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Home My WebLink AboutTHROUGH THE ARTN-2018-159-01 MAYOR Miguel A. Pulido INSURANCE NOT ON FILE MAYOR PRO TEM WORK MAY NOT PROCEED Juan Villages COUNCILMEMBERS CLERK OF COUNCIL Cecilia Iglesias David Penaloza DATE; AUG 0 6 201� Vicente Sanniento Jose Solorio CITY OF SANTA ANA PUBLIC WORKS AGENCY 20 Civic Center Plaza a P.O. Box 1988 Santa Ana, California 92702 W W W aanta-ana.orc June 26, 2019 Through the Art P.O. Box 567 Trabuco Canyon, CA 92678 Attn: Cathy Kazmark Re: Extension of Agreement to Provide Space Planning Services Agreement No. N-2018-159 CITY MANAGER Kristine Ridge CITY ATTORNEY Sonia R. Carvalho ACTING CLERK OF THE COUNCIL Norma Mitre Pursuant to Section 3 ("Term") of the above -referenced Agreement, entered into by Through the Art and the City of Santa Ana, dated July 16, 2018, the time period of the Agreement is hereby extended for an additional one-year period, from July 16, 2019 through July 15, 2020. The 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. S. S eiss, PE, PLS itiveIpirector, Public Works Agency CITY OFIISANTA ANA Kristine e City Manager APPROVED AS TO FORM -f.L J4& M. Funk Assistant City Attorney ATTEST ,. Daisy Clerk of the Council THROUGH THE ART Name: Cathy Kazmark Title: Designer SANTA ANA CITY COUNCIL Migual A. Pulido Juan Villegas Vicente Sanniento David Penaloza Jose solono Mayor Mayor Pro Tem, Ward 5 Waist 1 Ward 2 Ward 3 moulldIXcDsantaana.ora ivilleaas®santa-ana ore vsarmisntoicaanla-anaoro doeneozaasantaanaore solonoCdsanla-ana.c, #1641vl Vacant cache Iglesias Ward3 Warda ciglesias(olsanta-ana ore REVIEWED & APPROVED By Risk MANAgEMENT DMSION APR 2 8 2020 ANGIE ACEvEdo CERTIFICATE OF LIABILITY INSURANCE I 00o2E/pauaviY o612020lzozo I THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS III` 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 WANED, subject to the terms and conditions of the policy, certain policies may require an andomement. A statement on PROBUCER kAME: _ _ Hiscox Inc. WOW Hiswx Insurance Agency in CA ° (888) 202-3007 520 Madison Avenue MAL canted�hUfA%cam 32nd Floor New York, NY 10022 Maugo"APPoROMacov Cathy Kazmark through the Art Po Box 567 Trabuw Canyon, CA 92678 COVERAGES 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 HEREW IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, TYPE OFINSURANCE Suits POLICYMBMBEA ICYEFF IMNLYEXP DMRa CeYYHICIALGEXERAL LNBMY CI C UCCNi EgU1 pCCURRCNLE I $ E S MEG EXP N^YmM roMONI PERSON4 a ADV MAIRY $ UIMTAPPUE6 PER: POLICY . CT 171 LGC E DFNL.LaaREDATE ! GENERALAGGREORTE PROOUGTS- COMP/OPAGG s s AUrGMOaIilLU1Ll1Y CJMBINEDSIN UM ESM s s ANY AUTO BOOILY MIJURY(Pspenm) ANDS CNLY AUT(19U�0 HIRED NONOWNED AUTOS ONLY AUTOS ONLY BODILY IHAfirr(Pw av3] U PROPSRTY DAMA(£ S s S UMMELI.ALNB OCCUR EACH OCCURRENCE $ 3 EXCESS UAe CUUMSMAOE AGGREGATE DEO I RETENTKK 5E %0RZ 3COMPFN3ATXIX AND EMPLOYERaLIABanY YIX µYPROPRIETOWPARTNER ECUTNE OFFICERQI MBEREXCLUDEDT X)A STA EL EACHACCIDENT E - E.L. MSEASE - EA EMP $ (M W,ry N NH) IIW eau.u.' OEECRIPTION OF OPEMTONS Mbw ELDaEASE-POLICYLIMM s A Professional Liability Y UDCA0098B EO-19 12/03/2019 12/03127 Each Claim: Aggregate: E1,000,000 E 1,000,OW oEBCRIPPEMnoa6l LacanoxslvERN:LEa(Aaonorn, Aaweol,.IR.man.xmaMA. mNr e..mcn.enma. RMuanRPAwI Csy dSanla SeMa Ma Rkk Menegemant DNiaion, dU Floors Imbd as etltlX'ronal inaumtl Par Me Palley terms antl cotMiliona. m „aN,„w,,,W P,— ID CINk Center Plaza Santa Ma, CA 9ZTU2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD REVIEWED & APPROVED By Risk MANACIEll DNiSiON A 2 8 2020 ANC{IE ACEVE(IO A CA & CERTIFICATE OF LIABILITY INSURANCE Doz06/2020 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: N the certificate holder Is an ADDITIONAL INSURED. the policy(les) must have ADDITIONAL INSURED provisions or be endorsed. N SUBROGATION IS WAIVED, subject to the tome and conditions of the policy, certain Wilts, may, require an endorsement. A statement on this certificate does not center rights to the DerlMcate holder In lieu of such endorsement(s). PRODUCER MM1P. His.. Inc. dlbi HiscoX Insurance Agency in CA (888) 202-3007 PA% 520 Madison Avenue mnt,ICt@hisocw.00m 32nd Floor Now York, NY 1D022 _ IMsuRaRs aEPanoxocoveAADE NRe• wauRBR A: Hismzlnsurance Companylro 1020D _ IMBUREp J MBURER B: Cathy Kavnark through the M J NauRER c: Po Box 567 NnIRu o,:.. Trabuoo Canyon, CA 92678 _ Muni MBURER F: 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, TR TYPE OFIMSUMMC[ RM RMJcY NUYBER M«ICY are IPDLR^(E%Y LIYf[ X COMMERCMLGENERA�LLNBBRY _ CWMBMAOE ^ OCCUR I EACH OCCURRENCE / PREMISE9(F[— [ 1,00D.ODO S 100,000 j5.ODe MEn EXP 1Any Ms penpnl A Y UDC<0098BSCGL-iB 12/03/2019 12J=020 rEBsoNgLawvIH.NRr i 1,0D0,D00 DENLMOREMTE X LIMTAPPLIEB PE0. PIXICY _ ,nC LDC 32.000.000 GENERAL QATE PROOVCT9LOk1PIW AGD S 2.000,000. [ TX R AVTOYO[Ii LMBEf1Y COMBIN IN le [ s unwro aoonv lNJwvlPw p«FYII Oan AUTO,, T. I-ED .1111 INJURY(EI rmivel [ HIRED NON-0WNEp AVTOD CIDY NROBONIY PROPERTY DAMAGE _LPR avfem S t UMBIIE1lA WM OCGIIR EACHO_C_WRRENCE E [ IX<ESE WI CWM9MADE AGGREGATE DIED R NTI N S WORKERBCdIpEMAigM .0 EYPLDYEIIY CARD" T.IN MIYPROPRIEIORRARTNERAISECUINE OEFREIRMEMBEREXCLUDED? MIA PER K STANTE OR EL EALX ACCIDENT S E BlnlenMY aI XM EL. DISEASE-EAEMPLDYEE Il yes Ww S n'm DEBCflIPTIDN Cf OPEMTIONS tNow E.I. DISEASE P0.iCV LIMIT OE ICANTON OF OPEMTKNSILOGATION01vp11CL[! (ACCORD M. Addevul RemeAe SuIRSAW Ivy W YMaN MlMnpau M rpuMf/ City at5anle AIu Rkk Management Wrldm, 4U Floor N Esled ea eddklallal InaulM per the pokey Leann ant wndEMM. �/ CERTIFICATE HOLDER CANCELLATION JU LMY NOTICE Will De Sent TO Ute notoer City IN Santa Ana Rick Management Divism, 41h Floor M CNID Center Plaza Santa Ma, 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. AUTMpIMED MPREBFNTATNE C 1988-2015 ACORD CORPORATION. All right, reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD CITY OFSANTA ANA RISK MANAGEMENT. di.6vr 4HumAN REsouRCET ti^snaySng Risk uywzhPosltive Change D / WORKERS' COMPENSATION DECLARATION /.1 hereby affirm under penalty of perjury, the (Nome/title) following declaration: 1-74 I certify on behalf T, V 4- L7 that during the term (ConsuftantlComponY Name) of my contract for Qesc,� M/ services with the City of Santa Ana, (Type of service provided) I will not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with the provisions and provide proof of workers' compensation coverage immediately. Date: Print Name: Print Title: Signature: Telephone: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. REVIEWED & APPROVED By Risk MANAGEMENT DIVISION APRJ§ 2020 ANGIE ACEVEdo MMA Mgmtllnsum"e RequireMMAWC OedaWtbn 08252019 To: Risk Management City Of Santa Ana I have an agreement with the City's Water Resources Division for Space Planning Services. I provide my services to the City Staff via email communication. My business does not own a company vehicle. The services that I provide do not require that I own a company vehicle. Thank you, Cathy Kazmark htheart@yamil.com REVIEWED & APPROVED By RISk ^'MANAGEMENT U16S10N AP 2020 _— --- ANG1E ACEVEdo , PO BOX 567, Trabuco Canyon, CA 92678 (949) 289-2768, throughtheart@ymail.com