HomeMy WebLinkAbout19E - ON-CALL ENVIROMENTAL PLANNING SERVICESREQUEST FOR
COUNCIL ACTION
CITY COUNCIL MEETING DATE:
AUGUST 18, 2020
CLERK OF COUNCIL USE ONLY:
TITLE:
APPROVED
❑ As Recommended
AUTHORIZE RELEASE OF REQUEST
ElAmended
ElOOrrdinance on 1"Reading
FOR QUALIFICATIONS TO ESTABLISH A
❑ Ordinance on 2ntl Reading
LIST OF PRE -QUALIFIED CONSULTANTS
❑ Implementing Resolution
PROVIDING AS NEEDED ON -CALL
❑ Set Public Hearing For
ENVIRONMENTAL AND PLANNING
SERVICES
/s/Kristine
CITY MANAGER
CONTINUED TO
111111111111►1I1TA1:3gC7
RECOMMENDED ACTION
Authorize the Planning and Building Agency to release the Request for Qualifications to establish
a list of pre -qualified professional consulting firms providing as needed on -call environmental and
planning services.
DISCUSSION
In October 2017, the City Council approved a list of over 30 consultants that were qualified to assist
staff and developers in the preparation of environmental documents and related technical studies.
The list was approved for a period of three years. Staff is proposing to continue the program and
is requesting authorization to distribute a Request for Qualifications to establish a new list (Exhibit
1).
The ability to select a consultant from a pre -approved list eliminates the need to circulate individual
Request for Proposals thus reducing the time it takes to hire a consultant and streamlines the
entitlement preparation process. The scope of work to be performed by consultants includes any
and all work efforts needed by City agencies that are related to analysis of a proposed project for
compliance with the California Environmental Quality Act and National Environmental Policy Act,
including the preparation of technical studies. Further, consultants are needed to provide expertise
in a range of functions such as the processing of specialized development project applications,
code amendments related to unique and/or special planning related topics, and the provision of
planning staff services.
The Statement of Qualifications received in response to this Request for Qualifications will be
reviewed by staff and compiled into a list of qualified firms for City Council approval. Selection for
the pre -approved list does not guarantee work to a consultant. Upon selection for a specific project,
a side letter agreement to provide Environmental and Planning Services is drafted, insurance
19E-1
RFQ for Environmental and Planning Services
August 18, 2020
Page 2
information is collected, and funding for the project is verified. Selected firms that are responsive
to this RFP will remain on the City's official list for a period of three years.
FISCAL IMPACT
There is no fiscal impact associated with this action.
Submitted By: Minh Thai, Executive Director - Planning and Building Agency
Exhibit: 1. Request for Qualifications
19E-2
EXHIBIT 1
REQUEST FOR QUALIFICATIONS (RFQ)
FOR
ENVIRONMENTAL AND PLANNING SERVICES
RFQ #20-100
Issued By:
CITY OF SANTA ANA
PLANNING DIVISION, M-20
20 CIVIC CENTER PLAZA
SANTA ANA, CALIFORNIA 92702
Release Date: August 19, 2020
Deadline for Submission:
SEPTEMBER 18, 2020
By 5:00 PM
�NO LATE PROPOSALS WILL BE ACCEPTED
The City of Santa Ana reserves the right to reject any or all Proposals, to waive any
informality in any Proposal, and to select the Proposals that best meet the City's needs.
19E-3
REQUEST FOR QUALIFICATIONS (RFQ)
FOR
ENVIRONMENTAL AND PLANNING SERVICES
I. Introduction
The City of Santa Ana is seeking Statements of Qualifications from qualified professional
consulting firms to provide environmental and planning services for the City of Santa Ana.
The scope of work may include any and all work efforts related to analysis of a proposed
project for compliance with California Environmental Quality Act (CEQA) and National
Environmental Policy Act (NEPA). This may include preparation of required technical
studies, peer review of technical studies prepared by others, preparation of Initial Studies,
Negative Declarations, Mitigated Negative Declarations, Environmental Impact Reports,
Environmental Assessments, Environmental Impact Statements and staffing services on
an as -needed basis.
The City will review the qualification information received to establish a pre -qualified
consultant list. Consultants will be utilized on an as -needed basis. The City will enter into
separate agreements with each of the selected firms. Selection to be on the pre -qualified
list does not guarantee work.
II. General Information
It is the intent of the City to establish a list of consulting firms to be utilized for a period of
three (3) years, as -needed. Consulting firms shall enter into master agreements with the
City on the City's Standard Agreement Form.
A. This RFQ does not commit the City to pay costs incurred in preparation of a response.
The City reserves the right to accept or reject the combined or separate components of
this proposal in part or in its entirety. All responses to the RFQ shall become property
of the City. Applicants who wish to retrieve documents submitted as part of the
response to the RFQ may do so after the list of pre -qualified consultants is established.
B. All costs incurred in the preparation of the proposal, the submission of additional
information and/or any aspect of a proposal prior to award of a written contract will be
borne by the respondent. The City will provide only the staff assistance and
documentation specifically referred to herein and will not be responsible for any cost or
obligation of any kind, which may be incurred by the respondent.
C. The City of Santa Ana will evaluate each proposal based on technical criteria and
qualifications listed within the RFQ, reference checks, and other information, which will
be gathered independently. A final listing of the most qualified Consultants will then be
established and subsequently be approved by City Council.
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19E-4
D. It should be noted that multiple firms may be selected to provide services and there is
no guarantee of work. The City reserves the right to select consultants in any manner
that will best serve the City's interests.
E. At such time when the consultant's services are required, staff will forward a request
for services, including a project description, any pertinent supporting information and
technical studies, and copies of the proposed application and plans (as available). The
consultant may be requested to provide additional services such as the preparation of
supporting technical reports and studies for the project application or a peer review of
applicant -submitted materials. The consultant will evaluate the proposal and in turn
provide a Scope of Work and Cost Estimate for services.
F. Firms will be selected based upon their ability to perform the required work within each
project's schedule and budget constraints. All work prepared by the consultant will be
performed for and at the direction of the City of Santa Ana.
G. When appropriate, the City will furnish information in its possession relevant to
preparation of the environmental documentation, including the General Plan and
Zoning Code.
H. The Consultant shall be responsible for retaining data, records and documentation for
the preparation of the environmental documents. These materials shall be made
available at the request of the City.
I. All data, documents and other products used or developed during preparation of the
environmental documentation will become property of the City.
J. The City reserves the right to reject and replace any and all subcontractors, and
reserves the right to approve all subcontractors.
K. Progress review meetings for each assigned project shall be held at intervals deemed
appropriate by the City.
COORDINATION
Coordination with the City, other consultants and agencies will be required to achieve
satisfactory and timely delivery of the final work product. Coordination may include, but
not be limited to: coordination with applicant/developer, neighborhood and civic groups,
other local agencies and consultants, County of Orange, Airport Land Use Commission,
State Agencies and Boards, Federal Aviation Administration, and Environmental Protection
Agency.
The City will decide the manner in which the coordination efforts with be conducted. At the
City's option, coordination efforts may be performed by the Consultant's direct contact, by
the Consultant acting through the City or by the City only. When coordination efforts require
agreements, such agreements shall be coordinated through the City.
2
19E-5
PROFESSIONAL SERVICES AGREEMENT
A Professional Services Agreement will be required. The Statement of Qualifications
submitted in response to this Request for Qualifications will be attached and become part
of the service agreement as an exhibit.
INSURANCE
All required insurance must be provided to the City in advance and renewed annually. A
consultant may not work for the City of Santa Ana until the appropriate insurance has been
approved. A copy of the Insurance Requirements for Consultants and additional insured
Endorsement for Commercial General Liability Policy are included as Attachment "A".
Please refer to these attachments for the necessary amounts of general liability,
automotive, worker's compensation and professional liability insurance. The certificate
shall include the City and its officers and employees as insured or additional insured.
PRIME CONSULTANT RESPONSIBLITIES
The selected Consultant will be required to assume responsibility for all services in their
proposal. The selected Consultant will be the sole point of contact with regard to
contractual matters, including payment of any and all charges resulting from the
Agreement.
RULES FOR PROPOSALS
The signer of the proposal must declare in writing that the only person, persons, company
or parties interested in the proposal as principals are named therein; that the proposal is
made without collusion with any other person, persons, company or parties submitting a
proposal; that it is in all respects fair and in good faith without collusion or fraud; and, that
the signer of the proposal has full authority to bind the principal proposer.
rA991►IA
Any subsequent changes in RFQ from the date of issuance to date of submittal will result
in an addendum by the issuing office.
III. Scope of Services
Consultants will be expected to provide experienced and knowledgeable professional staff
familiar with federal, state and local regulations including the Santa Ana Municipal Code
and General Plan and the CEQA and NEPA. The Consultants' Project Manager and staff
shall be responsive and maintain excellent working relationships with project applicant,
property owners, developers and City staff. Consultants shall be committed to provide
adequate staffing levels at all times in order to adhere to established schedules. All
consultants shall provide services under the direction of City staff. Services may include
attendance at appropriate City Council, City Commissions and neighborhood meetings.
3
19E-6
A. Environmental Services
Services include, but are not limited to preparation of documents, distribution and filing
of environmental noticing, preparation of studies and technical reports as required by
the CEQA and NEPA including, but not limited to:
• Initial Study
• Notice of Preparation
• Notice of Availability
• Notice of Determination
• Categorical Exemption
• Negative Declaration
• Mitigated Negative Declaration
B. Technical Studies
• Environmental Impact Report
(Program, Focused, Master, Staged)
• EIR Addendum, Supplemental EIR,
Subsequent EIR
• Mitigation and Monitoring Program
• Response to Comments
• Statement of Overriding Considerations
• NEPA compliance documents
As necessary, prepare any technical studies needed to complete the environmental
review or for development projects or City projects as -needed, including but not limited
to:
• Air Quality Study
• Biological Resource Assessment
• Cultural Resource Study
• Environmental Site Assessments
• Economic/Market Study
• Geological/Soil Study
• Greenhouse Gas Assessment
• Health Risk Assessment
C. Staffing Services
• Historical Resource Assessment
• Hydrology/Water Quality Study
• Noise Impact Study
• Parking Study
• Water Supply Assessment
• Mineral Resource Study
• Utility/Sewer Study
• Traffic Study
The Planning Division is also seeking qualified professional individuals, firms, or multi-
disciplinary teams with experience in current, historic preservation and advanced
planning to assist with processing development project applications, counter services
and planning efforts on an as -needed basis.
IV. Submittal Requirements
The Request for Qualifications is intended to assess and evaluate each firm's capabilities
as they apply to the City of Santa Ana. Each firm must address each of the following items
in their response to the RFQ:
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19E-7
A. Statement of Qualifications
In order to maintain uniformity with each Consultant, the Statement of Qualifications
must be limited to a maximum of 20 pages (excluding front and back covers, table of
contents, section dividers and resumes). The page limitation includes all appendixes,
attachments and supplemental information. Except as specified above, each page of
text will be counted individually i.e. pages printed on the front and back will count as
two pages. The following information is required:
1. Cover Letter
A letter signed by a principal or authorized officer who may make legally binding
commitments for the entity. The scope of services that the firm is qualified for should
be identified within the cover letter along with the primary project contact and contact
information.
a. Scope of Services
Clearly identify the scope of services that will be provided (if one, two or all
three services can be provided). Services to be provided should be identified
by both the letter and name that is listed in Section III above (i.e. "A.
Environmental Services," "B. Technical Studies — Historical Assessments,"
"B. Technical Studies — Air Quality, Noise and Traffic, etc.).
b. Project Contact
The Project Manager/Principal Agent for the proposed work shall be
identified. The contact's name, email and phone number should be included.
The project manager shall be the primary contact person to represent your
firm and will be the person to conduct the presentation, if invited for an
interview.
2. Firm and Personnel Experience
A profile of the firm's experience in producing environmental documents and
technical studies and a brief resume of key personnel who may perform work for the
City.
3. Relevant/Related Experience
Provide a list of projects, which your firm or personnel have completed within the
last 5 years, including significant work with public agencies. Project information
should include project description, year completed, client name, along with a person
to contact and their telephone number or email.
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19E-8
Firms that specialize in technical studies (biology, noise, air quality, traffic, etc.) shall
submit materials describing their qualifications to prepare such studies. Technical
firms will be placed on the list with a technical study annotation.
4. References
Provide at least three (3) references that may be contacted for verification of the
respondent's experience and qualifications.
B. Insurance Verification
Include a statement of understanding that all required insurance must be provided to
the City in advance of any work performed and renewed annually.
C. Fee Schedule
The Consultant shall furnish a general fee schedule for environmental and planning
services and technical studies. The fee schedule shall depict the general hourly rates
for each personnel category to be used. Personnel hourly rates shall reflect all costs for
office overhead, including phones, cellular phones, vehicles, mileage and other direct
and indirect costs. The fee schedule is not counted as part of the maximum page count.
V. Submittal Information and Deadline
Proposals must be submitted via email and mail on or before September 18, 2020 by
5:00 p.m. Proposals emailed or postmarked after the date and time specified in this RFQ
will be rejected by the City as non -responsive.
Email one (1) electronic copy to SKelahera-santa-ana.org. Include "Environmental and
Planning Services SOQ 2020" in the subject line. PDF attachments less than 20 MB may
be sent or include a link to download from DropBox, sharefile, etc.
AND
Mail one (1) bound copy and an electronic version (USB flash drive or CD) of the proposal.
Proposals must be post marked prior to August 20, 2020 and sent to:
City of Santa Ana
Planning Division
Attn: Selena Kelaher
20 Civic Center Plaza
Santa Ana, CA 92701
For all questions and inquiries related to the Request for Qualification for Environmental
and Planning Services please contact Selena Kelaher, Associate Planner at (714) 667-
2740 or SKelahera-santa-ana.org.
0
19E-9
VI. Method of Payment
The Consultant shall submit a monthly invoice to the City for the services rendered in that
month. The invoice format shall be approved by the City and include a summary of and
detailed breakdown of the services, the project title, the tasks, the hours, and hourly rates,
total cost of services budgets and amount of services billed to date and amount remaining
in the budget.
VII. Project Control
Control of the project shall remain the total responsibility of the City of Santa Ana.
Vill. Consultant Selection
The City of Santa Ana will evaluate the consultants based on technical criteria and
qualifications listed within the RFQ, reference checks, and other information, which will be
gathered independently. Upon selection, the City will provide the firm with a new vendor
packet. All information within the packet and any additional information must be submitted
back to the City in order to be included on the final list for City Council approval. A final
listing of the most qualified consultants will then be established and subsequently be
approved by City Council.
The City reserves the right to reject any or all proposals submitted and no representation
is made hereby that any contract will be awarded pursuant to this RFQ or otherwise.
IX. Filing a Protest
Bidders may file a "protest" with the City's Planning Agency. In order for a vendor's protest
to be considered valid, the protest must:
1. Be filed in writing within five (5) business days of either the RFP posted date or
before 5:00 p.m. of the 5th business day following the posting of RFP results/Notice
of Intent to Award Contract on the City's website;
2. Clearly identify the specific irregularity or accusation;
3. Clearly identify the specific City staff determination or recommendation being
protested;
4. Specify, in detail, the grounds of the protest and the facts supporting the protest;
and
5. Include all relevant, supporting documentation with the protest at time of filing.
If the protest does not comply with each of these requirements, it will be rejected as invalid.
If the protest is valid, the City's Planning Manager, or other designated City staff member,
shall review the basis of the protest and all relevant information. The Planning Manager
will provide a written decision to the protestor within fourteen (14) calendar days from
receipt of protest. The decision from the Planning Manager, or her/her designee, is final
and no further appeals will be considered.
7
19E-10
X. Attachment
Attachment A - INSURANCE REQUIREMENTS FOR CONSULTANTS AND ADDITIONAL
INSURED ENDORSEMENT FOR COMMERCIAL GENERAL LIABILITY
POLICY
0
19E-11
ATTACHMENT A
19E-12
ATTACHMENT A
CITY OF SANTA ANA
FINANCE AND MANAGEMENT SERVICES
Purchasing Division
20 Civic Center Plaza • P.O. Box 1988
Santa Ana, California 92702
w .santa-ana.orq
PURCHASING MINIMUM INSURANCE REQUIREMENTS
A current Certificate of Liability Insurance is required for vendors providing services to, for, or on behalf of
the City of Santa Ana. Certificate of Liability Insurance Acord's 25-S form to include the following:
COVERAGE
MINIMUM LIMITS
General Liability
$1,000,000 per occurrence
$2,000,000 aggregate
Automobile Liability including coverage for any
$1,000,000 per occurrence with no annual aggregate
auto oreach of the following: all owned, hired
limit for each of the following:
- Bodily Injury
autos, non -owned autos.
Property Damage
Workers' Compensation
*
$1,000,000 per occurrence
Sole proprietor, see below.
REQUIRED LANGUAGE
Additional Insured and Primary & Non Contributory: City of Santa Ana, officers, agents, employees, and
volunteers are named as additionally insured on this policy pursuant to written contract, agreement, or
memorandum of understanding. Such insurance as is afforded by this policy shall be primary, and any insurance
carried by City shall be excess and noncontributory.
Certificate Holder must be addressed as follows: City of Santa Ana
Risk Management Division
20 Civic Center Plaza
Santa Ana, CA 92702
Cancellation Clause: City will be mailed 30 days' written notice of policy cancellation and the references
"endeavor to" and "failure to mail such notice shall impose no obligation or liability of any kind upon the
company, its agents or representatives" shall be removed or crossed out.
• A separate "Additional Insured Endorsement Form" CG2010 or CGL216 may be completed, signed by the
insurance broker, and returned with your Certificate of Insurance. The Additional Insured Endorsement
CG2010 or CGL216 must include the following statement: "The City of Santa Ana, its officers, employees,
agents, and representatives are named as additional insured on this policy pursuant to written
contract, agreement, or memorandum of understanding."
• Vendors working on City vehicles housed on Vendor's property are required to carry Garage Liability.
• If you are a sole proprietor and have no employees and your company does not require Workers
Compensation coverage, request a Sole Proprietor Waiver.
• For your convenience, samples of a properly executed insurance certificate and endorsement are attached.
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r� NIGHCON-02 MCGRAVI
.4iCiCORa CERTIFICATE OF LIABILITY INSURANCE VATEIMWJ Ds vl
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMAMU ONLY AND CONFERS NO RIGHTS LIPON THE CERTIFICATE HOLDER_ THIS
CERTIFICATE ODES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE ODE& NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERIS},AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER -
IMPORTANT: R the corlificala hvlltur is aM ADpT1ONAL INSURE®, Vw pmlicyllw} mlrsl Mur ADDITIONAL IH6N1RE0 prnrlatnna ar 1se endaraad
IF SUBROGATION 15 WAIVED, subject 1p Ow. [arms -nd wndlUlnna of the policy, comin pelielos may mquim an endorsement. A 8talamenLon
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RAGE„_ CERTIFICATE HIIMBER: '6E3rISION NUMBER'
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELCW HALE REFN 15AUFD TOTHE INSURED NAMEDABOVETOR THE PCLICYPERIOD
INDICATED. HOTL'ATI ISTANLHNG ANY REATUIREMBNI, 16RM OR CONDITION C' ANY rnNTRACT00 OTHER DbCUMENTWITH RESPECT TO WII10H THIS
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y of Santa Ana, Re of lcet6. empfoye . aganks m.d mpmaernnau,&sm a AddRWnal Insureds wleh reapuwt to Gum-rel and Auto Liability per the ilfwb.d
dnrrarnuntaarmquimd by WIUea C&Otract. In6uranaa IN Primary and Non-ConlribuUors. WalYar of SubmgaVPn appileet. W.1-. -Compensation•
Dare Notice o1 Cancellation with 10 Gaya Notice lot RnilFaymerrt o, Premium In aec4Tdmnr-a with the pallet' preVl9Fone.
City of Santa Ana
Risk Management ❑Ivlslon
20 Civic Center Plaza
Santa Ana, CA927DZ
SHOULD ANY OF THIS ABOVE DESDRII9ED POLICICS BE CAKELI.FD ElEFbiNt
THE EXPIRATION DATE THEREOF, Fj&nCB WILL BE DELTA€REM N
ACCORDANCE WITtN TW POucY PRdVISIONL
Aunialaarme[eneSeaTwTrrc
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c 19aa-.Za1 S ACORN CORPORATION. All rlghte mservA
The ACORD name and logo are rogiah red marks of ACORD
Polity Number 6667964S746M
Named Insured. Singh. A. J. CBA Sign.A.Rama
CG2015 1168
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADIDIf IONAL INSIJRED - VEN0ORS
This endoesamani modifies k1suranoa prgvidad unuler the fgllw ing.
COMMERCIAL GENERAL LIABILITY COVERAGE PART.
P R OO Il CTSiCOM PL ETED OPE RAT ION LIABILITY COVERAGE PART.
SCHEDULE
Name of Parson or drgairarptlpn lVondorj:
C;ty of Santa Ana, Its officers, agents, and emplaygas
Zit Civic Center Plaza
Santa Ana, CA 927D1
fid no entry appears above, infarmatlbn reg4lifed to complete this endorsement w111 be shown 1n
tha Declarations as applicable to (tis endorsement.)
WHO IS AN INSURED fSaction lly Is amended io repackaged in line original corllvfw
nduce a� aR.ir,ur47W)
ran cr SrIzA11d t An Idlslfi b ngl a_st#1 inspecGan,
(refereed g'ppya.own i 6rs' �surrll0 ty fir_se� ng as the
Sohedul�twt t nJbrPxopenti�mage'"shaven�n'llth�' gcefrit.,Ora a o4 (`bu ea raC aCls�lnedi'stdbUlldn
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gubJect tc the follov�ing eddlianar exclusluns f, �emnnsWairorl.-lnstaiiiRgriad+vlcing pr
Npoir operallon5, except Such oper Dons
1. The insurance afforded the vendor doe's not performed at the vendor's premises in
apply 10 oannection with the sale of the PxbdUct.;
a. -Bedify injury' or'propeirly damKe For q_ Products which, alter dletribullos of Sale bV
which the vendor is obligaled to pay you, have been labeled or re-0abe!'W or used
oamages by ren%on or the owumptlon or as ® coniainor. earl or ingredien[ all any other
lyb ltty rn y oorrlrA�or agrewrwnl. TN& I.Nng or sabelandAe by or for the vandor.
escluglon doe's notappy to liability for
48rnage2 that the vandorwould have in ri
absence of the conlr t or agreement:
4. Any express warranty unaulltorized by you:
c. Any physical 0r chemical change in the
products mogi dntenr on ally by the vendor,
d. Repackap ing, uMeet unpackeed loteiy for the
purpose al insoWlca. deincow bon,
lasting, 5r the suloslifulion of parts under
. nslruoicel % from the rnanufacturar. and U,.en
2 This insurance doom nC1 apply [o any neared,
parson or organization from Whom ycv have
acqui rod suCh products, or any Ingredient, part
or writalner. entering Into. aCCompamyarig or
containing such products.
CQj04 11 §¢ CaooglhL lrawanc% 5sMloes 4rrcc. lrK, 1986 1988
ADDITIONAL INSURED ENDORSEMENT
Insurance Company
This endorsement modifies such insurance as is afforded by the provisions of Policy
# relating to the following:
1. The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701; it officers,
employees, agents and representative 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 the additional insureds, this insurance shall not be cancelled, 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
Policy If
Issued to
Name Insured
Countersigned by
this endorsement form as part of
S1 .' .;