HomeMy WebLinkAboutCALIFORNIA STATE UNIVERSITY, FULLERTON (2)-2012MAYOR N!C}F!K MAY pi' "% r
Miguel A. Pulldt}J1VfJ INSI94,�
MAYOR PRO TEM 77 s
Sal Tinajero e..,'w; l'l l(7
COUNCIL MEMBI€WK
Angelica Amez TE: t 2_ Z -_ 1.5
P. David Benavides
Michele Martinez
Roman Rayne
Vincent F. Sarmiento
December 15, 2015
20 Civic Center Plaza • P.O. Box 1988
Santa Ana, California 92702
www.santa -ana orc
CSU Fullerton Auxiliary Services Corporation
Attn.: Denise Belle
2600 Nutwood Avenue, Suite 250
Fullerton, CA 92$31
Subject: Extension of Agreement #A- 2012 -016
Dear Ms. Belle:
CITY MAFtAg9J 2- 016 -01
David Cavazos
CITY ATTORNEY
Sonia R. Carvalho
CLERK OF THE COUNCIL
Maria D. Huizar
Pursuant to Agreement under the Workforce Investment Act, #A- 2012 -016, entered between
CSU Fullerton Auxiliary Services Corporation and the City of Santa Ana, dated February 6,
2012, Section III — Time Period of Agreement, the expiration of the time period of said
Agreement is hereby extended for one additional year from November 30, 2015, until November
t 30, 2016. The insurance certificates, if any, are required to be extended and/or renewed to cover
this extension. All other terms and conditions of said Agreement remain unchanged and in frill
force and effect.
If you have any questions in this regard, please feel free to contact my office.
Sincerely,
Executive Dire
Community Development Agency
A m O Fy)
Soa 411 I i JCit Attorney
By:,
Ryan
CITY OF SANTA ANA,
David Cavazos
City Manager
ATTEST
;'
aria D. Huizar
City Clerk
SANTAANA CITY COUNCIL
Miguel A, Puiitic
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CERTIFICATE OF COVERAGE
6 DATE26 'MMIO2015 DI5 Y)
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF EVIDENCE ONLY AND CONFERES NO RIGHTS
UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR
TYPE OF COVERAGE
NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
A1.liant Insurance Services, Inc.
MEMORANDUMNJ3 OF COVERAGE BELOW,
100 Pine Street
THIS CERTIFICATE OF COVERAGE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE
11th Floor
San Francisco CA 94111
-
ISSUING COVERAGE PROVIDER, AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE
CERTIFICATE HOLDER.
IMPORTANT: IF THE CERTIFICATE HOLDER IS AN ADDITIONAL COVERED PARTY, THE
4/1/2015
MEMORANDUM OF COVERAGE MUST BE ENDORSED. A STATEMENT ON THIS CERTIFICATE
EACH OCCURRENCE
DOES NOT CONFER RIGHTS TO THE CERTIFICATE HOLDER IN LIEU OF SUCH
ENDORSEMENT(S),
IMPORTANT: IF SUBROGATION IS WAIVED, SUBJECT TO THE TERMS AND CONDITIONS OF THE
NbyMEO COVERED PARTY
CSU Fullerton Auxiliary services Corporation
2600 NutWOOC1 Ave,, Suite 275
MEMORANDUMDR OF COVERAGE AN ENDORSEMENT MAY BE REQUIRED. A STATEMENT ON
THE CERTIFICATE DOES NOT CONFER RIGHTS TO THE CERTIFICATE HOLDER IN LIEU OF SUCH
ENDORSEMENTS).
FU7.,lerton CA 9 2631-3599
PROGRAM AFFORDING COVERAGE
A: CSURMA AORMA —.
&:AORMA WC/Safety National Cas.
CLAIMS MADE OCCUR
C:
COVERAGES
]'HIS IS TO CERTIFY THAT THE COVERAGE IS AFFORDEO TO THE ABOVE NAMED MEMBER, AS PROVIDED BY THE MEMORANDUMS) OF COVERAGE, FOR THE PERIOD SHDWN BELOW, NOT WITHSTANDING ANY
RE.OUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE COVERAGE AFFORDED BY THE PROGRAM
DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS, AND CONDITIONS OF SUCH MEMORANDUM'S) OF COVERAGE. THE FOLOWING COVERAGE IS IN EFFECT.
JPA
LTR
TYPE OF COVERAGE
MEMORANDUM NUMBER
COVERAGE EFFECTIVE
DATE(MMMDPaH
COVERAGE EXPIRATION
DATE(MMIDOMY)
LIMITS
A
GENERAL LIABILITY
AORMA- 1516 -01
4/1/2015
7/1/2016
EACH OCCURRENCE
$5,000,000
FIRE DAMAGE (Any we fire)
S
COMMERCIALGENERAL LIABILITY
CLAIMS MADE OCCUR
MED EXPENSE (Any ow, Person)
$5,000
PERSONAL &ACV INJURY
$5,000,000
Prof
_'lit
GENERALAGGREGATE
$5,000,000
BELL AGGREGATE LIMIT APPLIES PER:
PRODUCTS- COMPIOPAGG
55,000,000
MEMOM R PROJECT LOC
ANDll
A
AVTDMOBICE 4IABtLiTY
AORMA - 1516 -01
7/1/2015
7/1/20166
COMBINED SINGLE LIMIT
$5,000,000
ANY AUTO
iEa acdd.nG
$
ALL OWNED AUTOS
SCHEDULED AUTOS
X HIRED AUTOS
NON -CA ... AUT15
B
WORKERS' COMPENSATION AND
EMPLOYERS LIABILITY
AORPIA -WO- -1515
7J1/2015
4/1/2016
we
X STATUTORY OTHER
LIMITS
ANY PROPRIETOWPARTNERI
EXECUTIVFICPFIGERIMEMBER
E.L. EACH ACCIDENT
55,000,01111
EXCLUDED?
IF YES, DESCRIBED TINDER SPECIAL
EL. DISEASE- EA EMPLOYEE
$5,000,000
E.L. DISEASE - POLICY LIMIT
$5,000,000
PROVISION BELOW
OTHER
OTHER
DESCRIPTION OF OPERATIONStLOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIALIPROYISIONS
Note: Workers' Compensation Coverage is provided as evidence only.
City of Santa Ana and State of California are named as additional. covered parties as
respects the Agreement under, the Workforce Investment Act for Orange County Bridge to
Engineering Project. Contract No. 50104012. Term of Agreement: 12/1/2011 - 11/30/2015.
CERTIFICATE HOLDER CANCELLATION
City
of Santa
Ana
SHOULD ANY OF THE ABOVE DESCRIBED MEMORANDUM(S) OF COVERAGE-
Attn:
Manager,
WIB Administrative Office
BE CANCELLED BEFORE THE EXPIRATION DATE 'I'HEREOF, NOTICE WILL BE
P.O.
Box 1988
(M -73)
DELIVERED IN ACCORDANCE WITH THE MEMORANDUM(S) OF COVERAGE
Santa
Ana CA 92702
PROVISIONS.
AUTHORI7S:D REPRESENTATIVE
V _�
California Slate University Risk Management Authority
Auxiliary Urgnnimtlons Risk Management Alliance
Endorsement No.:
Effective:
Forms a part of MOC No.:
Issued to:
Issued by:
Issued on behalf of Member:
Per Blanket Additional Covered Party attached to Memorandum of
Coverage of Coverage listed below
07/01/2015
AORMA -15 -16
Per Attached Certificate of Coverage
CSURMA Auxiliary Organizations Risk Management Authority
AORMA Member On File With Company
This endorsement modifies the Memorandum of Coverage of Coverage. Please read it carefully.
ADDITIONAL COVERED PARTY
Additional Covered Party means any person(s), entity(ies), or organization(s) to whom the Member is obligated by
virtue of any written contract to provide coverage solely with respect to bodily injury, property damage and personal
injury arising out of the Member's operations or premises owned by or rented to the Member; and
For which a certificate of coverage has been issued to such person(s), entity(ies) or organization(s) and is on file with
CSURMA AORMA evidencing their status as an additional insured under this coverage.
The coverage provided does not apply to any occurrence taking place:
Prior to the Members' operations or r occupation of the premises; or
2. After the Members' operations have been completed or occupation of the premises has ceased.
The limits of coverage will be limited to the limits required within the terms of the written contract of the limits of liability
of this Memorandum of Coverage, whichever is less, and will apply in excess of the Members' retained limit shown in
the Declarations. CSURMA AORMA will not be obligated for limits of coverage shown in the written contract that are
greater than the limits of liability of this Memorandum of Coverage.
The inclusion of more than one Covered Party under this policy shall not operate to impair the rights of one Covered
Party against another Covered Party and the coverages afforded by this Memorandum of Coverage shall apply as though
separate Memorandum of Coverage had been issued to each Covered Party. The inclusion of more than one Covered
Party shall not, however, operate to increase the limit of the Company's liability.
Any other insurance carried by a certificate holder which may be applicable shall be deemed excess and the Covered
Party's coverage primary notwithstanding any conflicting provisions in the Covered Party's Memorandum of Coverage.
A certificate holder shall not, by reason of their inclusion under this Memorandum of Coverage, incur liability for payment
of premium for this Memorandum of Coverage.
In the event of reduction in coverage or cancellation of this Memorandum of Coverage before the expiration date thereof,
notice will be delivered in accordance with the Memorandum of Coverage provisions to each entity added as per
certificates on file with CSURMA AORMA which specify that a written contract exists and requires that the entity be an
additional covered party.
All other terms and conditions in the Memorandum of Coverage remain unchanged. 15 \ t
2
Signed:__ _ Date: 7/1/15