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HomeMy WebLinkAboutMENTE, INC. DBA VARGAS, CESAR & ASSOCIATES -2019r..0 UN FILE N-2019-125-01 ,,ARANCEEEXPIRES Ib 21 vi COUNCIL u FIRST AMENDMENT TO AGREEMENT TO PROVIDE TRANSLATION SERVICES 1 THIS FIRST AMENDMENT to the above -referenced agreement is entered into on March 22, 2021, by and between MENTE, Inc., a California corporation doing business as Cesar Vargas & Associates ("Consultant'), and the City of Santa Ana, a charter city and municipal corporation organized and existing under the Constitution and laws of the State of California ("City"). RECITALS A. The parties entered into Agreement No. N-2019-125, dated June 25, 2019, by which Consultant agreed to provide translation services ("Agreement'). The term of the Agreement continues through June 24, 2022, and is current and in effect. B. The parties wish to amend the Agreement to increase the overall compensation for the remainder of the term. The Parties therefore agree: 1. Section 2.a., .Compensation, is amended to increase the total amount to be expended during the term of the Agreement by $25,000, including any extension periods. 2. Except as modified by this First Amendment, all terms and conditions of the Agreement shall remain in full force and effect. 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 1 Ir�3GJ 9 Daisy Gomez Krisfine Ridge Clerk of the Council City Manager APPROVED AS TO FORM Sonia R. Carvalho City Attorney By: jq64 ?A, -f.-�, n M. Funk Senior Assistant City Attorney CONSULTANT 044 W / � 104 1 -) By: Cesar Vargas Title: Executive Director/CEO Page 1 of I Villareal N-2019-125-01 s. o' a CERTIFICATE OF LIABILITY INSURANCE D05/2012020Y) 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 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 Sariah Devereaux- Barrie ntos, Agent 1417 S Broadway Staterarm Santa Ana, CA 92707 } NAME: SARIAH DEVEREAUX-BARRIENTOS AICNNo EXI:714-541-7280 AIc No:714-384-3892 EMAIL ADDRESS: sariah.devereaux.t8lb statefarm.com INSURERjSi AFFORDINGCOVERAGE NAIC# INSURERA : State Farm Fire and Casualty Company 25143 INSURED Mente Inc 12664 CHAPMAN AVE UNIT 1419 GARDEN GROVE CA 92840-4034 INSURERS: INSURERC: INSURER D: INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: RFVISInN NNMRFP� 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 MAYHAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE INSRADDL POLICY NUMBER MMIDDIYYYY MMIDDI LIMITS A GENERAL LIABILITY ly-1 ❑ 92-EK-V825-0 W20/2020 05/16/2021 EACH OCCURRENCE $ 1,000,000 X COMMERML GENERAL LIABILITY CLAIMS -MADE IOCCUR PREMISES Es occunence $ 300,000 MED EXP(Any one person) If 51000 PERSONAL &ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGO $ 2,000,000 X1 POLICY PRO- oc Business Property $ 11,400 AUTOMOBILE LIABILITY ❑COMBINED(Ea secant SINGLE LIMIT$ BODILY INJURY (Per person) $ ANY AUTO AAUTOOS AUTOSULEL HIREDAUTOS NONI AUTOS BODILY INJURY (Per aoGtlent) $ P - DAMA Peracciderd $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE LED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEYIN xECUTIVE OFFICOMEMBER EXCLUDED? NIA RC STATU- OTH- TORY LIMITS ER EL EACH ACCIDENT $❑ EL. DISEASE - EA EMPLOYEE $ (Mandatory in NM If yes, describe under EL. DISEASE -POLICY LIMB $ -7 ❑ ❑ DEDUCTIBLE $2000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) 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 bythis policy shall be primary, and any insurance carried by City shall be excess 30 Days Notice of Cancellation with 10 Days Notice for Non -Payment of Premium in accordance with the policy provisions. 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 ACCORDANCE WITH THE POLICY PROVISIONS. 20 Civic Center Plaza Santa Ana, CA 92702 AUTHORIZED REPRESENTATIVE �L4ZGC..Q. b CL(;P ,� Rick ManegementDiwra[un I gry REMEWED&APPROVED Y. O 1988-20 0 ACORD C ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD �—� Ruk Management Analyst CUP-42M 1C Page 1 d3 IMPORTANT NOTICE Effective with this policy term, CMP-4260.1 AMENDATORY ENDORSEMENT (California) replaces CMP-4260 AMENDATORY ENDORSEMENT (California). This notice summarizes the changes being made to your policy. Please read the new endorsement care- fully and note the following changes: SECTION II - DEFINITIONS: Paragraph 18. Personal and Advertising Injury: • Infringementof anothers patent, trademark, ortradesecret is no Iongerwithin the definition of personal and advertising injury. SECTION II -EXCLUSIONS: Paragraph 17. Personal and Advertising Injury: • Damages from infringement of anther's patent, trademark, or trade secret continue to be specifically excluded under this policy. EnclorsementCMP-4260.1 follows this notice. Please read it thoroughly and place itwithyOur policy. If you have any questions about the information in this notice, please contact your State Farm agent. This notice is a general description of coverage andfor coverage changes and Is not a statement of con- tract. This message does not change, modify, or invalidate any of the provisions, terms, or conditions of Your policy, or any other applicable endorsements. AMENDATORY ENDORSEMENT (California) This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM 1. SECTION I — EXCLUSIONS is amended as follows: a. Paragraph 21 Dishonesty Is replaced by the following: f. Dishonesty (1) Dishonest or criminal acts by you, anyone else with an Interest In the property, or any of your or their Partners, "members", officers, managers", employees, directors, trustees, or authorized representa- tives, whether acting alone or In collusion with each other or with any other party; or (2) Theft by any person to whom you entrust, the property for any pur- pose, whether acting alone or In collusion with any other party. This exclusion applies whether or not an act occurs during your normal hours of operation. This exclusion does not apply to acts of destruction by your employees; but theft by your employees Is not covered. With respect to accounts receivable and °valuable papers and records', this exclusion does not apply to carriers for hire. b. Under Paragraph 1. Fungi, Virus Or Bac- teria, the reference to 23. Fungi, Wet Or Dry Rot is changed to 24. Fungi, Wet Or Dry Rot. 2. Paragraph 24. d. under Fun?!, Wet Or Dry Rot And Bacteria of SECTION 1— EXTENSIONS OF COVERAGE does not apply. _ 3. SECTION II — LIABILITY is amended as fol- owa. a. When used in this policy, the words "his or her" are replaced with 'that persons", b. Section ll-Exclusionsisamendedasfel- lows: (1) Paragraphs 17.b. and 17.c. under Per- sonal And Advertising Injury are re- placed by the following: It. Adsing out of oral or written publlca; lion of material, in any manner, If done by or at the direction ofthe in- sured with knowledge of its falsity; 0, OpyrbM, She Farm Mutual Automobile mounmos Company, 2019 Includes coWtaNed materlal d Insurance SeMces Offlce. Inc., xlth IR permission. y Risk Ma& APPRaVED BY.' RkVIEUVED & APPROVm BY: t `�� 1"At1i+Gb'Nd h, tts+�i�iblaa.4 Risk Management Analyst CMP 42153.113 Page 2 or3 c. Arising out of oral or written publica- tion of material, In any manner, whose flat publication took place before the beginning of the policy period; Under SECTION II — MEDICAL EX- PENSES, Paragraph 1.d.(2) under Cover- age M - Medical Expenses is replaced by the following: (2) Executes authorization to allow us to obtain copies of medical bills, medical records, and any other information we deem necessary to substantiate the claim. Such authorizations must not: (a) Restrict us from performing our business functions in: I. Obtaining records, bills, infor- mation, and data, or 11. Using or retaining records, bills, information, and data collected or received by us; (b) Require us to violate federal or state laws or regulations; (c) Prevent us from fulfilling our data reporting and data retention obliga- tions to insurance regulators; or (d) Prevent us from disclosing claim in- formation and data: I. To enable performance of our business functions, I. To meet our reporting obliga- tions to insurance regulators; III. To meet our reporting obliga- tions to insurance data consoli- dators; and iv. As otherwise permitted by law. If the holder of the information re- fuses to provide It to us despite the authorization, then at our request the person making claim or his or her legal representative must ob- tain the Information and promptly provide it to us; and d. SECTION II — DEFINITIONS is amended as follows; (1) Paragraphs 181 and 18.g are replaced by the following: f. The use of another's advertising idea In your 'advertisement"; or g. Infringing upon another's copyrlpht, trade dress or slogan In your'ad- vertisement'. (2) Paragraph 18.h. is deleted, 4. The following are added to SECTION I AND SECTION II — COMMON POLICY CONDI- TIONS'. Our Rights Regarding Claim Information a. We will collect, receive, obtain, use, and re- tain all the Items described in Paragraph bolt) below and use and retain the inror- mation described in Paragraph b.(3)(b) be- low in accordance with applicable federal anc( state laws and regulations and con- sistent with the performance of our busi- ness functions. b. Subject to Paragraph a. above, we will not be restricted In or prohibited from: (1) Collecting, receiving, or obtaining rec- ords, receipts, invoices, medical bills, medical records, wage information, Sal- aryinformation, employment information, data, and any other Information; (2) Using any ofthe items described InPar- agraph b.(1) above; or (3) Retaining: (a) Any of the items in Paragraph b.(1) above; or (b) Any other information we have in our possession as a result of our processing, handling, or otherwise resolving claims submitted under this policy. c. We may disclose any of the items In Para- graph b41) above and any of the later- maion described in Paragraph b.(3)(b) above: (1) To enable performance of our business functions; (2) To meet our reporting obligations to in- surance regulators; ®, Copyright, State Farm Mutual Automoblle Ireuranca Company, 2019 Includes copyrtaMed inn ilal of Insurance SeMces Offloe. Inc., with Its perni weq PiskMLnutwri ];Division GRBAEwm & APPR0VM ll L—{ Risk Management Analyst CMP 42WAC Page 3 of3 (3) To meet our repoding obligations to In- (1) Authorization related to any claim sub- surnnce data consolidators; mitted under this policy; or (4) To meet other obligations required by (2) Act or omission of an insured or a legal law, and representative acting on an insured's (5) As otherwise permitted by law, behalf. d. Our rights under Paragraphs a., b., and c. 5 above shall not be impaired by any: All other policy provisions apply. y CMP-4280.1 0, Copyright, Sale Fsim Mlml AU ..bile I.... Company. 2019 Inplud¢s coMlght¢tl mat¢gal p(Ineurence SeMses Omce. Inc., vnm its p¢rmlmlm. FE-SR99.2 Page 1 ar 1 In accordance with the Terrorism Risk Insurance Act of 2002 as amended and extended by the Terrorism Risk Insurance Program Reauthorization Act of 2015, this disclosure is part of your policy. FE-6999.2 POLICYHOLDER DISCLOSURE NOTICE OF TERRORISM INSURANCE COVERAGE 7M 3 for acts of terrorism Is not excluded current policy. However your policy sin other exclusions which may be ap- as any States, or outside the certain air carriers or United States missiol ted byy an individual effort to coerce the cl, the on January 1, FE eA19.2 s—to be an act of ter - or an act that is dan- erty, or infrastructure' is within the United States In the case of s or the premises of a to have been commit - or affect the con- :rnment by coer- covered losses errodsm may be Iced States GeV - shed by the Ter - on Janus ry 1 2017; 82% beginning on January 1 2018; 81% beginning. on January, 1, 2019; anti 80% beginning on January 1, 2020 of covered terrorism losses exceeding the statutorily estab- lished deductible paid by the insurance company providing the coverage. The Terrorism Risk Insur- ance Act as amended, contains a $100 billion cap thatlimits U.S. Government reimbursement as well as insurers' liability for losses resulting from certified acts of terrorism when the amount of such losses exceeds $100 billion in any one calendar year. It the agggregate insured losses for all insureexceed $1e0 billion, your coverage may be reduced. There is no separate premium charged to cover insured losses caused by terrorism. Your insur- ance policy establishes the coverage that exists for insured losses. This notice does not expand coverage beyond that described in your policy. THIS 15 YOUR NOTIFICATION THAT UNDER THE TERRORISM RISK INSURANCE ACT, AS AMENDED, ANY LOSSES RESULTING FROM CERTIFIED ACTS OF TERRORISM UNDER YOUR POLICY MAY BE PARTIALLY REIM- BURSED BY THE UNITED STATES GOVERN- MENT AND MAY BE SUBJECT TO A $100 BILLION CAP THAT MAY REDUCE YOUR COV- ERAGE. 0, Copyright State Farts Mutusl ARomobile Insurance Company, 2015 (CONTINUED) ° M p IiIalf ManagemeniDiviaforr a�REVIEWED& APPROVED BY: � %+t�svaaa �, V;�4,sneuc Risk Management Analyst ASIOCKCOMPANYMTHHOMEOFFICESINNLOOMINOTO,,IIIMII5 RENEWALOEGLA1iATIGNZi EPaxafias7s76ea5-e925 ratlsnn, Policy Number 92-EK-VO25.4 Named Insured Policy Period Effective Data Ex Iraliorl Date 12 Mon��tyle M� 3� Aft 002972 jy 50610-FBOA F N 162020 MRY 162021 NENTE TnC rrII qMAY InvepsilalE �reinlses to a➢oaends at 12:0'I am standard 11111 CNAPMAN AVE ❑NIP 1419 GARDEN GROVE CA 92040-4034 Agent and Mailing Address SARIAR DEVEREAO% 1202 W IST ST III'I�'I��1�1"'IIIII�I''IIII�'��III��II�III��IIII�iIle,�l�di SANTA ANA CA 927D3-3810 6 PHONE: (714) 541-7280 e Office Policy Autommic Konowed It the policy period is shown as 12 alaldhs, thispolicy will be renewed automatically subjeetto the premiums, rules and forms in effectfor each succeeding policy period. If this policy isterminated, we will give you and the Mortgagee/4enholder written notice in compliance with the policy provisions or as requhed bylaw. Entity: Corporation NOTICE: Information concerning changes In your policy language Is Included. Please call your agent If you have any quesilons. POLICY PREMIUM $ 328.00 Discounts Applied: Renewal Year Years In Business Protective Devices Claim Record Prepared MAR 032020 e; CapyriehC SmtaPormMvNal ActoireNla Insurance Ceiryamt�Ue CMP4000 Includes capyli9gted im[enaloilraurance Services Once, Inc.wiW hsparmdien 01=9 204 1 Continued on Reverse Side of Page N Page 1 of 8 9IFEaa0" tm1.1111011) Yc aq RiekManogtnaerxfDiviaian y RmAEwEO S. APPROVED BY: 5 GG pp E ,tic r/464HYru6of R. V+,��si/e4Fi �� Risk Managernent Analyst RENEWAL DECLARATIONS (CONTINUED) Office Policy for MENTE INC Policy Number 92-EK-V025.4 SECTION PROPERTY SCHEDULE Location Location of Limit of insurance- Limit of Insurance- Seasonal Number Described Inemase- Premises Coverspe A- covers pe B- Business Personal Buildings Business Personal Property Property 001 12664 W CHAPMAN STE 1410 No coverage $ 11,400 251/6 GARDEN GROVE CA 92840-4034 "As of the el Iva date of this policy the Limit of insumnce as shown includes any Increase In the Ilmit due to Inflation Coverage. SEC" - INFLATION CDVERnne runoxrvS) Cov A -Inflation Covece Index: 256 NIA Cov B- Consumer Price Intlex: 258.0 SECTION I DEDUCTIBLES Basic Deductible $500 Special Deductibles: Money and Securities $$22550 Employee Dishonesty $260 Equipment Bmakdovm $500 Other deductibles may apply - refer to policy. Prepared MAR 032020 e:cwoglRstate Farm Mmal Aularwbilepisurence Caripary,2018 GMP-4000 Includascopyudhled avren lotImmance services Orrice, Inc., V&iu permission. 019279 Continued on Next Page Page 2 of 8 tic,-=c.� Risk Maruglmtsel Dtvis[on ;rys RE AEwrD & MPRcrvm fir. R. VwAuidC 1 Risk Management Analyst RENEWAL DECLARATIONS (CONTINUED) Office Policy for MENTE INC Policy Number 92-EK-V925.4 SECTION I - EXTENSIONS OF COVERAGE -LIMIT OF INSURANCE -EACH DESCRIBED PREMISES q The coverages and corresponding limits shown below apply separately to each described promises shown in these $ Declarations, unless Indicated by "Soo Schedule." If a coverage does not have a corresponding limit shown below, but has "Included' Indicated, please refer to that po licy prevision for an explanation of that coverage. LIMIT OF COVERAGE INSURANCE Accounts Receivable On Promises 50,000 Of Pramises 15,000 Amon Roward $6,000 Back -Up Of Sewer Or Drain $16,000 Collapse Included Damage To Non Owned Buildings From Theft, Burglary Or Robbery Coverage B Limit Debds Removal 25%of covered loss Equipment Breakdown Included Fire Department Service Charge $5,000 Fire Extinguisher Systems Recharge Expense $6,000 Forgery OrAlteretlon $10,000 Glass Expenses Included Increased Cost Of Construction And Demolition Costs (applies only when buildings are 1011. Insured on a replacement cost basis) Money And Securities (Off Premises) $5,000 MonoyAnd Securities (On Premises) $10,000 Money Orders And Counterfeit Money $1,000 Newly Acquired Business Personal Property (applies only If this policy provides $100,000 Coverage R- Business Personal Properly) Newly Acquired Or Constructed Buildings(applies only if this policy provldes $260,000 Coverage A- Buildings) Prepared MAR 032020 04*lit Srate FmmMuwalku rwtile lnsurame Cmapany.2m) CMP4000 Includes eoppgrwd material0 Marva Services pKoe, Ina,Wdi its porntron 019280294 Continued on Reverse Side of Page Page 3 of B N 1- x RiskMimagemadDiuision RY CREVIEweo& APPROVED BY. 8 I A3LF+fia�AB n,. �iX,rp�.tifti ®t Risk M.ana gemen [Analyst RENEWAL DECLARATIONS (CONTINUED) Office Polisyy for MENTE INC Policy Nemper 92-EKN825-4 Ordinance Or Law -Equipment Coverage Included Outdoor Property $5,000 Personal Effects (applies only to those premises provided Coverage B- Business $5,W0 Personal Property) Personal Properly Off Promises $15,000 Pollutant Clean Up And Removal $10,000 Preservation Of Property 36 Days Property Of Others (applies only to those premises provided Coverage B- Business $2,500 Personal Properly) Signs $2,500 Unauthorized Business Card Use $5,000 Valuable Papers And Records 50,000 On Premises Off Premises 15,000 SECTION EXTENSIONS OF COVERAGE- LIMIT OF INSURANCE -PER POLICY The coverages and corresponding limits shown below are the most we will pay regardless of the number of described premises shown in these Declarations. _ COVERAGE Dependent Property- Loss Oflncome Employee Dishonesty Utility Interruption - Loss Of Incomo Loss Of Income And Extra Expense LIMIT OF INSURANCE $5,000 $10,000 $10,000 Actual Loss Sustained -12 Months Prepared MAR 032020 kMrohile Insurance Cwrpany, 2000 CMP-4000 ledudw eopyri9hed material of Insurance Services eAice, Inc., adth"ormiscia,. 019280 Continued on Next Page Page 4 of B rs RiskManagonelttDivisisn [REVIEWED & APPROVED BY; MMO Rib lc Management Analyst 40 RENEWAL DECLARATIONS (CONTINUED) Office Policy for MENTE INC Policy Number 02-EK-VS25.4 H SECTION II - LIABILITY q' LIMIT OF 5 COVERAGE INSURANCE Coverage L- Business Liability $1,000,000 Coverage M - Medical Expenses (Any One Person) $6,000 Damage To Premises Rented To You $300,000 LIMIT OF AGGREGATE LIMITS INSURANCE ProductarCompleted Operations Aggregate $2,000,000 General Aggregate $2,000,000 Each paid clalm for Liability Coverage reduces the amount of Insurance we provide duringg the appllaabla annual period. Please refarfo Section II -Liability in the Coverage Form and any attached endorsements. Your pally consists of these Declarations, the BUSINESSOWNERS COVERAGE FORM shown below, and any other forms andyendorsements that apply, Including those shown below as well as these Issued subsequent to the Issuance of this policy. CMPA101 Busineseowners Coverage Form CMP-4200.1 -Amendatory Endaraement-CA FE-6999.2 'Terrodsm Insurance Cov Notice CMP-4261 'Amendatory Endorsement CMP-4703.1 Utility Interruption Loss Incm CMP-4713.1 Excl Testing Consulting E&O CMPA819.1 Unauthorized Business Card Use CMP4008 Back -Up of Sower or Drain CMP4704.1 Dependent Prop Loss of Income CMP4710 Employee Dishonesty CMP-4709 Money and Securities CMP4705.2 Loss of Income& Extra Expense CMP 4786.1 Addl had Owners Lessee Sched Prepared MAR 032020 2 Cepydght State HinfluNal Autmmhilu lnsurente Coupeny,2008 CMP-4000 iacludescopyriehted matedd Nlnmrance Services 011ice, luc,uah 0 permimm. 019201 294 Continued on Reverse Bids of Page Page 5 of 8 N y RiekMsnagernrntDiviaion g�x cRREmEWED&ppAPPRO�V$EDBY, i�' r 4tt+Wiirh$ n,. V�UMFf4G Risk Management Analyst j RENEWAL DECLARATIONS (CONTINUED) Office Polls yy for MEN7E INC Policy NUM of 92•EK•VO25-4 YoulCoverage amount...: It is up to you to Choose the coverage and limits that meet your needs. We recommend that you purchase a coverage limit equal to the osdmaled replacement cost of your structure. Replacement cost estimates are available from building contractors and replacement cost appraisers, or, your agent can provide an estimate from Xachvam, Inc. using information you provide about your structure. We can accept ti type of estimate you choose as long as It provides a reasonable level of detail about Your structure. State Farm"does not guarantee that any estimate will be the actual tutus cost to rebuild your structure. Higher limits are available at higher premiums. Lower limits are also available, as long as the amount of coverage meals our undarwrlling requirements. We encourage you to porlodically review your coverages and limits with your agent and to notify us of any changes or additions to your structure, Prepared MAR 032020 OeWwi9ht State FarnMumal Au lmbilelnsumnoe Carpanv.2000 CMP4000 Indudaeeopyeahted metelialel Inwrance Services Office, Inc., audh Bepaaniaaao. 019202294 Page 8of 8 N �aa-nmxg Risk ManagarmiDivision REVIEWED &APPROvm BY: '> F�as�ma �, V;AP,cneal Risk Nlarlagement Analyst Cesar Vargas Associates December 1, 2020 City of Santa Ana Risk Management Division 20 Civic Center Plaza, 4th Floor Santa Ana, CA 92702 Re: Auto Insurance Requirement Dear City of Santa Ana Risk Management Division: Cesar Vargas & Associates, a DBA of MENTE, Inc., has intent to enter into an agreement with the City of Santa Ana. Throughout the course of this agreement, Cesar Vargas & Associates attests to the following: 1. Cesar Vargas & Associates will not use/drive any vehicle during the course and scope of the services provided in the agreement/contract. 2. Cesar Vargas & Associates will not use any owned/rented/leased vehicles during the course and scope of the services provided in the agreement/contract. 3. Cesar Vargas & Associates consultants/independent contractors/employees utilize their personal vehicles/non-company owned, borrowed, or rented/leased vehicles for transportation to and from work and if applicable carry their own automobile insurance. By signing below, I, Cesar Vargas, attest that I possess the legal authority to enter into an agreement with the City of Santa Ana as well as the legal authority to attest to the statements above. If at any time it is found that Cesar Vargas & Associates is not adhering to any/all statements in this document and has not provided the minimum Auto liability insurance coverage of $1 million per occurrence, the contract will be considered null and void and the company will be held fully liable for any and all damages. Cesar Vargas Executive Director Cesar Vargas & Associates 714-987-2889 cavargas@hotmail.com 8502 East Chapman Avenue # 302 1 Orange, �' Z< REVIEWED&APPROV®BY. Californk ai � � Risk Management Analyst CITY OFSANTA ANA ry RISK MANAGEMENTa &Aaem gHUMAN RESOURCES Managing . 000MA p nce WORKERS' COMPENSATION DECLARATION Cesar Vargas, Exec. Director hereby affirm under penalty of perjury, the (Name/Title) following declaration: I certify on behalf of Cesar Vargas & Associates/MENTE, Inc. that during the term (Consultant/Company Name) of my contract for Translation/interpretation � 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: November 12, 2020 Print Name: Cesar Vargas Print Title: Executive Director Signature: 4- l/F� Telephone: 714.987.2889 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. I tRisk M,gmt�lnsurance Requirements�WCDecloration 08152019 � sn�> RiekMnnagtm�mtDividon REVIEWED & APPR0vm BY., Ru k Manatjement Analyrt Digitally signed by Francine R. Francine R. Villareal Villareal Date: 2021.06.21 17:29:09-07'00' 0 A CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 06/10/2021 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: StateFarm Sariah Devereaux-Barrientos, Agent A/CONN Ext : 714-541-7280 FAX No 1417 S Broadway = E-MAILss: sariah@7145417280.com • INSURER(S) AFFORDING COVERAGE NAIC # Santa Ana, CA 92707 INSURERA: State Farm Fire and Casualty Company 25143 INSURED INSURER B INSURER C Mente Inc. INSURER D 12664 Chapman Ave Unit 1419 INSURER E Garden Grove, CA 92840-4043 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 SUBR POLICY NUMBER POLICY EFF MM DD/YYYY POLICY EXP MM DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE OCCUR DAM PREM Soc ES Ea currDence $ 300,000 VIED EXP (Any one person) $ 5,000 PERSONAL& ADV INJURY $ 1,000,000 A Y Y 92-EK-V825-4 05/16/2021 05/16/2022 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY ❑PRO JECT ❑ LOC X PRODUCTS - COMP/OP AGG $ 4,000,000 BUSINESS PROPER $ 11,700 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY L $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN PER OTH- STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N / A E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The City of Santa Ana, its officers, officials, employees, and volunteers are to be covered as additional insureds on the CGL policy with respect to liability arising out of work or operations performed by or on behalf of the Contractor including materials, parts, or equipment furnished in connection with such work or operations. CERTIFICATE HOLDER CANCELLATION The City of Santa Ana Risk Management Division 20 Civic Center Plaza Santa Ana, CA 92702 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 M © 1988-2015 ACORD The ACORD name and logo are registered marks of ACORD �oRaN RiskMwagementDMsian REVIEWED & APPROVED BY.- 3 z Risk Management Analyst AD Policy No. 92-EK-V825-4 0810-FB8A CMP-4786.1 Page 1 of 2 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY CMP-4786.1 ADDITIONAL INSURED (Scheduled) This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number: 92-EK-V825-4 Named Insured: Mente Inc. 12664 Chapman Ave Unit 1419 Garden Grove, CA 92840-4043 Name and Address Of Additional Insured Person Or Organization: The City of Santa Ana Risk Management Division 20 Civic Center Plaza Santa Ana, CA 92702 1. SECTION II —WHO IS AN INSURED of SECTION II — LIABILITY is amended to include, as an additional insured, any person or organization shown in the Schedule, but only with respect to liability for "bodily injury', "property damage", or "personal and advertising injury" caused, in whole or in part, by: a. Ongoing Operations (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 that additional insured; or b. Products —Completed Operations "Your work" performed for that additional insured and included in the "products- completed operations hazard". However, Paragraph 1. Above is subject to the following a. The insurance afforded to the additional insured only applies to the extent permitted by law; CMP-4786 b. If coverage provided to the additional insured is required by a contract or agreement, the insurance provided to the additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured; and c. If the contract or agreement between you and the additional insured is governed by California Civil Code Section 2782 or 2782.05, the insurance provided to the additional insured is the lesser of that which: (1) Is allowed for the satisfaction of a defense or indemnity obligation by California Civil Code Section 2782 or 2782.05 for your sole liability; or (2) You are required by contract or agreement to provide for such additional insured. We have no duty to defend or indemnify the additional insured under this endorsement until a claim or "suit" is tendered to us. 1007 ©, COPYRIGHT, STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, 2013 INCLUDES COPYRIGHTED MATERIAL OF INSURANCE SERVICES OFFICE, INC., WITH ITS PERMISSION CONTINUED o ?ccREvEWED RiskMmagmentDMsian & APPROVED BY.- Risk Management Analyst CM P-4786.1 Page 2 of 2 2. 3. 4. Any insurance provided to the additional insured shall only apply with respect to a claim made or a "suit" brought for damages for which you are provided coverage. With respect to the insurance afforded to the additional insured, the following is added to SECTION II — LIMITS OF INSURANCE: If coverage provided to the additional insured is required by contract or agreement, the most we will pay on behalf of the additional insured will be the lesser of the amount of insurance: a. Required by the contract or agreement; or b. Available under the applicable Limits Of Insurance shown in the Declarations. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. With respect to the insurance afforded to the additional insured, the following is added to Paragraph 3. Duties In The Event Of Occurrence, Offense, Claim Or Suit of SECTION II —GENERAL CONDITIONS: The additional insured must: a. See to it that we are notified as soon as practicable of an "occurrence" or an offense which may result in a claim. To the extent possible, notice should include: (1) How, when and where the "occurrence" or offense took place; (2) The names and addresses of any injured persons and witnesses; and CM P-4786 (3) The nature and location of any injury or damage arising out of the "occurrence" or offense; b. Tender the defense and indemnity of any claim or "suit" to us and to all other insurers who may have insurance potentially available to the additional insured; and C. Agree to make available any other insurance the additional insured has for defense or damages for which we would provide coverage under SECTION II — LIABILITY. S. With respect to the insurance afforded the additional insured, the following replaces SECTION II LIABILITY- of paragraph 7.Other insurance of SECTION II- COMMON POLICY CONDITIONS: a. This insurance company is primary to and will not seek contribution from any other insurance available to the additional insured is a named insured under such other insurance. b. regardless of any agreement between you and the additional insured, this insurance excess over any other insurance whether primary, excess, contingent or on any other basis for which the additional insured has been added as an additional insured on other policies. There will be no refund of premium in the event this endorsement is cancelled. All other policy provisions apply. 1007033 148011910-3-19 ©, COPYRIGHT, STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, 2013 INCLUDES COPYRIGHTED MATERIAL OF INSURANCE SERVICES OFFICE, INC., WITH ITS PERMISSIOis CONTINUED RA MwagP.P ere DRR810R _ REVIEWED & APPRCIVED BY. - Risk Management Analyst 92-EK-V825-4 019284 CMP-4260.1C Page 1 of 3 IMPORTANT NOTICE Effective with this policy term, CMP-4260.1 AMENDATORY ENDORSEMENT (California) replaces CMP-4260 AMENDATORY ENDORSEMENT (California). This notice summarizes the changes being made to your policy. Please read the new endorsement care- fully and note the following changes: SECTION II — DEFINITIONS: Paragraph 18. Personal and Advertising Injury: ° Infringement of another's patent, trademark, or trade secret is no longerwithin the definition of personal 's and advertising injury. SECTION II — EXCLUSIONS: Paragraph 17. Personal and Advertising Injury: • Damages from infringement of another's patent, trademark, or trade secret continue to be specifically excluded under this policy. Endorsement CMP-4260.1 follows this notice. Please read it thoroughly and place it with our policy. If you have any questions about the information in this notice, please contact your State Farm agent. This notice is a general description of coverage and/or coverage changes and is not a statement of con- tract. This message does not change, modify, or invalidate any of the provisions, terms, or conditions of your policy, or any other applicable endorsements. AMENDATORY ENDORSEMENT (Cal This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM 1. SECTION I — EXCLUSIONS is amended as follows: a. Paragraph 2.f. Dishonesty is replaced by the following: f. Dishonesty (1) Dishonest or criminal acts by you, anyone else with an interest in the property, or any of your or their partners, "members", officers, "managers", employees, directors, trustees, or authorized representa- tives, whether acting alone or in collusion with each other or with any other party; or (2) Theft by any person to whom you entrust the property for any pur- pose, whether acting alone or in collusion with any other party. This exclusion applies whether or not an act occurs during your normal hours of operation. This exclusion does not apply to acts of destruction by your employees; but theft by your employees is not covered. With respect to accounts receivable and "valuable papers and records", this exclusion does not apply to carriers for hire. b. Under Paragraph i. Fungi, Virus Or Bac- teria, the reference to 23. Fungi, Wet Or Dry Rot is changed to 24. Fungi, Wet Or Dry Rot. 2. Paragraph 24. d. under Fungi, Wet Or Dry Rot And Bacteria of SECTION I — EXTENSIONS OF COVERAGE does not apply. 3. SECTION II — LIABILITY is amended as fol- lows: a. When used in this policy, the words "his or her" are replaced with "that person's". b. Section II — Exclusions is amended as fol- lows: (1) Paragraphs 17.b. and 17.c. under Per- sonal And Advertising Injury are re- placed by the following: b. Arising out of oral or written publica- tion of material, in any manner, if done by or at the direction of the in- sured with knowledge of its falsity, ©, Copyright, State Farm Mutual Automobile Insurance Company, 2019 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Ride Management Division REVIEWED & APPROVED BY. - Risk Management Analyst 92-EK-V825-4 019284 M 19279 CMP-4260.1C Page 2 of 3 c. Arising out of oral or written publica- tion of material, in any manner, whose first publication took place before the beginning of the policy period; c. Under SECTION II — MEDICAL EX- PENSES, Paragraph 1.d.(2) under Cover- age M — Medical Expenses is replaced by the following: (2) Executes authorization to allow us to obtain copies of medical bills, medical records, and any other information we deem necessary to substantiate the claim. Such authorizations must not: (a) Restrict us from performing our business functions in: I. Obtaining records, bills, infor- mation, and data; or ii. Using or retaining records, bills, information, and data collected or received by us; (b) Require us to violate federal or state laws or regulations, (c) Prevent us from fulfilling our data reporting and data retention obliga- tions to insurance regulators; or (d) Prevent us from disclosing claim in- formation and data: I. To enable performance of our business functions; ii. To meet our reporting obliga- tions to insurance regulators, iii. To meet our reporting obliga- tions to insurance data consoli- dators; and iv. As otherwise permitted by law. If the holder of the information re- fuses to provide it to us despite the authorization, then at our request the person making claim or his or her legal representative must ob- tain the information and promptly provide it to us; and d. SECTION II — DEFINITIONS is amended as follows: (1) Paragraphs 18.f. and 18.g are replaced by the following: f. The use of another's advertising idea in your "advertisement". or g. Infringing upon another's copyright, trade dress or slogan in your "ad- vertisement'. (2) Paragraph 18.h. is deleted 4. The following are added to SECTION I AND SECTION II — COMMON POLICY CONDI- TIONS: Our Rights Regarding Claim Information a. We will collect, receive, obtain, use, and re- tain all the items described in Paragraph b.(1) below and use and retain the infor- mation described in Paragraph b.(3)(b) be- low, in accordance with applicable federal and state laws and regulations and con- sistent with the performance of our busi- ness functions. b. Subject to Paragraph a. above, we will not be restricted in or prohibited from: (1) Collecting, receiving, or obtaining rec- ords, receipts, invoices, medical bills, medical records, wage information, sal- ary information, employment information, data, and any other information; (2) Using any of the items described in Par- agraph b.(1) above; or (3) Retaining: (a) Any of the items in Paragraph b.(1) above; or (b) Any other information we have in our possession as a result of our processing, handling, or otherwise resolving claims submitted under this policy. c. We may disclose any of the items in Para- graph b.(1) above and any of the infor- mation described in Paragraph b.(3)(b) above: (1) To enable performance of our business functions; (2) To meet our reporting obligations to in- surance regulators; ©, Copyright, State Farm Mutual Automobile Insurance Company, 2019 Includes copyrighted material of Insurance Services Office, Inc., with its permission. RAMwagemerd Division REVIEWED & APPROVED BY. - Risk Management Analyst 92-EK-V825-4 019285 CMP-4260.1C Page 3 of 3 (3) To meet our reporting obligations to in- surance data consolidators; (4) To meet other obligations required by law; and NA (5) As otherwise permitted by law. (1) Authorization related to any claim sub- mitted under this policy; or (2) Act or omission of an insured or a legal representative acting on an insured's behalf. d. Our rights under Paragraphs a., b., and c. above shall not be impaired by any: All other policy provisions apply. CMP-4260.1 m, Copyright, State Farm Mutual Automobile Insurance Company, 2019 Includes copyrighted material of Insurance Services Office, Inc., with its permission. FE-6999.2 Page 1 of 1 In accordance with the Terrorism Risk Insurance Act of 2002 as amended and extended by the Terrorism Risk Insurance Program Reauthorization Act of 2015, this disclosure is part of your policy. FE-6999.2 POLICYHOLDER DISCLOSURE NOTICE OF TERRORISM INSURANCE COVERAGE Coverage for acts of terrorism is not excluded from your current policy. However your policy does contain other exclusions which may be ap- plicable, such as an exclusion for nuclear hazard. You are hereby notified that under the Terrorism Risk Insurance Act, as amended in 2015, the def- inition of act of terrorism has changed. As defined in Section 102(1) of the Act: The term "act of ter- rorism" means any act that is certified by the Sec- retary of the Treasury ---in consultation with the Secretary of Homeland Security, and the Attorney General of the United States —to be an act of ter- rorism; to be a violent act or an act that is dan- gerous to human life, property, or infrastructure; to have resulted in damage within the United States, or outside the United States in the case of certain air carriers or vessels or the premises of a United States mission; and to have been commit- ted by an individual or individuals as part of an effort to coerce the civilian population of the United States or to influence the policy or affect the con- duct of the United States Government by coer- cion. Under this policy, any covered losses resulting from certified acts of terrorism may be partially reimbursed by the United States Gov- ernment under a formula established by the Ter- rorism Risk Insurance Act, as amended. Under the formula, the United States Government generally reimburses 85% through 2015; 84% beginning on January 1, 2016; 83% beginning on FE-6999.2 January 1, 2017; 82% beginning on January 1, 2018; 81% beginning on January 1, 2019; and 80% beginning on January 1, 2020 of covered terrorism losses exceeding the statutorily estab- lished deductible paid by the insurance company providing the coverage. The Terrorism Risk Insur- ance Act, as amended, contains a $100 billion cap that limits U.S. Government reimbursement as well as insurers' liability for losses resulting from certified acts of terrorism when the amount of such losses exceeds $100 billion in any one calendar year. If the aggregate insured losses for all insurers exceed $100 billion, your coverage may be reduced. There is no separate premium charged to cover insured losses caused by terrorism. Your insur- ance policy establishes the coverage that exists for insured losses. This notice does not expand coverage beyond that described in your policy. THIS IS YOUR NOTIFICATION THAT UNDER THE TERRORISM RISK INSURANCE ACT, AS AMENDED, ANY LOSSES RESULTING FROM CERTIFIED ACTS OF TERRORISM UNDER YOUR POLICY MAY BE PARTIALLY REIM- BURSED BY THE UNITED STATES GOVERN- MENT AND MAY BE SUBJECT TO A $100 BILLION CAP THAT MAY REDUCE YOUR COV- ERAGE. (9, Copyright, State Farm Mutual Automobile Insurance Company, 2015 (CONTINUED) RAManagement Drwatan REVIEWED & APPROVED BY. - Risk Management Analyst CITY OF SANTA ANA RISK MANAGEMENT a deco 4 HUMAN RESOURCES Managing Risk e►awh Posldve Chan WORKERS' COMPENSATION DECLARATION Cesar Vargas/Executive Director hereby affirm under penalty of perjury, the (Name/Title) following declaration: certify on behalf of Cesar Vargas & Associates / MENTE, Inc. that during the term (Consultant/Company Name) of my contract for Translation/Interpretation services with the City of Santa Ana, (Type of service provided) 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: May 24, 2021 Print Name: Cesar Vargas Print Title Signature Telephone Executive Pirector - 0,zW 714-987-2889 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. I:�Risk Mgmt�lnsurance Requirements �WC Declaration 08152019 a �ortaN Risk MwaganedDMsiun 3 REVIEWED & APPROVED BY.- -ERisk Management Analyst Cesar Vargas �• . Associates December 1, 2020 City of Santa Ana Risk Management Division 20 Civic Center Plaza, 4th Floor Santa Ana, CA 92702 Re: Auto Insurance Requirement Dear City of Santa Ana Risk Management Division: Cesar Vargas & Associates, a DBA of MENTE, Inc., has intent to enter into an agreement with the City of Santa Ana. Throughout the course of this agreement, Cesar Vargas & Associates attests to the following: 1. Cesar Vargas & Associates will not use/drive any vehicle during the course and scope of the services provided in the agreement/contract. 2. Cesar Vargas & Associates will not use any owned/rented/leased vehicles during the course and scope of the services provided in the agreement/contract. 3. Cesar Vargas & Associates consultants/independent contractors/employees utilize their personal vehicles/non-company owned, borrowed, or rented/leased vehicles for transportation to and from work and if applicable carry their own automobile insurance. By signing below, I, Cesar Vargas, attest that I possess the legal authority to enter into an agreement with the City of Santa Ana as well as the legal authority to attest to the statements above. If at any time it is found that Cesar Vargas & Associates is not adhering to any/all statements in this document and has not provided the minimum Auto liability insurance coverage of $1 million per occurrence, the contract will be considered null and void and the company will be held fully liable for any and all damages. e','W I 0�� Cesar Vargas Executive Director Cesar Vargas & Associates 714-987-2889 cavargas@hotmail.com 8502 East Chapman Avenue # 302 1 Orange, Californi �oRaN � z RiskMmWmerdDMaian REVIEWED & APPROVED BY.- f R. V;d Risk Management Analyst EBUF!)NN0EE0ZZZZ* Ejhjubmmz!tjhofe! DFSUJGJDBUF!PG!MJBCJMJUZ!JOTVSBODF 1602303133 UIJT!DFSUJGJDBUF!JT!JTTVFE!BT!B!NBUUFS!PG!JOGPSNBUJPO!POMZ!BOE!DPOGFST!OP!SJHIUT!VQPO!UIF!DFSUJGJDBUF!IPMEFS/!UIJT cz!Bohjf! Bohjf! 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XPSLFST!DPNQFOTBUJPO TUBUVUFFS BOE!FNQMPZFST(!MJBCJMJUZ Z!0!O BOZ!QSPQSJFUPS0QBSUOFS0FYFDVUJWF F/M/!FBDI!BDDJEFOU% O!0!B PGGJDFS0NFNCFS!FYDMVEFE@ )Nboebupsz!jo!OI* F/M/!EJTFBTF!.!FB!FNQMPZFF% Jg!zft-!eftdsjcf!voefs F/M/!EJTFBTF!.!QPMJDZ!MJNJU% EFTDSJQUJPO!PG!PQFSBUJPOT!cfmpx EFTDSJQUJPO!PG!PQFSBUJPOT!0!MPDBUJPOT!0!WFIJDMFT!!)BDPSE!212-!Beejujpobm!Sfnbslt!Tdifevmf-!nbz!cf!buubdife!jg!npsf!tqbdf!jt!sfrvjsfe* DFSUJGJDBUF!IPMEFSDBODFMMBUJPO TIPVME!BOZ!PG!UIF!BCPWF!EFTDSJCFE!QPMJDJFT!CF!DBODFMMFE!CFGPSF UIF!FYQJSBUJPO!EBUF!UIFSFPG-!OPUJDF!XJMM!CF!EFMJWFSFE!JO BDDPSEBODF!XJUI!UIF!QPMJDZ!QSPWJTJPOT/ Djuz!pg!Tboub!Bob BVUIPSJ\[FE!SFQSFTFOUBUJWFBVUIPSJ\[FE!SFQSFTFOUBUJWF Sjtl!Nbobhfnfou!Ejwjtjpo!! 31!Djwjd!Dfoufs!qmb{b Tboub!Bob!DB!:3813 ª!2:99.3126!BDPSE!DPSQPSBUJPO/!!Bmm!sjhiut!sftfswfe/ BDPSE!36!)3127014*Uif!BDPSE!obnf!boe!mphp!bsf!sfhjtufsfe!nbslt!pg!BDPSE 2112597!!24395:/24!!15.33.3131 NOTICE OF COMPLIANCE CITY STAFF: PRINT THIS PAGE AND INCLUDE WITH AGREEMENT TO THE CLERK OF THE COUNCIL Contractor Mente Inc Name: Project N-2019-125-01 Number: Project First Amendment To Agreement To Provide Translation Name: Services 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 COI DATE FILE NAME NUMBER DATE AUTO Waiver AUTOMOBILE LIABILITY WAIVER 05/31/2023 10/25/2022 Exp 5-31- 23.pdf Business COI - GENERAL LIABILITY 92EKV8254 05/16/2023 10/24/2022 MENTE INC oct22.pdf WC Waiver WORKERS COMPENSATION AND WAIVER 05/31/2023 10/25/2022 Exp 5-31- EMPLOYERS' LIABILITY 23.pdf Thank you, City of Santa Ana Risk Management Division in partnership with CTrax Plus Services Team 11/16/2022 10:46 AM