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HomeMy WebLinkAboutWEST COAST COMMUNITY DEVELOPMENT, LLC 4-2016City of Santa Ana Clerk of the Council �r l AGREEMENT TERMINATION ^,^ 'Al!s 2 1 P"1 4: sg Please complete this form when the attached agreement is no longer in effect. Return form to the Clerk of the Council Office (M-30). CITY OF SANTA ANA Call 647-5237 if you have any questions. CLERK OF COUNCIL ....... ________________________ The agreement with N- aokL -cur (no LSIa� ao\--� No. „— was completed on and final payment has been made. Revised 07-23-07 Department: P R G s A Phone/Ext.: Signature: Date: of on I q MAYOR Miguel A. Puiido MAYOR PRO TEM Ancenle Sarmlenlo COUNCILMEMBERS Angelica Amezcua P. David Benavldes Mldiale Martinez Roman Reyna Sal Tmalero WC required if consultant N-2014-146-001 has employees. CITY OF SANTA ANA PARKS, RECREATION, AND COMMUNITY SERVICES AGENCY 20 Chic Center Plaza M-23 + P.O. Sox 1888 M-23 Santa Ana,. Callicmis 92702 �mmgaixrda-arm.as September 20, 2016 Mark Payan West Coast Community Development, LLC 59 Long Meadow Irvine, CA 92620 Ret ExtensitlpofRecreation �Services Agreement Agreement No. N-2014446 Dear Mr. Payan: CITY MANAGER David Cavazos CITY ATTORNEY Santa R, Carvalho CLERK OF THE COUNCIL Maria O. Huizar Pursuant to Section 3 of the above -referenced agreement between the City of Santa Ana and °wVest. Coast Development, LLC, the terns of such Agreement is hereby extended on a month-to-month basis for up to six months, effective October 1, 2016. All insurance certificates are required to be extended and/or renewed to cover this extension. All other terms and conditions of said Agoameat remain unchanged and In full force and effect.. Sincerely, Gerardo Mouet Executive Director, Parks, Recreation, and Cornitunity Services Agency CX OT A AN David Cavazos City Manager APPROVED AS TO FORM u1 M, lruiik Assistant City Attorney WEST COAST COMMWTY DEVELOPMENT No= GAJ -4-C f#YA0J Title: C.✓i%d'F�OWOOZA- ATTEST Marfa Clerk of Council SANTA ARA CITY COUNCIL Mlg' A. Poitou mncanh. Saude0o i A Srta aaa a A NANt Amuma P navideamviaas € Rmaa T*" SO T**n Mega I MeyWROTMANAIt TNwf& WWII Wwdd Wss% wwat �(uN,ia�aaiiaana ora $ X$AGmFeMaiasaab-mw.aea ' # APxamab$w ,yy I gaane.Me.�nmea.s nap { d$a r NW -M CERTIFICATE OF LIABILITY INSURANCE DATE IMM/ D/YYYY) 3/24/2016 PRooucen THIS CERTIFICATION IS ISSUED AS A MATTER OF INFORMATION Mamba lesmnn=o AEanW, LAa' ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 21Wlpe goal Sults 20o HOLDER. THIS CERTIFICATE DOES NOT AMMEND, EXTEND OR IN0ste MF1.43- lelq Ep 9x691- (Aii1.A3�A.i459 ALTER THE COVERAGE AFFORDED BY TH E POLICIES BELOW. TYPE OF INSURANCE INSURERS AFFORDING COVERAGE NAICN INSURED INSURERA: PhIlAnd hie lndem nt Insurance company10030 Mme Payar,dha, INSURER B: West CPAtACommanity.DPvaiRlnellt,LLD INSURER S9 LOJIR Md,, INSURER D: IMM, CA 92520. INSURER r:: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FUME POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERIFICATION MAY BE ISSUE, OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, AGGREGATC LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, HIM ADWIL POLICY EFFECTIVE POLICY ENPIRATION LTR INS40 TYPE OF INSURANCE POLICYNUMEH OATS MM DO YYVV DATE(MM/DO/YYYY) LIMITS A N GENBRALLIADMITY PHPRI021936' 5/24/2010 5/24/2017 EACNOCCURF.NCE $1,700,000 X COMMERCIALGENEMLLIASIUTY CLAIMS MADE Fxl COLOR 000 pR M16E5 eenrre eo $100,000 _ MED IBP (Aly ane PIraan) $2,500 PORSONAL&ADV INJURY JI1,000000 X PROFESSIONAL LIABILITY (IENERALAGGREOATE $3,000,000 GEN'LAGGRFBRATELIMITAPPLIESPIt PRODUCTS-COMP/OP AGO $3000,000 X POLICY PROJECT LOC AU BOARDERS LIABILITY COMBINED SINGLE LIMIT ANYAUTO (EAualdent) ALLOWNPDANTOS BODILYINJURY SCHEDULED AUTOS (Par Person) LAREPAOTOS ... BODILYINJUIIY NON-OWNEDAUTOS (Per araldant) IY PROFERDAMAGE QaW� (ParnuldenQ GARAGE UABRIW .L� AUTO ONLY - EA ACCIDENT ANYAUTO J OTHER THAN EAAC4 nr G2' AUTO ONLY; AGO EXCLIS I UMBRELLA'' 'L7IABILITY OCCUR L� CLAIMS MADE OEOUCtIOIE +An ( . :�\\i� �V CJ.. \` A r� EACH OCCURBNLE AOORCGA Tf RETENTION v�T ryMYPI AVppII�RpS IABIL/ITTpYYpgqiiryryQQpp// y/N OFFICER/MEMBEER PXCLUDEORE%ECUTIVE L� TO YUMI S ER P.L. EACH ACCIDENT (Mandatory yyIn AIR) SPYECNLePWOS18ft1,alow Et, Et, DISFASR- EA AMPLOYEE E. L. DISEASE -POLICY LIMIT OTHER DESCRIPTION DP OPERATIONS/LOCATIONS/VEHICLES/ EXCLUSIONS ADDED BY ENDORSEMENT), SPECIAL PROVISIONS an n understood and agreed than he Pa t,Y0ng tBARY 15 added as an addltlonel lamed An only With rrEPaat(s) to His operations it he earned gaved .,,pit hot IlahllltV resalfir, from the,,JMC.anl Iaamd's We neRliemmo. CITY of Santo Are, Its aTAmr; agents and empinVem 2D CIvIC Center Pix Santa Ano, CA 92101 'DIEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ID DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR ACORD 25 (2009/01) © 1988-2009 ACORD CORPORATION, All rights reserved. The ACORD name and logo are registered marks of ACORD ADDITIONAL INSURED ENDORSEMENT Insurance Company Philadelphia Indemnity Insurance Company This endorsement modifies such insurance as is afforded by the provisions of Policy PHPPK1024916-000 relating to the following: 1. The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701; it officers, employees, agents and representative are named as additional insureds ("additional insureds") with regard to liability and defense of suits arising from the operations and uses performed by or on behalf of the named insured, 2. With respect to claims arising out of the operations and uses performed by or on behalf of the named insured, such insurance as is afforded by this policy is primary and is not additional to or contributing with any other insurance carried by or for the benefit of the additional insureds. 3. This insurance applies separately to each insured against whom claim is made or suit is brought except with respect to the company's limits of liability. The inclusion of any person or organization as an Insured shall not affect any right which such person or organization would have as a claimant If not so Included. 4. With respect the additional insureds, this insurance shall not be cancelled, or materially reduced in coverage or limits except after thirty (30) days written notice has been given to the City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701. (Completion of the following, including countersignature, is required to make this endorsement effective.) Effective 05/24/2016 , this endorsement form as part of Policy# PHPPI<1024916-000 Issued to Mo.R.yan,dba WuaKnnt CommunityDevelopmanl,LLC. Name Insured Countersigned by IMII-ace AgamL lgurum �edby�� `- 5�� CS I Pd�ar Commercial General Liability CG 00 01 12 07 Bankruptcy or Insolvency of the insured or of the insured's estate will not relieve us of our obligations under this Coverage Part, 2. Duties In The Event Of Occurrence, Offense, Claim Or Suit a. You must see to it that we are notified as soon as practicable of an "occurrence" or an offense which may result In a claim. To the extent possible, notice should include: (1) Haw, when and where the "occurrence" or offense took place; (2) The names and addresses of any Injured persons and witnesses; and (3) The nature and location of any Injury or damage arising out of the "occurrence" or offense. b. If a claim is made or "suit" Is brought against any Insured, you must: (1) Immediately record the specifics of the claim or "suit" and the date received; and (2) Notify us as soon as practicable. You must see to it that we receive written notice of the claim or "suit" as soon as practicable. c. You and any other involved insured must: (1) Immediately send us copies of any demands, notices, summonses or legal papers received in connection with the claim or "suit"; (2) Authorize us to obtain records and other Information; (3) Cooperate with us in the Investigation or settlement of the claim or defense against the "suit"; and (4) Assist us, upon our request, in the enforcement of any right against any person or organization which may be liable to the insured because of Injury or damage to which this Insurance may also apply. d. No insured will, except at that Insured's own cost, voluntarily make a payment, assume any obligation, or Incur any expense, other than for first aid, without our consent. 3. Legal Action Against Us No person or organization has a right under this Coverage Part: a• To join us as a party or otherwise bring us into a "suit" asking for damages from an insured; or b. To sue us on this Coverage Part unless all of its terms have been fully compiled with. A person or organization may sue us to recover on an agreed settlement or on a final Judgment against an insured; but we will not be liable for damages that are not payable under the terms of this Coverage Part or that are in excess of the applicable limit of Insurance, An agreed settlement means a settlement and release of liability signed by us, the Insured and the claimant or the claimant's legal representative. 4. Other Insurance If other valid and collectible insurance is available to the insured for a loss we cover under Coverages A or B of this Coverage Part, our obligations are limited as follows: a. Primary Insurance This insurance is primary except when Paragraph b. below applies. If this Insurance is primary, our obligations are not affected unless any of the other insurance is also primary, Then, we will share with all that other Insurance by the method described In Paragraph c, below. b. Excess Insurance (1) This Insurance Is excess over: (a) Any of the other insurance, whether primary, excess, contingent or on any other basis. eab� (1) That is Fire, Extended Coverage, Builder's Risk, Installatlon Risk or similar coverage for "your e� we , 1) That is Fire insurance for premises rented to you or temporarily occupied by you with permission of the owner; �J �Qti) That is Insurance purchased by you to cover your liability as a tenant for "property damage" to premises rented to you or temporarlly occupied by you with permission of the owner; or GCj (iv) If the loss arises out of the maintenance or use of aircraft, "autos" or watercraft to the extent not P� subject to Exclusion g. of Section I — Coverage A — Bodily Injury And Property Damage Liability. CG 00 01 12 07 0 180 Properties, Inc. , 2000 Page 11 of 16 WORKERS' COMPENSATION DECLARATION I Marc Payap hereby affirm under penalty of'perjury, the (Name/Tide) following declaration I certify on behalf of_yve-8 Coast Communiry Development. LLC that during the term of my (Consultant/Conipany Name) contract for Recreation Services Agreement N-2014-14(i services with the City of Santa Ana, I will not employ any person in any manner 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 SWI forthwith comply with those provisions and provide proof of workers' compensation coverage. DATE: 10/01/2016 J�J,-c2 CALk- I By: Name: Marc Title: Managing Member Telephone: 949-954-0621 WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND 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,