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HomeMy WebLinkAboutKIMLEY-HORNCity of Santa Ana t Clerk of the Council core office u:� only AGREEMENT TERMINATION FORM Please complete this form in its entirety when the attached agreement and all amendments (if any) are no longer in effect. 279 VtC i Note. If your agreement is grant related, please ensure that all grant retention requirement tT g-� have been satisfied prior to signing the termination form. U UNT Is the agreement(s) a permanent record? Yes No ul o COUNCIL Return form to the Clerk of the Council Office (M-30). Call 647-1520 if you have any questions. The agreement with , No. /T �S — �% I was completed on �FyS� and final payment has been made. (List all amendments. Use space below N needed.) Department: Phone/Ext.: ( 7/— O y Signature: Date: Revised: 10-13-16 tlj x�0�3 MAYOR Miguel A, Pulido MAYOR PRO TEM Michele Martinez COUNCILMEMBERS P. David Benavides Vicente Sarmiento Jose Solorio Sal Tinajero Juan Villages Darren Adrian, PE Kimley-Horn 765 The City Drive, Suite 200 Orange, CA 92868 CITY OF SANTA ANA 20 Civic Center Plaza • PA. Box 1988 Santa Ana, California 92702 Www.sagta-ana.oro July 5, 2017 Reference: First Extension of Consultant Atsreement No. A-2015-171 Dear Mr, Adrian: A-2015-171 -01 ACTING CITY MANAGER Cynthia J. Kurtz CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL Marla D, Huizar Pursuant to Section 1 of Agreement No. A-2015-171, entered into by Kimley-Horn and the City of Santa Ana, dated August 5, 2015, the term of the Agreement is hereby extended for an additional one (1) year period from August 6, 2017 to August 6, 2018 to cover existing services that are on-going on the date of this extension. 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 full force and effect. Si 1 , r2. red Mousavipaw• Executive Director Public Works Agency CITY OF SANTA AN Cynthia J. K z Acting City Manager ATTEST Maria D. Huizar Clerk of the Council INSURANCE ON FILE APPROVED AS TO FORM WORK MAY PROCEED ® UNTIL INSURANCE EXPIRES ``"1�,�� 21 IVV . _ 3 M. Funk CLERKOFCOUNCIL Assistant City Attorney DATE: -1/M 2 z7 t SANTA ANA CITY COUNCIL Miguel A. Pulldo i Mr7wte Martinez i vMaMe sarmlenio i Jose sewn I R Dawd banati des i Juan Vi6egas i Sai Tinajero Mayor 'i, Mayor Pro Tem, Ward 2 Ward1 Ward Ward Ward Wand MPulitlofa3sanla-ana.oro MMatl'nezrolsanta ane ora VSarml nto sen-ena.orr j JSalorio§aa0jL-tna.org__ 1 09en m,@. Ville s to .or $Tirm er nonla-ane ora Client#: 25320 KIMLHORN ACORD_ CERTIFICATE OF LIABILITY INSURANCE DATE/YYYY) 7/300/201/2018 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER Greyling Ins. Brokerage/EPIC 3780 Mansell Road, Suite 370 Alpharetta, GA 30022 CONTACT Jerry Noyola PHONE 770-552-4225 FAX /C, a L°' EXt : (A/C, N° : B66-550-4082 ADDRESS: jerry.noyola@greyling.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: National Union Fire Ins. Co. � 19445 INSURED Kimley-Horn and Associates, Inc. 421 Fayetteville Street, Suite 600 Raleigh, NC 27601 INSURER B: Aspen American Insurance Company 143460 New Ham shire Ins. Co. 123841 INSURER C: P INSURER D: Lloyds of London 085202 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 18-19 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. LTR TYPE OF INSURANCE NSRLSUBR WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS A X, COMMERCIAL GENERAL LIABILITY 5268169 4/01/2018 04/01/2019 EACH OCCURRENCE $1 00,000 CLAIMS -MADE � OCCUR PREMISESOEaoccurrDence $500000 MED EXP (Any one person) s25,000 X Contractual Liab. PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRO - POLICY nX JECT X LOC GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP/OP AGG $2,000,000 $ OTHER: A AUTOMOBILE LIABILITY 4489663 4/01/2018 04/01/2019 id.nIINGLELIMIT $1,000,000 Ea acccS BODILY INJURY (Per person) $ Xi, ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS X AUTOS ONLY X NON -OWNED AUTOS ONLY BODILY INJURY (Per accident) $ PROPERTYnt DAMAGE $ Per accide B X UMBRELLA LIAB X I OCCUR CX005FT18 04/01/2018 04/01/2019 EACH OCCURRENCE s5,000,000 AGGREGATE s5,000,000 EXCESS LIAB F_ICLAIMS-MADE DED X. RETENTION $0 $ C A C WORKERS COMPENSATION AND EMPLOYERS' LIABILITYSTATUTE ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N / A 015893685 (AOS) 015893686 (CA) 039326820 (ME) 4/01 /2018 04/01/2018 04/01/2018 04/01 /201 04/01/2019 04/01 /201E.L. X PER OTH- IER E.L. EACH ACCIDENT $1 OOO OOO DISEASE - EA EMPLOYEE $1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $1,000,000 _ D Professional Liab P070831800 4/01/2018 04/01/2019 Per Claim $2,000,000 Aggregate $2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Re: On -Call Agreements A-2015-171, A-2017-108, A-2016-344, A-2017-273, A-2017-025, A-2009-212, A-2018-159 01 & A-2018-160-01. The City of Santa Ana, its officers, employees, agents & representatives are named as Additional Insureds with respects to General Liability where required by written contract. The above referenced liability policies with the exception of workers compensation & professional liability are primary & no-no---c� 'tributory (See Attached Descriptions) REVIEWED BY: 4 /0 EUNICE HEREDIA (PG 1 OF y) LA:H I It-IL;A I t City of Santa Ana Purchasing Department 20 Civic Center Plaza Santa Ana, CA 92701-0000 ACORD 25 (2016/03) 1 of 2 #S1150205/M1017400 Of 1112 Lf1 q 4 4_111 Lel 9 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 �4/�1 ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD JNOY1 DESCRIPTIONS (Continued from Page 1) where required by written contract. Separation of Insureds applies to the General Liability Policy. Umbrella Follows Form with respects to General, Automobile & Employers Liability Policies. Should any of the above described policies be cancelled by the issuing insurer before the expiration date thereof, 30 days' written notice (except 10 days for nonpayment of premium) will be provided to the Certificate Holder. SAGITTA 25.3 (2016/03) 2 of 2 #S1150205/M1017400 REVIEWED BY: EUNICE HEREDIA (PGiZOF ) POLICY NUMBER: 5268169 COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organizations) Location And Description Of Completed Operations ANY PERSON OR ORGANIZATION PER THE CONTRACT OR AGREEMENT, 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 If - Who 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 in the "products -completed operations hazard". 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 agree- ment, the insurance afforded to such addi- tional insured will not be broader 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 is added to Section III - Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insu- rance shown in the Declarations; whichever is less. This endorsement shall not increase the appli- cable Limits of Insurance shown in the Decla- rations. CG 20 37 04 13 O Insurance Services Office, Inc„ 2012 Page 1 of 1 p REVIEWED BY: EUNICE HEREDIA (PGF L ) This page has been left blank intentionally. REVIEWED BY: EUNICE HEREDIA (PG of )