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HomeMy WebLinkAboutSIEMENS INDUSTRY, INC. (2)INSURANCE NOT ON FILE WORK MAY NOT PROCE MAYOR uel A. Pulldo CLERK OF COUNCIL MAYOR PRO TEM. Michele Martinet DATE: MAY 0 1 20 COUNCILMEMBERS P. David Benavides Vicente Sarrilento 1_ Jose Solorlo Sal Tini Juan Villegas CITY OF SANTA ANA CITY ATTORNEY'S OFFICE 20 Civic Center Plaza M-29 • P.O, Box 9968 Santa Ana, California 92702 S�kY,aat?04:4ftt April 17, 2018 Siemens Industry, Inc. Attn: Julie Slick 10775 Business Center Drive Cypress, CA 90630 A-2015-078-01 CITY MANAGER Raul Godlnez II CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL Maria D. Hazer Re: Extension of Agreement #A-2015-078 to provide HVAC and lighting controls technical support Dear Ms. Slick Pursuant to Section 3 ("Ferm") of Agreement No. A-2015-078 ("Agreement") entered into by Siemens Industry, Inc. and the City of Santa Ana, dated May 5, 2015, the time period or said Agreement is hereby extended for an additional one (1) year period, from May 1, 2018 to April 30, 2019. The total amount to be expended under the term of this extension shall not exceed $50,890. Monies approved by the City Council from the Agreement remain to fund this extension and no additional funding is required by the City Council for this extension, 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, Francisco Gutierrez } Executive Director Finance and Management Services Agency APPROVED AS TO FORM: Sonia R. Carvalho City Attorney J M. Funk Senior Assistant City Attorney CITY OF SANTA`kNA /�— Raul Godinez II City Manager ATTEST: Mart Tzar Clerk of the Council SANTA ANA CITY COUNCIL Miguel A. Polido Michele Martinez VicentD Sarmiento Jose solorio R David Banavides Juan wlegas Sal Tnalero Mayor Mayor Pro Tem, Ward 2 WSWI Wards Ward Ward Ward rn A rrwa orp 11 g is- vsetttdenio®ann a a+xrfgWy b(r S,gyNe-2na cen y"mgyyla4&t , bYtsuas(oi€sn(a rma we go _Mgsanta_ oeg A� 0 CERTIFICATE OF LIABILITY INSURANCE DATE 12018 YVYY) 04/12/2018® 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 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 MARSH USA, INC. 445 SOUTH STREET MORRISTOWN, NJ 07960.6454 CONTACT NAME: PHONE FAX No EMAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: HDI Global Insurance Company 41343 100129 -SOT -CA WC -17/18 610 CICKO NOC60 INSURED SIEMENS INDUSTRY, INC. INSURER B: The Travelers Indemnity Company 25658 INSURER C: Travelers Propemy Casualty Co. of America 25674 BUILDING TECHNOLOGIES 1000 DEERFIELD PARKWAY BUFFALO GROVE, IL 60089 INSURER D INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: NYC -010269414-01 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 ADDL SUER POLICY NUMBER POLICY EFF MMIODNYW POLICY EXP MM/DDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 71 OCCUR GLD1110109 10/01/2017 10/01/2018 EACHOCCURRENCE S 1,000,000 PREMI ES(TO -RENTED PREMISES Ea occurrence) $ 1,000,000 MED EXP (Any one person) $ 100,000 PERSONAL &ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: X POLICY ❑ PRO- JECT FILOC GENERAL AGGREGATE 5 10,000,000 PRODUCTS - COMP/OPAGG $ INCL $ OTHER. C AUTOMOBILE LIABILITY TC2JCAP7440L34A17 10/01/2017 10/01/2018 COMBINED SINGLE LIMIT $ 2,000,000 Ea accident) X ANY AUTO BODILY INJURY (Per person) $ N/A X OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Par accident) $ N/A ( ) X HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY(Per PROPERTY DAMAGE ... [dent $ N/A UMBRELLA LAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED IRETENTIONI 1 $ 1 C B C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN OFFCERMEMB REXCLUDED?ECUTIVE (Mandatory in NH) If yep, describe under°"$500KLIMIT DESCRIPTION OF OPERATIONS below NIA TC20UB8049X50817(AOS) TRKUB8049X51A17 AZ, MA, OR & WI ( ) TWXJUD7440L33817(OH &WA) / $500K SIR / 7 10/0112017 10/01/2017 10/01/2018 10101/2018 10/01/2018 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,900,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: SIEMENS JOB# 2600077971, 5/01/CITY OF SANTA ANA SERVICE AGREEMENT SEE ATTACHED CERTIFICATE HOLDER CANCELLATION CLERK OF THE CITY COUNCIL SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF SANTA ANA THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO BOX 1988 ACCORDANCE WITH THE POLICY PROVISIONS. SANTA ANA, CA 92702-1988 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukherjee _J*Lot'vta " :¢�-e.:r_ © 1988.2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD COMMERCIAL AUTO POLICY NUMBER: TC2s-CAP-7440L34A-TIL-17 ISSUE DATE: 08-28-17 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED FOR COVERED AUTOS LIABILITY COVERAGE This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modi- fied by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage pro- vided in the Coverage Form, SCHEDULE Name Of Person(s) Or Organization(s): ANY PERSON OR ORGANIZATION WHOM YOU RAVE AGREED TO ADD AS ADDITIONAL INSURED, BUT ONLY TO COVERAGE AND MINIMUM LIMITS REQUIRED IN A WRITTEN CONTRACT Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Each person or organization shown in the Schedule is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provi- sion contained in Paragraph A.1. of Section II - Cov- ered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section I - Covered Autos Coverages of the Auto Dealers Coverage Form. CA 20 4810 13 O Insurance Services Office, Inc., 2011 Page 1 of 1 POLICY NUNPBER: TC2J—CAP-7440L34A—TIL-17 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM The following replaces Paragraph A.S., Transfer of required of you by a written contract executed Rights Of Recovery Against Others To Us, of the prior to any "accident" or "loss",provided that the CONDITIONS Section: "accident' or "loss" arises out of the operations S. Transfer Of Rights Of Recovery Against Oth- contemplated by such contract. The waiver ap. ers To Us plies only to the person or organization desig- We waive any right of recovery we may have nated in such contract. against any person or organization to the extent CA T3 40 0215 4 2015 The Travelers Indemnity Company. All rights reserved. Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc. with its permission. TRAVELERS, WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 00 03 13 (00) _ POLICY NUMBER: (TC20UB-8049x50-8-17) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our payments from anyone liable for an injury 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 you perform work under a written contract that requires you to obtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit any one not named in the Schedule. SCHEDULE DESIGNATED PERSON: DESIGNATED ORGANIZATION: ANY PERSON OR ORGANIZATION FOR WHOM A WAIVER OF SUBROGATION IS REQUIRED BY CONTRACT OR AGREEMENT OR PERMIT, BUT COVERAGE IS LIMITED TO THE SCOPE OF THE WORK PERFORMED BY THE INSURED UNDER SUCH CONTRACT, AGREEMENT OR PERMIT. DATE OF ISSUE: 08-28-17 STASSIGN: