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HomeMy WebLinkAboutWILLDAN ENGINEERING (2)City of Santa Ana Clerk of the Council AGREEMENT TERMINATION FORM Please complete this form in its entirety when the attached agreement and all amendments (if any) are no longer in effect. Note: If your agreement is grant related, please ensure that all grant retention requirements have been safisfied prior to signing the termination form. 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 U(/ u'b fi-iy No. A _�r /� d was completed on (List all amendments. Use space below it needed.) COTC Office Use Only 2n"`� C 12 AN 9. SU CITY OF c�,�+T CLOF CO NC L� ( and final payment hasbeenmade. Department: Phone/Ext.:- Signature: Date: Re lsed: I C-13-16 MAYOR Miguel A. Pulldo MAYOR PRO TEM Michele Martinez COUNCILMEMBERS P. David Benavides Vicente Sarmiento Jose Solorio Sal Tinajero Juan Villages CITY OF SANTA ANA 20 Civic Center Plaza - P.O. Box 1988 Santa Ana, California 92702 wvvw.sania-ana.org July 5, 2017 Peter Miessner, PE Wildau Engineering 2401 East Katella Avenue, Suite 300 Anaheim, CA 92806-5982 Reference: First Extension of Consultant Agreement No. A-2015-168 Dear Mr. Miessner: A-2015-168 —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-2015-168, entered into by Wildan 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. Si eerely Fred Mousavipour Executive Director Public Works Agency CITY OF SANTA�ANA, Cynthia J. kurtz `✓�„J Acting City MahAger APPROVED AS TO FORM J M. Punk Assistant City Attorney ATTEST Maria D. Huizar Clerk of the Council INSURANCE ON FILE WORK MAY PROCEED UNTIL INSURANCE EXPIRES CLERK OF COUNCIL DATE: -)m) il I SANTA ANA CITY COUNCIL Miguel A. Pulldo li, Michele Vicente SermlenW Jose Soloda P. David eonavides Juan as Sal 6ro Mayor I em, Ward Mayor Pro Tern, Wartl2 i Ward i 1Vard3 i Ward6 k .i,d Wartl6 ( Ward6 We'd 5 MPuid6�saniaa ta.om MMa tnexCatSent&-ana wa j VSarrteery{q!<dsania-ana ora I JVille ;, Mtaanag[q STnajQrokisanta ana or9 coirc�® CERTIFICATE OF LIABILITY INSURANCE °"Till"2oo"°' 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 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 endorsemente . PRODUCER ADD Risk insurance services West, Inc. Los An eles CA Off Ce 707 Wi shire Boulevard Suite 2600 Las Angeles CA 90017-0460 USA cow7 AD NAME' aC.N�66) 263-7122 FN( (500) 363-0105 NC. Npp: EMAIL ADDRESS: Limits shown are as requested INSURERt31 AFFORDING COVERAGE NAIC If INSURED Willdan Enolneerinl 2401 East Katella Avenue suite 300 Anaheim CA 92806 USA INSURER A: National Fine. Ins. CO, Of Hartford 20478 INSURER B: The continental Insurance Company 35289 INSURER G LeXington Insurance Company 19437 INSURER 0: fkvlffiyry�yll INSURERS; NSURER P: COVERAGES CERTIFICATE NUMBER: 570004S8860g PF\/ISIfIM NIIIMGCA, 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 LTR TYPE OF INSURANCE ASUDIWMI POLICYNUMBER MMIDDYF fkvlffiyry�yll LIMITS X COMMERCIALGENERALLIABILITY EACHOCCURRENCE $1,000,000 CLAIMS MADE FE OCCUR $1,000,000 P L- S 8 Ee Sora ce MEDEXP(Anyonepader) $15,000 PERSONAL A ACV INJURY $1.,000,000 S GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE2,000,000 8 POLICY El�EC ❑X LOU ad PRODUCTS -COMPIOP AGO $2,000,000 OTHER: o 0 A AUTOMOBILE LIABILITY 60205 1619 11/09/201 11/09/2017 COMBINED SINGLE LIMIT EeaaaMent $110001000 BODILY INJURY(Per person) X ANYAUTO 0 OWNED SOHeOULEp AUTOS ONLY AUT09 BO OILV INJURY (Perecpltlan0 PROPERTYDAMAGE HIRED AUTOS NONAWNED ONLY AUTOS ONLY gPar.aodI C C UMBRELLA LIAR OCCUR EACH OCCURRENCE N U EXCE88 LIAR El CLAIMS -MADE AGGREGATE DED I IRETENTION B WORKERS COMPENSATION AND 6022647422 2016 09 017 X PER OT& EMPLOYERS' LIABILITY Y AOS STATV E ER E.L. EACH ACCIDENT $1,000,000 B ANY PROPRIETOR I PARTNER I EXECUTIVE OFFICERIMEMBER EXCLUDED? N NIA 6020541572 11/09/2016 11/09/2017 (Mandatory In NH) If ea, describe under CA E.L. DISEA9E•EA EMPLOYEE $1,000,000 EL. DISEASE -POLICY LIMIT 1,000,000-- DESCRIPTION OF OPERATIONS beIaY 0 Archi t&Eng Prof 028174912 11/09/2016 —11/155746&per claim 1,000,000 SIR applies per policy terns & condi ions Aggregate $2,000,000 B SIR $250,000 DESCRIPTION OF OPERATIONS I LOCATIONS VEHICLES tACDRD tat, Atldlllonai Ramarha 9ohetlu1a, moy bo attached If more Spada la reeulmd) nI Re: To provide engineering services on an as -needed basis. Engineering services may include, but are not limited to, civil z:A engineering, electrical engineering, traffic engineering, geotechnical, land /property surveMg, structural, architecture and landscaping ng design services and grant writing services. General Liability policy excludes c aims arising out of the performance Df prafessTonal services. Independent contractors are included as respects to General Liability. REVIEWED BY EUNICE HEREDIq CPG 1.,OF `f) J II CERTIFICATE HOLDER CANCELLATION11101 AI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 'THE R EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Santa Ana tcenterkPlaza(M-30) AUTHORIZED REPRESENTATIVE 20tcivic Santa Ana CA 92702 USA cXYa ..:71.c9k J f�a�✓ el®� ©19882015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD �,,...._ CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 10/31/2017 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 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 Insurance Services West, Inc. Los Angeles CA Office 707 Wilshire Boulevard Suite 2600 CONTACT NAME: PHE (A/CNNo. Ext): (866) 283-7122 (AAC. No.): (800) 363-0105 E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # LOS Angeles CA 90017-0460 USA INSURED INSURER A: Travelers Property Cas Co of America 25674 willdan Enqineerinq 2401 East Katella Avenue INSURER B: Lexington Insurance Company 19437 INSURER C: Suite 300 Anaheim CA 92806 USA INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570069106101 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 ILTfi TYPE OF INSURANCE ADDL INSD SUER WVI POLICY NUMBER EFF MMIDDIYYYY DD/YYYY FXP MW_Pb_R7 LIMITS A X COMMERCIAL GENERAL LIABILITY 20 civic center M-30) Santa Ana CA 9270202 VSAUSA TIL �°. EACH OCCURRENCE $1,000,000 CLAIMS -MADE ^ IOCCUR DAMAGE TO RENTED PREMISES Ea occurrence $1,000,000 MED EXP (Any one person) $15,000 X Employee Benefits Liability PERSONAL& ADV INJURY $1,000,0Q0 GEML AGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $2,000,000 X POLICY ❑ PRO ❑ LOC JECT PRODUCTS - COMP/OPAGG $2,000,000 OTHER: A AUTOMOBILE LIABILITY BA -77365332 -TIL -17 11/09/2017 11/09/2018 COMBINED SINGLE LIMIT $1,000,QQO Ea accident _ BODILY INJURY ( Per person) X ANY AUTO BODILY INJURY (Per accident) OWNED SCHEDULED AUTOS ONLY AUTOS HIREDAUTOS NON -OWNED ONLY AUTOS ONLY PROPERTYDAMAGE Per accident UMBRELLALIAB OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS -MADE AGGREGATE DED RETENTION A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y1 N ANY PROPRIETOR/ PARTNER I EXECUTIVE N UB97558819TIL17 11/09/201711/09/2018X PER OTH- STATUTE E E.L. EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N/A E.L. DISEASE -EA EMPLOYEE $1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below I E.L. DISEASE -POLICY LIMIT $1,000,000 B Archit&Eng Prof 028174912 11/09/2017111/09/2018 Aggregate $2,000,000 SIR applies per policy terns & condi ions Per Claim $1,000,000 SIR $250,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: To provide engineering services on an as -needed basis. Engineeringg services may include, but are not limited to, civil engineering, electrical engineering, traffic engineering, geotechnical) land/property surveying, structural, architecture and landscaping design services and grant writing services. General Liability policy excludes claims arising out of the performance of professional services. Independent Contractors are included as respects to General Liability. i ( RRE'VlF_ ED L3Y: < -- EUNtCE FIEREDIA (PG OF ) CERTIFICATE HOLDER CANCELLATION 01988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 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: City Clerk 20 civic center M-30) Santa Ana CA 9270202 VSAUSA 9ffi 9FalGt68?tCG GZ2�@�9 �°. 01988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Policy Number: 8307j366586T|L17 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY' BLANKET ADDITIONAL INSURED - WRITTEN CONTRACTS (ARCHITECTS, ENGINEERS AND This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. The following is added to SECTION U —VVHO IS Any person or organization that you agree in o 11whttencontract requiring insurance" toinclude ua onadditional insured onthis Coverage Part, but: a. Only with respect to liability for "bodily injury''. "property damage" or "personal injury"; and b. If, and only hnthe extent that, the injury or damage is caused by acts or omissions of you oryour subcontractor inthe performance of"your work" to which the "written contract requiring insurance" applies. The person or organization does not qualify aeonadditional insured with respect tothe independent acts oromissions ofsuch person o/organization. The insurance provided 0osuch additional insured is limited as follows: c. In the event that the Lhnho of Insurance of this Coverage Part shown inthe Declarations exceed the Umda of liability required by the "written contract requiring inauronoe", the in- surance provided kr the additional insured shall bolimited bzthe limits ufliability required bythat "written contract requiring insurance". This endorsement shall not increase the limits ofinsurance described in Section U||— Limits Of Insurance. d. This insurance does not apply bzthe render- ing of or failure to render any "professional services" or construction management errors or omissions. This insurance does not apply b "bodily in- jury" or"property damage" caused by "your work" and included in the "products - completed operations hazard" unless the ^writtoncontract requiring insurance" specifi- cally requires you to provide such coverage for that additional insured, and then the insur- ance provided to the additional insured ep' CG D4 14 04 08 plies only Vosuch "bodily injuryy or "property damage" that occurs before the end ofthe pe- riod of time for which the '\whM»n oonineot re- quiring insurance" requires you to provide such coverage orthe end ofthe policy period, whichever isearlier. 2. The following is added to Paragraph 4.m. of SEC- TION [V—COMMERCIAL GENERAL LIABILITY CONDITIONS: The insurance provided tothe additional insured is excess over any valid and collectible "other in- surance", ot a/in- auronue". whether primary, emcosn, contingent or on any other baeiu, that is available to the addi- tional insured for a loss we cover. However, if you ddiUonalinauradfbrm|oseweoovmr.Hmwove/.ifyou specifically agree inthe "written contract requiring insurance" that this insurance provided tothe ad- ditional insured under this CoyenoQa Pod must apply on a primary basis ora primary and non- contributory basis, this insurance is primary to "other insurance" available to the additional in- sured which covers that person ororganization ee a named insured for such |Vua, and we will not share with that "other innunanue". But this insur- ance nouponce provided bothe additional insured still is ex- cess over any valid and collectible "other insur- ance", naupance"` whether phmory, excess, contingent oron any other booim, that is available to the additional insured when that person or organization is an additional insured under any "other inaumanne". 3. The following is added to SECTION K/—COM' MERCIAL GENERAL LIABILITY CONDITIONS: Duties Of AnAdditional Insured As oconditiun of coverage provided tuthe addi- tional a. The additional insured must give us written notice as soon as practicable of an "occur- rence" or an offense which may result in a claim. To the extent poeoib|o, such notice should include: 0 2008The Travelers Companies, Inc. Paoe1of2 EUNICE FIEREDIA (PG 20 COMMERCIAL GENERAL LIABILITY L How, when and where the "occurrence" or offense took place; ii. The names and addresses of any injured persons and witnesses; and iil. The nature and location of any injury or damage arising out of the "occurrence" or offense. b. If a claim is made or "suit" is brought against the additional insured, the additional insured must: I. Immediately record the specifics of the claim or "suit" and the date received; and ii. Notify us as soon as practicable. The additional insured must see to it that we receive written notice of the claim or "suit" as soon as practicable. c. The additional insured must immediately send us copies of all legal papers received in con- nection with the claim or "suit", cooperate with us in the investigation or settlement of the claim or defense against the "suit", and oth- erwise comply with all policy conditions. d. The additional insured must tender the de- fense and indemnity of any claim or "suit" to any provider of other insurance which would cover the additional insured for a loss we cover. However, this condition does not affect whether this insurance provided to the addi- tional insured is primary to that other insur- ance available to the additional insured which - covers that person or organization as a named insured. 4. The following is added to the DEFINITIONS Sec- tion: "Written contract requiring insurance" means that part of any written contract or agreement under which you are required to include a person or or- ganization as an additional insured on this Cover- age Part, provided that the "bodily injury" and "property damage" occurs and the "personal in- jury" is caused by an offense committed: a. After the signing and execution of the contract or agreement by you; b. While that part of the contract or agreement is in effect; and c. Before the end of the policy period. Page 2 of 2 0 2008 The Travelers Companles, Inc. CG D4 14 04 08 REVIEWED BY: EUNICE HEREDIA {PG dF ) POLICY NUMBER: 6307J366586TIL17 ISSUE DATE: 11/09/2017 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. 14fil k, M A W11 M 0 1 U. i 0 This endorsement modifies insurance provided under the following: ALL COVERAGE PARTS INCLUDED IN THIS POLICY SCHEDULE CANCELLATION: Number of Days Notice of Cancellation: 30 Days PERSON OR ORGANIZATION: As Per Written Contract or Agreement ADDRESS: PROVISIONS: If we cancel this policy for any statutorily permitted reason other than nonpayment of premium, and a number of days is shown for cancellation in the schedule above, we will mail notice of cancellation to the person or organization shown in the schedule above. We will mail such notice to the address shown in the schedule above at least the number of days shown for cancellation In the schedule above before the effective date of cancellation. IL T4 05 0311 O 2011 The Travelers Indemnity Company. All rights resery d. Page 1 of 1 REVIEWED BY: EUNICE HEREDIA (P� C F ) �— CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 03/20/2018 1 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 Insurance Services west, Inc. LOS Angeles CA Office 707 Wilshire Boulevard Suite 2600 CONTACT NAME: PHONE(866) 283-7122 FAX (800) 363-0105 (AJC. No. Ext): (A/C. No.): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # LOS Angeles CA 90017-0460 USA INSURED INSURER A: Travelers Property Cas CO Of America 25674 wi l l dan Financial Services 27368 Via Industria INSURER B: Lexington Insurance Company 19437 INSURER C: suite 200 Temecula, CA 92590 USA INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570070486210 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 SUBR WVD POLICY NUMBER (MWDDQ= IMM1DDIYYYY1LIMITS A X COMMERCIAL GENERAL LIABILITY PbJUIJJbb586TIL17 EACH OCCURRENCE $1,000,000 CLAIMS -MADE X❑OCCUR DAMAGEOR N $1,000,000 PREMISES Ea occurrence) MED EXP (Any one person) S15,000 X Employee Benefits Liability X Contractual Liability Included PERSONAL 8 ADV INJURY S1,000,000 GEML AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,006 X POLICY PRO ❑ LOC JECT PRODUCTS-COMP/OP AGG $2,000,000 OTHER: A AUTOMOBILELIABILRY P -810 -7j365332 -TIL -17 11/09/201711/09/2018 COMBINED SINGLE LIMIT $1,000,000 Ea accident BODILY INJURY ( Per person) X ANYAUTO BODILY INJURY (Per accident) OWNED SCHEDULED AUTOS ONLYAUTOS HIRENON-OWNED PROPERTYDAMAGE ONLY AUTOS ONLY Per accident) UMBRELLALIA6 EACH OCCURRENCE AGGREGATE EXCESS LIAB HOCCUR CLAIMS -MADE DED I RETENTION A WORKERS COMPENSATION AND PJUB9355881917 1:70-912017 11 09/2018 X PER STATUTE I OTH- ER EMPLOYERS' LIABILITY YIN E.L EACH ACCIDENT $1,000,000 ANY PROPRIETOR/ PARTNER I EXECUTIVE N OFFICER/MEMBER EXCLUDED? ❑ NIA E.L. DISEASE -EA EMPLOYEE $1,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $1,000,000 B Archit&Eng Prof 028174912 11/09/2017111/09/2018 Aggregate $2,000,000 SIR applies per policy terns & condiions Per Claim $1,000,000 SIR $250,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) RE: User Fee Study; Prop 218 Sanitation Review. The City of Santa Ana, its officers, employees, agents and representatives are included as Additional Insured in accordance with the policy provisions of the General Liability policy. The General Liability policy evidenced herein is Primary and Non -Contributory to other insurance available to an Additional Insured, but only in accordance with the policy's provisions. Should General Liability, Automobile Liability and workers' Compensation policy be cancelled before the expiration date thereof, the policy provisions will govern how notice of cancellation may be delivered to c rtificate holders in accordance with the policy provisions. REVIEWED BY: EUNICE HEREDIA (PG I OF ) Ll O N m O 0 O r U) O Z m R V d U CERTIFICATE HOLDER CANCELLATION Qq: 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 Finance and Management Services Agency Purchasing Division L%� �s 20 Civic Center Plaza _-} Santa Ana CA 92701 USA �i ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Policy Number: P6307J366586TIL17 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED - WRITTEN CONTRACTS (ARCHITECTS, ENGINEERS AND SURVEYORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. The following is added to SECTION II — WHO IS AN INSURED: Any person or organization that you agree in a "written contract requiring insurance" to include as an additional insured on this Coverage Part, but: a. Only with respect to liability for "bodily injury", "property damage" or "personal injury"; and b. If, and only to the extent that, the injury or damage is caused by acts or omissions of you or your subcontractor in the performance of "your work" to which the "written contract requiring insurance" applies. The person or organization does not qualify as an additional insured with respect to the independent acts or omissions of such person or organization. The insurance provided to such additional insured is limited. as follows: In the event that the Limits of Insurance of this Coverage Part shown in the Declarations exceed the limits of liability required by the "written contract requiring insurance", the in- surance provided to the additional insured shall be limited to the limits of liability required by that "written contract requiring insurance". This endorsement shall not increase the limits of insurance described in Section III — Limits Of Insurance. d. This insurance does not apply to the render- ing of or failure to render any "professional services" or construction management errors or omissions. e. This insurance does not apply to "bodily in- jury" or "property damage" caused by "your work" and included in the "products - completed operations hazard" unless the "written contract requiring insurance" specifi- cally requires you to provide such coverage for that additional insured, and then the insur- ance provided to the additional insured ap- plies only to such "bodily injury" or "property damage" that occurs before the end of the pe- riod of time for which the "written contract re- quiring insurance" requires you to provide such coverage or the end of the policy period, whichever is earlier. 2. The following is added to Paragraph 4.a. of SEC- TION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: The insurance provided to the additional insured is excess over any valid and collectible 'other in- surance", whether primary, excess, contingent or on any other basis, that is available to the addi- tional insured for a loss we cover. However, if you specifically agree in the "written contract requiring insurance" that this insurance provided to the ad- ditional insured under this Coverage Part must apply on a primary basis or a primary and non- contributory basis, this insurance is primary to "other insurance" available to the additional in- sured which covers that person or organization as a named insured for such loss, and we will not share with that 'other insurance". But this insur- ance provided to the additional insured still is ex- cess over any valid and collectible 'other insur- ance", whether primary, excess, contingent or on any other basis, that is available to the additional insured when that person or organization is an additional insured under any "other insurance". 3. The following is added to SECTION IV — COM- MERCIAL GENERAL LIABILITY CONDITIONS: Duties Of An Additional Insured As a condition of coverage provided to the addi- tional insured: The additional insured must give us written notice as soon as practicable of an 'occur- rence" or an offense which may result in a claim. To the extent possible, such notice should include: CG D4 14 04 08 © 2008 The Travelers Companies, Inc. Page 1 Of 2 REVIEWED BY: EUNICE HEREDIA (PG OF ) COMMERCIAL GENERAL LIABILITY L How, when and where the "occurrence" or offense took place; ii. The names and addresses of any injured persons and witnesses; and iii. The nature and location of any injury or damage arising out of the "occurrence" or offense. b. If a claim is made or "suit" is brought against the additional insured, the additional insured must: L Immediately record the specifics of the claim or "suit" and the date received; and ii. Notify us as soon as practicable. The additional insured must see to it that we receive written notice of the claim or "suit" as soon as practicable. c. The additional insured must immediately send us copies of all legal papers received in con- nection with the claim or "suit", cooperate with us in the investigation or settlement of the claim or defense against the "suit", and oth- erwise comply with all policy conditions. d. The additional insured must tender the de- fense and indemnity of any claim or "suit" to any provider of other insurance which would cover the additional insured for a loss we cover. However, this condition does not affect whether this insurance provided to the addi- tional insured is primary to that other insur- ance available to the additional insured which covers that person or organization as a named insured. 4. The following is added to the DEFINITIONS Sec- tion: "Written contract requiring insurance" means that part of any written contract or agreement under which you are required to include a person or or- ganization as an additional insured on this Cover- age Part, provided that the "bodily injury" and "property damage" occurs and the "personal in- jury" is caused by an offense committed: a. After the signing and execution of the contract or agreement by you; b. While that part of the contract or agreement is in effect; and c. Before the end of the policy period. Page 2 of 2 © 2008 The Travelers Companies, Inc. CG D4 14 04 08 REVIEWED BY: EUNICE HEREDIA (PG 6OF Gi ) POLICY NUMBER: P -810 -7J365332 -TIL -17 ISSUE DATE: 11-16-17 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED ENTITY- NOTICE OF CANCELLATION PROVIDED BY US This endorsement modifies insurance provided under the following: ALL COVERAGE PARTS INCLUDED IN THIS POLICY SCHEDULE CANCELLATION: Number of Days Notice of Cancellation: 30 PERSON OR ORGANIZATION: ANY PERSON OR ORGANIZATION TO WHOM YOU HAVE AGREED IN A WRITTEN CONTRACT THAT NOTICE OF CANCELLATION OF THIS POLICY WILL BE GIVEN, BUT ONLY IF: 1. YOU SEND US A WRITTEN REQUEST TO PROVIDE SUCH NOTICE, INCLUDING THE NAME AND ADDRESS OF SUCH PERSON OR ORGANIZATION, AFTER THE FIRST NAMED INSURED RECEIVES NOTICE FROM US OF THE CANCELLATION OF THIS POLICY; AND 2. WE RECEIVE SUCH WRITTEN REQUEST AT LEAST 14 DAYS BEFORE THE BEGINNING OF THE APPLICABLE NUMBER OF DAYS SHOWN IN THIS ENDORSEMENT. ADDRESS: THE ADDRESS FOR THAT PERSON OR ORGANIZATION INCLUDED IN SUCH WRITTEN REQUEST FROM YOU TO US. PROVISIONS: If we cancel this policy for any statutorily permitted reason other than nonpayment of premium, and a number of days is shown for cancellation in the schedule above, we will mail notice of cancellation to the person or organization shown in the schedule above. We will mail such notice to the address shown in the schedule above at least the number of days shown for cancellation in the schedule above before the effective date of cancellation. IL T4 05 03 11 @2011 The Travelers Indemnity Company. All rights reserved. Page 1 of 1 REVIEWED BY: EUNICE HEREDIA (P OF(9 ) POLICY NUMBER: P6307J366586TIL17 ISSUE DATE: 11/09/2017 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED ENTITY - NOTICE OF CANCELLATION PROVIDED BY US This endorsement modifies insurance provided under the following: ALL COVERAGE PARTS INCLUDED IN THIS POLICY SCHEDULE CANCELLATION: Number of Days Notice of Cancellation: 30 Days PERSON OR ORGANIZATION: As Per Written Contract or Agreement ADDRESS: PROVISIONS: If we cancel this policy for any statutorily permitted reason other than nonpayment of premium, and a number of days is shown for cancellation in the schedule above, we will mail notice of cancellation to the person or organization shown in the schedule above. We will mail such notice to the address shown in the schedule above at least the number of days shown for cancellation in the schedule above before the effective date of cancellation. IL T4 05 03 11 © 2011 The Travelers Indemnity Company. All rights reserved. Page 1 of 1 REVIEWED BY: EUNICE HEREDIA (PGP5oF ; POLICY NUMBER: PJUB9J55881917 ISSUE DATE: 11/09/2017 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED ENTITY - NOTICE OF CANCELLATION PROVIDED BY US This endorsement modifies insurance provided under the following: ALL COVERAGE PARTS INCLUDED IN THIS POLICY SCHEDULE CANCELLATION: Number of Days Notice of Cancellation: 30 Days PERSON OR ORGANIZATION: As Per Written Contract or Agreement ADDRESS: PROVISIONS: If we cancel this policy for any statutorily permitted reason other than nonpayment of premium, and a number of days is shown for cancellation in the schedule above, we will mail notice of cancellation to the person or organization shown in the schedule above. We will mail such notice to the address shown in the schedule above at least the number of days shown for cancellation in the schedule above before the effective date of cancellation. IL T4 05 03 11 © 2011 The Travelers Indemnity Company. All rights reserved. Page 1 of 1 REVIEWED BY: EUNICE HEREDIA (PG ,e OF