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HomeMy WebLinkAboutKPFFCity of Santa Ana t Clerk of the Council AGREEMENT TERMINATION FORM 7M? DEC 12 AM Please complete this form in its entirety when the attached a r t Qnd al amendments (if any) are no longer in effect: ) V ENT +T CLERK OF COI Note: If your agreement is grant related, please ensure that all grant retention requirements have been satisfied prior to signing the termination fc m. Is the agreement(s) a permanent record? Yes _ No _ Return form to the Clerk of the Council Office (M-30). Call 647-1520 if you have any questions. The agreement with F No. /r✓ 17� was completed on (List all amendments. Use space below If needed.) lr -/7S-6 / /7S -�y Use SD and final payment has been made. xso r3 J. Cfi-8RleL r�l /r9 Department: Phone/Ext.: Signature. - Date: Revised: l U- I B- 16 i— -(j ,IN L0Pc'— INSURANCE ON FILE WORK MAY PROCEED UNI 'IL. INSURANCE EXPIRES July 25, 2018 CITY OF SANTA ANA PUBLIC WORKS AGENCY 20 Civic Center Plaza, M36 s P.O. Box 1988 Santa Ana, California 92702 www..santa-ana.orit KPFF Consulting Engineering Attn: Ali Khamsi, PE 18400 Von Karman Ave., Suite 600 Irvine, CA 92612 A-2015-175-02 CITY MANAGER Raul Godinez II CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL Maria D. Huizar Ret Second Extension of Professional Services Aereement A-2015-175 for0 l&all EnQineerin Ser -Aces Dear Mr. Khamsi: Pursuant to Section 3 ("Term") of Agreement No. A-2015-175 entered into by KPFF Consulting Engineering 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-2015-175-01). 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 6d in full force and effect. Alu.d Sweiss, PE, PLS ve Director, Public Works Agency CITY OF SANTA ANA Raul Co- M City Manager r. r. ti t: s. � It�1`�s 11T1�11 J M. Funk Assistant City Attomey ATTEST Maria D. Huizar Clerk of the Council SANTA ANA CITY COUNCIL Mqg d A POO. W?'Ne Madinez Vicente Sarmiento JWe adagio P. Dwd aenaldes Juan Villegas Sall mqw. Mayor A .'.'Pro Tem.Wa 2 Wards W.r 3 Wa 4 Waed5 Wad s,My+jYiJ -^s 22LO rzmu4ym kDraeea-a"2 Wq dnwn..rfawiDsanYe arm rxn rvdeCa tl4g' "� atria gGM*L11& t . 0 MAYOR Miguel A. Pulido MAYOR PRO TEM Michele Martinez COUNCILMEMBERS P. Oavid Senavides Vicente Sarmiento � Jose Solario Sal Tinajero Juan Villeglas 0 n FWA cli1 i— -(j ,IN L0Pc'— INSURANCE ON FILE WORK MAY PROCEED UNI 'IL. INSURANCE EXPIRES July 25, 2018 CITY OF SANTA ANA PUBLIC WORKS AGENCY 20 Civic Center Plaza, M36 s P.O. Box 1988 Santa Ana, California 92702 www..santa-ana.orit KPFF Consulting Engineering Attn: Ali Khamsi, PE 18400 Von Karman Ave., Suite 600 Irvine, CA 92612 A-2015-175-02 CITY MANAGER Raul Godinez II CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL Maria D. Huizar Ret Second Extension of Professional Services Aereement A-2015-175 for0 l&all EnQineerin Ser -Aces Dear Mr. Khamsi: Pursuant to Section 3 ("Term") of Agreement No. A-2015-175 entered into by KPFF Consulting Engineering 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-2015-175-01). 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 6d in full force and effect. Alu.d Sweiss, PE, PLS ve Director, Public Works Agency CITY OF SANTA ANA Raul Co- M City Manager r. r. ti t: s. � It�1`�s 11T1�11 J M. Funk Assistant City Attomey ATTEST Maria D. Huizar Clerk of the Council SANTA ANA CITY COUNCIL Mqg d A POO. W?'Ne Madinez Vicente Sarmiento JWe adagio P. Dwd aenaldes Juan Villegas Sall mqw. Mayor A .'.'Pro Tem.Wa 2 Wards W.r 3 Wa 4 Waed5 Wad s,My+jYiJ -^s 22LO rzmu4ym kDraeea-a"2 Wq dnwn..rfawiDsanYe arm rxn rvdeCa tl4g' "� atria gGM*L11& t . 0 Client#: 25326 KPFFINCO ACORDT. CERTIFICATE OF LIABILITY INSURANCE F.ATE(MM/DD/YYYY) 9/21/2018 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER Greyling Ins. Brokerage/EPIC 3780 Mansell Road, Suite 370 Alpharetta, GA 30022 CONTACT NAME: Katie Kresner a�"r o El): 770.552.4225 ac No): 866.550.4082 E-MAIL Katie.Kresner@ re Iln ADDRESS: g Y gcom INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: National Union Fire Ins. Co. :19445 INSURED KPFF, Inc. 1601 5th Ave INSURER B: The Continental Insurance Company 135289 i INSURER C: Lloyds of London EACH$1,000,000 Suite 1600 INSURER D: Seattle, WA 98101 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 18-19 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 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. INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X, COMMERCIAL GENERAL LIABILITY CLAIMS -MADE _ OCCUR GL5268336 4/01/2018 04/01/2019 EACH$1,000,000 �OECCURRENCE PREMISES EsEoccccu ence $5001 000 MED EXP (Any one person) s25,000 PERSONAL & ADV INJURY $1 9000t000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X JECOT LOC GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP/OP AGG $2,000,000 $ OTHER: I A AUTOMOBILE LIABILITY CA9775930 4/01/2018 04/01/201 EO MBINEDa.,d.n,)S LE LIMIT 1,000,000 BODILY INJURY (Per person) $ X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per accident B X UMBRELLA LIAB NX OCCUR 6050399824 10/10/2017 04/01/201 EACH OCCURRENCE $10,000,000 AGGREGATE $10,000000 EXCESS LIAB CLAIMS -MADE DED I X; RETENTION$O $ A WORKERS COMPENSATION EMPLOYERS' LIABILITYSTATUTE ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? N / A WCO22298245(AOS) WCO22298244 (CA) 34/01/2018 4/01/2018 4/01/2018 04/01/201 04/01/201 X PER OH- E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $1,000,000 C Professional/ B0146LDUSA1804384 0/10/2018 10/10/201 Per Claim $10,000,000 Pollution Liab Aggregate $10,000,000 SIR $250,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Re: Contract #s A-2015-175 & A-2016-135 - Engineering Consultant Agreement; KPFF Job #1600031. The City of Santa Ana, its officers, employees, agents & representatives are named as Additional Insureds with respects to General Liability where required by written contract. 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 BY: EUNICE HEREDIA (PG 'O ) City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Clerk of the City Council ACCORDANCE WITH THE POLICY PROVISIONS. 20 Civic Center Plaza (M-30) P.O. BOX 1988 AUTHORIZED REPRESENTATIVE Santa Ana, CA 92702-1988 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD #S1218426/M1214603 KKRE1