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HomeMy WebLinkAboutA1 EVENT & PARTY RENTAL 7C. City of Santa `na �• Clerk of the Cou . it 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TERMINATION FORM Please complete this form in its entirety when the attached agreement and all amendments (if any) are no longer in effect. Note: If your agreement is grant related, please ensure that all grant retention requirements City of Santa Ana have been satisfied prior to signing the termination form. oz N6 Is the agreement(s) a permanent record? Yes No Clerk of the Council Return form to the Clerk of the Council Office (M-30). Call 647-1520 if you have any questions. The agreement with No. '4` ,�� '�J C was completed on I� I and final payment has been made. (List all amendments. Use space below N needed.) / 'n {4— 011— 05-.a 0 Department: PQS-4 ! ��Yy-UV\�, 4—ao I -I_ Phone/Ext.: -�C k�—r Signature: Date: -71 �a i Revised: 10-18-16 A-2017-053-03 INSURANCE NOT ON FILE YOR WORK MAY �VQT PROCEED MAMiguel A. Pulido CLERK OF COUNCIL MAYOR PRO TEM Michele Martinez COUNCILMEMBERS P. David Bonavides Vicente Sarmlento Jose Salado Sal Tinalero Juan Wages DATEJPAN 2 2 2013 CITY OF SANTA ANA PARKS, RECREATION AND COMMUNITY SERVICES AGENCY 20 Civic Center Plaza M-23 • P.O. Box 1988 Santa Ana, California 92702 wwwsanta-ana.ora December 11, 2018 CWF, Inc, (dba At Party Rental) Attu: Rene Martinez 251 E. Front Street Covina, CA 91723 Re: Second Extension of Contractor Agreement No. A-2017-053 to provide provision, installation and removal of rental equipment for various City events Dear Mr. Martinez: CITY MANAGER Raul Godinez II CITY ATTORNEY Sonia R. Carvalho CLERIC OF THE COUNCIL Maria D. Huizar Pursuant to Section 3 ("Term") of Agreement No. A-2017.053, entered into by A 1 Party Rental and the City of Santa Ana, dated March 21, 2017, the time period of the Agreement is hereby extended for an additional one (1) year period, from January 1, 2019 through December 31, 2019, Tile insurance certificates are required to be extended and/or renewed to cover this extension. All other terms and conditions of the Agreement remain unchanged and in full force and effect, Sinc rely ?4 P&e� sa rdIoff Executive Director Plamring and Building Agency CITY OF SANTA ANA Lr_ Raul Godinez 11 City Manager APPROVED AS TO FORM Laura A. Rossini Senior Assistant City Attorney Al =TYRE,AL By: r:', ns5 Mwrs� r�1 Title: co o ATTEST 1vf rra D, IIuizar / ___ Clerk of Council SANTA ANA CITY COUNCIL MIgud&Pulido Michele Marmez vicerde sarmfenlo Jose soiodo P. David Benavides Juan Villages Saf ureters Mayor Mayor Pro Tom, Ward Ward r Ward B Word A Ward 5 Ward 6 n vllUn®canal eora nlmarlirezatsanla-ananr10Mka1Q@-UiuAuwrjIsolnr Rasa rl@,;gaAorO QbenaddeafiD=ante-anaRL INlleaes(olsa Fla r In fln8.e a ALBIe[9LL�eaafa:9113.4C8 ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYVYI 1013112018 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 BoltoCONTACT n & Company 3475 E. Foothill Blvd., Suite 100 NAME, PHONE HAIC, No E.U: . _(626) 799-7000 _ _ (AIc Nu): (622� 583-21 T7 Pasadena, CA 91107 EMAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAICq _ INSURERA: New York Marine And General Insurance Co_ 16608 www.boltonco.com 0008309 INSURED CWF, Inc. INSURER e: Fireman's Fund Insurance Company _ 21873 DBA: Al Party Rentals INSURER C: INSURERD: 251 E. Front Street Covina CA 91723 INSURER E INSURER F : COVERAGES CERTIFICATE NUMBER: 4fi177E11 REVISION NUMBER - PERIOD THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE P;THE INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TOCH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS._r_______ INSR, TYPE OF INSURANCE A0So SUBRPOUCYEFF POLICY NUMBER MMIDDIYYYY POLICYEXPLTR MARDDIYYW LIMITS A `/ COMMERCIAL GENERAL LIABILITY OCCUR PK201800007271 2/1/2o1B 112/112019 I EACHOCCURRENCE_ $100CLAIMS-MADE _ D MAGE TORENTE PREMISESEaoccurrence)$5QMEDXP(Any oneperson) $10, PERSONAL&. ADV INJ URY $1 000,000 GENE RAL AGGREGATE $2,000,000 GEN'L _ AGGREGATE LI MIT APPLIES PER: POLICY ?ROT �/ JECT ✓ HOC PRODUCTS- OMPIOP AGG P C $2,000,000 $ OTHER: A AUTOMOBILE LIABILITY JAU201800011938 2/1/2018 2/1/2019 I COMBINED SINGLE LIMIT $ I (Ea accident) _ _ 1,000 000 ✓ ANYAUTO - BODILY INJURY (Per person) $ OWNED SCHEDULED, AUTOS ONLY AUTOS BODILY INJURY (PeraccitlenQ $ ✓ HIRED — NON -OWNED AUTOS ONLY ✓ AUTOS ONLY PROPERTY DAMAGE $ (Per agpirlenil A ✓y1, UMBRELLA LIAR ✓ OCCUR UM201800003772 2/l/2018 2/1/2019 EACH OCCURRENCE $5,000,000 EXCESS LIAB CLAIMS-MADEI AGGREGATE $5,000000 DED ✓ RETENTION$10,000 $ B WORKERS COMPAND NATIOIN YIN ANYPROPRIETORIPARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED? IT (MandatorylnNH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA SCW0058721801 11/1/2018 I 11/1/2019 V (STATUTE _ ER E. L. EACH ACCIDENT - E,L. DISEASE - EA EMPLOYEE -- E. L. DISEASE -POLICY LIMIT $1 QQQ,000 $ ,000000 $1000000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) The certificate holder is included as an additional insured, but only as respects to claims arising out of the negligence of the N W Insured. x �l�C Additional Insured: The City of Santa Ana, it's officers, employees, agents, and representatives r-,C�\�3�\C n �(`(\\� ` CERTIFICATE HOLDER CANCELLATION Parks, Recreation SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE & Communityy Services Agency M23 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN P.O. BOX1988 9 y ACCORDANCE WITH THE POLICY PROVISIONS. 20 Civic Center Plaza AUTHORIZED REPRESENTATIVE w Santa Ana CA 92702 Angela Hochberger © 1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 45177511 1 CWFINCA-01 1 18-19 ADD rcri Cei Cifieate I Nancy Cadwallader 1 10/31/2018 2:47:22 PM (PDT) I Page 1 of 2 POLICY NUMBER: PK201800007271 COMMERCIAL GENERAL LIABILITY CG 20 26 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Name Of Additional Insured Person(s) Or Organization(s): Any person or organization when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy prior to performance of the agreement. Any Person or Organization as Required by Contract. It is agreed that this insurance is primary and non-contributory and that no insurance held or owned by the designated Additional Insured shall be called upon to cover a loss under said policy up to the limits of this policy if loss under this policy arises directly from work performed by Named Insured or if others performed on behalf of the Named Insured. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: 1. In the performance of your ongoing operations; or 2. In connection with your premises owned by or rented to you. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that 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 Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 26 04 13 © Insurance Services Office, Inc., 2012 45199511 1 CWPINCA-01 110-19 ALL Master Cartiflwte I Nancy Cadivallader 1 10/31/2018 2:47:22 PM (POT) I Page 2 of 2 Page 1 of 1