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Home My WebLink AboutINTERNATIONAL BUS LINES, INC nr City of Santa Ana -_ �' Clerk of the Council COTC Office Use Only ' :• " AGREEMENT TERMINATION FORM Please complete this form in its entirety when the attached agreement and all amendments (if any) are no longer in effect. r Note: If your agreement is grant related, please ensure that all grant retention requirements Cr,Nl `— „ n have been satisfied prior to signing the termination form. CL w- - ;:_ Is the agreement(s)a permanent record?Yes No i, Return form to the Clerk of the Council Office (M-30). Call 647-1520 if you have any questions. ,/� The agreement with --A-0)-f4 CIA O% YDLI_S �V`eL- A-2017-321-02 No. _ was completed on 1!5 t 5c. and final payment has been made. (List all amendments. use space below if needed.) Department: ?NA-- Phone/Ext.: h'";- n _Z!" Signature: i d / Date: O;dii,e Revised:10-18-16 I INSURANCE NOT ON FILE WORK MAY NQT PROCEED CLERK OF COUNCIL MAYOR `.- ° IT L.Ulu Migum A Puliao MAYOR PRO TEM Michels Martinez COUNCILMEMBER$ P. David esnavides Vicente sarmianm Jose Solorio Sal 1 inajera Juan Yule as Nrti ts`t •...�?t L y 1'�'C'i f PUBLIC WORKS AGENCY 20 civic Center Plaza M-38 . F O. Box 1988 M -a4 Santa Ana, California 92762 ww9v sanW-ADA� 24 May 30, 2018 . International Bus Lines,,Inc, 2083 West Hillcrest Drive, #f3208 Newbury Park, CA 91320 Atin, Richard Gomez A-2017 -321-02 CITY MANAGER Rdxil Goa[nez tI CITY ATTORNEY Sonia R. CarvaPw CLERK OF THE COUNCIL Mara 4. Hufzar Re. Second Extension of Lease Agreement Na. A-2017-322 and W'alver of Requirement to Demolish "The Kiosk " pursuant to Section 5 ("Extension Periods") of Lease Agreement No. A-2017-,21, entered into by International Bus Lines, Inc, ("Tenant") and the City ofSanta Ana, dated December 6, 2017 and as previously extended by l.,attar No. A-2017-321-01, the option is hereby provided to '7!"errant to further extend the term of the Lease Agreement for two weeks, from lune 1, 2013 through lune 15, 2018, Teraasnt shall agree to this extension by signature belarv. The insurance certificates are required to be extended and/or renewed to cover this extension. In addition, as pcnnittc<I by Section 26(c) of the Lease Agreement, the City her'cby waives the requirement in Section l() of the Lease Agreement to demolish "The Kiosk" and related fixtures at lease end or termination. Accordingly, at such time, provided That all other conditions of Section 10 are satisfied, Tenant shall be entitled to a refund of its deposit in the amount of $5,000 that was paid to the City to guarantees this obligation. All other teens and conditions of the lease Agreement remain unchanged and in full fiance and effect. If you have any questions regarding this matter, please contact Gabriela Lomeli in the Public Works Agency at 714-56 5-2692. Sine , Edwin "Wil liani"Ga1v ,:. P -E. Acting Executive Director, Public Warks Agency -- srgrecrrrrrv.>s corrtlrrne ae nexr1rage -- SANTA ANA CITY COUNCIL MyuW A r'uFdb M:<A91a MMtl:+103 Yt BiAB $iirlrr0mo J09p $ilIN•u a. [hyNtl 80(10'dtlNS .cat"I pGJdY $8. ,i PB G•0 Mayor MayVr Mo T&m. Watp2 Ward Ward3 Wardc W5rd5 Wad b 2EVCt'zErs mtaanaena n;�ia£cd'�'.�.4t5 0#+me+*z�ta�cw m' '3Wn-,A2waurs35 A4€."" @3r$+ar+±aau«a aaJe9A9�#a+'n.aaa,�„y a+¢g's Second Extension of Cease Agreement and Waiver May 30, 2018 Page; 2 CITY OF SAN'r&AN %taui CYo Jinez. IC City Manager APPROVED AS TO FORM 1r, _: RM M. Funk — Assistant City Attomey ATTEST i Mania D. Htaixar Clerk of the Council TEN_A ff F. me. ro Title: a I do #Rv v Sai ale i WeN b SANTA ANA CITY COUNCIL 44yuM a !'ww Mal=r PV ., Wa, 4feyms Rro Tem. Wdrn1 Sermierru� awe Sa�3 pg 8enatipe=. woo WONt di,nn Veli! m,`.vAI -: 1 -az— Ward9 War04 W.0 Aww'011a^_IEP^_a u9&384HeAMM-AL9_.m We�eg m".Esani&.0�3yY': Sai ale i WeN b ® Policy Number: CP4957-070-a Date Entered: 07/02/2018 `� G'CERTIFICATE OF LIABILITY INSURANCE DATE{MM/DDIYri^() //L/—, tt 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 poiicy(IGS) 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 ceitificate holder in lieu of such endorsement(s). PRODUCER interstate Trans Insurance Broker Inc. CONEACT rV. SK #0G22050 AaM PRONE (323) 728 0003 Np , (323) 888-2331 P. O. BOIL 911094 Commerce, Ca 90091 7bmoARIbs4l_a.tib2OOO@aol.com Lia# OG22050 INSURERS AFFORDING COVERAGE NAIC# 07/02/2019 EACH OCCURRENCE d7+MAi r FzENS`e15` E Eaocnurre INSURERA3A'J'.A.T.N SPECIALTY INSURANCE C0:4E'AN'X 17159 INSURED INTERITA.TIONAL BUS LINES INC. NC INSURER B:MOG"ASSSVE I NUIIAE GOLdPANxES 10243 EVANSTON :WSVE+ANCB C6iiWANY IN„_SURERC: 37352 INSURE D3 Gid iJR,A1 G QdP 40460 2088 WEST HILLCPM8T DR. B208 NEWBURY PARK, CA 91320 PERSONAL&ADVINJURY $ INsuRERE: INSURER F 3 4 V V C[[Hli CJ ctrc l iPK;A1 k� N 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 A S POLICYNOMSER POlDt7 POLI DY YYYI EXP LIMITS A COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR �/ X C IP364071 07/02/201$ 07/02/2019 EACH OCCURRENCE d7+MAi r FzENS`e15` E Eaocnurre $2,000,000.00 $ 500,000.00 MED EXP An ane rsnn $ 5, DOD . 00 PERSONAL&ADVINJURY $ GEN'LAGGREGATE LIMIT APPLIES PER! POLICY ❑ JRCQT LOC GENERAL AGGREGATE $3,000,000.00 PRQDUGTS-CpMpIOPAGG $ $ OTHER: S AUTOMOBILE LIABILITYM ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY X C:P4957-070--8 06/22/2018 06/22/2019 1 NGLE U.,I aaccd0 t $5 000 , 400^ BODILYFNJURY(Perpersnn) ^—__.0(T' S BODILY INJURY (Poraactdant) S PR PERTY DAMAO ancidont) _ $ C UM9RELLA UAB OCCUR EACH OCCURRENCE $3,000,000.00 EXCESS LIAB CLAIMS•MADr XOBW7268517 EXCESS GENERAL LTAB 07/02/2018 07/02/2019 AGGREGATE $ — DED I I RETENTION $ EXMSS FIRE LGI, $ ,500, 000.00 WORKERS COMPENSATION AND EMPLOYERS' LIABIUTY YIN ANY PROPRIETORIPARTNERIEXECUTIV6 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) DEclo SCRIPTION OP OPERATIONS below NIA 5C -2306159-0:L 06/19/2018 07/02/2018 06/19/241.8 a7/02/2019 PER, 47H- E„L. EACH ACCIDENT $ 1, 000 r 000. QO EL.DISEASE-EAEMPLOYEE $1,000,000.00 E,L, DISEASE'- POLICY LIMIT ANNUAL 1,1141T v$ 1, 000 , 000.00 $ 50,000.00 A BUSINESS INTERRUPTION INSURANCE (1 'YEAR. ) CIP36407:L DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORO 101, Addlttanal Remarks.Schedulo, may be attached If mare space Is roqulred) Commercial Livery Packaged Policy. *** Certificate holder is named as additional insured *** New Location: SANTAANA, CA. 92701 - REVIEWEDBY: EUNICE HERED(A P m�OF CITY OF SANTA ANA, PUBLIC WORKS AGENCY SANTA ANA REGIONAL TRANSPORTATION CENTER 1000 E. SANTA ANA.BLVD.SUITE las SANTA ANA, CA 92701 FAX -714-565-2692 AUORD 26 (2016103) SHOULD ANY OF THE ABOV5 DESCRIBED POLICIES BE CANCELLED BIEFORE THE EXPIRATION DATE: THEREOF, NOTICE WILL 13E DELIVIERED IN ACCORDANCE,WITH THE POLICY MOVISIONS. AUTHORIZED R R SENTATIVE Q 1888-2016 Che ACORD name and logo are registered marks ofACORD Produced using Farms Bass Plus software. www.FormsBoss.com: Impressive PubllshlnD 1300-200-1977 All rights reservgrl ADDITIONAL INSURED ENDORSEMENT FOR COMMERCIAL GENERAL LIABILITY POLICY Insurance Company: ATAIN SPECIALTY INSURANCE COMPANY This endorsement modifies such insurance as is afforded by the provisions of policy # CIP364071 relating to the following: 1. The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701 -its Officers, employees, agents, volunteers and representatives are named as additional insureds ("additional insured")'with regard to liability and defense of suits arising from the operations and uses performed by or on behalf of the named insured. 2. With respect to claims arising out of he operations and uses performed by or on behalf of the named insured, such insurance as is afforded by this policy is primary and is not additional to or contributing with any other insurance carried by or for the benefit of the additional insureds. 3. This insurance applies separately to each Insured against whom claim is made or suit is brought except with respect to the company's limits of liability. The inclusion of any person or organization as an insured shall not affect any right which such person or organization, would have as a claimant if not so included. 4. With respect to the additional insureds, this insurance shall not be cancelled, or materially reduced in coverage or limits expect after thirty (30) days written notice has been given to the City of Santa Ana,20 Civic Center Plaza, Santa Ana, California 92701. (Completion of the following, including countersignature, is required to make this endorsement effective) Effective 07/02/201$ this endorsement form as a part of Policy#. CIP364071 Issued to INTERNATIONAL BUS LINES INC._ � Named Insured Countersigned by Auth C R.eprjs�t_ative FtEV ECJ RY. E. NICE H REDIA PG OF