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HomeMy WebLinkAboutPENCO, A CANNON COMPANY (2)a - INSURANCE ON FILE A-2021-075-03 `= WORK MAY PROCEED `" UNTIL INSURANCE EXPIRES c%a Oa /01 21 EXHIBIT 3 CLERK OF COUNCIL Z DATE: SECOND AMENDMENT TO AGREEMENT TO PROVIDE ENGINEERING, TECHNICAL, AND ADMINISTRATIVE SUPPORT SERVICES FOR O: War,q, +)` 4, (54 1 PUBLIC WORKS PROJECTS (PENCO) THIS SECOND AMENDMENT to the above -referenced agreement is entered into on May 18, 2021, by and between Penco, a Cannon Company ("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. Following City's issuance of Request for Proposal No. 19-045, the parties entered into Agreement No. A-2019-117-03, dated July 16, 2019, by which Consultant agreed to provide engineering, technical, and administrative support services on an as -needed basis for the City's Public Works Agency ("Agreement"). B. Consultant was one of five consultants selected to provide services on an as -needed basis under RFP No. 19-045. The total compensation for services provided by all consultants selected under RFP No. 19-045 was not to exceed a shared aggregate amount of $2,500,000 during the term of the Agreement, including any extension periods. The Agreement remains in effect through July 15, 2022. C. On July 21, 2020, the parties entered into a First Amendment to the Agreement (#A-2020-153- 03) to increase the maximum shared aggregate expenditure under the Agreement. D. The parties now wish to amend the Agreement to further increase the maximum shared aggregate expenditure under the Agreement. The Parties therefore agree: 1. Section 2.a., Compensation, is amended to increase the total compensation for services provided by all consultants selected under RFP No. 19-045 by the shared aggregate amount of $2,500,000 during the term of the Agreement, including any extension periods. Except as modified by this Second Amendment, and all prior amendments, all terms and conditions of the Agreement shall remain in full force and effect. IN WITNESS WHEREOF, the parties hereto have executed this Second Amendment to the Agreement on the date and year first written above. Daisy Gomez Clerk of the Council Kristme Ridge City Manager - signatures continue on nextpage - Page 1 of 2 APPROVED AS TO FORM CONSULTANT SONIA R. CARVALHO City Attorney By; 7�" 0 hn M. Funk Name: harry Krae ier Senior Assistant City Attorney Title: Director, Public Infrastructure RECOMMENDED FOR APPROVAL A h b. 1 Saba ive Director Works Agency Page 2 of 2 I Iallllllc n. VIIlal cal ' Date: 2020.09.14 15.41:46 -07-00' .ACC>R6r CERTIFICATE OF LIABILITY INSURANCE 111 1 DATE(MMIDD/YYYY) 9/3/2020 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 pollcy(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 Dealey, Renton & Associates P. O. Box 12675 Oakland CA 94604-2675 CONTACT PHONE FAX • 510-465.3090 AIC No:510-452-2193 ADDRESS: certificates Beale renton.com INSURERS AFFORDING COVERAGE NAIC II INSURERA: Continental Insurance Company 35289 LicenseM 0020739 INSURED CANNGOR-02 Cannon Corporation 1050 Southwood Drive INSURER B: Valley Fore Insurance Company 20508 INSURER c: HARTFORD INSURANCE COMPANY 38288 INSURER D: Beazley Insurance Company Inc 37540 San Luis Obispo CA 93401 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER:1564012275 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. M R TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF IMMi POLICY EXP IMMIDDIYYYY)LIMITS B X COMMERCIAL GENERALLIABILITY CLAIMS-MAGE � OCCUR Y V 6079204724 9/1/2020 9/1/2021 EACH OCCURRENCE $1,000,000 DAM ETORENTED PREMISES fEaoccunence $500,000 X MED EXP (Any one person) $ 15,000 Contractual Liab Included PERSONAL &ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: ] JEC � LOC $2,000,000POLICY S-COMP/OPAGG $2,000,000OTHER: $AUTOMOBILE LIABILITY MGENERALAGGREGATE$2,000,000AGGREGATE D SINGLE LIMIT $ntANY JURY(Per person) $OWNED AUTO SCHEDULEDJURY ONLY AUTOS Peraccldent ( IHIRED $AUTOS NON -OWNED ONLY AUTOS ONLY Y DAMAGEAUTOS ent $ A X UMBRELLA LIAB X OCCUR Y Y 6079210751 9/1 /2020 9/1/2021 EACH OCCURRENCE $ 9,000,000 I AGGREGATE $9,000,000 EXCESS LIAB I CLAIMS -MADE DELI I X I RETENTION$ 1, D,D $ C WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN ANYPROPRIETORIPARTNER/EXECUTIVE OFFICER/MEMSEREXCLUDED7 N/A Y 57WE1116HIH 9/1/2020 1/1/2021 X PERTOTRH- E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 (Mandatory In NH) If yes, describe under E.L. DISEASE- POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS below D Professional Liability V27737190102 9/1/2020 9/1/2021 Limit $2,000,000 Aggregate $2,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) Umbrella Liability policy is a follow -form to underlying General Liability/Auto Liability/Employers Liability. RE: JN 190815 - City of Santa Ana Engineering Technical and Admin. Support Services/City of Santa Ana contract #A-2019-117-03 City of Santa Ana, its officers, employees, agents, volunteers and representatives are named as an additional insured as respects general and auto liability as required per written contract or agreement. General and Auto Liability are Primary/Non-Contributory per policy form wording. Insurance coverage includes waiver of subrogation per the attached endorsement(s). Certificate of Insurance shall provide thirty (30) day prior written notice of cancellation of 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. Attn: Risk Management Division 20 Civic Center Plaza, 4th Floor AUTHORIZED REPRESENTATIVE Santa Ana CA 92701 (k..A{C,i s'riTiu. <_I,tGu---- �. � RiekMan+�mtadDMaiDn x�1 �; REVIEWED&APPROVE) 6Y:. ©1988-2015 ACORD C (,) - ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD I IMMUMIR` RI:k Management Arlalyzt THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA Policy Number: 57WE01-61-11 H Endorsement Number: Effective Date:09/01/2020 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: cannon corporation 1050 Southwood Drive San Luis Obispo, CA 93401 We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 2 % of the California workers' compensation premium otherwise due on such remuneration. SCHEDULE Person or Organization Job Description Any person or organization from whom you are required by written contract or agreement to obtain this waiver of rights from us Countersigned by Form VIC 04 03 06 (1) Printed in U.S.A. �,9� as Risk Mamgvwt D1*1m . qY p REVIEWED&gAP'PiROVED BY:. Policy E tom` Risk Mar,1QensntAMyit CNA CNA PARAMOUNT Blanket Additional Insured - Owners, Lessees or Contractors -with Products -Completed Operations Coverage Endorsement This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART It is understood and agreed as follows: I. WHO IS AN INSURED is amended to include as an Insured any person or organization whom you are required by written contract to add as an additional insured on this coverage part, but only with respect to liability for bodily injury, property damage or personal and advertising injury caused in whole or in part by your acts or omissions, or the acts or omissions of those acting on your behalf: A. in the performance of your ongoing operations subject to such written contract; or B. in the performance of your work subject to such written contract, but only with respect to bodily injury or property damage included in the products -completed operations hazard, and only if: 1. the written contract requires you to provide the additional insured such coverage; and 2. this coverage part provides such coverage. II. But if the written contract requires: A. additional insured coverage under the 11-85 edition, 10-93 edition, or 10-01 edition of CG2010, or under the 10- 01 edition of CG2037; or B. additional insured coverage with "arising out of language; or C. additional insured coverage to the greatest extent permissible by law; then paragraph I. above is deleted in its entirety and replaced by the following: WHO IS AN INSURED is amended to include as an Insured any person or organization whom you are required by written contract to add as an additional insured on this coverage part, but only with respect to liability for bodily injury, property damage or personal and advertising injury arising out of your work that is subject to such written contract. M III. Subject always to the terms and conditions of this policy, including the limits of insurance, the Insurer will not provide such additional insured with: A. coverage broader than required by the written contract; or N B. a higher limit of insurance than required by the written contract. IV. The insurance granted by this endorsement to the additional insured does not apply to bodily injury, property damage, or personal and advertising injury arising out of: A. the rendering of, or the failure to render, any professional architectural, engineering, or surveying services, including: 1. the preparing, approving, or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; and _ 2. supervisory, inspection, architectural or engineering activities; or Ili B. any premises or work for which the additional insured is specifically listed as an additional insured on another endorsement attached to this coverage part. V. Under COMMERCIAL GENERAL LIABILITY CONDITIONS, the Condition entitled Other Insurance is amended to add the following, which supersedes any provision to the contrary in this Condition or elsewhere in this coverage part: CNA75079XX (10-16) P Page 1 of 2 E r M" xkJe>4tMVM AMERICAN CASUALTY CO OF READING, PA EffeCfIV T RE`nexeo&ArRr Insured Name: CANNON CORPORATION alb '��, Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its I Rick Management Analyxt CNA CNA PARAMOUNT Blanket Additional Insured - Owners, Lessees or Contractors -with Products -Completed Operations Coverage Endorsement Primary and Noncontributory Insurance With respect to other insurance available to the additional insured under which the additional insured is a named insured, this insurance is primary to and will not seek contribution from such other insurance, provided that a written contract requires the insurance provided by this policy to be: 1. primary and non-contributing with other insurance available to the additional insured; or 2. primary and to not seek contribution from any other insurance available to the additional insured. But except as specified above, this insurance will be excess of all other insurance available to the additional insured. VI. Solely with respect to the insurance granted by this endorsement, the section entitled COMMERCIAL GENERAL LIABILITY CONDITIONS is amended as follows: The Condition entitled Duties In The Event of Occurrence, Offense, Claim or Suit is amended with the addition of the following: Any additional insured pursuant to this endorsement will as soon as practicable: 1. give the Insurer written notice of any claim, or any occurrence or offense which may result in a claim; 2. send the Insurer copies of all legal papers received, and otherwise cooperate with the Insurer in the investigation, defense, or settlement of the claim; and 3. make available any other insurance, and tender the defense and indemnity of any claim to any other insurer or self -insurer, whose policy or program applies to a loss that the Insurer covers under this coverage part. However, if the written contract requires this insurance to be primary and non-contributory, this paragraph 3. does not apply to insurance on which the additional insured is a named insured. The Insurer has no duty to defend or indemnify an additional insured under this endorsement until the Insurer receives written notice of a claim from the additional insured. VII. Solely with respect to the insurance granted by this endorsement, the section entitled DEFINITIONS is amended to add the following definition: Written contract means a written contract or written agreement that requires you to make a person or organization an additional insured on this coverage part, provided the contract or agreement: A. is currently in effect or becomes effective during the term of this policy; and B. was executed prior to: 1, the bodily injury or property damage; or 2. the offense that caused the personal and advertising injury; for which the additional insured seeks coverage. Any coverage granted by this endorsement shall apply solely to the extent permissible by law. 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 effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below, and expires concurrently with said Policy. Page 2 of 2 AMERICAN CASUALTY CO OF READING,PA Insured Name: CANNON CORPORATION F VZ" Copyright cNA All Rights Reserved. Includes copyrighted material of Insurance services Office, Inc., with CNA CNA PARAMOUNT Waiver of Transfer of Rights of Recovery Against Others to the Insurer Endorsement This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: ANY PERSON OR ORGANIZATION WHOM THE CONTRACT OR AGREEMENT TO WAIVE SUCH CONTRACT OR AGREEMENT: NAMED INSURED HAS AGREED IN WRITING IN A RIGHTS OF RECOVERY, BUT ONLY IF SUCH 1. IS IN EFFECT OR BECOMES EFFECTIVE 2. WAS EXECUTED PRIOR TO THE BODILY ADVERTISING INJURY GIVING RISE TO THE DURING THE TERM OF THIS COVERAGE PART; AND INJURY, PROPERTY DAMAGE OR PERSONAL AND CLAIM. (Information required to complete this Schedule, if not shown above, will be shown in the Declarations.) Under COMMERCIAL GENERAL LIABILITY CONDITIONS, it is understood and agreed that the condition entitled Transfer Of Rights Of Recovery Against Others To Us is amended by the addition of the following: With respect to the person or organization shown in the Schedule above, the Insurer may have against such person or organization because of payments arising out of the Named Insured's ongoing operations or your work included hazard. All other terms and conditions of the Policy remain unchanged. Insurer waives any right of recovery the the Insurer makes for injury or damage in the products -completed operations This endorsement, which forms a part of and is for attachment to the Policy issued by the designated Insurers, takes effect on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below, and expires concurrently with said Policy. CNA75008XX (10-16) Page 1 of 1 AMERICAN CASUALTY Insured Name: CANNON CO OF READING,PA CORPORATION Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance services Office, Inc., with �.m rcrsxmangecmeasurneion 1 RWDX-0&APPROvEDBY: lei Risk klari meat Anolyit PolicyBusiness Auto It is understood and agreed that this endorsement amends the BUSINESS AUTO COVERAGE FORM as follows: SCHEDULE Name of Additional Insured Person Or Organization . ANY PERSON OR ORGANIZATION THAT YOU ARE REQUIRED BY WRITTEN CONTRACT OR WRITTEN AGREEMENT TO NAME AS AN ADDITIONAL INSURED 1. In conformance with paragraph A.1.c. of Who Is An Insured of Section II - LIABILITY COVERAGE, the person or organization scheduled above is an insured under this policy. 2. The insurance afforded to the additional insured under this policy will apply on a primary and non-contributory basis if you have committed it to be so in a written contract or written agreement executed prior to the date of the "accident" for which the additional insured seeks coverage under this policy. 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. Form No: CNA71527XX (10-2012) Endorsement Effective Date: Endorsement Expiration Date: Endorsement No: 15; Page: 1 of 1 Underwriting Company: American Casualty Company of Reading, Pennsylvania, 151 N Franklin St, Chicago, IL 60606 REVIEWED & APPROVED By,. F44"*4 V Risk Ntanagemcut Analyst Copyright CNA All Rights Reserved. asz+s kip p + Nli L x^ Business Auto Policy Policy Endorsement THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: CANNON CORPORATION Endorsement Effective Date: 09/01/2019 SCHEDULE Name(s) Of Person(s) Or Organization(s): ANY PERSON OR ORGANIZATION FOR WHOM OR WHICH YOU ARE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT TO OBTAIN THIS WAIVER FROM US. YOU MUST AGREE TO THAT REQUIREMENT PRIOR TO LOSS. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or organizationls) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident" or the "loss" under a contract with that person or organization. Form No: CA 04 44 10 13 Endorsement Effective Date: Endorsement Expiration Date: Endorsement No: 6; Page: 1 of 1 Underwriting Company: American Casualty Company of Reading, Pennsylvania, 151 N Franklin St, Chicago, IL 60606 REvmwED &APPRovED By., F44"`44 P, WUVAt Rkk Management AnalyU Business Auto Policy Policy Endorsement THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organizationls) who are "insureds" for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: CANNON CORPORATION Endorsement Effective Date: 09/01 /2019 SCHEDULE Name Of Person(s) Or Organization(s): ANY PERSON OR ORGANIZATION THAT THE NAMED INSURED IS OBLIGATED TO PROVIDE INSURANCE WHERE REQUIRED BY A WRITTEN CONTRACT OR AGREEMENT IS AN INSURED,BUT ONLY WITH RESPECT TO LEGAL RESPONSIBILITY FOR ACTS OR OMISSIONS OF A PERSON/ORGANIZATION FOR WHOM LIABILITY COVERAGE IS AFFORDED UNDER THIS POLICY Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Each person or organization shown in the Schedule is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Paragraph A.1. of Section II - Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section I - Covered Autos Coverages of the Auto Dealers Coverage Form. Form No: CA 20 48 10 13 Endorsement Effective Date: Endorsement Expiration Date: Endorsement No: 5; Page: 1 of 1 Underwriting Company: American Casualty Company of Reading, Pennsylvania, 151 N Franklin St, Chicago, IL 60606 Copyright Insurance Services F JZ1 k Risk Management tinalysS Digitally signed by Tori Pierson Tori Pierson Date: 2021.10.12 11:40A9 -07'00' ACOR 7 0 `IO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 10/5/2021 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 AssuredPartners Design Professionals Insurance Services, LLC 3697 Mt. Diablo Blvd Suite 230 CA 94549 CONTACT NAME: Brlttlnl Alberty PHONE FAX (A/C, No Ext : A/C, No): E-MLafayette ADDRESS: Brittini.Alberty@AssuredPartners.com INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: Continental Insurance Company 35289 License#:6003745 INSURED CANNCOR-02 INSURERB: Valley Forge Insurance Company 20508 Cannon Corporation 1050 Southwood Drive INsuRERc: Beazley Insurance Company Inc 37540 INSURERD: HARTFORD INSURANCE COMPANY 38288 San Luis Obispo CA 93401 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER:23760527 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 POLICYNUMBER POLICY EFF MM/DD POLICY EXP MM/DD LIMITS B X COMMERCIAL GENERAL LIABILITY Y Y 6079204724 9/1/2021 9/1/2022 EACH OCCURRENCE $1,000,000 CLAIMS -MADE OCCUR PREMISES DAMAGE TO PREMISES Ea occurrence) ccurrence $ 500,000 X MED EXP (Any one person) $ 15,000 Contractual Liab Included PERSONAL &ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY � PRO- � LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ FIR ER DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY L $ A X UMBRELLALIAB X OCCUR Y Y 6079210751 9/1/2021 9/1/2022 EACH OCCURRENCE $9,000,000 AGGREGATE $ 9,000,000 EXCESS LAB CLAIMS -MADE DED X RETENTION $ 1 n nnn $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N Y 57WEAD8G7X 9/1/2021 9/1/2022 X PER OTH- STATUTEI ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? ❑ N/A E.L. DISEASE - EA EMPLOYEE $ 1,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 C ProfessionalLiability V27737190101 9/1/2021 9/1/2022 Per Claim $2,000,000 Annual Aggregate $2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) Umbrella Liability policy is a follow -form to underlying General Liability/Auto Liability/Employers Liability. RE: City of Santa Ana on Project #A2019-1174-03 , A-2020-153-03, A-2021-075-03 / Cannon #190815 City of Santa Ana, its officers, employees, agents, volunteers and representatives are named as an additional insured as respects general liability as required per written contract or agreement. General Liability are Primary/Non-Contributory per policy form wording. Insurance coverage includes waiver of subrogation per the attached endorsement(s). Certificate of Insurance shall provide thirty (30) day prior written notice of cancellation L,r-M I lr'IL A I C MULUCK L AIVI.CLLA I Ivry OU uav Ivouce Of k anceuauon City of Santa Ana Attn: Risk Management Division 20 Civic Center Plaza, 4th Floor Santa Ana CA 92701 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 RiskMowgemenf Division HEmEwm & APPROVED B © 1988-2015 ACORD C( — rus._nage ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD CNA CNA PARAMOUNT Blanket Additional Insured - Owners, Lessees or Contractors - with Products -Completed Operations Coverage Endorsement This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART It is understood and agreed as follows: I. WHO IS AN INSURED is amended to include as an Insured any person or organization whom you are required by written contract to add as an additional insured on this coverage part, but only with respect to liability for bodily injury, property damage or personal and advertising injury caused in whole or in part by your acts or omissions, or the acts or omissions of those acting on your behalf: A. in the performance of your ongoing operations subject to such written contract; or B. in the performance of your work subject to such written contract, but only with respect to bodily injury or property damage included in the products -completed operations hazard, and only if: 1. the written contract requires you to provide the additional insured such coverage; and 2. this coverage part provides such coverage. II. But if the written contract requires: A. additional insured coverage under the 11-85 edition, 10-93 edition, or 10-01 edition of CG2010, or under the 10- 01 edition of CG2037; or B. additional insured coverage with "arising out of language; or C. additional insured coverage to the greatest extent permissible by law; then paragraph I. above is deleted in its entirety and replaced by the following: WHO IS AN INSURED is amended to include as an Insured any person or organization whom you are required by written contract to add as an additional insured on this coverage part, but only with respect to liability for bodily injury, property damage or personal and advertising injury arising out of your work that is subject to such written contract. III. Subject always to the terms and conditions of this policy, including the limits of insurance, the Insurer will not provide N such additional insured with: 0 0 A. coverage broader than required by the written contract; or B. a higher limit of insurance than required by the written contract. IV. The insurance granted by this endorsement to the additional insured does not apply to bodily injury, property damage, or personal and advertising injury arising out of: A. the rendering of, or the failure to render, any professional architectural, engineering, or surveying services, including: 1. the preparing, approving, or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; and 2. supervisory, inspection, architectural or engineering activities; or B. any premises or work for which the additional insured is specifically listed as an additional insured on another endorsement attached to this coverage part. V. Under COMMERCIAL GENERAL LIABILITY CONDITIONS, the Condition entitled Other Insurance is amended to add the following, which supersedes any provision to the contrary in this Condition or elsewhere in this coverage part: MWWgMWdDMMM CNA75079XX (10-16) Poli �� Page 1 of 2 Endorseme 161t1' 70u, VALLEY FORGE INSURANCE COMPANY Effective Insured Name: CANNON CORPORATION r;�sknrta�ye �„rn��iade Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. CNA CNA PARAMOUNT Blanket Additional Insured - Owners, Lessees or Contractors - with Products -Completed Operations Coverage Endorsement Primary and Noncontributory Insurance With respect to other insurance available to the additional insured under which the additional insured is a named insured, this insurance is primary to and will not seek contribution from such other insurance, provided that a written contract requires the insurance provided by this policy to be: 1. primary and non-contributing with other insurance available to the additional insured; or 2. primary and to not seek contribution from any other insurance available to the additional insured. But except as specified above, this insurance will be excess of all other insurance available to the additional insured. VI. Solely with respect to the insurance granted by this endorsement, the section entitled COMMERCIAL GENERAL LIABILITY CONDITIONS is amended as follows: The Condition entitled Duties In The Event of Occurrence, Offense, Claim or Suit is amended with the addition of the following: Any additional insured pursuant to this endorsement will as soon as practicable: 1. give the Insurer written notice of any claim, or any occurrence or offense which may result in a claim; 2. send the Insurer copies of all legal papers received, and otherwise cooperate with the Insurer in the investigation, defense, or settlement of the claim; and 3. make available any other insurance, and tender the defense and indemnity of any claim to any other insurer or self -insurer, whose policy or program applies to a loss that the Insurer covers under this coverage part. However, if the written contract requires this insurance to be primary and non-contributory, this paragraph 3. does not apply to insurance on which the additional insured is a named insured. The Insurer has no duty to defend or indemnify an additional insured under this endorsement until the Insurer receives written notice of a claim from the additional insured. VII. Solely with respect to the insurance granted by this endorsement, the section entitled DEFINITIONS is amended to add the following definition: Written contract means a written contract or written agreement that requires you to make a person or organization an additional insured on this coverage part, provided the contract or agreement: A. is currently in effect or becomes effective during the term of this policy; and B. was executed prior to: 1. the bodily injury or property damage; or 2. the offense that caused the personal and advertising injury; for which the additional insured seeks coverage. Any coverage granted by this endorsement shall apply solely to the extent permissible by law. 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 effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below, and expires concurrently with said Policy. CNA75079XX (10-16) Page 2 of 2 VALLEY FORGE INSURANCE COMPANY Insured Name: CANNON CORPORATION Copyright CNA All Rights Reserved Endorseme 70u p Effective Risk Ma ger 1Cl rii-1 Aide Includes copyrighted material of Insurance Services Office, Inc., with its peimusiwi. CNA CNA PARAMOUNT Waiver of Transfer of Rights of Recovery Against Others to the Insurer Endorsement This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: ANY PERSON OR ORGANIZATION WHOM THE CONTRACT OR AGREEMENT TO WAIVE SUCH CONTRACT OR AGREEMENT: NAMED INSURED HAS AGREED IN WRITING IN A RIGHTS OF RECOVERY, BUT ONLY IF SUCH l.IS IN EFFECT OR BECOMES EFFECTIVE DURING THE TERM OF THIS COVERAGE PART; AND 2.WAS EXECUTED PRIOR TO THE BODILY INJURY, PROPERTY DAMAGE OR PERSONAL AND ADVERTISING INJURY GIVING RISE TO THE CLAIM. (Information required to complete this Schedule, if not shown above, will be shown in the Declarations.) Under COMMERCIAL GENERAL LIABILITY CONDITIONS, it is understood and agreed that the condition entitled Transfer Of Rights Of Recovery Against Others To Us is amended by the addition of the following: With respect to the person or organization shown in the Schedule above, the Insurer waives any right of recovery the Insurer may have against such person or organization because of payments the Insurer makes for injury or damage arising out of the Named Insured's ongoing operations or your work included in the products -completed operations hazard. 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 effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below, and expires concurrently with said Policy. CNA75008XX (10-16) Page 1 of 1 VALLEY FORGE INSURANCE COMPANY Insured Name: CANNON CORPORATION PO I I` �, �� REMEWED APPROV®8Y: EndorseME '1, 1JLt1' EffeetiVE Risk Management Clerical Aide Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA Policy Number: 57WEAD8G7X Endorsement Number: Effective Date:09/01/2021 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: Cannon Corporation 1050 Southwood Drive San Luis Obispo, CA 93401 We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 2 % of the California workers' compensation premium otherwise due on such remuneration. SCHEDULE Person or Organization Job Description Any person or organization from whom you are required by written contract or agreement to obtain this waiver of rights from us Countersigned by Form WC 04 03 06 (1) Printed in U.S.A. R;ek �s�g�t�,t nivisinn A R"EwED & APPROVED BY.' ?o Rislc Management ❑erir lAide Policy Ex.„u�..,,, vuac. V7/V I/LULL DATE (MM/DD/YYYY) •y- — �y CERTIFICATE OF LIABILITY INSURANCE Acct#:2807366 09/02/2021 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 LOCKTON AFFINITY, LLC CONTACT NAME: LOCKTON AFFINITY, LLC PHONE FAX P.O. BOX 879610 (A/C, No, Ext): 888-828-8365 (A/C, No): 913-052-7599 ADDRESS: KANSAS CITY, MO 64187-9610 INSURERS AFFORDING COVERAGE NAIC # INSURER A: Old Republic Insurance Company 24147 INSURED INSURER B : Cannon Corporation 1050 Southwood Dr INSURER C : INSURER D: San Luis Obispo, CA 93401-5813 INSURER E: 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. ILTR TYPE OF INSURANCE IANSD SWVDR POLICY NUMBER POLICY EFF) (M POLICY YYYY ( POLICY EXP ) POLICY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ _7RENTED DAMAGE CLAIMS- OCCUR PREM SESOEa occurrrence $ MED EXP (Any oneperson) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER : GENERAL AGGREGATE $ POLICY RO- LOC P D.IFC:T PRODUCTS - COMP/OP AGG $ OTHER: A AUTOMOBILE LIABILITY X X L315536-21 09/01/2021 09/01/2022 COMBINED SINGLE LIMIT Ea accident $ 1,000,000 X BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE 'per a.,dent) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ $ WORKERS COMPENSATION I PER OTH- AND EMPLOYERS' LIABILITY Y/N STATUTE ER E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) If yes, describe under E.L. DISEASE- EA EMPLOYEE $ DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT DESCRIPTION OF OPERATIONS 1 LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) GPBR: 2FL5 POLICY PROVIDES PROTECTION FORANYAND ALL OPERATIONS/JOBS PERFORMED BY THE NAMED INSURED WHERE REQUIRED BY WRITTEN CONTRACT. CERTIFICATE HOLDERIS AN ADDITIONAL INSURED WHERE REQUIRED BY WRITTEN CONTRACT. WAIVER OF SUBROGATION INCLUDED BY WRITTEN CONTRACT. INSURANCE IS PRIMARY AND NON-CONTRIBUTORY.City of Santa Ana, its officers, agents and representatives are Additional Insureds withrespect to Auto Liability as required by written contract. Insurance is Primary and Non -Contributory. 30Days' Notice of Cancellation with 10 Days' Notice for Non -Payment of Premium in accordance withpolicy provisions. Project#A2019-1174-03. Cannon #190815. City of Santa Ana Risk Management Division, 4th Floor 20 Civic Center Plaza Santa Ana, CA 92702 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 Rielt:lferd8erneni Division HEAEwm & APPROVED BY: °cam_ '7o © 1988-2016 ACORC u— Rik ManegementCleriralAide ed. ACORD 26 (2016/03) The ACORD name and logo are registered marks of ACORD NOTICE OF COMPLIANCE CITY STAFF: PRINT THIS PAGE AND INCLUDE WITH AGREEMENT TO THE CLERK OF THE COUNCIL Contractor Cannon Corporation Name: Project A-2021-075-03 Number: Second Amendment To Agreement To Provide Engineering, Project Technical, And Administrative Support Services For Public Name: Works Projects (PENCO) 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: EXPIRATION TYPE OF INSURANCE POLICY NUMBER COI DATE FILE NAME DATE City of Santa AUTOMOBILE LIABILITY L31553622 09/01/2023 09/06/2022 Ana_auto .pdf CERT- GENERAL LIABILITY 6079204724 09/01/2023 09/01/2022 1797123285.pdf CERT- PROFESSIONAL LIABILITY V27737210401 09/01/2023 09/01/2022 1797123285.pdf WORKERS COMPENSATION AND EMPLOYERS' CERT- 57WEOL6H1H 09/01/2023 09/01/2022 LIABILITY 1797123285.pdf Thank you, City of Santa Ana Risk Management Division in partnership with CTrax Plus Services Team 9/23/2022 2:38 PM