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HomeMy WebLinkAboutAPPLIED TECHNOLOGY GROUP, INC. (2)INSURANCE ON FILE WORK MAY PROCEED UNTIL INSURANCE EXPIRES 03 / Z-21s _ MAYOR CLERK F Miguel A. Pulido DATE: MAYOR PRO TEM Juan Villages COUNCILMEMBERS O; Cecilia Iglesias 1 David Penaloza Vacant Vicente Sarmiento Jose Solono CITY OF SANTA ANA PUBLIC WORKS AGENCY 20 Civic Center Plaza . P.O. Box 1988 Santa Ana, California 92702 v .santa-ana.orc November 21, 2019 Applied Technology Group, Inc. 4440 Easton Drive Bakersfield, CA 93309 Attn: Lori B. Barnes Re: Extension of Agreement for Professional Wireless Services, No. N-2019-035 N-2019-035-01 CITY MANAGER Kristine Ridge CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL Daisy Gomez Pursuant to Section 3 ("Term") of Agreement No. N-2019-035, entered into by Applied Technology Group, Inc., and the City of Santa Ana, dated January 16, 2019, the time period of the Agreement is hereby extended for an additional one (1) year period, from January 16, 2020 through January 15, 2021. Any 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. Sincerely, 4 ^^—;�Sa y , 40. Fuad S. Sweiss, PE, PLS Executive Director, Public Works Agency CITY OF SANTA ANA ` z Z, Kristine Ridge City Manager APPROVED AS TO FORM JoWi M.Funk Assistant City Attorney ATTEST Cerkof Ile APPLIED TECHNOLOGY GROUP, INC. Name: Lori B. Barnes Title: President #16318v1 APPLTEC-03 CERTIFICATE OF LIABILITY INSURANCE I nAn4mal Qnn arnRlsnnn 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($), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. _ IMPORTANT; If the certificate holder Is an ADDITIONAL INSURED, the poiicylles) 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 PRODUCER I-/cansa x eoow<+1m Heffernan Insurance Brokers 1676 Cheater Avenue, Suite 310 Bakersfield, CA 933DI INSURED Applied Technology Group Inc, 4440 Easton Drive Bakorstield, CA 93309 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 NTH 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, R ADUL BUER„ PODGY EFF POLICY EXP TYPE OF INSURANCE�IN90,��„ „,„ POLICY NUMDER d�lppryyyy, �M/dOIYYYYf „,„„,,,, LIMITS 1I X I COMMERCIAL GENERAL LIAOILITY - HOCCURRENCE S 1,000,9' CLAIMS -MADE OOCCUR x 36025222WCE 07A71f2019 07f01J2020 QAMAIGE10RENTEp 1,000,0 £_ 'LAGOREO TELIMITAPP i $PER, PrpLiCY �( in tOC )MOBILE LIABILITY ANY AUTO 1973584639 07101/2019 0710112020 0 Q SCHEDULED AU� 4NLY AUTppOppSwN pp AUTOS ONLY AVTOS 9 UMBRELLA OAR I A I OCCUR EXCESS LM I I CLAIMS-MADE7989.46.22 0710112019 1602 1 03/22120101031221202D D Inland Marino ( I ISML93032865 107/01/20191 07/01/2020 JTowerlAntenna Equip MONSt LOCATIONS IVEHICLES tACORD tat, AadRional R4mark3 Schedule, may ea aadchodIt morn apace Is mcsArve or Agreement on Fite with Insured. The City of Santa Ana its offices, employees, agents, volunteers and representatives are included as i (primary and noncontributory) on General Liability policy per the attached endorsements, if nmulmd. '*"The 30 DAYS' Notice of Cancellation with 10 Days' Notice for Non -Payment of Premium endorsement has boon requested from the General Liability Carrier and will be forwarded once received (� C y TS�HOULD ANY OF THE AS, AT City of Santa Ana' t�EYt4 ED ill l�PPR E-t} E RDANC WITH THE Risk Management Division, 4th CQRDANCE WITH THE 20 Civic Center Plaza 14 4 ANACIEMENT D1V UQN- Santa Ana, CA 92702 AUTnOMED RePRESENTATAIR N 3 2020,r"L_ _ (2016103) CARAAAITlrA .E , ,.,,n. C1965.201 CANCELLED BEFORE BE .DELIVERED IN rights reserved. marks of ACORt3 C H U B B° Liability Insurance Endorsement Policy Ported JULY L 2019 TO JULY 11 2020 Sffoolive bate JULY 11 2019 PolloyNumber 3602-52-22WCB Insured AP MI) TECHNOLOGY GROUP INC. Name of Company POERALiNSURANCECOMPANY Date issued JUKE 6, 2019 This Endorsernent applies to the following forms: a• t Under Who is An insured, the following provision is added~ Who Is An Insured Additional Insured - persons or organizations shown in the Schedule arc insureds; but they are insureds only if you are Scheduled Pdfson obligated pursuant to a contractor agreement to provide them with such insurance as Is afforded by OrOrganizadon this policy. Insurance However, dra person or organization is an insured only: if and then Only to the satentrhe Person or organization Is describcdin the Schedule; to the extent such Contract or agreomentsequires the person or organization to be afforded stanta as an burred; for activities that did not occur, in whole oria put, before the oxecutionof the contract or agreement; and a with respectto damages, loss, Cost or expense for Wary or damage as which this insurance applies, No person or organixationis an Insured under thisprovisiom that Is more spoe"il'icallyldeatified under any other provision of the Wbo is An Insured seetion (regardless of any limitationeppIIcablethoreto), • with respect to any assumption of liability (of another porann or otganizatiou}by theta in a contrast or agreement, This 7hnitaM,a does not apply to the iiabliityy for damages, loss, cost or expense for igjury or damage, to which this insurance applies, that the person or organization would have in the absence of such contract or agreement. & APPROVED kgEMENt DivisiON ( (' I M. tAMBERT Liability Endorsement (continued) Under Coaditions, the Following provision is added to the condition flaod Other insuranco. Conditions Other Insurance — If YOU are obligated pursuant to a contract or agreement, to provide the person or organization Primary, Noncontributory drown in the Schedule with primacy Insmanoo such as is Worried by thus policy, then In such case Insurance-- Scheduled Wig insurance is primary and we will not sc* contribution from insurunco available to such person Person Or Organization or organization. Schedule Persons Of organizations that you are obligated, pursuant to a contract or agreement, to provide with such insurance as is afforded by this policy, All other torms and conditions remain unchanged. Authorhwd Rsprdaantalivo DLO A� " CERTIFICATE OF LIABILITY INSURANCE OATE(MMIDDYYYY) 4l6/2020 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 INSURERS), 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 CONTACT NAME: (BK) Heffernan Insurance Brokers PNONE FAx661-344-4132 1675 Chester Avenue, Suite 310 ,C N . 661-327-3321 IL Bakersfield CA 93301 INSURERS AFFORDING COVERAGE NAIC8 INSURER A: Federal Insurance Company 20281 INSURED APPLTE"O INSURER B: Scottsdale Insurance Company 41297 Applied Technology Group Inc 4440 Easton Drive INSURER C: AGCS Marine Insurance Company 22837 INSURER D: Insurance Company of the West 27847 Bakersfield CA 93309 INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: 804783905 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 TYPE OF INSURANCE POLICY NUMBER POLICY EFF POLICY EXP LIMITS A X COMMERCMI-GENERALLIASUM Y 36025222WCE 7/1/2019 711/2020 EACH OCCURRENCE f1,D00,000 CLAIMS -MADE I A I OCCUR Pft MI6E$ (Eir ocuurrencelf 1.000,000 MED EXP (My one erson f 10,000 PERSONALBADVINJURY $1,000,000 GENL AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE f2,000,0G0 P' LOC X POLICY ❑ JECT PRODUCTS -COMPIOP AGG $2,000,000 S OTHER: I A AUTOIWBILELIASILITY 1973584639 7/1/2019 711/2020 COMBINED SINGLE LIMIT (Ea amdant) $1,000.000 BODILY INJURY (Per Person) f ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS IX BODILY INJURY (Per aocslam) f PROPERTYDAMAGE (Pa, axaIsrItI f X HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY f A X UMSRELLAUAB X OCCUR 7989-48-22 7/1/2019 7/1/2020 EACH OCCURRENCE $5,000,000 AGGREGATE $5,000.000 EXCESS LIAB CWMSMADE DEO I IRETENTION If D WORKERS COMPENSATION AND EMPLOYERS' LIABILITYYIN ANYPROPRIETORIPARTNERIEXECUTIVE WPL503611603 3/22/2020 312:71 ✓ PER OT14 STA T UTE E.L. EACH ACCIDENT $1.000,000 OFFICERNIEMBEREXCLUDEDP D (Mantlrtory In NH) NIA E.L. DISEASE - EA EMPI OYEE $1,000,000 E.L DISEASE - POLICY LIMIT E1,000,000 If yes tlescnbe ewer DESCRIPTION OF OPERATIONS W. B C Professional Uab. 2019Commeroallnl dMarne EKS3312214 SML93032865 11/19/2019 7/1/2019 11/19/2020 7/1/2020 Per Claim 8 A9y Tower/AMenna Equip 2,000 D00 1755,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be aeachad if more apace is rpuiml) Re: As Per Contract or Agreement on File with Insured. The City of Santa Ana its officers, employees, agents, volunteers and representatives are included as butory) an additional insured (primary and non-contrion General Liability policy per the attached endorsements, If required. Cancellation notice endorsement for General Liability is attached, if required. ✓ REVIEWED IS APPROVED By Risk R'1ANACeEMENT DIVIs10N CERTIFICATE HOLDER ^ An CANCELLATION LULU SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE -"'—'—"' THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Santa Ana ANgiE ACEVEdo ACCORDANCE WITH THE POLICY PROVISIONS. Risk Management Division, 4th Floor AUTHORRED REPRESENTATIVE 20 Civic Center Plaza Santa Ana, CA 92702 / © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD C H U B B' Liability Insurance Endorsement Pa icy Period Eflectfva Data Policy Number Insured Name of Company Data Issued This Endorsement applies to the following forms. GENERAL L1ABlLiTY Who Is An Insured Addtional Insured Scheduled Person Or Organization )ULY t• 2019 TO JMY I• 2020 IDLY t.2019 3602.52-22 VICE APPUEDTEC1II woyGRoupINC. FEDERAL INSURANCE. COMPANY )UNF.6, 2019 Unda Who Is An Insured, the following provision is added. Persons or organizations shown m the Schedule are insureds; but they are insureds only if you are obligated pursuant to a contractor agreensror M provide them with such insurance as is afforded by this policy. However, the person or organization is an insured only: • if and then only to the extent the person or organization is described in the Schedule: to the extent such contract or agreement requires the peson or organization to be afforded stains as an insured; • for activities that did not occur, in whole or in part, before the execution of the contract or agreement: and • with respect to damages. loss, con or expense for injury or damage to which this insurance applies. No person or organization is an lamed under this provision: • that is more specifically identified under any other provision of the Who Is An Iosued section (regardless of any limitation applicable therein). • with respect to any assumptioa of liability (of another person or organization)by them in a contract or agreement. This limitation does not apply to the liability for damages, loss, cost or expense for injury or damage, to which this insurance applies, that the person or organization would have in the absence of such contract or agreement. REV4EWED & APPROVED By Risk MANAGEMENT DNISiON AP 6 2020 Usoxity insurance A&Wanaf rnnred�cmanved Form 8042-2367 (Rsv. 5 07) Endaumwa Page 1 CHUBB' Liabi fty Endorsement (continued) Under Coodidoat the following provision is added to the condition tided Other Insurance. Conditions Other Insurance — If you are obligated, pursuant to a contract or agreement. to provide the perwn or organization Primary, Noncontributory shown in the Schodule with primary insurance such as is afforded by this policy, then in such case Insurance — Scheduled this insurance is primary and we will not seelt contribution from instmnce available to such person Person Or Organization or organization. Schedule Persons or organizations that you are obligated, pursuant to a contract or ugre =t, to provide with such insurance as is afforded by this policy. All other terms and conditions rennin unchanged. Autnaind Rapaaanfativa Q-0A,I di�, REVIEWED & APPROVED By Risk MANAGEMENT DIViStON P 2020 Liability Insarsnca AtloRbnal Insured Gs�op an2aawt last Page Form 80-02-2367 (Rev. 5-07) Endofaamrnt ` Pager 2 C H U B B' Policy Conditions Endorsement Policy Period JULY 1, 2019 TO JULY 1, 2020 Effective Date DECEMBER 30, 2019 Policy Number 3602-52-22 WCE Insured APPLIED TECI INOLOGY GROUP INC. Name of Company FEDERAL INSURANCE COMPANY Date Issued JANUARY 14, 2020 This Endorsement applies to the following forms: COMMON POLICY CONDITIONS Under Conditions, the following condition is added. Conditions Notice Of Cancellation When we cancel this policy we will notify person(s) or organizations(s) shown in the Schedule at To Scheduled Persons least 30 days (10 days in the event of nonpayment of premium) in advance of the cancellation date. Or Organizations When We Cancel Any failure by us to notify such person(s) or organization(s) will not: • impose any liability or obligation of any kind upon us; or • invalidate such cancellation. Schedule Person(s) or Organizahon(s): CTTY OF SANTA ANA RISK MANAGEMENT DIVISION Address: 20 CIVIC CENTER PLAZA, 4TH FLOOR SANTA ANA, CA 92702 All other terms and conditions remain unchanged. REVIEWED & APPROVED By Risk MANAGEMENT DIVISION P , 2020 Porxy CondoWns Notln Of Cwn ftnon rp, ,pPjgprR,piaiganina" "hued r.Farm 80-02-9790 (Ed 9-11) EndOrslmMN 1 Pap 1 Conditions (continued) Auftdzad Repreaenlaave REVIEWED & APPROVED By RISk MANACrEMENT DIVISION 2020 Policy Condlaona NOdce Fern 90-02-9790(Ed 9-11) Endorse~ F Nglt /i4EVEO!: - yap ACORO® CERTIFICATE OF LIABILITY INSURANCE `�/3012020 OAT61301DONIYYI 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 (BK) Heffernan Insurance Brokers 1675 Chester Avenue, Suite 310 Bakersfield CA 93301 CONTACT PHONNAMEE IM - 661-327-3321 Ne:661-344-4132 wvL INSURMS)A OROING COVERAGE NAILS INSURER A: Federal Insurance Company 20281 ❑cen e 0564249 INSURED APPLTEC43 Applied Technology Group Inc 4440 Easton Drive INSURER B: Insurance Company of the West 27847 INSURER c :Scottsdale Insurance Company 41297 LNSURER O: Bakersfield CA 93309 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 802520440 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. MR TYPE OFIN9VRANCE ADD. SUER POLICY NUMBER POLICYEFF POUCYEXPLM 1J11ffS A X COMMERCIALGENERALUABILITY Y 36025222ACE 7/1/2020 7/V2021 EACH OCCURRENCE $1.000.000 CLAIMS -MADE XI OCCUR PREMISES Eaoaurrerce $1,000,000 MED EXP (Any one parson) S 10,D00 PERSONAL S ADV INJURY $1,000.000 GENL AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $2.000,000 %t POLICY PECOT1:1 LOC PRODUCTS-COMP/OP AGG $2,000.000 S OTHER: I I A AUTOMOBILELMBILITY 2073594639 7/1/2020 7/1/2021 EO.M..den31NGLE LIMIT S1,000,000 X BODILY INJURY Per person) S ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accitlen0 S X PROPERTY DAMAGE Par accident $ HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY S A X UMBRELLALIAB X OCCUR 79894822 7/1/2020 7/12021 EACH OCCURRENCE S5,000.000 AGGREGATE S 5,000,000 EXCESS LUIB nuliMADE DED I I RETENTIONS S e WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN WPL503611803 3/22/2020 3/22/2021 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $1,000.000 ANYPROPRIETOWPARTNERIEXECUTIVE OFFICER/MEMBEREXCLUDED? NIA E.L. DISEASE -EA EMPLOYEEI S1,000,000 (Mnldetory In NH) K we describe under DESCRIPTION OF OPERATIONS below E.L DISEASE -PODGY LIMIT $1,000,000 C Pmlesuonal Lab. EKS3312214 11/1/12019 11/19/2020 Per Claim S A99 2.000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD HIT, Additional Ramarka Schaduk. may Ire anached it more autos is rsqulrsd) ReAs Per Contract or Agreement on File with Insured. The CIry of Santa Ana its officers, employees, agents. volunteers and representatives are included as an additional insured (primary and non-contributory) on General Liability policy per the attached endorsements, if required. Cancellation notice endorsement for General Liability is attached. if required, REVIEWED & APPROVED By Risk MANAGEMENT DIVISION ,III Am n1n FI2A 4 NE R. VILCARgA4HOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE HE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS, Risk Management Division, 4th Floor AUTHORIZED REPRESENTATIVE 20 Civic Center Plaza Santa Ana, CA 92702 t719811-2015 ACORD CORPORATION. All A.hts resew. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD C H U B B• Policy Conditions Endorsement Policy Period ICILY 1, 2020 TO DULY I, 2021 Effective Date RILY I, 2020 Policy Number 3602-52-22 WCE Insured APPLIED TECHNOLOGY GROUP INC. Name of Company FEDERAL INSURANCE COMPANY Date Issued APRIL 21, 2020 This Endorsement applies to the following forms: COMMON POLICY CONDITIONS I Inder Conditions, the following condition is added. Conditions Notice Of Cancellation When we cancel this policy we will notify person(s) or organizations(s)shown in the Schedule at To Scheduled Persons least 30 days ( Ill days in the event of nonpayment of premium) in advance of the cancellation date. Or Organizations When We Cancel Any failure by us to notify such person(s) or organization(s) will not: • impose any liability or obligation of any kind upon us: or • invalidate such cancellation. Schedule Persons) or Organization(s): CTPY OF SANTA ANA RISK MANAGIMENT DIVISION Address: 20 CIVIC CENIliR PLAZA, 4TH FLOOR SANTA ANA, CA 92702 All other terms and conditions remain unchanged. REVIEWED & APPROVED By Risk MANAGEMENT DMSi0N ,,..JUL 07.20211 Policy Condibena Notice or Cancellanon I r ptzd n� contlnued Form 80-02-9790 (Ed 3-11) Endorsement y N\ Page 1 Conditions (continued) Authorized Represenlstive _a REVIEWED & APPROVED By RISK MANAGEMENTDIVISION ,444M4 FRANCINE VILLAREAL Polley Condtloru Notice Of Cancellation To Scheduted Parsons Or Organizatons fast page Famee-o&97e0(Ed }11) EMoroement Paget C H U E3 B' Liability Insurance Endorsement Policy Period JULY 1. 2020 TO JULY 1, 2021 Effective Date JIILY I, 21)211 Policy Number 3602-52-22 W(T Insured APPLIED TECHNOLOGY GROUP INC. Name of Company FEDERAL INSI IRANCE COMPANY Date Issued APRIL 21, 2020 �ffiYYELSQMA%FR`Ai.5i'69' N'b�R..�d:?.e5ii.le'sit::a.'�:a">O"m'iittl4.U�9.b"N'iE:ilkhe1'�%AWlh��6!=Y.GPoYR.Y.YSARCS, `YA�5`.RAP..TA`.K<SA: This Endorsement applies to the following forms: GENERAL LIABH-ffY x�n�w. �ar.�<aw:w:avarz .�w.xvaceamnm� 11nder Who Is An Insured the following provision is added. Who Is An Insured Additional Insured - Persons or organizations shown in the Schedule are Insureds: but they are insureds only if you are Scheduled Person obligated pursuant to a contract or agreement ao provide them with such insurance as is afforded by Or Organization this policy. However, the person or organization is an hasered only: • if and then only to the extent the person or organization is described in the Schedule; • to the extent such contract or agreement requires the person or organization to be afforded status as an insured; • for activities that did not occur, in whole or in pan, before the execution of the contract or agreement;and • with respect to dumages, loss, cost or expense for injury or damage to which this insurance applies. No person or organization is an insured under this provision: • that is morespecifac:dly identified under any other provision of the Who h An Insured section (regardless of any limitation applicable thereto). • with respect to any assumption of liability (of another person or organization) by them in a contract or agreement. This limitation does not apply to the liability for damages, loss, cost or expense for injury or damage, to which this insurance applies, that the perm or organization would have in the absence of such contractor agreement. ' noxat�exc�.t�ixun.'s.�sz�suw:u�:�=wsa..':�.>wz:�mrau ' babildy Insurance Adcrdonal Msured- Schadukd Paraara Or orgaruz,hon Form 60-02-2367(Rev 5.07) Endorsement REVIEWED 8t APPROVED By Risk MANAr4EMENT DIVISION J 72 0� FRANCINE R. VILLAREAL continued CHUBS' Liability Endorsement (continued) Linder Conditions, the following provision is added to the condition titled Other Insurance. Conditions Other Insurance — If you are obligated, pursuant to a contract or agreement, to provide the person or organization Primary, Noncontributory shown in dic Schedule with primary insurance such as is afforded by this policy. then in such case Insurance — Scheduled this insurance is primary and we will not seek contribution from insurance available to such person Person Or Organization or organization. Schedule Persons or organizations that you are obligated, pursuant to a contract or agreement, to provide with such insurance as is afforded by this policy. All other terms and conditions remain unchanged. Aufhor¢ed Represenfative ��. ,�' a Liability Insurance Additional Insured - Scheduled Person Or organization last page Form 80-02-2367(Rev. 5-07) Endorsement Page 2 REVIEWED & APPROVED By RISk MANAQEMENT DIVISION yoOO t FRANCINE R. VILLAREAL Francine R. n1g�rally59r dby r,eouoeR V/illorcal uale,�l ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 11/11/2020 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 (BK) Heffernan Insurance Brokers 7702 Meany Ave., Suite 102 Bakersfield CA 93308 CONTACT NAME: Kariss Perry PHONE FAX No.Eat: 661-489-7380 AIC Ne:415-778-0301 emA ADDRESS: karissp@heffins.com INSURER($) AFFORDING COVERAGE NAIC# INSURERA: Federal Insurance Company 20281 License#: 0564249 INSURED APPLTEC-03 Applied Technology Group Inc 4440 Easton Drive INSURER B: Insurance Company ofthe West 27847 INSURER C: Scottsdale Indemnity Company 15580 INSURER D: Bakersfield CA 93309 INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: 129189129 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 LTR OF INSURANCE ADDLSUBRTYPE INSD W/D POLICYNUMBER POLICY EFF MMIDDIYYYY POLICYEXP MMIDDYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY V 36025222VVCE 7/1/2020 7/1/2021 EACH OCCURRENCE $1,000,000 Cl-AIMS-MADE 1XI OCCUR DAMAGE PREMISES Ea occurrOence $1,000,000 MED EXP (Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 Fyl POLICY PEP LOC PRODUCTS-COMP/OP AGO $2,000,000 $ OTHER: A AUTOMOBILE LIABILITY 2073584639 7/1/2020 7/1/2021 COMBINED SINGLE LIMIT Ea accident) $1,000,000 X BODI LV I NJURY(Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTO$ BODILY INJURV(Per accident) $ X HIRED N NON -OWNED AUTO$ ONLY AUTO$ ONLY PROPERTY DAMAGE Per accitlenl $ A X UMBRELLA LIAB X OCCUR 79894822 7/1/2020 7/1/2021 EACH OCCURRENCE $5,000,000 AGGREGATE $5,000,000 EXCESS LIAB CLAIMS -MADE DED RETENTION$ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN VVPL503611603 3/22/2020 3/22/2021 X PER GTH- STATUTE ER ANYPROPRIETOMPARTNER/EXECUTIVE EL EACH ACCIDENT $1,000,000 OFFICER/MEMBEREXCLUDED9 ❑ N/A E. L. DISEASE - EA EMPLOYEE $1,000,000 (Mandatory in NH) If as, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $1,000,000 C Proffesional Laibility EK13354264 11/19/2020 11/19/2021 Per Claim &Agg $2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Re: As Per Contract or Agreement on File with Insured. The City of Santa Ana its officers, employees, agents, volunteers and representatives are included as an additional insured (primary and non-contributory) on General Liability policy per the attached endorsements, if required. Cancellation notice endorsement for General Liability is attached, if required. CERTIFICATE HOLDER CANCELLATION City of Santa Ana Risk Management Division, 4th Floor 20 Civic Center Plaza Santa Ana, CA 92702 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Risk Managment Diuisian ram. REVIEWED &{APPRcZvED By., olllli111-1� /-z' rb6HlM�e UsRRE/t¢bl. ® Risk Management Analyst C H U B B' Policy Conditions Endorsement Policy Penod JULY 1, 2020 TO JULY 1, 2021 Effective Date Policy Number Insured Name of Company Date Issued This Endorsement applies to the following forms: COMMON POLICY CONDITIONS Conditions JULY 1, 2020 3602-52-22 WCE APPLIED TECHNOLOGY GROUP INC. FEDERAL INSURANCE COMPANY APRHI 21. 2020 Under Conditions, the following condition is added. Notice Of Cancellation When we cancel this policy we will notify person(s) or organizations(s) shown in the Schedule at To Scheduled Persons least 30 days (10 days in the event of nonpayment of premium) in advance of the cancellation date. Or Organizations When We Cancel Any failure by us to notify such person(s) or organizations) will not: • impose any liability or obligation of any kind upon us; or • invalidate such cancellation. Schedule Person(s) or Organizaflon(s): CITY OF SANTA ANA RISK MANAGEMENT DIVISION Address: 20 CIVIC CENTER PLAZA, 4TH FLOOR SANTA ANA, CA 92702 All other terms and conditions remain unchanged. Policy Conditions Notice Of Cancellation To Scheduled Persona Or Organizations Form 80-02-9780(Ed. 9-11) Endorsement I,tin 13l% Rink Mot figment DtHean REVIEWED&APPRDVEDBY: f.W�P. V& d Risk Management Analyst Conditions (continued) Authorized Representative v<_�Qi�-yU i Policy Conditions Notice Of Cancella8on To Scheduled Persons Or Organizations Form 80-02-9780 (Ed. 3-11) Endorsement �® Rink Mrvugzment Drawn REVIEWED&AiTRevmBY: Risk Management Analyst C H U B B' Liability Insurance Endorsement Policy Period JULY 1, 2020 TO JULY 1, 2021 Effective bate JULY 1, 2020 Policy Number 3602-52-22 WCE Insured APPLIED TECHNOLOGY GROUP INC. Name of Company FEDERAL INSURANCE COMPANY Date Issued APRIL 21, 2020 ,......<as<ttxmra,.umttxscc�+:.�r<axttxm _' _' ..«<ttrcc�nrkr:asmxsaatt::: a.xttax:r•..%� :stts:::„ ;;„sr: This Endorsement applies to the following forms: GENERAL LIABILITY xaxxmxaHH� ' sss>ss::n:>.rs;:; m-::;;:. �xx:xxx::r�xxxx¢ssnsttt>�:xurauaamc>::xxat.xzxxxxs:.wz::atsssm�r<xxxxnvrec^.m�t Under Who Is An Insured, the following provision is added, Who Is An Insured Additional Insured - Persons or organizations shown in the Schedule are insureds; but they are insureds only if you are Scheduled Person obligated pursuant to a contract or agreement to provide them with such insurance as is afforded by Or Organization this policy. However, the person or organization is an insured only: • if and then only to the extent the person or organization is described in the Schedule; • to the extent such contractor agreement requires the person or organization to be afforded status as an insured; for activities that did not occur, in whole or in part, before the execution of the contract or agreement; and • with respect to damages, loss, cost or expense for injury or damage to which this insurance applies. No person or organization is an insured under this provision: • that is more specifically identified under any other provision of the Who Is An Insured section (regardless of any limitation applicable thereto). with respect to any assumption of liability (of another person or organization) by them in a contractor agreement. This limitation does not apply to the liability for damages, loss, cost or expense for injury or damage, to which this insurance applies, that the person or organization would have in the absence of such contract or agreement. s>sawMM;a . M. ,,,a,s. �::::x v:;xxxmvccx�•:: Liability Insurance Additional Insured - Scheduled Person Or Organization nor/ enaorsemenr continued Rink Mrvugzmed Esn— € ' rREV 13 &{APPRrOeVem By Risk Management Analyst CHUBB` Liability Endorsement (continued) Under Conditions, the following provision is added to the condition titled Other Insurance. Conditions Other Insurance — If you are obligated, pursuant to a contract or agreement, to provide the person or organization Primary, Noncontributory shown in the Schedule with primary insurance such as is afforded by this policy, then in such case Insurance — Scheduled this insurance is primary and we will not seek contribution from insurance available to such person Person Or Organization or organization, ss:::.`:::z: nAm, Schedule Persons or organizations that you are obligated, pursuant to a contract or agreement, to provide with such insurance as is afforded by this policy. All other terms and conditions remain unchanged. Authorized Representative Q<-_I��� , Sfbi Liability Insurance Additional Insured - Scheduled Person Or Organization test page Form 80-02-2367(Rsv. 6-07) Endorsement Rink Mrvugzment Drawn REVIEWED&AITRDVEDBY: P. V&A"d �® Risk Management Analyst