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HomeMy WebLinkAboutMICHAEL BAKER INTERNATIONAL (FORMERLY PACIFIC MUNICIPAL CONSULTANTS AND RBF CONSULTINGCity of Santa Ana ' ~ I Clerk of the Council core office use only AGREEMENT TERMINATION FORM Please complete this form in its entirety when the attached agreement AT Err 12 M 9: Lj9 amendments (if any) are no longer in effect. _ Note: If your agreement is grant related, please ensure that all grant retention requirements Ci T Y OF SA NTA ANA have been satisfied prior to signing the termination form. ti Y` Cr COUNCIL Is the agreement(s) a permanent record? Yes _ No _ Return form to the Clerk of the Council Office (M-30). Call 647-1520 if you have any questions. The agreement with'cL No. /7 �� ® 3 was completed on/ and final payment has been made. (List all amendments. Use space below if needed.) Department: r X Phone/Ext.: — � ( Signature: n-8 R /EL Date: R:vi;ah: 12-13-16 MAYOR Miguel A. Pulido MAYOR PRO TEM Michele Martinez COUNCILMEMBERS P. David Benavides Vicente Sarmiento Jose Solorio Sal Tinajero Juan Villegas w t% Lbw Z co �. John McCarthy, PE, CFM z 6j Michael Baker International '- � 14725 Alton Parkway Irvine, CA 92618 CITU OF SANTA ANA 20 Civic Center Plaza • PA, Box 1988 Santa Ana, California 92702 www.santa-ana.or April 11, 2017 Reference: First Extension of Consultant Alareeiment No. A-201.6-093 Dear Mr. McCarthy: A-2016-093-40 ACTING CITY MANAGER Gerardo Mouet CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL Maria D. Huizar Pursuant to Section 3 of Agreement No. A-2016-093, entered into by Michael Baker International and the City of Santa Ana, dated May 4, 2016, the term of the Agreement is hereby extended for an additional one (1) year period from May 5, 2017 to May 5, 2015. The 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 fall force and effect. ,,Si ncerely, Fred Executive Director Public Works Agency APPROVED AS TO FORM: Sonia R. Carvalho City Attorney J funk Assistant City Attorney CITE' OF SANTA ANA: ROBERT C. CORTEZ Deputy City Manager Maria D. Huizar Clerk of the Council SANTA ANA CITY COUNCIL Miguel A. Pulido i, Michele Martinez i Vicente Sarmiento i Jose Solodo i P. David Benavides i Juan Villegas i Sal Tinajero Mayor Mayor Pro Tem. Ward 2 i Ward 1 i Ward 3 i Ward 4 i Ward 5 i Ward 6 hiPulidq nssnta-ana.or hiMartinez Santa-ana.or i VSarmientaCasanta-ana.orp 1 JSclonorNsama-arik' i nnenavides;i�sanla-ana.oro i STinaiero sarnta-ana-orri A RO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/09/05/22017017 ) 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 endorsement(s). PRODUCER Aon Risk Services Central, Inc. Pittsburgh PA office CONTACT NAME: PHONE (866) 283-7122 FAX (800) 363-0105 (A/C No. Ext): (ac. No.): Dominion Tower, 10th Floor 625 Liberty Avenue E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # Pittsburgh PA 15222-3110 USA INSURED INSURERA: XL insurance America Inc 24554 Michael Baker International, Inc 5 Hutton centre Drive Suite 500 INSURER B: Liberty Mutual Fire Ins CO 23035 INSURER C: Liberty Insurance Corporation 42404 Santa Ana CA 92707 USA INSURER D: Lloyd's Syndicate No. 2623 AA1128623 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570068250186 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 are as requested INSR LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDDIYYYY MM/DDIYYYY LIMITS B X COMMERCIAL GENERAL LIABILITY TB EACH OCCURRENCE $2,000,000' General Liability A. N $300,000 PREMISES Ea occurrence CLAIMS -MADE X❑ OCCUR MED EXP (Any one person) $10,000 PERSONAL &ADV INJURY $2,000,000 GEML AGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $4,000,000 POLICYPRO LOC EJECT PRODUCTS - COMP/OPAGG $4,000,000 OTHER: B AUTOMOBILE LIABILITY AS2-681-004145-727 08/30/201708/30/2018 COMBINED SINGLE LIMIT $2,000,000 Ea accident Commercial Auto - ADS BODILY INJURY ( Per person) X ANYAUTO OWNED SCHEDULED BODILY INJURY (Per accident) AUTOS ONLY AUTOS PROPERTY DAMAGE HIREDAUTOS NON -OWNED ONLY AUTOS ONLY Per accident A X UMBRELLALIAB X OCCUR US00079952LI17A 08/30/2017 08/30/2018 EACH OCCURRENCE $10,000,000 umbrella AGGREGATE $ZO, OOO,000 EXCESS LIAR CLAIMS -MADE DED X RETENTION SID, 000 C ORKS SCOM�PBENSATIONAND WORKERS wA768DO04145777 08/30/2017 08/30/2018 X STATUTE OTH- ER v/N workers Comp - ADS E.L. EACH ACCIDENT $1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE N OFFICER/MEMBER EXCLUDED? N / A E.L. DISEASE -EA EMPLOYEE $1,000,000 (Mandatory in NHi If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $1,000,000 D E&O-PL-Primary PSDEF170046008/31/2017 08/31/2018 Per Claim $5,000,000 Professional Liab. and CP Aggregate $5,000,000 SIR applies per policy ter s & condi ions DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) For Named Insured Only: Kim Hartsfield. RE: Project Name: Agreement Numbers A-2016-093 & A-2015-170. City of Santa Ana, its officers, employees, agents and representatives are included as Additional Insured in accordance with the policy provisions cf thz Gene; i^bil ity ^1 icy. General Liability --i-ed is Primary and Non -Contributory to Dther ilisUi'diiCe available to an�AdditionalIVlnsured'but only in accordance with the policy's provisions. Should General Liability, Automobile Liability and Workers' Compensation policies be cancelled before the expiration date there f, the policy provisions will govern how notice of cancellation may be delivered to certificate Holders in accordance with t olicy provisions of each policy, REVIEWED BY: EUNICE HEREDIA (PGJ OF ) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Santa Ana AUTHORIZED REPRESENTATIVE Attn: Ross Annex '.. 20 Civic Center Plaza, Po Box 1988 Santa Ana CA 92702-1988 USA ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD m 6 to cc 0 LnO h- 0 Z d W V 4� t W U POLICYNUMBER: T132-681-004145-717 COMMERCIAL GENERAL LIABILITY C{S201O0413 ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section U — Who Is An Insured is amended to include as an additional insured the n(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury', 11property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts nromissions; or 2. The ads or omissions of those acting on your behalf, in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 1. The insurance afforded to such additional 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 bebroader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds' the following additional exclusions apply: This insurance does not apply to "bodily injury" or ''pmpedydamage" Occurring after: Name OfAdditional Insured Penson(s) Or Organ ization(s): All persons cxorganizations with whom you have entered into awritten contract oragreement, prior toan "occurrence"oroffense, krprovide additional insured 1. All work, including matereb, parts or equipment furnished in connection with such wmdk, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed: or Z. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal asapart of the same project. C. With respect to the insurance afforded to these additional insureds, the following is added to Section III —Limits Of Insurance: If coverage provided to the additional insured is required byacontract oragreement, the most we will pay on behalf of the additional insured is the amount ofinsurance: 1. Required bythe contract u/agveement;or 2. Available under the applicable Limits of insurance shown inthe Declarations; whichever isless. This endorsement shall not increase the applicable Limits of insurance shown in the Declarations. Locadon(s)OfCovered Operations All locations asrequired byawritten contract or agreement entered into prior to an "occurrence" or Information required Vucomplete this Schedule, if not shown above, will beshown inthe Declarations, CG 20 10 04 13 (D Insurance Services Office, Inc., 2012 COMMERCIAL GENERAL LIABILITY CG2037O413 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART A. Section U—VVho Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury' or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included inthe "prod mc1s-comp|etedoperations hazand" t The insurance afforded to such additional 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. Name OfAdditional Insured Person(s) Or Organization(s): B. With respect to the insurance afforded to these additional insuneds, the following is added to Section III —Limits Of Insurance: U coverage provided to the additional insured is required by contract or agreement, the most we will pay on behalf of the additional insured is the amount ofinsurance: 1. Required bythe contractor agreement; or 2. Available under the applicable Limits of Insurance shown inthe Declarations, whichever isless. This endorsement shall not increase the applicable Limits ofInsurance shown inthe Declarations. SCHEDULE All persons ororganizations with whom you have entered into awritten contract oragreement, prior toan ,occunence"oroffense, bzprovide additional insured status. Location And Description Of Completed Operations All locations required by a written contract or agreement entered into prior Loan"occunence^or Information required to complete this Schedule, if not shown above, will be shown in the Declarations. CG 20 37 04 13 @ Insurance Services Office, Inc,2O1J - COMMERCIAL GENERAL LIABILITY CG2OO1O413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PROD U CTS/COM PLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance 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 Named Insured under such other insurance; and (2) You have agreed in writing in o contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. CG2OO1O413 @ Insurance Services Office, Inc., 2012 Page 1 of 1 Policy Number AS2-681-004145-727 Issued by LIBERTY MUTUAL FIRE INSURANCE COMPANY 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 COMMERCIAL LIABILITY — UMBRELLA COVERAGE FORM Schedule Name of Other Person(s) / Organizations : Email Address or mailing address: Number Days Notice: Per schedule on file with the company Per schedule on file with the company 30 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. We will send notice to the email or mailing address listed above at least 10 days, or the number of days listed above, if any, before the cancellation becomes effective. In no event does the notice to the third party exceed the notice to the first named insured. B. This advance 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 01 05 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. FZElf9'EwEC iSY: EUNICE HEIREDIA (FIG C71