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HomeMy WebLinkAboutALLIANCE ENVIRONMENTAL GROUP, LLC (2)A 2020-059-01 990 W. Tenth Street, Azusa, CA 91702 AWO phone 626.633.3500' fax 626.633.3599 INSURANCE ON FILE WORK 11W PROCEED ^E EXPIRES `;�r:dCIL 0 QVC "ol I tvro ell OZOZ 9 0 AA City of Santa Ana 20 Civic Center Plaza Santa Ana, CA 92701 Attn: Ron Ono ORDER""*`Due to extra time cleaning up debris from vandalism . Due to removal of section of ceiling asked by PD to remove homeless personsDue to re -sealing containments Down time from police activity. Re -cleaning areas that were created by homeless persons Any further questions please contact Jeremie McPhail Invoice Invoice Date Customer Invoice Job No 4/28/2020 C2225 Claim No PO City of Santa Ana - Firehouse 625 Cypress Avenue Santa Ana, CA 927015831 www. alliance-enviro. com Please reference job number when making your payment 160982 X-20-194526 ID#: 8,365.23 Amount Billed: 8,365.23 Total Tax: 0.00 Retainage Held: 0.00 Amount Due: 8,365.23 Interest at the rate of 1-1/2% per month will be charged on all past due accounts. In the event of failure to pay any of the amount due in this invoice, all collection costs and/or attorney fees in the collection of any such amount will be paid by the customer. CITY OF SANTA ANA ATTEST: ISTIN� DAISY GOMEZ City Manager Clerk of the Council N' APPROVED AS TO FORM: SONIA R. CARVALHO City Attorney By: HN M. FUNK Senior Assistant City Attorney RECOMMENDED FOR APPROVAL LISA RUDLOFF Executive Director, Parks, Recreation and Community Services Agency 4/28/2020 9:57:53PM Page 1 of 1 CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 4/8/2020 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 have ADDITIONAL INSURED provisions or be endorsed. H SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement an this certificate does not confer dates to the certificate holder in lieu of such endorsemem(s). LOCKTON COMPANIES 3657 BRIARPARK DRIVE, SUITE 700 Houston TX 77042 Alliance Environmental Group, LLC 990 West Tenth Street J Azusa CA 91702 CAVFRAr:FR CFRTIFIr.ATF MIIMRFR- 166RI669 REVISION NUMBER: XXXXXXX 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. TYPE OF INSURANCE GO Mr) POLICYNUMBER IY F 02618M LIMITS A X. I COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X❑ OCCUR ✓ Y Y 1000065722191 6/1(7 6/10/2020 ✓/III EACHOCCURRENCE f OOO OOO MED MEDEXP(MyonevarsoOl 30O OOO s 50 000 PERSONAL A ADO/ INJURY S 1.000 000 GENL AGGREGATE LIMIT APPLES PER PoLICY�J� �LOC GENERAL AGGREGATE s 2,000,000 PRODUCTS- COMP/OP AGG s2000000 $ OTHER: B LIABILITY Y Y SISIPCA08264419 6/10/2019 6/10/2020 OMBINED BIN LE LIMIT CMe a dens $ 1000000 BODILY INIURY(Per person) S XXXXXXX NOMOBILE AApNNWYNNAEEUU�TO EEppUU AUTOS ONLY NUTOBWLEO BODILY INJURY(Per accidenl s XXXXXXX AUTOS ONLY ONWLY p OPFRTY DAMAGEs X)CK)O X• • XComp Medical Pav 5000 &Coll UMBRELLAUMB EXCESS UAB I OCCUR CL"S-MADE NOTAPPLICABLE EACH OCCURRENCE S XXXXXXX AGGREGATE $ XXXXXXi( DED RETENTION S WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYMOPRIETONPARTNENE%ECUTIVE OITICEnME1.91ER E%0.UOED'1 ryymmNtory In NN IOESCNPTIDN N OPERATIONS MYw NIA Y NC1868045-f10 129/2020 1/29/2021 / ✓ X ST.TUTE EL. EAp ACL10ENT f I OOD ODD E L DISEASE - EA EMPLOYEE 1 OD000D 6EA4 -POLICY IMIT 1,000,000 A Contredon Pollution Y Y 1000065722191 6/10/2019 6/IORS120 ✓ nem/ Per Occue: S1,000,000 , Aggregme: $2,000,000 `✓ DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarin, Schedule, may be.1bet ed B more space Is remared) THIS CERTIFICATE SUPERSEDES ALL PREVIOUSLY ISSUED CERTIFICATES FOR THIS HOLDER, APPLICABLE TO THE CARRIERS LISTED AND THE POLICY TERM(S) REFI RENC All policies include a blanket notice of cancellation to certificate holders endorsement, providing for 30 days' advance notice if the policy is cancelled by the company other than for nonpayment of premium, 10 days notice if the policy is cancelled for nonpayment of premium. Notice is sent to certificate holders with matting addresses on file with the agent or the company. The endorsement does not provide for notice of cancellation if the Denied insured requests cancellation EVIEWED & APPROV y Risk MANAGEMENT DIVIS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED i (('((HEEXPDNCEV DATE THEREOF, NOTICE W LL BE DEWERED IN V. LACCORDANGE WITH THE POLICY , PROVISIONS. ON 16683669 AUTHORIZED REPRESENTATIVE City of Santa Ana AP 9 2020 Risk Management Division 20 Civic Center Plaza, 41h floor Santa Ana CA92702 ANCIIEACEVEdO Cf �, I All rights reserved V The ACORD name and logo are registered marks of ACORD Attachment Code : D544488 Master ID: 1444909, Certificate ID: 16683669 Professional Liability Policy No.: 1000065722191 Policy Term: 6/10/2019 - 6/10/2020 Insurer: Starr Surplus Lines Insurance Company Limits: $1,000,000 Each Claim $1,000,000 Aggregate REVIEWED & APPROVED By Risk MANAGEMENT DIVISION AP 2020 ANGIE ACEVEdo Attachment Code: D543064 Master ID: 1444909, Certificate ID: 16683669 *Starr Surplus Lines Insurance Company Chicago, IL 1-646-227-6300 Primary and Non-contributory, Additional Insured and Waiver of Subrogation Policy Number: 1000065722191 Effective Date: 6/10/2019 at 12:01 A.M. Named Insured: Alliance Environmental Holdings, LLC This endorsement modifies the insurance coverage form(s) listed below that have been purchased by you and evidenced as such on the Declarations page. Please read the endorsement and respective policy(ies) carefully. Commercial General Liability Coverage Form Owners and Contractors Protective Liability Coverage Form Products/Completed Operations Liability Coverage Form Contractors Pollution Liability Coverage Form Professional Liability Coverage Form Site Pollution Liability Coverage Form SCHEDULE Where Required By Written Contract A. SECTION II - WHO IS AN INSURED is amended to include as an insured the person or organization shown in the schedule of this endorsement, but only with respect to liability arising out of "your work" for that insured by or for you. B. As respects additional insureds as defined above, this insurance also applies to "bodily injury" or "property damage" arising out of your negligence when the following written contract requirements are applicable: 1. Coverage available under this coverage part shall apply as primary insurance. Any other insurance available to these additional insured's shall apply as excess and not contribute as primary to the insurance afforded by this endorsement. 2. We waive any right of recovery we may have against these additional insured's because of payments we make for injury or damage arising out of "your work" done under a written contract with the additional insured. 3. The term insured Is used separately and not collectively, but the inclusion of more than one insured shall not increase the limits or coverage provided by this insurance. Insureds and Agents are advised that certificates of insurance should be used only to provide evidence of insurance in lieu of an actual copy of the applicable insurance policy. Certificates should not be used to amend, expand or otherwise alter the terms of the actual policy. All other terms and conditions of this Policy remain unchanged. Signed for STARR SURPLUS RNM ARM"Y By Risk MANAGEMENT DivisiON APR 2020 /i/��ir,wE Xu r9w �v*r Steve Blakey, Presid hemiah E. Ginsburg, General,Counsel ANGIE ACEVEdO St.023 (06111) Page 1 of 1 Copyright O C. V. Starr S Company and Starr Surplus Lines Inaaance Company. All righla reserved. Includes copydgMad material of ISO Propades, Inc., used w M as pmmission. Attachment Code: D543996 Master rD: 1444909, Certificate ID: 16683669 POLICY NUMBER: 1000065722191 THIS ENDORSEMENT CHANGES THE POLICY COMMERCIAL GENERAL LIABILITY CG 20 10 0413 PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OIL CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Or anization s : Location(s) Of CovtDecl�tr--ations.t Where Required By Written Contract Where Required By Written Information required to complete this Schedule if not shown above, will be shown in the 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: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. 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 additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: CG20100413 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. C. 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. REVIEWED & APPROVED By Risk MANAGEMENT Dn4SION AP 2020 © InsurancgA$*gAt Inc., 2012 Page 1 of 1 Attachment Code : D543997 Master ID: 1444909, Certificate ID: 16683669 POLICY NUMBER: 1000065722191 COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Or anization s : Location And Description Of Completed I O erntions Where Required By Written Contract I Where Required By Written Contract Information required to complete this Schedule if not shown above will be shown in the Declarations. 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' or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products -completed operations hazard". 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. REVIEWED & APPROVED By Risk MANAGEMENT Division `AP 0 9 2020 ANCIIE AcEVEdO CG 20 37 04 13 0 Insurance Services Office, Inc., 2012 Page 1 of 1 Attachment Code: D543060 Master 1D: 1444909, Certificate ID: 16683669 Dallas, TX 1-866-519-2522 Additional Insured - Where Required Under Written Contract or Written Agreement Endorsement Policy Number: SISIPCA08264419 Effective Date: 6/10/2019 at 12:01 A.M. Named Insured: Alliance Environmental Holdings, LLC This endorsement modifies the insurance coverage form(s) listed below that have been purchased by you and evidenced as such on the declarations page. Please read the endorsement and respective policy(ies) carefully. Business Auto Coverage Form THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. It is hereby agreed that SECTION II — COVERED AUTOS LIABILITY COVERAGE, A. Coverage, 1. Who Is An Insured, is amended to include the following: d. Any person or organization whom you become obligated to include as an additional insured under this policy, as a result of any written contract or written agreement you enter into which requires you to fumtsh insurance to that person or organization of the type provided by this policy, but only with respect to liability arising out of use of a covered "auto". However, the insurance provided will not exceed the lesser of: (1) The coverage and/or limits of this policy, or (2) The coverage and/or limits required by said written contract or written agreement. All other terms and conditions of this Policy remain unchanged. Steve Blakey, President aner Nehemiah E. Ginsburg, General Co sel Chief Executive Officer REVIEWED & APPROVED By Risk MANAGEMENT Divi$iON APR 9 2020 SICA 1016 (04/14) — Page I of I ANC)iE ACEVEdo Copyright ® Starr Indemnity & t.labnity Company. A0 rights reserved. Includes copyrighted material of ISO Properties, Inc., used with its permission. Attachment Code : D544287 Master ID: 1444909, Certificate ID: 16683669 POLICY NUMBER: SISIPCA08264419 COMMERCIAL AUTO CA 04 4410 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: Alliance Environmental Holdings, LLC Endorsement Effective Date: 6/10/2019 SCHEDULE Name(s) Of Blanket where required by a written contract. The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident" or the "loss" under a contract with that person or organization. REVIEWED & APPROVED 13y Risk MANAGEMENT DIVISION A" 2020 CA 04 4410 13 © Insurance NNO9U409nc., 2011 Page 1 of 1 Attachment Code: D544681 Master ID: 1444909, Certificate ID: 16683669 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 (Ed. 4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule All persons and/or organizations - other than manufacturers of asbestos, manufacturers whose component parts include asbestos, or distributors of a product that contains asbestos - that are required by written contract or written agreement with you, executed prior to the accident or loss, that waiver of subrogation be provided under this policy for work performed by you for that person and/or organization. Endorsement Effective: 1/29/2020 Insured: Alliance Environmental Holdings, LLC Policy No.: WC 1868045-00 WC 00 03 13 (Ed. 4-84) /1983 National council on compensation Insurance. REVIEWED & APPROVED By Risk MANAGEMENT DIVISION AP 2020 ANgiE ACEVEdO Attachment Code: D544681 Master ID: 1444909, Certificate ID: 16683669 WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT— CALIFORNIA This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. (The following "attaching clause" need be completed only when this endorsement is Issued subsequent to preparation of the policy.) This endorsement, effective on 1/29/2020 at 12:01 A.M. standard time, forms a part of (DATE) Policy No. WC 1868045 - 00 Endorsement No. of the (NAME OF INSURANCE COMPANY) Issued to Premium (if any) $ Authorized Representative We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be % of the California workers' compensation pre- mium otherwise due on such remuneration. Schedule Person or Organization Job Description All persons and/or organizations - other than manufacturers of asbestos, manufacturers whose component parts include asbestos, or distributors of a product that contains asbestos - that are required by written contract or written agreement with you, executed prior to the accident or loss, that waiver of subrogation be provided under this policy for work performed by you for that person and/or organization. Insured: Alliance Environmental Holdings, LLC REVIEWED & APPROVED By Risk MANAGEMENT DivisiON WC 252 (4-84) Af 9 2020 WC 04 03 06 (Ed. 4-84) Confidential \ Personal Data ANGIE ACEVEdo Page 1 of 1