Loading...
HomeMy WebLinkAboutVERIZON WIRELESS (LOS ANGELES SMSA LIMITED PARTNERSHIP) (68) A-2024-205A 0�4 1ZOO- AUG 10 2026 m fwr-l°) SUPPLEMENT AGREEMENT �. I Soy?,�h O-L) This Supplement("Supplement"), is approved by Licensor this I day of j y Lam( , 20 2& (the date executed by all parties,referred herein as "Supplement Effective Date"). 1. Supplement. Licensee has submitted an application for approval to use a Municipal Facility pursuant to that certain Municipal Facility License Agreement between Licensor and Licensee dated December 3, 2024 ("Agreement"). Licensor has reviewed the application and grants approval subject to the terms of this Supplement. All of the terms and conditions of the Agreement are incorporated hereby by reference and made a part hereof without the necessity of repeating or attaching the Agreement. In the event of a contradiction,modification or inconsistency between the terms of the Agreement and this Supplement, the terms of this Supplement shall govern. Capitalized terms used in this Supplement shall have the same meaning described for them in the Agreement unless otherwise indicated herein. IF THE SUPPLEMENT IS NOT COUNTER-SIGNED BY LICENSEE AND RETURNED TO LICENSOR WITHIN 30 DAYS AFTER LICENSOR HAS GRANTED APPROVAL, THE SUPPLEMENT SHALL BE VOID AND OF NO LEGAL EFFECT. IF LICENSEE STILL WANTS TO USE THE MUNICIPAL FACILITY, LICENSEE WILL BE REQUIRED TO SUBMIT A NEW APPLICATION AND ASSOCIATED FEES. 2. Licensed Area Description and Location. Licensee shall have the right to use the space on the specific Municipal Facility(the "Licensed Area") depicted in Attachment 1 attached hereto to install Equipment as further listed in Attachment 2 attached hereto. - 3. Equipment. The Equipment to be installed at the Licensed Area is described and depicted in Attachment 1. 4. Term. The term of this Supplement shall commence on the Supplement Effective Date and continue for the life of the Agreement, as described in Paragraph 2 of the Agreement. 5. License Fee/Alternate License Fee. The initial fee for this Supplement shall be as follows per year: $270.00. This fee is subject to annual increase as provided in the Agreement, and is payable in accordance with the Agreement. 6. Performance Bond. The Performance Bond [circle on(E)s not covered by existing performance bond. If not covered by existing performance bond, a bond is required pursuant to Section 8 of the Agreement. 7. Miscellaneous. [Signature page follows] A-1 IN WITNESS THEREOF, the parties hereto have caused this Supplement to be legally executed in duplicate, effective upon execution by both parties. Licensor: CITY OF SANTA ANA, CA By: Name: fo Rosas, P.E. Title: Acting Executive Director Public Works Agency Date: /(, Zo Z(* Licensee: Accepted: P By: Name: Title: Date: Attachments: Attachment 1 —Licensed Area(Bristol_MarketPlace) Attachment 2—Equipment List and Description A-2 Attachment 1 Licensed Area [Map showing licensed area of applicable Municipal Facility and showing proposed Equipment installation.] A-3 Ck City of Santa Ana�Small Cell Resemation Web App r i___.— Y.._ • o o o O 0 0 • 0 ° 0 ° TRSTL149W ® • o p 0 116 1 N Bristol St • ° ., is t.`i`: • o 0 varuoe • ♦ ♦ 0 O O �essrnuan stzrez O • p ° Reserved • • 0• e • ® 0 0 • • • ® �'' 0® • • e • e • • • ® e • ® ® o ° • • ® aezerztian Oa:e V O O o N.—.11co—.-d • e • e • a ® ® • • • ® •• ® ® d sift • p • • 8 0 • ® • • Licensed Area B 2 ®] ® 0 • • e z .- t, 0 40 0-op o .o o o 0 o o o ♦ o o �o 0 o ♦ o 0 o- 0 0 ♦o 9 Ij o A-4 _E3RISTCJIi t verizon crry E3-rp_F-E:-r L--r (#.za-4--�a-72E: "ahow-m- .... ti t Ak ` SI , E XISTIMG L r °`• PRO POSEO venzo ' Attachment 2 Equipment List: • (1)27' Galvanized Steel Streetlight with Faux Concrete Finish • (1)48" Tri-Sector Antenna Shroud • (1) 12"Architectural Transition Shroud e (3)Panel Antennas mounted within the 48" Tri-Sector Antenna Shroud A-6 DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 07/16/2U26 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 w � policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT 'O NAME: AOn Risk Services Northeast, Inc. PHONE FAX d New York NY Office (A/C.No.Ext): (866) 283-7122 (A/c, No.); (800) 363-0105 a_ one Liberty Plaza E-MAIL o _ 165 Broadway, Suite 3201 ADDRESS: New York NY 10006 USA INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURERA: LM Insurance Corporation 33600 Los Angeles SMSA LP INSURERS: Liberty insurance Corporation 42404 dba verizon Wireless 1095 Avenue of the Americas INSURERC: Liberty Mutual Fire ins Co 23035 New York NY 10036 USA INSURER D: '.. INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570121908349 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. Limits shown areas requested INSR ADDL SUBR EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (POLICYMM/DD/YYYY) (MM/DDNYYY) LIMITS B X COMMERCIALGENERALLIABILITY Y Y TB7691550588146 06/30/2026 06/30 2027 EACH OCCURRENCE $2,000,000 �� CLAIMS-MADE I X I OCCUR DAMAGE TO RENTEDPREMISES(Ea occurrence) $2 r 000 r 000 X XCU Coverage is Included MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $2 r 000 r 000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $510001000 M X POLICY ❑PRO ❑LOC PRODUCTS-COMPIOPAGG $5,000,000 m N OTHER: O ti C AUTOMOBILE LIABILITY AS2-691-550588-126 06/30/2026 06/30/2027 COM DINED SINGLE LIMIT AOS (Ea accident) _ $1,000,000 C X ANY AUTO AS2-691-550588-136 06/30/2026 06/30/2027 BODILY INJURY(Per person) OWNED SCHEDULED NH — Primary BODILY INJURY(Per accident) Z C AUTOS ONLY AUTOS TL2-691-550588-186 06/30/2026 06/30/2027 PROPERTY DAMAGE m HIREDAUTOS NON-OWNED O ONLY AUTOS ONLY NH - Excess (Per accident) i.. df UMBRELLA LIAB OCCUR EACH OCCURRENCE U EXCESS LIAB CLAIMS-MADE AGGREGATE DED RETENTION A WORKERSCOMPENSATIONAND wA569D550588096 06/30/2026 06/30/2027 X PERSTATUTE OTH- EMPLOYERS'LIABILITY Y/N AOS ER ANY PROPRIETOR/PARTNER A OFFICER/MEMBEREXCUDED?XECUTIVE N NIA WC5691550588086 06/30/2026 06/30/2027 E.L.EACH ACCIDENT $1,000,000 (Mandatory in NH) WI, MN E.L.DISEASE-EAEMPLOYEE $1,000,000 D Yes,describe under $1,000,000 DESCRIPTION OPERATIONS below E.L.DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) Contractual Liability is included in the General Liability policy. RE: Project Number: A-2020-047. City of Santa Ana, its council members, officers and employees are included as Additional Insured with respect to the General Liability policy. The General Liability policy shall apply as Primary insurance & Non-Contributory to each Additional Insured listed herein. where permitted by law, the Named Insured parties listed herein waive all rights against the City of Santa Ana, its council members, officers and employees listed herein for recovery of damages to the extent these damages are covered by the above-referenced General Liability policy and, as further limited by written contract between the parties. zi Ky— CERTIFICATE HOLDER CANCELLATION mill SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIONy DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. _ City of Santa Ana AUTHORIZED REPRESENTATIVE 20 Civic center Plaza . Santa Ana CA 92701 USA J . �� L _ APPROVED By Tu Tran Nguyen at 12:17 pm,Jul 16,2026 ©1988-2016 ACORD CORPORATION.All rights reserved ACORD 26(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 570000027366 LOC#: A�--� ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY NAMEDINSURED Aon Risk Services Northeast, Inc. Los Angeles SMSA LP POLICY NUMBER See Certificate Number: 570121908349 CARRIER I NAIC CODE see Certificate Number: 570121908349 EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance INSURER(S)AFFORDING COVERAGE NAIC# INSURER INSURER INSURER INSURER ADDITIONAL POLICIES If a policy below does not include limit information,refer to the corresponding policy on the ACORD certificate form for policy limits. POLICY POLICY INSR ADDL SUBR POLICY NUMBER LIMITS LTR TYPE OF INSURANCE INSD WVD EFFECTIVE EXPIRATION DATE DATE (MM/DD/YYYY) MM/DD/YYY WORI(ERS COMPENSATION B N/A wA769D550588076 06/30/2026 06/30/2027 MA ACORD 101(2008/01) ©2008 ACORD CORPORATION.All rights reserved. The ACORD name and logo are registered marks of ACORD Policy Number T137-691-550588-146 COMMERCIAL GENERAL LIABILITY CG 20 26 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED ® DESIGNATE® PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s):Any person or organization whom you become obligated to include as an additional insured as a result of any contract or agreement you have entered into. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following is added to organization(s) shown in the Schedule, but only Section III—Limits Of Insurance: with respect to liability for "bodily injury", "property If coverage provided to the additional insured is damage" or personal and advertising injury" required by a contract or agreement, the most we caused, in whole or in part, by your acts or will pay on behalf of the additional insured is the omissions or the acts or omissions of those acting amount of insurance: on your behalf: 1. Required by the contract or agreement; or 1. In the performance of your ongoing operations; or 2. Available under the applicable limits of 2. In connection with your premises owned by or insurance; rented to you. whichever is less. However: This endorsement shall not increase the 1. The insurance afforded to such additional applicable limits of insurance. insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 26 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 COMMERCIAL GENERAL LIABILITY CG 20 01 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance (2) You have agreed in writing in a contract or Condition and supersedes any provision to the agreement that this insurance would be contrary: primary and would not seek contribution Primary And Noncontributory Insurance from any other insurance available to the additional insured. This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and CG 20 01 12 19 C Insurance Services Office, Inc., 2018 Page 1 of 1 POLICY NUMBER: T137-691-550588-146 COMMERCIAL GENERAL LIABILITY CG24041219 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART ELECTRONIC DATA LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART DESIGNATED SITES POLLUTION LIABILITY LIMITED COVERAGE PART DESIGNATED SITES PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICY DESIGNATED TANKS SCHEDULE Name Of Person(s)Or Organization(s): Any location owned or managed by Additional Insured Person(s)or Organizations as required by written contract Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV—Conditions: We waive any right of recovery against the person(s) or organization(s) shown in the Schedule above because of payments we make under this Coverage Part. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person(s) or organization(s) prior to loss. This endorsement applies only to the person(s) or organization(s)shown in the Schedule above. CG 24 04 12 19 C Insurance Services Office, Inc., 2018 Page 1 of 1 Policy Number TB7-691-550588-146 Issued by LIBERTY INSURANCE CORPORATION THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION AND NON-RENEWAL This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART EXCESS COMMERCIAL GENERAL LIABILITY COVERAGE PART GARAGE COVERAGE PART LIQUOR LIABILITY COVERAGE PART MOTOR TRUCK CARGO COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRINTERS LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART SPECIAL PROTECTIVE AND HIGHWAY LIABILITY POLICY—NEW YORK WAREHOUSEMAN'S LEGAL LIABILITY COVERAGE PART We will not cancel or non-renew this policy or make changes that reduce the insurance afforded by this policy until written notice of cancellation, non-renewal or reduction has been mailed or delivered to those scheduled below at least a) 10 days before the effective date of cancellation, if we cancel for non-payment of premium; or b) days before the effective date of the cancellation, non-renewal or reduction if we 30 cancel or reduce the insurance afforded by this policy for any other reason. NAME ADDRESS Per schedule on file with the Company Per schedule on file with the Company LIM 02 01 12 11 ©2011, Liberty Mutual Group. All rights reserved. Page 1 of 1 Policy Number: AS2-691-550588-126 Issued By: Liberty Mutual Fire Insurance Co. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION TO THIRD PARTIES This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE PART MOTOR CARRIER COVERAGE PART GARAGE COVERAGE PART TRUCKERS COVERAGE PART EXCESS AUTOMOBILE LIABILITY INDEMNITY COVERAGE PART SELF-INSURED TRUCKER EXCESS LIABILITY COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART EXCESS COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART Schedule Name of Other Person(s)/ Email Address: Organization(s): Per Schedule on file with the Per Schedule on file with the Company Company A. If we cancel this policy for any reason other than nonpayment of premium, we will notify the persons or organizations shown in the Schedule above by email as soon as practical after notifying the first Named Insured. B. This advance email notification of a pending cancellation of coverage is intended as a courtesy only. Our failure to provide such advance notification will not extend the policy cancellation date nor negate cancellation of the policy. All other terms and conditions of this policy remain unchanged. LIM 99 02 08 11 ©2011, Liberty Mutual Group of Companies. All rights reserved. Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc. with its permission. NOTICE OF CANCELLATION TO THIRD PARTIES A. If we cancel this policy for any reason other than nonpayment of premium, we will notify the persons or organizations shown in the Schedule below by email as soon as practical after notifying the first Named Insured. B. This advance email notification of a pending cancellation of coverage is intended as a courtesy only. Our failure to provide such advance notification will not extend the policy cancellation date nor negate cancellation of the policy. Schedule Name of Other Person(s)/Organization(s): Email Address: Per Schedule on file with Verizon Communications, Inc. All other terms and conditions of this policy remain unchanged. Issued by LM Insurance Corporation 27243 For attachment to Policy No.WA5-69D-550588-096 Effective Date Premium$ Issued to Verizon Communications Inc. Endorsement No. WC 99 20 74 ©2016 Liberty Mutual Insurance Page 1 of 1 Ed. 12/01/2016