HomeMy WebLinkAboutDAVID VOLZ DESIGN-2017City of Santa R -a
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AGREEMENT TERMINATION FORM
�202-�
Please complete this form in its entirety when the attached agreement and all
City of Santa Ana
arnendnnents (it any) are no longer in effect.
Note: If your agreement is grant related, please ensure that all grant retention requirements
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have been satisfied prior to sighing the termination form.
Clerk of the Council
Is the agreements) a permanent record? Yes No
Return form to the Clerk of the Council Office (M-30).
Call 647-1520 it you have any questions.
The agreement with
No. was completed on r 4and final payment has been made.
(List all a�ymeendments. Use space before if needed.)
t61 --q Department:
GL �L
Phone/Ext.:
24. -7 Signature: _..
Date: 4 � ,Z -:
Revised: 10-18-16
A-2017-062
CONSULTANT AGREEMENT
CITY OF SANTA ANA
This AGREEMENT is made and entered into this 5th day of April, 2017 by and between the City of
Santa Ana, California, a charter city and municipal corporation organized and existing under the
Constitution and laws of the State of California, (hereinafter "CITY") and David Volz Design
(hereinafter "CONSULTANT").
RECITALS
A. The CITY desires to retain a consultant having special skill and knowledge in the field of
Architectural and Landscape Architectural Design
B. CONSULTANT represents that CONSULTANT is able and willing to provide such services to
the CITY.
C. In undertaking the performance of this Agreement, CONSULTANT represents that it is
knowledgeable in its field and that any services performed by CONSULTANT under this
Agreement will be performed in compliance with such standards as may reasonably be expected
from a professional consulting firm in the field.
NOW THEREFORE, in consideration of the mutual and respective promises, and subject to the terms
and conditions hereinafter set forth, the parties agree as follows:
1. SCOPE OF SERVICES
CONSULTANT shall perform during the term of this Agreement, the tasks and obligations
including all labor, materials, tools, equipment, and incidental customary work required to fully and
adequately complete the services described and set forth in Scope of Services - Exhibit A, attached
hereto and incorporated by reference. The Scope of Services shall include a Schedule for the Delivery
of Services which shall be delivered as prescribed, beginning upon the CITY's issuance of a Notice to
Proceed. '
2. COMPENSATION
CITY agrees to pay, and CONSULTANT agrees to accept as total payment for its services for
CITY, an amount not to exceed $225,019 in accordance to rates and charge identified in Compensation
— Exhibit B, attached hereto and incorporated by reference. This includes a 10 percent contingency
amount of $20,456 which shall be expended at the sole discretion of the City. Compensation shall be
processed in accordance with Section 18.
3. TERM
This Agreement shall commence on the date first written above for a two -Year term with the
option for the CITY to grant up to two (2) one --year renewal option(s) exercisable by the City Manager
and the City Attorney, unless terminated earlier in accordance with Section 15, below.
INSURANCE NOT ON FILE
WORK MAY NOT PROCEED
CLERK OF COUNCIL
DATE: y'51-,
rev.01/26/2017 Page 1 of 8
4. INDEPENDENT CONTRACTOR
CONSULTANT shall, during the entire term of this Agreement, be construed to be an
independent contractor and not an employee of the CITY. This Agreement is not intended nor shall it be
construed to create an employer -employee relationship, a joint venture relationship, or to allow the
CITY to exercise discretion or control over the professional manner in which CONSULTANT performs
the services which are the subject matter of this Agreement; however, the services to be provided by
CONSULTANT shall be provided in a manner consistent with all applicable standards and regulations
governing such services. CONSULTANT shall pay all salaries and wages, employer's social security
taxes, unemployment insurance and similar taxes relating to employees and shall be responsible for all
applicable withholding taxes.
5. OWNERSHIP OF MATERIALS
This Agreement creates a non-exclusive and perpetual license for CITY to copy, use, modify,
reuse, or sublicense any and all copyrights, designs, and other intellectual property embodied in plans,
specifications, studies, drawings, estimates, and other documents or works of authorship fixed in any
tangible medium of expression, including but not limited to, physical drawings or data magnetically or
otherwise recorded on computer diskettes, which are prepared or caused to be prepared by
CONSULTANT under this Agreement ("Documents & Data"). CONSULTANT shall require all
subcontractors to agree in writing that CITY is granted a non-exclusive and perpetual license for any
Documents & Data the subcontractor prepares under this Agreement. CONSULTANT represents and
warrants that CONSULTANT has the legal right to license any and all Documents & Data.
CONSULTANT makes no such representation and warranty in regard to Documents & Data which were
provided to CONSULTANT by the CITY. CITY shall not be limited in any way in its use of the
Documents and Data at any time, provided that any such use not within the purposes intended by this
Agreement shall be at CITY's sole risk.
6. INSURANCE
Prior to undertaking performance of work under this Agreement, CONSULTANT shall maintain
and shall require its subcontractors, if any, to obtain and maintain insurance as described below:
a. Commercial General Liability Insurance. CONSULTANT shall maintain commercial
general liability insurance naming the CITY, its officers, employees, agents, volunteers
and representatives as additional insured(s) and shall include, but not be limited to
protection against claims arising from bodily and personal injury, including death
resulting therefrom and damage to property, resulting from any act or occurrence arising
out of CONSULTANT's operations in the performance of this Agreement, including,
without limitation, acts involving vehicles. The amounts of insurance shall be not less
than the following: single limit coverage applying to bodily and personal injury,
including death resulting therefrom, and property damage, in the total amount of
$1,000,000 per occurrence, with $2,000,000 in the aggregate. Such insurance shall (a)
name the CITY, its officers, employees, agents, and representatives as additional
insured(s); (b) be primary and not contributory with respect to insurance or self-insurance
programs maintained by the CITY; and (c) contain standard separation of insured's
provisions.
Page 2 of 8
b. Business automobile liability insurance, or equivalent form, with a combined single limit
of not less than $1,000,000 per occurrence. Such insurance shall include coverage for
owned, hired and non -owned automobiles.
C. Worker's Compensation Insurance. In accordance with the provisions of Section 3700 of
the Labor Code, CONSULTANT, if CONSULTANT has any employees, is required to
be insured against liability for worker's compensation or to undertake self-insurance.
Prior to commencing the performance of the work under this Agreement,
CONSULTANT agrees to obtain and maintain any employer's liability insurance with
limits not less than $1,000,000 per accident.
d. If CONSULTANT is or employs a licensed professional such as an architect or engineer:
Professional liability (errors and omissions) insurance, with a combined single limit of
not less than $1,000,000 per claim with $2,000,000 in the aggregate.
e. The following requirements apply to the insurance to be provided by CONSULTANT
pursuant to this section:
i. CONSULTANT shall maintain all insurance required above in full force and
effect for the entire period covered by this Agreement.
ii. Certificates of insurance shall be furnished to the CITY upon execution of this
Agreement and shall be approved by the CITY.
iii. Certificates and policies shall state that the policies shall not be canceled or
reduced in coverage or changed in any other material aspect without thirty (30)
days prior written notice to the CITY.
iv. CONSULTANT shall supply CITY with a fully executed additional insured
endorsement.
f. If CONSULTANT fails or refuses to produce or maintain the insurance required by this
section or fails or refuses to furnish the CITY with required proof that insurance has been
procured and is in force and paid for, the CITY shall have the right, at the CITY's
election, to forthwith terminate this Agreement. Such termination shall not affect
CONSULTANT's right to be paid for its time and materials expended prior to
notification of termination. CONSULTANT waives the right to receive compensation
and agrees to indemnify the CITY for any work performed prior to approval of insurance
by the CITY.
7. INDEMNIFICATION
To the fullest extent permitted by law, CONSULTANT shall indemnify, defend and hold
harmless CITY, its officers, agents and employees (collectively, the "indemnified parties") from and
against any and all claims (including, without limitation, claims for bodily injury, death or damage to
property), demands, obligations, damages, actions, causes of action, suits, losses, judgments, fines,
penalties, liabilities, costs and expenses (including, without limitation, attorney's fees, disbursements
and court costs) of every kind and nature whatsoever (individually, a claim; collectively; "claims"),
related to any work performed or services provided under this Agreement arising out of, relating to or
pertaining to the negligence, recklessness or willful misconduct of CONSULTANT, its principals,
officers, agents, employees, vendors, suppliers, contractors, subcontractors, anyone employed directly or
indirectly by any of them or for whose acts they may be liable for any or all of them. Notwithstanding
Page 3 of 8
®
QC®R®
� CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
5/12/2017
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 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
Cornerstone Specialty Insurance Services, Inc.
14252 Culver Drive, A299
Irvine CA 92604
CONTACT Aimee Guesno
NAME:
PHONE Ext• (714)731-7700 AXNo:(719)731-7750
AIL
ADDRESS:aimee@cornerstonespecialty.com
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURERA:RLI Insurance Comnpany
13056
INSURED.
DAVID VOLZ DESIGN LANDSCAPE ARCHITECTS, INC.
151 Kalmus Drive, Ste. M-8
Costa Mesa CA 92626
INSURERB:Liberty Insurance Underwriters
19917
INSURERC:
INSURERD:
INSURER E :
1 INSURERF:
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.
INSR
LTR
TYPE OF INSURANCE
DDL
S BR
POLICY NUMBER
POLICY EFF
MM/DDIYYYY
PO��CY EXPP
MM/[3DNYYY
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE F_x1OCCUR
EACH OCCURRENCE
$ 2,000,000
DA AGE STOEa RENT—accuEErc[ ence —
PREMISES
$ 1,000,000
X
MED EXP (Any one person)
$ 10,000
ADDT' L INSURED/PRIMARY
X
PSB0001408
3/14/2017
3/14/2018
X
BLNKT WVR OF SUBRO
PERSONAL & ADV INJURY
$ INCLUDED
PER FORM #PPB3040212
AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$ 4,000,000
GENIL
AS REQUIRED BY WRITTEN
POLICY JEO- 0 LOC
CONTRACT
PRODUCTS-COMP/OPAGG
$ 4,000,000
OTHER;
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
Ea accident
$ 2,000,000
BODILY INJURY (Per person)
$
A
X
ANY AUTO
ALLOWNED SCHEDULED
AUTOS AUTOS
NON -OWNED
HIRED AUTOS IX
HIRED AUTOS AUTOS
PSB0001408
3/14/2017
3/14/2018
BODILY INJURY (Per accident)
$
PROPERTYDAMAGE
Per accident
$
$
UMBRELLA LIAB I
OCCUR
EACH OCCURRENCE
$
AGGREGATE
$
EXCESS LIAB
CLAIMS -MADE
DED I I RETENTION $
$
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
(Mandatory In NH)
N/A
PSWO001346
3/14/2017
3/14/2018
PER OTH.
X STATUTE ER
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE- EA EMPLOYE 11
$ 1,000,000
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
1 $ 1,000,000
B
PROFESSIONAL LIABILITY
AEA100668-0004
3/14/2017
3/14/2018
EACH CAIM $2,000,000
Claims Made
ANNUAL AGGREGATE $2,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space Is required)
the City of Santa Ana, its officers, employees, agents, and representatives are named as Additional
Insured for General Liability but only if required by written contract with the Named Insured prior to an
occurrence and as per attached endorsement. Coverage is subject to all policy terms and conditions. *30
days notice of cancellation, except for 10 days notice for non-payment of premium. For Professional
Liability coverage, the aggregate limit is the total insurance available jo,ali covered claims reported
within the policy period. REVIEWED BY: EUNICE HEREDIA (PG OF
City of Santa Ana
ATTN: Gaby Lomeli
20 Civic Center Plaza
Santa Ana, CA 92701
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
imee Guesno/AIMEEG
ACORD 25 (2014/01)
INS025 (gnuni)
O 1988.2014 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
Policy Number: PSB0001408 RLI Insurance Company
Named Insured: David Volz Design Landscape Architects, Inc.
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
RLIPack° FOR PROFESSIONALS
BLANKET ADDITIONAL INSURED ENDORSEMENT
This endorsement modifies insurance provided under the following:
BUSINESSOWNERS COVERAGE FORM - SECTION II — LIABILITY
1-. C. WHO IS AN INSURED is amended to include as
an additional insured any person or organization that
you agree in a contract or agreement requiring
Insurance to include as an additional insured on this
policy, but only with respect to liability for "bodily
injury", "property damage" or "personal and
advertising injury" caused in whole or in part by you
or those acting on your behalf:
a. In the performance of your ongoing operations;
b. In connection with premises owned by or rented
to you; or
c. In connection with "your work" and included
within the "product -completed operations
hazard".
2. The insurance provided to the additional insured by
this endorsement is limited as follows:
a. This insurance does not apply on any basis to
any person or organization for which coverage
as an additional insured specifically is added by
another endorsement to this policy.
b. This insurance does not apply to the rendering
of or failure to render any "professional
services".
c. This endorsement does not increase any of the
limits of insurance stated in D. Liability And
Medical Expenses Limits of Insurance.
3. The following is added to SECTION III H.2. Other
Insurance — COMMON POLICY CONDITIONS
(BUT APPLICABLE ONLY TO SECTION 11 —
LIABILITY)
However, if you specifically agree in a contract or
agreement that the insurance provided to an
additional insured under this policy must apply on a
primary basis, or a primary and non-contributory
basis, this insurance is primary to other insurance
that is available to such additional insured which
covers such additional insured as a named insured,
and we will not share with that other insurance,
provided that:
a. The "bodily injury" or "property damage" for
which coverage is sought occurs after you have
entered into that contract or agreement; or
b. The "personal and advertising injury" for which
coverage is sought arises out of an offense
committed after you have entered into that
contract or agreement.
4. The following is added to SECTION III K. 2.
Transfer of Rights of Recovery Against Others to
Us — COMMON POLICY CONDITIONS (BUT
APPLICABLE TO ONLY TO SECTION 11 —
LIABILITY)
We waive any rights of recovery we may have
against any person or organization because of
payments we make for "bodily Injury", "property
damage" or "personal and advertising injury" arising
out of "your work" performed by you, or on your
behalf, under a contract or agreement with that
person or organization. We waive these rights only
where you have agreed to do so as part of a
contract or agreement with such person or
organization entered into by you before the "bodily
injury" or "property damage" occurs, or the "personal
and advertising injury' offense is committed.
ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED.
PPB 304 02 12 Page 1 of 1
REVIEW D BY: EUNIGE H,EREDIA (PG r,2 }
the foregoing, nothing herein shall be construed to require CONSULTANT to indemnify the
indemnified parties from any claim arising from the sole negligence or willful misconduct of the
indemnified parties. This indemnity shall apply to all claims and liability regardless of whether any
insurance policies are applicable. The policy limits do not act as a limitation upon the amount of
indemnification to be provided by the CONSULTANT.
8. INTELLECTUAL PROPERTY INDEMNIFICATION
CONSULTANT shall defend and indemnify the CITY, its officers, agents, representatives, and
employees against any and all liability, including costs, for infringement of any United States' letters
patent, trademark, or copyright infringement, including costs, contained in the work product or
documents provided by CONSULTANT to the CITY pursuant to this Agreement.
9. RECORDS
CONSULTANT shall keep records and invoices in connection with the work to be performed
under this Agreement. CONSULTANT shall maintain complete and accurate records with respect to the
costs incurred under this Agreement and any services, expenditures, and disbursements charged to the
CITY for a minimum period of three (3) years, or for any longer period required by law, from the date of
final payment to CONSULTANT under this Agreement. All such records and invoices shall be clearly
identifiable. CONSULTANT shall allow a representative of the CITY to examine, audit, and make
transcripts or copies of such records and any other documents created pursuant to this Agreement during
regular business hours. CONSULTANT shall allow inspection of all work, data, documents,
proceedings, and activities related to this Agreement for a period of three (3) years from the date of final
payment to CONSULTANT under this Agreement.
10. CONFIDENTIALITY
If CONSULTANT receives from the CITY information which due to the nature of such
information is reasonably understood to be confidential and/or proprietary, CONSULTANT agrees that
it shall not use or disclose such information except in the performance of this Agreement, and further
agrees to exercise the same degree of care it uses to protect its own information of like importance, but
in no event less than reasonable care. "Confidential Information" shall include all nonpublic
information. Confidential information includes not only written information, but also information
transferred orally, visually, electronically, or by other means. Confidential information disclosed to
either party by any subsidiary and/or agent of the other party is covered by this Agreement. The
foregoing obligations of non-use and nondisclosure shall not apply to any information that (a) has been
disclosed in publicly available sources; (b) is, through no fault of the CONSULTANT disclosed in a
publicly available source; (c) is in rightful possession of the CONSULTANT without an obligation of
confidentiality; (d) is required to be disclosed by operation of law; or (e) is independently developed by
the CONSULTANT without reference to information disclosed by the CITY.
11. CONFLICT OF INTEREST CLAUSE
CONSULTANT covenants that it presently has no interests and shall not have interests, direct or
indirect, which would conflict in any manner with performance of services. Conflict may be further
specified in Certifications - Exhibit C, attached hereto and incorporated in this Agreement by
reference.
Page 4 of 8
12. DISCRIMINATION
CONSULTANT shall not discriminate because of race, color, creed, religion, sex, marital status,
sexual orientation, age, national origin, ancestry, or disability, as defined and prohibited by applicable
law, in the recruitment, selection, training, utilization, promotion, termination or other employment
related activities. CONSULTANT affirms that it is an equal opportunity employer and shall comply
with all applicable federal, state and local laws and regulations and as further specified in Certifications
- Exhibit C, attached hereto and incorporated in this Agreement by reference.
13. EXCLUSIVITY AND AMENDMENT
This Agreement represents the complete and exclusive statement between the CITY and
CONSULTANT, and supersedes any and all other agreements, oral or written, between the parties. In
the event of a conflict between the terms of this Agreement and any attachments hereto, the terms of this
Agreement shall prevail. This Agreement may not be modified except by written instrument signed by
the CITY and by an authorized representative of CONSULTANT. The parties agree that any terms or
conditions of any purchase order or other instrument that are inconsistent with, or in addition to, the
terns and conditions hereof, shall not bind or obligate CONSULTANT or the CITY. Each party to this
Agreement acknowledges that no representations, inducements, promises or agreements, orally or
otherwise, have been made by any party, or anyone acting on behalf of any party, which is not embodied
herein.
14. ASSIGNMENT
Inasmuch as this Agreement is intended to secure the specialized services of CONSULTANT,
CONSULTANT may not assign, transfer, delegate, or subcontract any interest herein without the prior
written consent of the CITY and any such assignment, transfer, delegation or subcontract without the
CITY's prior written consent shall be considered null and void. Nothing in this Agreement shall be
construed to limit the CITY's ability to have any of the services which are the subject to this Agreement
performed by CITY personnel or by other consultants retained by CITY.
15. TERMINATION
This Agreement may be terminated by the CITY upon thirty (30) days written notice of
termination. In such event, CONSULTANT shall be entitled to receive and the CITY shall pay
CONSULTANT compensation for all services performed by CONSULTANT prior to receipt of such
notice of termination, subject to the following conditions:
a. As a condition of such payment, the Executive Director may require CONSULTANT to
deliver to the CITY all work product(s) completed as of such date, and in such case such
work product shall be the property of the CITY unless prohibited by law, and
CONSULTANT consents to the CITY's use thereof for such purposes as the CITY deems
appropriate.
b. Payment need not be made for work which fails to meet the standard of performance
specified in the Recitals of this Agreement.
Page 5 of 8
16. JURISDICTION - VENUE
This Agreement has been executed and delivered in the State of California and the validity,
interpretation, performance, and enforcement of any of the clauses of this Agreement shall be
determined and governed by the laws of the State of California. Both parties further agree that Orange
County, California, shall be the venue for any action or proceeding that may be brought or arise out of,
in connection with or by reason of this Agreement.
17. PROFESSIONAL LICENSES
CONSULTANT shall, throughout the term of this Agreement, maintain all necessary licenses,
permits, approvals, waivers, and exemptions necessary for the provision of the services hereunder and
required by the laws and regulations of the United States, the State of California, the City of Santa Ana
and all other governmental agencies. CONSULTANT shall notify the CITY immediately and in writing
of its inability to obtain or maintain such permits, licenses, approvals, waivers, and exemptions. Said
inability shall be cause for termination of this Agreement.
18. PAYMENTS & INVOICES
a. Payment by CITY shall be made within forty-five (45) days following receipt of proper
invoice evidencing work performed, subject to CITY accounting procedures. Payment
need not be made for work which fails to meet the standards of performance set forth in
the Recitals which may reasonably be expected by CITY.
b. Invoices should be submitted on the 15th of each month and shall include the following
information at a minimum:
i. CONSULTANT's invoice number and CITY's agreement number
ii. Beginning and ending dates for services
iii. CITY Project and/or Task Order number and/or name (if applicable)
iv. Work site address/location (if applicable)
V. Tasks or deliverables completed and percentage (%) of total services completed.
vi. Remaining Overall and Task Order budget available
19. MISCELLANEOUS PROVISIONS
a. Additional provisions, if any, are identified as Additional Provisions, Exhibit D, attached
hereto and incorporated into this Agreement by reference.
b. Each undersigned represents and warrants that its signature herein below has the power,
authority and right to bind their respective parties to each of the terms of this Agreement,
and shall indemnify CITY fully, including reasonable costs and attorney's fees, for any
injuries or damages to CITY in the event that such authority or power is not, in fact, held
by the signatory or is withdrawn.
C. All Exhibits referenced herein and attached hereto shall be incorporated as if fully set
forth in the body of this Agreement.
Page 6 of 8
20. NOTICE
Any notice, tender, demand, delivery, or other communication pursuant to this Agreement shall
be in writing and shall be deemed to be properly given if delivered in person or mailed by first class or
certified mail, postage prepaid, or sent by fax or other telegraphic communication in the manner
provided in this Section, to the following persons:
To CITY:
Clerk of the City Council
City of Santa Ana
20 Civic Center Plaza (M-30)
P.O. Box 1988
Santa Ana, CA 92702
Fax: (714) 647-6956
With courtesy copies to:
Executive Director, Public Works Agency
City of Santa Ana
20 Civic Center Plaza (M-21)
P.O. Box 1988
Santa Ana, CA 92702
Fax: (714) 647-5635
To CONSULTANT:
David Volz
President
David Volz Design Landscape Architects, Inc.
151 Kalmus Drive Suite M8
Costa Mesa, CA 92626
Fax: (714) 641-1323
City Attorney
City of Santa Ana
20 Civic Center Plaza (M-29)
P.O. Box 1988
Santa Ana, CA 92702
Fax: (714) 647-6515
A party may change its address by giving notice in writing to the other party. Thereafter, any
communication shall be addressed and transmitted to the new address. If sent by mail, communication
shall be effective or deemed to have been given three (3) days after it has been deposited in the United
States mail, duly registered or certified, with postage prepaid, and addressed as set forth above. If sent
by fax, communication shall be effective or deemed to have been given twenty-four (24) hours after the
time set forth on the transmission report issued by the transmitting facsimile machine, addressed as set
forth above. For purposes of calculating these time frames, weekends, federal, state, County or CITY
holidays shall be excluded.
Page 7 of 8
IN WITNESS WHEREOF, the parties hereto have executed this Agreement on the day and year first
above written.
ATTEST:
MARIA D. HUIZAR
Clerk of the Council
APPROVED AS TO FORM:
SONIA R. CARVALHO
City Attorney
By: &
JWIN FUNK
Assistant City Attorney
RECOMMENDED
FRED MOUSAVIP01
Executive Director
Public Works Agency
APPROVAL:
CITY OF SANTA ANA
Robert C. Cortez
Deputy City Manager
CONSULTANT:
David Volz Design
1
DAVID VOLZ
President
Tax ID# 33 0835 124
Page 8 of 8
EXHIBIT A
SCOPE OF SERVICES
David Volz Design will provide construction documents for public
bidding of Santiago Park Gas House Area development plans.
The basis of the design will be the city supplied program and the
concept plan to be developed in Task 1 below.
Task 1 - Pre -Design
Initial project services will include a site analysis, review of the
preliminary plan and review of background documents. A kick-off
meeting with the city project staff will be held to review initial find-
ings, discuss the project scope, goals and objectives, potential
elements and issues and schedule. The DVD team will facilitate
and lead three (3) concept planning meetings with the Park San-
tiago Neighborhood Association (PSNA) to obtain input and to
finalize a concept plan for this area.
Meetings - Project Kick-off Meeting with city staff
Three (3) Concept Planning Meetings with PSNA
Presentation and review for approval by the
PRCSA
Deliverables - Synopsis of initial reviews and project schedule
Up to three (3) rendered concept plans for
community review
Final Concept Plan for the area development
Task 2 - Design Development (50% plans)
The park design will be developed based upon the approved con-
ceptual design. The DVD team will undertake initial engineering,
landscape architectural, and electrical engineering.
Meetings - City Project Team Review Meeting
Deliverables - 50% construction documents, draft technical
specifications, opinion of probable cost, lighting
layouts, photometrics, materials submittal. Also,
site survey and utilities information will be
submitted for city review.
Task 3A - Construction Documents (90% plans)
Construction documents will be updated based upon city guid-
ance after review of Design Development documents. The up-
dated plans will provide detailed engineering, landscape, irriga-
tion and construction layout plans. Plans shall include:
Tusfln Branch Trails.
City of Tustin
Los Rios Park. City of San Juan Capistrano
Pioneer Road Park.
City of Tustin
Hu deas Barton Amphitheater. City of Yorha Linda
Stanton Central Park. City of Stanton
11111aY1111®
........................................................................................................................................................-...�-
Designing landscape that create community...
SCOPE OF SERVICES
Los Rios Park, City of Ban Juan Capistrano
Heniage Island Park, City of Cerritos Tustin Branch Trails. City of Tustin
Admiral Kidd Park City of Long Beach
Title Sheet
Civil Engineering
• Site Erosion Plan
• Parking lot at Valencia Avenue
• Horizontal and Vertical Control Plan
• Grading and on -site Drainage Plan
• Site Utility Plan
Architectural (Gas House and Restroom)
• Plans Elevations, Electrical, Plumbing details
Structural Engineering Details (Gas House and Restroom)
• Plans, details
• Structural calculations
Landscape Architecture
• Site Layout / Construction Plans and Details
(including plumbing)
• Site Sections, as applicable
• Planting Plans/Details/Notes
• Irrigation Plans/Details/Calculations/Notes
Electrical
• Electrical Site Plan to include lighting and electrical outlets
• Photometrics
• Location of panels, switchgear, meters
• Schedules
• Details
• Notes, specifications
Meetings - City Project Team Review Meeting
Deliverables - Construction Document submittal (90% and
100%) for plan review by Park, Recreation and
Community Services Agency, Planning and
Building Agency and Public Works Agency. This
Construction Plan set will include technical
specifications and an updated opinion of probable
costs.
Task 3B - Final Construction Documents (100%)
Construction plans, specifications, and estimate will be updated
based upon city reviews. The final design package will be read-
ied for bidding and construction
Meetings - Final Review Meeting with city project staff
Deliverables - Turnover of files for city records and bidding.
........................................................................................................................................................
OVID
Designing landscape that create community...
SCOPE OF SERVICES
Task 4 - Bid Advertisement, Construction Administration,
Record Drawings
Assistance During Bidding
DVD will assist the city staff during bidding by answering "Re-
quests for Information" from the potential bidders, preparing
and distributing necessary addendum and assisting with the
bid evaluations
Construction Period Assistance
During construction David Volz Design will attend the pre -con-
struction meeting, review shop drawings and submittals, and
change orders, answer requests for information and make
site visits at key times during construction. DVD will provide
support as -needed to City staff, project manager, general
contractor and the City Inspector. DVD will attend the final
walk through of the project and provide a written final review
of the project.
As -Built Drawings
Once the project construction is complete DVD will prepare
as -built drawings for the city based on red lined plans of field
conditions provided by the construction contractor.
Meetings - Attend meetings as directed by city staff during
bidding and construction.
Deliverables - Provide site reviews, RFI responses, submittal
reviews and general assistance to the city's
construction management team.
Los Rias Park,
City of San Juan Capistrano
Stanton Central Park. City of Stanton
Washington Street Mini Park.
City of Diamond Bar
Heniage Island Park, City of Cerritos
1t1VIlt
....esigning lan........ '1a.n'...dscape a*p.e..that....create.........communi...........ty.......................................................................................................
D
EXHIBIT B
FEE SCHEDULE
David Volz Design proposes the following Not to Exceed fee schedule to provide the services identified in this
proposal. The tasks listed below are offered at a fixed fee for the design services for identified program elements.
The services included in this spread sheet are project management, park design, landscape architecture, and
listed support services.
TASK 1 - PRE DESIGN
A. Landscape Architect - Project Management, Pre
Design
B. Civil Engineering
C. Architectural / Structural Engineering
D. Electrical Engineering
TASK 2 - DESIGN DEVELOPMENT (50% PLANS)
A. Landscape Architect - Project Management,
Design Development
B. Civil Engineering
C. Architectural / Structural Engineering
D. Electrical Engineering
PR
LA
PP
CT
AD
Total
$220
$193
$135
$121
$115
Hrs
Fee
8
8
8
12
2
[38
J$ 6,066
c'I7�I m i)■mull
TASK 3A - CONSTRUCTION DOCUMENTS (90% PLANS)
A. Landscape Architect - Project Management,
Construction Documents 32 1 44 1 42
B. Civil Engineering
C. Architectural / Structural Engineering
D. Electrical Engineering
44
$ 5,290
$ 2,523
$ 631
$ 14,510
12 1162 I $ 25,940
$ 17,825
$ 8,503
$ 2,126
$ 54,393
12 1174 I $ 27,906
$ 31,223
$ 14,893
$ 3,723
TASK 313 - FINAL CONSTRUCTION DOCUMENTS
A. Landscape Architect - Project Management, Final 2 I 8 6 8 2
Construction Documents
B. Civil Engineering
C. Architectural / Structural Engineering
D. Electrical Engineering
Proposal to Provide Landscape Architectural Services for
Santiago Park Gas House, City of Santa Ana
$
77,745
26 I $
3,992
$
10,408
$
4,964
$
1,241
$ 20,605
2/21/2017
FEE SCHEDULE
TASK 4 - BID ADVERTISEMENT, CONSTRUCTION ADMINSTRATION, RECORD DRAWINGS
A. Landscape Architect - Project Management, Bid
Advertisement, Construction Administration, 6 6 6 16 4 38 J$ 5,684
Record Drawings
B. Civil Engineering $ 2,760
C. Architectural / Structural Engineering $ 1,317
D. Electrical Engineering $ 329
$ 10,090
OPTIONAL:
Site Survey $ 9,545
Geotechnical (LGC Geotechnical) $ 16,675
REIMBURSABLES
Reimbursable expenses, printing, copying, postage, etc.
where identified included in proposed fee.
Estimate $ 1,000
TOTAL PROPOSED DESIGN FEE $ 204,563
ASSUMPTIONS:
1. Subconsultant services, civil engineering and electrical engineering, listed above include administrative mark-
up of 15%.
2. Boundary and property line research if needed will required an additional fee.
Proposal to Provide Landscape Architectural Services for
Santiago Park Gas House, City of Santa Ana
2/21/2017
EXHIBIT C
ATTACHMENT C
APPENDIX
ATTACHMENT 3-1: NON -COLLUSION AFFIDAVIT
CERTIFICATIONS
CITY OF SANTA ANA
REQUEST FOR PROPOSALS
FOR
SANTIAGO PARK GAS HOUSE AREA DEVELOPMENT
RFP NO.: 16-040
NON -COLLUSION AFFIDAVIT
(Title 23 United States Code Section 112 and
Public Contract Code Section 7106)
To the CITY OF SANTA ANA DEPARTMENT OF PUBLIC WORKS
In accordance with Title 23 United States Code Section 112 and Public Contract Code 7106 the BIDDER declares that the bid
is not made in the interest of, or on behalf of, any undisclosed person, partnership, company, association, organization, or
corporation; that the bid is genuine and not collusive or sham; that the BIDDER has not directly or indirectly induced or
solicited any other BIDDER to put in a false or sham bid, and has not directly or indirectly colluded, conspired, connived or
agreed with any BIDDER or anyone else to put in a sham bid, or that anyone shall refrain from bidding, that the BIDDER has
not in any manner, directly or indirectly, sought by agreement, communication, or conference with anyone to fix the bid price
of the BIDDER or any BIDDER, or to fix any overhead, profit, or cost element of the bid price, or of that of any other
BIDDER, or to secure any advantage against the public body awarding the contract of anyone interested in the proposed
contract; that all statements contained in the bid are true; and, further, that the BIDDER has not, directly or indirectly,
submitted his or her bid price or any breakdown thereof, or the contents thereof, or divulged information or data relative
thereto, or paid, and will not pay, any fee to any corporation, partnership, company association, organization, bid depository,
or to any member or agent thereof to effectuate a collusive or sham bid.
Note: The above Non -collusion Affidavit is part of the Proposal. Signing this Proposal on the signature portion
thereof shall also constitute signature of this Non -collusion Affidavit. BIDDERS are cautioned that making a false
certiiiNation may subject the certifier to criminal prosecution.
Signed
State of California
County of
Subscribed and swom to (or affirmed) before me on this yam_ day of¢e}oher 20k, by �L/tee' 00^f 7
proved tome on the basis of satisfactory evidence to be the person(s) who appeared before me. rdi7�i�
Notary Public Signature Notary Public Seal
City of Santa Ana RFP 16-040
Page 24
APPENDIX
ATTACHMENT 3-2: NON -LOBBYING CERTIFICATION
CERTIFICATIONS
CITY OF SANTA ANA
REQUEST FOR PROPOSALS
FOR
SANTIAGO PARK GAS HOUSE AREA DEVELOPMENT
RFP NO.: 16-040
The prospective participant certifies, by signing and submitting this bid or proposal, to the best of his or her knowledge and
belief, that:
1. No federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any
person for influencing or attempting to influence an officer or employee of any federal agency, a Member of
Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with
the awarding of any federal contract, the making of any federal grant, the making of any federal loan, the
entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or
modification of any federal contract, grant, loan, or cooperative agreement
2. If any funds other than federal appropriated funds have been paid or will be paid to any person for
influencing or attempting to influence any officer or employee of any federal agency, a Member of Congress,
an officer or employee of Congress, or an employee of a Member of Congress in connection with this federal
contract, grant loan, loan or cooperative agreement, the undersigned shall complete and submit a "Disclosure
of Lobbying Activities".
This certification is a material representation of fact upon which reliance was placed when this transaction was made or
entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by Section
1352, Title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less
than $10,000 and not more than $100,000 for each such failure.
The prospective participant also agrees by submitting his or her bid or proposal that he or she shall require that the language of
this certification be included in all lower tier subcontracts, which exceed $100,000 and that all such sub recipients shall certify
and disclose accordingly.
Signed and Printed Name:vl• i
Title
I� ►..�i�
Date V
City of Santa Ana RFP 16-040
Page 25
APPENDIX
ATTACHMENT 3-3: NON-DISCRIMINATION CERTIFICATION
CERTIFICATIONS
CITY OF SANTA ANA
REQUEST FOR PROPOSALS
FOR
SANTIAGO PARK GAS HOUSE AREA DEVELOPMENT
RFP NO.: 16-040
The undersigned consultant or corporate officer, during the performance of this contract, certifies as follows:
The Consultant shall not discriminate against any employee or applicant for employment because of race,
color, religion, sex, or national origin. The Consultant shall take affirmative action to ensure that applicants
are employed, and that employees are treated during employment without, regard to their race, color,
religion, sex, or national origin. Such action shall include, but not be limited to, the following:
employment, upgrading, demotion, or transfer; recruitment or recruitment advertising; layoff or termination;
rates of pay or other forms of compensation; and selection for training, including apprenticeship. The
Consultant agrees to post in conspicuous places, available to employees and applicants for employment,
notices to be provided setting forth the provisions of this nondiscrimination clause.
2. The Consultant shall, in all solicitations or advertisements for employees placed by or on behalf of the
Consultant, state that all qualified applicants will receive consideration for employment without regard to
race, color, religion, sex, or national origin.
3. The Consultant shall send to each labor union or representative of workers with which he/she has a
collective bargaining agreement or other contract or understanding, a notice to be provided advising the said
labor union or workers' representatives of the Consultant's commitments under this section, and shall post
copies of the notice in conspicuous places available to employees and applicants for employment.
4. The Consultant shall comply with all provisions of Executive Order 11246 of September 24, 1965, and of
the rules, regulations, and relevant orders of the Secretary of Labor.
5. The Consultant shall famish all information and reports required by Executive Order 11246 of September
24, 1965, and by rules, regulations, and orders of the Secretary of Labor, or pursuant thereto, and will permit
access to his/her books, records, and accounts by the administering agency and the Secretary of Labor for
purposes of investigation, to ascertain compliance with such rules, regulations, and orders.
6. In the event of the Consultant's non-compliance with the nondiscrimination clauses of this contract or with
any of the said rules, regulations, or orders, the contract may be canceled, terminated, or suspended in whole
or in part and the Consultant may be declared ineligible for further Government contracts or federally
assisted construction contracts in accordance with procedures authorized in Execution Order 11246 of
September 24, 1965, and such other sanctions may be imposed and remedies invoked as provided in
Executive Order 11246 of September 24, 1965, or by rule, regulations, or order of the Secretary of Labor, or
as otherwise provided by law.
7. The Consultant shall include the portion of the sentence immediately preceding paragraph (I) and the
provisions of paragraphs (1) through (7) in every subcontract or purchase order unless exempted by rules,
regulations, or orders of the Secretary of Labor issued pursuant to Section 204 of Executive Order 11246 of
City of Santa Ana RFP 16-040
Page 26
EXHIBIT D
ADDITIONAL PROVISIONS
NONE
AC40R " CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
03/12/2018
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
CONTACT Aimee Guesno
NAME:
Cornerstone Specialty Insurance Services, Inc.
PgHCNNo Ext : (714) 731-7700 FAX,
No): (714) 731-7750
14252 Culver Drive, A299
E-MAIL amee@cornerstonespecialty.com
ADDRESS:
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURERA: RLI Insurance Company
Irvine CA 92604
INSURED
INSURER B : Liberty Insurance Underwriters
DAVID VOLZ DESIGN LANDSCAPE ARCHITECTS, INC.
INSURER C :
151 Kalmus Drive, Ste. M-8
INSURER D :
INSURER E :
Costa Mesa CA 92626
INSURER F :
COVERAGES CERTIFICATE NUMBER: 18/19 COVERAUES 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 CONTRACTOR 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.
INSR
LTR
TYPE OF INSURANCE
INSD
WVD
POLICY NUMBER
PO YEFF__P_0LlCYEXP
MM/DD/YYYY
MMIDDIYYYY
LIMITS
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE X OCCUR
EACH OCCURRENCE
$ 2,000,000
E
PREMISES Ea occurrence
$ 1,000,000
X
MED EXP (Any one person)
$ 10,000
ADDTL INSURED / PRIMARY
X
BLANKET WVR OF SUBRO
PERSONAL&ADV INJURY
$ INCLUDED
A
Y
PSB0001408
03/14/2018
03/14/2019
GEN'LAGGREGATE LIMITAPPLIES PER:
POLICY ❑X PRO ❑
JECT LOC
I GENERAL AGGREGATE
$ 4,000,000
PRODUCTS
$ 4,000,000
OTHER:
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
Ea accident
$ 2,000,000
BODILY INJURY (Per person)
$
ANY AUTO
A
OWNED SCHEDULED
AUTOS ONLY AUTOS
PSB0001408
03/14/2018
03/14/2019
BODILY INJURY (Per accident)
$
X
HIRED HNON-OWNED
AUTOS ONLY AUTOS ONLY
PROPERTY DAMAGE
Per accident
$
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
$
HCLAIMS-MADE
AGGREGATE
$
EXCESS LIAR
DED I I RETENTION $
$
AOFFICER/MEMBER
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR/PARTNER/EXECUTIVE
EXCLUDED? ❑
(Mandatory in NH)
NIA
PSW0001346
03/14/2018
03/14l2019
X STATUTE ERH
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYEE
$ 1,000,000
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
$ 1,000,000
PROFESSIONAL LIABILITY
B
CLAIMS MADE
AEA100668-0004
03/14/2018
03/14/2019
EACH CLAIM
$2,000,000
ANNUALAGGREGATE
$2,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required)
the City of Santa Ana, its officers, employees, agents, and representatives are named as Additional Insured for General Liability but only if required by
written contract with the Named Insured prior to an occurrence and as per attached endorsement. Coverage is subject to all policy terms and conditions. *30
days notice of cancellation, except for 10 days notice for non-payment of premium. For Professional Liability coverage, the aggregate limit is the total
insurance available for all covered claims reported within the policy period.
REVIEWED BY: LIlbi EUNICE HEREDIA (PG OF )
City of Santa Ana
20 Civic Center Plaza
Santa Ana
CA 92701
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
@ 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
Policy Number: PSB0001408 RLI Insurance Company
Named Insured: David Volz Design Landscape Architects, Inc.
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
RLIPack° FOR PROFESSIONALS
BLANKET ADDITIONAL INSURED ENDORSEMENT
This endorsement modifies insurance provided under the following:
BUSINESSOW NERS COVERAGE FORM - SECTION II — LIABILITY
1. C. WHO IS AN INSURED is amended to include as
an additional insured any person or organization that
you agree in a contract or agreement requiring
insurance to include as an additional insured on this
policy, but only with respect to liability for "bodily
injury", "property damage" or "personal and
advertising injury" caused in whole or in part by you
or those acting on your behalf:
a. In the performance of your ongoing operations;
b. In connection with premises owned by or rented
to you; or
c. In connection with "your work" and included
within the "product -completed operations
hazard".
2. The insurance provided to the additional insured by
this endorsement is limited as follows:
a. This insurance does not apply on any basis to
any person or organization for which coverage
as an additional insured specifically is added by
another endorsement to this policy.
b. This insurance does not apply to the rendering
of or failure to render any "professional
services".
c. This endorsement does not increase any of the
limits of insurance stated in D. Liability And
Medical Expenses Limits of Insurance.
3. The following is added to SECTION III H.2. Other
Insurance — COMMON POLICY CONDITIONS
(BUT APPLICABLE ONLY TO SECTION II —
LIABILITY)
However, if you specifically agree in a contract or
agreement that the insurance provided to an
additional insured under this policy must apply on a
primary basis, or a primary and non-contributory
basis, this insurance is primary to other insurance that
is available to such additional insured which covers
such additional insured as a named insured, and we
will not share with that other insurance, provided that:
a. The "bodily injury" or "property damage" for
which coverage is sought occurs after you have
entered into that contract or agreement; or
b. The "personal and advertising injury" for which
coverage is sought arises out of an offense
committed after you have entered into that
contract or agreement.
4. The following is added to SECTION III K. 2.
Transfer of Rights of Recovery Against Others to
Us — COMMON POLICY CONDITIONS (BUT
APPLICABLE TO ONLY TO SECTION II —
LIABILITY)
We waive any rights of recovery we may have against
any person or organization because of payments we
make for "bodily injury", "property damage" or
"personal and advertising injury" arising out of "your
work" performed by you, or on your behalf, under a
contract or agreement with that person or
organization. We waive these rights only where you
have agreed to do so as part of a contract or
agreement with such person or organization entered
into by you before the "bodily injury" or "property
damage" occurs, or the "personal and advertising
injury" offense is committed.
ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED.
PPB 304 02 12 Page 1 of 1
REVIEWED BY: EUNICE HEREDIA (PG 24Y )
WORKERS' COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT—CALIFORNIA
WC040306
(Ed. 04-84)
We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the
person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract
that requires you to obtain this agreement from us.)
You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the
Schedule.
The additional premium for this endorsement shall be % of the California workers' compensation premium otherwise due on such
remuneration.
Person or Organization
All persons or organizations that are party to a
contract that requires you to obtain this
agreement, provided you executed the contract
before a loss
Schedule
Job Description
Job performed for any person or organization that you
have agreed with in a written contract to provide this
agreement.
This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated.
(The information below is required only when this endorsement is issued subsequent to preparation of the policy.)
Endorsement Effective 03-14-2018 Policy No. PSW0001346
Insured David Volz Design Landscape Architects, Insurance Company RLI Insurance Company
Inc.
Endorsement No. 1
REVIEWED BY: EUNICE HEREDIA (PG OF )