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HomeMy WebLinkAboutWOOLPERT, INC.A-2018-015-01 MAYOR cv Vicente Sarmiento o MAYOR PRO TEM David Penaloza rn COUNCILMEMBERS ,— Phil Bacerra Johnathan Ryan Hernandez c Jessie Lopez —� Nelida Mendoza Thai Viet Phan CITY OF SANTA ANA �'• PW CO )�" r^°%o1r`� Mtn`=rJF� PUBLIC WORKS AGENCY 20 Civic Center Plaza • P.O. Box 1988 Santa Ana, California 92702 www.santa-ana.org (714) 675-5050 January 11, 2021 Woolpert, Inc. Attn: Dave Feuer. Vice President 116 Inverness Drive East, Suite 105 Englewood, CO 80112-5125 Re: First Extension of Consultant Agreement No. A-2018-015 CITY MANAGER Kristine Ridge CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL Daisy Gomez Pursuant to Section 3 ("Term") of Agreement No. A-2018-015, entered into by Woolpert, Inc., and the City of Santa Ana, dated January 16, 2018, the time period of the Agreement is hereby extended for an additional two years, from January 16, 2021, through January 15, 2023. The 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. If you have any questions regarding this matter, please contact Margaret Mercer in the Public Works Agency at (714) 647-5050. Sincerely, Nabil Saba, P.E., Executive Director Public Works Agency CITY OF SANTA ANA Kristine Ridge City Manager APPROVED AS TO FORM ATTEST V ON aisy Gomez Clerk of the Council WOOLPERT, INC. W 1�L, -f.w.,& a���, n Funk By: David Feuer Senior Assistant City Attorney Title: vice President SANTA ANA CITY COUNCIL Vicente sanniento David Penaloza The Viet Phan Jessie Lopez Phil Became Johnalhan Ryan Hemandez Nelida Mendoza Mayor Mayor Pro Tem, Ward 2 Ward Word Ward Ward Word ksarneienloroisinla-anaom doenalozarAsanta-anaom tohenesania-anaom Iessielooez6Dsants-ana.are ahacenreatsante.naom 'rvanhemandezLD5afta-anaom mendozarssanta�anaom A-2018-015-01 WOOLINC-01 CERTIFICATE OF LIABILITY INSURANCE I aAT0901nrYn vnalnnnn 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 certlflcslD holder Is an ADDITIONAL INSURED, the policy(los) must have ADDITIONAL INSURED provisions or be endorsed. if SUDROGATION IS WAIVED, subject to the forms and conditions of the policy, Certain policies may require an endorsement. A statement on PRODUCER Amos&: Gough 8300 0mensboro Drive, Suite 900 McLean, VA 22102 Woolpart Inc. 4454 Idea Center Boulevard Dayton, ON 45430-1500 AA6JCYYh P_ah M1CY,YIC,r+n TG' \,e,\iio:cc,. THIS IS TO CERTIFY THA4 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 TOALL THETERMS, LIMITS SHOWN MAY HAVE BEEN REDUCED PAID CLU81ONS AND CONDITIONS OF SUCH POLADIYII P IC.BY Iflyq CIEs. ICLAIM _..___,__.__..__..._.._.__..._...._.._._...,.„................._ TYp oP INSDRANCE POLICY NUTAaaR LIM149 )( .. commiiRCLALORNERfAL` - 1 B99r 9D 1LIASILIT'r ..� CLAIMS -MADE L_XJ DocLwt X 118633 31V2020 311/2021 &8 E roaargwrogncs5-- 3®0,060 j( Contractual Llab. % 2",OIDO .. »� ,N>n0 E3t.'. ifYir.mraawl;u0 '•�, .�1<RSimS1.,S.tJ,2rniduaC ..:4 _ 1 000s000 _g LAOOR tmir �, 9PCRt: t .6dl�NLSOLJ]ra9f3052At0. ... 2,9D9,ODD _ Pol.rcY X � i i IX� r ..Pk143aLUC.7.S.:.C.Rh!+'1SlP�a4Li.. l,.�r......_,......2 099Rb00 A AUTOMOBILaLIAEILITY w/' { -.. -. I, IN UILIMIT .Ri._....._ 1,000,009 X ANY AUTO [ 2448855 31112020 311.12021 II.i1Nx11i1xY.LP�f.aB[44Pi_ r — OWNE'n gg(( HppDIAFO AUI�TIOrr.$rONLY ti(L�+pf�t'.NORyy ( ,,/ ✓ '"� .'#w.............Y,..,._.,... p� AN1GS ONLY ., AU'ftN9 UkCY t [H�R@SNLY_IIJ.Il1p1iV V:9S.244�1L9JII.AA'IACE. B X aMBRELAALIAa X OCCUR ,.._. O OYRRENCE„� J� 10,0001000 .y_�.............._..wx_ exDCssuAa cLUMS-MADE( __C.. 0 LIAR. ,.. __ _ � , ZUP•31N10802.20•NF 311/2020 3111Z021 —... 10,000,000 _ I DEA x RETENTIONS A W9qFRD1,kSC%p%Att NEATIpN ANn EMPLOYErid'LIAarL4'rM' X P DTH- srA�LtiT>r, ANY PROPRIET01bPARTMERmxECUTNE F MV&, EXCLUDED? (yIN1A 31112020 3�1112021 .1U3 ..03_ __ a4 m 0DD0© reaIpn 1Pro L,L�),iE�U+gr•eA CMP)rSZY_t_' ,,D0D000OD0,,,000O1 I C nu H 883 50T2 1 2020, 31112021 Per lalmlAggregale 2,000,000 I DE90RVPTIONDPOPERATIONSILOCATIONS1VEHKLES IACCRD 10, Ad sJoaal Ramarke Schedule, maybe erWahee I(monospace 1%rJ 40frod) RE: Project #7092 'The Clty of Santo Ana, Its of icer$, employees, agents, volunteers and representatives are Included as additional insumd with respect to General Liability when required by written contract, Donors) Liability Includes Ark ionai Insured coverage for On -Going &, Completed Operations as required by written contract. General Liability is p6mary and ncn•contributory over any oxrsting insurance and limited to Itabrtity arising out of the operations of the named Insured and when required by written contract. 30•day Notice of Cancellation will be issuer) for the General Lia:blllty, Automobile Liability, Umbrella Llablllly, Workers Compensation and Professional Liability policies In accordance with policy termsend conditions. E RPTIFIr!ATF mn1 nFn a 0. T rl_ TT Y..LF 4]I k9r-I'll[t )WJ,IT4 b I AVnna, I�TA?T&EM-ENr:vex(.rN SHOULD ANY OF THE ABOVE 00CRIBED POLICIES BE CANCELLED BEFORE City of Santa Ana 28 Civic Cantor Plaza (M•30) a THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. I PO Box 1988 e AVT1111,e REPRP.SENTATIVE Banta Ana, CA 82T02^79B5 �Vil Cir. f)Auvr o Au mu Zo tzu1 olus) 01908.201$ ACORO CORPORATION. Ail rights reserved. The ACORO name and logo are registered marks of ACORD "I., Francine R. Dlglta l ly signed by Francine R. V11 area] Villareal Date: 2021.04.lslo:a817-o7'00' WOOLINC-01 KGODWIN CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 4/6/2021 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 CONTACT NAME: PHONE (A/C, No, Ext): (703) 827-2277 FAX No): (703) 827-2279 Ames & Gough 8300 Greensboro Drive Suite 980 E-MAIL-ADDRESS: admin@amesgough.com McLean, VA 22102 INSURER S AFFORDING COVERAGE NAIC # INSURER A: Travelers Indemnity Co. of America A++ XV 25666 INSURED INSURERB: Phoenix Insurance Company A++ XV 25623 INSURER C : Travelers Property Casualty Company of America 25674 Woolpert Inc. INSURERD: National Union Fire Insurance Company 19445 4454Idea Center Boulevard Dayton, OH 45430-1500 INSURERE: Continental Casualty Company CNA) A XV 20443 INSURER 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 LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MWDD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE i OCCUR P6309P881661 3/1/2021 3/1/2022 DAMAGE TO RENTED PREMISES Ea occurrence 1,000,000 $ MED EXP (Any oneperson) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X71 JECT El LOC PRODUCTS - COMP/OPAGG $ 2,000,000 $ OTHER: B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident 1,000,000 $ X BODILY INJURY Perperson) $ ANY AUTO 8109P88164821 3/1/2021 3/1/2022 OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY C X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10,000,000 EXCESS LIAB CLAIMS -MADE ZUP-31NIO602-21-NF 3/1/2021 3/1/2022 AGGREGATE $ 10,000,000 DED X RETENTION $ 0 $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE 11326673 3/1/2021 3/1/2022 X PER OTH- STATUTE ER E.L. EACH ACCIDENT 1,000,000 $ OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) N/A E.L. DISEASE- EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1,000,000 $ E Professional Liab. :E7 8355072 3/1/2021 3/1/2022 Per Claim/Aggregate 2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: PROJ #78392 — RFP #17-101 The City of Santa Ana, its officers, employees, agents, volunteers and representatives are included as additional insured with respect to General Liability when required by written contract. General Liability includes Additional Insured coverage for On -Going & Completed Operations as required by written contract. General Liability is primary and non-contributory over any existing insurance and limited to liability arising out of the operations of the named insured and when required by written contract. 30-day Notice of Cancellation will be issued for the General Liability, Automobile Liability, Umbrella Liability, Workers Compensation and Professional Liability policies in accordance with policy terms and conditions. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Santa Ana ty THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Risk Management Division, 4th Floor ACCORDANCE WITH THE POLICY PROVISIONS. 20 Civic Center Plaza Santa Ana, CA 92702 AUTHORIZED REPRESENTATIVE RisieMatlagementDiviaian REVIEWED & APPROVED BY.- / z ACORD 25 (2016/03) © 1988-2015 ACORD CII The ACORD name and logo are registered marks of ACORD Risk Management Analyst Policy Number: P6309P881661 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED - WRITTEN CONTRACTS (ARCHITECTS, ENGINEERS AND SURVEYORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. The following is added to SECTION II — WHO IS AN INSURED: Any person or organization that you agree in a "written contract requiring insurance" to include as an additional insured on this Coverage Part, but: a. Only with respect to liability for "bodily injury", "property damage" or "personal injury"; and b. If, and only to the extent that, the injury or damage is caused by acts or omissions of you or your subcontractor in the performance of "your work" to which the "written contract requiring insurance" applies. The person or organization does not qualify as an additional insured with respect to the independent acts or omissions of such person or organization. The insurance provided to such additional insured is limited as follows: C. In the event that the Limits of Insurance of this Coverage Part shown in the Declarations exceed the limits of liability required by the "written contract requiring insurance", the in- surance provided to the additional insured shall be limited to the limits of liability required by that "written contract requiring insurance". This endorsement shall not increase the limits of insurance described in Section III — Limits Of Insurance. d. This insurance does not apply to the render- ing of or failure to render any "professional services" or construction management errors or omissions. e. This insurance does not apply to "bodily in- jury" or "property damage" caused by 'your work" and included in the "products - completed operations hazard" unless the "written contract requiring insurance" specifi- cally requires you to provide such coverage for that additional insured, and then the insur- ance provided to the additional insured ap- CG D4 14 04 08 plies only to such "bodily injury" or "property damage" that occurs before the end of the pe- riod of time for which the "written contract re- quiring insurance" requires you to provide such coverage or the end of the policy period, whichever is earlier. 2. The following is added to Paragraph 4.a. of SEC- TION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: The insurance provided to the additional insured is excess over any valid and collectible 'other in- surance", whether primary, excess, contingent or on any other basis, that is available to the addi- tional insured for a loss we cover. However, if you specifically agree in the "written contract requiring insurance" that this insurance provided to the ad- ditional 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" available to the additional in- sured which covers that person or organization as a named insured for such loss, and we will not share with that 'other insurance". But this insur- ance provided to the additional insured still is ex- cess over any valid and collectible 'other insur- ance", whether primary, excess, contingent or on any other basis, that is available to the additional insured when that person or organization is an additional insured under any 'other insurance". 3. The following is added to SECTION IV — COM- MERCIAL GENERAL LIABILITY CONDITIONS: Duties Of An Additional Insured As a condition of coverage provided to the addi- tional insured: a. The additional insured must give us written notice as soon as practicable of an "occur- rence" or an offense which may result in a claim. To the extent possible, such notice should include: c02008 The Travelers Companies, Inc. Risk Mwag mentDivision REVIEWED & APPROVED BY. - Risk Management Analyst COMMERCIAL GENERAL LIABILITY L How, when and where the 'occurrence" or offense took place; ii. The names and addresses of any injured persons and witnesses; and iii. The nature and location of any injury or damage arising out of the 'occurrence" or offense. b. If a claim is made or "suit' is brought against the additional insured, the additional insured must: L Immediately record the specifics of the claim or "suit' and the date received; and ii. Notify us as soon as practicable. The additional insured must see to it that we receive written notice of the claim or "suit' as soon as practicable. C. The additional insured must immediately send us copies of all legal papers received in con- nection with the claim or "suit', cooperate with us in the investigation or settlement of the claim or defense against the "suit', and oth- erwise comply with all policy conditions. d. The additional insured must tender the de- fense and indemnity of any claim or "suit' to Page 2 of 2 any provider of other insurance which would cover the additional insured for a loss we cover. However, this condition does not affect whether this insurance provided to the addi- tional insured is primary to that other insur- ance available to the additional insured which covers that person or organization as a named insured. 4. The following is added to the DEFINITIONS Sec- tion: "Written contract requiring insurance" means that part of any written contract or agreement under which you are required to include a person or or- ganization as an additional insured on this Cover- age Part, provided that the "bodily injury" and "property damage" occurs and the "personal in- jury" is caused by an offense committed: a. After the signing and execution of the contract or agreement by you; b. While that part of the contractor agreement is in effect; and C. Before the end of the policy period c02008 The Travelers Companies, Inc. Risk Mwag mentDivision REVIEWED & APPROVED BY. - Risk Management Analyst POLICY NUMBER: P6309P881661 ISSUE DATE: 3/1/21 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED ENTITY - EARLIER NOTICE OF CANCELLATIONMONRENEWAL PROVIDED BY US This endorsement modifies insurance provided under the following: ALL COVERAGE PARTS INCLUDED IN THIS POLICY SCHEDULE CANCELLATION: Number of Days Notice: 30 WHEN WE DO NOT RENEW (Nonrenewal) NAME: AS REQUIRED BY WRITTEN CONTRACT ADDRESS: AS REQUIRED BY WRITTEN CONTRACT A. For any statutorily permitted reason other than nonpayment of premium, the number of days re- quired for notice of cancellation, as provided in the CONDITIONS Section of this insurance, or as amended by any applicable state cancellation endorsement applicable to this insurance, is in- creased to the number of days shown in the SCHEDULE above. B. For any statutorily permitted reason other than nonpayment of premium, the number of days re- quired for notice of When We Do Not Renew (Nonrenewal), as provided in the CONDITIONS Section of this insurance, or as amended by any IL T3 54 03 98 Number of Days Notice: 30 applicable state When We Do Not Renew (Nonrenewal) endorsement applicable to this in- surance, is increased to the number of days shown in the SCHEDULE above. C. We will mail notice of cancellation or nonrenewal or material limitation of those coverage forms to the person or organization shown in the schedule above. We will mail the notice at least the Num- ber of Days indicated above before the effective date to our action. Copyright, The Travelers Indemnity Company, 1998 �oRaN RAMmaganadDMsiun REVIEWED & APPROVED BY. - Risk Management Analyst POLICY NUMBER: 8109P88164821 ISSUE DATE: 3/1/21 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED ENTITY - EARLIER NOTICE OF CANCELLATIONMONRENEWAL PROVIDED BY US This endorsement modifies insurance provided under the following: ALL COVERAGE PARTS INCLUDED IN THIS POLICY SCHEDULE CANCELLATION: Number of Days Notice: 30 WHEN WE DO NOT RENEW (Nonrenewal) NAME: AS REQUIRED BY WRITTEN CONTRACT ADDRESS: AS REQUIRED BY WRITTEN CONTRACT A. For any statutorily permitted reason other than nonpayment of premium, the number of days re- quired for notice of cancellation, as provided in the CONDITIONS Section of this insurance, or as amended by any applicable state cancellation endorsement applicable to this insurance, is in- creased to the number of days shown in the SCHEDULE above. B. For any statutorily permitted reason other than nonpayment of premium, the number of days re- quired for notice of When We Do Not Renew (Nonrenewal), as provided in the CONDITIONS Section of this insurance, or as amended by any IL T3 54 03 98 Number of Days Notice: 30 applicable state When We Do Not Renew (Nonrenewal) endorsement applicable to this in- surance, is increased to the number of days shown in the SCHEDULE above. C. We will mail notice of cancellation or nonrenewal or material limitation of those coverage forms to the person or organization shown in the schedule above. We will mail the notice at least the Num- ber of Days indicated above before the effective date to our action. Copyright, The Travelers Indemnity Company, 1998 �oRaN RAMmaganadDMsiun REVIEWED & APPROVED BY. - Risk Management Analyst POLICY NUMBER: ZUP-31N10602 ISSUE DATE: 03/01/21 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED ENTITY - NOTICE OF CANCELLATION PROVIDED BY US This endorsement modifies insurance provided under the following: ALL COVERAGE PARTS INCLUDED IN THE POLICY SCHEDULE — MINIMUM PREMIUM Cancellation: Number of Days Notice of Cancellation: 30 Person or organization: ANY PERSON OR ORGANIZATION TO WHOM YOU HAVE AGREED IN A WRITTEN CONTRACT THAT NOTICE OF CANCELLATION OF THIS POLICY WILL BE GIVEN, BUT ONLY IF: 1. THE FIRST NAMED INSURED SENDS US A WRITTEN REQUEST TO PROVIDE SUCH NOTICE, INCLUDING THE NAME AND ADDRESS OF SUCH PERSON OR ORGANIZATION, AFTER YOU RECEIVE NOTICE FROM US OF THE CANCELLATION OF THIS POLICY, AND 2. WE RECEIVE SUCH WRITTEN REQUEST AT LEAST 14 DAYS BEFORE THE BEGINNING OF THE APPLICABLE NUMBER OF DAYS SHOWN IN THE SCHEDULE. Address: THE ADDRESS FOR THAT PERSON OR ORGANIZATION INCLUDED IN SUCH WRITTEN REQUEST FROM YOU TO US. PROVISIONS If we cancel this policy for any statutorily permitted reason other than nonpayment of premium, and a number of days is shown for cancellation in the schedule above, we will mail notice of cancellation to the person or organization shown in the schedule above. We will mail such notice to the address shown in the schedule above at least the number of days shown for cancellation in the schedule above be- fore the effective date of cancellation. IL T4 05 03 11 0 2011 The Travelers Indemnity Company. All rights reserved. �oRaN 'a Risk MmRgementDMsian REVIEWED & APPROVED BY. - Risk Management Analyst THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. (The following "attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy). This endorsement, effective 12:01 AM 03/01/2021 forms a part of Policy No. WC 113-26-672 Issued to WOOLPERT, INC By NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA. LIMITED ADVICE OF CANCELLATION PROVIDED VIA E-MAIL TO ENTITIES OTHER THAN THE NAMED INSURED (WORKERS' COMPENSATION ONLY) This policy is amended as follows: In the event that the Insurer cancels this policy for any reason other than non-payment of premium, and 1. the cancellation effective date is prior to this policy's expiration date; 2. the Named Insured or, if applicable, any other employers named in Item 1 of the Information Page is under an existing contractual obligation to notify a certificate holder when this policy is canceled (hereinafter, the "Certificate Holder(s)") and the Named Insured has provided to the Insurer, either directly or through its broker of record, the email address of a contact at each such entity; and 3. the Insurer received this information after the Named Insured receives notice of cancellation of this policy and prior to this policy's cancellation effective date, via an electronic spreadsheet that is acceptable to the Insurer, the Insurer will provide advice of cancellation (the "Advice") via e-mail to each such Certificate Holders within 30 days after the Named Insured provides such information to the Insurer; provided, however, that if a specific number of days is not stated above, then the Advice will be provided to such Certificate Holder(s) as soon as reasonably practicable after the Named Insured provides such information to the Insurer. Proof of the Insurer emailing the Advice, using the information provided by the First Named Insured, will serve as proof that the Insurer has fully satisfied its obligations under this endorsement. This endorsement does not affect, in any way, coverage provided under this policy or the cancellation of this policy or the effective date thereof, nor shall this endorsement invest any rights in any entity not insured under this policy. The following definitions apply to this endorsement: 1. Named Insured means the insured first named employer in Item 1 of the Information Page of this policy. 2. Insurer means the insurance company shown in the header on the Information Page of this policy. All other terms, conditions and exclusions shall remain the same. AUTHOR WC 99 00 56 (Ed. 04/11) Archive Copy �oRaN IZAManWmen DMsian REVIEWED & APPROVED BY.- 3 z Risk Management Analyst Professional Liability and Pollution Incident Liability Insurance 1 It is understood and agreed that if the Named Insured has agreed in a written contract with its client to provide such client with notice of cancellation or non -renewal of this Policy, or notice of a reduction in the Limits of Liability of this Policy by endorsement during the policy term, the Insurer will provide such notice of cancellation, non -renewal or reduction in Limits to the client as set forth herein. Within ten (10) business days of the Insurer's request, the Named Insured will deliver to the Insurer, or cause to be delivered by the broker or agent of record, a list acceptable to the Insurer containing the names and addresses of all entities entitled to receive notice. If the list is not provided to the Insurer within such time period, the Insurer will not provide notification. The Insurer will assume that the list provided to the Insurer by the Named Insured or the broker is a complete and accurate list of certificate holders. Only those persons or entities listed on the schedule will receive notification. The Insurer will keep no other record of any certificate holders in the Insurer's file. Such notice will be delivered to such client at the address recorded by certificate on file with the broker or agent of record and provided to the Insurer. With respect to cancellation or non -renewal of this Policy, the Insurer will provide the Named Insured's client with the greater of: (1) thirty (30) days' notice; or (2) the number of days' notice set forth in the applicable State Provisions endorsement attached to this Policy in accordance with the Cancellation/Non-Renewal condition of the Policy. With respect to a reduction in the Limits of Liability of this Policy by endorsement during the policy term, the Insurer will provide the Named Insured's client with the lesser of: (1) sixty (60) days' notice; or (2) the number of days' notice required in the Named Insured's contract with such client. The Insurer's failure to provide such notification will not extend the Policy cancellation date, negate cancellation or non -renewal of the Policy, invalidate any endorsement to the Policy or be cause for legal action against the Insurer. All other terms and conditions of the policy remain unchanged. This endorsement, which forms a part of and is for attachment to the policy issued by the designated Insurers, takes effect on the Policy Effective date of said policy at the hour stated in said policy, unless another effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy unless another expiration date is shown below. Form No: CNA83699XX (11-2015) Po RiskMwaganerdDivisian Endorsement Effective Date: 03/01/2021 Po o r RE�AED&APPROVED SY: Endorsement No: 8 ; Page 1 of 1 Po Underwriting Company: Continental Casualty Company` Risk Management Analyst 151 North Franklin Street, Chicago, IL 60606 Ejhjubmmz!tjhofe!cz!Upsj!Qjfstpo! Upsj!Qjfstpo Ebuf;!3133/14/41!26;58;34!.18(11( WOOLINC-01KSUTTON DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 2/28/2022 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). CONTACT PRODUCER NAME: PHONEFAX Ames & Gough (703) 827-2277(703) 827-2279 (A/C, No, Ext):(A/C, No): 8300 Greensboro Drive E-MAIL admin@amesgough.com Suite 980 ADDRESS: McLean, VA 22102 INSURER(S) AFFORDING COVERAGENAIC # Travelers Indemnity Co. of America A++, XV25666 INSURER A : INSURED Phoenix Insurance Company A++, XV25623 INSURER B : Travelers Property Casualty Company of America 25674 INSURER C : Woolpert Inc. 4454 Idea Center Boulevard National Union Fire Insurance Company19445 INSURER D : Dayton, OH 45430-1500 Continental Casualty Company (CNA) A, XV20443 INSURER E : INSURER F : COVERAGESCERTIFICATE 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. INSRADDLSUBRPOLICY EFFPOLICY EXP TYPE OF INSURANCEPOLICY NUMBERLIMITS LTRINSDWVD(MM/DD/YYYY)(MM/DD/YYYY) 1,000,000 A COMMERCIAL GENERAL LIABILITY X EACH OCCURRENCE$ DAMAGE TO RENTED 1,000,000 CLAIMS-MADEOCCUR X P6309P8816613/1/20223/1/2023 $ PREMISES (Ea occurrence) 5,000 MED EXP (Any one person)$ 1,000,000 PERSONAL & ADV INJURY$ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE$ PRO- 2,000,000 X POLICYLOC PRODUCTS - COMP/OP AGG$ JECT OTHER:$ COMBINED SINGLE LIMIT 1,000,000 B AUTOMOBILE LIABILITY $ (Ea accident) X ANY AUTO 8109P8816483/1/20223/1/2023 BODILY INJURY (Per person)$ OWNEDSCHEDULED AUTOS ONLYAUTOSBODILY INJURY (Per accident)$ PROPERTY DAMAGE HIREDNON-OWNED (Per accident)$ AUTOS ONLYAUTOS ONLY $ 10,000,000 C XX UMBRELLA LIAB OCCUR EACH OCCURRENCE$ CUP-1T790932-22-NF3/1/20223/1/2023 10,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE$ 10,000 X DEDRETENTION$ $ PEROTH- WORKERS COMPENSATION D X STATUTEER AND EMPLOYERS' LIABILITY Y / N 113266733/1/20223/1/2023 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT$ N / A N OFFICER/MEMBER EXCLUDED? 1,000,000 (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE$ If yes, describe under 1,000,000 DESCRIPTION OF OPERATIONS belowE.L. DISEASE - POLICY LIMIT$ Professional Liab.AEH2883550723/1/20223/1/2023 Per Claim/Aggregate2,000,000 E DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: PROJ #78392 – RFP #17-101 The City of Santa Ana, its officers, employees, agents, volunteers and representatives are included as additional insured with respect to General Liability when required by written contract. General Liability includes Additional Insured coverage for On-Going & Completed Operations as required by written contract. General Liability is primary and non-contributory over any existing insurance and limited to liability arising out of the operations of the named insured and when required by written contract. 30-day Notice of Cancellation will be issued for the General Liability, Automobile Liability, Umbrella Liability, Workers Compensation and Professional Liability policies in accordance with policy terms and conditions. CERTIFICATE HOLDERCANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS. Risk Management Division, 4th Floor 20 Civic Center Plaza AUTHORIZED REPRESENTATIVE Santa Ana, CA 92702 ACORD 25 (2016/03)© 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Professional Liability and Pollution Incident Liability Insurance Policy Endorsement NOTICE ENDORSEMENT - NOTICE OF CANCELLATION, NON-RENEWAL OR REDUCTION IN LIMITS WHERE REQUIRED BY WRITTEN CONTRACT It is understood and agreed that if the Named Insured has agreed in a written contract with its client to provide such client with notice of cancellation or non-renewal of this Policy, or notice of a reduction in the Limits of Liability of this Policy by endorsement during the policy term, the Insurer will provide such notice of cancellation, non-renewal or reduction in Limits to the client as set forth herein. Within ten (10) business days of the InsurerÓs request, the Named Insured will deliver to the Insurer, or cause to be delivered by the broker or agent of record, a list acceptable to the Insurer containing the names and addresses of all entities entitled to receive notice. If the list is not provided to the Insurer within such time period, the Insurer will not provide notification.The Insurer will assume that the list provided to the Insurer by the NamedInsured or the broker is a complete and accurate list of certificate holders. Only those persons or entities listed on the schedule will receive notification. The Insurer will keep no other record of any certificate holders in the InsurerÓs file. Such notice will be delivered to such client at the address recorded by certificate on file with the broker or agent of record and provided to the Insurer. With respect to cancellation or non-renewal of this Policy, the Insurer will provide the Named InsuredÓs client with the greater of: (1)thirty (30) daysÓ notice; or (2)the number of daysÓ notice set forth in the applicable State Provisions endorsement attached to this Policy in accordance with the Cancellation/Non-Renewal condition of the Policy. With respect to a reduction in the Limits of Liability of this Policy by endorsement during the policy term, the Insurer will provide the Named InsuredÓs client with the lesser of: (1)sixty (60) daysÓ notice; or (2)the number of daysÓ notice required in the Named InsuredÓs contract with such client. The InsurerÓs failure to provide such notification will not extend the Policy cancellation date, negate cancellation or non-renewal of the Policy, invalidate any endorsement to the Policy or be cause for legal action against the Insurer. All other terms and conditions of the policy remain unchanged. This endorsement, which forms a part of and is for attachment to the policy issued by the designated Insurers, takes effect on the Policy Effective date of said policy at the hour stated in said policy, unless another effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy unless another expiration date is shown below. Policy No: AEH288355072 Form No: CNA83699XX(11-2015) Policy Effective Date: 03/01/202 Endorsement Effective Date: 03/01/202 Page1 1of Policy Page: 31of 44 Underwriting Company: Continental Casualty Company 151 North Franklin Street, Chicago, IL 60606 © Copyright CNA All Rights Reserved.