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Home My WebLink AboutAECOM (2)City of Santa Ana Clerk of the Council 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TERMINATION FORM Please complete this form in its entirety when the attached agreement and all amendments (if any) are no longer in effect.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 have been satisfied prior to signing the termination form. CL E" 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. COTC Office Use ON OF THE COUNCIL L 6121 PM2:53 The agreement with n U t I r No. n— nil &.49c) was completed on Z I and final payment has been made. (List all amendments. Use space below N needed.) �krGNcn - A " wn -3wo- cI iAagreemenlslformeRorm- agreement termination form_goldenrod.doe Department:�V1 111xbvu l Phone/Ext.: Signature: Date: A-2017-360-01 n N N N MAYOR Miguel A. Pulido MAYOR PRO TEM Juan Villages COUNCILMEMBERS Phil Bacerra Cecilia Iglesias David Penaloza Vicente Sanniento Jose Solorio G; f: CITY OF SANTA ANA INSURANCE ON FILEPLANNING AND BUILDING AGENCY IAIORKUNTIL MAY PROCEED UNTIL INSURANCE EXPIRES 20 Civic Canter Plaza . P.O. Box 1998 Santa Ana, California 92702 (j U/ 0 1/ Z OZ Q www.santa-ana.orc CLERK OF COUNCIL DATE 0 : ?4 (, I jP3 fl to m eh Woz" 41 December 18, 2019 AECOM Attn: Ryan Wiggins, Principal Agent 410 West A Street, Ste. 1200 San Diego, CA 92101 Re: Extension of Consultant Agreement No. A-2017-360 Dear Mr. Wiggins: CITY MANAGER Kristine Ridge CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL Daisy Gomez Pursuant to Section 3 of Agreement No. A-2017-360, entered into by AECOM and the City of Santa Ana, dated March 16, 2018, the term of the Agreement is hereby extended through June 30, 2020. The insurance certificates are required to be extended and/or renewed to cover this extension. All other terms and conditions of the Agreement, as amended, remain unchanged and in full force and effect. Sincerely, Minh Thai Executive Director, Planning and Building Agency CITY OF SANTA ANA Kr stine Ridge 01 City Manager APPROVED AS TO FORM Lisa Storck Assistant City Attorney ATTEST "' Daisy Gomez Clerk of the Council AECOM NXv By: Nathan O. Pepple Title: VP, Authorized Signatory SANTA ANA CITY COUNCIL Mpuel A PNido Jvan valegas v¢enla sarmunto David Penal is Jose Solaro Pail Baoeme Ceuaa Iglesas Mayor Mayor Pm Tom Ward 5 Ward t Ward 2 Ward ] Ward 4 Ward 6 aulldomseMa-ana om IVil1eda,15Wta-an1 omysannientonsanta-ana ma of Aw icidsa la-ana or ooacemaOsamaana or Paleaias sam}ana or M21670v1 CERTIFICATE OF LIABILITY INSURANCE 03/1012019 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 pollcy(las) 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 Marsh Risk B Insurance Services CA Ucense #0437163 633 W. Fifth Street, Suite 1200 Las Angeles, CA 90071 Alin: LosA igeles.CeRReques @Marsh.Com CNIDI348564-STND-GAUE-19-20 _. _ 09 2020 INSURED AECOM AECOM Technical Servlces, Inc. 999 Town and County, Road Orange, CA 92868 INSURER(5)AFFORDING COVERAGE COVERAGES CERTIFICATE NUMBER- LOS002349005.00 REVISION NUMRER- 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. '— ILTP TYPE OFINSURANCE ADDLE B POLICY NUMBER POLICY EF imwan POLICY EXP MWDD1YYYY LIMITS A X I COMMERGALGENERALLKRIUW HDO G71234137 04101/2019 0410112020 EACH OCCURRENCE S 1,000,000 CLAIMS-MADE1XI OCCUR li- PREM3CS IIIEe^cCiart.1_ 3 1,000,000 MED EXP(Any me person) S _ 6,01IX PERSONAL 6 ADV INJURY $ 1,000,000 _ GENL AGGREGATE LIMIT APPLIES PER X POLICY El JEC1:1 LOC GENERALAGGREGATE $ 2,000,000 S 2,000,000 PRODUCTS -COMPIOP AGG s OTHER. A AUTOMOSILELIABILITY ISA H25280532 04101I2019 0410112020 COMBINED SINGLE LIMIT (EEa #i- _ $ 1,000,000 X ANYAUTO BODILY INJURY War Poem) $ GWNEG SGNEOULEO AUT04ONLY AUTO$ HIRED N WOWNED AUIOSONLY _ AUTOS ONLY BODILY INJURY (PeramldM,q PROPERTY DAMAGE IF. nockni ; $ - _ _ $ UMBRELLALIAS OCCUR EACH OCCURRENCE s__ AGGREGATC- $ _ _ EXCESSLIAS CLAIMS -MADE_ OEU I I RETENTION$ $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYPROPRIETORIPARTHERIEXECUtIVE OFFICERNEMSEREXCLUDEO? (MandateryMNH) NIA SEEACORDI01 / 0410112020 X I ER __ - -- It 1,000,WD - ---STTE - -EL EACH ACCIDENT - -- EL_DISEASE - EA EMPLOYEE — — 4 11100,000 as, 4aRIPTscnGNbe Of underDPE 0 GRATONSbebw 0 $ 1,000,000 ' EL DISEASE -POLICY LIMIT C ARCHITECTS B ENG, EON 021654693005 04AN/2019 Per ClaimlAgg $1,000,000 PROFESSIONAL LIA& 'CLAIMS MADE' �0410112020 Defense Included DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD Hit, Additional Remarks Schedule, may on attached If more space Is rsqulrad) Re: City of Santa Ana Envlrmanimial and Planning Services I Proposal M. 04103279 - 5939- SO but Se Cerfirl a Holder is named as additional insured for GL coverage, but only as respects work porli med by or on behalf of the named insured and where required by water crolmd This insurance is primary and not contributory over any existing insurance and limited to liability arising oUi of the operations of the named insured and where required by wrillen contract Witi respect to the GLpcoverage. �/VIaA Cifyol Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Bona MeoradisnlAdmInatradve Services Mana9 r 242019 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 Civic Center Plaza ACCORDANCE WITH THE POLICY PROVISIONS. Santa Ana, CA 02701 SAMA THA M. LAMBE AUTHORIZED REPRESENTATIVE of Marsh Rlak S Insurance Services James L. Vogel S51 ARR-201A ACORn CORPORATION All A.htc mcm .rI ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: CNIO1348564 LOC #: Los Angeles AC<>Rda ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAM ED INSURED Marsh Risk & Insurance Services AECOM AECOM Technical Services, Inc POLICY NUMBER 999 Tom and Counlry Road Orange, CA 92868 CARRIER NAIC CODE EFFECTIVE DATE: THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate Of Liability Insul Workers CompensellonlEmpbyer LiaWily coal Policy Number Iasaar Slales Covered WLR 06589827A Indemnify Insurance Company of North America - NAIC d 48575 ACE WLR C65893150 ACE American Insurance Company - NAIC d 22667 CA and MA SCF C65893190 ACE American Insurance Company -NAIC N 22667 wRaw WCU C65890893 ACE American Insurance Company-NAICa22667 ON,Oeo 0.01irlsdSell Insured(O51f- SIR $600,000; Only appikable to specific Nu,6rvd entities self insured In the stale of Ohio 101 The ACORD name and logo are registered marks of ACORD