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HomeMy WebLinkAboutPALACIOS LAW OFFICE (2)N-2022-334A MAYOR Valerie Amezcua MAYOR PRO TEM Thai Viet Phan COUNCILMEMBERS Phil Bacerra Johnathan Ryan Hernandez Jessie Lopez David Penaloza Benjamin Vazquez INSURANCE ON FILE WORK MAY PROCEED ............... NTlL INSURA�gE IRIS CITY INK i DATE. NOV 0 4 2024 CITY OF SANTA ANA PLANNING AND BUILDING AGENCY 20 Civic Center Plaza • P.O. Box 1988 Santa Ana, California 92702 WwW.santa-ana.orc October 16, 2024 PALACIOS LAW OFFICE Attn: Elio Palacios 7121 Magnolia Avenue Riverside, California 92504 Fjprurnc Vlllokal Re: JExtension of Agreement N-2022-334 CITY MANAGER Alvaro Nunez CITY ATTORNEY Sonia R. Carvalho CITY CLERK Jennifer L. Hall Pursuant to Section 3 ("Term") of the above -referenced Agreement, entered into by Palacios Law Office ("Contractor") and the City of Santa Ana, the term of the Agreement is hereby extended for an additional one-year period until October 31, 2025. 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, 0 Minh Thai Executive Director, Planning & Building Agency CITY OF S TA AN _"VA44 / Alvaro Nunez City Manager APPROYEDAS TO FORM Meli sa Crosthwaite Senior Assistant City Attorney vaned¢amezzua Mayor meztlla'b}sanla-ana om ATTEST ennnfer L. al I PALACIOS LAW OFFICE C� Elio Palacios SANTA ANA CITY COUNCIL That Viol Phan Renlina n Vazquez Jesse Law Phil Raze. Mayor Pm Tem. Wait i Wind 2 Wartl 0 Wald 4 Iphaneltsanla ana.ry bvazauenffisuits,enaom essielooez&saitaan. ory pbarertslas.,ta-ana am Jolmafhan Ryan Hernandez Oavld Penaloza Want Wind nanhemandeziq[sanaananm dpend.za®same-ana am " CERTIFICATE OF LIABILITY INSURANCE DATE 06/2212023 06/22/2023 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 be endorsed. If SUBROGATIONIS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT DANIELS HEAD INS AGENCY INC/PHS 65813296 The Hartford Business Service Center NAME: PHONE (866)467-8730 (I No, Ext): -TIC. Fax No): 3600 Wiseman Blvd E-MAIL San Antonio, TX 78251 ADDRESS: INSURER($) AFFORDING COVERAGE NAICY INSURED INSURERA: Sentinel Insurance Company Ltd. 11000 PALACIOS LAW OFFICE INSURER B: PO BOX 7282 INSURERC: RIVERSIDE CA 92513-7282 INSURER D : 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. INSH LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF WMIDDIYYYYI POLICY UP IMMI LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 CLAIMS -MADE OCCUR DAMAGETO RENTED PREMISES Eaoccurrence $1,000,000 X MED EXP(Any one person) $10,000 General Liability A X X 65 SBM TH3424 06/28/2023 06/28/2024 PERSONAL& ADV INJURY $1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY❑ECT PRO' FLOC PRODUCTS - COMP/OP AGG $2,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ed accident) $1,000,000 BODILY INJURY (Per person) ANY AUTO A ALLOWNED SCHEDULED AUTOS AUTOS 65 SBM TH3424 06/28/2023 06/28/2024 BODILY INJURY(Peraccident) X HIRED NON -OWNED AUTOS X AUTOS PROPERTY DAMAGE (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS- M AGGREGATE DED RETENTION $ADE WORKERS COMPENSATION IPER OTH- ANDEMPLOYERS'LIABILITY ISTATUTE I ER E.L. EACH ACCIDENT ANY YIN PROPRIETOR/PARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? NIA E.L. DISEASE -EA EMPLOYEE (Mandatory in NH) If yes, describe under E.L. DISEASE - POLICY LIMIT DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) Those usual to the Insured's Operations. Certificate holder is an additional insured per the Business Liability Coverage Form SS0008 attached to this policy. Waiver of Subrogation applies in favor of the Certificate Holder per the Business Liability Coverage Form SS0008, attached to this policy. Risk Management Division BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED 20 CIVIC CENTER PLZ IN ACCORDANCE WITH THE POLICY PROVISIONS. SANTA ANA CA 92701-4058 AUTHORIZED REPRESENTATIVE � RleleMxnlygemmtDlvielan MGM REVIEWED &APPROV®BY: ©1988-2015 ACORD COF I�N�� �"d AsAaodo ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Rim Management specialm ,e.c Rci° CERTIFICATE OF LIABILITY INSURANCE DA07/08/2024 Y) 07/08/2024 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 be endorsed. If SUBROGATIONIS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT MEDPRO INSURANCE SERVICES LLC/PHS NAME, 36214543 The Hartford Business Service Center PHONE (866)467-8730 (A/C, No, Ear\ FAX (AIC, No): 3600 Wiseman Blvd • San Antonio, TX 78251 E-MAIL ADDRESS: , IN J CO G NAIC# INSURED INSURER A: entinelI urance Company 11000 PALACIOS LAW OFFICE PO BOX 7282 INSURER Brl — INSURER RIVERSIDE CA 92513-7282 N Rr.D: e: Acpve( 1 F: • t COVERAGES CERTIFICATE NUMBER: • R.—AUNU THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTEF BEI _;W HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT, TERM OR C:,,NDITION 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. INS LTR TYPE OF INSURANCE ADDL INSR SUER WVD POLICY NUMBER POLICY EFF MM/DD(MMIDDNYYn POLICY EXP LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 CLAIMS -MADE OCCUR DAMAGETO RENTED PREMISES Ea onto $1,000,000 X General Liability ty MED EXP (Any one person) $10,000 A X X 36 SBM TH3424 06/28/2024 06/28/2025 PERSONAL B AOV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY❑PRO- JECT Lac PRODUCTS-COMP/OP AGO $2.000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000 Ea accident BODILY INJURY (Per person) ANY AUTO A ALL OWNED SCHEDULED AUTOS AUTOS 36 SEIM TH3424 06/28/2024 06/28/2025 BODILY INJURY (Per accident) X HIRED NONOWNED AUTOS rx AUTOS PROPERTY DAMAGE (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS- MADE AGGREGATE ED RETENTION $ WORKERS COMPENSATION IPER OTH- AND EMPLOYERS' LIABILITY IsTATUTE ER E.L. EACH ACCIDENT ANY YIN PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? NIA E.L. DISEASE -EA EMPLOYEE IMandatory In NH) If yes, describe under E.L. DISEASE- POLICY LIMIT DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101, Addldonal Remarks Schedule, may be aaaehed if more space is required) Those usual to the Insured's Operations. Certificate holder is an additional insured per the Business Liability Coverage Form SS0008 attached to this policy. Waiver of Subrogation applies in favor of the Certificate Holder per the Business Liability Coverage Form SS0008, attached to this policy. Clty of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED Risk Management Division BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED 20 CIVIC CENTER PLZ IN ACCORDANCE WITH THE POLICY PROVISIONS. SANTA ANA CA 92701-4058 AUTHORIZED REPRESENTATIVE GJ uectn dim Cgp it.i�2 7; REVIEWED&APPROv®B ©1988.2015 ACORD COF ,ol®i' -, A� A,444 ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Risk Management Specidist A` �� CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 03/17/25 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: a/CNN EXt: 847 541-0900 FAX No: 847 541-0444 COMPLETE EQUITY MARKETS INC A DRIESS: 1190 Flex Court INSURER(S) AFFORDING COVERAGE NAIC # Lake Zurich, IL 60047 INSURERA: National Specialty Insurance Company Complete Equity Markets Insurance Agency Inc(CASL#OD44077) INSURED INSURER B INSURERC: Elio Palacios, Jr. dba INSURER D Palacios Law Office INSURERE: 7121 Magnolia Avenue INSURER F : Riverside CA 92504 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL I SUBR POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE1:1 OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY ❑ PRO - POLICY ❑ LOC PRODUCTS - COMP/OP AGG $ $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN PER OTH- STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N I A E.L. DISEASE - EA EMPLOYE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ A Professional Liability JQF 1805527 02/01/25 02/01126 Each Claim $1,000,000 Aggregate $2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 1D1, Additional Remarks Schedule, may be attached if more space is required) Subject to all policy terms, conditions, exclusions and endorsements. The City of Santa Ana, its City Council, officers, officials, employees, agents, and volunteers are listed as an Additional Insured with Waiver of Subrogation but only per the terms and conditions of the endorsement generated and subject to all policy terms, conditions, exclusions, and endorsements. Tu Tran Digitallysigned by Tu Tran Nguyen D:*14Nguyen 09:46:15-07100' APPROVED CERTIFICATE HOLDER CANCELLATION By Tu Tran Nguyen at 9:45 am, Apr 14, 2025 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. Planning and Building Agency AUTHORIZED REPRESENTATIVE 20 Civic Center Plaza Santa Ana CA 92702 �/� �eu.�+�w� 7PA""Y © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD MASTER POLICY NO.: CEM 14 - 24 DECLARATIONS National Specialty Insurance Company (a stock insurance company) 1900 L Don Dodson Dr. Bedford, Texas 76021 (800) 877-4567 END. NO. JQF1805527 PREVIOUS NO. JQ'1804285 ARBITRATORS, HEARING OFFICERS AND MEDIATORS PROFESSIONAL LIABILITY INSURANCE issued to the National Association of Salaried Professionals Purchasing Group, Inc. and SPECIFIED MEMBERS EVIDENCE OF INSURANCE Named Assured and Address ELIO PALACIOS, JR. 7121 Magnolia Avenue Riverside CA 92504 LIMITS OF LIABILITY: I. A. Professional Liability - A.1. Professional Liability and Personal Injury Coverage Each Claim $1,000,000.00 Aggregate $2,000,000.00 Deductible $1,000.00 each claim Retroactive Date: NONE A.3. Social Engineering Fraud Liability Each Claim $250,000.00 Aggregate $250,000.00 Deductible $1,000.00 each claim Retroactive Date: NONE Producer Name and Address Complete Equity Markets, Inc. 1190 Flex Court Lake Zurich, IL 60047 A.2. Defense Cost Coverage Each Claim $1,000,000.00 Aggregate $2,000,000.00 Deductible $1,000.00 each claim Retroactive Date: NONE Overall Aggregate Limit of Liability for Insuring Agreement I. A. Professional Liability Aggregate: $2,000,000.00 AMENDATORY ENDORSEMENT NO.: JQF1805527 ADDITIONAL PREMIUM: Included ASSURED: ELIO PALACIOS, JR., DBA PALACIOS LAW OFFICE EFFECTIVE: February 1, 2025 to February 1, 2026 :0big S) 011 W 10.311 In consideration of the Assured's payment of the premium set forth, it is hereby understood and agreed that under Endorsement No.: JQF1805527 the following: City of Santa Ana, its City Council, officers, officials, employees, agents, and volunteers is/are added to coverage under Endorsement No. JQF1805527 as an additional insured(s), but only as respects the operations of the Named Assured and subject to the terms, conditions, limits, and exclusions of the policy of insurance. It is further agreed that Underwriters waive all rights of subrogation against the Additional Insured with respect to claims or losses arising out of services provided by the Named Assured pursuant to the contract between the Named Assured and the Additional Insured referenced above. CEMSN 300 (07/21) All other terms, conditions, limits and exclusions remain unchanged. Attached to and forming part of Certificate No.: CEM 14 - 24 Dated: March 18, 2025 Complete Equity Markets, Inc. dba Complete Equity Markets Insurance Agency, In . (CASL#OD44077) (UMR) B2429BR2401037 �—�p Lib•" 641 By (_ r Lawrence T.P. Molloy Endorsement #13 AMENDATORY ENDORSEMENT NO.: JQF1805527 ASSURED: ELIO PALACIOS, JR.. EFFECTIVE: February 1, 2025 to February 1, 2026 It is hereby understood and agreed that under Endorsement No.: JQJF1805527 the Assured's name is altered to read: ELIO PALACIOS, JR., DBA PALACIOS LAW OFFICE CEMSN 314 (07/21) All other terms, conditions, limits and exclusions remain unchanged. Attached to and forming part of Certificate No.: CEM 14 - 24 Dated: March 18, 2025 National Specialty Insurance Company AUTHORIZATION NO.: (UMR) B2429BR2401037 Complete E uity Markets, Inc. dba Complete Equity Markets Insurance Agency, Inc. (CASL#OD44077) e199"12 (JQF1805527/10026532) G/ee~ (- i . By Lawrence T.P. Molloy Endorsement #12