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HomeMy WebLinkAboutMIG, INC.City of Santa Ana Clerk of the Council AGREEMENT TERMINATION FORM Please complete this form in its entirety when the attached agreement and all amendments (if any) are no longer in effect. Note: If your agreement is grant related, please ensure that all grant retention requirements CLEF have been satisfied prior to signing the termination form. 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 M� No. 1"► /�VI I� / 1 was completed on v %is (List all amendments. Use space below N needed.) pew -i"A q crrz 2 1-1 �1�12I COTC Office Use Onlv OF THE COUNCIL L 6121 PM2:53 ilagreementslformsVform-agreL+menttermina" , ffljm gdddeenrSd�.doc" s� Department: Phone/Ext.: Signature: Date: and final payment has been made. INSURANCE ON FILE WORK MAY PROCEED A-2017-359-02 UNTIL INSURANCE EXPIRE. ``�� �� MAYOR ��� 9 g-3�' Z� CITY MANAGER Miguel RA. TE MAYOR PRO TEM o CLERK OF COU - Q.SQp12 Kristine Ridge CITY ATTORNEY Juan COUNCILIIMEMBERS ,� (/' Q. ts•+.v ' `- ��UATE. �,,., `,y Sonia R. Carvalho Phil �y'p`p CLERK OF THE COUNCIL Daisy Gomez Cecilia Iglesias ��� dBaca Pena11.. David Penaloza � Vicente Sarmiento Jose Solorio - - CITY OF SANTA ANA PLANNING AND BUILDING AGENCY 20 Civic Center Plaza • P.O. Box 1988 Santa Ana, California 92702 Wvvvsanta-ana.om June 1, 2020 MIG, Inc. Attn: Rick Barrett, Principal 1111 6' Avenue, Ste. 4 San Diego, CA 92101 Re: Extension of Consultant Agreement No. A-2017-359 Dear Mr. Barrett: Pursuant to Section 3 of Agreement No. A-2017-359 entered into by MIG, Inc., and the City of Santa Ana, dated March 16, 2018, as extended through June 30, 2020 by Extension Letter dated December 18, 2019, the "Term" of the Agreement is further extended through December 31, 2020. The insurance certificates are required to be extended/renewed to cover this extension. All other terms and conditions of said Agreement remain unchanged and in full force and effect. Sincerely, Minh Thai, Executive Director Planning & Building Services Agency CITY OF SANTA ANA r stine Ridge City Manager APPROVED AS TO FORM: Sonia R. Carvalho City Attorney Lisa Storck Assistant City Attorney A Daisy Gomez Clerk of the Council MIG, Inc. By: Richard D. Barrett Title:Principal •Z SANTA ANA CITY COUNCIL Miguel A Pulido Juan Villages Vicente Sarmienlo Dowd Penaloza Jose Solana Phil Bacerra Cecilia Iglesias Mayor Mayor Pro Tem, Ward 5 Ward Vi Wand Ward Ward moulldoAsanta-anaom ivilleoas[dsentaana.ora vsarmienlo0sanla.ana ora doenal.Oaaaaana am isolono(dsarla-ana oro rbacerrd@santa-anaorg cidesiasAsanla-ana ore CERTIFICATE OF LIABILITY INSURANCE I DAM ',""y"�" 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 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 endorsement(s). PRODUCER CONTACT Deals , Renton & Associates PHONE SiD<65-3O9D _ r'ix — P. O. ox 12675 510-452-2193 Oakland CA 94604-2675 1 nnr�ieass Dertificatest8dealevrentnn Dom INSURED MIG, Inc. 800 Hearst Ave. Berkeley CA 94710 COVERAGES (HCRTICIr1ATC MIIMCCG. mcowna cwc 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. WTSR0. TYPE OF INSURANCE AD 9UBR� POLICYNUMBER POLICY EFF POLICY E%P"- MMIDDM'W NMIOD/YYYY '. LIMITS B X COMMERCIALGENERALLIABILn't Y I Y 6801HB99998 8/3112019 8/31/2020 L- EACH OCCURRENCE $1.000,000 li---- CLAIMSJMDE X PAMAG OCCUR 'PREMISES IEa oca,ran�$1,000,000__ _ . _ MED EXP.Q o Person) 1 $ 5,000 __. PERSONALAADVINJURY 51,000,000 GEN'L AGGREGATE UMRAPPUES PER GENERAL AGGREGATE 52,000,000 '�� POLICY X ! JET LOG PRODUCTS-COMP/OP G 52.000,000 OTHER: $ C AUTOMOBILE LIABILITY Y Y BAW9312eg 813112019 a/31/2020 I COMBINED SINGLE LIMIT $1.000,000 X ANY AUTO Laociderstri BODILY INJURY(P. person) 5 i OWNED SCHEDULED - '---—'------- ----- 5 AUTOS ONLY AUTOS BOOILY INJURY (Per acCdenll X AUTOS ONLY I X ! AUTOS ONLY PROPERTYDAMAGE $---_ -" SXM*al _ B X UMBRELLA LUIB X OCCUR Y Y CUPOH758762 ~ 8r312019 8,31/2020 EACHOCCURRENCE 510,000.000 EXCESS LIAB 71CLAIMS -MADE _ AGGREGATE 510,000,000 `_ -_ S QED...I RETENTIONS c WORKERS COMPENSATION '! UB2L553909 8/312019 B/31/2020X STATUTE, ER. AND EMPLOYERS' LIABILITY YIN $ 1,000.000 ANYPROPRIETOWPARTNERIEXECUTIVE OFFICERA/EMBEREXCLUOEOt N jNIA l El EACH ACCIDENT E.L. DISEASE -EA EMPLOYEE - —__ S1,000,000 (Nomiata In NN A ) It yes. desmbe under .— 'EL. DISEASE -POLICY LIMIT - 31,000,000 DEOCRIPTIONOFOPERATIONShaiov. A Proleesimal AEC903162701 l mbiDty B/31/2019 813112020 PsKCN-m $3, 000DOO LAnnuel Aggmgate i $5,000.000 DESCRIPTION OF OPERAMNS I LOCATION31 VEHICLES (ACORD 101, Addleonal Remarks Schedule, may he aeachad If man apace ie ms uhmd) RE: All operations of the named insured. The City of Santa Ana, its officers, employees, agents, volunteers and representatives are named as Additional Insureds as respects General and Auto Liability as required per written contract or agreement. General Liability insurance is Primary/Non-Conlnbutory per policy form wording. Insurance coverage includes Waiver of Subrogation per the attached. 30 Days Notice of Cancellation. APPR CVULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE The City of Santa Ana EMENT DI �FIi� EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ISIBIDCORDANCE WITH THE POLICY PROVISIONS. Risk Management Divison 20 Civic Center Plaza, 4th Flo7 Santa Ana CA 92701 JR1-skA ZO O AUTHOR DREPRESENTAME U 1333-Z015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Policy: BA61<931299 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM The following is added to Paragraph c. in A.1., Who Is An Insured, of SECTION II — COVERED AUTOS LIABILITY COVERAGE in the BUSINESS AUTO COVERAGE FORM and Paragraph e. in A.1., Who Is An Insured, of SECTION II — COVERED AUTOS LIABILITY COVERAGE in the MOTOR CARRIER COVERAGE FORM, whichever Coverage Form is part of your policy: This includes any person or organization who you are required under a written contract or agreement between you and that person or organization, that is signed by you before the "bodily injury" or "property damage" occurs and that is in effect during the policy period, to name as an additional insured for Covered Autos Liability Coverage, but only for damages to which this insurance applies and only to the extent of that person's or organization's liability for the conduct of another "insured". y & MPP iVs0 is AND114 07 2020 CA T4 37 02 16 ® 20MT4^14" NarIuQ1AUW. All rights reserved, Includes copyrighted material of Insurance Services Office, Inc. with its permission. Page 1 of 1 POLICY NUMBER: 68011-1899998 COMMERCIAL GENERAL LIABILITY ISSUED DATE: 11/25/2019 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 SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Any person or organization that you agree in a written contract to include as an additional insured on this Coverage Part for "bodily injury" or "property damage" included in the "products - completed operations hazard", provided that such contract was signed and executed by you before, and is in effect when, the bodily injury or property damage occurs. Location And Description Of Completed Operations Any project to which an applicable contract described in the Name of Additional Insured Person(s) or Organization(s) section of this Schedule applies. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II — Who Is An Insured is amended to in- clude as an additional insured the person(s) or or- ganization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property dam- age" 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 in- sured and included in the "products -completed opera- tions hazard". & APPROVED igFMFNT DIVISION 07 2020 CG 20 37 07 0412004 Page 1 of 1 POLICY NUMBER 6801H899998 COMMERCIAL GENERAL LIABILITY ISSUED DATE: 11/25/2019 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Names of Additional Insured Person(s) or Organization(s): Any person or organization that you agree in a written contract, on this Coverage Part, provided that such written contract was signed and executed by you before, and is in effect when the "bodily injury" or "property damage" occurs or the "personal injury' or "advertising injury' offense is committed. Location of Covered Operations: Any project to which an applicable written contract with the described in the Name of Additional Insured Person(s) or Organization(s) section of this Schedule applies. (Information required to complete this Schedule, if not shown above, will be shown in the Declarations.) A. Section II — Who Is An Insured is amended to in- clude as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage', "personal injury" or "advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) desig- nated above. B. With respect to the insurance afforded to these additional insureds, the following additional exclu- sions apply: CG D3 61 03 05 Copyright 2005 l Includes copyrighted This insurance does not apply to "bodily injury' or "property damage" occurring, or "personal injury" or "advertising injury" arising out of an offense committed, after: 1. All work, including materials, parts or equip- ment furnished in connection with such work, on the project (other than service, mainte- nance or repairs) to be performed by or on behalf of the additional insured(s) at the loca- tion of the covered operations has been com- pleted; or 2. That portion of "your work" out of which the injury or damage arises has been put to its in- tended use by any person or organization other than another contractor or subcontrac- tor engaged in performing operations for a principal as a part of the same project. & APPROVED 4EMENt DIVISION 2020 Companies, Inc. All rights reserved. Page 1 of 1 , ,=jW�,�ffice, Inc. with its permission. NAMED INSURED: MIG, Inc. COMMERCIAL GENERAL LIABILITY COVERAGE POLICY NUMBER: 68011-1899998 ADDITIONAL COVERAGES BY WRITTEN CONTRACT OR AGREEMENT This is a summary of the coverages provided under the following forms (complete forms available). Excerpt from COMMERCIAL GENERAL LIABILITY COVERAGE (FORM #CG T1 00 02 19) SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS 4. OTHER INSURANCE - d. PRIMARY AND NON-CONTRIBUTORY INSURANCE IF REQUIRED BY WRITTEN CONTRACT: If you specifically agree in a written contract or agreement that the insurance afforded to an insured under this Coverage Part must apply on a primary basis, or a primary and non-contributory basis, this insurance is primary to other insurance that is available to such Insured which covers such insured as a named insured, and we will not share with that other insurance, provided that: (1) The "bodily injury" or "property damage" for which coverage is sought occurs, and (2) The "personal and advertising injury" for which coverage is sought is caused by an offense that is committed. subsequent to the signing of that contract or agreement by you. Excerpt from XTEND ENDORSEMENT FOR ARCHITECTS, ENGINEERS AND SURVEYORS (FORM #CG D3 79 02 19) PROVISION M. - BLANKET WAIVER OF SUBROGATION - WHEN REQUIRED BY WRITTEN CONTRACT OR AGREEMENT: If the insured has agreed in a written contract or agreement to waive that insured's right of recovery against any person or organization, we waive our right of recovery against such person or organization, but only for payments we make because of a. "Bodily injury" or "property damage" that occurs, or b. 'Persona and advertising Injury" caused by an offense that is committed. subsequent to the signing of that contract or agreement. REVIEWED & APPROVED Rv Rich M, NAGENIFNf DIVISION 7 2020 M. LAMBERT Page 1 i11111111W WORKERS COMPENSATION TRAVELERS J AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 99 03 76 ( A) — POLICY NUMBER: U1321-5539139 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT — CALIFORNIA (BLANKET WAIVER) 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. The additional premium for this endorsement shall be % of the California workers' compensation pre- mium. Schedule Person or Organization Job Description Any Person or organization for which the insured has agreed by written contract executed prior to loss to furnish this waiver. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The Information below is required only when this endorsement is issued subsequent to preparation of the policy.) Insurance Company Travelers Property Casualty Company of & AfgRR®?fij�ed by %nFMENT DIVISION DATE OF ISSUE: 11125/2019 I 1 IIA 07 2020 Page 1 of 1 M. LAMBERT POLICY NUMBER: BA61<931299 COMMERCIAL AUTO CA 20 48 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED FOR COVERED AUTOS LIABILITY COVERAGE This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: MIG, Inc. Endorsement Effective Date: 8/31/2019 SCHEDULE Name Of Person(s) Or Organization(s): RE: All operations of the named insured. The City of Santa Ana, its officers, employees, agents, volunteers Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Each person or organization shown in the Schedule is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained In Paragraph A.1. of Section II — Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section I — Covered Autos Coverages of the Auto Dealers Coverage Form. & APPROVED GEMENT DIVISION 07 2020 SAMA�THA M. LAMBERT CA 20 48 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1