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Home My WebLink AboutORANGE COUNTY CONSERVATION CORPS 2B - 2003 iNSURANCE ON FILE "O,;K MAY PROCEED uhriL iNSUR/\NCE E:XPIRES 7 <À{) -M LCLI'" Of COUNCIL 01,":0 9-/5-03 ,: Cb,4 THIS AMENDMENT, made and entered into this 21st day of July, 2003, by and between the Orange County ft.-.; Conservation Corps ("Contractor") and the City of Santa Ana, a charter city and municipal corporation duly "'".:r" organized and existing under the Constitution and laws of the State of California ("City"). R'I . . A-2003-154 AMENDMENT TO AGREEMENT RECIIALS A. The City and Contractor entered into that certain Agreement dated June 3, 2002, hereinafter referred to as "said Agreement", to provide career preparation and basic skills services for disadvantaged youth who are out-of- school. B. The parties hereto now desire to amend the "City's Obligations" amount found in Section 2 and the "Time Period of Agreement" term of Section 3 of said Agreement. WHEREFORE, in consideration of the mutual and respective covenants and promises hereinafter contained and made, and subject to all of the terms and conditions of said Agreement as hereby amended, the parties hereto do hereby agree as follows: 1. The "City's Obligation" section of said Agreement will be amended to read: "".a sum not to exceed $111,01 R 60 " 2. The "Time Period of Agreement" section of said Agreement will be amended to read: "".shall have been performed by S~pt~mh.".10 ?-001." 3. Except as hereinabove modified, the terms and conditions of said Agreement remain unchanged and in full force and effect. IN WITNESS WHEREOF, the parties hereto have executed this Amendment to said Agreement the date and year first above written. ATTEST: ~ G?~ Patricia Ë. Healy Clerk of the Council CITY o~ David N. Ream, City Manager APPROVED AS TO FORM: Orange County Conservation Corps. ~I-r Executive Director M-;<- f.~ By: Lisa E. Storck Assistant City Attorney RECOMMENDED FOR APPROVAL: Jo . Reekstin, Executive Director Conununity Development Agency .;.c 0110. CERTIFICA T F LIABILITX .IN~URA - .OW~ THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE PIIODUeER Andreini & Company 300 Esplanade, Suite 100 Oxnard, CA 93030 (805) 981-9585 F: (805) 981-0161 COMPANY A PHILADELPHIA INDEMNITY INS CO "SURED ORANGE COUNTY CONSERVATION CORPS FAX NO. 1(714)-956-1944 700 N. VALLEY STREET, STE. AB ANAHEIM CA 92801 COMPANY B FUND COMPANY C "'$:' . COMPANY D -03 THIS IS TO CERTIFY THAT THE POliCIES OF INSURANCE LISTEO 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 AUL THE TERMS, EXCLUSIONS AND CQNDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POUCY EFFEeYIVE POuey EXPIRAYION UMITS .ATE (MUIDDIVY) DATE (MMJDDIVY) 07/20/03 07/20/04 GENERAl. AGGREGATE PRODUCTs. COMP/OI' AGG PERSONAL' ADV INJURY EACH OCCURRENCE FIRE DAMAGE IAny ,". "'I MED EXP IAny on. pe""") 07/20/03 07/20/04 COMB"ED SINGLE LIMIT $1,000,000 BOD~Y INJURY IP" pe""") FORM BODILY ItWRY IP" ""'~en~ PROPERTY DAMAGE AUTO ONLY. EA ACCIDENT OTHER THAN AUTO ONLY, EACH ACCIDENT AGGREGATE 07/20/03 07/20/04 EACH OCCURRENCE AGGREGATE 06/01/03 EL OISEASE - POLICY L""T El D~EASE . EA EMPLOYEE 07/20/03 07/20/04 DEDUCTIBLE 1,000 COMP DEDUCTIBLE 1,000 COLL CO LTR TYPE OF "BU"NeE POUCY NUMBER A EXCESS UABIJTY UMBRELLA FOAM OTHER THAN UMBRELLA FOAM B WOR"'S eOMPENSAYION AND EMPLOYEnS' UABIUTY PHPK055497 PHPK055497 PHUBO21098 48-012055-03 THE PROPRIETOR! INCL PARTNERSÆXECUTIVE OFFICERS ARE' EXCl OTHER A AUTO PHYSICAL PHPKOS5497 DAMAGE DESCRIPTION OF OPERAYIONBI\.OCAYIONSlYEHICLESlSÆCIAL "",,s RE: GENERAL LIABILITY COVERAGE-THE CERT HOLDER ITS OFFICERS, EMPLOYEES AGENTS AND REPRESENTATIVES ARE NAMED AS ADDITIONAL INSUREDS WITH RESPECT TO THE OPERATIONS OF THE NAMED INSURED. ADDITIONAL INSURED ENDORSEMENT,ATTCHED.*10 DAY NOTICE OF CANCEL FOR NON-PAY SHALL APPLY. CITY OF SANTA ANA ATTN:ESTHER AKHAVAN/PARK PLANNING 888 W. SANTA ANA BLVD., STE 200 SANTA ANA CA 92701 SHOULD ANY OF THE ABOVE DESCRIBED POUCIu BE CANCELW> BEFORE THE EXPIRAYION DATE THEREOF, THE ISSU... COMPANY WILLJœllIIÐI9QIIXJOXMAIL ~ DAYS WRITTEN NOTICE TO THE CER11FICATE HOLDER NAMED TO THE LEFT, ...ãA_::~ø¡¡f: . . A~ùITIONAL IÑSURE'Q_~~M.m:!I FOR COMMERCIAL GENERAL L1AI51UTY POLICY InsuranooCompax¡y Phi1D,q""pl-¡i.. T1;J~"'t'illlI"'9 ~¡,j~ This endOl'Somèlil modifies such ìnS\lJ:ance as i~ afforded by the prov¡~ions of Policy # PIiPIŒ 5$497 relating to th~ following: ¡. The City of Santa An$, 20 Civic Center PJIIla, Sanl.à Ana, California 92701; its OffiOè¡'S. employees, lI¡¡;enl$. volunteers and iepre~e!lt8.ti'llèS are llàmed as additional insureds ("additional insured$") with regard to liability alld defense of suits illising ÎfQm the oper~dons ønd uses peJ:fonned by or on behalf of the named ins\\red. 2. With respect to claims arising out of the Dperations a.nd uses performed by or on benalf oftbe named io'sIJred, such io.s\lranc.e as h afforded by this policy is primary and is not additional to or contt'ibUting with MY oth~ insurance carried by or for the benefit of the additional insureds. Utlless thè c.i, ty ie grossly negligent. 3, This il1slJrance applies sep~rately 10 each InS1Jfed against whom claim is made Of suit iQ brou~ht o)tcepl Wilh x~spec:t to the èoropany's limits of liablUty. The itlt;!lusion of any person or organization as an insured shall not affect any right which such person or orga¡,intion would have as Il Claillllll\t ¡enol so ino1ud~d. 4. With respect 10 the additional ius\.\reds. tbi$ ¡~sw-ance shall not be è~col1ed, or materially reduced i1'J. Covetage 0. limits exc"'pt after thirty (30) days written notice has been given 10 the City of Santa Ana, 20 Civic Center Ploza. 88(11.. Ana, CtLlifomia 92701- (Completion ofÛl; following, including countersignature, is required to rno-ke Ihis endorsement effective.) !;;«ective -.:J./.:J.JJ/JJ.J. ' Irus endorsement fonn as a part of Policy # PHPKO § 51 9 7 1S$\.\edI0~..c eel!;!!!!:} e ~. ~ Jm!'~ I In\'éð. ¡¡¡~~d" CoW'ltersigned by ~~~ Authorized Repr entative GO 'd 'ON X!;J.:J lid Z!: GO 301 EOQG-GO-d3S , . . . . . ¡ POLICY NUMBER:PH~K055497 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED-DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided LInder the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART. SCHEDULE Name of Person or Organization: CITY OF SANTA ANA ATTN: ESTHER AKHAVAN/PARK PLANNING 888 W. SANTA ANA BLVD., STE 200 SANTA ANA, CA 92701 (If no entry appears abQve, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the SchedLile as an Insured but Qnly with respect to liability arising out of yoLir operations or premises owned by or rented to you. CG20261185 Copyright, InsLirance ~ervices Office, Inc.. 1984 ,- "~ ANDREINI &: COMPANY ,",",""" I Ri,k M""geme", I Employ" Be"en" . . ACORD FORM 25-S - CONTINUED... IT IS AGREED THAT ANY INSURANCE MAINTAINED BY THE CITY OF SANTA ANA SHALL APPLY IN EXCESS OF, AND NOT CONTRIBUTE WITH, INSURANCE PROVIDED BY THIS POLICY EXCEPT IN THE CASE OF SOLE NEGLIGENCE OR WILLFUL MISCONDUCT BY THE CITY OF SANTA ANA. 300 E'pbmde. Suit, 100, Oxnmd. CA 93030 Licen" 0208825 805/981-9585 FAX 805/981-0161 CERTHOLOER COpy STATE P.O. BOX 420807, SAN FRANCISCO, CA 94142-0807 COMPENSATION INSURANCE F=UN D CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE, 12-02-2003 GROUP: 000046 POLICY NUMBER: 12055-2003 CERTIFICATE 10: 48 CERTIFICATE EXPIRES: 06-01-2004 06-01-2003/06 -01-2004 "1- ),,003-/&3 ~----._- "",A - ;),,003 - .;253 CITY OF SANTA ~~ ATTN, KIM PF"TFF"~ . \ \ 20 ClVÍë CENTER PLAZA SANTA ANA CA 92701 JOB, ALL OPERATIONS This is to certify that we have issued a valid Worker's Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer. We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policies listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or may pertain, the insurance afforded by the policies described herein is subject to alilhe terms, exclusions, and conditions,of such. pOlicies. ~ ,&~ C. 1)£ AUTHORIZED REPRESENT."VE PRESIDENT EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS, $1,000,000 PER OCCURRENCE. ENDORSEMENT #15B6 - VOLUNTEER COVERED. ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 06-01-2003 IS ATTACHED TO AND FORMS A PART OF THIS POLICY, ?~c>'2 ( ~'iI. % \" ~GC>'>" 0<-,,--<- -\oc- ¡;;;,.- os ToT;; c:. ~ .;= ¿=~ b ~ iL,~ "'" E:....r-- <;':.~....- ~~~~ ~~"""-<;'J ~c~ ,-> EMPLOYER APPROVED AS TO FORM --~ d<7._. Laura Stite ~"cI)' .\ssiswnf City MccraeY ORANGE COUNTY CONSERVATION CORP. CORP.) 7DO N VALLEY ST STE B ANAHEIM CA 92801 (A NON PROFIT SCIF 10262E w,¡,?ii'~'12.02'200' PAGE 1 OF 1 Aooept ""œrufiœ" only """ ~. f"",w.I.~~ thot re"" 'OFFICIAl STATE FUND DOCUMENT'