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HomeMy WebLinkAboutMDG ASSOCIATES, INCCity of Santa Ana Clerk of the Council ^1 l COTc orrice Use Only AGREEMENT TERMINATION FORM Please complete this form in its entirety when the attached agreement and ails amendments (if any) are no longer in effect. THE C01jmCIL Note: If your agreement is grant related, please ensure that all grant retention requirements `TAN 31 '23 PM3:5$ have been satisfied prior to signing the termination form. 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 t " ` / 6 / 1 5io6 caie-9j A-2018-091-01 it 'L(� ZZ No. was completed on and final payment has been made. (List all amendments. Use space below if needed.) rr�/n Department: W1+ Phone/Ext.: &S (c Signature: � ) - Date: Revised: 10-18-16 A-2018-091-01 MAYOR Miguel A. Pulido MAYOR PRO TEM Juan Villegas COUNCILMEMBERS Cecilia Iglesias David Penaloza Roman Reyna Vicente Sarmiento V Jose Solorio INSURANCE ON FILE WORK MAY PROCEED UNTIL IN 0 CE EXPIRES _ i CLFRKOFCO CIL DATE: JAN a ? 2013 CITY OF SANTA ANA COMMUNITY DEVELOPMENT AGENCY 20 Civic Center Plaza . P.O. Box 1988 Santa Ana, California 92702 714-647-5360 www.santa-ana.orq January 9, 2019 MDG Associates, Inc. 10722 Arrow Route, Suite 822 Rancho Cucamonga, California 91730 Re: Extension of Aareement No. A-2018-091 Dear Mr. Munoz, CITY MANAGER Raul Godinez ti CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL Maria D. Huizar Pursuant to Section 3 ("Term") of Agreement No. A-2018-091, entered into by MDG Associates, Inc., and the City of Santa Ana, dated April 4, 2018, the term of the Agreement is hereby extended for an additional one (1) year period, from May 1, 2019 to April 30, 2020, 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. If you have any questions regarding this matter, please contact David Flores in the Community Development Agency at (714) 647-6561. Sincerely, Steven Mendoza Executive Director Community Development Agency CITY OF SANTA ANA Ly� Raul Godinez 11 City Manager ATTEST X Maria D. Huizar Clerk of Council AP D TO FORM Rya ge, istant City Attorney SANTA ANA CITY COUNCIL Mtguel A M6do June Wages Vicente Sam;iento ❑avid Penatozs Jose Solurio Roman Rayne Cecilia ig(eeres Mayer Maya Pro Tern, Wad 5 Ward 1 Ward 2 Want 3 Wa-c q Ward @ moutidoCcOsonta-ana ore ivftastoisanta-ana om vserm antaCWsanJ yagr�c dnenaloza{dsanta-ana wo jQehdyasania-fora rzevnaCcdsama-an9 Ctp �santa-anawn DATE (MMIDDYIYY) 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($), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the poll—y(les) must be endorsed. If SUBROGATION IS WAIVED, subject to nnriWlrmta hn1Am In li®„ ni m..,.r. .....L...._--..u_. the teems and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the PRODUCER NAME, T Chip Francis PHONE(626)396-1035'—_......_._._...____�� KelleyJi rI"(R/AC Nol. 21O i96-1045 ggina and Associates Insurance Brokers E-MDJIRN. , chip®kjains.com PO Box 60310 -- '�---- -- _`_ INSRER(S)AFFORDING COVERAGE NAIC#� Pasadena _ CA 91116-6310_ INsugggA;West American Insurance CompL 44393 INSURED IN_SURERB_O_hi0 Security _ 27082 INSURER CtAlaeriCBA _Fire & CasualtY_CO w_ d 24066 NDG Associates, Inc. INSURER D: _______ 10722 Arrow Route STE 822 ___...... INsuREaE: Rancho Cucamonga CA 91730 INSURER F:- COVERAGFA rG>DTICIr Arewwace In,. onan ... ....... __. ____.._._...._.._....-_.. ____ ___- -._ .._., MCVIOIIJM rvvmi3CK: 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. LR TYPE OF INSURANCE POLICYEFF PM1DDfYXP —"' PO NU YYY1 LIMITS X COMMERCIAL GENERAL LIABILITY A ---i ctAIMS-MADE ® EACH OCCURRENCE 'AM ET-F ENT D $ 1,000, 000 y — _j OCCUR SEg 1 200, 000 X BKW57179298 7/1/2018 7/1/2019 - MED EXP Anyone Gerson) IS 15,000 --- PERSONAL&ADV INJURY $ 11000,000 GEN' X L AGGREGATE LIMIT APPLIES PER: ❑ PRO-JECT . ❑ GENERAL AGGREGATE $� 2,00000 0, —.—,. _ POLICY LOC PRO DUCTS-COMPIOP AGO $ 2,000,000 TH R: Employee Benefits IS 1, 000, 000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ X Ea acrid nt 1 000,000 B ANY AUTO BODILY INJURY (Per person) $ ALL OS SCHEDULED AUTOS AU70S I X 1BAS57179298 7/1/2018 7/1/2019 BODILY INJURY (Per accident) $ X HIRED AUTOS X ANOTN SWNED i I PH PERTY DAMAGE $ --- Medical ents $ 51000 UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 4 000, 000 - G, X EXCESS DAS �_LLAIMS-M_A_0_E_ GGREGATE_„ $ 4 OOO, D00 O D RETENTI N$ j ESA57179296 7/1/2010 7/1/2019 $ WORKERS COMPENSATION ANDEMPLOYERS'LIABILITY PI ER OTH- STATUTE Y/N ANY PROPRIETORIEXCLUDRIEXECUTIVE (Mandatory In ER EXCLUDED? �INIA (Mandatory in NH) E ._ E.L:EACH ACCIDENT ..$ If yes, describa under E.L. DISEASE-EAEMPLOYE _ DESCRI ION OF OPERATIONS below E.L DISEASE -POLICY LIMIT 1 $ s DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (ACORU 101, Addltlonal Remarks Schedule, may be attached U more space is required) The City of Santa Ana, Its officers, employees, agents and volunteers and named additional insured, but only as respecys the insured's operations as it relates to their signed contract in regards to the CDBG Administration Consluting Services per form CGB$lo 0413Primay Insurance and Transfer of rights or recovery against others is included in the form. Auto Al CAS810 0113 *30days notice of cancellation except 10 days for non-payment, City of Santa Ana Attn.: Terri Eggers, Senior Mgmt. Analyst Community Development Agency 20 Civic Center Plaza Santa Ana, CA 92701 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 Jiggins/CHIP 3" ©1988.20t4 ACORD CORPORATION. All riahts reser J d:, (6V IN/Y 1) I ITS, ACORD name and logo are registered marks of ACORD INS025 (201401) AC. cWc" �,.. CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIYYYY) 06/18/2018 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 RPRODUCER, AND THE TIFIC HOLD IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must 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 cadificaw holder In lieu of such endorsemeDtfs). PRODUCER °OMEpCr Karen Bronson CorRisk Solutions nnaxe 312-637-8755 Duo.�ti 225 W. Washington St. Suite 1560 E.u,L vmeas• kbronson@corrisksolutions.com Chicago, IL 60606 INSURERS) AFFORDING COVERAGE NAIC0 INSURER A: New Hampshire Insurance Company 23841 INSURED INSURER 8: MDG Associates, Inc. INSURER C: 10722 Arrow Route INSURERD: ""— Suite 822 INSURER E: Rancho Cucamonga., CA 91.730 INSURER F: COVFRAGFS CERTIFICATE NUMBER: REVISION NUMBEK: 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. INSK Lm TYPE OF INSURANCE ADO'L INSRD SUBR me POLICY NUMBER POLICY EFF {NNdDDtY m POLICY EXP (NONDDA'YYY1 LIMITS GENERAL LIABILITY EACH OCCURANCE COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES (EaaNTED ce? CLAIMS MADE OCCUR MEDEXP(Anymapernim) DOES NOT APPLY PERSONAL B AND INJURY GFNERALAGGREGATE PRODUCTS - COMPIOP AGO GEN'L AGGREGATE LIMIT APPLIES PER: POLICY 7 PROJECT 0LOC AUTOMOBILE LIABILITY iMPA. NED swine LIMIT (Ea mxHentl ......... BODILY INJURY(Per person) ...... ANYAUTO - BODILY INJURY (Pei axltlenl) ALL OWNED SOHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS Al Dine DOES NOT APPLY PRweNTv TAMAUE (Par n9t UMBRELLA LIAB OCCUR EACH OCCURANCE AGGREGATE EXCESS LIAB CLAIM' MADE DOES NOT APPLY DED RETENTION IS WORKERS COMPENSATION AND EMPLOYERS' LIABILITY WC STATU- TORY LIMITS OTHER E.L. EACH ACCIDENT ANY PROPRIETOWPARTNE WFXECUTIVE OFFICIDMEMSER EXCWDED7 YIN (Mandatory in NH) ❑ N/A DOES NOT APPLY L.L. vlStSAt-EA EMPLOYEE E.L. DISEASE, POLICY LIMIT' It yee, describe under DESCRIPI ION OF OPERATIONS below A Professional Liability 064 R91891- 02 07/01/18 07l01ji9 wOccurrence: Annual Aggregate: $^< 000, 000 DESCRIPTION OF OPERATIONS / LOCATIONS/ VEHICLES (Attach ACCORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER CANCELLAI ION ty of. Santa Ana, Community Development n.: Terri Eggers, Sr. Mgmt. Analyst Civic Center Plaza Ana, CA 92701 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. REPRESENTATIVE t.„� ;if ACORD 25 (2010195) 01888-2010 ACORD CORPORATION. Affrights reserved. The ACORD name and logo are registered marks of ACORD A��!zp� CERTIFICATE OF LIABILITY INSURANCE D6/26/zo e ) 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 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 Amorelli, Rosemann & Associates Insurance Services 3333E Concours St Building 9-200 Ontario CA 91764 NANEACT Lizette Barges PHONE (909)987-7600 aC No:(909)987-7656 -MAIL lizetteb@arainsurance.com ADDRESS: INSUREI AFFORDING COVERAGE NAIC # INSURERA:State Coal Insurance Fund 35076 INSURED Mdg Associates, Inc. 10722 Arrow Route Ste 822 Rancho Cucamonga CA 91730 INSURER B: INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:18/19 WC 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 rypE OF ADDL SUER POLICY NUMBER POLICYEFF MM DDIYVYV POLICY E%P M DD LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE El OCCUR EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES Es accurren e $ MED EXP (Any one person) $ PERSONAL &ADV INJURY $ AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ GEN'L POLICY PRO- ECT ❑ JOB PRODUCTS - COMPIOP AGG $ $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODI LV INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY Per accident ( ) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE Per accident $ is UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTIVE ❑NIA OFFICERIMEMBER EXCLUDED? (Mandatory in NH) If yes, describe under 1980750-18 7/1/2018 7/1/2019' X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYE $ 1,000,000 E.L. DISEASE -POLICY LIMIT $ 11000,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS LOCATIONS I VEHICLES (ACORD IOf, Additional Remarks Schedule, may be attached if more space is required) PROOF OF INSURANCE FOR CITY OF SANTA ANA COMMUNITY DEVELOPMENT AGENCY. 4� CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF SANTA ANA THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ATTN: TERRI EGGERS, SENIOR MGMT ANALYST ACCORDANCE WITH THE POLICY PROVISIONS. COMMUNITY DEVELOPMENT AGENCY AUTHORIZED REPRESENTATIVE 20 CIVIC CENTER PLAZA SANA ANA, CA 92701� Lizette Barges/JULIO YJ� ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) INS025 1961401) The ACORD name and logo are registered marks of ACORD CITY OF SANTA ANA BUSINESS TAX SECTION (M45) 20 CTVIC CENTER PLAZA, FIRST FLOOR, P.O. CITY OF SANTAANA BUSINESS LICENSE TAX. RECEIPT BUSINESS TAX NUMBER: 345731: TAX. PERIOD: BUSINESS NAME:. MDGASSOCIATES INC, AMOUNT PAID: BUSINESS ADDRESS: 10722 ARROW ROUTE, SUITE 822 RANCHO CUCAMONGA, CA91730 DATE PAID: OWNER NAME: MDG ASSOCIATES;INC. THIS IS NOT A BILL 647-5447 ATTACHED BELOW IS YOUR CITY OF SANTA ANA BUSINESS LICENSE TAX RECEIPT 4/112018. 3/31/2019 $55.00 02120/2018 PLEASE DETACH AND POST IN CONSPICUOUS LOCATION (SEEREVERSE SIDE OF BUSINESS LICENSE TAX RECEIPT FOR POSTING REQUIREMENTS) CITY OF SANTA ANA BUSINESS LICENSE TAX RECEIPT This business license tax account Is void upon Sale or transfer of a business Every business is responsible for the annual renewal of their business license tax account • it Is the responsibility of the applicantAlcensee to ensure that the business complies with all applicable City codes, City zoning ordinances and all Local, State and Federal Laws. Contact the Business License Tax Office at (714) 647-5447 prior to any of the following changes; Name change Location Change • Ownership or representative change Business activity change: The business license tax receipt must be displayed at the place of business; See reverse side for posting requirements, Sec.21.18. • No required permits waived. The business license issued pursuant to the provisions of this Chapter (Santa Ana Municipal Code. (SAMC) Chapter 211 constitutes a .receipt for the license fee paid and shall have no other legal effect. A business license is ;a requirement, not a permit, to transact and carry on any business activity within the city. The business license tax receipt is evidence only of the fact that such tax has been paid. Neither the payment of the tax nor the possession of the business tax receipt authorizes, permits or allows the doing of any act which the person paying or holding the same would net otherwise be entitled to do; and any permit, license, variance or other Instrument of approval or evidence that any conditions exist as required by any other Section of this Code [SAMC) or by any statute or code provisions of the state must first be obtained or complied with before the doing of any actor thing for which it is required. (Ord. No. NS-1922, § 1,7-20-87) The person; firm or corporation named below has been Issued this business license tax receipt pursuant to the provisions of the City Business License Tax Code (SAMC Chapter 21). Issuance of this receipt for the business license tax paid shall have no other legal effect (SAMC Sec. 21-18) and is not an endorsement, nor cerb'fication of compliance with other ordinancesor laws. It is the responsibility of the applicantilicensee to ensure that the business is operated in compliance with thelaws, ordinances and regulations that are now or may hereafter be in force by the United States Government, State of California, and the City of Santa Ana pertaining to such business. In the event It is determined that the applicantllicensee fraudulently applied for or renewed this business license tax account, the account may be suspended or revoked. This business license tax account is nontransferable. Please note that It is your responsibility to renew and update this license annually. CITY OF SANTA ANA - TREASURY M-15 20 CIVIC CENTERPLAZA-PO BOX 1964 SANTA ANA, CALIFORNIA 92702 PHONE (714) 647-5447 Ii ASSOCIATES, INC. PO BOX 368 RANCHO CUCAMONGA, CA 91729 THIS LICENSE MUST BE DISPLAYED AT THE PLACE OF BUSINESS BUSINESS TAX ND. 345731 TAX PERIOD: 4/112018 •313112019 BUSINESS TYPE: CONSULTING, MISC. BUSINESS ADDRESS: 10722 ARROW ROUTE, SUITE 822 RANCHO CU BUSINESS NAME: MDG ASSOCIATES, INC. OWNER/REP: MDG ASSOCIATES, INC. ���� J(f EXPIRATION LATE: 03131 019