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HomeMy WebLinkAboutVENTURA BUSINESS SYSTEMS, INC. (3)City of Santa Ana Clerk of the Council AGREEMENT TERMINATION FORM COTC office Use Only C2,03 Please complete this form in its entirety when the attached agreement and all amendments (if any) are no longer in effect. Nate; If your agreement is grant related, please ensure that all grant retention requirements have been satisfied prior to signing the termination form. , SI- B A ANA C Tiy="LYE. K Is the agreement(s) a permanent record? Yes No -Lila Return form to the Clerk of the Council Office (M-30). E Call 647-1520 if you have any questions. The agreement with No N-2017-094-03 was completed on (List all amendments. Use space below if needed.) 02- --0j ctagreementsftrmsftrm - agreement termination form_goldenrod.doc Department: Phone/Ext.: Signature: Date: and final payment has been made. LA 6 S VQ� �uRANCE ON FILE V'ORK MAY PROCEED c� UNTIL INSURANCE EXPIRES 2 41 2 CLERK OFCOUNCII. „T1 U�prz-(.5nn�1�5i��1G ���US SECOND AMENDMENT TO CONSULTANT AGREEMENT WITH VENTURA BUSINESS SOLUTIONS N-2017-094-02 THIS SECOND AMENDMENT to the above -referenced agreement is entered into on September 1, 2020, by and between Ventura Business Solutions, hic. ("Consultant"), and the City of Santa Ana, a charter city and municipal corporation organized and existing under the Constitution and laws of the State of California ("City"), collectively referred to as the "Parties". RECITALS A. The Parties entered into Agreement No, N-2017-094, dated June 1, 2017, by which Consultant agreed to provide copy and printing services for the public at the Santa Ana Library and its branches ("Agreement"). The Agreement is current and in effect. B. On May 1, 2020, the Parties amended the Agreement to add additional services and compensation. C. The Parties now wish to again amend the scope of services and increase the compensation under the Agreement. The Parties hereby agree as follows: 1. Section 1, Scope of Services, is amended to include the BookScan Center which is a public scanning service for the public patrons at the Newhope Library location. New services for both the Main and Newhope Library locations will include the Mobile Print service. The Quotes for the added service components dated August 27, 2020, are attached hereto and incorporated with this Second Amendment and identified as Exhibit A. 2. Section 2, Compensation, is amended to increase the not -to -exceed amount by $8,332.29, per the costs and rates identified in Exhibit A to this Second Amendment. The total amount to be expended under the Term of this Agreement shall not exceed $33,417.95, which includes the $1,200 annual maintenance fee. 3. Except as modified by this Second Amendment, all terms and conditions of the Agreement shall remain in full force and effect. [Signature Page Follows) #58837v1 N-2017-094-02 IN WITNESS WHEREOF, the parties hereto have executed this Second Amendment to the Agreement on the date and year first written above. ATTEST CITY OF SANTA ANA Daisy Gomez Kris me Ridge Clerk of the Council City Manager APPROVED AS TO FORM Sonia R. Carvalho City Attorney Lisa Storck Assistant City Attorney FOR APPROVAL Brian Steinberg Executive Director Library Services Agency #58837v1 CONSULTANT Trev� ates President VENTURA BUSINESS SYSTEMS INC. 2582 Fig Street Simi Valley, CA 93063 Phone (805) 583-3299 Fax (719) 470-2122 Federal Tax ID# 77-0508735 Name / Address Attn: Lynn Nguyen Santa Ana Public Library 20 Civic Center Plaza Santa Ana, CA 92701 Quote Date Quote # 8/27/2020 265707 Terms Rep Net 30 TFY Description Qty Cost Total SUBSCRIPTION (I-YearPrepaid) MobilePrint 2 725.00 1,450.00 Service(tm) -Print from virtually any patron device via App, Email or Custom Web Portal. Pick up at LPT:One Print Release Terminals. No additional hardware required. - Licensed by the number of Buildings or Job Queue Engines, whichever is greater, ++REQUIRES LPT:One EnvisionWare Print Management v4.9+ Any questions please call (805) 583-3299 Cell (805) 501-8515 Price good for 60 days from date above. Subtotal Sales Tax (9.25%) Signature Total Page 1 VENTURA BUSINESS SYSTEMS INC. 2582 Fig Street Simi Valley, CA 93063 Phone (805) 583-3299 Fax (719) 470-2122 Federal Tax ID# 77-0508735 I Name/Address I Attn: Lynn Nguyen Santa Ana Public Library 20 Civic Center Plaza Santa Ana, CA 92701 Quote . Date Quote # 6/17/2020 265707 Terms Rep Net 30 TFY Description Qty Cost Total ENVISIONWARE PROFESSIONAL SERVICES - 3 175.00 525.00 Professional Services delivered on an hourly basis for Circulation Security and Inventory Solutions. For onsite services the minimum charge is 8 hours plus actual first and additional day expense charges. Any questions please call (805) 583-3299 Cell (805) 501-8515 Price good for 60 days from date above. Subtotal $1,975.00 Sales Tax (9.25%) $0.00 Signature Total $1,975.00 Page 2 VENTURA BUSINESS SYSTEMS INC. 2582 Fig Street Simi Valley, CA 93063 Phone (805) 583-3299 Fax (719) 470-2122 Federal Tax ID# 77-0508735 Name/Address Attn: Lynn Nguyen Santa Ana Public Library 20 Civic Center Plaza Santa Ana, CA 92701 Quote Date Quote # 8/27/2020 265708 Terms Rep Net 30 TFY Description Qty Cost Total BookScanCenter: Turnkey system includes All -in -One 21 "+ touchscreen PC pre -loaded with Scannx Standard Edition software, 11" x 17" book -edge scanner, and Scannx Cloud Services which provides usage information and device profiles. 1 year ScannXtra Care Premium advance exchange warranty coverage. 21" touchscreen AIO PC, i5-9500 (6 cores), 8GB 1 2,500.00 2,500.00T DDR4 RAM, 50OGB HDD, Articulating Stand, Win 10 Pro, Scannx Standard Editon software, USB dock. BookScanner 7145, 11" x 17" Flatbed Book Edge 1 1,995.00 1,995.00T scanner 1 YEAR SCANNXTRA CARE SOFTWARE 1 350.00 350.00 ASSURANCE, STANDARD EDITION hardware covered under Depot Repair Thank you for your business. Subtotal Sales Tax (9.25%) Signature Total Page 1 VENTURA BUSINESS SYSTEMS INC. 2582 Fig Street Simi Valley, CA 93063 Phone (805) 583-3299 Fax (719) 470-2122 Federal Tax ID# 77-0508735 Name/Address Attn: Lynn Nguyen Santa Ana Public Library 20 Civic Center Plaza Santa Ana, CA 92701 Quote Date Quote # 8/27/2020 265708 Terms Rep Net 30 TFY Description Qty Cost Total Shipping After 1 st Year yearly maintenance is $600.00 for software and hardware Discount for 2 or more 1 1 115.00 -200.00 115.00 -200.00T Thank you for your business. Subtotal $4,760.00 Sales Tax (9.25%) $397.29 Signature Total $5,157.29 Page 2 `�`� �® CERTIFICATE OF LIABILITY INSURANCE °0412612019 °' 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 endorsements). PRODUCER DARRYL NIND INSURANCE AGENCY N 'DA RYL NIND AGENT 940 Enchanted Way #101 Simi Valley, CA 93065 1kc N. PHONE ID (805)62FA% e. 2 Eo-ALn` ^: dar I.nlnd.rebi slatefarm.wnn Q INSURERS AFFORDING COVERAGE NMC• INSURER A: Slate Farm General Insurance Company INSURED VENTURA BUSINESS SYSTEMS INC C/O TREVOR YATES ✓ INSURER a: 1 to Farm Mutual Automobile ile Insurances Coman INSURER C: INSURER D. 2582 FIG ST INSURER E: SIMI VALLEY CA 93063-2416 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 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 rypE OF INSUMNCE POLICY EFF POLICY EXP LIMRS A GENERAL LIABILITY X COMMERCIAL GENERAL WIBILRY/ CLAIMS -MADE N OCCUR 92-W4-0493-7 0412612020 D412612021 EACH OCCURRENCE S 1.000.000 E TtT11oE REMISES aoccurrence) S MEO EXP An ma rson S 51000 PERSONAL S AOV INJURY S 1,000,DDO GENERAL AGGREGATE S 2,000,OD° GEN'L AGGREGATE X POLICY LIMIT APPLIES PER: PRa LOC PRODUCTS-COMP/OP AGG S 2,000,DG0 $ B AUTOMOBILE x X LIABILITY ANY AUYD ALL UTOOWNED SCHEDAUTOS NON-O NON -OWNED HIRED AUTOS 051 5512-A18-75L 01119/2021 COMBINED0711012020 40 IN I $ BODILY INJURY(Perpe.) $ 1,000,000 BODILY BODILY INJURY(Peracclden0 S 1,000,000 P-0R -PPETE R17 DAMAGE $ 1,000.000 It UMBRELLA LIAR EXCESS LIFO OCCUR CLAIMSMADE EACH OCCURRENCE S AGGREGATE S DEO I I RETENTION S WORKERS COMPENSATION AND EMPLOYERS' LIASIUM( Y YIN ANY PROPRIETOR/PARTNEWEXECUTIVE OFFICEAIEMBER EXCLUDED? ❑ (Mandatory In NMI 9 yes, descd0e under N)A WC STATU- OTH- E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEJ S E.L. DISEASE -POLICY LIMIT I S DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (AIMch ACORD 101, AddIVonM Remarks Schedule, If more apace is required) RFC/ F�V�(� (yy,APPR VE There is no Workers Compensation policy for Ventura Business Systems as all employees are officers of the ccrpofLRlarLl'Otilc�P rf18 L.OrOBraoll0a D not required to have a Work Comp policy in the Slate of California. y 15 MANAGEMENT LJNISIVIV Certificate of Insurance shall provide thirty (30) day prior written notice of cancellation ✓ 2 2 2020 V CERTIFICATE HOLDER CANCELLATION ADDITIONAL INSURED: CITY OF SANTA ANA / RISK MANAGEMENT DIVISION / ✓✓✓ S HOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 20 CIVIC CENTER PLAZA, 4TH FLOOR SANTA ANA, CA 92701 MYSBOADED RE E TATNE C 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD 1001486 132849.6 11-15-2010 CITY OF SANTA ANA RISK MANAGEMENT a dtrstataw 4HUMAN RESOURCES Managing Risk Post We Change ADDITIONAL INSURED ENDORSEMENT Insurance Company: State Farm This endorsement modifies such insurance as is afforded by the provisions of Policy It 92-W4-0493-7 relating to the following 1. The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701; its officers, employees, agents and volunteers are named as additional insureds ("additional insureds") with regard to liability and defense of suits arising from the operations and uses performed by or on behalf of the named insured. 2. With respect to claims arising out of the operations and uses performed by or on behalf of the named insured, such insurance as is afforded by this policy is primary and is not additional to or contributing with any other insurance carried by or for the benefit of the additional insureds. 3. This insurance applies separately to each insured against whom claim is made or suit is brought except with respect to the company's limits of liability. The inclusion of any person or organization as an insured shall not affect any right which such person or organization would have as a claimant if not so included. 4. With respect to the additional insureds, this insurance shall not be canceled, or materially reduced in coverage or limits except after thirty (30) days written notice has been given to the City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701. Completion of the following, including countersignature, is required to make this endorsement effective. Effective 4/26/2020 - 4/26/2021 '� Policy g this endorsement form asf> *ft%ED & APPROVED By Risk MANAGEMENT DIVISION MAYO#212020 Issued to Ventura Business Systems Inc AnrticACEVEdo (Named Insured) Countersigned by Authorized Representative IrlRisk Mgmtllnsuronce RequirementslAdditionol Insured Endorsement August1019 92-W4-0493-7 CITYOFSANTAANA Ri$K MANAGEMENT d&&ea 4HUMAN RESOURCES Managing Risk owsh Pos M Change WORKERS' COMPENSATION DECLARATION Trevor Yates (Name/Title) following declaration: I certify on behalf of hereby affirm under penalty of perjury, the that during the term (Consultant/Company Name) of my contract for copier/Printing 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. Ventura Business Systems, Inc Date:4/10/2020 .1// Print Name: Trevor Yates Print Title: President Signature: y,� Telephone: 805-58 -3299 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 150. 2020 ANgiE AcEvedo I: I Risk Mgm t\lnsuronce RequirementsJWC Declaration 08151019 Ventura Business Systems, Inc. 2582 Fig Street Simi Valley, CA 93063 Phone (805) 583-3299 May 5, 2020 To Whom it May Concern: Ventura Business Systems, Inc. is a coin operated copier and printing company. We don't touch anything that is owned by the Library. Therefore, we do not carry Professional Liability insurance (errors and omissions requirement) required by the city. Ventura Business Systems is not and will NOT employ a licensed professional therefore we do not meet this requirement. Thank You Trevor Yates REVIEWED & APPROVED By Risk MANAGEMENT DiviSiON MAY 2020 ANGiE ACEVECIO Digitally signed by Francine R. Francine R. Villareal Villareal Date: 2021.12.09 1129,08-08'00' CERTIFICATE OF LIABILITY INSURANCE D1zosi202 "' 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 DARRYL NIND INSURANCE AGENCY NAME: DARRYL NIND, AGENT 4378 EILEEN ST o SIMI VALLEY, CA 93063 A/C. PHONE Ext : 805 823-8373 FVC No): 805 823-8377 E-MAIL ADDRESS: darryl.nind.rebi@statefarm.com INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: State Farm General Insurance Company 25151 INSURED VENTURA BUSINESS SYSTEMS, INC INSURER B: State Farm Mutual Automobile Insurance Company 25178 INSURERC: C/O TREVOR YATES INSURERD: 2582 FIG ST SIMI VALLEY CA 93063-2416 INSURERE: 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 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 TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A GENERAL LIABILITY ❑ ❑ 92-W4-0493-7 04/26/2021 04/26/2022 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE ( RENTED PREMISES Ea occurrence) $ CLAIMS -MADE � OCCUR MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 X POLICY PRO LOC JECT $ B AUTOMOBILE LIABILITY 1-1 ❑ 051 5512-A18-75N 01/18/2022 07/18/2022 COMBINED SINGLE LIMIT Ea accident $ X ANY AUTO BODILY INJURY (Per person) $ 1,000,000 X ALLOWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ 1,000,000 NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE Per accident $ 1,000,000 UMBRELLA LAB OCCUR ❑ ❑ EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N WC STATU- OTH- TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICE/MEMBER EXCLUDED? ❑ N / A ❑ E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) E.L. DISEASE - POLICY LIMIT $ If yes, describe under DESCRIPTION DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) There is no Workers Compensation policy for Ventura Business Systems as all employs are officers of the corporation. Officers of the Corporation are not required to have a Work Comp policy in the State if California. CERTIFICATE HOLDER ADDITIONAL INSURED: City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Risk Management Division ACCORDANCE WITH THE POLICY PROVISIONS. 20 Civic Center Plaza, 4th floor IZED RE RESENTATIVE SANTA ANA, CA 92701 7 u" cF ` ILLi3RMwag't'.Ih12t'lt DMsiun REVIEWED & APPROVED SY: © 1988-2010 ACORD C( ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD _ _— Wsk Management Analyst Policy No. 92 W40493 7 CMP-4786.1 Page 1 of 2 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CMP-4786.1 ADDITIONAL INSURED — OWNERS, LESSEES, OR CONTRACTORS (Scheduled) This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number: 92 W40493 7 Named Insured: VENTURA BUSINESS SYSTEMS INC Name And Address Of Additional Insured Person Or Organization: THE CITY OF SANTA ANA ITS OFFICERS AGENTS & EMPLOYEES 20 CIVIC CENTER PLZ SANTA ANA CA 92701 4058 1. SECTION II — WHO IS AN INSURED of b. If coverage provided to the additional in - SECTION II — LIABILITY is amended to in- sured is required by a contract or agree- clude, as an additional insured, any person or ment, the insurance provided to the organization shown in the Schedule, but only additional insured will not be broader than with respect to liability for "bodily injury", "property "personal that which you are required by the contract damage", or and advertis- or agreement to provide for such addition- ing injury caused, in whole or in part, by: al insured; and a. Ongoing Operations c. If the contract or agreement between you (1) Your acts or omissions; or and the additional insured is governed by (2) The acts or omissions of those acting California Civil Code Section 2782 or on your behalf; 2782.05, the insurance provided to the additional insured is the lesser of that in the performance of your ongoing opera- which: tions for that additional insured; or (1) Is allowed for the satisfaction of a de- b. Products — Completed Operations fense or indemnity obligation by Cali - "Your work" performed for that additional fornia Civil Code Section 2782 or insured and included in the "products- 2782.05 for your sole liability; or completed operations hazard". (2) You are required by contract or However, Paragraph 1. above is subject to the agreement to provide for such addi- following: tional insured. a. The insurance afforded to the additional We have no duty to defend or indemnify the insured only applies to the extent permit- additional insured under this endorsement un- ted by law; til a claim or "suit" is tendered to us. ©, Copyright, State Farm Mutual Automobile Insurance Company, 2013 Includes copyrighted material of Insurance Services Office, Inc., with its permission. CONTINUED cF IZAMwagzmentDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst CMP-4786.1 Page 2 of 2 2. Any insurance provided to the additional in- sured shall only apply with respect to a claim made or a "suit" brought for damages for which you are provided coverage. 3. With respect to the insurance afforded to the additional insured, the following is added to SECTION II — LIMITS OF INSURANCE: If coverage provided to the additional insured is required by contract or agreement, the most we will pay on behalf of the additional insured will be the lesser of the amount of insurance: a. Required by the contract or agreement; or b. Available under the applicable Limits Of Insurance shown in the Declarations. This endorsement shall not increase the ap- plicable Limits Of Insurance shown in the Declarations. 4. With respect to the insurance afforded to the additional insured, the following is added to Paragraph 3. Duties In The Event Of Occur- rence, Offense, Claim Or Suit of SECTION II — GENERAL CONDITIONS: The additional insured must: a. See to it that we are notified as soon as practicable of an "occurrence" or an of- fense which may result in a claim. To the extent possible, notice should include: (1) How, when and where the "occur- rence" or offense took place; (3) The nature and location of any injury or damage arising out of the "occur- rence" or offense; b. Tender the defense and indemnity of any claim or "suit" to us and to all other insur- ers who may have insurance potentially available to the additional insured; and c. Agree to make available any other insur- ance the additional insured has for de- fense or damages for which we would provide coverage under SECTION II — LIABILITY. 5. With respect to the insurance afforded the ad- ditional insured, the following replaces SEC- TION II —LIABILITY of Paragraph 7. Other Insurance of SECTION I AND SECTION II — COMMON POLICY CONDITIONS: a. This insurance is primary to and will not seek contribution from any other insurance available to the additional insured, provided that the additional insured is a named in- sured under such other insurance. b. Regardless of any agreement between you and the additional insured, this insur- ance is excess over any other insurance whether primary, excess, contingent or on any other basis for which the additional in- sured has been added as an additional in- sured on other policies. There will be no refund of premium in the event this endorsement is cancelled. (2) The names and addresses of any in- jured persons and witnesses; and All other policy provisions apply. CMP-4786.1 1007033 148011 08-21-2014 0, Copyright, State Farm Mutual Automobile Insurance Company, 2013 Includes copyrighted material of Insurance Services Office, Inc., with its permission. cF IZAMwagzmedDi sign Jy/,'q REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst 478 Policy No. 92 W40493 7 age oof1 9 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY CMP-4787 WAIVER OF TRANSFER OF RIGHTS OR RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number: 92 W40493 7 Named Insured: VENTURA BUSINESS SYSTEMS INC Name And Address Of Person Or Organization: THE CITY OF SANTA ANA ITS OFFICERS AGENTS & EMPLOYEES 20 CIVIC CENTER PLZ SANTA ANA CA 92701 4058 The following is added to Paragraph 10.b. of SECTION I AND SECTION II — COMMON POLICY CONDITIONS: We waive any right of recovery we may have against the person or organization shown in the Schedule because of payments we make for injury or damage arising out of: a. Your ongoing operations; or b. "Your work" done under contract with that person or organization and included in the "products - completed operations hazard". This waiver applies only to the person or organization shown in the Schedule. All other policy provisions apply. CMP-4787 1006225 137715.1 11-19-2013 ©, Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. cF IZAMwagzmentDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst WORKERS' COMPENSATION DECLARATION I _Trevor Yates hereby affirm under penalty of perjury, the (Name/Title) following declaration: I certify on behalf of _Ventura Business Systems that during the term Of my (Consultant/Company Name) contract for 5 years services with the City of Santa Ana, 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 those provisions and provide proof of workers' compensation coverage. DATE: M. Name: Trevor Yates Title: President Telephone: 805-583-3299 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. cF RAManagementDMsian Jy/,'q REVIEWED & APPROVED BY.- V"° W-- PIR Risk fjanagement Analyst Ventura Business Systems, Inc 2582 Fig Street Simi Valley CA (805) 583-3299 Fax (719) 470-2122 Trevor Yates 2582 Fig Street Simi Valley, CA 93063 tyates@vbsl.com (805)501-8515 8/19/2021 City of Santa Ana Risk Management Division, 41h floor 20 Civic Center Plaza Santa Ana, CA 92702 Re: Professional Liability Insurance Requirement. Dear City of Santa Ana Risk Management Division: I, Trevor Yates, Ventura Business Systems, Inc, am not a licensed professional and will not employ a licensed professional during my course of my contract with the City of Santa Ana, CA. Sincerely, 'Trevor Yates President ew cF RAMwagementDMsian Jy/,'q REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst TOri Pierson f),ite 022.4.121 13 Pierson 1 Date: 2022.04.1212:13:38 -07'00, m '�'"�� CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 4/07/2022 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 DARRYL NIND INSURANCE AGENCY NAME: DARRYL NIND, AGENT 4378 EILEEN ST o SIMI VALLEY, CA 93063 A/C. PHONE Ext : 805 823-8373 FVC No): 805 823-8377 E-MAIL ADDRESS: darryl.nind.rebi@statefarm.com INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: State Farm General Insurance Company 25151 INSURED VENTURA BUSINESS SYSTEMS, INC INSURER B: State Farm Mutual Automobile Insurance Company 25178 INSURERC: C/O TREVOR YATES INSURERD: 2582 FIG ST SIMI VALLEY CA 93063-2416 INSURERE: 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 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 TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A GENERAL LIABILITY ❑ ❑ 92-W4-0493-7 04/26/2022 04/26/2023 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE ( RENTED PREMISES Ea occurrence) $ CLAIMS -MADE � OCCUR MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 X POLICY PRO LOC JECT $ B AUTOMOBILE LIABILITY 1-1 ❑ 051 5512-A18-75N 01/18/2022 07/18/2022 COMBINED SINGLE LIMIT Ea accident $ X ANY AUTO BODILY INJURY (Per person) $ 1,000,000 X ALLOWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ 1,000,000 NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE Per accident $ 1,000,000 UMBRELLA LIAB OCCUR ❑ ❑ EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N WC STATU- OTH- TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICE/MEMBER EXCLUDED? ❑ N / A ❑ E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) E.L. DISEASE - POLICY LIMIT $ If yes, describe under DESCRIPTION DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) There is no Workers Compensation policy for Ventura Business Systems as all employs are officers of the corporation. Officers of the Corporation are not required to have a Work Comp policy in the State if California. CLK I IFICA I L HULULK ADDITIONAL INSURED: City of Santa Ana Risk Management Division 20 Civic Center Plaza, 4th floor 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. IZED RE RESENTATIVE �, t t� 7 ReAeaw & APPRavED Br. 14 I���� �,.)' la,t P 2ao © 1988-2010 ACORD CC ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD , 0 Policy No. 92 W40493 7 CMP-4786.1 Page 1 of 2 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CMP-4786.1 ADDITIONAL INSURED — OWNERS, LESSEES, OR CONTRACTORS (Scheduled) This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number: 92 W40493 7 Named Insured: VENTURA BUSINESS SYSTEMS INC Name And Address Of Additional Insured Person Or Organization: THE CITY OF SANTA ANA ITS OFFICERS AGENTS & EMPLOYEES 20 CIVIC CENTER PLZ SANTA ANA CA 92701 4058 1. SECTION II — WHO IS AN INSURED of b. If coverage provided to the additional in - SECTION II — LIABILITY is amended to in- sured is required by a contract or agree- clude, as an additional insured, any person or ment, the insurance provided to the organization shown in the Schedule, but only additional insured will not be broader than with respect to liability for "bodily injury", "property "personal that which you are required by the contract damage", or and advertis- or agreement to provide for such addition- ing injury caused, in whole or in part, by: al insured; and a. Ongoing Operations c. If the contract or agreement between you (1) Your acts or omissions; or and the additional insured is governed by (2) The acts or omissions of those acting California Civil Code Section 2782 or on your behalf; 2782.05, the insurance provided to the additional insured is the lesser of that in the performance of your ongoing opera- which: tions for that additional insured; or (1) Is allowed for the satisfaction of a de- b. Products — Completed Operations fense or indemnity obligation by Cali - "Your work" performed for that additional fornia Civil Code Section 2782 or insured and included in the "products- 2782.05 for your sole liability; or completed operations hazard". (2) You are required by contract or However, Paragraph 1. above is subject to the agreement to provide for such addi- following: tional insured. a. The insurance afforded to the additional We have no duty to defend or indemnify the insured only applies to the extent permit- additional insured under this endorsement un- ted by law; til a claim or "suit" is tendered to us. ©, Copyright, State Farm Mutual Automobile Insurance Company, 2013 Includes copyrighted material of Insurance Services Office, Inc., with its permission. CONTINUED Pawn I Ph�w�rsv� Glv. RYsk NYanagernena CY'erirvl'Aticfle CMP-4786.1 Page 2 of 2 2. Any insurance provided to the additional in- sured shall only apply with respect to a claim made or a "suit" brought for damages for which you are provided coverage. 3. With respect to the insurance afforded to the additional insured, the following is added to SECTION II — LIMITS OF INSURANCE: If coverage provided to the additional insured is required by contract or agreement, the most we will pay on behalf of the additional insured will be the lesser of the amount of insurance: a. Required by the contract or agreement; or b. Available under the applicable Limits Of Insurance shown in the Declarations. This endorsement shall not increase the ap- plicable Limits Of Insurance shown in the Declarations. 4. With respect to the insurance afforded to the additional insured, the following is added to Paragraph 3. Duties In The Event Of Occur- rence, Offense, Claim Or Suit of SECTION II — GENERAL CONDITIONS: The additional insured must: a. See to it that we are notified as soon as practicable of an "occurrence" or an of- fense which may result in a claim. To the extent possible, notice should include: (1) How, when and where the "occur- rence" or offense took place; (3) The nature and location of any injury or damage arising out of the "occur- rence" or offense; b. Tender the defense and indemnity of any claim or "suit" to us and to all other insur- ers who may have insurance potentially available to the additional insured; and c. Agree to make available any other insur- ance the additional insured has for de- fense or damages for which we would provide coverage under SECTION II — LIABILITY. 5. With respect to the insurance afforded the ad- ditional insured, the following replaces SEC- TION II —LIABILITY of Paragraph 7. Other Insurance of SECTION I AND SECTION II — COMMON POLICY CONDITIONS: a. This insurance is primary to and will not seek contribution from any other insurance available to the additional insured, provided that the additional insured is a named in- sured under such other insurance. b. Regardless of any agreement between you and the additional insured, this insur- ance is excess over any other insurance whether primary, excess, contingent or on any other basis for which the additional in- sured has been added as an additional in- sured on other policies. There will be no refund of premium in the event this endorsement is cancelled. (2) The names and addresses of any in- jured persons and witnesses; and All other policy provisions apply. CMP-4786.1 1007033 148011 08-21-2014 0, Copyright, State Farm Mutual Automobile Insurance Company, 2013 Includes copyrighted material of Insurance Services Office, Inc., with its permission. REme&w & APPR avEo 8v. RYsk NYanagernena CY'erirvl'Aticfle 478 Policy No. 92 W40493 7 age oof1 9 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY CMP-4787 WAIVER OF TRANSFER OF RIGHTS OR RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number: 92 W40493 7 Named Insured: VENTURA BUSINESS SYSTEMS INC Name And Address Of Person Or Organization: THE CITY OF SANTA ANA ITS OFFICERS AGENTS & EMPLOYEES 20 CIVIC CENTER PLZ SANTA ANA CA 92701 4058 The following is added to Paragraph 10.b. of SECTION I AND SECTION II — COMMON POLICY CONDITIONS: We waive any right of recovery we may have against the person or organization shown in the Schedule because of payments we make for injury or damage arising out of: a. Your ongoing operations; or b. "Your work" done under contract with that person or organization and included in the "products - completed operations hazard". This waiver applies only to the person or organization shown in the Schedule. All other policy provisions apply. CMP-4787 1006225 137715.1 11-19-2013 ©, Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. a. REmeam & APPR ovEo 8v. RYsk NYanagernena CY'erirvl'Aticfle CITY OF SANTA ANA RISK MANAGEMENT a dCu<asaa 4 HUMAN RESOURCES Managing Risk mrtwh Osidve Change WORKERS' COMPENSATION DECLARATION Trevor Yates (Nome/Title) following declaration: certify on behalf of hereby affirm under penalty of perjury, the Ventura Business Systems, Inc (Consultant/Company Nome) of my contract for 1 Year that during the term services with the City of Santa Ana, (Type of service provided) 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: 4/7/2022 Print Name: Trevor Yates Print Title: President Sign ature: r� Telephone: 805-501-8�515 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. I:�Risk Mgmt�lnsurance Requirements�WC Declaration 08152019 & wR 8,r. RYsk NYanagernena CY'erirvl'Aticfle Ventura Business Systems, Inc 2582 Fig Street Simi Valley CA (805) 583-3299 Fax (719) 470-2122 Trevor Yates 2582 Fig Street Simi Valley, CA 93063 tyates@vbsl.com (805)501-8515 4/7/2022 City of Santa Ana Risk Management Division, 41h floor 20 Civic Center Plaza Santa Ana, CA 92702 Re: Professional Liability Insurance Requirement. Dear City of Santa Ana Risk Management Division: I, Trevor Yates, Ventura Business Systems, Inc, am not a licensed professional and will not employ a licensed professional during my course of my contract with the City of Santa Ana, CA. Sincerely, 'Trevor Yates President Rooe&w & APPRavm 8,. '76,t boo RYsk NYanagernena CY'erirvl'Aticfle NOTICE OF COMPLIANCE CITY . "A ,AM I1111RI T I'III I IPi 1111AGE ,CCp INCLUDE Ck I 111 1AGREEMENTTOT111IE CLERK CSC 111I➢C COUNCIL Contractor Ventura Business Systems, Inc Name: Project N-2017-094-03 Number: Project Third Amendment To Consultant Agreement With Ventura Name: Business Systems, Inc. The Certificate of Insurance (COI) submitted indicates that the coverages are in compliance with the insurance requirements. No further action is required at this time. The compliant coverage(s) are: POLICY EXPIRATION TYPE OF INSURANCE NUMBER DATE COI DATE FILE NAME AUTOMOBILE LIABILITY 2947361D2875 10/28/2023 03/30/2023 Insurance Certificate , .............. 2023.pdf GENERAL LIABILITY 92KJX0429 01/26/2024 03/30/2023 Insurance Certificate , 2023.pdf Professional Liability PROFESSIONAL LIABILITY WAIVER 03/30/2024 04/03/2023 Insurance Release.pdf WORKERS COMPENSATION AND WAIVER 03/30/2024 04/10/2023 WC Declaration EMPLOYERS' LIABILITY Rev.2022.pdf .................... Thank you, City of Santa Ana Risk Management Division in partnership with CTrax Plus Services Team 4/20/2023 2:10 PM