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HomeMy WebLinkAboutHALL AQUATIC LIFE SUPPORT DESIGN CONSULTANTS, LLC (2)N-2019-048-01 MAYOR Mguel A pwao MAYOR PRO TEM COUNCILMEMPERS Ph'I Bacarre Ce0ta loleslas WVC panaiaaa V"Me samuento N Jm SOIOne 0 o INSURANCE NOT ON FILE WORK MAY NO PROCEED CLERK OF COUNCIL p DATE: 0 ��t cf61 ils1/LI4 4[bP64j a� flail Aquatic Design Attn: Eric [fall 347 Grant Street SE Atlanta, GA 30312 CITY OF SANTA ANA PARKS, RECREATION, AND COMMUNITY SERVICES AGENCY 20 C•Vw Gents; Fiam • P.O, ea, 1966 Sams Ana Ca tforna 92702 November 26.2019 CfTY MANAGER Kristine Rafge CITY ATTORNEY Swua R Carvaew CLERK OF THE COUNCIL t"y Games Re! Extension of Agreement No. N-20194)48 to Provide llesign Res ice for Proposed Otter F shihit at the Ntanta Ana Zoo f.lear Mr. Hall; I'ursuant to Section 3 ("Term-) of Agreement No. \ 2014-048, entered into by Hall Aquatic Life Support Dr.ign Consultants. LLC, and the City of Santa Ana. dated January 23, 2019, the term of the Agreement is hereby extended firr a ouc-year period. from January 23. 2020 through January 22, 2021. 2020. Any insurarwe certificate% are required it, 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. Siuccrvi). VA� li a\\VVVVVVI1IIRrallof f Executive Director. Parks. Recreation, and Community Sen ices Agency CITY OF SANTA ANA ATTEST Kristine Ridge Daisy Gomez. CMIC' City *VlanagCr t'lcrk of the t'uuncil APPROVED AS TO FORM HALL A C DESIGN Laura A. Rossini I ric I (all Senior .Assistant City Attorney Owner SANIA ANA CITY COUNCIL W.. n I 19"u' 1 i4C a� CERTIFICATE OF LIABILITY INSURANCE OATE(MMDD)YYYY) 02/24/2020 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: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATIONIS 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 CONTACT BIZINSURE LLC/PHS 57102005 The Hartford Business Service Center NAME' PHONE (866)467-8730 (A/C, No, skill: FAX (888)443-6112 (AIC, No): 3600 Wiseman Blvd E-MAIL San Antonio, TX 78251 ADDRESS: INSURER(S) AFFORDING COVERAGE NAICN INSURED INSURER A: Twin City Fire Insurance Company 29459 Hall Aquatic Life Support Designs DBA Hall Aquatic Design LLC INSURER B : Hartford Accident and Indemnity Company 22357 347 GRANT ST SE INSURER C : ATLANTA GA 30312-2226 INSURER D INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 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 INDICATEDMOTWITHSTANDING 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 TYPE OF INSURANCE ADDL INSR SUBR WVO POLICY NUMBER POLICY EFF IDO POLICY EXP M/DD/Y YYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $2,000,000 CLAIMS -MADE -OCCUR General Liability DAMAGE TO RENTED PREMISES Ea o rence $1,000,000 X MED EXP (Any one person) $10,000 A X 57 SBM BL2522 11/09/2019 11/09/2020 PERSONAL&ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER; GENERAL AGGREGATE $4,000,000 POLICY PRO- ECT X LOG PRODUCTS - COMP/OP AGG $4,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $2,000,000 BODILY INJURY (Per person) ANY AUTO A ALL OWNED SCHEDULED AUTOS AUTOS 57 SBM BL2522 11/09/2019 11/09/2020 BODILY INJURY (Per accident) X HIRED NON -OWNED AUTOS X AUTOS PROPERTY DAMAGE (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS- MADE AGGREGATE DEO RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY X PER STATUTE OTH- E F.L. EACH ACCIDENT $1.000,000 ANY YIN B PROPRIETORIPARTNEWEXECUTIVE OFFICERIMEMBER EXCLUDED? NIA 57 WEC AC3MZN 11/09/2019 11/09/2020 F.L. DISEASE -EA EMPLOYEE $1,000,000 (Mandatory in NH) If yes, describe under E.L. DISEASE -POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS below A EMPLOYMENT PRACTICES LIABILITY 57 SBM BL2522 11/09/2019 I 11/09/2020 I Each Claim Limit Aggregate Limit $10,000 $10,000 DESCRIPTION OF OPERATIONS /LOCATIONS / VEHICLES (ACORD 101, Addifional Remarks Schedule, may be attached U more space is required) Those usual to the Insured's Operations. CERTIFICATE HOLDER 01-VIEWED Qk CANCELLATION City of Santa Ana By R151( ANAgEM SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED Risk Management Division BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED 20 CIVIC Center Palaza, 4th Floor 1lD "frVl�'� IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE PORTLAND OR 97202 CI 1�r CCiO ACORD 25 (2016103) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: LOC#: AG' RLjt° ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY BIZINSURE LLC/PHS NAMED INSURED HALL AQUATIC LIFE SUPPORT DESIGNS DBA HALL AQUATIC DESIGN LLC 347 GRANT ST SE ATLANTA GA 30312-2226 POLICY NUMBER SEE ACORD 25 CARRIER SEE ACORD 25 NAIC CODE EFFECTIVE DATE: SEE ACORD 25 THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM FORM NUMBER: ACORD 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE City of Santa Ana, Risk Management, it's officers, employees, agents, representatives, and volunteers are additional insured per the Business Liability Coverage Form SS0008 attached to this policy. Notice of Cancellation will be provided in accordance with Form SS1223, attached to this policy. Notice of Cancellation will be provided in accordance with Form WC990394, attached to this policy. RgE VIEWiskED & APPRANAqEmrmpOV ON D M 09 ACORD 101 (2014/01) © 2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION TO CERTIFICATE HOLDER(S) This policy is subject to the following additional Conditions: 0 a If this policy is cancelled by the Company, other than for non-payment of premium, notice of such cancellation will be provided at least thirty (30) days in advance of the cancellation effective date to the certificate holder(s) with mailing addresses on file with the agent of record or the Company. If this policy is cancelled by the company for non- payment of premium, or by the insured, notice of such cancellation will be provided within ten (10) days of the cancellation effective date to the certificate holder(s) with mailing addresses on file with the agent of record or the Company. If notice is mailed, proof of mailing to the last known mailing address of the certificate holder(s) on file with the agent of record or the Company will be sufficient proof of notice. Any notification rights provided by this endorsement apply only to active certificate holder(s) who were issued a certificate of insurance applicable to this policy's term. Failure to provide such notice to the certificate holder(s) will not amend or extend the date the cancellation becomes effective, nor will it negate cancellation of the policy. Failure to send notice shall impose no liability of any kind upon the Company or its agents or representatives. REVIEWED & APPROVED By Risk MANAGEMENT DIVISION Form SS 12 23 06 11 Page 1 of 1 © 2011, The Hartford THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION TO CERTIFICATE HOLDER(S) Policy Number: 57 WEC AC3MZN Endorsement Number: Effective Date: 11/09/19 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: Hall Aquatic Life Support Designs 347 GRANT ST SE ATLANTA GA 30312 This policy is subject to the following additional Conditions: A. If this policy is cancelled by the Company, other than for non-payment of premium, notice of such cancellation will be provided at least thirty (30) days in advance of the cancellation effective date to the certificate holder(s) with mailing addresses on file with the agent of record or the Company. B. If this policy is cancelled by the Company for non-payment of premium, or by the insured, notice of such cancellation will be provided within ten (10) days of the cancellation effective date to the certificate holder(s) with mailing addresses on file with the agent of record or the Company. n If notice is mailed, proof of mailing to the last known mailing address of the certificate holder(s) on file with the agent of record or the Company will be sufficient proof of notice. Any notification rights provided by this endorsement apply only to active certificate holder(s) who were issued a certificate of insurance applicable to this policy's term. Failure to provide such notice to the certificate holder(s) will not amend or extend the date the cancellation becomes effective, nor will it negate cancellation of the policy. Failure to send notice shall impose no liability of any kind upon the Company or its agents or representatives. Form WC 99 03 94 Printed in U.S.A. Process Date: 09/30/19 Policy Expiration Date: 11/09/20 © 2011, The Hartford