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HomeMy WebLinkAboutVENTURA BUSINESS SYSTEMS, INC. (2)City of Santa Ana Clerk of the Council AGREEMENT TERMINATION FORM COTC office Use Only C2,03 Please complete this form in its entirety when the attached agreement and all amendments (if any) are no longer in effect. Nate; If your agreement is grant related, please ensure that all grant retention requirements have been satisfied prior to signing the termination form. , SI- B A ANA C Tiy="LYE. K Is the agreement(s) a permanent record? Yes No -Lila Return form to the Clerk of the Council Office (M-30). E Call 647-1520 if you have any questions. The agreement with No N-2017-094-03 was completed on (List all amendments. Use space below if needed.) 02- --0j ctagreementsftrmsftrm - agreement termination form_goldenrod.doc Department: Phone/Ext.: Signature: Date: and final payment has been made. LA 6 S INSURANCE NOT ON FILE N-2017-094-01 WORK MAY NQT PROCEED CLERK OF COUNCIL o; Prisu DATE: l'I � Vice cV2yg5 c(,� FIRST AMENDMENT TO CONSULTANT AGREEMENT WITH VENTURA BUSINESS SOLUTIONS < THIS FIRST AMENDMENT to the above -referenced agreement is entered into on May 1, 2020 by and between Ventura Business Solutions, Inc. ("Consultant"), and the City of Santa Ana, a charter city and municipal corporation organized and existing under the Constitution and laws of No the State of California ("City"), collectively referred to as the "Parties". N O RECITALS A. The Parties entered into Agreement No. N-2017-094, dated June 1, 2017, by which Consultant agreed to provide copy and printing services for the public at the Santa Ana Library and its branches ("Agreement"). The Agreement is current and in effect. B. The Parties now wish to amend the scope of services and increase the compensation under the Agreement. The Parties hereby agree as follows: Section 1, Scope of Services, is amended to include the BookScan Center which is a public scanning service for the public patrons at the library locations. The Quote for the added service component dated December 15, 2019, is attached hereto and incorporated to this First Amendment and identified as Exhibit A-1. 2. Section 2, Compensation, is amended to increase the not -to -exceed amount by $5,375.79, per the costs and rates identified in Exhibit A -I to this First Amendment. The total amount to be expended under the Term of this Agreement shall not exceed $25,085.66, however there will be an additional $600.00 annual maintenance fee which will be payable after the first year that the BookScan Center is initiated. 3. Except as modified by this First Amendment, all terms and conditions of the Agreement shall remain in full force and effect. [Signature Page Follows] k38446v1 IN WITNESS WHEREOF, the parties hereto have executed this First Amendment to the Agreement on the date and year first written above. ATTEST CITY OF SANTA ANA Daisy Gomez + "' Kristine Ridge Clerk of the Council City Manager APPROVED AS TO FORM Sonia R. Carvalho City Attorney By: '(�L � C • /lJt co^ cam_ Lisa Storck Assistant City Attorney FOR APPROVAL �1 Brian Stemberg Executive Director Library Services Agency #38446v1 CONSULTANT T vor Yates President A�� �® CERTIFICATE OF LIABILITY INSURANCE °04/266/20 s' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endomement(s). PRODUCER DARRYL NIND INSURANCE AGENCY 940 Enchanted Way #101 NAME, DARRYL NIND AGENT - PFM HONE 2 - ya No): 5 522- s 2 as IE : dar I.nind.rebi G statefamncom Simi Valley, CA 93065 INSURERS AFFORDING COVERAGE NAIC 0 INSURER A: Slate Farm General Insurance Company INSURED VENTURA BUSINESS SYSTEMS INC INSURER B: State Farm Mutual Automobile Insurance Company INSURERC: C/O TREVOR YATES / INSURER O: 2582 FIG ST SIMI VALLEY CA 93063-2416 INSURER E: IN URER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDLSUSR POLICY NUMBER POLICY EFF POLICY EXPLTR LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FRI OCCUR 92-W4-0493-7 04/26/2020 04/26/2021 EACH OCCURRENCE $ 1,000,000 YG'1E PREMISES Ea occurrence $ MED EXP (Any one person) $ 5,000 PERSONAL S ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000.000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO- LOC PRODUCTS - COMPIOP AGG S 2,000,000 $ B AUTOMOBILE LIABILITY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON-OWNEDPROPERTYDAMAGE AUTOS AUTOS 051 5512-A18-75L 07/18/2020 01/18/2021 Eaa COMBINED SINGLE IN LE LIMIT $ BODILY INJURY(Per person) $ 1,000,000 MANY BODILY INJURY(Per accident) $ 1,000,000 Peraccni.rt 1,000,000HIRED $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY y 1 N ANY PROPRIETOMPARTNEWEXECUTIVE OFFICEIMEMSER EXCLUDED? (Mandatory In NH) If yes, descd0e under NIA CTH- WCSTATUI. T- IE E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS LOCATIONS I VEHICLES (ANach ACORD 101, Additional Remarks Schedule, H more space Is required) jj��� ��r�// �F'p���q//r��� f�}iQr�,h P� $� E There is no Workers Compensation policy for Ventura Business Systems as all employees are officers of the corpor`rII�rL,Ii'Offkk AG MENTrp(5 SI a not required to have a Work Comp policy in the State of California. liy It SIC M �I tv� Vry Certificate of Insurance shah provide thirty (30) day prior written notice of cancellation .� 2 2 2020 CERTIFICATE HOLDER CANCELLATION ADDITIONAL INSURED: CITY OF SANTA ANA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN RISK MANAGEMENT DIVISION / Z/ ✓✓✓ ACCORDANCE WITH THE POLICY PROVISIONS. 20 CIVIC CENTER PLAZA, 4TH FLOOR SANTA ANA, CA 92701 Mk2UOR ZED RE EE T/ ✓nVE / ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD 1001486 132849.6 11-15-2010 CITY OF SANTA ANA RISK MANAGEMENT a 4w44na 4 HUMAN RESOURCES Managing Risk ovoogh Posldve Change ADDITIONAL INSURED ENDORSEMENT Insurance Company: `Mate Farm This endorsement modifies such insurance as is afforded by the provisions of Policy # 92-W4-0493-7 relating to the following 1. The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701; its officers, employees, agents and volunteers are named as additional insureds ("additional insureds") with regard to liability and defense of suits arising from the operations and uses performed by or on behalf of the named insured. 2. With respect to claims arising out of the operations and uses performed by or on behalf of the named insured, such insurance as is afforded by this policy is primary and is not additional to or contributing with any other insurance carried by or for the benefit of the additional insureds. 3. This insurance applies separately to each insured against whom claim is made or suit is brought except with respect to the company's limits of liability. The inclusion of any person or organization as an insured shall not affect any right which such person or organization would have as a claimant if not so included. 4. With respect to the additional insureds, this insurance shall not be canceled, or materially reduced in coverage or limits except after thirty (30) days written notice has been given to the City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701. Completion of the following, including countersignature, is required to make this endorsement effective. Effective 4/26/2020 - 4/26/2021 Z , Policy # 92-W4-0493-7 Issued to Ventura Business Systems this endorsement form asWWWED & APPROVED By Risk MANAGEMENT DivisioN MAY 2020 Inc ANrIF ACEVEdo (Named Insured) Countersigned by ` P1V/l V,(/,,'••�/l/ Authorized Representative I:iRisk Mgmtilnsurance RequirementsiAdditional Insured Endorsement August1019 CITY OF SANTA ANA RISK MANAGEMENTa dtwacaa 4HUMAN RESOURCES Managing Rlsk mmag* Posttive Change WORKERS' COMPENSATION DECLARATION Trevor Yates (Nome/Title) following declaration: I certify on behalf of hereby affirm under penalty of perjury, the Ventura Business Systems, Inc that during the term (Consultant/Company Name) of my contract for Copier/Printing services with the City of Santa Ana, (Type of service provided) I will not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with the provisions and provide proof of workers' compensation coverage immediately. Date:4/10/2020 Print Name: Trevor Yates Print Title: President Signature: �uuez Telephone: 805-58 -3299 WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. REVIEWED & APPROVED By RISK MANAGEMENT DIVISION 15P 2020 ANgiE ACEVEdo kl Risk Mgmtllnsurance Requirements�WC Declaration 08151019 Ventura Business Systems, Inc. 2582 Fig Street Simi Valley, CA 93063 Phone (805) 583-3299 May 5, 2020 To Whom it May Concern: Ventura Business Systems, Inc. is a coin operated copier and printing company. We don't touch anything that is owned by the Library. Therefore, we do not carry Professional Liability insurance (errors and omissions requirement) required by the city. Ventura Business Systems is not and will NOT employ a licensed professional therefore we do not meet this requirement. Thank You Trevor Yates ✓ REVIEWED & APPROVED By Risk MANAGEMENT DivisioN MAY 2020 ANGiE ACEVECIO NOTICE OF COMPLIANCE CITY . "A ,AM I1111RI T I'III I IPi 1111AGE ,CCp INCLUDE Ck I 111 1AGREEMENTTOT111IE CLERK CSC 111I➢C COUNCIL Contractor Ventura Business Systems, Inc Name: Project N-2017-094-03 Number: Project Third Amendment To Consultant Agreement With Ventura Name: Business Systems, Inc. The Certificate of Insurance (COI) submitted indicates that the coverages are in compliance with the insurance requirements. No further action is required at this time. The compliant coverage(s) are: POLICY EXPIRATION TYPE OF INSURANCE NUMBER DATE COI DATE FILE NAME AUTOMOBILE LIABILITY 2947361D2875 10/28/2023 03/30/2023 Insurance Certificate , .............. 2023.pdf GENERAL LIABILITY 92KJX0429 01/26/2024 03/30/2023 Insurance Certificate , 2023.pdf Professional Liability PROFESSIONAL LIABILITY WAIVER 03/30/2024 04/03/2023 Insurance Release.pdf WORKERS COMPENSATION AND WAIVER 03/30/2024 04/10/2023 WC Declaration EMPLOYERS' LIABILITY Rev.2022.pdf .................... Thank you, City of Santa Ana Risk Management Division in partnership with CTrax Plus Services Team 4/20/2023 2:10 PM