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HomeMy WebLinkAboutSTUDIOFOLIA, INC. (2)0'.M46)- (W U!1 3URANf'EONFILE l t'.'ORK MAY PROCEED .'(. UWTIL INSURANCE EXPIRES a q OFCOUNC" �r-- MAYOR "r Miguel A;:P I ' I o MAYOR PR6 EM Juan \Alleges Tr COUNCILMEMBERS N Phil Bacerra Lz.1 Nelida Mendoza David Penaloza Vicente Sarmiento Jose Solorio CITY OF SANTA ANA PARKS, RECREATION AND COMMUNITY SERVICES AGENCY 20 Civic Center Plaza • P.O. Box 1988 Santa Ana, California 92702 www.santa-ana.ora August 20, 2020 Attn: James Dinh Studiofolia, Inc. 12723 Park Street Cerritos, CA 90703 Re: Extension of Consultant Agreement No. N-2019-251 Dear Mr. Dinh: N-2019-251-01 CITY MANAGER Kristine Ridge CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL Daisy Gomez Pursuant to Section 3 of Agreement No. N-2019-251, entered into by Studiofolia, Inc. and the City of Santa Ana, the City hereby exercises its first and final one (1) year optional extension. The term of the Agreement is hereby extended for an additional one (1) year period from October 26, 2020 through October 25, 2021. 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. Please sign this extension letter below acknowledging acceptance of the extension and return the signed letter to the City. Sincerely, nn �Y --� Steven Mendoza Executive Director Community Development Agency CITY OF SANTA ANA ATTEST %I Kris ine Ridge— Daisy Gomez City Manager Jerk of the Council [Signatures continue on the next page] SANTA ANA CITY COUNCIL Miguel A. Pulido Juan Villages Vicente Samiiento Dadd Penaloni Jose 3olorio Phil eacema Mayor Mayor Pro Tom, Ward 5 Wom 1 Ward 2 Wad 3 Wad 4 mrauldonsenta-and.om Iyi11enas(dlsanla2na..gysa mnmtorMsanta-ana om drum.longilsantaana.oro jsolodo*sanla-ana.om obacerra(cilSanta-ana oro Wide Mardi.. Wad 6 nmendoza0santa- ana.ora #42312vl N-2019-251-01 APPROVED D� AS TO FORM STUDIOFOLIA, INC. 7 Jose Montoya James inh Deputy City Attorney Own SANTA ANA CITY COUNCIL Mquel A Punoo Juan Viltogas V¢ante Samnento Oaw Panaloza Jese SOlnno Nlaym Mavv Pro Tarr, Ward 5 Ward I Ward 2 Ward 3 n'oulitlerNsarta-ana. urn rvJleaasmsanta-arm or vsarmrenfcwvsanl:Nana are tluensl,05anla do. or selonoralsanla-ena.mo 442312Vi Phil 9acean Neirda Mentic Waal Ward o6azeaa�sanm-ana oro nm nmzaOsa ana ara Francine K. Francine RyVillareal ^ Villareal Date: 2020.09.17 / . ® 11:28:40-07'00' ACORO _ DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 11/22/2019 THIS CERTIFICATE IS ISSUED AS MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND ORALTER THE COVERAGE AFFORDED BYTHE POLICIES BELOW. THIS CERTIFICATEOF INSURANCE DOES NOTCONSTTFUTEA CONTRACT BETWEEN THE ISSUING INSURERS). AUTHORIZED REPRESENTATIVE OR PRODUCER, ANDTHE CERTIFICATE HOLDER. IMPORTANT:Ifthecerif Wholderican ADDITIONALINSURED,thepolicy(im)musthweADDTIIONALINSUREDpmvlsionsorbeendorsed.lf SUBROGATIONISWAIVED,wbje W0etermsaod conditions of the pollq,certain polides may requirean endorsemem.Astatementon this cer6Rc stedoesnotconfer nightsto thecertificateholder in lieu ofwcherWamement(s). PRODUCER CONTACT NAME: Kathy Lamm(975534H) PHONE FAx 2915 Red Hill Ave She F201 (A/c, NO, EXh: 86& 416-8939 (A/C, NO) : 866-416-8939 E-MAIL Costa Mesa CA 92626-3428 ADDRESS: klamm@farmemagenl.com INSURER(S)AFFORDINGCOVERAGE NAIC4 INSURED STUDIOFOLIA 12723 PARK ST CERRITOS CA 90703 INSURERA: Truck Insurance Exchange 21709 INSURERB: Farmers Insurance Exchange 21652 INSURER C: Mid Century Insurance Company 21687 INSURER D: _ INSURER E: ------ INSURERF: COVERAGES CERTIFICATE NUMBER REVISION NUMBER: THIS Is TO CERTIFY THATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEABOVE FORTHE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OFANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH MIS CERTIFICATEMAY BE ISSUED OR MAY PERTAIN, THE INSURANCEAFFORDED BYTHE POLICIES DESCRIBED HEREIN ISSUBJECT TOALL THETERMS, EXCLUSIONS AND CONDITIONS OF SUCH POUCIES-UMITSSHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 1NSR TYPEOFINSURANCE ADDTL SUER POUCVNUMBER INS, WVD POLICY ENE POUCY EXP (MM/DD/YYYY) (MM/DD/YYYY) LIMITSVTR COMMERCUILGENERALIIABiUfV EACHOCCURRENCE $ 1,000,00 $ ]5,00 CWMSMADE LJ� OCCUR J DAMAGE TO RENTED PREMISES LEA Occurrence) $ 500 MEDEXP(Anyom Person) $ 1,000,00 q Y Y 605513299 02/01/2020 02/01/2021 PERSONALBAOV INJURY E ZOOO OO GEN'L AGGREGATE LIMIT APPLI ES PER: GENERALAGGREGATE X' POLICY PROJECT LOC J PRODUCTS.COMP/OP AGG $ 1,000,00 $...-. OTHER: AUTOMOBILELMBILnY COMBINED SINGLE LIMIT (Ea Acddent) $ 1,000,00 ANY AUTO i BODILY INJURY (Per person) $ A OWNEDAUTOS-i SCHEDULED ONLY ; i autos 605513299 BODILY INJURY (PeraccidenH 02l01/2020 02/01/2021 _ $ HIREDAUTOS X NON -OWNED ONLY AUTOSONLY PROPERTY DAMAGE (Per w6dem) $ $ I UMBRELLA UAB . OCCUR EACH OCCURRENCE $ $ EXCESS UAB CLAIMS -MADE AGGREGATE DIEDRETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS' UABIUTY _ PER T OTHER '�$ STATUTE E.L. EACH ACCIDENT ANY PROPRIETOR/PARTNER/ Y/N EXECUTIVE OFFICER/MEMBER N/A EXCLUDED7(Mandatoryin NH) L~ E.L. DSEASE-EA EMPLOYEE E.V. DISEASE -POLICY LIMR 4 lfyes, describe under DESCRIPTION OF OPERATI,NSheloW - I OPERATIONS/LOCATIONS/VEHICLES (ACORD 101, Adddonal RmakSchedule, may bahacd if more.pw is reuimc1)NOFESRIO 1D2PARK ST, CERRITOS, CA 90703 I CERTIFICATE HOLDER CANCELLATION City of Santa Ana SHOULD ANY OFTHE MOVE DESCRI Risk Management Division DATE THEREOF, NOTICE WILL BE -- — 20 CIVIC Center Plaza, 4th floor — AUTNORIZEDREPRESEM Santa Ana, CA 92701 ACORD 25(2016/03) ©1988-2( 31-1769 11-15 The ACORD name and logo are registered marks of ACORD POLICY PROVISIONS •v'r �.,.\� Ntnle mafugemenx Unanum rV \� REVIVIEWED&APPROVED BY.' Z kL°Pw ® Risk Management Analyst WORKERS' COMPENSATION DECLARATION James Dinh (Nat idhitle) following declaration: hereby affirm under penalty of peijary, the that during the term of my (Organization Name) contract with the Community Development A eg ncy, 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. DATE: I certify on behalf of September 23, 2019 Studiofolia By: Name: James Dinh Title: Principal Telephone: 562-841-2512 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 TI4E COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. �e RskManagmxenfDMsian g RtviimED&pAPPR,OeV,ED BY: el®. .�pl �M�1YNFl R. VaCL�l1,::. � Iw Risk Management A aiyst studiofolia 12723 Park Street I Cerritos, CA 90703 1562.841.2512 1 james@studiofolia.com I www.studlofolia.com October 10, 2019 To Whom It May Concern: I will not be using a vehicle (any owned, rented, or non -owned automobiles) for activities related to the Willits & Sullivan Beautification Project Permanent Display. The term of my contract will be one year from the signing of the agreement. Sincerely, ` James Dinh 4 enRiskE Managem [Ul Wsion cR&pAPPROVM BYE: r4f4�/NbL . VaC(f�1Rl. ® Risk Management Analyst CITY OF SANTA ANA RisK MANAGEMENT, Gu aiaw 4 HUMAN RESOURCES N°I.ma(png Rl%1, . Po>am. Change ADDITIONAL INSURED ENDORESEMENT Insurance Company: This endorsement modifies such insurance as is afforded by the provisions of Policy# (cG�j`) relating to the following -5A udiC;.bO� i Ct` 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 LJ & /�2C /'/ , this endorsement form as a part of Policy# ie0 �s 17-�,7 `?rl Issued to (Named Insured) Countersigned �Au�rized epresentative RmleMarwganodD( l: I Risk Mgmtllnsurance RequirementsiAdditional Insured Endorsement 08152019 REVIEVIm m BY: 5 APPROVED BY: Risk Management Analyst