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HomeMy WebLinkAboutPRUDENTIAL RETIREMENT INSURANCE AND ANNUITY COMPANY-ro � a TaN MAYOR Vicente Sarmiento MAYOR PRO TEM David Penaloza COUNCILMEMBERS Phil Bacerra Johnathan Ryan Hernandez Jessie Lopez Nelida Mendoza Thai Viet Phan INSURANCE ON FILE WORK MAY PROCEED UNTIL INSUr�NCE pcPIRES 01 /1 / ZaZ2 CLERK OF COUNCIL DATE: August 30, 2021 CITY OF SANTA ANA FINANCE AND MANAGEMENT SERVICES 20 Civic Center Plaza, M-36 • P.O. Box 1988 Santa Ana, California 92702 www.santa-ana.orc Prudential Retirement Insurance and Annuity Company Attn: Robert A. Lucian 30 Sacramento Office Park Scranton, PA 18507 Re: Extension of Services Agreement No. A-2018-179 Dear Mr. Lucian, A-2018-17q.A CITY MANAGER Kristine Ridge CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL Daisy Gomez Pursuant to Section G.1. ("Duration") of Agreement No. A-2018-179 entered into by Prudential Retirement Insurance and Annuity Company ("Prudential'), and the City of Santa Ana, dated October 1, 2018, the time period of said Agreement is hereby extended for two (2) additional one (1) year periods from October 1, 2021 to September 30, 2023. The insurance certificates are required to be extended and/or renewed to cover this time extension. All other terms and conditions of said Agreement remain unchanged and in full force and effect. Sincerely, Kathryn Downs Executive Director, Finance and Management Services Agency CITY OF SANTA ANA Kn ''nest Ridge City Manager PRUDENTIAL �� 1A-% Robert A. Lucian, Vice President Specialty Markets & Retirement Counseling ATTEST aisy Gomez Clerk of the Council APPROVED AS TO FORM �al rra Deputy City Attorney rya u eT_1 a r:0y uzK.m a [N 1 111 Vicente Barmiento David Penaloza Thai Viet Phan Jessie Lopez Phil Became Johnathan Ryan Hernandez Nalida Mendoza Mayor Mayor Pro Tom, Ward 2 Ward Ward Word Ward Ward .armi.re0santa-anaaro doenaloza@santa-anaoro tohanasanta-anaore essielooeziesanta-ana.ora pe.crace ]soma-anaom 'ryaohemandeziesemz-ana.orp nmendozaeteanta-anae Digitally signed by Francine R. Francine R. Villareal Villareal A� isCERTIFICATE OF LIABILITY INSURANCE OATS 08/0412021 YYYY 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(les) 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 Marsh USA, Inc. 1166 Avenue of the Americas CONTACT NAME, PHONE AX , END. AllNo: E-MaL ADDRESS, New York, NY 10036 Attn: NmYork.Cens@marsh.com Fax: 212-940500 INSURERS AFFORDING COVERAGE NAICM INSURERA: Travelers Property Casualty Company of America 25674 INSURED PRUDENTIAL FINANCIAL INC. INSURER B: Endurance Assurance corporation 11551 INSURER C 655 BROAD STREET NEWARK, NJ 07102 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: NYC-011164643.01 REVISION NUMBER: 1 THIS 15 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 OF INSURANCE ADDLSUTYPE J=rerBR POLICYNUMBER MM/DDYmEFYFY MM/DDYEJ(P LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR TC2J-GLSA-8045X417-TIL-21 01/0112021 01/01/2022 URRENCE $ 2,000,000 O RENTED Ea occurrence $ 2,OOD,000 Any one person) $ 5,000 VAGFOREN &ADV INJURY $ 2,000,000 GEN-L AGGREGATE LIMIT APPLIES PER: POLICY PEo- LOC OTHER: GGREGATE $ 4,000,000 -COMP/OP AGG S 4,000.000 $ A AUTOMOBILELIABILITY A1NY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY TC2JCAP-8045X045-TIL-21 0110112021 01/0112022 SINGLE LIMIT Ea acddenl $ 2,000,000 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ X UMBRELLALIAB EXCESS LIAB OCCUR CLAIMS -MADE GUF30000914002 01/0112021 01/0112022 EACH OCCURRENCE $ 5.000,000 N AGGREGATE $ 5,000,000 DED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS- LIABILITY YIN ANYPROPRIEFORIPARTNERIEXECUTIVE ❑ OFFICERIMEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA I PER OH - STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE -EA EMPLOYEE $ E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) The City of Santa Ana, ifs officers, employees, agents, and representative are included as additional insured where required by written contract. 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. 9=- ©1988.2016 ACORD C ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD Risk Msnsgmlmt Division REoEwED & APPROVEDBr 17071111 Risk Management Analyst rc0 COMMERCIAL GENERAL LIABILITY POLICY NUMBER: TC2J-GLSA-8045X417-T1L-21 ISSUE DATE: 01-15-21 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Additional Insured Person(s) or Organization(s): "Any person or organization that you agreed in a written contract or agreement to include as an additional insured on this Coverage Part, provided that such written contract or agreement was signed by you before, and is in effect when, the "bodily injury" or "property damage" occurs or the "personal and advertising injury" offense is committed and only for the limits of insurance agreed to in such written contract or agreement, or the limits of insurance of this policy, whichever is less." Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage", "personal injury" or "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; or B. In connection with your premises owned by or rented to you. CG D4 11 04 08 © 2008 The Travelers Companies, Inc. Includes the copyrighted material of Insurance Services Office, Inc. with its permissio � RiekMnugementDtvislon RwEwED APPRO BY: ��-cun.u-kr-e.� r �rN.GyK ram. V N—WIMP, Risk Management Analyst ACORL CERTIFICATE OF LIABILITY INSURANCE DATE Au Lls[ 4, 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 OF 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 poltcy(ies) 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 endorsements . PRODUCER Aon Risk Services Northeast, Inc. One Liberty Plaza, 165 Broadway, Suite 3201 New York, NY 10006 coxtwr NAME PHONE ND.F : dCNxp.: EMAIL ADDRESS: PRODUCER CUSTOMERIDR: INSURERS AFFORDING COVERAGE NAIC# INSURED Prudential Financial, Inc. and its subsidiaries 751 Broad Street Newark, NJ 07102 INSURERA: ACE AMERICAN INSURANCE COMPANY ICHUBB1 (LEAD)22657 INSURER 8: INSURER C: INBU0.ER D: INSURERS: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NI IMRFR- THIS IS TO CERTIFY THAT POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POL CY PFRIOD 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. Limits shown are as requested ec Unt TYPE OF INSURANCE POLICY NUMBER POLICY EFF DATE POOCYEXPDATE LIMITS RETENTIONS GENERAL LIABILITY EACH OCCURRENCE ❑ COMMERCIAL GENERAL LIABILITY PREMISESCLAIMSUPEaeucu) ❑ CLAIMS MADE ❑OCCUR MED P (Puy one persone—. ❑ PERSONAL &ADV INJURY ❑ GENERAL AGGREGATE GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMPIOP ADD ❑ POLICY ❑ PROJECT ❑ LOC AUTOMOBILE LIABILITY ❑ ANY AUTO COMBINED SINGLE LIMIT (Ea accident) ❑ ALL OWNED AUTOS ❑ SCHEDULED AUTOS BODILY INJURY (Per person) ❑ HIRED AUTOS ❑ NON -OWNED AUTO _ BODILY INJURY (Per accident) ❑ PROPERTY DAMAGE (Per aaidenp ❑ ❑UMBRELLA LAB ❑OCCUR EACH OCCURRENCE ❑ EXCESS LIAR ❑ CLAMS MADE AGGREGATE ❑ DEDUCTIBLE ❑ RETENTION WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN WCSTATU- ❑ To,Y LIMITS OTHER ❑ A. ETORIPA,ONodExccu aFAOENME.a A...a.? E.L. EACH ACCIDENT E.L. DISEASE -EA EMPLOYEE (Mandatory in NMI IfYe: dee under DESCRIPTION OF OPERATIONS be— E.L. DISE)VSE-POLICY LIMIT A Insurance Company Professional Liability G21648346 019 Nov. 1, 2020 Nov. 1, 2021 At least $6,000,000 $260,000,000 A Financial Institution Bond, Form 25 G29010961 004 Nov. 1, 2020 Nov. 1, 2021 At least $5,000,000 $250,000,000 A Cyber Liability G46761029 003 Nov. 1, 2020 Nov. 1, 2021 At least $5,000,000 $260,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I (Attach ACORD 101, Additional Remarks Schedule, IF more space Is required) City of Santa Ana Risk Management Division, 4n 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 AUTHORIZED REPRESENTATIVE ACORD 25 (2009109) ©1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Wak MareganaltDivbWl i.v° REmEWEQ&ARPROVm BY: ' �' Risk Management Analyst �►`020® CERTIFICATE OF LIABILITY INSURANCE E (MMID DATE/4/20Y1 YY) 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 Edgewood Partners Insurance Center 1 American LaneINC.No)- CONTACT NAME: Amanda Massa PHONE . 203-658-0507 FAX Ea BESS, amanda.massa a lebrokers.com Greenwich CT 06831-2560 INSURERS AFFORDING COVERAGE NAICIf INSURER A: Travelers Prop Casualty Cc of America 25674 INSURED PRUDEN2069A INSURER B: Prudential Financial, Inc. 751 Broad Street INSURERC: INSURER D: Newark NJ 07102 INSURER E : INSURER F: COVERAGES CERTIFICATE NUMBER: 1103252456 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 TYPE OF INSURANCE ADDLSUBR POUCYNUMBER POLICY EFF MM/DD/Y1'YY POLICY UP (MMIDDIYYYYI LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR EACH OCCURRENCE $ DAMAGETORENTED PREMISES Ea com.. $ MED UP (Any one person) $ PERSONAL S AOV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ POLICY❑JECT LOC PRODUCTS-COMP/OP AGG $ $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO OWNED SCHFOULED AUTOS ONLY AUTOS BODILY INJURY (Per eccklen) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accident $ $ UMBRELLALIAS OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CIAIMS-MADE DEO I I RETENTIONS $ A A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN UBBN67804A2151R UB8N7282432151 K 1/1/2021 1/1/2021 1/1/2022 7A/2022 X PER OTH. STATUTE I ER E.L EACH ACCIDENT $1,000,000 ANYPROPRIETORIPARTNER/EXECUMVE ❑ OFFICERIMEMBER EXC W DED? NIA E.L. DISEASE -EA EMPLOYEE S1,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS LOCATIONS I VEHICLES (ACORD IU1, Additional Remarks Schedule, may be attached if more space is required) Location Address: 751 Broad Street Prudential Property Number: N/A Property Type: Owned (Prudential occupied) CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS. Risk Management Division, 4th Floor 20 Santa Civic Center Plaza AUTHpRIzao REPRESENTATIVE Santa Ana CA 92702 Rtek MRnagenlmt 1)ivislan REvie&Eo 6 APPRCNm BY. ©1988-2015 ACORD C f44*,C,�K P. V:utnr t ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Rise Management Analyst