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Home My WebLink AboutAU ZONE SANTA ANA, LLC.INSURANCE NOT ON FILE Please return an original A-2017-272-01 WORK MAY � PROCEED executed agreement 0. our CLERKUEf O0 ,�{� DATE.t; 1 RIGHT OF ENTRY [2120 — 2130 S. Bristol Street, Santa Ana] The City of Santa Ana, a charter city and municipal corporation duly organized and existing under the Constitution and laws of the State of California, does hereby grant to AU ZONE SANTA ANA, LLC, a California limited liability company ("Grantee"), the right to enter the westerly 11' of the parcel described as Parcel 1 adjacent to 2120 -- 2130 S. Bristol Street, Santa Ana, County of Orange, as more particularly shown in Exhibit A, attached hereto and incorporated herein by reference ("Property"), for the following purposes: The right to enter and use the Property for the purpose of constructing new signage and related purposes. Grantee agrees to indemnify, defend, and hold harmless City, its officers, agents, representatives, employees, and volunteers from and against any and all actions, suits, claims, demands, judgments, losses, expenses, or liabilities, injuries and damages to persons and property, including death, arising out of or related to Grantee's use of the Property or the entry by any Grantee party on the Property, including without limitation, Grantee's guests and invitees. Grantee further agrees to repair any damage to the Property caused by the exercise of this Right of Entry at its sole cost and expense and to restore said property to the state in which it existed prior to its use. Grantee shall maintain commercial general liability insurance which 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 its use of the Property, 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 and $2,000,000 in the aggregate. Such insurance shall (a) name the City, its officers, employees, agents, volunteers 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. The rights herein granted to Grantee are exclusive, and Grantee agrees not to assign, transfer, lease, pledge, or otherwise dispose of this Right of Entry without the prior express written approval of the City. This instrument conveys no right of entry to existing buildings, if any. 1 This Right of Entry shall expire on December 31, 2018, unless otherwise terminated earlier or extended by written agreement between the parties. THE CITY OF SANTA ANA A charter city and municipal corporation duly organized and existing under the Constitution and laws of the StState aoffCCalifornia. BY:�T°'""' ( I Raul Godinez II City Manager Date: All ZONE SANTA ANA, LLC, a California limited liability company By: % Date: APPROVED AS TO FORM: 1' 'L'. � JM. Funk A sistant City Attorney Maria D. Huizar Clerk of the Council 2 First American Title EXHIBIT "A" LEGAL DESCRIPTION OF REAL PROPERTY FOR FUTURE STREET WIDENING Legal description of real property which is hereby irrevocably offered for dedication for the future widening of Bristol Street. PARCEL I The easterly 25.00 feet of Parcels 4, 5 and 6, in the City of Santa Ana, County of Orange, State of California, as shown on a map filed in Book 130, Page 3 and 4 of Parcel maps, in the office of the County Recorder of said county. Except therefrom the following described parcel: Commencing at the southeast corner of said parcel 6; thence North 891 48' 31" West 25.00 feet; thence North 0° 11' 29" East 37.25 feet to the True Point of Beginning; thence South 89° 48' 31" East 16.10 feet; thence North 01 11' 29" East 50.57 feet; thence North 890 48' 31" West 16.10 feet; thence South 0" 11' 29" West 50.57 feet to the True Point of Beginning. Exhibit "B" attached hereto and made a part hereof. Prepared by or under direction of: Richard B. Morsch R.C.E. 29506 Registration expires 03/31/99 First American Title First American Title EXHIBIT "B" Nor 7C 25' 37 SCALE PARCEL 4 174.00' I I , 277.01, za1.99' Pl W O � I Y YSY.01' o, WARNER AVENUE SKETCH FOR REFERENCE ONLY. First American Title H LLI W 0t F m :f F / 509.13' 494.13' PM 13013-4 PARCEL 5 PARCEL t IRREVOCABLE OFFER OF DEDICATION FOR , BRISTOL STREET N m ,Y ,o � 174.99' m i 149.00' o PM 130/3-4 m PARCEL 6 936.O_S'A i o 11 �I C � Ih w Iln � I n o I h9 PM 13013-4 — 1— 25' 37 SCALE PARCEL 4 174.00' I I , 277.01, za1.99' Pl W O � I Y YSY.01' o, WARNER AVENUE SKETCH FOR REFERENCE ONLY. First American Title H LLI W 0t F m :f F / ACOR6r CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 5/14/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Arthur J. Gallagher & Co. Insurance Brokers of CA, Inc. LIC #0726293 18201 Von Karman Ave Suite 200 Irvine CA 92612 CONTACT NAME: Arthur J. Gallagher & Company PHONE 949-349-9800 FAX 949-349-9962 A/c No ADD IL INSURERS AFFORDING COVERAGE NAIC4 INSURER A: Federal Insurance Company 20281 EACH OCCURRENCE $1,000,000 INSURED HKJGOLD-01 INSURER B : AU Zone Santa Ana, LLC. 1311-2158 S Bristol St INSURER C : Santa Ana, CA 92704 INSURER D: PERSONAL &ADV INJURY $1,000,000 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 1121419647 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. INSR LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MMIDDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR Y 35843977 4/30/2018 4/30/2019 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence $1,000,000 MED EXP (Any one person) $10,000 PERSONAL &ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRO - X POLICY JECT LOC GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP/OPAGG $2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SI G E LIMIT $ Ea accident ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ ( ) HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accident $ $ A X UMBRELLA LIAB X OCCUR 79846218 4/30/2018 4/30/2019 EACH OCCURRENCE $25,000,000 EXCESS LIAB CLAIMS -MADE AGGREGATE $25,000,000 DED RETENTION $ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY Y / N STATUTE ER E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED' N / A E.L. DISEASE - EA EMPLOYE $ (Mandatoryin NH) If yes, describe under E.L. DISEASE - POLICY LIMIT 1 $ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The certificate holder(s) is/are named additional insured as respects to the general liability policy, per the attached form(s), as required per written contract. REVIEWED BY: EUNICE HEREDIA (PG f OF ) City of Santa Ana Attn: Leticia Lopez, Public Works Agency Design Engineering 20 Civic Center Plaza, M-36 Santa Ana CA 92702 USA 1 IUN 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 i U 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD CH U B B° Liability Insurance Endorsement Policy Period Effective Date Policy Number Insured Name of Company Date Issued This Endorsement applies to the following forms: GF.NER Ar . LIABRHY Who Is An Insured APRIL 30, 2018 TO APRIL. 30, 2019 APRIL 30, 2018 358439-77 WC HKJ GOLD INC. FEDERAL INSURANCE COMPANY MAY 9, 2018 Under Who Is An Insured, the following provision is added Additional Insured - Persons or organizations shown in the Schedule are insureds; but they are insureds only if you are Scheduled Person obligated pursuant to a contract or agreement to provide them with such insurance as is afforded by Or Organization this policy. However, the person or organization is an insured only: • if and then only to the extent the person or organization is described in the Schedule; • to the extent such contractor agreement requires the person or organization to be afforded status as an insured; • for activities that did not occur, in whole or in part, before the execution of the contract or agreement; and • with respect to damages, loss, cost or expense for injury or damage to which this insurance applies. No person or organization is an insured under this provision: • that is more specifically identified under any other provision of the Who Is An Insured section (regardless of any limitation applicable thereto). • with respect to any assumption of liability (of another person or organization) by them in a contract or agreement. This limitation does not apply to the liability for damages, loss, cost or expense for injury or damage, to which this insurance applies, that the person or organization would have in the absence of such contractor agreement. Liability Insurance Additional Insured - Scheduled Person Or Organizaffon continued Form 80-02-2387 (Rev. 5-07) Fndorsarmnt page 1 REVIEWED BY: EUNICE HEREDIA (PG 2oF ) CHUBB° Liability Endorsement (continued) Under Conditions, the following provision is added to the condition titled Other Insurance. Conditions Other Insurance — If you are obligated, pursuant to a contract or agreement, to provide the person or organization Primary, Noncontributory shown in the Schedule with primary insurance such as is afforded by this policy, then in such case Insurance — Scheduled this insurance is primary and we will not seek contribution from insurance available to such person Person Or Organization or organization. Schedule CITY OF SANTA ANA ATTN: LETICIA LOPEZ, PUBLIC WORKS AGENCY DESIGN ENGINEERING 20 CIVIC CENTER PLAZA M-36 SANTA ANA CALIFORNIA 92702 All other terms and conditions remain unchanged Authorized Representative Q—AV—, ou Liability Insurance Addiffonal Insured - Scheduled Person OrOrganizadon lastpage Form 8042-2367 (Rev. 5-07) Endorsement Page 2 REVIEWED BY: EUNICE HEREDIA (PG OF )