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HomeMy WebLinkAboutKIMLEY-HORN (4)City of Santa Ana t Clerk of the Council core office u:� 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TERMINATION FORM Please complete this form in its entirety when the attached agreement and all amendments (if any) are no longer in effect. 279 VtC i Note. If your agreement is grant related, please ensure that all grant retention requirement tT g-� have been satisfied prior to signing the termination form. U UNT Is the agreement(s) a permanent record? Yes No ul o COUNCIL Return form to the Clerk of the Council Office (M-30). Call 647-1520 if you have any questions. The agreement with , No. /T �S — �% I was completed on �FyS� and final payment has been made. (List all amendments. Use space below N needed.) Department: Phone/Ext.: ( 7/— O y Signature: Date: Revised: 10-13-16 tlj x�0�3 MAYOR Miguel A. Pulido MAYOR PRO TEM Michele Martinez COUNCILMEMBERS P. David Benavides Vicente Sarmiento it JosenSola Salinajer Juan Villegaos QVj f INSURANCE NOTON FILE WORK MAY al PROCEED ALERK OF COUNCIL DATE; AUG 2 g 2010 July 25, 2018 Kimley-Horn Attn: Darren Adrian, PE 765 The City Drive, Suite 200 Orange, CA 92868 i PUBLIC WORKS AGENCY 20 Civic Center Plaza, M36 • P.O. Box 1988 Santa Ana, California 92702 www.santa-gnii.org A-2015-171-02 CITY MANAGER Raul Godinez II CITY ATTORNEY Sonia R. Carvaiho CLERK OF THE COUNCIL Maria D. Huizar Re: Second Extension of Professional Services Agreement A-2015-171 for On -Call Engineerine Services Dear Mr. Adrian: Pursuant to Section I ("Term") of Agreement No. A-2015-171 entered into by Kimley-Horn, and the City of Santa Ana, dated August 5, 2015, the parties extended the Agreement for an additional one- year period from August 6, 2017 to August 5, 2018 (A-2015-171-01). The parties, by operation of this letter, agree to extend the term for a second and final one-year period from August 6, 2018 to August 5, 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 r Sweiss, PE, P1,S ✓e Director, Public Works Agency CITY OF SANTA ANA City Manager APPROVED AS TO FORM Jo M. Funk Assistant City Attorney ATTEST 1L. ,... . Maria D. Huizar Clerk of the Council SANTA ANA CITY COUNCIL Mque! & Pulido mchde Martinez Vicente Sarmienlo Jule sdwto P. Oav,d Benaades Juan Villega5 Sal Tlnaiero Mayor Mayor Pra Tem.WaM2 Ward Ward3 Ward Ward5 Ward ppyl_do(ol9'm14 a-an=q („jmatlinnz(olaaola an90rg wartKento(dJsanlam Eg ao—f- Pam anj= dhy't_<vl.`PyS,�alSd+la-,aom Nlleaaan.5anta�anam 5!inalerol,USantd ana ON Client#: 25320 KIMLHORN ACORD,. CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYV) 6/18/2019 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. iMPORTAN f: 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER : CoN Jerry Noy ola Greyling Ins. Brokerage/EPIC PHONE I-AX (41C, Nc Ext , 770-552-4225 {wc, NuI; 866-550-4082 3780 Mansell Road, Suite 370 ADORIES , Jerry. noyoia@greyling.com Alpharetta, GA 30022 INSURER St AFFORDING COVERAGE NAIC # INSURER A; National Union Fire Ins. Co. 19445 INSURED Kimley-Horn and Associates, Inc. Fayetteville Street, Suite 6O0 Raleigh, NC 27601 Raleigh, INSURER B ; Aspen American Insurance Company 43460 New Ham INSURER C ; shire Ins. Co. P 23841 INSURER D : Lloyds of London 085202 INSURER E: INSURER F : COVERAGES CFRTIFIRATF MIIMRFR• to-9n ocvlc In �I . 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 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. INSRpT7L5UHR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MMMD/YYYV MM/DD/YYYV LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE �� OCCUR 5268169 4/01/2019 04/011202C EACH OCCURRENCE $ 1,000000 _ $500000 DAMAGET RENTED PREMISES Ea occurrence X Contractual Liab. MED EXP (Any oneperson) $25 000 _ PERSONAL & ADV INJURY $ 1 000 000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY, ER JECOT LOC GENERAL AGGREGATE s2,000,000 PRODUCTS - COMP/OP AGG $2,000 000 $ OTHER: A AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY X AUTOS ONLY 4489663 4/01/2019 04/0112020 COMBINED SINGLE LIMIT 1,000i 000 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ X PRCi}"+FA 5 WAdE -{Pur acCidenl) $ $ $5000000 ,�t� B UMBRELLA LIAB OCCUR 4/01/2019 04/01/202 CX005FT19 EACH OCCURRENCE X -X EXCESS LIAR CLAIMS -MADE AGGREGATE DED X RETENTION O _ _$5,000,000 $ C A WORKERS COMPENSATION AND FJIAPLOYERS' LIABILITY YIN ANYPROPRIET4 WPARTNER/EXECUTIVE OFFICERIMFMIlF.R EXCLUDED? � N I A 015893685 AOS ( ) 015893686 (CA) 4/01l2019 4/01/2019 04/01 /202 04/01/202 PER OTH- X E.L. EACH ACCIDENT $1 000 000 E.L. DISEASE - EA EMPLOYEE $1 00O 000 (Mandatory In NIi) If yes, describe under DESCRIPTION OF OPERATIONS below I I B0146LDUSA1904949 E.L. DISEASE - POLICY LIMIT 1 $1,000,000 D Professional Liab 4/01/2019 04/01/2020, Per Claim $2,000,000 Aggregate $2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may bo attached if more space Is required) Re: On -Call Agreements A-2015-171, A-2017-108, A-2016-344, A-2017-273, A-2017-025, A-2009-212, A-2018-159 01 & A-2018-160-01. The City of Santa Ana, its officers, employees, agents & representatives are named REVIEWED & APPRO Additional Insureds with respects to General Liability where required by written contract. The above By Risk MANAGEMENT DIVIS referenced liability policies with the exception of workers compensation & professional liability are primary & non-contributory where required by written contract. Separation of Insureds applies to the 7 201f1 la (See Attached Descriptions) �Im A 0 VCR I I F§LM I C nyt_UCM is AN GE LLA TIUN FDA hI!'IhIC n lkru t Are City of Santa Ana Risk Management Division 20 Civic Center Plaza Santa Ana, CA 92702 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 1 In ACORD 25 (2016103) 1 of 2 #S1641449/M1513917 © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD JNOY1 DESCRIPTIONS (Continued from Page 1) General Liability Policy. Umbrella Follows Form with respects to General, Automobile & Employers Liability Policies. Should any of the above described policies be cancelled by the issuing insurer before the expiration date thereof, 30 days' written notice (except 10 days for nonpayment of premium) will be provided to the Certificate Holder. REVIEWED & APPROVEL, By Risk MANAGEMENT DiVi$iON 272019 FRANCINE R. VILLAREAL SAGITTA 25.3 (2016/03) 2 Of 2 #S1641449/M1513917 POLICY NUMBER: 5268169 COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 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. COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Addifional Insured Person(s) Location And Description Of Completed Operations Or Organization(s) ANY PERSON OR ORGANIZATION PER THE CONTRACT OR AGREEMENT, WHOM YOU BECOME OBLIGATED TO INCLUDE AS AN ADDITIONAL INSURED AS A RESULT OF ANY CONTRACT OR AGREEMENT YOU HAVE ENTERED INTO, Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II - Who Is An Insured is amended to include as at) additional insured the person(s) or organizations) 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", However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 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 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 Insu- rance shown in the Declarations; whichever is less. 2. If coverage provided to the additional i insured is required by a contract or agree- This endorsement shall not increase the appli- I meal, the insurance afforded to such addi- cable Limits of Insurance; shown in the Decla- ! tional insured will not be broader than that rations, REVIEWED & APPRpOV b 1 By RIs G 272019 CO 20 37 04 13 © Insurance Services Office, Inc., 2012 FRANCI E R. VILLA EAF This page has been left blank intentionally. REVIEWED & APPROVEL By Risk MANACtEMENT DIVISION