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Home My WebLink AboutMARIPOSA LANDSCAPE (2)City of Santa ' na com ohic e Use Only Clerk of the Coocil AGREEMENT TERMINATION FORM Please complete this form in its entirety when the attached agreement and all amendments (if any) are no longer in effect. C;'Y of Santa Ana Note: If your agreement is grant related, please ensure that all grant retention requirements have been satisfied prior to signing the termination form. kJ 0 2 2621 Is the agreement(s) a permanent record? Yes— No Clerk of the Counc-ill Return form to the Clerk of the Council Office (M-30). Call 647-1520 if you have any questions. The agreement with O"W\ vm-'c U(3'n&'UKff==a' � . No. L7-0n-2-16 was completed on and final payment has been made. (List all amendments. Use space below if needed.) Department: Phone/Ext.: Signature: Date: Revised: 10- 18-16 MAYOR Miguel A. Putldo MAYOR PRO TEM Micheis Martinez COUNCILMEMBERS P. David Benavldes Vicente Sarmiento Jose Solorlo Sal Tinajero Juan Villages INSURANCE NOT ON PILE WORK MAY NE PROCEED_ CLERK OF COUNCIL k DATE, FEB D 1 7018 December 2&, 2017 Mariposa Landscapes, Inc. 15529 Arrow Highway Irwindale, CA 91706 CITY OF SANTA ANA PARKS, RECREATION AND COMMUNITY SERVICES AGENCY 20 Civic Center Plaza M•23 • P.Q. Box 1988 Santa Ana, Caiibrnia 92702 WWW.Santa-ana.ore A-2017-216-01 CITY MANAGER Raul Godinez 11 CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL Maria D. Huizar Re: Extension of Contractor Agreement No, A-2017-216 to provide landscape maintenance services for District 4 Dear Mr, Noriega: Pursuant to Section 3 C Temr') of Agreement No. A-2017-216 entered into by Mariposa Landscapes, Inc. and the City of Santa Ana, dated August 15, 2017, the time period for said Agreement is hereby extended for an additional one (1) year period, from February 1, 2019 to January 31, 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. Sincerely, Gerardo -Monet Executive Director Parks, Recreation and Community Services Agency APPROVED AS TO FORM: Sonia R. Carvalho City Attorney �} Laura A. Rossini Senior Assistant City Attorney CITY OF SANTA ANA" Raul Godinez 11 City Manager ATTEST: te: �o Maria D. Huizar .. _. Clerk of the Council SANTA ANA CITY COUNCIL Miguel A. Pulido Michele Mod... Vicente Sarmiento Jose Solorlo P. David Benavides Juan Vlllegas Sal Tmajem Mayor Mayor Pro Tam, Ward 2 Ward 1 Ward 3 Ward 4 Ward 5 Ward 6 Ztguii}ip(p?sante-ana.ora nipigC115€zralsanta-ana org yggrmiento(rSsanta-ana om Isolorlorinsonta-angora dbenavidessasanta-areoro ivilleoas/nu)santasAtJ.RGg stlnaleroCZasanta-enwn ACC>RH CERTIFICATE OF LIABILITY INSURANCE F7TE(MMIDOIYYYY) 1 8/17/2017 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 certgicate holder is an ADDITIONAL INSURED, the pollcy(les) must be endorsed, If SUBROGATION IS WAIVED, subject tD the terms and conditions of the policy, certain pollcles may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements . PRODUCER Landscape Contractors (Lic#0755906) Insurance Services, Inc. 1835 N. Fine Avenue Fresno CA 93727 CONTACT Bonita, Hall, C18R NAME: AFIONE. Est: (559)630-3555 qID 00(559)650-3338 AooaEll,bhall@101sino.aom INSURERIS) AFFORDING COVERAGE NAIL# INSURERA Atlantic Specialty Insurance 27154 INSURED /[ r^- Mariposa Landscapes Inc �T I 'O} ,I 15529 Arrow Highway Irwindale CA 91706 INSURERS Navigators Specialty Ins CO 36056 INSURERc; INSURERo; INSURERS: INSURERF: COVERAGES CERTIFICATE NUMBER:17/18 Pkg & Auto REVISION NUMBER: THIS IS TO CERTIFY THAT TiH E 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 VM11CH 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 MAYHAVE BEEN REDUCED BYPAID CLAIMS, R TYPE OF INSURANCE POLICYNUMBER PO MIDDIYYYY OLICY ll MMIDDIYYYY LIMITS X CDMMERCIAL GENERAL LIAa0.ITY EACH OCCURRENCE $ 1,000, 000 A CLAIMS -MADE OCCUR PRENIISE9(EdocNTCurcenCe S 500,000 MED EXP (Any one orson) $ 5,000 618-00-11-21-0001 4/l/2017 4/1/2018 $1,000 Ed Dad PERSONAL &ADV INJURY $ 1,000,000 X Blanket contractual AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 GENL Liability POLICY IJECT F-1LOC PRODUCTS-COMPIOPAGG $ 2, 000, PO0 Employee Benefits $ 1,gg0, 0q0 OTHER: Ee LIIN`U NG LNII$ 1,Ob0,00q BOOILY IMJIIRY(Porporson) $ A PnOMOSILELIABIL ANY AUTO AUTOS IED S(EdEESULED Uro 618-00-11-21-0001 4/1/2017 4/l/2018 BOOILV INJURY(Per sccklant) HIREDAVT09 X AU -OWNED FPepacclrl Y DAMAGE $ —" Uninsured mu lstmmtlned $ 1,000,000 X UMBRELLALIAB X OCCUR EACH OCCURRENCE $ 5,000 000 AGGREGATF $ 5,000,000 B EXCESS LIAR CLAIM"ADE DED I I RETENTION $ SF17EXC0406141C 4/1/2017 4/1/2018 WORKERS COMPENSATION ANDEMPLOYERsUABILITY YIN ANY PROPRIETORIPARTNERIEXECUTIVE OFFICER/MEN TIER EXCLUDED? � (Mandatory In INN) NIA PER OTH- STATUTE ER EL EACH ACCIDENT $ E.L, DISEASE-EAEMPLOYEE $ 0yoo doadrlbo under DESCRIPTION OF OPEPATIONISbelow EL DISEASE-POLICV LIMIT $ Ranted/Leased Equipment 618-00-11-21-0001 411/2017 4/1/2016 U.ItOod:$500 $300, 000 Scheduled Equip 618-00-11-21-0001 4/1/2017 4/1/2010 UmII/Dod:$600 $3 ,7162,565 DESCRIPTION OF OPERATION81 LOCATIONS IVEHICLES (ACORC 101, Addl6anal Remarks Schedule, may be attsohed Irmaro apace Is roorwed) RE: All landscape operations performed by er on behalf of the named insured Primary Insurance/Ron Contributory Blanket Additional insured per attached OBPG'''''G''L```O��'apLW12� & CG20010413 City of Santa Ana, it's officers, employees, agents and representatives (Exc1 q 7"Professional Liability) are named as additional insured This revises Certificate dated31-201`7`4(, cr 91�\��i✓a,� City a£ Banta Ana Attn: Purchasing Department 20 Civic Centex Plaza Santa All CA 92701 SHOULD ANY OF THE ABOVE DESC3rMF OLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THERE3 NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESEM'ATIVE Hall, CTSR/KSACNZ -_ ozFilfrzry�r�[K.�:i.z.T.�dsa:�_f,if.�al�evr�fmafarrtmm� ACORD 25 (2014101) The ACORD name and logo are reglsterod marks of ACORD INSU25 (201401) COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED ENDORSEMENT This endorsement modlfles Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM A. The following is added to Paragraph 2. In SECTION II - WHO IS AN INSURED: Any person or organization you are required by written contract or agreement to name as an additional Insured subject to the fallowing: Any such person or organization must be approved in writing by us as an additional insured. Coverage for such person or organization will begin on the date of our approval. a. No such person or organization is an additional insured for your acts, errors or omissions if such acts, errors or omissions are not also covered under such person or organization's liability insurance. It. No such person or organization is an additional Insured for "bodily Injury" or "property damage" for acts, errors or omissions of any additional insured. B. With respect to the insurance afforded to the additional insureds under Paragraph A. above, the following is added to SECTION III - LIMITS OF INSURANCE: The most we will pay on behalf of the additional insured is the amount of insurance: a. Required by the contract or agreement; or I Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement does not Increase the applicable Limits of Insurance shown in the Declarations. C. With respect to the Insurance afforded to the additional insureds under Paragraph A. above, Paragraph I. Damage To Your Work in Paragraph 2. Exclusions of COVERAGE A — BODILIY INJURY AND PROPERTY DAMAGE LIABILITY In SECTION I — COVERAGES is replaced by the following This insurance does not apply to: I. Damage To Your Work "Property damage" to "your work" arising out of it or any part of it and included in the "products - completed operations hazard". D. With respect to the insurance afforded to the additional insureds under Paragra '�r above, The following is added to Paragraph 4. Other Insurance in SECTION IV — C®fCIAL GENERA LIABILITY CONDITIONS: This insurance is primary if required by the contract or agreement. If there is no dt yyr"\ri fpcnt, this insurance will be excess and paragraph b. Excess Insurance applies. \\J\raG P "0 Q�GgP OBPG GL 0434 04 14 Contains copyrighted material of Insurance Services Office, Inc. with Its permission. Page 1 of 2 Copyright, OneBeacon Insurance Group, 2014 COMMERCIAL GENERAL LIABILITY E. With respect to the insurance afforded to the additional insureds under Paragraph A. above, the following is added to Paragraph B. Transfer of Rights Of Recovery Against Others To Us, in SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS, However, we will waive our rights to recover against any additional insured for payments we make for injury or damage arising out of: a. Your ongoing operations; or i "Your work" done under the contract or agreement and included in the "products completed operations hazard' if such waiver is required by the contract or agreement. Policy Number: 618-00-11-21-0001 Name Insured. Mariposa Landscapes Inc This endorsement is effective on the inception date of this policy unless otherwise stated herein. Endorsement Effective Date: 04/01/2017 �e'4 cJ OBPG GL 0434 04 14 Contains copyrighted material of Insurance Services Offioe, Inc, with its permission, Page 2 of 2 Copyright, OnOBOAGon Insurance Group, 2014 Policy 4618-00.11-21-0001 COMMERCIAL GENERAL LIABILITY 0020010413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. M 01169 110400 This enclorsement modifies Insurance provided under the fallowing; COMMERCIAL, GENERAL LIACILI` Y COVERAGE PART PRODUCTSWMPLETEI3 OPERATIONS LIACILITY COVERAGE PART The following is .added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And NoncorrWbutofy Insurance Thin insurance Is primary to and will riot seek contribution frorri any other insurance avaliable to an additional insured under your policy provided that, (1) The additional insured Is a foamed Insured Under such other insurance; .and (2) You have _agreed in writing to a contract of agreement that This insurance would be primary and would not seek contribution from any other insurance available to the additional insured, ��GS� Pam�n• P CG 20 010413 0 Insurance Services Office, Inc., 2012 Page 1 of 1 AC"RO® CERTIFICATE OF LIABILITY INSURANCE `.i ATE D03/24/201 YY) 03/24/2017 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 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 CONTACT NAME: _ PHONE 310-514-8425 _ FAX 310-514-8688 1AIG No ExiP A/C No: Global Risk, LLC 800 N. Wilshire Blvd., Second Floor E-MAIL certs@globalriskcap.com ADDRESS: Los Angeles, CA 90017 INSURERS) AFFORDING COVERAGE NAIC N License #OA55460 INSURERA: Send Casualty Company 128460 INSURED Mariposa Landscapes, Incorporated 15529 Arrow Highway Irwindale, CA 91706 _ INSURER B : _ INSURERC: --- INSURER D INSURER E 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 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. ILTR TYPE OF INSURANCE '.ADDL SUER POUCYEFF MqQ WVD POLICY NUMBER MMIDDnry`yY) POLICVEXP IMMIDDIYYYYI LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑ OCCUR GEN'L AGGREGATE LIMIT APPLIESPER: POLICY I JEo El LOB OTHER: Y� • V ` Q/` `1 `_e�\ \ EACH OCCURRENCE DAMAGE TORN E PREMISES Ea occurrence MED EXP (Any one person) PERSONAL &ADV INJURY GENERAL AGGREGATE PRODUCTS-COMP/OP AGG $ $ $ $ $ $ $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS a qq �\(�V V f -P f` `' 77��, ` !�{// COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accid.h0 $ $ $ $ UMBRELLA LIAB OCCUR J, EXCESS LIAB CI -AIMS -MADE_ DED RETENTION$ EACH OCCURRENCE $ AGGREGATE $ $ A WORKERS COMPENSATION Y 90-20720-01 AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE YIN OFFICER/MEMBER EXCLUDED? �. NIA (Mandatory in NH) (r describe under DESCRIPTION OF OPERATIONS below 04/01/17 04/01/18 X I PER,BITE ERH E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT I$ $ 1,000,000 1,000,000 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached R more space Is required) Re: Operations of the Named Insured. City of Santa Ana Attn: Purchasing Department 20 Civic Center Plaza Santa Ana, CA 92701 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE nc 1988-2014 ACORO CORPORATION. All Ar hfe ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD SENTRY CASUALTY COMPANY Carrier Code No. 37877 WORKERS' COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY POLICY NUMBER: 90-20720-01 00 171 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right an injury covered against the perso agreement applies a written contrac from us.) to recover our payments from anyone liable for by this policy. We will not enforce our right I or organization named in the Schedule. (This only to the extent that you perform work under t that requires you to obtain this agreement This agreement shall not operate directly or indirectly to benefit any one not named in the Schedule. Schedule "ALL WRITTEN CONTRACTS PROVIDED SUCH CONTRACT WAS MADE PRIOR TO LOSS" WC 00 03 13 (Ed. 04-84) Copyright 1983 National Council on Compensation Insurance. MAR 90-20720-01 00 171 MARIPOSA LANDSCAPES INC 03-22-17 PAGE 001 ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE (MM DDM ri) 1 4/1/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(ies) must 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 CONTACT NAME: Benita Hall, CISR Landscape Contractors (Lic#0755906) (PA E (559) 650-3555 Alt No: (559)650-3558 AE40MSS,bhall@lcisinc.com SS'bhall@lcisinc.com Insurance Services, Inc. INSURER(S) AFFORDING COVERAGE NAICi 1835 N. Fine Avenue INSURERA:Wesao Insurance Company 25011 Fresno CA 93727 INSURED ��tt /• Mariposa Landscapes Inc /-s-aoj-1-a(Lp 6232 Santos Diaz Drive A-i901-7-o tk-oI INsuRERB:Greeinhich Ins Co 22322 INSURERC: INSURERD: INSURERS: 1 INSURERF: Irwindale CA 91702 COVERAGES CERTIFICATE NUMBER:18-19 Pkg & Auto & 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 NMICH 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. LIMBS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR L R TYPE OF INSURANCE POLICY NUMBER MMIDD EFF MMIDDIYVYY LIMITS X COMMERCIALGENERALLIABILRY EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE X� OCCUR DAMAGE TO RENTED PREMISES Be omunence $ 500,000 MED ESP(Any one person) $ 5,000 WPP1621859 00 4/1/2018 4/1/2019 X $1,000 PD DED PERSONA- &ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2,000,000 'Y POLICY E].ECTPRO- F7]LOC PRODUCTS-COMP/OP AGG $ 2,000, 000 Employee Benefits $ 1,000,000 OTHER: AUTOMOBILE LIABILRY Eaeccident L IT $ 1,000,000 BODILY INJURY(Per person) $ A ANY AUTO PLL OWNED SCHEDULED AUTOS AUTOS Ix UPPI621859 00 4/1/2018 4/1/2019 BODILY INJURY(Per amident) $ NON -OWNED HIREDAUTOS X AUTOS PROPERTYDAMAGE Peracddent $ Unireured motorist combined $ 1,000,000 X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 51000,000 AGGREGATE $ 5,000,000 B EXCESS LIAB CIAIMSWADE DED RETENTION $ NEC6005017-00 4/1/2018 4/1/2019 WORKERSCOMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNERFXECUTIVE PER OTH- STATUTE ER E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N/A E.L. DISEASE EA EMPLOYEE $ (Mandatory in NH) Ifyas, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is requl red) RE: All landscape operations performed by or on behalf of the named insured ��• (See attached CG2010 & CG20010413) e1N City of Santa Ana, it's officers, employees, agents and representatives (Excludirth ofeg1Sional Liability) are named as additional insured ; QiVv�� e�I111 City of Santa Ana Attn: Purchasing Department 20 Civic Center Plaza Santa Ana„ CA 92701 SHOULD ANY OF THE ABOVE DESCRIBED PdL1CIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Hall, CISR/KSAENZ — u.F✓ZX-7-�-�� 09 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) INS025 (201401) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: WPP1621859 00 COMMERCIAL GENERAL LIABILITY CG 20 10 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED — OWNERS, LESSEES OR CONTRACTORS — SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional insured Person(s) Or Or anizatto s Locations OfCovered Operations Blanket as required by written contract. Information required to complete this Schedule if not shown above will be shown in the Declarations. A, Section 11 Who Is An Insured is amended to Include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", 'property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or 'properly damage" occurring after. 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for principal as a part of the same project_ 6v_r� e A\0 l� qe CG 20 10 04 13 6 Insurance Services Office, Inc., 2012 Page 1 of 2 C. With respect to the insurance afforded to these additional insureds, the following is added to Section III - Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Page 2 of 2 0 Insurance Services Office, Inc., 2012 CG 2010 0413 Policy Number; WPP1621859 00 COMMERCIAL GENERAL LIABILITY CG 20 01 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following. COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance (2) You have agreed in writing in a contract or Condition and supersedes any provision to the agreement that this insurance would be contrary: primary and would not seek contribution Primary And Noncontributory Insurance from any other insurance available to the additional insured. This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that. (1) The additional insured is a Named insured under such other insurance; and CG 20 0104 13 0 Insurance Services Office, Inc.. 2012 Page 1 of 1 AFROr CERTIFICATE OF LIABILITY INSURANCE DATE(N1M/DD/YYYY) 04/02/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must 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 CONTACT NAME: Global Risk, LLC PANEMo. ED. 213-550-2253 ac Na:213-550-2258 1800 N. Wilshire Blvd., Second Floor E-MAIL certs lobalriskca com ADDRESS: @9 p Los Angeles, CA 90017 INSURERS AFFORDING COVERAGE i NAIC# License#01_60361 _ INSURER A: Sentry Casualty Company 284.6.0__ INSURED INSURER B: Mariposa Landscapes, Inc. INSURERC: 6232 Santos Diaz St. 1. NSURER E: Irwindale, CA 91702 INSURERF. 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. ILTR TYPE OF INSURANCE ANOD WVDI POUCYNUMBER BR MMIDDY� MM/�DYYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS -MADE OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ $ _MED EXP (Any one person) $ PERSONAL &ADV INJURY $ GENLAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE POLICY JEC �, LOD PRODUCTS - COMPIOP AGG $ $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident)_ $ $ ANY AUTO BODILY INJURY (Per person) ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accidenq $ $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE (Peraccident UMBRELLA LIAB ti OCCUR EXCESS LIARETENTIONS CLAIMS -MADE EACH OCCURRENCE AGGREGATE _ $ IrrI$ DED A WORKERS COMPENSATION 90-20720-01 AND EMPLOYERS LIABILITY ANVPROPRIETORRARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? ❑Y NIA (Mandaroryin Ntq 04/01/201804/01/2019 X SPER TATUTE OTRH- - — E. L. EACH ACCIDENT E. L. DISEASE -EA EMPLOYE $ 1,000,000 $ 1,000,000 describe under DESCRIPTION OF OPERATIONS below IE. L. DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS ]VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached If more space is required) Re: Operations of the Named Insured. City of Santa Ana Attn: Purchasing Department 20 Civic Center Plaza Santa Ana, CA 92701 SHOULD ANY OF T THE EXPIRATION THE POLICY es BE CANCELLED BEFORE WILL BE DELIVERED IN U 1933.2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD P191414] SENTRY CASUALTY COMPANY Carrier Code No. 37877 WORKERS' COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY POLICY NUMBER: 90-20720-01 00 181 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our payments from anyone liable for an injur covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that ou perform work under a written contract that requires you to ob�ain this agreement from us.) This agreement shall not operate directly or indirectly to benefit any one not named in the Schedule. Schedule ALL WRITTEN CONTRACTS PROVIDED SUCH CONTRACT WAS MADE PRIOR TO LOSS" WC 00 03 13 (Ed. 04-84) Copyright 1983 National Council on Compensation Insurance. MAR 90-20720-01 00 181 MARIPOSA LANDSCAPES INC 03-30-18 PAGE 001