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HomeMy WebLinkAboutXV SOLUTIONS-2014A-2014 293-01 MAYOR Miguel A. Pulldo MAYOR PRO TEM Michele Martinez COUNCILMEMBERS P. David Benavides Vicente Sarmlento Jose Solorio Sal Tinajero Juan Villegas k,04+ 9 `y"-i INSURANCE NOT ON FILE WORK MAY (�If PROCEED CLERK OF COUNCIL DATE: OCT 11 2017 September 1, 2017 XV Solutions Attn: Servando Varela 344 Orange Blossom Irvine, CA 92618 PUBLIC WORKS AGENCY 20 Civic Center Plaza. M36 • P.O. Box 1988 Santa Ana, California 92702 www.sgnta-ana.oro Re: Extension of Consultant Agreement No. A-2014-293 Dear Mr. Varela: INTERIM CITY MANAGER Cynthia J. Kurtz CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL Maria D. Huizar Pursuant to Section 4 ("Term") of Agreement. No. A-2014-293 entered into by XV Solutions and the City of Santa Ana, dated November 24, 2014, the time period of said Agreement is hereby extended for an additional two (2) year period from November 24, 2017 to November 23, 2019. The insurance certificates are required to be extended and/or renewed to cover this extension. All other terms and conditions of said Agreement remain unchanged and in full force and effect. If you have any questions regarding this rmatter, please contact the Water Resources Division at 714-647-3320. Sincerely, Fred Mousavipour Executive Director, Public Works Agency CITY OFSANTA ANA �� -� Cynthia Kurtz. Interim City Manager XV SOLUTIONS Narne: j�T o' FYI ID Title: D�vt,e,Y.. ATTEST IN M is D. Huizar Clerk of the Council APPROVED AS TO FORM J n M.Funk Assistant City Attorney 8/29/2019 5:58:50 PM 178504 Servando Varela Dba Xv Solutions Certificate or Insurance Page 0 az) A �® `o�ao CERTIFICATE OF LIABILITY INSURANCE DAT/29/2DIYYYY) 8/29/2019 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 ORDEDINSUR BETWEEN THE IS R(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 or be provisions 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 ri hts [o the certificate holder in lieu of such endorsements . PRODUCER CONTACT 000 Loi Techlnsurance NAME: PHONE : (800 868 7020FAX > UUC No'- 877-826-9067 "s 7echlnsurance ADDRESS: 30 N. LaSalle, 25th Floor, Chicago, IL 60602 INSURE S AFFORDING COVERAGE NAIC9 INSURER A: Sentinel Insurance Company, Limited 11000 INSURED Servando Varela Dba Xv Solutions INSURER B: PO BOX 28373, Santa Ana, CA, 92799 INSURER C: INSURER D INSURER E : INSURER F —""" THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED REVISION NUMBER: TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE OTHER DOCUMENT WITH RESPECT TO WHICH THIS POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY INSR ADDL BR PAID CLAIMS. LTR TYPE OF INSURANCE POLICY NUMBER M /M POLICY EFF POUCY EXP LIMITS ✓ COMMERCIAL GENERAL LIABILITY EACH OCCURRW 82•DOD•D00 CLAIMS -MADE ❑✓ OCCUR PREMISES Ea omLsrsnoe $ 1,000,000 A MED EXP (Any one Pelson) $ 10,000 Yes 46SBMUN0237 SGO/2019 BYJ012020 PERSONAL aADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- GENERAL AGGREGATE $4,DOO,OOD JECT LOC PRODUCTS - COMP/OP AGG $ZOO DOD OTHER: 8 AUTOMOBILE LIABILITY C MBI INGL LIMIT Ea awdenl $ 2,DOD,000 ANY AUTO ALL ED BODILY INJURY (Per person) 3 AUTOSSCHED Yes Yes 46SBMUNU37 6l M019 WQI2M0 BODILY INJURY (Per accldeM) $ `Y NONA HIRED AUTOS ✓ AUTOS PROPERTY DAMAGE $ Till ecccl t $ UMBRELLA LIAR OCCUR E%CESS LIAR EACH OCCURRENCE $ AGGREGATE $ CLAIMS -MADE DEC RETEMION$ WORKERS COMPENSATION $ AND EMPLOYERS'LIABIUTY YIN STATUTE ER ANVCERNEETORIEXCLUDRIEXECUTIVE ❑NIq NIA E.L. EACH ACCIDENT $ (Mantlatory In NN) (Mandatory In NH) E.L. DISEASE - EA EMPLOYE $ If Yes, tlecrtibe under DESCRIPTION OF OPERATIONS below E.L. DISEASE- POLICY LIMIT $ I DESCRIPTION OFOPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule, may beattached amore apace is required) Please see the attached "Additional Remarks Schedule" form for additional details and remarks REVIEWED & APPROVED By tkMANAQEMENT DIVISION 09�21 Gig CERTIFICATE HOLDFR _...__... _. _ _ _ City of Santa Ana 20 Civic Center Plaza, Santa Ana, CA 92701 Attn: Risk Management Division, 4th Floor aI'e--............, SHOULD ANY OF THE ABOVE DESCRIBEb POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE © 1988-2014 All rights 1 fins el vmu name ano logo are registered marks of ACORD 178504 Servando Varela Dba Xv Solutions ACORO0 "r Insureon AGENCY POLICY NUMBER CARRIER Certificate of Insurance Page (2 of 2) AGENCY CUSTOMER ID: 178504 LOC #: ADDITIONAL REMARKS SCHEDULE NAIC CODE NAMED INSURED Servando Varela Dba Xv Solutions Po Box 28373 Santa Ana, CA 92799 EFFECTIVE DATE: 8/29/2019 5:58:50 PM Page 1 of 1 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE City of Santa Ana, its officers, employees, agents and representatives are Additional Insureds with respect to General Liability and Auto Liability per the attached endorsements or as required by written contract.This insurance is primary and non-contributory to any other insurance provided as respects general liability coverage.Should any of the above described policies be cancelled before the expiration date, the issuing insurer will endeavor to mail 30 days written notice (10 days notice if due to non-payment) to the certificate holder named below, but failure to do so shall Impose no obligation or liability of any kind upon the insurer, its agents or representatives. For all policies listed above, cancellation notice provisions are located in your policy documents. Please refer to those documents for information pertaining to notification of certificate holders when a policy is cancelled before the expiration date. ACORD 101 (2008/01) TL . ^^^ © 2008 ACORD CORPORATI N. All ights reserved. •�•••_ �•� ivyv a,c ieylsrereo nnarxs WACORD MQUERS' COMPENSATION DECLAR TION I 5ervando Varela W_ Y affirm under penalty of perjury, the following declaration: I certify on behalf of XV Solutions _ that during the term of my contract for mahromm aoa supponnre SC�o�r � with the City of Santa Ana, I will not employ any Person in any manner so as to become subject to the workers' - compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions and provide proof of workers' compensation coverage. DATE: 2 j Name: Servando Varela Title: Owner Telephone: 714-269-8190 WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. l(tvlh�f""WED & APPROVED By Ris h Ki N,10EMENT DIVISION 09 Mfg 1A M. LAMBERT This e-mail (and attachments, if any) may be subject to the California Public Records Act and as such, may, therefore, be subject to public disclosure unless otherwise exempt under the Act. From: Reyes, Kathia Sent: Thursday, August 29, 2019 6:00 PM To: RMD <RMD@santa-ana.org> Subject: COI Review: XV Solutions Hi Ladies, Please review attached C01 to cover XV Solutions. Request for C01 Review: Department: Public Works Agency Department Contact & Extension: Kathia Reyes X3319 Contractor/Vendor: XV Solutions Brief description of project: Provide computer servers and SCADA support services. Agreement Number: A-2014-293, A-2014-293-01 Agreement Termination Date: 11/30/19 Agreement link htip:Hclerk/Webiink/l/doc/81315/Pagel aspx Extension link: httn://clerk/Web]ink/1/doc/96970/Pa eg 1 aspx Thank you, Kathia Reyes Water Resources Division Ext. 3319/M-85 ....................................... I................... From: Servando Varela <xsvarela@gmail.com> Sent: Thursday, August 29, 2019 2:14 PM To: Reyes, Kathia <KReyes2(@santa-ana ore> Subject: Re: FYI: Insurance and workers comp statement Hi Kathia, u V A.. w. �....... MANAgEMENT Divi$iON 09 2019 M. LAMBERT The reason OWNED is not checked for the commercial auto liability is because I do not own a commercial vehicle for XV SOLUTIONS. I called the Hartford Insurance Co., and explained that I do have a personal vehicle to commute from my house to the City Yard, once or twice a week and they said they don't insure personal vehicles. I understand that other contractors for the City, such as Electricians or Construction contractors, have commercial vehicles they use to carry loads or equipment. I don't have anything like that, since I'm a computer consultant and I only use my personal vehicle for commuting to and from the City Yard. I hope that with this additional context you will find the coverage for commercial auto liability in the certificate sufficient since it includes a $2,000,000 combined single limit for HIRED AUTOS and NON -OWNED AUTOS. Kind Regards, Servando Varela (714)269-8190 r iQ,