTA ANA �f� ----_ STEVEN MENDOZA ACTING CITY MANAGER DMS Facility Services Lhy: Fred Gon les --- Title: Goner• , lanager AT'PE "T -` Norma. Mitre - Acting Clerk of Council APPROVED AS TO FORM 4am A. 4wri Laura A. Rossini Senior Assistant City Attorney SANTA ANA CITY COUNCIL iv,,a APaX Juan Yaiegaa Yrce+rte $azmamo Mtid Pazwtrsza Jule Semiu fiumaa Rena C-ereGa 4detias Mayor Mayor Pra Tam, Wwd,5 Wank Wa z Ward3 Wards We 6 ulsnlakunfe arsa.om twilmg; canto--anama yymrmwftmu as,a gwrjrna",�saMa , �r'a a 112dSaa pa,py9 21es021duta,annmo A ue & CERTIFICATE OF LIABILITY INSURANCE 9/25/2018 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(les) must have ADDITIONAL INSURED provisions or 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). PRODUCE"S IverStone Grou 11516 Miracle Hills Drive N: ° Sherry Allen PH'NA P q, Sol, 402-064-5644 NE ,Sic Not: Suite 100 Omaha NE 68154 Isgi.com __ _ NSURERIS AFFORDING COVERAGE__ __ NAICA �INSURERA: Uberly In8Ur8nCe GOmOraflOn _ 42404 INSURED DMS Facility Services LLG a01 I'C�6Ca DMS Facility Services, Inc. '� � INSURER Se AIG Specially Insurence Company 26883__ INsuaEac_Uberl Mutual Fire Insurance Cq_.._.._.___ I 23035_ _ INSURER o: First Liberty Insurance Corp. _ 1 33688 1040 Arroyo Drive South Pasadena CA 91030-2908 INSURER E: Travelers Property Casualty Cc of America INSURER F: COVERAGES CERTIFICATE NUMBER: 1285819545 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, ILTR TYPEOFINSURANCE ��INADAb�l ppLICy NUMBER MMIOICDIYYYYFF MMIOO�Y LIMITS C X I COMMERCIAL GENERAL LIABILITY CLAIMS -MADE u OCCUR T82-691458727-088 10/1/2018 10/1/2019 EACHOCCURRENCE $1,000,000 U MA�T'O1FE�D PREMISES1E occur $1001000 ,e MEOEXPfAnnWperson $10,000 _ PERSON_AL&ADV INJ_UR_Y AGGREGATE LIMIT APPLIES PER: ®JECr C LOG GENERAL AGGREGATE _$1,000,0_00 _ $2,000,000 GEN'L PRODOCTS_COMPIOPAGG $2,000,000 OOLICY HER. 0 AUTOMOBILE LIABILITY A86-691458727.078 10/1/2018 10/1/2019 (CO.BIN DSINGLEUMI $1,000.000 X ANYAUTO BODILY INJURY $ OWNED SCHEDULED AUTOS ONLY L.. AUTOS AUTOS ONLY L. AUTN SONLOY BODILY INJURY (Per acrJdaW $ Pe� cdtlHIRnjAMAGE $ I E X UMBRELLALIAS X OCCUR ZUP-21P17G59A8NF 10/1/2010 10/1/2019 'EACH OCCURRENCE $10,000.000 AGGREGATE .� $10,000,000 EXCESS LIA13 CLAIMS -MADE_ ( DEC)X I RETENTIONS A WORKERS COMPENSATION ANOEMPLOY RS'UASILnY YIN ANYPROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMDER EXCLUDED? yandatory In NH) M DESCRIPTION desedn QF OPERATIONS below NIA WA7$90458727-088 10/1/2018 J 10(1/2019 X STATUTE EAH E.L. EACH ACCIDENT $1,000,000 E.L.OISEASE - EA EMPLOYEE $1,000,000 E.L. DISEASE -POLICY LIMIT $1,000,000 B Cammctors P011Won Uoutty CP016083633 10/1/2018 10/1/2019 Esoh Loss Aggregate 1.000,000 11000,000 DESCRIPTION OF OPERATIONS LOCATIONS1 VEHICLES(ACORD 104, Addl6oaal Re.dn Schedule, may bo attached If..,.apac. ierequired) Re: Landscape Maintenance (District 1 and 4) for the RFP No. 15-112 Ciry of Santa Ana, Its officers, employees, agents and representatives me Inc as Additional Insureds as respects General Liability, including completed operations, as required by written contract. PrimarylNon-Contributory warding Is included as respects General Liability, as required by written contract. Waiver of Subrogation with respects to Workers Compensation applies In favor of the City of Santa Ana, is officers, employ presentatives as required byy written contract, r_ 30 days' tJGiles of Cancellation provided with respects to General Liability, Auto, & Workers Compensation as requi y write u1JaCI. (Except for 10 days for non-payment of premium) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL as DELIVERED IN City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS. Parks Recreation, and Community Services Agency 20 Civic Center Plaza AUTHORIZED REPRES NTATVE Santa Ana CA 92701 / ) IV 41 ACORD ACORD 25 (2016/03) The ACORD name end logo are registered marks of ACORD WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS CALIFORNIA We have the right to recover our payments from anyone liable for an Injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 20/ of the California workers' compensation premium otherwise due on such remuneration. Schedule Additional premium Is a percent of the California Manual Workers Compensation premium. Subject to a minimum premium charge of $ 250 Person or Organization Where required by contract or written agreement prior to loss and allowed by law. Issued by Liberty Insurance Corporation 21814 For attachment to Policy' Issued to DMS Facility Services Policy term 10-1-1 a to 10-1-19 Policy # WA7-69D458727-068 Effective Date Job Description Premium $ WC 04 93 06 Page 1 of 1 Ed: 04/1984 NOTICE OF CANCELLATION TO THIRD PARTIES A. If we cancel this policy for any reason other than nonpayment of premium, we will notify the persons or organizations shown in the Schedule below. We will send notice to the emall or mailing address listed below at lead 10 days, or the number of days listed below, W any, before cancellation becomes effective. In no event does the notice to the third party exceed the notice to the first named insured. B. This advance notification of a pending cancellation of coverage is intended as a courtesy only. Our failure to provide such advance notification will not extend the policy cancellation date nor negate cancellation of the policy. Schedule Name of Other Person(s) I Email Address or mailing address: Number Days Notice-. Organlzation(s)t Broker will provide list of Broker will provide list of 30 organizations and contacts at organizations and contacts at least 10 days prior to the least 10 days prior to the advanced notification date advanced notification date All other terms and conditions of this policy remain unchanged. Issued by Lib " 1 errylnsurance CorporaUon21614 Foranachmentto Policy No. DMS Facility Services Policy term 10-1-18 to 10-1-19 Issued to Policy # WA7-69D458727-068QQ`� WM9016 0611 02011. Liberty Mutual Group. All Rights Reserved. Pdgee l of 1 Ed. 061OU2011 ' DIMS Facility Services " Policy term 10-1-18 to 10-1-19 •'OPolky Number. , Policy # AS6-691-458727-078 Issued By: The First Liberty Insurance Corp. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION TO THIRD PARTIES This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE PART MOTOR CARRIER COVERAGE PART GARAGE COVERAGE PART TRUCKERS COVERAGE PART EXCESS AUTOMOBILE LIABILITY INDEMNITY COVERAGE PART SELF•INSUREDTRUCKER EXCESS LIABILITY COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART EXCESS COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTSfCOMPLETED OPERATIONS LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART Schedule Name of Other Person(s)l Organization(s): Email Address or mailing address: Number Days Noticet Broker will provide list of organizations and contacts at least 30 ie days prior to the advanced notification date A. If we cancel this policy for any reason other than nonpayment of premium, we will notiy the persons or organizations shown in the Schedule above. We will send notice to the small or mailing address listed above at least 10 days, or the number of days listed above, If any, before the cancellation becomes effective. In no event does the notice to the third party exceed the notice to the lust named insured. S. This advance notification of a pending cancellation of coverage is Intended as a courtesy only. Out failure to pmvide such advance notification will not extend the policy cancellation date nor negate cancellation of the policy. All other terms and conditions of this policy remain unchanged. LIM 99 010511 02011. Liberty Mutual Group of Companies. All rights reserved Includes copyrighted material of Insurance Services Office. Inc. with Is permission. DMS Facility Services Policy term 10-1.18 to 10-1.19 Policy Number Policy# TB2-691-458727-088 Issued by LIBERTY MUTUAL FIRE INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION TO THIRD PARTIES This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE PART MOTOR CARRIER COVERAGE PART GARAGE COVERAGE PART TRUCKERS COVERAGE PART EXCESS AUTOMOBILE LIABILITY INDEMNITY COVERAGE PART SELF -INSURED TRUCKER EXCESS LIABILITY COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART EXCESS COMMERCIAL GENERALLIABILITY COVERAGE PART PRODUCTSICOMPLETED OPERATIONS LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART COMMERCIAL LIABILITY— UMBRELLA COVERAGE FORM Schedule Name of Other Personfe) I Or anization a Email Address or mailing address: Number Days Notice: Broker will provide list of organizations and contacts at Least 10 days prior to the advanced notification date 30 A. If we cancel this policy for any reason other than nonpayment of premium, we will notify the persons or organizations shown in the Schedule above. We will send notice to the email or mailing address listed above at least 10 days, or the number of days listed above, if any, before the cancellation becomes effective. In no event does the notice to the third party exceed the notice to the first named Insured. B. This advance notification of a pending cancellation of coverage Is Intended as a courtesy only. Our failure to provide such advance notification will not extend the policy cancellation date nor negate cancellation of the Policy, All other terms and conditions of this policy remain unchanged. LIM 99 01 0611 0 2011 Liberty Mutual Group of Companies. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc., with Its permission. Page 1 of 1 DMS Facility Services Policy term 10-1-18 to 10-1-19 Policy 8 TB2-691-458727-088 Policy Number ' Issued by Liberty Mutual Fire Insurance Co. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EXPANDED ADDITIONAL INSURED —CONTRACTORS AUTOMATIC STATUS WHEN REQUIRED BY WRITTEN AGREEMENT (CONFORMING TO WRITTEN AGREEMENT) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Paragraph 2. of Section II - Who Is An Insured is amended to include as an additional insured any person(s) or organization(s) to whom you are obligated by a written agreement to procure additional insured coverage under your policy, but only with respect to liability for "bodily injury', "property damage" or "personal and advertising injury' caused, in whole or in pan, by your acts or omissions, or the acts or omissions of those acting on your behalf, in the performance of your ongoing operations. This insurance does no apply to "bodily injury', "property damage" or "personal and advertising injury' arising out of "your wort" and included in the "products -completed operations hazard' unless you are required to provide such coverage for the additional insured by written agreement, In which case coverage will be prodded for the period of time required by the written agreement and only for liability caused, in whole or in part, by your acts or omissions, or the acts or omissions of those acting on your behalf. There is no coverage for the additional insured for liability arising out of the sole negligence of the additional Insured or those acting on behalf of the additional Insured, except as provided below, If the written agreement obligates you to procure additional insured coverage for the additional Insured's sole negligence, then the coverage for the additional insured shall conform to the agreement, but only if the applicable law would allow you to indemnify the additional insured for liability arising out of the additional insured's sole negligence. B. Exclusions With respect to the insurance afforded to these additional insureds, the following additional exclusions apply. This insurance does not apply: 1. To "bodily injury', "property damage" or "personal and advertising injury' arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, including: a. The preparing, approving or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications: or b. Supervisory, inspection. architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of otters by that insured, N the "occurrence" which caused the "bodily Injury' or "property damage", or the offense which caused the "personal and advertising Injury', involved the rendering of, or failure to render, any professional architectural. engineering or surveying services. LC 20 34 10 13 0 2013 Liberty Mutual Insurance. AN rights reserved. p f,(A s' t �(t\'� ` includes copyrighted material of Insurance Services Office, Inc., with its permissim.=` C L��1`C?1` "C 3/15/2018 10:09:47AM Batch: 4415136 2. To "bodily injury' or "property damage that occurs during the ongoing operations of a project Insured by an Owners and Contractors Protective Liability or Railroad Protective Liability Policy where you are the contractor designated in that policy's declarations. 3. When coverage is available under a consolidated (wrap-up) insurance program that has been provided by the prime conlractorfmanager or owner of a construction project in which you are involved. This exclusion applies whether or not the consolidated (wrap-up) Insurance program: a. Provides coverage identical to that provided by this Coverage Part: b. Has limits adequate to coverall claims; or . c. Remains in effect. C. The insurance afforded to any person or organization as an insured under this endorsement: 1. Applies only to coverage and minimum limits of insurance required by the written agreement, but in no event exceeds either the scope of coverage or the limits of insurance provided by this policy; 2. Does not apply to any person or organization for any "bodily injury, 'property damage" or "personal and advertising injury" If any other additional Insured endorsement attached to this policy applies to that person or organization with regard to the "bodily injury', "property damage" or "personal and advertising injury'; and 3. Applies only if the "bodily injury' or "properly damage" occurs, or offense giving rise to "personal and advertising injury is committed, subsequent to the execution of the written agreement. LC 20 341013 02013 Liberty Mutual Insurance. All rights reserved. S v$`ge 2 of 2 Includes copyrighted material of Insurance services Office. Inc., with its permission. 3/15/2018 10:09:48 AM Batch: 4415136 DMS Facility Services Policy term 10-1-18 to 10.1-19 POLICY NUMBER: Policy# TB2-491-458727.088 COMMERCIAL GENERAL LIABILITY CG 20 37 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED . OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITYCOVERAGE PART A. Section 11 — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily Injury" or "property damage" caused, in whole or in part, by 'your work' at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products -completed operations hazard". However: 1. The Insurance afforded to such additional Insured only applies to the extent permitted by law; and 2: If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. Name Of Additional Insured Persons) Or Organization(s): B. With respect to the insurance afforded to these additional insureds, the following is added to Section III —Limits Of Insurance: If coverage provided to the additional insured Is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. SCHEDULE As specked in a written agreement which is signed in advance of the "occurrence" or offense for which the additional insured seeks coverage. Location And Description Of Completed Operations WA Information required to complete this Schedule, if not shown above, will be shown in the Declarations. CG 20 37 0413 0 Insurance Services Office, Inc., 2012 Page 1 of 1 DMS Facility Services Policy term 10-1-18 to 10-1-19 Policy Number Policy # TB2-691-458727-088 Issued by Liberty Mutual Fire Insurance Co. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, OTHER INSURANCE AMENDMENT — SCHEDULED ADDITIONAL INSURED This endorsement modifies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTSICOMPLETED OPERATIONS LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART If you are obligated under a written agreement to provide liability Insurance on a primary, excess, contingent, or any other basis for any person or organization shown In the Schedule of this endorsement that qualifies as an additional Insured on this policy, this policy will apply solely on the basis required by such written agreement and Paragraph 4, Other Insurance of Section IV • Conditions will not apply, If the applicable written agreement does not specify on what basis the liability insurance will apply, the provisions of Paragraph 4.Other Insurance of Section IV • Conditions will govern, However, this insurance is excess over any other insurance available to the additional insured for which it Is also covered as an additional insured by attachment of an endorsement to another policy providing coverage for the same "occurrence", claim or "suit". Schedule Person or Organization: All persons or organizations with whom you have entered into a written contract or agreement, prior to an occurrence or offense, to provide additional insured status. cl'6 LC 2420 0213 0 2013 Liberty Mutual Insurance. All rights reserved. � � 1 of 1 Includes copyrighted material of Insurance Services Office, Inc., with its permission. DATE (MM/DD/YYYY) ACOR" CERTIFICATE OF LIABILITY INSURANCE 9/26/2019 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 have ADDITIONAL INSURED provisions or 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 NAIL: CONTA Sherry Allen SilverStone Group PHONE 402-964-5644 N�; 11516 Miracle Hills Drive EMAIL Suite 100 ADDRESS, sellen ss i.com Omaha NE 68154 INSURERS AFFORDING COVERAGE NAIC# INSURERA: Liberty Insurance Corporation 42404 INSURED INSURER e : Liberty Mutual Fire Insurance Co 23035 DMS Facility Services LLC DMS Facility Services Inc INSURERC: First Liberty Insurance Corp. 33588 1040 Arroyo Drive INSURER D : AIG Specialty Insurance Company 26883 South Pasadena CA 91030 INSURERE: INSURER F : COVERAGES CERTIFICATE NUMBER: 1555272138 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 KWLTYPE OF INSURANCE INSD WVDViYWR POLICY NUMBER POLICY YYY) (MM/DDNYYYI LIMITS B X COMMERCIALGENERALLIABILITY TB2-691-458727-089 10/1/2019 10/1/2020 EACH OCCURRENCE $I,000000 RENTED CLAIMS -MADE X OCCUR PREJvI SFSsU urrence $ 100,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1.000.000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY jERO- LOC PRODUCTS - COMP/OP AGG $2.000.000 $ OTHER' C AUTOMOBILE LIABILITY AS6-691-458727-079 10/1/2019 10/1/2020 COMBINED3INGLELIMIF Ea acc dent $1,000,000 BODILY INJURY (Per person) $ X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTYDAMA �� $ UMBRELLA LIAB HCLAIMS-MADE OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB QED I I RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN WA7-69D458727-069 10/1/2019 10/1/2020 X STATUTE R ANYPROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 1,000,000 OFFICERIMEMBER EXCLUDED? ❑ NIA E.L, DISEASE - EA EMPLOYEE $ 1,000,000 (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 D Contractors Pollution CP016083633 10/1/2019 10/1/2020 Each Loss $1,000,000 Liability Aggregate $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Additional insured an a primary and non-contributory basis With respects to General Liabilityy, Including completed operations, as required by written contract: City of Santa Ana, Risk Management, it's officers, employees, agents, representatives, and valunteers. 1Walver of Subrogation with respects to Workers Compensation as required by written contract. 30 days' Notice of Cancellation provided with respects to General Llability, Auto and Workers Compensation as required by written contract. BE I WM D & APPRpOVEoD Y L;LK I IFIC:A I r HULutK 111-.1 Ili IU 13 // GANUEL.LA I WN City of Santa Ana FRA Risk Management Division 20 Civic Center Plaza, 4th Floor Santa Ana CA 92702 f�' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE INN R• VI LAREA THE ORDAEXPIRicETION W THDATTHE POLICY CY THEREOF, NOPROIOTICE WILL BE DELIVERED IN ACC AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD DMS Facility Services Policy term 10-1-19 to 10-1-20 Policy Number: Auto Policy #AS6-691-458727-079 Issued By: The First Liberty Insurance Corp. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION TO THIRD PARTIES This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE PART MOTOR CARRIER COVERAGE PART GARAGE COVERAGE PART TRUCKERS COVERAGE PART EXCESS AUTOMOBILE LIABILITY INDEMNITY COVERAGE PART SELF -INSURED TRUCKER EXCESS LIABILITY COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART EXCESS COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART Schedule Name of Other Person(s)/ Organizatlon(s): Email Address or mailing address, Number Days Notice. Broker will provide list of organizations and contacts at least 30 10 days prior to the advanced notification date A. If we cancel this policy for any reason other than nonpayment of premium, we will notify the persons or organizations shown in the Schedule above. We will send notice to the email or mailing address listed above at least 10 days, or the number of days listed above, if any, before the cancellation becomes effective. In no event does the notice to the third party exceed the notice to the first named insured. B. This advance notification of a pending cancellation of coverage is intended as a courtesy only. Our failure to provide such advance notification will not extend the policy cancellation date nor negate cancellation of the policy. All other terms and conditions of this policy remain unchanged. LIM 99 0105 11 V 2011, Liberty Mutual Group of Companies. All rights reserved. Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc. with its permission. REVIEWED & APPROVED By Risk MANAGEMENT DIVISION /NIR4 7 19 F AN INE 1q. VILLAREAL DMS Facility Services Policy term 10-1-19 to 10-1-20 GL Policy #TB2-691-458727-089 Policy Number Issued by LIBERTY MUTUAL FIRE INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION TO THIRD PARTIES This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE PART MOTOR CARRIER COVERAGE PART GARAGE COVERAGE PART TRUCKERS COVERAGE PART EXCESS AUTOMOBILE LIABILITY INDEMNITY COVERAGE PART SELF -INSURED TRUCKER EXCESS LIABILITY COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART EXCESS COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTSICOMPLETED OPERATIONS LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART COMMERCIAL. LIABILITY -- UMBRELLA COVERAGE FORM Schedule Person(s) I I Email Address or mailing address: I Number Days Notice: Broker will provide list of organizations and contacts at least 10 days prior to the advanced notification date A. If we cancel this policy for any reason other than nonpayment of premium, we will notify the persons or organizations shown to the Schedule above. We writ send notice to the email or mailing address listed above at least 10 days, or the number of days listed above, if any, before the cancellation becomes effective. In no event does the nuke to the third party exceed the notice to the first named insured. B. This advance notification of a pending cancellation of coverage is intended as a courtesy only, Our failure to provide such advance notification will not extend the policy cancellation date nor negate cancellation of the policy. All other terms and conditions of this policy remain unchanged. LIM 99 0105 11 U 2011 Liberty Mutual Group of Companies. All rights reserved. Page 1 of 1 Includes copyrighted material of insurance Services Office, Inc., with its permission. REVIEWED & APPROVED By Risk MANAGEMENT DivisiON '�10 ina FRANCINE R. VILLAREAL DMS Facility Services Policy term 10-1-19 to 10-1-20 GL Policy #TB2-691-458727-089 Policy Number Issued by Liberty Mutual Fire Insurance Co. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, EXPANDED ADDITIONAL INSURED — CONTRACTORS AUTOMATIC STATUS WHEN REQUIRED BY WRITTEN AGREEMENT (CONFORMING TO WRITTEN AGREEMENT) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Paragraph 2. of Section II - Who Is An Insured is amended to include as an additional insured any person(s) or organization(s) to whom you are obligated by a written agreement to procure additional insured coverage under your policy, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury' caused, in whole or in part, by your acts or omissions, or the acts or omissions of those acting on your behalf, in the performance of your ongoing operations. This insurance does not apply to "bodily injury', "property damage" or "personal and advertising injury" arising out of "your wok" and included in the "products -completed operations hazard" unless you are required to provide such coverage for the additional insured by written agreement, in which case coverage will be provided for the period of time required by the written agreement and only for liability caused, in whole or in part, by your acts or omissions, or the acts or omissions of those acting on your behalf. There is no coverage for the additional insured for liability arising out of the sole negligence of the additional insured or those acting on behalf of the additional insured, except as provided below. If the written agreement obligates you to procure additional insured coverage for the additional insured's sole negligence, then the coverage for the additional insured shall conform to the agreement, but only if the applicable law would allow you to indemnify the additional insured for liability arising out of the additional insured's sole negligence. B. Exclusions With respect to the insurance afforded to these additional insureds, the following additional exclusions apply. This insurance does not apply: 1. To "bodily injury", "property damage" or "personal and advertising injury' arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, including: a. The preparing, approving or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or b. Supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury" or "property damage", or the offense which caused the "personal and advertising injury', involved the rendering of, or failure to render, any professional architectural, engineering or surveying services. LC 20 3410 13 0 2011 Liberty Mutual Insurance. All rights reserved. Page 1 of 2 Includes copyrighted material of Insurance Services Office, Inc., with its permission. REVIEWED & APPROVEO/15i2018 10:09:47 AM Batch: 4415136 By Risk MANACEhtENT DlvisiON 0 7 � FRANCINE R. VfLLAREAL 2, To "bodily injury' or "property damage" that occurs during the ongoing operations of a project insured by an Owners and Contractors Protective Liability or Railroad Protective Liability Policy where you are the contractor designated in that policy's declarations. 3. When coverage is available under a consolidated (wrap-up) insurance program that has been provided by the prime contractor/manager or owner of a construction project in which you are involved. This exclusion applies whether or not the consolidated (wrap-up) insurance program: a. Provides coverage identical to that provided by this Coverage Part: b. Has limits adequate to cover all claims; or c. Remains in effect. C. The insurance afforded to any person or organization as an insured under this endorsement: 1. Applies only to coverage and minimum limits of insurance required by the written agreement, but in no event exceeds either the scope of coverage or the limits of insurance provided by this policy: 2. does not apply to any person or organization for any "bodily injury", "property damage" or "personal and advertising injury' if any other additional insured endorsement attached to this policy applies to that person or organization with regard to the "bodily injury', "properly damage" or "personal and advertising injury and 3. Applies only if the "bodily injury' or "property damage" occurs, or offense giving rise to "personal and advertising injury' is committed, subsequent to the execution of the written agreement. LC 20 34 10 13 ® 2013 Liberty Mutual Insurance. All rights reserved. Page 2 of 2 Includes copyrighted R�yIof We� m' Off�etrr�Dw.th its permission. By RISk MANAGEMENT DIviS1ON 3/15/2018 10:09:48 AM Batch: 4415136 l0 7 2 19 FRANCINE R. VILLAREAL DMS Facility Services Policy term 10-1-19 to 10-1-20 POLICY NUMBER: GL Policy #TB2-691-458727-089 COMAERCIAL GENERAL LIABILITY CG 20 37 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, ADDITIONAL INSURED -- OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART A. Section it — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in park, by "your work' at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products -completed operations hazard". However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2: If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds. the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contractor agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Location And Description Of Completed Operations As specified in a written agreement which is signed in NIA advance of the "occurrence" or offense for which the additional insured seeks coverage. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. CG 20 37 0413 0 InsuraA����iFg�RffyAlr MOVED iBy RIsCCkWWMALLNNA154EMFFE''NT DivWON Page 1 of 1 7 9 -qq_� FRANCINE R. VILLAREAL DMS Facility Services Policy term 10-1-19 to 10-1-20 GL Policy #TB2-691-458727-089 Policy Number Issued by Liberty Mutual Fire Insurance Co. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, OTHER INSURANCE AMENDMENT —SCHEDULED ADDITIONAL INSURED This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART If you are obligated under a written agreement to provide liability insurance on a primary, excess, contingent, or any other basis for any person or organization shown in the Schedule of this endorsement that qualifies as an additional insured on this policy, this policy will apply solely on the basis required by such written agreement and Paragraph 4. Other Insurance of Section IV - Conditions will not apply. If the applicable written agreement does not specify on what basis the liability insurance will apply, the provisions of Paragraph 4.Other Insurance of Section IV - Conditions will govern. However, this insurance is excess over any other insurance available to the additional insured for which it is also covered as an additional insured by attachment of an endorsement to another policy providing coverage for the same "occurrence", claim or "suit". Schedule Person or Organization: All persons or organizations with whom you have entered into a written contract or agreement, prior to an occurrence or offense, to provide additional insured status. LC 24 20 02 13 0 2013 Liberty Mutual Insurance, All rights reserved. Page 1 of '1 Includes copyrighted material of Insurance Services Office. Inc., with its permission. RgEVRIEWM D & ANAqEMPPRENTpOV oD 7 2019 FRA CAVE R. VILLAREAL NOTICE OF CANCELLATION TO THIRD PARTIES A. If we cancel this policy for any reason other than nonpayment of premium, we will notify the persons or organizations shown in the Schedule below. We will send notice to the email or mailing address listed below at least 10 days, or the number of days listed below, if any, before cancellation becomes effective. In no event does the notice to the third party exceed the notice to the first named insured. B. This advance notification of a pending cancellation of coverage is intended as a courtesy only. Our failure to provide such advance notification will not extend the policy cancellation date not negate cancellation of the policy. Name of Other Person(s) Organization(s): Broker will provide list of organizations and contacts at least 10 days prior to the advanced notification date Schedule Email Address or mailing address: Broker will provide list of organizations and contacts at least 10 days prior to the advanced notification date All other terms and conditions of this policy remain unchanged. Number Days Notice: 30 Issued by Liberty Insurance Corporation21814 Policy term 10-1-19 to 10-1-20 For attachment to Policy No Work Camp Policy #WA7-69D458727-069 Premium $ Issued to DMS Facility Services, Inc. REVIEWED & APPROVED By Risk MANAgEMENT UVi$iON WC 99 20 75 C 2016 Liberty Mutual Insurance Ed, 12/012016 Q �TA 7 2019 �]V( '�' � ay- . FRANCINE R. VILLAREAL Page 1 of 1 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 211% of the California workers' compensation premium otherwise due on such remuneration. Schedule Additional premium is a percent of the California Manual Workers Compensation premium. Subject to a minimum premium charge of $ 250 Person or Organization Jab Descrption Where required by contract or written agreement prior to loss and allowed by law. Issued by Liberty Insurance Corporation 21814 For attachment to Policy Effective Date Premium $ Issued to DMS Facility Services Policy term 10-1-19 to 10-1-20 Work Comp Policy #WA7-69D458727-069 dC04 o4/1 3 D6 By R+ k WED & APPROVED Page 1 of 1 o )0 7 T FRANCINE R. VILLAREAL