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Home My WebLink AboutORANGE COUNTY CONSERVATION CORPS 3B -2003 ::\SURIINCE ON f"_E '. Dim MAY PROCEED LNflL INSURANCE EX~IR~ 1-;{¿)-OLf "bI'~K DI' COUNCIL DATE: 9-15-D3 THIS AMENDMENT, made and entered into this 21st day of July, 2003, by and between the Orange County t. C/M Conservation Corps ("Contractor") and the City of Santa Ana, a charter city and municipal corporation duly (L .HQ"!/I'I) organized and existing under the Constitution and laws of the State of California ("City"). FM . . A-2003-155 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 in- schoo\. B. The parties hereto now desire to amend the "City's Obligations" amount found in Section 2 and the "Time Period of Agreement" term found in 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 ~77, ,7/i 4O." 2. The "Time Period of Agreement" section of said Agreement will be amended to read: "".shall have been performed by September '10,7001." 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. CITY °?:J:1i3 12<- David N. Ream, City Manager APPROVED AS TO FORM: Orange County Conservation Corps. ~~ Executive Director ~~(~ By: Lisa E. Storck Assistant City Attorney RECOMMENDED FOR APPROVAL: OF LIABILITY INSUR E DATE ,"'1>0 YV) /' .CQR;;)N CERTIFICA PRODUC" Andreini « Company 300 Esplanade, Suite 100 Oxnard, CA 93030 (805)981-9585 F:(805)981-0161 I 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 POUCIES BELOW. COMPANIES AFFORDING COVERAGE INSURED COMPANY A PHILADELPHIA INDEMNITY INS CO COMPANY B FUND ORANGE COUNTY CONSERVATION CORPS FAX NO. 1(714)-956-1944 700 N. VALLEY STREET, STE. AB ANAHEIM CA 92801 COMPANY C .J""":!" -",. ...'>.,. . COMPANY . o' . 'ì <J. ,,"'1 D . ~;m:f¡: '":"' ': ~,"""_T- -u¿:-:---- §¡m§ßì~~ÎÌi)M¡Œ¡¡¡1iH*iIHìltîf¡¡tjŒî!iIlWtM~W\\[t:t;J¡m%\\!¡Mttm¡¡¡@m¡¡;¡¡W¡¡¡¡¡¡¡mH¡¡¡ii1¡¡¡¥jjWHÆMM¡¡¡¡%j¡¡¡ii1g¡¡;¡Mlf@l1l1%tnjH¡¡;f1H¡HH}i1~¡¡¡H; THIS IS TO CERTIFY THAT THE POUCIES OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE PDUCY PERIOD INDICATED. NOTWITHSTANDING ANY REOUIREMENT. 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 POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCUUSIONS AND CONDITIONS OF SUCH POUCIES- UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CD Lm TYPE OP INSURANCE EXC"S UABILITY UMBRELLA FORM OTHER THAN Uto1!IRELLA FORM B WORkEIIS CO""'SA11ON AHD EMPLOYEI1S' UABIUTY A THE PROPAIET,,", PARTNERSÆXECUTIVE OFFICERS ARE' OTHOR A AUTO PHYSICAL DAMAGE POUtY NUMB" POUtY EFfECTIVE POUtY EXPIRA11ON DATE (IIMIDDIYV) DATE (MM/DDIYV) UlllTS PHPKO55497 07/20/03 07/20/04 GENERAL AOOREOATE PRODUCTS. CaMP^'" AGG PERSONAL . ADY INJURY EACH OCCURRENCE FIRE OAMAGE (An, one ~e) MED EX? (Any one """,,) 07/20/03 07/20/04 COMBINED SINGLE LIMIT S1,ooo,ooo BODILY IN..,RY (Po< ",""') FORM BODILY INJJRY Po< ecc'denQ PHPKO55497 PROPERTY DAMAGE AUTO ONLY. EA ACCIDENT OTHER THAN AUTO ONLY, EACH ACCIOENT AGGR£GATE EACH OCCURRENCE AGGR£OATE PHUB021098 07/20/03 07/20/04 46-012055-03 06/01/03 06/01/04 INCL EXCl El 01SEAS.E - POLICY LIMIT El DISEAS.E - EA EMPLOYEE PHPKO55497 07/20/03 07/20/04 DEDUCTIBLE DEDUCTIBLE 1,000 COMP 1,000 COLL DESCRIPTION OF OPERA11ONS/LOCA11ONSIVEHICLES/SPECIAL ITEMS 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. þgðiî!1¡;:Atßj!ìþ~p§ì!1¡¡@¡¡¡¡¡W;¡mm¡¡¡¡@;m::¡¡:¡¡@m¡¡¡¡¡¡¡¡¡mmn¡¡nmm::¡¡¡¡¡¡M1ç§t!(*!!Q!'I¡¡¡¡tim¡¡mnm¡¡¡nmm¡¡iW¡gmW¡¡¡¡m¡mM@Mltdm;¡¡ti,¡¡¡ SHOULD ANY OF THE ABOVE DESCRIBED POUtIU BE CANCELLED BEFORE THE CITY OF SANTA ANA ATTN:ESTHER AKHAVAN/PARK PLANNING 888 W. SANTA ANA BLVD., STE 200 SANTA ANA CA 92701 AUTHOR ..!!An¡:¡¡¡ti~ijji@ ,~ . . A)D~TIONAL INSURE';U~¡¡2~MEm FO~ COMMERCIAL GENERAL I.lAEslLITY POLICY Insurartcc Company ":hI 1 ,,1\.., p\'I " T'!~"~iå¡:¡'... c~~ This endOl'$cmcnl modifies such ìnsural\ce as Is afforded by the pro\>Í¡¡ions of Þolicy # p¡'¡J?Ke5S4~7 re1atîngtothefbltowing: 1. The Ci~yofSantllAna, 20 Civic Center Plaza, SantA Ana, California 92701; ils officers, employees, a¡¡;ent$, volunteers and tepresentath/ès are nåmed as additional insured~ ("additional insurecJ.&") wi1h regard to liability and defense of suits arising from 1I1e operr.tions and Uses perfonned by or on behalf of the named ins\1r~. 2. With respect to claims arising out of the operations and useS performed by Or on behalf of 111e named insured, suth ins\lrance as Is afforded by ~his polio y is priInlltY and Is not additional to or contribUting with any other insurance c&!'ried by or for the benefit of the additionalinsureds. Unless thè cJ,ty is c;¡rossly Mql19'ent. 3, This insurance applies sep~rately to each. insuced againSt whom clain1 is made Or suit ì~ brought except wì.h respect 10 the company's limits of lìab!l\ty. The inclusion of any þerson or organization as an insured shall not affect any right which such person or orga.nizaúon would have as a. clalma¡\t Ihot 50 inclUded. 4. With respect to the £ldditional insureds. Ibis inst.\fa11ce shall not be cancelled, Dr materially reduced in c(¡verage Or limits except after thil-ty (30) days written notic<: has been given to the City of Santa Ana, 20 Civic Center Plaza, Ssnta Ana, C!llìfornia 92701. (Completion Clfme follbwing, including eountc¡;3ignattJre, is ¡;equired to moke ,m3 endb¡;Sement effective.) \;;ffective -.:!./.:;;J-!4+ , this endorsement form 85 a part of Folicy# PHPKO!i§197 lssuedlo~~~c e"l:Irt~J e ~. -~~~-:J ,j1'l']'~~ t~iå1'fišûW'd" COWltersigned by ~~ IÞtl Authodzed Repr en~a~ GO 'd 'ON XI;J:I ¡'¡d G! :GO 301 £OOG-GO-d3S . . POLICY NUMBER:PHPK055497 COMMERCIAL GENERAL LIABILITY 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 Person Dr 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 above. 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 Schedule as an Insured but only with respect to liability arising out of your operations or premises owned by or rented to you. CG 20 2611 85 Copyright, Insurance ~ervices Office. Inc.. 1984 . . . ¡~ ANDREINI &: COMPANY In,oun" I Ri,k Monog,m,", I Employ" B,ndi" . 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 Espbnod,. Sui" 100, Oxnard. CA 93030 License 0208825 805/981-9585 FAX B05/9SI-O161 CERTHOLOER COpy STATE P.O. BOX 420807. SAN FRANCISCO. CA94142-0807 COMPENSATION INSURANCE FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 12-D2-2003 GROUP: 000046 POLICY NUMBER: 12055-2003 CERTIFICATE 10: 48 CERTIFICATE EXPIRES: 06-01-2004 06 -01-2003/06-01-2004 ~------~.- CITY OF SANTA ANA '\ ATTN: KIM PFF.r""F," ' 20 cntrc CENTER PLAZA SANTA ANA CA 92701 ,1- :2.003-/ (P3 .'A - ð-DO3 - .;253 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 Ihe 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 sobjeclto all the terms, exclusions, and cond~ions,of such policies. ~ ,&~ C. ~ AUTHOR"ED REPRESENT A T1VE PRES'DENT EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS. $1, OOD, 000 PER OCCURRENCE. ENDORSEMENT #1586 - VOLUNTEER COVERED. ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 06-01-2003 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. ¿"~D'2 ( +="-i:r.. <1;- \" ~GC>""- 0<...-<--<-- -<.... ¡;;,..--. S ToT ¡z- C. ~ .¡::: L..C:o- b ~ "'" E:"""'" \::.,~ ç ':.':"0.- - c.. ~ ~" ~.;.,.."....,<--<.., ~,~ IS EMPLOYER APPROVED AS TO FORM .~~1_.-- Laura Sli,' ~"cI/ '\S$iswot City AtlcrncY ORANGE COUNTY CONSERVATION CORP. CORP.) 7DO N VALLEY ST STE B ANAHEIM CA 92801 (A NON PROFIT SCIF 10262E 1"'R,\?!if/',"'02-'OO3 PAGE 1 OF1 Aoœp11hi. """œ.. ndy '",""" 0 ""'Iwo""",~ thol""", "OFFICIAl STATE FUND DOCUMENT"