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HomeMy WebLinkAboutKPFF (2)City of Santa Ana t Clerk of the Council AGREEMENT TERMINATION FORM 7M? DEC 12 AM Please complete this form in its entirety when the attached a r t Qnd al amendments (if any) are no longer in effect: ) V ENT +T CLERK OF COI Note: If your agreement is grant related, please ensure that all grant retention requirements have been satisfied prior to signing the termination fc m. 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 F No. /r✓ 17� was completed on (List all amendments. Use space below If needed.) lr -/7S-6 / /7S -�y Use SD and final payment has been made. xso r3 J. Cfi-8RleL r�l /r9 Department: Phone/Ext.: Signature. - Date: Revised: l U- I B- 16 MAYOR Miguel A. Pulido MAYOR PRO TEM Michele Martinez COUNCILMEMBERS P. David Benevides Vicente Sarmiento Jose Solodo Sal Tinalero Juan Villages CITY OF SANTA ANA 20 Civic Center Plaza • P.O. Box 1988 Santa Ana, California 92702 v✓WW Santa-ana.oro July 5, 2017 Ali Khamsi, PE Principal KPFF Consulting Engineering 18400 Von Karman Avenue, Suite 600 Irvine, CA 92612 Reference: First Extension of Consultant Agreement No. A-2015-175 Dear Mr. Khamsi: ACTING CITY MANAGER Cynthia J. Kurtz CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL Maria D. Huizar Pursuant to Section 3 of Agreement No. A-2015-175, entered into by KPFF Consulting Engineering 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. Sincerely, 'K'��✓2- �wi . red Mousavipour Executive Director Public Works Agency CITY OF SANTA ANA r' L ,Cynthia J. Kl z Acting City Manager APPROVED AS TO FORM an M. Funk Assistant City Attorney ATTEST Maria D. Huizar Clerk of the Council SANTA ANA CITY COUNCIL INSURANCE ON FILE WORK MAY PROCEED UNTIL INSURANCE EXPIRES CLERK OP COUNCP DArE: -7//I1,dO t-7 Miguel A. Pulido I Michele Martinez i Vicente Sarmiento i Jose solod0 i P. Damd Benavitles i Juan Villages i Sal Toajero Maya[ i Mayor Pro Tern, Ward 2 I Ward I Ward i Wartl MiR�icloKasantai Wards Ward6 fdariiflkSm{9Csanaa,�gao ma�SnTn@�ro a ne - 2 o� �.wi f:lfanttt• 9A19A r4o=yUlTbTsl ACORDT,, CERTIFICATE OF LIABILITY INSURANCE COVERAGES DATE(MM/DD/YYYY) 10/07/2017 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(les) 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 Greyling Ins. Brokerage/EPIC 3780 Mansell Road, Suite 370 Alpharetta, GA 30022 NAMEACT Jerry Noyola PHONE F A/C No Ext : 770-552-4225 A/C, No); 866-550-4082 E-MAIL ADDRESS: lerry.noyoia@greyling.com INSURER(S) AFFORDING COVERAGE NAIC it INSURER A: National Union Fire Ins. Co. 19445 GL6268336 _: INSURED ,.. - ' � - KPFF, Inc. 1601 5th Avenue irtsuRER B: Continental Insurance Company 35289 INSURER 0: Lloyds of London ��.y�� CLAIMS -MADE i +a OCCUR Sulte "1600 INSURER D INSURER E f A 98101" Seattle, WA-98101-­ pp NN PR- I Eaoccur n e - $500,000_, u, COVERAGES _ CERTIFICATE NUMBER! 17«1A RFVISICIN NIIMRFR! - - THIS IS TO CERTIFY THAT THE PCLICISS OF INSURANCE LISPED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOp -INDICATED; NOTWITHSTANDING ANY -REQUIREMENT, TERM OR CONDITION Or ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS - ='CEFMFICATE MAY gE�ISSUED'OR MAY�PERTAIN; THE1NSURANOE AFFORDED BY THE POLICIES DESCRIBED HEREINISSUBJECT TO ALL THE TERMS, EXCLUSIONS -AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN. MAY HAVE BEEN REDUCED BY PAIL) CLAIMS. INSR LTR TYPE OF INSURANCE ADDL I I R POLICY N MBER P L I P Li Yy E p /D IY Y LIMITS A (=COM(uf,ERCIALGENERALLIA61LfTY GL6268336 _: 10/10/2017 04/0`1/201 EACH OCCURRENCE $1.000.000 ��.y�� CLAIMS -MADE i +a OCCUR pp NN PR- I Eaoccur n e - $500,000_, X Contractual Liab. MED EXP (Any one person)_ $2$ 000 PERSONAL & ADV INJURY $1,000,009 GEN'LAGGREGATELIMITAPPLIES PER; GENERALAGGREGATE $2,000000 -POLICY JECT LOC: PRODUCTS • OOMPIOP AGO $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY, _ CA9775930 10/10/2017 04/01/201 C a a ciden INLIMIT'$1,000,000 X ANY AUTO BODILY INJURY (Perperson) $ ALL OWNED SUCH8DDULED AUTOS NON•(SWNEC) BODILY INJURY (Per accident) $ HIRED AUTOS AUTOS p OPERT OA'AG' Pera r ident $ $ B X UMBRELLA LIAB OCCUR 6050399824 10/10/2017 04/01/201 EACH OCCURRENCE $1-01000,090 EXCESS LIAB CLAIMS -MADE AGGREGATE $) 910091000 . DED X RETENTION$O A WORKERS COMPENSATION WCO22298246 (AOS) ` 10/10/20'17 04/01/201 X p R H. AND EMPLOYERS' LIABILITY IN ANY PROPRIETOR/PARTNR/ xECUTIVE OFFIC R/MEMBEREXCLUU E9 nj N/A E.L. EACH ACCIDENT 0,00Q.000 A (Mandatory In NH) -- - WCO22298244 (CA) 10/10/2017 04/01/201 E.L. DISEASE - EA EMPLOYEE $1,000,000 If describe under DESCRIPTION OF OPERA I N low : E.L. DISEASE - POLICY LIMIT $1,0000000 C Professional/ -' - 80146LDUSA1704384 10/10/2017 10/10/201 Per Claim $10,000,000 Pollution Liab. - ; - Aggregate $10,000,000 Sufi $250,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additl0nal Remarks Schedule, may be attached If more apace Is required) Re: Contract #s -A-2015.175 & A-2016.135 - Engineering Consultant Agreement; KPFF Job #1600031. 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. Should any of the above described policies be cancelled by the Issuing insurer before the expiration date thereof, 30 days' written notice (exc ,pt 10 days for nonpayment of premium) will be provided to the Certificate Hold r- REVIEWED BY: EUNICE 1lEREDIA (PG of ) City Of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Clerk of the City Council ACCORDANCE WITH THE POLICY PROVISIONS. 20 Civic Center Plaza (M-30) P.O. BOX 1988 AUTHORIZED REPRESENTATIVE Santa Ana, CA 92702.1988 vow. 01988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) 1 of 1 The ACORD name and logo are registered marks of ACORD #S874982/M874944 JNOY1 This page has been left blank intentionally. REVIEWED BY: EUNICE HEREDIA (PG, OF ) POLICY NUMBER: GL5268336 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION _This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART _ SCHEDULE Name Of Additional Insured Person(s) Organizations) = - Location(s) Of Covered Operations' Any person or organization whom you become Per the contract or agreement. 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 11"� Who Is An Insured is amended to 'include .as an additional insured the person(s) or organizations) shown in the Schedule, but only with respect to liability for "bodily injury", "property- damage" or "personal and advertising injury caused; in whole -or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in _the performance of your ongoing operations for the -additional ins_ ured(s) at the location(s) designated above. :Hdwever _ 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 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 additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, Including materials, parts or equipment furnished in connection with such work, 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 2. 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- as a part of the same project C. With respect to the insurance afforded to these additional insureds, the following is added to SectionIII - 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 Insurance shown in the Declarations; whichever Is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 10 04 13 0 Insurance Services Office, Inc., 2012 Page 1 of 1 REVIEWED BY: EUNICE HEREDIA (PG OF ) This page has been left blank intentionally. REVIEWED BY: EUNICE HEREDIA (PG , OF POLICY NUMBER: GL5268336 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 Organization(s) Location And Description Of Completed Operations Any person or organization whom you become obligated to include as an additional insured as a result of any contract or agreement you have entered into. Per the contract or agreement. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section li — 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 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. CG 20 37 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 2 REVIEWED BY: EUNICE HEREDIA (PG OF ) 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 Insurance shown in the Declarations, whichever is less. This endorsement shall not increase the applicable Limits of insurance shown in the Declarations. Page 2 of 2 0 ISO Properties Inc. 2004 CG 20 37 0413 � REVIEWED BY: EUNICE HEREDIA (PG6 OF ) Client#: 25326 KPFFINCO ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, 03/25/2018 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 CONTACT NAME: Katie Kresner Greyling Ins. Brokerage/EPIC PHONE, .54AC, NoEl): 770.552.4225 860 3780 Mansell Road, Suite 370 E-MAIL ss: Katie.Kresner@greyling.com Alpharetta, GA 30022 04/01/2019 EACH OCCURRENCE $1,000,000 INSURER(S) AFFORDING COVERAGE NAIC # MED EXP (Any one person) s25,000 INSURER A : National Union Fire Ins. Co. 19445 INSURED INSURER B : The Continental Insurance Company i35289 KPFF, Inc. 1601 5th Ave INSURER C Lloyds of London Suite 1600 INSURER D: Seattle, WA 98101 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 ADDLSUBFI NSR WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR GL5268336 4/01/2018 04/01/2019 EACH OCCURRENCE $1,000,000 PREMISES Ea occurrence $500 OOO MED EXP (Any one person) s25,000 PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X JECT LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS -COMP/OP AGG $2,000,000 $ OTHER: A AUTOMOBILE LIABILITY CA9775930 4/01/2018 04/01/201 COMBINED SINGLE LIMIT Ea accident 1,000,000 BODILY INJURY (Per person) $ X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY q BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per accident $ B X UMBRELLA LIAB X OCCUR 6050399824 0/10/2017 04/01/2019 EACH OCCURRENCE $10,000,000 EXCESS LIAB CLAIMS-MADEAGGREGATE $10,000,000 DED Xk RETENTION $0 $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? � N / A WCO22298245 (AOS) WCO22298244 (CA) 4/01/2018 4/01/2018 04/01/201 04/01/201 -APER OTH- E.L. EACH ACCIDENT $1 OOO OOO E.L. DISEASE - EA EMPLOYEE $1,000,000 (Mandatory in NH) II yes, describe under _DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $1,000,000 C Professional/ B0146LDUSA1704384 10/10/2017 10/10/2018 Per Claim $10,000,000 Pollution Liab. Aggregate $10,000,000 SIR $250,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Re: Contract #s A-2015-175 & A-2016-135 - Engineering Consultant Agreement; KPFF Job #1600031. 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. Should any of the above described policies be cancelled by the issuing insurer before the expiration date thereof, 30 days' written notice (exce -t 10 days for nonpayment of premium) will be provided to the Certificate Hold REVIEWED BY: EUNICE HEREDIA (PG I OF ) City of Santa Ana Clerk of the City Council 20 Civic Center Plaza (M-30) P.O. Box 1988 Santa Ana, CA 92702-1988 ACORD 25 (2016/03) 1 of 1 #S1023386/M1022304 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 19514/�1 ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD KKRE1 POLICY NUMBER: GL5268336 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location(s) Of Covered Operations Any person or organization whom you become Per the contract or agreement. 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 II - 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", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts 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 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 additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, 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 2. 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 as a part 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 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 Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. ❑ CG 20 10 04 13 0 Insurance Services Office, Inc., 2012 11 Page 1 of 1 REVIEWED BY: EUNICE HEREDIA (PG 2oF ) POLICY NUMBER: GL5268336 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 Organization(s) Location And Description Of Completed Operations Any person or organization whom you become obligated to include as an additional insured as a result of any contract or agreement you have entered into. Per the contract or agreement. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — 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 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. CG 20 37 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 2 REVIEWED BY: EUNICE HEREDIA (PG5 OFy ) 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 Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Page 2 of 2 © ISO P REVIEWED BY: `-�//v EUNICE HEREDIA (PG 11 OF C/)