HomeMy WebLinkAboutTELFORDS 1E - 2007iNSURawcF r~Dr ftEQI„~eo a-2oo7-l07
W6!?K PgAY PROCEED
CLEftK OF COUNCIL
DATE: 5-(O -p ~
~ ~a-~ FIFTH AMENDMENT TO AGREEMENT
L~. KQ,Q,Q(~.~ THIS FIFTH AMENDMENT TO AGREEMENT is entered into on April 16,
00 2007, by and between Telfords ("Vendor") and the City of Santa Ana, a charter city and
municipal corporation of the State of California ("City").
RECITALS:
A. The parties entered into Agreement #A-2001-257, dated December 18, 2001,
(hereinafter "said Agreement") by which Vendor has provided information
technology services as needed by the City.
B. In accordance with the terms and conditions of said Agreement, the parties wish to
increase compensation to pay for services for an additional period of time.
WHEREFORE, in consideration of the covenants contained in said Agreement, and
subject to all the terms and conditions of said Agreement, except those amended in this
Fifth Amendment to Agreement, the parties agree as follows:
l . Section 3, COMPENSATION, shall be amended to increase total compensation
available to all Vendors supplying information technology temporary personnel and
consulting services, by $425,000.00. Said total shall be divided among all such service
providers at the City's sole discretion.
2. Except as herein amended, all terms and conditions of said Agreement shall
remain in full force and effect.
IN WITNESS WHEREOF, the parties hereto have executed this Fifth Amendment to
Consultant Agreement on the date and year first written above.
CITY OF SANTA ANA
AT
PATRICIA E. HEAL . ~ DAVID N. REA
Clerk of the Council City Manager
APPROVED AS TO FORM:
,.. /
` r'"ct~ta'~ ~~P.ro~1
JOSEPH W.FLETCHER
City Attorney
TELFORDS
LINDA CARSON
Owner
WORKERS' OMPENSATION DECLARATION
I ~t,-,r ~~~_ hereby affirm under penalty ofperjury, the
(Namo/X'itle)
following declaration
I certify on behalf of ~ ~S that during the term of m3'
o~aa~tion xmne)
contract with the I n~-,~,~x~i u~ t ~fe~-v~ rot ~ Gity of Santa Ana, I will not
employ any person in any irianner so as to become subject to the workers' compensation
laws of California, and agree that if I should become subject to the workers'
compensation provisions of Section 3700 of the Labor Code, I Shall forthwith comply
with those provisions.
DATE: ~/3~d 6
Name: L,.r~G., ¢' L..en.c~
Title: ,~-~~- _
v
Telephone: `~/d ~Id~`%a~~/
WARNING: FAILURE'I'O SECURE WORKERS' COMPENSATION COVERAGE IS
UNLAWFUL, ANA SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($1'00,000). IN
ADDITION TO TIIE COST OF' COMPENSATION, DAMAGES AS PROVIDED FOR
AV SECTION 370b OF THE LABOR CODE, INTEREST, AND ATTORNEY'S F);ES.
~,JUn*17 03 10:26a STHTE FARM INS 3103792436 p.2
4 • •
CERTIFICATE OF INSURANCE
T ~SrC~ItF ~ at ^STATE FARM FIRE AND CASUALTY COMPANY, 131oomington, Illinois
®STATE FARM GENERAL INSURANCE COMPANY, Bloomington, Illinois
(d"~ ^STATE FARM FIRE AND CASUALTY COMPANY, Scarborough, Ontario
„:,,,,„r, ^STATE FARM FLORIDA INSURANCE COMPANY, Winter Haven, Florida
^ STATE FARM LLOYDS, Dallas, Texas
insures the following policyholder for the coverages indicated below:
POIiCyh0lder TELFUAnS
Address ofpoligh0lder C/0 LINUA K. CARSON, 1255 19r" ST.,aEAMOSA aEACN,CA. 90254-3309
Location of operations
Description of operations
The policies listed below have bP.en issued to the policyholder for the policy periods shown. The insurance described in these policies is
subject to atl the terms exclusions, and condlBOns of those policies. The limds of liability shown may have been reduced by any paid
Calms.
POLICY PERIOD LIMITS OF LIABILITY
POLICY NUMBER TYPE OF INSURANCE Effective Date i lion DaCa (at beginning of policy period)
Comprehensive BODILY INJURY AND
BusinessLiabilitY_________ _,,,.___._..______~_ PROPERTY DAMAGE
_____________________________
This insurance includes: _
^ Products -Completed Operations
^ Contractual Liability
^ Underground Hazard Coverage Each Occurrence $
^ Personal Injury
/ ^ Advertising Injury General Aggregate $
^ Explosion Hazard Coverage
^ Collapse Hazard Coverage Products -Completed $
^ Operations Aggregate
POLICY PERIOD BODILY INJURY AND PROPERTY DAMAGE
EXCESS LIABILITY Effective Date ; ERtiratiotl Date (Combined Single Limit)
^ Umbrella Each Occurrence $
^ Other Aggr ate $
Part 1 STATUTORY
Part 2 BODILY INJURY
Workers' Compensation
and Employers Liability Each Accident $
Disease -Each Employee$
Disease -Policy Limit $
- POLICY PERIOD LIMITS OF LIABILITY
POLICY NUMBER TYPE OF INSURANCE Effective Date i Etq~lrat+on Data Iat beginning of policy period)
92-QS-0209-7 G k1USTNESS 09!25/03 04/25/04 51,000,000//GEN AGG-52,000,000
THE CERTIFICATE OF INSURANCE IS NOT A CONTRACT OF INSURANCE AND NEITtIER AFFIRMATIVELY NOR NEGATIVELY
AMENDS, EXTENDS OR ALTERS THE COVERAGE APPROVED BY ANY POLICY DESCRIBED HEREIN.
If any of the described policies are canceled before
ita expiration date, State Farm shall mail a
written notice to the certificate holder 30 days before
Name and Address of Certificate Holder cancellation. If however, we fail to mail such notice,
no obligation or liability will be imposed on State
THE CITY OF SANTA ANA Farm Or it agents or representatives.
20 CIVIC CENTER 1?7,A7,A ~p~
SANTA ANA, CA. 92701-4010 --Cl "'~
'(~(~ }• ~)K ~ 9lgnatwe or Authorized Reprrraonfatiw
=',, 4'[-tC (J'J L' L? 1\S AGENT 06/17/03
Tllle Date
~ r~~' ~~~ _-.,___~__.- Agent's Code 3temp
3 u , ply _//7.
}~~ „IV r ,lb Attukncy AFO Code F776
edO~He~ a~~ 11-12-2002 Pelnlee In U.8.A.
~un ;17 03 30:33a
fIACF fAM1M
IHfVOANCI
LAtiEON.LTHOMAS E
AKELEY,
1255 19TH ST
HERM09A BEACH CA
STATUS:I'AID
AMT DUE:
,11 /1MM /
C5000
D50
G2 50
H
STATE FRRM IMS
i
AU'1'0 POLICY
MUTL 0
2000 E
90254-3309 vSN:
DUE DATE:
0.00 oXO:JUN-05-O1
3~'1r.76 U1 100
66.40 U1
190.80
2.40
3103792436
p.4
JUNE 17, 2003
US
H PHONE: 531.0) 372-1538 20
6102-k'US-75A 1RG:
ZIP: 80254
3231 CLASS: HF330A112
WAG ACC FREE: JUN-OS-O1
:R3346YJMO1.825 BIRTH: JUL-28-54
4 DATE: TOT PREM: b39.50
l DATE:DEC-OS-O1 PREV PREM: 610.07
500
300
16.60
42.22
1,'16
~~MT rAaD: 639.SO HATE PAID: JUN--06-03
CDR 1 491.40, MCD 124.37, GGDD 159.88,
VSD 40$ 11.84, ODM 12000 0 601., MLD 68. 1.
NAME: LARSON,LINDA K 6
REPLACED POLICY: 0376102-"15
EXCEe. ~ END: ADD'I• I13SURED - THE CITY
DRVRNTS, DT OF LICTERLSNXT RLVDT CEN7.'E~
LINDA 07/2B/1970 1 SR-06/05/2004
REC CHG:
COV. S & Z NAMES 5 AMT Z
At'i'i()w'I:l:~ ~\S 6't) F'ORNa'
~` r
r I~ +~ _...._._._~~~~,
.its <~il~ ~l [urarY
H PHONE: 1310) :372-1538
FOI.ICY FORM: 9805A
IL'I.A7,ATSANTA ANA OFAFIGe`~RSO~ EMPLOXL'ES,
^.~/CONV DATE INFORMATION
Jun 17 U3 1U:26a
STATE FARM IrV6
3103792436
ADp1T1ONA~ IN5~IRED ENDOF;SEMENT
Insurance Company ~sznzE lARM
This endorsement modifies such insura~ce as is afforded by the provisions of Policy
:# 92-q6-0204-7 G relating to the folio. Ong:
1. The Ciry of Santa Ana, 20 ivic Center Plaza, Santa Ana, California 92701;
its officers, employees, agents and rep esentatives are Hamad as additional insurcds
('additional insureds") with regard to (ability and defense of suits arising from the
~ operations and uses performed by or or behalf of the named insured.
2. With respect to claims arisi gout of the operations and uses performed by
or on bat,atf of the named insured, such f surance as is afforded by this policy IS primary
~~ and is not additional to or contributing vith any other insurance carried by or for the
benefit of the additional Insureds.
3. This Insurance applies separately to each insured against vhom claim is
made or suit is brought ~:xcept with re pact to the company's limits of liability. 'fhe
inclusion of any person or organization a an insured shall not affect eny right which such
person or organization would have as a claimant if not so included.
A. With respect to the adtlition I insureds, this insurance snail not be cancelled,
or materially reduced in Coverage or limit except aher thirty (30) days written notice has
been given to the City of Santa Ana, 20 ivic Center Plaza, Santa Ana, California 92707,
(Completion of the following, inclu
endorsement effective.)
C=tieCtlve _ 04 29_(03 _.
Policy
ISSUed 10
204-7 G
am
_. ,•!ZOViL~ w S t~ ~ t)62fGtounterslgned
'/
, ,. ~ty
CI~y nttorn cy
countersignature, Is required to make this
this endorsement form as a part of
p.3
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