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HomeMy WebLinkAboutWALNUT STREET S.A., U.S.A., LLC 1ACity of Santa Ana Clerk of the Council AGREEMENT TERMINATION FORM Please complete this form when the attached agreement and all amendments (if any) are no longer in effect. Return form to the Clerk of the Council Office (M-30). The agreement with WW VI COTC Office Use Only LER'� 1 0, a ,,st .2-A. R•S_A ., LL.C. No. was completed on (b ` �, d 1u4" (List all amendments. Use space below if needed.) Departmenf: Phone/Ext.: and final payment has been made. Signature: iCZ rz�� Date: _ ✓r'2�—(� Revised 04-12-10 WORK MAY PROCEED UNTIL INSURANCE EXPIRES N-2003-127-001 6 %`/ le 7 AMENDMENT TO RIGHT OF ENTRY CLERK OF COUNCIL AND LICENSE AGREEMENT DATE: 1,2-H-06 0: COA C2) (VicKi Veidi) ���Q, THIS AMENDMENT, trade and entered into this ' -r ` day of r, 2006, by and between the City of Santa Ana, a charter city and municipal corporation duly organized and existing under the Constitution and laws of the State of California ("City") and WALNUT STREET S.A. U.S A., 71C, a California limited liability company ("Walnut Street"). RECITALS A. The City and Walnut Street entered into that certain Right of Entry and License Agreement dated November 13, 2003, hereinafter referred to as "said Agreement", to allow Walnut Street to enter onto the City -owned properly located on the south side of First Street between Main and Sycamore Streets in the City of Santa Ana, California described as APN No. 398-278-03 ("Property') in order to undertake certain improvements, which if the Property was not purchased by Walnut Street, would belong to the City. B. The Agreement expires on November 13, 2006, therefore the parties hereto now desire to amend the term and expiration wording found in Section 1 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 following wording in section 1, `"I7t1s Agreement shall automatically terminate and expire one hundred twenty (120) days after written notice of expiration is provided by the City, or in three (3) years from the date of this Agreement, whichever occurs first", shall be replaced with the following wording:: "Ilus Agreement shall be extended as a mouth -to -month occupancy, subject to termination with thirty (30) days written notice by either party." 2. 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: PATRICIA F. HF.ALY Clerk of the Coc*:cil APPROVED AS TO FORM: JOSE,�,PHW. FLEE�TgCCHHER,��City Attorney By:. //F. Lisa Storek, Assistant City Attorney �RyECOMMENDED FOR APPROVAL: t l a tk 6tSTEPHFN G. HARDING Deputy City Manager for Development Services CITY OF SANTA ANA DAVID N. REA19f` City Manager WALNUT STREET SANTA ANA USA Tax ID# 45-D5o9400 MAYOR Miguel A- Pulido MAYOR PRO 1 EM Lisa Bist COUNCIL MEMBERS Claudia C. Alvarez Carlos Buslamame Alberta D. Christy Mike Garcia lose Solorio October 26, 2006 CITY OF SANTA ANA 20 CIVIC CENTER PLAZA • P.O. BOX 1988 SANTA ANA, CALIFORNIA 92702 Mr. Michael Harrah Caribou Industries NOV 1 0 2006 t 1200 N. Main Street, Suite 900 Santa Ana, CA 92701 SIJBJFCT: RIGHT OF ENTRY AND LICENSE AGREEMENT Dear Mike: CITY MANAGER David N. Ream CITY ATTORNEY Joseph W. Fletcher CLERK OF THE COUNCIL Patricia E. Healy As you will recall you entered into a Right of Entry and License Agreement between the City of Santa Ana and Walnut Street S.A. U.S.A., LLC for APN 398-278-03 located within your Original Mike's project. The term of that agreement is due to expire on November 13, 2006. Attached is an Amendment to Right of Entry and License Agreement providing a month -to -month occupancy. The monthly fee remains the same at $600. Your insurance requirement is satisfactory through May 2007. Please sign all three (3) amendments and return to me for further processing. A fully executed copy will be returned for your files. If you have any questions, please call me at 714/ 647-5390. Sincerely, Vicki Uehli Project Manager attachments COCIOlete Insurance 8/30/2006 3:00 PAGE 002/009 Fax Serve? 9.QBD CERTIFICATE OF LIABILITY INSURANCE PnO'AcER (949)263-0606 FAX (949)263-0906 THIS CERTIFICATE IS ISSUED AS, Complete Insurance, Inc. ONLY AND CONFERS NO RIGHTS California DOI *0437762 HOLDER. THIS CERTIFICATE DOE 19000 MacArthur Blvd., PH Flr ALTER THE COVERAGE AFFORDE Irvine', CA 92612-1447 INSURERS AFFORDING COVERAGE "ILAED N-2003-IZI-001 Rw -- Fir n's Fund Insur INS R ER a Caribou Industries NSLWEIi C, 1200 North Main Street, Suite 900 IMTLnERa Santa Ana, CA 92701 INURIOR E: ante LLwDPYTYT) NAIL 8 THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE NSUREDPNA*O ABOVE FORTHEPOLICYpERIODI ;&T� ED.Ix1TN'I)2.DG0, ING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENTWITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSMAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREN IB SUBJECT TO ALL THE TERNS, EXCU.USIONS AND I:ONOInONCHPOLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAIDCWM& FOLLY EFECTWE TYPEOFIHL41m11NCE POLLLY MRiBtGEIFAk UAREITY MZX808S9747 D6/14/2006 06/14/2007 EACH DGCURBENOE 6 ,0DAI100 uANEwDE//pv,-n�GccuR Leo E�w pe„r e,. F.•...,� ...A X $ZS,DBB 6I/PD Bed PI'ASONAL 6 API INJURY ,GEHEPAL AGGREGATE ,_�GEPRODOCTS-COMFHDPAGG ,EoucY JOLTX LOL..__ COMBINED $INGI F I IrAO ANY AUTO IteR 1YA1 KLOWNEUAUl09 ME _KDULEDA�OS DLY W ODDLY Ip. RV HREDN1165 d.IdIV INJURY ILY40WNEU All1O5 (Ptt acgOlnl] flIOPERtt DAMAf.E IPW FznKi'.1) GWGE YAnlf1Y AUTO ONLY- Fq ACCIGEN OME GA I ONLY GG EXCEY.4UINEWLN9UIY XA000069730657 06/14/2006 06/I4/2BB7 HOCCURRENCE I. so, DBB,D X CCCUR O CWNSANUE AGGREGATE _ _ 1.— SO,DDD.O EWP® uAmUn TIDNYID EMFL01•E16 MA�1TY WGSPATLL OT,4 AHI FROFRETCRT'RRTMEREAECVINE ....�'•" .. EL EK'M AfI.IOFN, L CfiCER11lAIEER fMYLREGi _ _ I. E.L gSEASEFA HIPIDY" . S yy�M,, 101Y NN[w El. DISEI•SE-POLICYLANT OVER Oneft REGCRPTION OEDPEwLTwalLxwTLGHsrvNPCLESIEuulelpe ADODLn EroGBEEEExrLSEEGPL PRpYLspg -- e: Walnut 0 Sycamore, Santa Ana, CA. The City of Santa Ana, its officers, employees, agents, lunteers and representatives are named as additional insured as respects to the general iability coverage per form OG7193 1203, but only if required by written contract with the awed insured prior to anocCurrence. Subject to all polity term and conditions. Except 10 day notice of cancellation for non-payment of premium. City of Santa Ana 20 Civic Center Plaza (M-25) Santa Ana, CA 92701 sxaxD ANY or TLEAROVE DEscwarD POLICIES SE CANCEL LED BEFORE THE E%PSLATKW DATE THEREOF, THE 1WKJMG INSLBER WS.L rNDEAYOR TOL *30 DAYS wNTT HOTLCE TO THE CEWWICATE HOLDER WIN EDTO THE LEF` INK FAEURE TO MY RICH NOTICE SHALL RHPOSE NO OBLIGATIOH OR LNNLDY OF ANY XOU THE HORLEA TIS MEWS OR REPAESENTATNES ILIOR@DPlPESmITATNB �.Ld -- dd Holliday/PEC A,..a U.TLLMH ©'CORD CORPORATION 798E Cohlplete Insurance 8/30/2006 3:00 PAGE 003/009 Fax Serv;r a MultiCovel® - CG 71 58 10 01 Policy Amendrneot(s) Commercial General Liability Coverage Form Your Commercial General Liability Coverage Form is revised as follows: 1. Broadened Named Insured A- SECTION B - WHO IS AN INSURED, item 4., is replaced by the following; 4. Any organization you own at the incep- tion of this policy, or newly acquire or form during the policy period, and over which you maintain during the policy period majority ownership or majority interest, will qualify as a Named Insured if. a There is no other similar insurance available to that organization; and b. The first Named Insured shown in the Declarations has the responsi- bility of placing insurnsuce on that organization; and c. That organization is incorporated or organized under the laws of the United States of America. However. (1) Coverage under this provision 4 is afforded only until the next occur. ring 12 month anniversary of the begiming of the policy period shown in the Declarations, or the end of the policy period, whichever is carlict:and (2) Coverage A does not apply to bodily injary or property damage that occurred before y-s-u required or formed the organization and (3) Coverage B does not apply to Personal and advertising injury ans. ing our of an offense committed be- fore you acquired or `ornted the organization. B. SECTION 11 - WHO IS AN INSURLo. the last paragraph, is replaced by the Iollowing No person or organization is an iusui ed with respect to the conduct of any concur or past Partnership, joint venture, or limited liability company, that is not shown w o Named In- sured in the Declarations. However, this does not apply to a limited liability company, that meets all of the conditions in Section Il - Who is An Insured, item 4_, abovr_ 2. Additional Insured - Blanket SECTION 11 - WHO IS AN INSURBI,, item 2s is added as follows: e. Any person or organization that you and smch Person or organization have agreed in writing in an insured contract that such person or or- ganization be added as an insured under this policy. With respect to the insurance afforded to such insured, all of the followini, additional provisions apply: (I) Such person or organization is an insured but only with respect to their liability arising out of. (a) Their ownership, marntrnaice, a use of that pat of the premises, or Ind owned by, rented to, or leased to you; and This F" must to atuchd io Change Esdpsasneot wb a laud B. the policy is wines Ore of eLe F4essn's}YW base a absapaves ae tinned is the poky Praidmt —.__— Miss 1"15 Pagc I of 6 complete insurance 8/30/2006 3:00 PAGE 004/009 Fax Serv.;r (b) Your ongoing operations performed for that insured; and (c) Their financial control of you; and (d) The maintenance, operation or use by you of equipment leased to you by such person or organization, and provided such liability does not arise out of the sole negligence of such person or organization; and (e) Operations performed by you or on Your behalf and for which such state or political subdivision has issued a permit, provided such operations are not performed for such state or pol- ideal subdivision. (2) This insurance does not apply to any bodily Injury; Property damage, personal and advertising injury, occurrence, or of- fense: (a) Which took place before the exe- cution of, or subsequent to the completion or expiration of, the written Insured contract; (b) Which takes place after you cease to be a rendm in that premises; (c) Which takes place after all work in- cluding materiels, parts or equip- ment famished in connection with such work to be performed by or an behalf of the additional insured at the site of the covered operations has been completed; or (d) Which takes place after that portion of your work out of which the injury or damage arises has been put to its intended use by any person or or- ganization other than another con- tractor or subcontractor engaged in performing operations for a princi- pal as part of the same project. (3) With respect to architects, engineers, or surveyors, coverage does not apply to bodily Injury, property damage, or personal and advertising Injury arising out of the rending of or the failure to render any professional services by or for you including: M711$ IaO15 (a) The preparing, approvin„ or lhrlmg to prepare or approve, naps, shop drawings, opinions_ reports, surveys, field orders, change orders, or drawings and specifications; and (b) Supervisory, inspection. architec- tural, or engineering actr itics. However, if an Additional Insured endorse- ment is attached to this policy that specifically names a person or organization as an insured, then this subsection 2.e. does not apply to that person or organization, 3. Additional Insured - Venders - Blanket Unless the products -completed operanon, hazard is excluded from this policy, SECTION 11 Wit() IS AN INSURED, item 21. is added V follows. Any vendor of yours but only with respect to bodily injury car property damage arising out of your products which are manufactured m whole or in part in the United States (includ- ing its territories and possessions), Puerto Rico and Canada, and which are distributed or sold in the regular course of the vendor's business, subject to the following additional excltrsions: (1) The insurance afforded the vandur does not apply to: (a) Bodily Injury Or property damage for which the vendor is obligates to pay damages by reason of the assump- tion of liability in a contact or agreement. This exclusion does not apply to liability for damages that the vendor would have in the ab- sence of the contract or a g-cement. (b) Any express warranty unauthorized by you; (c) Any physical or chemical change in the product made intentionally by the vendor; (d) Repuckaging, unless unpacked solely for the purpose of inspection, dem- onstration, testing, or the subsn- tution of parts under instructions from the manufacturer, and then no - packaged in the original amtainrr, Page 2 of 6 Complete Insurance 8/30/2006 3:00 PAGE 005/009 Fax Server (a) Any failure to make such in- speetions, adjustments, tests or ser- vicing as the vendor has agreed to make or normally undertakes to make in the usual course of bmi- ness, in connection with the distrib- ution or sale of the products; (f) Demonstration, installation, servic- ing or repair operations, except such operations performed at the vendor's premises in connection with the sale of the product; or (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. (2) 'this insurance does not apply to any in- sured person or organiution from whom you have acquired such products or any ingredient, part or conainer, entering into, accompanying or containing such products. However, if an Additional Insured - Vendors endorsernenl is attached to this policy that specifically names a person or organ -nation as an insured, then this subsection f. does not apply to that person or organization. 4. Waiver of Subrogation - Blanket SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, item 8., is replaced by the following: 8. Transfer of Rights of Recovery Against Oth- ers to Us and Blanket Waiver of Subrogation a. If the insured has rights to recover all or part of any payment we have made under this Coverage Part, those rights arc transferred to as. The insured must do nothing after the loss to impair those rights. At our request, the insured will bring nit or transfer those rights to as and help us enforce them. b. If required by a written insured contract executed prior to the uccturn mce or of- fense, we waive any right of recovery we may have against any person or organization named in such insured contract, because of paymen s we make for injury or damage arising rat of your operations or your work for hat person or organization. 5. Cancellation - 120 Dap Common Policy Conditions endorsement Il.W 17, A. Cancellation, item 2.b. is replaced by the fol- lowing: b. 120 days before the effective date of can- cellation if we cancel for :rob otacr rea- son. 6. Liberalization SECTION IV - COMMERCIAL GENERAI LIABILITY CONDITIONS, the tnticwirg is ad- ded: Liberalization If we adopt a change in our forms or vies which would broaden the coverageprovided by aay form that is a part of this policy without ar. extra pre- mium charge, the broader coverage will apply to this policy. This extension is effective upon the approval of such broader coverage in your state. 7. Flre, Explosion and Sprinkler Leakage Legal Li - slimily Coverage A. SECTION I - COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, 2 Exclusions, the last paragraph, is replaced by the fallowing. Exclusions a through n. do not apply to damage by fire, explosion, sprinkler leakage. or lightning to premises while 1. Rented to you; 2. Temporarily occupied by yot, with the permission of the owner; or 3. Managed by you trader a written agree- ment with the owner. A separate limit of insurance apples to this coverage as described in Section III - LIMITS OF INSURANCE. B. SECTION III - LIMITS OF INSURANCE. item 6., is replaced by the followmi- Crass tams Page 3 of 6 Comlrlete Insurance 8/30/2006 3:00 PAGE 006/009 Fax Server 6. Subject to 5, above, the most we will pay under Coverage A for all damages be- cause of property damage to any one premises, while rented to you, or in the case of damage by fire, explosion, sprig kler leakage or lightning while rented to you, temporarily occupied by you with the permission of the owner, or managed by you tinder a written agreement with the owner, is the greater of. L $1,000,0oD Any One Premises; or 2. The Damage To Premises Rented to You Limit shown in the Decla- rations. C. SECTION IV - COMMERCIAL GEN- ERAL LIABILITY CONDITIONS, 4. Other Insurance, b. Excess Insurance, (I), items (b) and (c), are replaced by the follow- ing: (b) That is Fire, Explosion, Sprinkler Lrak- age or Lightning insurance for promises while rented to you, temporarily ocar- pied by you with permission of the owner, or managed by you under a writ- ten agreement with the owner; (c) That is insurance purchased by you to cover your liability as a tenant for property damage to premises rented to you, temporarily occupied by you with the permission of the owner, or managed by you under a written agreement with the owner; or D. SECTION V - DEFINITIONS, 9. insured Contract, item a„ is replaced by the following: a. A contract for a lease of premises. However, flat portion of the contract for a lase of premises that indemnifies any person or organization for damage by fire, explosion, sprinkler leakage, or lightning to premises while rented to you, temporarily occupied by you with per- mission of the owner, or managed by you under a written agreement with the owner, isnot an insuredwertract; 8. Non-Oxmed or Chartered Watercraft SECTION I - COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, 2. Exclusions, item g. Aircraft, Auto Or Watercraft, item t2) is replaced by the following: (2) A watercraft you do not own that is. (a) Less than 51 feet long; and (b) Not being used for public tra isportahon or as a common carrier; 9. Chartered Aircraft SECTION I - COVERAGES, COVFRAGF. A BODILY INJURY AND PROPERTY DAM- AGE LIABILITY, 2. Exclusionis, g. .4ircnift Auto Or Watercraft, item (6), is added as milowi: (6) An aircraft in which you have no ownership interest and that you have chartered with crew. 10. Coverage Territory - Broadened SECTION V - DEFINITIONS, item 4_a., is re placed by the following: a. The United States of America (including its territories and possessions), Puerto Rico, Ca- nada, Bermuda, the Bahamas, The Cayman Islands and the British Virgin Islands, 11. Personal and Advertising Injury - Contractual Unless personal and advertising injury s deluded from this policy the following applies: SECTION 1 - COVERAGES, COVERAGE B. 2. Exclusions, item e., is deleted. 12. Fellow Employee Coverage SECTION II - WHO 1S AN INSURED, 2 a. item (1) is replaced by the following (1) Personal and advertising imen• However, subparts (a), (b), (c) and (d) )f item (I1 remain unchanged. 13. Bottily Injury Definition - Broadened SECTION V - DEFINITIONS, 3. Bodily Injury is replaced by the following: 3. Bodily injury means bodily injury, ,ickness or disease sustained by a person including death or mental anguish resulting from any of these Cetus tools Page 4 of 6 Complete Insurance 8/30/2006 3:00 PAGE 007/009 Fax Serv?r at any time, Mental anguish means any type of mental or emotional illness or disease. 14. Unintentional Failure to Disclose Hazards SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, item 6. Representa- tions, the following is added: d. If you unintentionally fail to disclose any he- zards existing at the inception date of this policy, we will not deny coverage under this Coverage Part because of such faiturl How- ever, this provision does not affect our right to collect additional premium or exercise our right of cancellation or non -renewal. I5. Supplementary Payments - Increased Limhs SECTION I - COVERAGES, SUPPLEMEN- TARY PAYMENTS -COVERAGES A AND B, items Lb. and I.d., are replaced by the follow. ing: b. The cost of bail bonds requited because of accidents or traffic law violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverage applies. We do not have to furnish these bonds. d All reasonable expenses inctured by the in- sured at our request to assist us in the inves- tigation or defense of the claim or suit, including substantiated loss of earnings up to $500 a day because of time off from work. 16. Per Location General Aggregate (Other Than Personal and Advertising Injury) A. SECTION BI- LIMITS OF INSURANCE, item 2., is amended to include the following as the last paragraph. However, the General Aggregate Limit ap- plies separately to each location owned by you, rented to you, or occupied by you with the permission of the owner, with respect to: a. Medical expenses under Coverage C; and b. Damages tinder Coverage A except dam- ages because of bodily injury or property damage included in the products -com- pleted operations bused. B. SECTION V - DEFINITIONS, item 23. is added as follows: 23. Location means premises ml the same or connecting lots, e r premises whose connection is interrupted only by a street, roadway, waterway x ightsf way of a railroad. 17. Duties in the Event of an Occurrence, Offense, Claim or Suit - Amended SECTION IV - COMMERCIAL fIFNFRAI LIABILITY CONDITIONS, items 2, 1. and 2.b., are replaced by the following; a. You must see to it that we or aly licensed agent of ours are notified of a General. Liabil- ity occurrence or offense which may result in a claim, as soon as practicable after it be- comes known to: (1) You, if you are an individual; (2) Your partner or member, if you arc a partnership orjoint ventum (3) Yom member, if you me a hnutcd hahil- ity company; (4) Your executive officer it you arc an or- ganization other than a partnership, joint venture or limited liability company; or (5) Your authorized representativz o- insur- ance managers. Knowledge of an occurrence or offense by persons other than those listed anove, does not imply that those listed above also have such knowledge. b. To the extent possible, notice should include: (1) How, when and where the oceurrene or offense took place; and (2) The names and addresses of any injured persons and witnesses; and (3) The nMt¢e and location of atrr injury or damage arising out of the oreurn:nce or offense. 18. Non Employment Disarlminatlon Liabiiry Unless personal and advertising Injuryis er;ciuded from this policy the following applies C07158 roots Page 5 of 6 Complete Insurance 8/30/2006 3:00 PAGE 0081009 Fax Serv,;r F A. SECTION V -DEFINITIONS, W. Personal and Advertising Igjory, item At. is added as follows: h. Discrimination. B. SECTION V - DEFINITIONS, item 23. is added u follows: 23, Discrimination means the unlawful treat- ment of individuals based on race, color, religion, gender, age, or national origin. C. SECTION I - COVERAGES, COVERAGE B PERSONAL AND ADVERTISING IN- JURY LIABILITY, 2. Exclusions, the fol- lowing we added: o. Discrimination directly or indirectly re- hired to the pest employment, employ- ment or prospective employment of any person or class of persona by coy insured; p. Discrimination directly or indirectly re- lated to the sale, rental, lease or sublease or prospective sale, rental, lease or sub- lease of any dwelling, pens ment lodging, or premises by or at the direction of any insured; Al. Diurlm[naflon, if insurance thereof is prohibited by law; or r. Fines, penalties, specific performance, or injunctions levied or unposed by a gov- ernmental entity, governmental code, law, or statute, because of dlserimiudon. 19. Medical Payments Unless COVERAGE C MEDICAL PAY- MENTS, or the products -completed operations hazard hest been excluded from this po icy thr fol- lowing applies: A. SECTION I - COVERAGES, COVERAGE C MEDICAL PAYMENTS, 2. Exclusions, item f, is replaced by the following: f. Prodorls-Completed Opemdons Hard Included within the produds-completed operations hazard. However, this exclu- sion does not apply to expen,es lot den- tal services. B- SECTION I -COVERAGES, CC iVIRAGL C MEDICAL PAYMENTS, is ;:mended to include item 3. as follows: 3- Limit of Insurance The Medical Expense Limit of insurancr shall he Abe Beater of: a. $10,000Any One Person or b- The amount shown in the Declara- tions. COVERAGE C MEDICAL PAY- MENTS insurance is priman and does not contribute with any other insurance, even if that other insurance is ;mmary also. CGMS hole Page 6 of 6 Complete Insurance 8/30/2006 3:00 PAGE 009/000 Fax Server FROM FAX NO. :714-647-6549 'rll p MOM a�.�_ t Y1C_1 aP6V, YVta�a - * a 1, iv.. atJ. ' [ 1 VI %"9• 02 2000 10: 12RI -,. Insurance Coamaty National Surety Corporation a reman a un ampany This endotsemert modifies such insuranco as is afforded by the provisions of Policy # HZX80859747 ---�_ relating to the Mlowutg: offi 1. The City of Sawa Ana, 20 Civic Center p� Seata+� California 92701; its employees, agents, volumeena aM repreaeuhtivea are caned as additional insureds ("additional mstreeds with regard to liability ark defense of suits arising from the operation and es performed by or on behalf of the named imaned, 2. bdtalf of the r> Witht t to claims +na g out oftbe operations and "sea Performed by or on ute such ina tIlm as 4aMrded bythis policy is primary and is nc4 additional to or contributing with my other instnance carried by or for the additionaliubeac6t of the sureda suit is b3. t Ibis insurance appliae separately to each i"mred against whom claim is made or gh cept with respect to the emnpany's limits of liability. The inclusion of any Peron or organization as an insured shall not affect any right which such Person or organization would have as a claimant if not so includod. 4. With respect to the additional lustuads, this instnance shalt not be cancelled or materially reduced is coverage or limits except after thirty (30) days written notice has been given to the City of Santa Ana, 20 Civic Centarplan, Santa Ana, California 92701. effec&e.) (Completion of the follosviug including countetsignatme is required to make this endorsement Effective August 2 2006 tbisendp Policy ll MZX80859747 - rsement form as a W of lssucdto Caribou Industries Named insured to Mitre -Ramirez, Norma From: Mitre -Ramirez, Norma Sent: Thursday, November 30, 2006 10:37 AM To: Kaufman, Benjamin Subject: N-2003-127 and Amend N-2003-127-001 Hello Ben -Just confirming that the list amendment to Walnut Street S.A. U.S.A., LLC agreement has insurance coverage through the insured name, Caribou Industries. Thank you, Norma CA N 1 CHECKLIST FOR PROCESSING AGREEMENTS AND AMENDMENTS TO: CLERK OF THE COUNCIL OFFICE FROM: DEPT.: ex> I STOP: M-� CONTACT PERSON: t i��11 Cam{ EXT.: 5-4qO THE FOLLOWING ITEMS SHOULD BE PROVIDED IN REQUESTING PROCESSING OF AGREEMENTS FOR THE CITY: AGREEMENT NUMMBER-(tf amendment): A / N i)")1'1P.i'llirh"i- —f.) UGeVLSL AMENDMENT NUMBER (if applicable): ❑ 1ST ❑ 2ND ❑ 3aD12 COUNCIL APPROVAL DATE: AMOUNT: ❑ O,V,,,,EIIR $10,000 ❑ UNDER $10,000 U NAME OF CONSULTANT: l nyt S>fr4 f' --A. At-S-A. LLC, TERM OF AGREEMENT: EFFECTIVE DATE: it-15-Q(e TERMINATION 4 INSURANCE REQUIRED: ❑ NO J� hGTIV ❑ YES If yes, ❑ ATTACHED ❑ IN PROGRESS ❑ AUTO ❑ CGL (Commercial General Liability) ❑ PROFESSIONAL LIABILITY ❑ WORKERS COMPENSATION (INS. APPROVAL REQUIRED BY CAD PRIOR TO SUBMITTING TO COTC) SIGNATURES REQUIRED: ❑ VENDOR ❑ AGENCY (UNDER $10,000) ❑ CITY ATTORNEY /9- OTHER CMO, GOTG COMMENTS: FOR CLERK OFFICE USE ONLY: ❑ PROCESS DO NOT PROCESS ❑ MISSING SIGNATURES NEEDS COUNCIL APPROVAL g OTHER L ADDITIONAL REMARKS: /� ?6 -0'/ / tui/. &W&A202M -&i ,- 1940m!3ode