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HomeMy WebLinkAboutJ SMITH & T MULI, INC. (3) INSURANCE NOT ON FILE A-2023-075-05A WORK MAY NOT PROCEED MAYOR C6TY CLERK CITY MANAGER Valerie Amezcua DATE. �; Alvaro Nunez MAYOR PRO TEM MAY 1 1 2026 CITY ATTORNEY David Penaloza - Sonia R.Carvalho COUNCILMEMBERS CITY CLERK Phil Bacerra Jennifer L. Hall Johnathan Ryan Hemandez Jessie Lopez Thai Viet Phan Benjamin Vazquez CITY OF SANTA ANA ° p"`m `) PUBLIC WORKS AGENCY tvlroln.uel 6rYiZ�Dz-) 20 Civic Center Plaza I PO Box 1988 Santa Ana,California 92702 www.santa-ana.ora April 17, 2026 J. Smith & T. Muli, Inc. Attn: Tim Muli, Principal 331.61 Camino Capistrano, Suite D San Juan Capistrano, CA 92675 Re: Extension of Agreement No. A-2023-075-05 to provide on-call en2ineerin2 services Pursuant to Section 3 ("Term") of the above-referenced Agreement, entered into by J. Smith & T. Muli, Inc. and the City of Santa Ana,which commenced on May 2,2023,the parties hereby exercise their option to extend the term of the Agreement for an additional one (1)year through May 1, 2027. 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. Sincerel r R olfo Rosas, P.E. Acting Executive Director, Public Works Agency CITY OF ANTA ANA ATTEST rs T a t _ l Alvaro Nunez enniferi L. l City Manager APPROVED AS TO FORM CONSULTANT e Nellesen *Y:l Jonis Smith Assistant City Attorney e: President SANTA ANA CITY COUNCIL Valerie Amezcua David Penaloza That Viet Phan Benjamin Vazquez Jessie Lopez Phil Bacerra Johnathan Ryan Hernandez Mayor Mayor Pro Tam-Ward 6 Ward 1 ward 2 Ward 3 Ward 4 Ward 5 vame7MacM,santa-anaom dnenalaza(dlsanta-ana.org Whandtnia-ana.orq bvazguez(d}santa-ana,ma iessielooe2santa-ana.oru pbacerra(Wsanlaana_am irvanhemandez(dasantaana oeo Ac ® DATE(MMIUDIYYYY) I`� CERTIFICATE OF LIABILITY INSURANCE J5/7/2025 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 ondorsement(s), PRODUCER LUNIAUI NAME: Jane Parmenter Parmenferinsurance A ene PHONE 949 R29-0516 g y AIC,No Ext: ) (AIC,No): 27758 Santa Margarita Parkway#283 ADDRESS: janeCaparmenterins.com INSURER(S)AFFORDING COVERAGE NAIC# Mission Viejo CA 92691 INSURER A: Hartford 11000 INSURED INSURER B: Iiiscox-PRO 10200 J.Smith and T.Muli,[tic INSURER C: INSURER O: 27525 Puerta Real Unit 300-1 INSURER E: Mission Viejo CA 9269I 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. LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMJDDIYYYY) (MM/DDlYYYY) LIMITS V COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 /� CLAIMS-MADE r—KI OCCUR PREMISES(Ea occurrence) $ 100,000 MED EXP(Any one person) $ 5000 A X Primary and Noncontributory Y Y 72SBABG 1946 04/29/2025 04/29/2026 1 PERSONAL&ADV INJURY $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 POLICY PE� LOC PRODUCTS-COMPIOPAGG $ S/T Gen Agg OTHER: I S AUTOMOBILE LIABILITY (Ea accident) 5 ANY AUTO BODILY INJURY(Per person) 5 A OWNED SCHEDULED Y Y 72SBABG1946 04/29/2025 04/29/2026 BODILY INJURY(Per accident) S AUTOS ONLY AUTOS y HIRED yy NON-OWNEDPROPERTY UAMA61r /� AUTOS ONLY /C AUTOS ONLY (Per accident) 5 CGL NNOA Limit 5 2,000,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DEO I I RETENTION S I $ WORKERS COMPENSATION STATUTE ER PER AND EMPLOYERS'LIABILITY YIN ANY PROPRIETORIPARTNERIEXEGUTIVE El E.L.EACH ACCIDENT $ OFFICE RIME MEER EXCLUDED? N i A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT $ Each Claim 2,000.000 B Professional Liability Y ANE5329238.24 04/29/2025 04/29/2026 Aggregatc 2,000.000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule„may be attached If more space is required) The City,its officers,officials,employees, and volunteers are to be covered as additional insureds on the CGL Dlgitaily signed policy with respect to liability arising out of work or operations Tu Tran bymr erformed b or on behalf of she Consultant including materials, arts, "Q"ye P Y P Nguyen"-1.ozs.os." APPROVED or equipment furnished in connection with such work or operations. 3:as:oo-0ruu Description of Operations:On-Call Engineering A-2023-075-05 By Tu Tran Nguyen at 1:42 pm,May 22,2025 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City or Santa Ana,Attn PWA Parks,Fleet&Facilities ACCORDANCE WITH THE POLICY PROVISIONS. 20 Civic Center Plaza(M-30) AUTHORIZED REPRESENTATIVE PO Box 1988 Ja a P0.Y se.Jir Santa Ana CA 92702 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD CITY OF SANTA ANA Risk Management a division of Human Resources ; Managing Risk through Awareness and Action AFFIDAVIT OF EXEMPTION FOR W ORDERS' COMPENSATION INSURANCE I Jonis Smith, President ("Representative"), attest that I am an authorized (Name and Title of Vendor Representative) representative of J. Smith & T. Mull, Inc. ("Company"), and (Consultant Company Name) possess the authority to legally bind Company. In my capacity as Representative of Company, I represent and confirm the following, as relates to the agreement between Company and City of,Santa Ana,agreement number R F P 23-025 ("Agreement")to provide On-Call Engineering Services ("Services"): (Services to be provided under agreement/contract) During the course and scope of Company's agreement with the City of Santa Ana, Company will not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if Company should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, Company shall forthwith comply with the provisions and provide proof of workers' compensation coverage immediately. If at any time it is found that Company is not adhering to any and/or all of the statements in this document and does not maintain the minimum workers'compensation insurance coverage as required in the Agreement,it will be considered a breach of Agreement rendering the Agreement null and void and Company will be fully liable for any and all damages. "�c 642 05/19/25 Signature Dante Jonis Smith Print Name President ride (949) 329-3639; jsmith@jstminc.com Contact Information,i.e.,Telephone Number and/or Email Address WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSANT DOLLARS($100,000).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST,AND ATTORNEY'S FEES. Affidavit of Exemption for Workers'Compensation Insurance 11.12.2024 Policy ANE5329238.24 oev HISCOX PROm Architects, Engineers, and Construction Managers Professional Liability Coverage Part Pollutants means any solid, liquid, gaseous, biological, radiological,or thermal irritant or contaminant, including smoke, vapor, dust,asbestos, silica, nanoparticles,fibers, mold, spores,fungi, soot, fumes, acids, alkalis, chemicals, nuclear materials, bacteria,viruses, and waste.Waste includes, but is not limited to, materials to be recycled, reconditioned, or reclaimed. Pollution liability claim means a claim against you arising out of any actual,alleged,or threatened discharge,dispersal, release, or escape of pollutants directly resulting from your performance of professional services and includes the reasonable and necessary lees, costs, and expenses you incur with our prior consent to test for, monitor,clean up, remove,contain,treat,detoxify, or neutralize pollutants. Potential claim means any acts, errors,or omissions of an insured or other circumstances reasonably likely to lead to a claim covered under this policy. Professional services means only the following services performed for others for a fee: 1. those services requiring specialized knowledge,skill,training, experience, education, certification, or licensing rendered in the capacity of an architect,engineer, landscape architect, land surveyor or planner, construction manager, program manager, project manager, owner's representative, LEED accredited professional, interior designer,scientist, technical consultant,design consultant, environmental consultant,construction consultant, or forensic consultant;and 2. ordinary technology services rendered in the course of any of the services in part 1 above, including your use of a drone, and the design,development, programming,analysis,training, use, hosting, management, support,or maintenance of any software, database, internet service, or website. Professional services also includes the above services you perform pro bono with the prior knowledge and consent of the named insured. For purposes of this definition,"drone"means any unmanned aircraft system without a human pilot onboard that: (i)is controlled by an operator on the ground; and(ii)weighs 55 pounds or less. Property damage means physical damage to or destruction of any tangible property which directly results from your performance of professional services, and any resulting loss of use of that property. Retention means the applicable amount(s)stated as such under the Architects, Engineers, and Construction Managers Professional Liability Coverage Part section of the Declarations, including any amount that corresponds to a specific coverage enhancement or sublimit in this Coverage Part. Third party discrimination means any non-physical harassment of or unlawful discrimination against a person or entity other than an insured or an employee of an insured, including any resulting violation of civil rights, but only if such harassment or discrimination directly results from your performance of professional services. You, your, or insured means a named insured, subsidiary,joint venture, acquired entity, insured organization, employee, independent contractor, or additional insured,as defined in Section Ill.Who is an insured. Vlll. Other provisions affecting coverage Waiver of subrogation A. With respect to any payment we make under this Coverage Part for any claim arising from your professional services performed for any client of yours,we agree to waive any right of recovery we may have against such client, provided you have agreed in a written contract or agreement prior to your performance of the professional services giving rise to the claim to waive your rights of recovery against such client. wCLANE P0001 CW(10/19) Page 10 of 10 Policy 72SBABG1946 Declarations: Business Liability Coverage Part Your policy includes the liability coverages listed below. The limits in the right-hand column show the maximum amount we'll pay. FORM NUMBER FORM SL 00 00 10 18 BUSINESS LIABILITY COVERAGE FORM Damage To Premises Rented To You Limit $1,000,000 !� General Aggregate Limit $4,000,000 Liability and Medical Expenses Limit $2,000,000 Medical Expenses Limit $10,000 Personal and Advertising Injury Limit $2,000,000 Products-Completed Operations Aggregate Limit $4,000,000 Property Damage Liability Deductible $2,500 ADDITIONAL BUSINESS LIABILITY COVERAGES SL 30 32 06 21 BLANKET ADDITIONAL INSURED BY CONTRACT Included' SL 30 23 1018 ELECTRONIC MEDIA LIABILITY Included' 5L 30 26 10 18 HIRED AUTO AND NON-OWNED AUTO LIABILITY Included' SL 10 00 10 18 PROPERTY DAMAGE LIABILITY DEDUCTIBLE Property Damage Liability Deductible $2,500 'Included In Business Liability Umit(s) ALL OTHER BUSINESS LIABILITY FORMS Form Numi6e. orm Name .. SL 30 29 10 18 1 ADDITIONAL INSURED EXCLUSION SL 20 64 10 18 EXCLUSION-ENGINEERS,ARCHITECTS OR SURVEYORS PROFESSIONAL LIABILITY SL 20 06 10 18 EXCLUSION-NUCLEAR ENERGY LIABILITY SL 20 78 10 18 EXCLUSION-SILICA-BUSINESS LIABILITY COVERAGE FORM SL 90 13 10 18 NOTICE OF CANCELLATION TO CERTIFICATE HOLDER(S) LIABILITYBUSINESS • *Price is subject to fees and surcharges. For more details, refer to Page 10 Forme SC 00 01 10 18 8 Nguyen, Tu Tran From: Arroyo, Zianya Sent: Thursday, May 22, 2025 9:54 AM To: RM D Subject: RE: Request for COI Review:J Smith &T Muli Attachments: Affidavit of Exemption-Workers' Compensation.pdf Good morning Tu, Vendor confirmed that it is a blanket WOS that applied to anyone that has an agreement with them. Please see the completed Workers Comp waiver. Thank you, Zee From: RMD<rmd@santa-ana.org> Sent:Wednesday, May 14, 2025 9:36 AM To: Arroyo,Zianya<zarroyo@santa-ana.org> Subject: RE: Request for COI Review:J Smith &T Muli Hi Zee, Can you request confirmation if it is a blanket Waiver of Subrogation that applies to anyone that has an agreement with the contractor? Please see attached for the Affidavit. Thank you, Tu Tran Nguyen I Risk Management Technician City of Santa Ana- Human Resources Department r; 20 Civic Center Plaza I Santa Ana, CA 92701 Office: 714-647-5141 Email: TNguyen20CcD_santa-ana.orrc I santa-ana.orct/human-resources Linkedin Instagram City Hall hours are 8 a.m, to 5 p.m. Monday through Thursday, and 8:00 a.m. to 5:00 p.m. every other Friday. Click here for a list of observed holidays and Friday closure dates. The mySantaAna mobile app puts the power of the Santa Ana city government in the palm of your hand! The free app allows residents to quickly and easily report issues to the City, access City services, and find news and events. It is available to download from the Apple App Store and on Google Play. Click here to report an issue directly from the City website. 1