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HomeMy WebLinkAboutHALL AQUATIC LIFE SUPPORT DESIGN CONSULTANTS, LLC 1-2017INSURANCE ON FILE CsL�: fl -LB -JY WORK MAY PROCEED UNTIL INSURANCE EXPIRES N-2417-260 We: 64 CLERK OF COUNCIL 64 KT& I S AGREEMENT WITH HALL AQUATIC DESIGN O: PROS ( ) TO PROVIDE DESIGN SERVICES FOR SANTA ANA ZOO EXHIBIT Silvia Cuevas THIS AGREEMENT' is made and entered into this 16th day of November, 2017 by and between Hall Aquatic Life Support Design Consultants, LLC, a Georgia Limited Liability Company, ("Consultant"), and the City of Santa Ana, a charter city and municipal corporation organized and existing under the Constitution and laws of the State of California ("City"). RECITALS A. The City desires to retain a consultant having special skill and knowledge in the field of design review and consultation services of a proposed giant otter exhibit at the Santa Ana Zoo including short and long term operational and maintenance considerations and impacts for the animals, zoo staff and the public. 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: SCOPE OF SERVICES a. 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 design and consultation services described and set forth Item #1 of the Proposal dated October 19, 2017, identified as Exhibit A, attached hereto and incorporated by reference. b. Consultant agrees and understands that commencement of work regarding Items #2-4 in Exhibit A are subject to continued funding for this project. Commencement of work regarding any of these listed items shall be mutually agreed upon by both parties. 2. COMPENSATION a. City agrees to pay, and Consultant agrees to accept as total payment for its services for City, the rates and charges identified in Exhibit A. The total amount to be expended under this agreement shall not exceed $12,000, contingent on funding for item #'s 2-4, for the term of this Agreement. This total amount shall include the $4,800 to pay for services related to Itern #1 in Exhibit A. Page 1 of b. Payment by City shall be made within 45 days (forty-five) 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. 3. TERM This Agreement shall commence on the date first written above for a one (1) year term, with the option for the City to grant up to two (2) one year renewals, exercisable by a writing by the City Manager and the City Attorney, unless terminated earlier in accordance with Section 15, below. 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, Page 2 of 9 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 insureds provisions. 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 -$1000;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. Page 3 of 9 7. INDEMNIFICATION Consultant agrees to defend, and shall indemnify and hold harmless the City, its officers, agents, employees, contractors, special counsel, and representatives from liability: (1) for personal injury, damages, just compensation, restitution, judicial or equitable relief arising out of claims for personal injury, including death, and claims for property damage, which may arise from the negligent operations of the Consultant, its subcontractors, agents, employees, or other persons acting on its behalf which relates to the services described in section I of this Agreement; and (2) from any claim that personal injury, damages, just compensation, restitution, judicial or equitable relief is due by reason of the terms of or effects arising from this Agreement. This indemnity and hold harmless agreement applies to all claims for damages, just compensation, restitution, judicial or equitable relief suffered, or alleged to have been suffered, by reason of the events referred to in this Section or by reason of the terns of, or effects, arising from this Agreement. The Consultant further agrees to indemnify, hold harmless, and pay all costs for the defense of the City, including fees and costs for special counsel to be selected by the City, regarding any action by a third party challenging the validity of this Agreement, or asserting that personal injury, damages, just compensation, restitution, judicial or equitable relief due to personal or property rights arises by reason of the terms of, or effects arising from this Agreement. City may make all reasonable decisions with respect to its representation in any legal proceeding. Notwithstanding the foregoing, to the extent Consultant's services are subject to Civil Code Section 2782.8, the above indemnity shall be limited, to the extent required by Civil Code Section 2782.8, to claims that arise out of, pertain to, or relate to the negligence, recklessness, or willful misconduct of 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. Page 4 of 9 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 specified under this Agreement. 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. 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 terms 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. Page 5 of 9 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 of Parks, Recreation and Community Services 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. —16a WAIVER No waiver of breach, failure of any condition, or any right or remedy contained in or granted by the provisions of this Agreement shall be effective unless it is in writing and signed by the party waiving the breach, failure, right or remedy. No waiver of any breach, failure or right, or remedy shall be deemed a waiver of any other breach, failure, right or remedy, whether or not similar, nor shall any waiver constitute a continuing waiver unless the writing so specifies. 17. 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. 18. 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 Page 6 of 9 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. 19. MISCELLANEOUS PROVISIONS a. 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. b. All Exhibits referenced herein and attached hereto shall be incorporated as if fully set forth in the body of this Agreement. 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 92702-1988 Fax: 714-647-6956 With courtesy copies to: Executive Director, Sonia R. Carvalho Parks, Recreation and Community City Attorney Services Agency City of Santa Ana City of Santa Ana 20 Civic Center Plaza (M-29) 20 Civic Center Plaza (M-23) P.O. Box 1988 P.O. Box 1988 Santa Ana, California 92702 Santa Ana, California 92702 Fax: 714- 647-6515 Fax: 714-571-4221 To Consultant: Hall Aquatic Design 347 Grant Street SE Atlanta GA 3 03 12 Attn: Eric Hall E-mail: hallaquaticdesign@gmail.com Page 7 of 9 N-2017-260 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. IN WITNESS WHEREOF, the pities hereto have executed this Agreement the date and year first above written. ATTEST: (��� Maria D. Nuizar 9 Clerk of the Council APPROVED AS TO FORM: SONIA R. CARVALHO City Attorney By: �CAL�ti�2rLe Laura A. Rossini Senior Assistant City Attorney RECOMMENDED FOR APPROVAL: GERARDO MOi7ET Executive Director' Parks, Recreation and Community Services Agency CITY OF SANTA ANA Raul Godinez II City Manager CONSULTANT: (name) t (title) Tax ID# �;)`I Page 8 of 9 EXHIBIT A SCOPE OF SERVICES and COMPENSATION 0 Exhibit A HALL A( ,RTIC DESIGN October 19, 2017 Mr. Ethan Fisher Operations Santa Ana Zoo Sent via Email: efisher@santa-ana.org RE: SANTA ANA ZOO — LSS DESIGN REVIEW Sr CONSULTATION SERVICES PROPOSAL — GIANT OTTER EXHIBIT — PROPOSAL# - HAD-SAZ-101917EH INTRODUCTION Hall Aquatic Design (HAD) is pleased to offer the following contract services proposal to the Santa Ana Zoo for design review & consultation services for its proposed Giant Otter exhibit Life Support Systems (LSS). The LSS design review will be from an end user point of view and will take into account all short & long term operational and maintenance considerations and impacts for the animals, staff and public. LSS design review typically involve a comprehensive review of design documentation generated to date. This review perod.generallyaakes between 1-.2 weeks and is- assumed s assumed to be at or very near the 50% Design Development (DD) phase. A comprehensive report will be written highlighting all areas of interest or concern. Redline of existing drawings or documentation may be utilized for clarity. Description of scope of work for the LSS Contractor: 1. Design Review & Construction Administration Scope: - Itemized Cost $4,800.00 a) Perform thorough review of all 50% DD phase or all documents generated to date - aquatic (LSS) design & construction documentation including narratives, process design drawings, equipment layouts and equipment specifications. b) Communicate all issues or concerns in a written report. Report will be accompanied by redlined drawings when needed. Reports will be emailed to the owner and other party deemed appropriate. c) Specific focus to ensure that the exhibit habitat, LSS equipment processes and water quality will be optimized and deemed as "animal ready" in regards to a safe, USDA compliant and esthetically pleasing environment for animals, staff and guests. d) During construction, assist the owner with Requests for Information (BFI's) from project team members including architects, engineers, consultants, Installers to clarify design concepts when appropriate. haIIaquaticdesign@gmail.com 347 Grant Street SE Atlanta, GA. 30312 Cell: 678.873.7401 1 0 HALL AQUATIC DESIGN 2. Assistance with outsourced LSS maintenance contract: - Itemized Cost $1,200.00 a) Provide a detailed scope of service for maintaining the LSS on a weekly, monthly and annual basis that can be included in the final agreement. b) Assist with writing and providing standard operating procedures for maintaining the LSS c) Assist with locating potential bidders for the LSS maintenance contract. 3. Exhibit Commissioning & Owner Training Support - Itemized Cost $3,600.00 a) Includes labor & travel expenses for one (1) site visit to CA for an onsite period of two (2) days. b) Time onsite includes assistance working with the installation contractor as well as the design engineer of record for exhibit start-up as well as testing & balancing of exhibit LSS. c) Time onsite includes owner staff training as well as any outsourced contract staff during the 2 days. Training will include daily, weekly monthly & annual preventative maintenance items. Includes water quality overview & recommendations for testing & data interpretation as well as corrective action. _. 4. Additional Site Visits (If requested).- Itemized Cost $2,400.00lonsite for_one day. a) Includes labor for onsite & travel time as well as travel expenses for one (1) site visit to CA for an onsite period of two (1) day. b) Additional days onsite beyond the first day if requested - $1200.00 labor rate Fee & Payment Term Contractor requests a purchase order for a "Not to exceed value" for the combination of desired services above. Contractor will invoice for services as they are rendered. TERMS AND CONDITIONS This proposal is valid for 90 days and is for the design review period listed above and does not include a provision for review of any other phases at this time. We appreciate the opportunity to be a part of your design team for this project. Thank you for requesting our services. z c� Best Regards, w ca Hall Aquatic Design LLC. hallaquaticdesign@gmail.com 347 Grant Street SE Atlanta, GA. 30312 Cell: 678.873.7401 2 <►co�rta® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 1012712017 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 entlorsement s . PRODUCER CONTACT CS&SIBIZINSURE LLC NAME: PHONE FAX (AIC, No, Ext): (AIC, No): PO BOX 958489 LAKE MARY, FL 32746-8989 E-MAIL Phone - 415-704.1408 ADDRESS: INSURER 5 AFFORDING COVERAGE NAIC p Fax - 877.763.5122 INSURERA: National Fire Insurance Company of Hartford 20478 INSURED HALL AQUATIC DESIGN LLC INSURERS: 347 GRANT ST SE INSURER C INSURER D: ATLANTA, GA 30312 INSURER E: Valley Forge Coman 20508 INSURER F : 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 CONTRACTOR OTHER DOCUMENT NTH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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, SR LTR TYPEOFINSURANCE ADDL INSD SUBR___POLICY WVD POLICYNUMSER EFF MMID11 POLICY EXP MMIDDiYYYY LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR EACH OCCURRENCE $ 2,000,000 DAMAGE TO RENTED $ 360,000 PREMISES (Ea occurrence) MED EXP (Any one person) 10,000 A Y N 6011593339 07/1812017 07118/2018 PERSONAL &ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER, PRO- POLICY �JECT GENERAL AGGREGATE 4,000,000 PROOUCTS-COMPIOPAGG $ 4,000,000 XLED OTHER AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) BODILY INJURY (Per person) $ ANY AUTO A OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY N N 6011593339 07/18/2017 07118/2018 BODILY INJURY (Per accident) PROPERTY DAMAGE (Peraccident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS -MADE AGGREGATE DED I RETENTION$ $ WORKERS COMPENSATIONPER X Ori AND EMPLOYERS' LIABILITY STATUTE ER E.L. EACH ACCIDENT 1'660'006 E OFFICERIMEMBEER EXC UDED?ECUTIVE YIN (Mandatory In NH) If yes, describe under N/A N 6021475975 0313112017. 0 313112 01 8 E.L. DISEASE - EA EMPLOYEE $ 1'0002000 E.L. DISEASE -POLICY LIMIT $ 1'000,600 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I 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�ards to Gen I Liability as provided in the blanket additional insured endorsement as it pertains to work being perforrtl,,q��'y the named Bred underwritten contract.\�N City will be mailed 30 days written notice of policy cancellation. CERTIFICATE HOLDER CANCELLATION The City of Santa Ana 20 Civic Center Plaza SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Santa Ana, CA 92701 ACCORDANCE WITH THE POLICY PROVISIONS. AU�T/JH�ORIZED RE%PRESENTATDIVE W17 -M- gL(rI..KCL(AWL r ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED — OWNERS, LESSEES OR CONTRACTORS — SCHEDULED PERSON OR ORGANIZATION - WITH PRODUCTS COMPLETED M]»7_1[tl TFes'ffil T1� This endorsement modifies insurance provided under the following: BUSINESSOWNERS LIABILITY COVERAGE FORM SCHEDULE* Hall Aquatic Design LLC - Policy # 6011583339 Name Of Person Or Organization: The city of Santa Ana, its officers, agents, employees and representatives are named as additional Insured in regards to General Liability as outlined in this additional Insured form. to complete this Schedule, if not shown on this endorsement, will be shown in the Declarations, A. The following is added to Paragraph C. Who Is An Insured: 4. Any persons) or organization(s) shown in the Schedule is also an additional insured, but only with respect to liability for "bodily injury," "property damage" or "personal and advertising injury," caused, in whole or in part, by: a. Your acts or omissions; or b. 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; or c. "Your work" that is included in the "products -completed operations hazard" and performed for the additional insured, but only if this Policy provides such coverage, and only if the written contract or written agreement requires you to provide the additional insured such coverage. B. The insurance provided to the additional insured does not apply to "bodily injury," "property damage," or "personal and advertising injury" arising out of: 1. The rendering of, or the failure to render any professional architectural, engineering, or surveying services, including: (a) The preparing, approving, or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; and (b) Supervisory, inspection, architectural or engineering activities. 2. 'Bodily Injury," "property damage," or "personal and advertising injury" arising out of any premises or work for which the additional insured is specifically listed as an additional insured on another endorsement attached to this Policy. C. The following is added to Paragraph H. of the Businessowners Common Policy Conditions: H. Other Insurance This insurance is excess over any other insurance naming the additional insured as an insured whether primary, excess, contingent or on any other basis unless a written contract or written agreement specifically requires that this insurance be either primary or primary and noncontributing.. SB -300120-C Page 1 of 1 (Ed. 06/11) 2. Executed prior to the "bodily injury," "property damage" or "personal and advertising injury," but Only the following persons or organizations are additional insureds under this endorsement and coverage provided to such additional insureds is limited as provided herein: a. Additional Insured —Your Work That person or organization for whom you do work is an additional insured solely for liability due to your negligence specifically resulting from your work for the additional insured which is the subject of the written contract or written agreement. No coverage applies to liability resulting from the sole negligence of the additional insured. The insurance provided to the additional insured is limited as follows: (1) The Limits of Insurance applicable to the additional insured are those specified in the written contract or written agreement or in the Declarations of this policy, whichever is less. These Limits of Insurance are inclusive of, and not in addition to, the Limits of Insurance shown in the Declarations. (2) The coverage provided to the additional insured by this endorsement and paragraph F.9. of the definition of "insured contract" under Liability and Medical Expenses Definitions do not apply to "bodily injury" or "property damage" arising out of the "products - completed operations hazard" unless required by the written contract or written agreement. (3) The insurance provided to the additional insured does not apply to "bodily injury," "property damage," or 'personal and advertising injury" arising out of the rendering or failure to render any professional services. b. State or Political Subdivisions A state or political subdivision subject to the following provisions: (1) This insurance applies only with respect to the following hazards for which the state or political subdivision has issued a permit in connection with premises you own, rent, or control and to which this insurance applies: (a) The existence, maintenance, repair, construction, erection, or removal of advertising signs, awnings, SB -146932-E (Ed. 06/11) SB -146932-E (Ed. 06/11) canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoistaway openings, sidewalk vaults, street banners, or decorations and similar exposures; or (b) The construction, erection, or removal of elevators; or (2) This insurance applies only with respect to operations performed by you or on your behalf for which the state or political subdivision has issued a permit. This insurance does not apply to "bodily injury," 'property damage" or "personal and advertising injury" arising out of operations performed for the state or municipality. c. Controlling Interest Any persons or organizations with a controlling interest in you but only with respect to their liability arising out of: (1) Their financial control of you; or (2) Premises they own, maintain or control while you lease or occupy these premises. This insurance does not apply to structural alterations, new construction and demolition operations performed by or for such additional insured. d. Managers or Lessors of Premises A manager or lessor of premises but only with respect to liability arising out of the ownership, maintenance or use of that specific part of the premises leased to you and subject to the following additional exclusions: This insurance does not apply to: (1) Any 'occurrence" which takes place after you cease to be a tenant in that premises; or (2) Structural alterations, new construction or demolition operations performed by or on behalf of such additional insured. e. Mortgagee, Assignee or Receiver A mortgagee, assignee or receiver but only with respect to their liabilitymortgagee, assignee, or receiver anc( ssing out of th ownership, maintena or se a premises by you p V L" This insurance does note Rctural alterations, new constr , qty dg6if ion Page 2 of 5 SB -146932-E (Ed. 06/11) operations performed by or for such 3. The following is added to Paragraph H. of the additional insured. BUSINESSOWNERS COMMON POLICY f. Owners/Other Interests — Land is Leased CONDITIONS: An owner or other interest from whom land H. Other Insurance has been leased by you but only with 4. This insurance is excess over any other respect to liability arising out of the insurance naming the additional insured ownership, maintenance or use of that as an insured whether primary, excess, specific part of the land leased to you and contingent or on any other basis unless subject to the following additional a written contract or written agreement exclusions; _ specifically requires that this insurance This insurance does not apply to: be either primary or primary and (1) Any "occurrence" which takes place noncontributing. after you cease to lease that land; 4. LEGAL LIABILITY — DAMAGE TO PREMISES or A. Under B. Exclusions, 1. Applicable to (2) Structural alterations, new Business Liability Coverage, Exclusion k, construction or demolition Damage To Property, is replaced by the operations performed by or on following: behalf of such additional insured. k. Damage To Property g. Co-owner of Insured Premises "Property damage" to: A co-owner of a premises co -owned by you 1. Property you own, rent or occupy, and covered under this insurance but only including any costs or expenses with respect to the co-owners liability as co- incurred by you, or any other owner of such premises. person, organization or entity, for h. Lessor of Equipment repair, replacement, enhancement, restoration or maintenance of such Any person or organization from whom you property for any reason, including lease equipment. Such person or prevention of injury to a person or organization are insureds only with respect damage to another's property; to their liability arising out of the maintenance, operation or use by you of 2. Premises you sell, give away or equipment leased to you by such person or abandon, if the "property damage" organization. A person's or organization's arises out of any part of those status as an insured under this premises; endorsement ends when their written 3. Property loaned to you; contract or agreement with you for such leased equipment ends. 4. Personal property in the care, With respect to the insurance afforded custody or control of the insured; these additional insureds, the following 5. That particular part of any real additional exclusions apply: property on which you or any contractors or subcontractors This insurance does not apply: working directly or indirectly in your (1) To any "occurrence" which takes place behalf are performing operations, if after the equipment lease expires; or the "property damage" arises out of 2 To "bodily injury," those operations; or O y "'property damage" or "personal and advertising injury" arising 6. That particular part of any property out of the sole negligence of such that must be restored, repaired or additional insured. replaced because "your work" was Any insurance provided to an additional insured incorrectly performed on it, designated under paragraphs b. through h.Para h 2 of this exclusion does not above does not apply to "bodily injury' o a if the premises are "your work" "property damage" included within th` nd were never occupied, rented or "products -completed operations hazard." �„JOeld for rental by you. ragraphs 1, 3, and 4, of this a`\xl exclusion do not apply to "property SB -146932-E Q Page 3 of 5 (Ed. 06/11) i damage" (other than damage by fire or explosion) to premises: (1) rented to you: (2) temporarily occupied by you with the permission of the owner, or (3) to the contents of premises rented to you for a period of 7 or fewer consecutive days. A separate limit of insurance applies to Damage To Premises Rented To You as described in Section D - Liability and Medical Expenses Limits of Insurance. Paragraphs 3, 4, 5, and 6 of this exclusion do not apply to liability assumed under a sidetrack agreement. Paragraph 6 of this exclusion does not apply to "property damage" included in the 'products -completed operations hazard." B. Under B. Exclusions, 1. Applicable to Business Liability Coverage, the last paragraph of 2. Exclusions is deleted and replaced by the following: Exclusions c, d, e, f, g, h, i, k, I, m, n, and o, do not apply to damage by fire to premises while rented to you or temporarily occupied by you with permission of the owner or to the contents of premises rented to you for a period of 7 or fewer consecutive days. A separate limit of insurance applies to this coverage as described in Section D. Liability And Medical Expenses Limits Of Insurance. C. The first Paragraph under item 5. Damage To Premises Rented To You Limit of Section D. Liability And Medical Expenses Limits Of Insurance is replaced by the following: The most we will pay under Business Liability for damages because of "property damage" to any one premises, while rented to you, or temporarily occupied by you, with the permission of the owner, including contents of such premises rented to you for a period of 7 or fewer consecutive days, is the Damage to Premises Rented to You limit shown in the Declaration. Jr. Discrimination or humiliation that results 6. Broad Knowledge of Occurrence The following items are added to E. Businessowners General Liability Conditions in the Businessowners Liability Coverage Form: e. Paragraphs a. and b. apply to you or to any additional insured only when such "occurrence," offense, claim or "suit' is known to: -(1) You or any additional insured that is an individual; (2) Any partner, if you or an additional insured is a partnership; (3) Any manager, if you or an additional insured is a limited liability company; (4) Any "executive officer" or insurance manager, if you or an additional insured is a corporation; (6) Any trustee, if you or an additional insured is a trust; or (6) Any elected or appointed official, if you or an additional insured is a political subdivision or public entity. This paragraph e. applies separately to you and any additional insured. 7. Bodily Injury Section F. Liability and Medical Expenses Definitions, item 3. 'Bodily Injury" is deleted and replaced with the following: "Bodily injury" means bodily injury, sickness or disease sustained by a person, including death, humiliation, shock, mental anguish or mental injury by that person at any time which results as a consequence of the bodily injury, sickness or disease. 8. Expanded Personal and Advertising Injury Definition a. The following is added to Section F. Liability and Medical Expenses Definitions, item 14. Personal and Advertising Injury, in the Businessowners General Liability Coverage Form: 2 injury to the feelings or reputation of a 5. Blanket Waiver of Subrogation natural person, but only if such We waive any right of recovery we may have discrimination or humiliation is: against: ��Aot done intentionally by or at the a. Any person or organization with whom you ?,vl direction of: have a written contract that requires such a `�� a. insured; or waiver. c3 SB-146932-E`1�\d 0X Page 4 of 5 (Ed. 06111 ) Q., CNA b. Any "executive officer," director, stockholder, partner, member or manager (if you are a limited liability company) of the insured; and 2. Not directly or indirectly related to the employment, prospective employment, past employment or termination of employment of any person or person by any insured. SB -146932-E (Ed. 06/11) (16)Fines or Penalties Fines or penalties levied or imposed by a governmental entity because of discrimination. c. This provision (Expanded Personal and Advertising Injury) does not apply if Personal and Advertising Injury Liability is excluded either by the provisions of the Policy or by endorsement. b. The following is added to _Exclusions _ Suction B.: g, Personal and Advertising Injury Re-defined- (16)Discrimination Relating to Room, Dwelling or Premises Caused by discrimination directly or indirectly related to the sale, rental, lease or sub -lease or prospective sale, rental, lease or sub -lease of any room, dwelling or premises by or at the direction of any insured. SB -146932-E (Ed. 06/11) Section F. Liability and Medical Expenses Definitions, item 14, Personal Advertising Injury, Paragraph c. is replaced by the following: c. The wrongful eviction from, wrongful entry into, or invasion of the right of private occupancy of a room dwelling or premises that a person or organization occupies committed by or on behalf of it's owner, landlord or lessor. Page 5 of 5 SB -146932-E (Ed. 06/11) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED - LIABILITY EXTENSION This endorsement modifies insurance provided under the following: BUSINESS OWNERS LIABILITY COVERAGE FORM — Hall Aquatic Design LLC — Policy # 6011593339 & 6021475975 The city of Santa Ana, its officers, agents, employees and representatives are named as additional insured in regards to General Liability as outlined in this blanket. Coverage afforded under this extension of coverage endorsement does not apply to any person or organization covered as an additional insured on any other endorsement now or hereafter attached to this Policy. 1. ADDITIONAL INSURED —BLANKET VENDORS WHO IS AN INSURED is amended to include as an additional insured any person or organization (referred to below as vendor) with whom you agreed, because of a written contract or agreement to provide insurance, but only with respect to "bodily injury' or "property damage" arising out of "your products" which are distributed or sold in the regular course of the vendor's business, subject to the following additional exclusions: 1. The insurance afforded the vendor does not apply to: a. "Bodily injury" or "property damage" for which the vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to liability for damages that the vendor would have in the absence of the contract or agreement; b. Any express warranty unauthorized by you; c. Any physical or chemical change in the product made intentionally by the vendor; d. Repackaging, except when unpacked solely for the purpose of inspection, demonstration, testing, or the substitution of parts under instructions from the manufacturer, and then repackaged in the original container; e. Any failure to make such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products; f. Demonstration, installation, servicing or repair operations, except such operations performed at the vendor's premises in connection with the sale of the product; g. Products which, after distribution or sale by you, have been labeled or relabeled or used as a container, part or ingredient of any other thing or substance by or for the vendor: or It. "Bodily injury" or "property damage" arising out of the sole negligence of the vendor for its own acts or omission or those of its employees or anyone else acting on its behalf. However, this exclusion does not apply to: (1) The exceptions contained in Subparagraphs d. or f.; or (2) Such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products. 2. This insurance does not apply to any insured person or organization, from whom you have acquired such products, or any ingredient, part or container, entering into, accompanying or containing such products. 3. This provision 2. does not apply to any vendor included as an insured by an endorsement issued by us and made a part of this Policy. 4, This provision 2. does not apply if "bodily injury" or "property damage" included within the "products -completed operations hazard" is excluded either by the provisions of the Policy or by endorsement. 2. MISCELLANEOUS ADDITIONAL INSUREDS WHO IS AN INSURED is amended to include as an insured any person or organization (called additional insured) described in paragraphs 2.a. ti 4�rgh 2.h. below whom you are required , dd as an additional insured on thisp�o� under a writt� contract or agreement but" w? cont ��or agreement must be: i o�Ia 1. Currently in effect or the term of this policy; SB -146932-E Page 1 of 5 (Ed. 06/11) " aP° CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDIVYYYY) 11/12/2018 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(les) must be endorsed. If SUBROGATIONIS 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 BIZINSURE LLC/PHS CONTACT NAME: OUCY-EPP D POUCYEXP 57102005 COMMERCIAL GENERAL LWBWTY THE HARTFORD BUSINESS SERVICE CENTER 3600 WISEMAN BLVD SAN ANTONIO, TX 78265 (AIC, o, Est): (866) 467-8730 FAX No): (888) 443-6112 E-MAIL CLAIMS -MADE OCCUR ADDRESS' INSURER(S) AFFORDING COVERAGE NAICN INSURED INSURER A: The Twin City Fire Insurance Company 29459 Hall Aquatic Life Support Designs DBA Hall Aquatic Design LLC INSURER a: The Hartford Accident and Indemnity 22357 347 GRANT ST SET� ATLANTA GA 30312-2226 Iij -3C)-7 —LAe0 Insurance Company INSURER C: A 57 SBM BL2522 INSURER D : 11/09/2019 1 INSURER E: PERSONAL SADV INJURY INSURER F: GENERAL AGGREGATE $4,000,00 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. INSF TYPE OF INSURANCE ADDL INSR SUB_POU CY NUMBER OUCY-EPP D POUCYEXP LIMITS COMMERCIAL GENERAL LWBWTY EACH OCCURRENCE $2,000,00 CLAIMS -MADE OCCUR DAMAGE TORENTEDPREMISES Ea ocunn $1,000,00 X MED EXP (My one person) $10,00 X General Liability A 57 SBM BL2522 11/09/2018 11/09/2019 1 PERSONAL SADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,00 PRO- LOC POLICY F] PRODUCTS-COMP/OP AGO $4,000,00 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $2,000,00 (Ea soon ant) INJURY (Per person) ANY AUTO A ALL OSMED SCHEDULED No, X HIREDAUTOS NTO$ 57 SBM BL2522 11/09/2018 11/09/2019 �e�`e DILVIAUTI�NJURV (Pare' PRrOPERT DA U 112P UMBRELLA LAB OCCURR EXCESS UAB CLAIMS -MADE 00 0 -- 11 G DED RETENTIONS ✓ WORKERS COMPENSATION PER X OTH- ANDEMPLOYERTUABILRY STATUTE ER E.L EACH ACCIDENT $1,000,00 B ANY PROPRIETORPARTNERIEXECIIrIVE YIN OFFICERIMEMBEREXCLUDED' (Mandatory In NH) MA 57 WEC AC3MZN 11/09/2018 11/09/2019 E.L. DISEASE -EA EMPLOYEE $1,000,00 If yes, describe under DE PTION F PERATI below E. L. DISEASE - POLICY LIMIT $1,000,DD A EMPLOYMENT PRACTICES LIABILITY 57 SBM BL2522 11/09/2018 I 11/09/2019 Each Claim Limit $10,00 Aggregate Limit $10,00 DESCRIPTION OF OPERATIONS/LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, may be allachad N mom apace u required) Those usual to the Insured's Operations. The city of Santa Ana, it's officers, employees, agents and representatives are named as additional insured per the Business Liability Coverage form, SS0008, attached to this policy. 30 Day Notice of Cancellation applies. CERTIFICATE HOLDER CANCELLATION THE CITY OF SANTA ANA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 20 CIVIC CENTER PLZ THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN SANTA ANA CA 92701-4058 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 THE HARTFORD Select Customer Insurance Center 3600 WISEMAN BLVD. SAN ANTONIO TX 78251 Policyholder, please callusat: (866) 467-8730 Agent, please callus at: (866) 467-8730 SERVICE.TX@THEHARTFORD.COM INSURANCE ENDORSEMENT ATTACHED *** PLEASE REVIEW THE CHANGE *** Enclosed is an endorsement for your business insurance policy. Please review it at your convenience. If you have questions or need to make further changes: Policyholder, please callus at: (866) 467-8730 Agent, please call us at: (866) 467-8730 between 7 A.M. and 7 P.M. CST. The premium billing will be mailed to you separately. You can expect to receive it soon. Thank you for allowing us to service your business needs. BIZINSURE LLC/PHS THE HARTFORD SELECT CUSTOMER INSURANCE CENTER The Hartford Hartford Fire Insurance Company and its Affiliates One Hartford Plaza, Hartford, Connecticut 06155 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY CHANGE This endorsement changes the policy effective on the Inception Date of the policy unless another date is indicated below: Policy Number: 57 SBM BL2522 DX Named Insured and Mailing Address; HALL AQUATIC LS DESIGN CONSLTNT LLC DBA HALL AQUATIC DESIGN LLC 347 GRANT ST SE ATLANTA GA 30312 Policy Change Effective Date: 11/12/18 Effective hour is the same as stated in the Declarations Page of the Policy. Policy Change Number: 003 Agent Name: BIZINSURE LLC/PHS Code: 102005 POLICY CHANGES: TWIN CITY FIRE INSURANCE COMPANY ANY CHANGES IN YOUR PREMIUM WILL BE REFLECTED IN YOUR NEXT BILLING STATEMENT.IF YOU ARE ENROLLED IN REPETITIVE EFT DRAWS FROM YOUR BANK ACCOUNT, CHANGES IN PREMIUM WILL CHANGE FUTURE DRAW AMOUNTS. THIS IS NOT A BILL. NO PREMIUM DUE AS OF POLICY CHANGE EFFECTIVE DATE PRO RATA FACTOR: 0.992 THIS ENDORSEMENT DOES NOT CHANGE THE POLICY EXCEPT AS SHOWN. Form SS 12110405T Page 001 (CONTINUED ON NEXT PAGE) Process Date: 11/12/18 Policy Effective Date: 11/09/18 Policy Expiration Date: 11/09/19 POLICY CHANGE (Continued) Policy Number: 57 SBM BL2522 Policy Change Number: 003 BUSINESS LIABILITY OPTIONAL COVERAGES ARE REVISED ADDITIONAL INSUREDS) ARE ADDED THE FOLLOWING ARE ADDITIONAL INSURED FOR BUSINESS LIABILITY COVERAGE IN THIS POLICY. LOCATION 001 BUILDING 001 ADDITIONAL INSURED #1 - OWNERS, LESSEE OR CONTRACTORS IS ADDED FORM SS4170 SS4171 NAME THE CITY OF SANTA ANA ADDRESS 20 CIVIC CENTER PLZSANTA ANA, CA 92701 FORM NUMBERS OF ENDORSEMENTS ADDED AT ENDORSEMENT ISSUE: SS 41 70 06 11 SS 41 71 06 11 Form SS 12 11 04 05 T Page 002 Process Date: 11/12/19 Policy Effective Date: 11/09/18 Policy Expiration Date: 11/09/19 POLICY NUMBER: 57 San? BL2522 CHANGE NUMBER: 003 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: BUSINESS LIABILITY COVERAGE FORM SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): THE CITY OF SANTA ANA Location(s) Of Covered Operations: 20—CTVIC—CENTER PLZSANTA ANA,, CA92701 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section C. — 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. Form SS 41 70 06 11 Process Date: 11/12/18 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 performirr��qq pperations for a principal as a part of � §��e project. .114 � G � Q� Page 1 of 1 Policy Expiration Date: 11/09/19 © 2011, The Hartford (Includes copyrighted material of Insurance Services Office, Inc., with its permission) POLICY NUMBER: 57 SBM BL2522 CHANGE NUMBER: 003 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: BUSINESS LIABILITY COVERAGE FORM SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): THE CITY OF SANTA ANA Location And Description Of Completed Operations: 20 CIVIC CENTER PLZSANTA ANA, CA 92701 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section C. — 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". Form SS 41 71 06 11 Process Date: 11/12/18 e�G Page 1 of 1 Policy Expiration Date: 11/09/19 © 2011, The Hartford (Includes copyrighted material of Insurance Services Office, Inc., with its permission)