HomeMy WebLinkAboutCOMMUNITY SENIORSERV, INC. DBA MEALS ON WHEELS ORANGE COUNTYINSURANCE NOT ON FILE
WORK MAY NQf PROCEED
JUN 2 3 2021 CLERK OF COUNCIL
A-2021-088
UA I L:
AGREEMENT BETWEEN THE CITY OF SANTA ANA AND
COMMUNNITY SENIORSERV, INC DBA MEALS ON WHEELS ORANGE COUNTY
FOR A SEN
IOR MEALS PROGRAMS
U: P', R(Sriviq Curvas)(!) I7.
THIS AGREEMENT is made and entered into on this 15th day of June, 2021 by and
between Community SeniorServ, Inc. a California nonprofit corporation doing business as Meals
on Wheels Orange County ("Contractor"), 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 City desires to retain Contractor to participate in delivering meals to homebound
senior residents and providing meals for senior residents at City senior centers.
B. Contractor represents that Contractor is able and willing to provide such services to the
City.
C. In undertaking the performance of this Agreement, Contractor represents that it is
knowledgeable in its field and that any services performed by Contractor under this
Agreement will be performed in compliance with such standards as may reasonably be
expected from a professional firm in the field.
NOW THEREFORE, in consideration of the mutual and respective promises, and subject
to the terms and conditions hereinafter set forth, the parties agree as follows:
1. SCOPE OF SERVICES
Contractor shall deliver a total of three nutritious meals, five days a week, to participants'
homes along with case management services through the Home Delivered Meal Program
("HDM"). In addition, Contractor will deliver nutritional lunches to participants at the Southwest
Senior Center and the Santa Ana Senior Center as part of the Lunch Cafe (Grab & Go) Program.
All participants in the program will be enrolled through the City of Santa Ana Parks, Recreation
and Community Services Agency. Programs shall operate as outlined in the attached Exhibit A,
attached hereto and incorporated by reference.
2. COMPENSATION
a. City agrees to pay, and Contractor agrees to accept as total payment for its services for
City, the rates and charges identified in Exhibit A. The total amount to be expended
during the term of this Agreement shall not exceed $90,290.
b. Payment by City shall be made within forty-five (45) days following receipt of proper
invoice evidencing work performed, subject to City accounting procedures. Payment
need not be made for work that fails to meet the standards of performance set forth in
the Recitals, which may reasonably be expected by City.
3. TERM
This Agreement shall commence on July 1, 2021 and terminate on June 30, 2022, unless
terminated earlier in accordance with Section 15, below. The parties agree that certain specified
sections of this Agreement will survive termination or expiration of the Agreement.
4. INDEPENDENT CONTRACTOR
Contractor and its employees, agents and officers shall, during the entire term of this
Agreement, be construed to be independent contractors and not employees of the City. This
Agreement is not intended nor shall it be construed to create an employer -employee relationship,
a joint venture relationship, or to allow the City to exercise discretion or control over the
professional manner in which Contractor performs the services which are the subject matter of this
Agreement; however, the services to be provided by Contractor shall be provided in a manner
consistent with all applicable standards and regulations governing such services. Contractor shall
pay all salaries and wages, employer's social security taxes, unemployment insurance and similar
taxes relating to employees and shall be responsible for all applicable withholding taxes.
Contractor is not an agent, representative, or employee of the City and Contractor shall have no
authority to act on behalf of the City.
5. INSURANCE
Prior to undertaking performance of work under this Agreement, Contractor shall maintain
and shall require its subcontractors, if any, to obtain and maintain insurance as described below:
a. Commercial General Liability Insurance. Contractor shall maintain commercial
general liability insurance naming the City, its officers, employees, agents,
volunteers and representatives as additional insured(s) 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 and shall include, but not be limited to protection against claims arising
from bodily and personal injury, including death resulting therefrom and damage
to property, resulting from any act or occurrence arising out of Contractor's
operations in the performance of this Agreement, including, without limitation, acts
involving vehicles. The amounts of insurance shall be not less than the following:
single limit coverage applying to bodily and personal injury, including death
resulting therefrom, and property damage, in the total amount of $2,000,000 per
occurrence, with $4,000,000 in the aggregate.
b. Business automobile liability insurance, or equivalent form, with a combined single
limit of not less than $1,000,000 per occurrence. Such insurance shall include
coverage for owned, hired and non -owned automobiles.
C. Worker's Compensation Insurance. In accordance with the California Labor Code,
Contractor, if Contractor has any employees, is required to be insured against
2
liability for worker's compensation or to undertake self-insurance. Prior to
commencing the performance of the work under this Agreement, Contractor agrees
to obtain and maintain any employer's liability insurance with limits not less than
$1,000,000 per accident.
d. Sexual Abuse or Molestation (SAM) Liability: either the commercial general
liability policy must be endorsed to include affirmative coverage for sexual abuse
or molestation or Contractor shall obtain and maintain a separate policy covering
Sexual Abuse and Molestation with a limit of no less than $1,000,000 per
occurrence or claim.
e. The following requirements apply to the insurance to be provided by Contractor
pursuant to this section:
1) If Contractor maintains broader coverage or higher limits than the
minimums shown above, the City requires and shall be entitled to the
broader coverage and/or the higher limits maintained by the Contractor.
2) Any available insurance proceeds in excess of the specified minimum limits
of insurance and coverage shall be available to the Entity.
3) Contractor shall maintain all insurance required above in full force and
effect for the entire period covered by this Agreement.
4) For any claims related to this contract, the Contractor's insurance coverage
shall be primary insurance coverage at least as broad as ISO CG 20 01 04
13 as respects the City, its officers, officials, employees, agents and
volunteers.
5) Contractor agrees that it will fill out whatever paperwork is necessary for
Contractor's insurance company to waive all rights of subrogation against
City, its elected or appointed officers, officials, agents or employees for
losses paid under the terms of any policy, which arise from work performed
by the Contractor for the Entity.
6) Certificates of insurance including all required amendatory endorsements
and a copy of the Declarations and Endorsement Page of the Commercial
General Liability policy listing all policy endorsements shall be furnished
to the City upon execution of this Agreement and shall be approved by the
City. City reserves the rights to require complete certified copies of all
required insurance policies, including endorsements affecting the coverage
required by these specifications, at any time.
7) No work shall be done pursuant to this Agreement until certificates of
insurance are approved by the City.
8) Certificates and policies shall state that the policies shall not be cancelled
or reduced in coverage or changed in any other material aspect, by
Contractor, without thirty (30) days prior written notice to the City.
9) Insurance coverage pursuant to this Agreement is to be placed with insurers
authorized to conduct business in California with a current A.M. Best's
rating of no less than A: VII, unless otherwise acceptable to the City.
f. If Contractor fails or refuses to produce or maintain the insurance required by this
section or fails or refuses to furnish the City with required proof that insurance has
been procured and is in force and paid for, the City shall have the right, at the City's
election, to forthwith terminate this Agreement. Such termination shall not affect
Contractor's right to be paid for its time and materials expended prior to notification
of termination. Contractor waives the right to receive compensation and agrees to
indemnify the City for any work performed prior to approval of insurance by the
City.
6. INDEMNIFICATION
Contractor agrees to defend, and shall indemnify and hold harmless the City, its officers,
agents, employees, contractors, special counsel, and representatives from liability: (1) for personal
injury, damages, just compensation, restitution, judicial or equitable relief arising out of claims for
personal injury, including death, and claims for property damage, which may arise from the
negligent operations of the Contractor or its subcontractors, agents, employees, or other persons
acting on their behalf which relates to the services described in section 1 of this Agreement; and
(2) from any claim that personal injury, damages, just compensation, restitution, judicial or
equitable relief is due by reason of the terms of or effects arising from this Agreement. This
indemnity and hold harmless agreement applies to all claims for damages, just compensation,
restitution, judicial or equitable relief suffered, or alleged to have been suffered, by reason of the
events referred to in this Section or by reason of the terms of, or effects, arising from this
Agreement. The Contractor further agrees to indemnify, hold harmless, and pay all costs for the
defense of the City, including fees and costs for special counsel to be selected by the City,
regarding any action by a third party challenging the validity of this Agreement, or asserting that
personal injury, damages, just compensation, restitution, judicial or equitable relief due to personal
or property rights arises by reason of the terns of; or effects arising from this Agreement. City
may make all reasonable decisions with respect to its representation in any legal proceeding. This
indemnification provision shall survive expiration or termination of this Agreement.
7. RECORDS
Contractor shall keep records and invoices in connection with the work to be performed
under this Agreement. Contractor shall maintain complete and accurate records with respect to
the costs incurred under this Agreement and any services, expenditures, and disbursements
charged to the City for a minimum period of three (3) years, or for any longer period required by
law, from the date of final payment to Contractor under this Agreement. All such records and
invoices shall be clearly identifiable. Contractor shall allow a representative of the City to
examine, audit, and make transcripts or copies of such records and any other documents created
pursuant to this Agreement during regular business hours. Contractor shall allow inspection of all
work, data, documents, proceedings, and activities related to this Agreement for a period of three
(3) years from the date of final payment to Contractor under this Agreement. This records
provision shall survive expiration or termination of this Agreement.
8. CONFIDENTIALITY
If Contractor receives from the City information which due to the nature of such
information is reasonably understood to be confidential and/or proprietary, Contractor agrees that
it shall not use or disclose such information except in the performance of this Agreement, and
further agrees to exercise the same degree of care it uses to protect its own information of like
importance, but in no event less than reasonable care. "Confidential Information" shall include all
nonpublic information. Confidential information includes not only written information, but also
information transferred orally, visually, electronically, or by other means. Confidential
information disclosed to either party by any subsidiary and/or agent of the other party is covered
by this Agreement. The foregoing obligations of non-use and nondisclosure shall not apply to any
information that (a) has been disclosed in publicly available sources; (b) is, through no fault of the
Contractor disclosed in a publicly available source; (c) is in rightful possession of the Contractor
without an obligation of confidentiality; (d) is required to be disclosed by operation of law; or (e)
is independently developed by the Contractor without reference to information disclosed by the
City. This confidentiality provision shall survive expiration or termination of this Agreement.
9. CONFLICT OF INTEREST CLAUSE
Contractor covenants that it presently has no interest and shall not have interests, direct or
indirect, which would conflict in any manner with performance of services specified under this
Agreement.
10. BACKGROUND CHECK
Provider shall not assign any employee, agent, subcontractor or volunteer to provide
services pursuant to this Agreement, if that employee, agent, subcontractor or volunteer is required
to register as a sex offender under California Penal Code Section 290 et seg, has a conviction for
any crime of moral turpitude, has a conviction for a violent felony as defined in California Penal
Code Section 667.5(c), or has a conviction for a serious felony as defined in California Penal Code
Section 1192.7(c). Disqualifying convictions include but are not limited to, violations of California
Penal Code Sections 37, 128, 136.1 with Section 186.22, 187, 190-190.4 and 192(a), 205, 206,
207-209.5, 211, 212, 212.5, 213, 214, 215, 218-219, 220, 236.1(b) or 236.1(c), 243.4, 261, 261.5,
273.5, 262, 264.1, 266, 266c, 266h, 266i, 266j, 267, 269, 272, 273a, 273ab, 273d, 285, 286, 288,
288a, 288.2, 288.3, 288.4, 288.5, 288.7, 289, 290, 311.1, 311.2, 311.3, 311.4, 311.10, 311.11, 314,
347(a), 368, 417(b), 451(a),518 with 186.22, 647.6, 653f(c), 664 and 187, 667.5(c), 18745,18750,
or 18755, 12022.53, 11418(b)(1) or (b)(2); Business and Professions Code Section 729. Failure
to comply with this Section shall be grounds for immediate termination of this Agreement.
11. NOTICE
Any notice, tender, demand, delivery, or other communication pursuant to this Agreement
shall be in writing and shall be deemed to be properly given if delivered in person or mailed by
first class or certified mail, postage prepaid, or sent by fax or other telegraphic communication in
the mariner provided in this Section, to the following persons:
To City: Clerk of the City Council
City of Santa Ana
20 Civic Center Plaza (M-30)
P.O. Box 1988
Santa Ana, CA 92702-1988
With copy to: Executive Director
Parks, Recreation and Community Services
City of Santa Ana
20 Civic Center Plaza (M-23)
P.O. Box 1988
Santa Ana, CA 92702
To Contractor: Community SeniorServ, hie. dba Meals on Wheels Orange County
1200 N. Knollwood Circle
Anaheim, CA 92801
Fax (714) 220-1374
Attn: Holly Hagler, President & CEO
A party may change its address by giving notice in writing to the other party. Thereafter,
any communication shall be addressed and transmitted to the new address. If sent by mail,
communication shall be effective or deemed to have been given three (3) days after it has been
deposited in the United States mail, duly registered or certified, with postage prepaid, and
addressed as set forth above. If sent by fax, communication shall be effective or deemed to have
been given twenty-four (24) hours after the time set forth on the transmission report issued by the
transmitting facsimile machine, addressed as set forth above. For purposes of calculating these
timeframes, weekends, federal, state, County or City holidays shall be excluded.
12. EXCLUSIVITY AND AMENDMENT
This Agreement represents the complete and exclusive statement between the City and
Contractor regarding the subject matter herein, and supersedes any and all other agreements, oral
or written, between the parties. In the event of a conflict between the terms of this Agreement and
any attachments hereto, the terms of this Agreement shall prevail. This Agreement may not be
modified except by written instrument signed by the City and by an authorized representative of
Contractor. The parties agree that any terms or conditions of any purchase order or other instrument
that are inconsistent with, or in addition to, the terms and conditions hereof, shall not bind or
obligate Contractor or the City. Each party to this Agreement acknowledges that no
representations, inducements, promises or agreements, orally or otherwise, have been made by any
party, or anyone acting on behalf of any party, which are not embodied herein.
13. ASSIGNMENT
Inasmuch as this Agreement is intended to secure the specialized services of Contractor, it
may not assign, transfer, delegate, or subcontract any interest herein without the prior written
consent of the City and any such assignment, transfer, delegation or subcontract without the City's
prior written consent shall be considered null and void. Nothing in this Agreement shall be
construed to limit the City's ability to have any of the services, which are the subject to this
Agreement performed by City personnel or by other Contractors retained by City.
14. WAIVER
No waiver of breach, failure of any condition, or any right or remedy contained in or
granted by the provisions of this Agreement shall be effective unless it is in writing and signed by
the party waiving the breach, failure, right or remedy. No waiver of any breach, failure or right, or
remedy shall be deemed a waiver of any other breach, failure, right or remedy, whether or not
similar, nor shall any waiver constitute a continuing waiver unless the writing so specifies.
15. TERMINATION
This Agreement may be terminated by the City upon fifteen (15) days written notice of
termination. In such event, Contractor shall be entitled to receive and the City shall pay Contractor
compensation for all services performed by Contractor prior to the effective date of termination.
16. NON-DISCRIMINATION
Contractor shall not discriminate because of race, color, creed, religion, sex, marital status,
sexual orientation, gender identity, gender expression, gender, medical conditions, genetic
information, or military and veteran status, age, national origin, ancestry, or disability, as defined
and prohibited by applicable law, in the recruitment, selection, training, utilization, promotion,
termination or other employment related activities or in connection with any activities under this
Agreement. Contractor affirms that it is an equal opportunity employer and shall comply with all
applicable federal, state and local laws and regulations.
17. JURISDICTION -VENUE
This Agreement has been executed and delivered in the State of California and the validity,
interpretation, performance, and enforcement of any of the clauses of this Agreement shall be
determined and governed by the laws of the State of California. Both parties further agree that
Orange County, California, shall be the venue for any action or proceeding that may be brought or
arise out of, in connection with or by reason of this Agreement. This jurisdiction provision will
survive expiration or termination of this Agreement.
7
18. LICENSES
Contractor shall, throughout the term of this Agreement, maintain all necessary licenses,
permits, approvals, waivers, and exemptions necessary for the provision of the services hereunder
and required by the laws and regulations of the United States, the State of California, the City of
Santa Ana and all other governmental agencies. Contractor shall notify the City immediately and
in writing of its inability to obtain or maintain such permits, licenses, approvals, waivers, and
exemptions. Said inability shall be cause for termination of this Agreement.
19. COMPLIANCE WITH LAWS
Contractor shall keep informed of State, Federal and Local laws, ordinances, codes and
regulations that in any manner affect those employed by it or in any way affect the performance
of its services pursuant to this Agreement. The Contractor shall at all times comply with such
laws, ordinances, codes and regulations. The City, its officers and employees shall not be liable
at law or in equity occasioned by failure of Contractor to comply with this Section.
20. SEVERABILITY
In the event that one or more of the phrases, sentences, clauses, paragraphs, or sections
contained in this Agreement shall be declared invalid or unenforceable by valid judgment or decree
of a court of competent jurisdiction, such invalidity or unenforceability shall not affect any of the
remaining phrases, sentences, clauses, paragraphs, or sections of this Agreement, which shall be
interpreted to carry out the intent of the parties hereunder.
21. EXHIBITS
All Exhibits referenced herein and/ or attached hereto shall be incorporated as if fully set
forth in the body of this Agreement.
22. AUTHORITY
The person(s) executing this Agreement on behalf of the parties hereto warrant that they
are duly authorized to execute this Agreement on behalf of said parties and that by so executing
this Agreement, the parties hereto are formally bound by the provisions of this Agreement.
23. COUNTERPARTS
This Agreement may be executed by the parties hereto in separate counterparts, each of
which when executed and delivered shall be an original, but all such counterparts shall together
constitute one and the same instrument. Each counterpart may consist of a number of copies hereof
each signed by less than all, but together signed by all of the parties hereto.
A-2021-088
24. ELECTRONIC SIGNATURES
This Agreement and counterparts of this Agreement may be executed and delivered by
facsimile or other electronic means by any of the parties to this Agreement. The facsimile, email,
or other electronically delivered signatures of the parties shall be deemed to constitute original
signatures.
IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and
year first above written.
ATTEST: 4#0
D. oucz
IL Cie
APPROVED AS TO FORM
SONIA R. CARVALHO
City Attorney
By: XamnnL
Laura A. Rossini
Chief Assistant City Attorney
RECOMMENDED FOR APPROVAL
LG
a Rudloff
CITY OF SANTA ANA
Kristine Ridge
City Manager
CONTRACTOR
Holly44aile
President & CEO
Executive Director
Parks, Recreation and Community Services Agency
0
EXHIBIT A
10
Name of Organization
Name of Funded Program
Annual Accomplishment Goal
City of Santa Ana
Scope of Work
Meals on Wheels Orange County
Home Delivered and Lunch Caf6/Grab & Go Meals Programs
I. Total number of unduplicated Participants (Santa Ana and Non -Santa Ana participants) anticipated to be served by
the funded program, named above, during the 12-month contract period.
8,500 Participants
II. Number of ONLY unduplicated Santa Ana Participants to be served by the funded program, named above, during
the 12-month contract period.
700 Participants
Program and Funding Description
For Fiscal Year 21-22, Santa Ana discretionary funds in the amount of $90,290 will be utilized to help fund the raw
food costs of home delivered and Lunch Cafe/Grab & Go meals to Santa Ana older adult participants from July 1,
2021-June 30, 2022.
Home Delivered Meal Program:
Participants in the HDM Program will receive a total of 3 nutritious meals, 5 days a week delivered to their home
along with case management services. Meals will be delivered by paid and volunteer drivers. Eligibility and case
management services will be provided by Meals on Wheels Orange County Case Managers. Participants will also
have access to other services at no charge including in -home services, respite services, home safety equipment,
and other resources.
Lunch Cafe (Grab & Go) Program:
Participants in this program will be provided with nutritional lunches at 2 sites in Santa Ana - Southwest Senior
Center and Santa Ana Senior Center.
Schedule of Performance
Estimate the number of ONLY unduplicated Santa Ana participants to be served by the funded program during the 12-
month contract period per quarter. (Enter number of new Santa Ana Participants served each quarter. If they were
served in quarter 1 do not count them again in quarter 2)
Quarter 1: July 1- September 30
Quarter 2: October 1- December 31
Quarter 3: January 1- March 31
Quarter 4: April 1-June 30
Schedule of Invoicing
Estimate the amount of grant funds to be
Quarter 1: July 1- September 30
Quarter 2: October 1- December 31
Quarter 3: January 1- March 31
Quarter 4: April 1-June 30
Participants
Participants
Participants
Participants
Total unduplicated Santa Ana Participants to be served.
during the 12-month contract period on a quarterly basis.
22572.5 0
Grant
Digitally signed by Francine R.
Francine R. Villareal Villareal
nara�m t n� m 1 �nFna ��mro
CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
V 7/l/2022 6/29/2021
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 endorsements ,
PRODUCER Lockton Insurance Brokers, LLC
777 S. Figueroa Street, 52nd Fl.
CA License #0F15767
Los Angeles CA 90017
NAME:
PHONE pAX
teuc No
E-MAIL
ADDRESS:
INSURER(S) AFFORDING COVERAGE
NAIC #
(213) 689-0065
INSURER A: Philadelphia Indemnit Insurance Co.
18058
INSURED Community SeniorServ, Inc.
1495634 Dba Meals on Wheels Orange County ty
1200 N. Knollwood Cit.
Anaheim CA 92801
INSURER B : Redwood Fire and Casualty Insurance Co
11673
INSURER C
INSURER D :
INSURER E :
INSURER F :
crniconr_cc �nr.,ro�nr n�n�•1�.n.�•�. .. ,_._.__.
--------------•••--•-• a.l-r,v 11 RGY101VIV IYUIVIDIMM; AAAAAAA
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 L SUBR POLICY NUMBER POLICY EFF POLICY EXP
MM/DD MM/DD LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE OCCUR
Y
N
PHPK2291894
7/1/2021
7/l/2022
EACH OCCURRENCE
$ 1,000 000
DAM DE-TO-IRMITM
PREMISESlEa occurrence)
$_ 1 00O 000
MED EXP (Any one person)
$ 20,000
PERSONAL & ADV INJURY
$ 1 000,000
LIMIT APPLIES PER:
❑ PE�
GENERAL AGGREGATE
$ 3000000
GEN'LAGGREGATE
PRODUCTS - COMP/OP AGG
$ 30000 000
X
POLICY LOC
OTHER:
$
A
AUTOMOBILE
LIABILITY
N
N
PHPK2291894
7/1/2021
7/1/2022
COMBINED SINGLE LIMIT
Ea accident
$ 1 OOO OOO
X
ANY AUTO
..,..-......1................,...._....._............
BODILY INJURY (Per person)
. _..._..f._..,._._a_.....-,..w_._...._..,.,..,...,.
$ j{3IXXXXX
OWNED SCHEDULED
AUTOS ONLY AUTOS
BODILY INJURY (Per accident)
$ XXXXXXX
HIRED NON -OWNED
AUTOS ONLYLY
AUTOS ONLY AUTOSXXXXXXX
PROPERTY DAMAGE
Per eccident�„•_,„,„,,,_.,,,,_.
....._,..,.....
$
...µµ-.,.,...�_w_
Com .Ded.
1,000
A
X
UMBRELLA LIAB
X
OCCUR
N
N
PHUB773736
7/1/2021
7/1/2022
EACH OCCURRENCE
$10000000
EXCESS LIAB
CLAIMS -MADE
AGGREGATE
$ 10,000 000
DED I X I RETENTION $ 10,000
$ XXXXXXX
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ECUTNEFN
�
N
COWC247800
7/1/2021
7/1/2022
_
X STATUTE I I ERH
E.L. EACH ACCIDENT
$ 12000,000
OFFICEBER EXCLUDED?
a (Mandtory In If yes, describe aundnder
NIA
E.L. DISEASE -EA EMPLOYEE
$ 1,000,000
E.L. DISEASE - POLICY LIMIT $ 1 000 000
DESCRIPTION OF OPERATIONS below
A
A
Prof. Liab.
Sexual/Physical Abuse or
Y
N
PHPK2291894 (Prof. Liab.)
7/1/2021
7/1/2022
$1,000,000; Agg. limit: $3,000,000
Molestation
PHPK2291894
7/1/2021
7/1/2022
$1,000 000 Occ./$2,000,000 Agg
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required)
The City of Santa Ana, its officers, employees, agents, representatives and volunteers are an Additional Insured to the extent provided by the policy language or
endorsement issued or approved by the insurance carrier. Insurance provided to Additional Insured(s) is primary and non-contributory as per the attached
endorsements or policy language.
/'. Cf1TIr1I. 1, T,� „w, ,•.,�e�
15476274 The City of Santa Ana, Risk Management SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
20 Civic Center Plaza THE EXPIRA71ON DATE THEREOF, NOTICE WILL BE DELIVERED IN
Santa Ana CA 92701 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPR
,,,. 1 Nsk R1sItAl�nagc+rlarLD[viefan
,��/ REvEWED&APPROVED BY:
o 88-201 c D c I,� .,
ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD Risk Management Analyst
Attachment Code: D567517 Master ID: 1495634, Certificate ID: 15476274
1 � 1
The City of Santa Ana, Risk Management
20 Civic Center Plaza
Santa Ana, CA 92701
To whom it may concern:
In our continuing effort to provide timely certificate delivery, Lockton Companies is
transitioning to paperless delivery of Certificates of Insurance, thus, this is your final hard -copy
delivery.
To ensure electronic delivery for fixture renewals of this certificate, we need your email address.
Please contact us via one of the methods below, referencing Certificate ID 15476274.
• Email: PacificeDelivery(alockton.com
• Phone: (213) 689-2300
If you received this certificate through an internet link where the current certificate is viewable,
we have your email and no further action is needed.
In the event your mailing address has changed, will change in the future, or you no longer
require this certificate, please let us know using one of the methods above.
The above inbox and phone number below are for automating electronic delivery of certificates
only. Please do NOT send future certificate requests to the above inbox or call into the number
below.
Thank you for your cooperation and willingness in reducing our environmental footprint.
Lockton Insurance Brokers, LLC - Pacific Series
Lockton Insurance Brokers, LLC
I �767
'Stl ,A' 5211.l N I i 1 u A 90017 71,0:i
-113 689-0065 / FAX 213-689-0550
lockton.corn
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Risk Management Analyst
POLICY NUMBER: PHPK22A18Q4 COMMERCIAL GENERAL LIABILITY
CG203M0413
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ /TCAREFULLY.
ADDITIONAL U���������_�����U�������� �� � ������ ���..��.�.��
P������� ���� ORGANIZATION ��_���_� �_��',,����,����,,��,�
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s) Or Organization (s): The City of Santa Aria; it officerst
employees, agents and representatives and volunteers are named as additional insureds (" additional
insureds") with regard to liability and defense of suits arising from the operations and uses performed
by or on behalf of the named insured,
With respect to claims arising OLA of the operations and uses performed by or on behalf of the named
inSUred, such insurance as is afforded by this policy is primary and is not additional to or contributing
with any other insurance carried by or for the benefit of the additional insureds."
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
A. Section |U—Who &sAnInsured ioamended
0oinclude eoonadditional insured the
penoon(o)ormganizaUon(o) shown inthe
8chadu|a, but only with respect to liability for
"bodily injury"."property damage" or"personal
and advertising injury" caused, inwhole orin
part, byyour acts nromissions orthe acts or
omissions ofthose acting onyour behalf:
1. |nthe performance ofyour ongoing
operations; or
2. |nconnection with your premises owned
Uyorrented toyou.
However:
1. The insurance afforded 0osuch additional
insured only applies 0othe extent
permitted bylaw; and
2. |fcoverage provided huthe additional
insured ierequired byocontract or
agreement, the insurance afforded tosuch
additional insured will not bebroader than
that which you are required bythe
contract oragreement toprovide for such
additional insured.
With respect to the insurance afforded to
these additional insureds, the following is
added hoSection III — Limits OfInsurance:
|fcoverage provided tothe additional insured
in required by a contract oragreement, the
most wewill pay onbehalf ofthe additional
insured iathe amount ofinsurance:
1. Required bythe contract oragreement; or
2. Available under the applicable Limits of
insurance shown inthe Declarations;
whichever ieless.
This endorsement shall not increase the
applicable Limits ofInsurance shown in the
Declarations.
CG 20280413 @ Insurance Services Office, |mc..2U12
RA
Risk Management Analyst
Attachment Code: D578001 Certificate ID: 15476274
PI-CANXAICH-002 (05/11)
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CANCELLATION NOTICE TO SCHEDULED ADDITIONAL INSURED OR
CERTIFICATE HOLDER
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PROFESSIONAL LIABILITY COVERAGE PART
COMMERCIAL CRIME COVERAGE PART
COMMERCIAL INLAND MARINE COVERAGE PART
COMMERCIAL PROPERTY COVERAGE PART
COMMERCIAL AUTOMOBILE COVERAGE PART
SCHEDULE OF ADDITIONAL INSUREDS OR CERTIFICATE
HULUtK,
AI or CH
Additional Insured or Certificate Holder
Address
CH
The City of Santa Ana, Risk Management
20 Civic Center Plaza
Santa Ana, CA 92701
The following is added to A. CANCELLATION of the Common Policy Conditions of the above
applicable
coverage part:
A. In the event we cancel the policy in accordance with the policy's terms and conditions, we will
endeavor to mail written notice of cancellation to Additional Insureds or Certificate Holders,
shown in the above SCHEDULE within the time frame listed below. However, failure to mail
such notice shall impose no obligation of any kind upon us, our agents or representatives.
1. 30 days before the effective date of cancellation if we cancel for any reason other than
for
non - payment of premium.
As respects Additional Insureds, the above cancellation provision applies only when the
Additional Insured shown in the above SCHEDULE is added to the policy by a separate
additional insured endorsement as the CANCELLATION NOTICE TO ADDITIONAL INSURED
OR CERTIFICATE HOLDER does not provide additional insured coverage.
402?7 , r
RI&MMaganatDiMsfan
R^EVIEWED&APPPIMVEDIft
Risk Management Analyst
Attachment Code: D594186 Certificate IL. 15476274
PI-GL-005 (07/12)
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED
PRIMARY AND NON-CONTRIBUTORY INSURANCE
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Effective Date: 07/01/2016
Name of Person or Organization (Additional Insured):
The City of Santa Ana its officers, employees, agents and representatives
20 Civic Center Plaza
Santa Ana CA 92701
SECTION II — WHO IS AN INSURED is amended to include as an additional insured the person(s) or
organization(s) shown in the endorsement Schedule, but only with respect to liability for "bodily injury,"
"property damage" or "personal and advertising injury' arising out of or relating to your negligence in the
performance of "your work" for such person(s) or organization(s) that occurs on or after the effective
date shown in the endorsement Schedule.
This insurance is primary to and non-contributory with any other insurance maintained by the person or
organization (Additional Insured), except for loss resulting from the sole negligence of that person or
organization.
This condition applies even if other valid and collectible insurance is available to the Additional
Insured for a loss or "occurrence" we cover for this Additional Insured,
The Additional Insured's limits of insurance do not increase our limits of insurance, as described in
SECTION III — LIMITS OF INSURANCE.
All other terms, conditions, and exclusions under the policy are applicable to this endorsement
and remain unchanged.
Page 1 of 6 _
Includes copyrighted material of Insurance Services Office, Inc., with its per ��`1A1ie"to0/
REVIEWED & APPROVED Bw N
b;
Risk Management pai lyst 8
�
PI-CXL-002 (05/19)
POLICY NUMBER: PHUB773736
SCHEDULE OF UNDERLYING INSURANCE
Employers' Liability
Company: Redwood Fire & Casulaty
Ins. Co.
Policy Number: COWC-034033
Policy Period: 07 01 2021 07/01/2022
Minimum Applicable Limits
Bodily injury by accident
Bodily injury by disease
Bodily injury by disease
$ i o00 , 00o
$ i 000 , 000Each
$ 1, 000, 000
Each Accident
Employee
Policy Limit
Commercial General Liability
® Occurrence
❑ Claims -Made
Company: Philadelphia Indemnity Insurance Company
Number: PHPK2291894
Policy
Policy Period: 07/01/2021 07/01/2022
Retroactive Date: Not Applicable
Minimum Applicable Limits:
General Aggregate
Products -Completed Operations Aggregate
$ 3,000,000
$ 3,000 , 000
Personal And Advertising Injury
$ 1, 000 , 000
Each Occurrence
$ 1,000,000
Commercial Auto Liability
Company: Philadelphia Indemnity
Insurance Company
Policy Number: PHPK2291894
Policy Period: 07/01/2021 07/01/2022
Minimum Applicable Limits
Garage Aggregate Limit For Other Than Autos
(if applicable)
Each Accident
$ Not Applicable
$ 1 000 , 000
Professional Liability
® Occurrence
❑ Claims -Made
Company: Philadelphia Indemnity
Insurance Company
Number: PHPK2291894
Policy
Policy Period: 07/01/2021 07/01/2022
Retroactive Date: Not Applicable
Minimum Applicable Limits
Each Professional Incident
$ 1 000,000_
Aaarecrate
$ 3 000,000..
PI-CXL-002 (05/19)
Page 3 of 5
Includes copyrighted material of Insurance Services Office, Inc., with
g,� �, �
y
RiekMitnagetne�Divisian
REVIEWED & APPROVED BY:
'
RskManagementAnalyst
per
PI-CXL-002 (05/19)
POLICY NUMBER: PHUB773736
Employee Benefits Liability
❑ Occurrence
® Claims -Made
Company: Philadelphia
Indemnity Insurance Company
Policy Number: PHPK2291894
Policy Period: 07/01/2021
07/01/2022
Retroactive Date: 07/01/2011
Minimum Applicable Limits
Each Claim
$ 11000,000
Aggregate
$ 1,000,000
Abusive Conduct Liability
® Occurrence
❑ Claims -Made
Company: Philadelphia
Indemnity Insurance Company
Policy Number: PHPK2291894
Policy Period: 07/01/2021
07/01/2022
Retroactive Date: Not Applicable
Minimum Applicable Limits
Each Abusive Conduct
$ 1.000 000
Aggregate
$ 2,000,000
Directors & Officers Liability
❑ Occurrence
❑ Claims -Made
Company:
Policy Number:
Policy Period:
Retroactive Date:
Minimum Applicable Limits
$
Liquor Liability
❑ Occurrence
❑ Claims -Made
Company:
Policy Number:
Policy Period:
Retroactive Date:
Minimum Applicable Limits
PI-CXL-002 (05119)
Page 4 of 5
Includes copyrighted material of Insurance Services Office, Inc., with
,,1. q "..—.it�IcMxnagc�nentDivis[on
REMEWED & APPROVED 817
V°
` OWO, Risk Management Analyst "
per �t �i
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