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HomeMy WebLinkAboutBLUERAY MANAGEMENT, LLC. (2)IIJSURANCE N01 ON FILE WORK MAY NOT PROCEED MAYOR Miguel A Pulida CLERK OF COUNCIL MAYOR PRO TEM Juan VAlegas COUNCILMF_MBERS Phil Bacerra Nelida Mendoza David Penafoza Vicente Sanniento Jose Solono DATE: CITY OF SANTA ANA ©'- i��CI�LSIIt/'icnCtevctS) PARKS, RECREATION, AND COMMUNITY SERVICES AGENCY 20 Civic Center Plaza • P.O. Box 1988 Santa Ana, California 92702 w sanla_ana ore November 3O, 2020 Blueray Management, LLC 10661 Ellis Ave., Ste, E Fountain Valley, CA 92708 Alm: Abdullah Pearose, President Re: First Extension of Agreement No. A-2020-007 Dear Ms. Pearose: A-2020-007-01 CITY MANAGER Knstine Ridge CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL Daisy Gomez, MMC Pursuant to Section 3 ("Term') of the above -referenced Agreement, entered into by Blueray Management, LLC and the City of Santa Ana, dated January 21, 2020, the term of the Agreement is hereby extended for a one-year Period, from Januarys 21, 2021 through January 20, 2022. 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. Please sign below and return this extension to the City at your earliest convenience. Since ly, C Lisa Lid off Executive Director. Parks, Recreation, and Community Services Agency CITY OF SANTA ANA Kristine Ridge City Manager APPROVED AS TO FORM SXIdiLil4_-_t1._ ne'��+'k Laura A. Rossini Acting Oncl'Assistanl CItA Atturnc.N ATTEST Gomez, CMC or the Council BLUERA Y M 'ENIENT, LLC. Nanw (Lo Title: eu t nit=_ Ejhjubmmz!tjhofe!cz!Gsbodjof!S/!Wjmmbsfbm!Ebuf;!3131/23/29!27;28;36!.19(11( Gsbodjof!S/!Wjmmbsfbm OBJD!$ 2:98: 1302303131 2-111-1112-111-1112-111-111 %%%%%%%%%%%%%%%%%% PUI.FS QFSTUBUVUF FBDI!PDDVSSFODFEBNBHF!UP!SFOUFEQSFNJTFT!)Fb!pddvssfodf*NFE!FYQ!)Boz!pof!qfstpo*QFSTPOBM!'!BEW!JOKVSZHFOFSBM!BHHSFHBUFQSPEVDUT!.!DPNQ0PQ!BHHDPNCJOFE!TJOHMF!MJNJU)Fb!bddjefou*CPEJMZ!JOKVSZ!)Qfs!qfstpo* CPEJMZ!JOKVSZ!)Qfs!bddjefou*QSPQFSUZ!EBNBHF)Qfs!bddjefou*FBDI!PDDVSSFODFBHHSFHBUFF/M/!FBDI!BDDJEFOUF/M/!EJTFBTF!.!FB!FNQMPZFFF/M/!EJTFBTF!.!QPMJDZ!MJNJU JOTVSFS)T*!BGGPSEJOH!DPWFSBHF Tfdvsjuz!Obum!Jot!Dp 13021031311302103132 2492886 OK18179 DB:3819DB:3813 O!0!B OOTXD2384989 Z!0!O MPD PDDVSDMBJNT.NBEF TDIFEVMFEBVUPTOPO.PXOFEBVUPT!POMZ QSP.KFDU CMVFSBZ!NBOBHFNFOU!MMD21772!Fmmjt!Bwf-!Tuf!FGpvoubjo!WbmmfzDjuz!pg!Tboub!Bob-!Sjtl!Nbobhfnfou31!Djwjd!Dfoufs!Qmb{bTboub!Bob DMBJNT.NBEFPDDVS DPNNFSDJBM!HFOFSBM!MJBCJMJUZ QPMJDZPUIFS;BOZ!BVUPPXOFEBVUPT!POMZIJSFEBVUPT!POMZEFESFUFOUJPO% HFO(M!BHHSFHBUF!MJNJU!BQQMJFT!QFS; )Nboebupsz!jo!OI*Jg!zft-!eftdsjcf!voefsEFTDSJQUJPO!PG!PQFSBUJPOT!cfmpx UIJT!DFSUJGJDBUF!JT!JTTVFE!BT!B!NBUUFS!PG!JOGPSNBUJPO!POMZ!BOE!DPOGFST!OP!SJHIUT!VQPO!UIF!DFSUJGJDBUF!IPMEFS/!UIJTDFSUJGJDBUF!EPFT!OPU!BGGJSNBUJWFMZ!PS!OFHBUJWFMZ!BNFOE-!FYUFOE!PS!BMUFS!UIF!DPWFSBHF! BGGPSEFE!CZ!UIF!QPMJDJFTCFMPX/!!UIJT!DFSUJGJDBUF!PG!JOTVSBODF!EPFT!OPU!DPOTUJUVUF!B!DPOUSBDU!CFUXFFO!UIF!JTTVJOH!JOTVSFS)T*-!BVUIPSJ\[FESFQSFTFOUBUJWF!PS!QSPEVDFS-!BOE!UIF!DFSUJGJDBUF!IPMEFS/JNQPSUBO U;!!Jg!uif!dfsujgjdbuf!ipmefs!jt!bo!BEEJUJPOBM!JOTVSFE-!uif!qpmjdz)jft*!nvtu!ibwf!BEEJUJPOBM!JOTVSFE!qspwjtjpot!ps!cf!foepstfe/Jg!TVCSPHBUJPO!JT!XBJWFE-!tvckfdu!up!uif!ufsnt!boe!dpoejujpot!pg!uif!qpm jdz-!dfsubjo!qpmjdjft!nbz!sfrvjsf!bo!foepstfnfou/!!B!tubufnfou!pouijt!dfsujgjdbuf!epft!opu!dpogfs!sjhiut!up!uif!dfsujgjdbuf!ipmefs!jo!mjfv!pg!tvdi!foepstfnfou)t*/ B Bvupnbujd!Ebub!Qspdfttjoh!Jotvsbodf!Bhfodz-!Jod/2!Beq!CpvmfwbseSptfmboe Digitally signed by Francine R. Francine R. Villareal Villareal A� " CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 01/31/2021 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 CONT-NAMEAutomatic Data Processing Insurance Agency, Inc. Automatic Data Processing Insurance Agency, Inc. PAH/C' N Ext : 1-800-524-7024 (AJC, No): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # 1 Adp Boulevard INSURERA : Security National Insurance Company 19879 Roseland NJ 07068 INSURED Blue Ray Management LLC INSURER B : INSURER C : INSURER D : DBA: Blue Ray Management LLC INSURER E : 10661 Ellis Ave, Ste E INSURER F : Fountain Valley CA 92708 COVERAGES CERTIFICATE NUMBER: 1831361 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 TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS -MADE OCCUR PREMISES (Ea occurrence) $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY ❑ PRO- JECT ❑ LOC PRODUCTS - COMP/OP AGG $ $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ A WORKERS COMPENSATION EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? (Mandatory in NH) N/A N SWC1326080 02/10/2021 02/10/2022 OT PER H- STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION City of Santa Ana, Risk Management 20 Civic Center Plaza Santa Ana ACORD 25 (2016/03) 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 CA 92702 © 1988-2015 ACORD The ACORD name and logo are registered marks of ACORD Risk Managzment Division REVIEWED & APPROVED BY.- � Risk Management Analyst