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HomeMy WebLinkAboutPITNEY BOWES PRESORT SERVICES, INC. (2)City of Santa Ana COTC office Use Only Clerk of the Council AGREEMENT TERMINATION FORM Please complete this form in its entirety when the attached agreement and all amendments (if any) are no longer in effect. ` i_ Note: If your agreement is grant related, please ensure that all grant retention requirements y have been satisfied prior to signing the termination form. Is the agreement(s) a permanent record? Yes No Return form to the Clerk of the Council Office (M-30). Call 647-1520 if you have any questions. The agreement with YIihe.{ Vjv./.(e 5 Qy f sbft- ' PCmu-< , Lj�P No. A-2019-038-01 was completed on � "2 and final payment has been made. (List all amendments. Use space below if needed.) (��,11ee 22 Department: F6°r"r S /� � C�T'2fiL SvrS` Phone/Ext.: )( 5-y 0 'L Signature: Date: i lagreemenlsVormslfarm- agreement termination form_goldenrod.doc ON FILE INSURANCE MAV PROCEED WORK PIKES UNTIL INSURANCEfX Of COUNCIL MAYOR CLERK Vioenie SanniJV' ; MAYOR PRO TEM Phil Baw a COUNCILMEMBERS N Johnathan Ryan Hernandez,' o Jessie Lopez N Nelida Mendoza David Penaloza a Thai Viet Phan CITY OF SANTA ANA LIA um FINANCE AND MANAGEMENT SERVICES AGENCY 20 Civic Center Plaza • P.O. Box 1988 Santa Ana, California 92702 vuvmJ.santa-ana.ora (,e'11Tajcfvj s(pAn HqrzA(#.6101 T January 27. 2022 Pitney Bowes Presort Services, LLC 18550 S Broadwick Street Rancho Dominguez, CA 90220 Attn: Ryan Radzinski Re: Extension of Agreement No. A-2019-038 A-2019-038-01 CITY MANAGER Kristine Ridge CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL Daisy Gomez Pursuant to Section 7 ("Term") of the above -referenced Agreement; entered into by Pitney Bowes Presort Services, Inc., and the City of Santa Ana, dated February 1, 2019, the time period of the Agreement is hereby extended for an additional two (2) month period, from February 1, 2022 through March 31, 2022. Any insurance certificates are required to be extended and/or renewed to cover this extension. All other terms and conditions of the Agreement remain unchanged and in full force and effect. Sincerely, (� Katherine Downs, CPA Executive Director, Finance and Management Services Agency CITY OF SANTA ANA Z�14 Kristine Ridge City Manager APPROVED AS TO FORM Sonia R- Carvalho City Attorney 'Brandon Salvatierra Deputy City Attorney Daisy Gomez, MMC Clerk of the Council PITNEY BOWES PRESORT SERVICES, LLC Name: Vinayipandhi a Title: Chief Financial Officer SANTA ANA CITY COUNCIL VI . S m t. ml aaoerta T M Uiel p mm Penwm Jassfa Lap¢ JMnaMm Ryan HemanC Nada Mentl Mayor MayerPm Tem,Wmtl4 mmi We 2 Wa.3 WaM5 W M6 renlNAsanlaana.om Obauttaa®sanla-ana.vm )oban®SaMa�ane om �eyalaueaenla-ana.wa jF Mope santa na av jm2nbemantleaesanlaana rnv rynentloia(v)saMa-ana om AC�ORG)� CERTIFICATE OF LIABILITY INSURANCE D12/10I//200212/10 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 Willis Towers Watson Northeast, Inc. c/o 26 Century Blvd P.O. Box 305191 CONTACT Willis Towers Watson Certificate Center NAME: AICNNo Ez, 1-877-945-7378 F No: 1-868-967-2378 E-MAIL ADDRESS: certificates@Willi a. one INSURER(S) AFFORDING COVERAGE NAIC# Nashville, TN 372305191 USA INSURER A: ACE American Insurance Company 22667 INSURED Pitney Bowes Inc. 3001 Sumner Street INSURERB: Commerce 6 Industry Insurance Company 19410 INSURER C: Indemnity Insurance Company of North Ameri 43575 INSURERD; ACE Fire Underwriters Insurance Company 20702 Stamford, CT 06926 INSURER E: National Fire S Marine Insurance Company 20079 INSURER F: COVERAGES CERTIFICATE NUMBER: W23052463 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL SUBR POLICYNUMBER POLICY EFF MMI�DIY1YY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 CLAIMS -MADE X OCCUR DAMAG TORENT PREMISES Es occurrenEDce $ 300,000 VIED EXP (Any one person) $ 5,000 A y HDO G72491075 07/01/2021 07/01/2022 PERSONAL&ADV INJURY $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PERT GENERAL AGGREGATE $ 4,000,000 X POLICY ❑ PRO- ❑ LOC ECT PRODUCTS-COMPIOP AGG $ 4,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident 2,000,000 $ )( BODILY INJURY (Per person) $ ANVAUTO A OWNED SCHEDULED AUTOS ONLY AUTOS ISA 925550511 07/01/2021 07/01/2022 BODILY INJURY (Per accident) $ HIRED NON -OWNED AUTOS ONLYPAUTOSONLY PROPERTY DAMAGE Per accident $ B X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 EXCESS LIAB CLAIMS -MADE 66323214 07/01/2021 07/01/2022 DED RETENTION $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICE MEMB R/PARTNERIE%ECUTIVE YIN OFFICEPRIET RIPARTERIEX No (Mandatory In NH) NIA WLR C67814630 07/01/2021 07/01/2022 x I STATUTE I ERH E.L. EACH ACCIDENT $ 2,000,000 E.L. DISEASE - FA EMPLOYEE $ 2,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 2,000,000 A Workers Compensation and WLR C67814678 07/01/2021 07/01/2022 E.L. Each Accident $2,000,000 Employers' Liability E.L. Disease -Ea Map. $2,000,000 Per Statute E.L. Disease Policy $2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) This Voids and Replaces Previously Issued Certificate Dated 06/29/2021 WITH ID: W21417247. SEE ATTACHED City of Santa Ana Risk Management Division 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 114 © 1988-2016 ACORD REVIEWED & APPP(R��;A4O�/,tV�ED BY. F`tAf,aN �. VWaRt Risk ManagementAnalyst ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD an Tn: 21927888 BATCH: 2336113 AGENCY CUSTOMER ID: LOC #: AC�R ® ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMEDINSURED Willis Towers Watson Northeast, Inc. Pitney Bowes Inc. 3001 Summer Street Stamford, CT 06926 POLICY NUMBER See Page 1 CARRIER NAIC CODE See Page 1 $ee Page 1 EFFECTIVE DATE: See Page 1 THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance The City of Santa Ana, its officers, officials, employees, and volunteers are included as Additional Insureds as respects to General Liability where required by written contract. General Liability policy shall be Primary and Non-contributory with any other insurance in force for or which may be purchased by Additional Insureds where required by written contract. INSURER AFFORDING COVERAGE: ACE Fire Underwriters Insurance Company POLICY NUMBER: SCF C6781471A EFF DATE: 07/01/2021 EXP DATE: 07/01/2022 TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT: Workers Compensation and E.L. Each Accident $2,000,000 Employers' Liability E.L. Disease -Ea Emp. $2,000,000 Per Statute E.L. Disease Policy $2,000,000 INSURER AFFORDING COVERAGE: National Fire S Marine Insurance Company POLICY NUMBER: 42-XSF-316064-01 EFF DATE: 07/01/2021 EXP DATE: 07/01/2022 TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AR40UNT: Excess Business Auto Limit: $1M xs $2M NAIC#: 20702 NAIC#: 20079 3 REVIEWED &APPROVED8Y: ACORD 101 (2008/01) © 2008 ACORD C1 a f4w ;, W The ACORD name and logo are registered marks of ACORD ` Risk M.mm lageent:Analyst SR ID: 21927888 HATCH: 2336113 CERT: W23052463 A a„-t... POLICY NUMBER: HDO G72491075 1 Endorsement Number: COMMERCIAL GENERAL LIABILITY C G 2015 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -VENDORS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organizations Vendor Your Products Any Vendorwhom you have agreed to include as an All of your products. additional Insured under a written contract, provided such contract was executed prior to the date of loss. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured Is amended to include as an additional Insured any person(s) or organization(s) (referred to below as vendor) shown In the Schedule, but only with respect to "bodily Injury" or "property damage" arising out of "your products" shown in the Schedule which are distributed or sold in the regular course of the vendor's business, subject to the following additional exclusions: 1. The insurance afforded the vendor does not apply to: a. "Bodily injury" or "property damage" for which the vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to liability for damages that the vendor would have in the absence of the contract or agreement; b. Any express warranty unauthorized by you; c. Any physical or chemical change in the product made Intentionally by the vendor; d. Repackaging, except when unpacked solely for the purpose of inspection, demonstration, testing, or the substitution of parts under instructions from the manufacturer, and then repackaged in the original container; e. Any failure to make such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products; f. Demonstration, installation, servicing or repair operations, except such operations performed at the vendor's premises in connection with the sale of the product; g. Products which, after distribution or sale by you, have been labeled or relabeled or used as a container, part or Ingredient of any other thing or substance by or for the vendor; or h. "Bodily injury" or "property damage" arising out of the sole negligence of the vendor for its own acts or omissions or those of its employees or anyone else acting on its behalf. However. this exclusion Mpg nnf onnly r CG 20 15 07 04 © ISO Properties, Inc., 2004 REVIEWED & APPRov® By. f � �. Vaom,;ate? Risk M anagement:Analyst (1) The exceptions contained in Sub- paragraphs d. or f.; or (2) Such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products. 2. This insurance does not apply to any insured person or organization, from whom you have acquired such products, or any ingredient, part or container, entering into, accompanying or containing such products. Page 2 of 2 © ISO Properties, Inc., 2004 a:"s-"-e RlekMarssgtmenEDLWeIon REVIEWED&APPROVED BY. R6k Nlanagemen[Analyst NOTICE TO OTHERS ENDORSEMENT— SCHEDULE Named Insured Pitney BOWeS InC. Endorsement Number Policy Symbol Policy Number Policy Period Effective Date of Endorsement HDO I G72491075 7/1/2021 to 7/1/2022 7/1/2021 Issued By (Name of Insurance Company) ACE American Insurance Company Insert the policy number, The remainder of the intormarron is to be completed only when this endorsement Is issued subsequent to the preparation of the policy, THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. A. If we cancel the Policy prior to its expiration date by notice to you or the first Named insured for any reason other than nonpayment of premium, we will endeavor, as set out below, to send written notice of cancellation, via such electronic or other form of notification as we determine, to the persons or organizations listed in the schedule that you or your representative provide or have provided to us (the "Schedule"). You or your representative must provide us with the physical and/or e-mail address of such persons or organizations, and we will utilize such e-mail address or physical address that you or your representative provided to us on such Schedule. B. The Schedule must be initially provided to us within 15 days after: L The beginning of the Policy period, if this endorsement is� effective as of such date; or it. This endorsement has been added to the Policy, if this endorsement is effective after the Policy period commences. C. The Schedule must be In an electronic format that is acceptable to us; and must be accurate, D. Our delivery of the notification as described in Paragraph A. of this endorsement will be based on the most recent Schedule in our records as of the date the notice of cancellation is mailed or delivered to the first Named Insured, E. We will endeavor to send or deliver such notice to the e-mail address or physical address corresponding to each person or organization indicated in the Schedule at least 30 days prior to the cancellation date applicable to the Policy. F, The notice referenced in this endorsement is Intended only to be a courtesy notification to the person(s) or organizations) named in the Schedule in the event of a 'pending cancellation of coverage, We have no legal obligation of any kind to any such person(s) or organization(s). Our failure to provide advance notification of cancellation to the person(s) or organization(s) shown in the Schedule shall impose no obligation or liability of any kind upon us, our agents or representatives, will not extend any Policy cancellation date and will not negate any cancellation of the Policy, G. We are not responsible for verifying any information provided to us In any Schedule, nor are we responsible for any incorrect information that you or your representative provide to us. If you or your representative does not provide us with a Schedule, we have no responsibility for taking any action under this endorsement. In addition, If neither you nor your representative provides us with e-mail and physical address Information with respect to a particular person or organization, then we shall have no responsibility for taking action with regard to such person or entity under this endorsement. H. We may arrange with your representative to send such notice in the event of any such cancellation, I. You will cooperate with us in providing the Schedule, or in causing your representative to provide the Schedule. J. This endorsement does not apply in the event that you cancel the Policy, ALL-32687 (05/11) � R1ekT,tnnagernmrDtdefon REVIEWED&MPROVtD BY. 8ff ' a 14e&tits€ r„. Risk M anagementAnalyst All other terms and conditions of the Policy remain unchanged. ALL-32667 (05111) Authorized Representative fie REVIEWED &AppRovB:)By., �t REVIEWEDni APPROV®BY: Risk Management Analyst NOTICE TO OTHERS ENDORSEMENT — SCHEDULE Named Insured Pitney Bowes Inc. Endorsement Number Policy Symbol Policy Number Policy Period Effective Date of Endorsement ISA I H25550611 7/1/2021 to 7/1/2022 7/1/20 .1 Issued By (Name of Insurance Company) ACE American Insurance Company Insert the policy number, The remainder of the information Is to be completed only when this endorsementrs issued subsequent to the preparation of the policy THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, A. If we cancel the Policy prior to its expiration date by notice to you or the first Named Insured for any reason other than nonpayment of premium, we will endeavor, as set out below, to send written notice of cancellation, via such electronic or other form of notification as we determine, to the persons or organizations listed in the schedule that you or your representative provide or have provided to us (the "Schedule"). You or your representative must provide us with the physical andtor e-mail address of such persons or organizations, and we will utilize such e-mail address or physical address that you or your representative provided to us on such Schedule. B. The Schedule must be Initially provided to us within 15 days after; 1. The beginning of the Policy period, if this endorsement is effective as of such date; or It. This endorsement has been added to the Policy, if this endorsement is effective after the Policy period commences. C. The Schedule must be in an electronic format that is acceptable to us; and must be accurate. D. Our delivery of the notification as described in Paragraph A. of this endorsement will be based on the most recent Schedule in our records as of the date the notice of cancellation is mailed or delivered to the first Named Insured. E. We will endeavor to send or deliver such notice to the e-mail address or physical address corresponding to each person or organization indicated in the Schedule at least 30 days prior to the cancellation data applicable to the Policy. F. The notice referenced in this endorsement is intended only to be a courtesy notification to the person(s) or organization(s) named in the Schedule in the event of a pending cancellation of coverage. We have no legal obligation of any kind to any such person(s) or organization(s). Our failure to provide advance notification of cancellation to the person(s) or organization(s) shown In the Schedule shall impose no obligation or liability of any kind upon us, our agents or representatives, will not extend any Policy cancellation date and will not negate any cancellation of the Policy. G. We are not responsible for verifying any information provided to us in any Schedule, nor are we responsible for any incorrect information that you or your representative provide to us. If you or your representative does not provide us with a Schedule, we have no responsibility for taking any action under this endorsement. In addition, If neither you nor your representative provides us with e-mail and physical address information with respect to a particular person or organization, then we shall have no responsibility for taking action with regard to such person or entity under this endorsement. H. We may arrange with your representative to send such notice in the event of any such cancellation. t. You will cooperate with us in providing the Schedule, or in causing your representative to provide the Schedule. J. This endorsement does not apply in the event that you cancel the Policy. ALL-32687 (05/11) Risk e medDhislon REVIEWED&APPR�cfvpD3y. p MIwd Risk ManagementAnalyst .. _v: u`v: _._ AN other terms and conditions of the Policy remain unchanged. ALL-32667 (05111) a WeleMassgemrnfD[Welrns s . BEVIEwm& APPRaVVE:) BY.' I Risk ManagemenCAnalyst