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HomeMy WebLinkAboutVERIZON WIRELESS (LOS ANGELES SMSA LIMITED PARTNERSHIP) (46)DocuSign Envelope ID: 099B6D51-EC85-4799--BA3D-203BB431919B -- A-2O2O-047HH SUPPLEMENT AGREEMENT Oct 14, 2020 This Supplement ("Supplement'), is approved by Licensor this day of 20 (the date executed by all parties, referred herein as "Supplement Effective Date"). 1. Supplement. Licensee has submitted an application for approval to use a Municipal Facility pursuant to that certain Municipal Facility License Agreement between Licensor and Licensee dated August 12, 2020 ("Agreement'). Licensor has reviewed the application and grants approval subject to the terms of this Supplement. All of the terms and conditions of the Agreement are incorporated hereby by reference and made a part hereof without the necessity of repeating or attaching the Agreement. In the event of a contradiction, modification or inconsistency between the terms of the Agreement and this Supplement, the terms of this Supplement shall govern. Capitalized terms used in this Supplement shall have the same meaning described for them in the Agreement unless otherwise indicated herein. IF THE SUPPLEMENT IS NOT COUNTER- SIGNED BY LICENSEE AND RETURNED TO LICENSOR WITHIN 30 DAYS AFTER LICENSOR HAS GRANTED APPROVAL, THE SUPPLEMENT SHALL BE VOID AND OF NO LEGAL EFFECT. IF LICENSEE STILL WANTS TO USE THE MUNICIPAL FACILITY, LICENSEE WILL BE REQUIRED TO SUBMIT A NEW APPLICATION AND ASSOCIATED FEES. 2. Licensed Area Description and Location. Licensee shall have the right to use the space on the specific Municipal Facility (the "Licensed Area") depicted in Attachment I attached hereto to install Equipment as further listed in Attachment 2 attached hereto. 3. Equipment. The Equipment to be installed at the Licensed Area is described and depicted in Attachment 1. 4. Term. The term of this Supplement shall commence on the Supplement Effective Date and continue for the life of the Agreement, as described in Paragraph 2 of the Agreement. 5. License Fee/Alternate License Fee. The initial fee for this Supplement shall be as follows per year: $270.00. This fee is subject to annual increase as provided in the Agreement, and is payable in accordance with the Agreement. 6. Performance Bond. The Performance Bond [circle one] is / is no covered by existing performance bond. If not covered by existing performance bond, a bon is required pursuant to Section 8 of the Agreement. Miscellaneous. [Signature page follows] A-1 DocuSign Envelope ID: 099B6D61-EC65-4799-BA3D-203BB431919B A-2020-047HH IN WITNESS THEREOF, the parties hereto have caused this Supplement to be legally executed in duplicate, effective upon execution by both parties. Accepted: Licensor: CITY OF SANTA ANA, CA By: f,-1.�— —tom "li 0. Name: Nabil Saba Title: Executive Director Public Works Agency Date: 09/14/2020 Licensee: By: Name. 'oeC"a' Title: Sr. Manager - Real Estate Date: Oct 14, 2020 Attachments: Attachment 1 — Licensed Area (STHCST_849) Attachment 2 — Equipment List and Description A-2 DocuSign Envelope ICJ: 099B6D61-EC85-4799-BA3D-203BB431919B Attachment 1 Licensed Area [Map showing licensed area of applicable Municipal Facility and showing proposed Equipment installation.] A-3 DocuSign Envelope ID: 099B6D61-EC85-4799-BA3D-203BB4319198 N 0 m a L c Oy 0_ Q LO m U] N i cn 6 a a)Ir fr � v N a)Q N [] 0 6 N a,-0 Ir ON o \ N 0 G ►d s —i O N I t- • Q DocuSign Envelope ID' O99B6D61-EC85 4799-BA3D 203BB431919B Photo simulation of Proposed Equipment am ----- - DocuSign Envelope ID: g9986D61-EC85-4799-BA3D-203BB431919B verizon Attachment 2 Equipment List: • (1) 27' Galvanized Steel Streetlight with Faux Concrete Finish • (1) 48" Tri-Sector Antenna Shroud • (1) 12" Architectural Transition Shroud • (3) Panel Antennas mounted within the 48" Tri-Sector Antenna Shroud M r ra nc(ne m Francine R. Villareal --Villareal— Date: 2020.09.02 10:18:53 -07'00' CERTIFICATE OF LIABILITY INSURANCE °AT0`e312200220 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. 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 endomement(s). PRODUCER ADD Risk Services Northeast, Inc. New York NY Office One Liberty Plaza 165 eroadway, suite 3201 CONTACT NAME: LAIC No. at): (866) 283-7122 FAX (800) 363-0105 E-MAIL ADDRESS: New New York NY 10006 USA INBURER(S)AFFORDING COVERAGE NAICp INSURED LOS Angeles SMSA LP dba verizon wireless INSURERA: National Union Fire Ins CD of Pittsburgh 19445 INSURER B: AIU Insurance Company 19399 INSURER C: American Home Assurance Co. 19380 1095 Avenue Of the Americas New York NY 10036 USA INSURER D: New Hampshire Insurance Company 23841 INSURER E: INSURER F: 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. Limits shown are as requested INSR LTR TYPE OF INSURANCE INSD MID POLICYNUMBER MMI�DIYYYY CYEFF CYUP MMILIDIYYYY LIMITS A X COMMERCIAL GENERA -LIABILITY Y Y GL EACH OCCURRENCE $2,000,000 CLAIMS -MADE ❑X OCCUR D A ETO RE T PREMISES Ea owurtence $2,000,000 X MED UP (Any one person) $10, 000 XCU Coverage is Included PERSONALS ADV INJURY $2,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: PRO- X POLICY JECT LOG GENERALAGGREGATE $5,000,000 PRODUCTS-COMPIOPAGG $5,000,000 OTHER: A AUTOMOBILE LIABILITY CA 4594298 ADS 06/30/2020 06/30/2021 COMBINED SINGLE LIMIT accident 81, 000, 000 BODILYINJURY(Perperso,) A X ANYAUTO CA 4594299 06/30/2020 06/30/2021 A OWNED SCHEDULED AUTOS ONLY AUTOS HIRED AUTOS NON -OWNED ONLY AUTOS ONLY MA CA 45943OG VA 06/30/2020 06/30/2021 BODILY INJURY(Per a...deng PROPERTY DAMAGE Per accasio A See Next Page 06/30/2020 06/30/2021 UMBRELLALIAB OCCUR EACH OCCURRENCE EXCESS LIAR CL IMS-MADE AGGREGATE DEDI IRETENTION B G WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN PARTNER IEXECUTIVE ANY PROPRIETORIEXCLUDED? (Mandatory in H)EXCLUDEDi (MandatoryinNH) D yes, antler NIA WC045886576 ADS CC045886575 CA 06 30/2020 06/30/202006/30/2021 06/30/20211 X I PER STATUTE 1 01 ER EL. EACHACCIDENT $1,000,000 EL DISEASEEA EMPLOYEE $1, 000, 000 E.L. DISEASE -POLICY LIMIT $1, 000, 000 RIPTI N DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, AtltlKional Remarks Schedule, may be attached a more space is inquired) The above -referenced General Liability policy shall cover the tort liability of the Certificate Holder assumed under the underlying agreement between parties for which the certificate has been issued. City of Santa Ana, its council members, officers and employees are included as Additional Insured with respect to the General Liability policy. The General Liability policy shall apply as Primary and Non -Contributory Insurance to each Additional insured listed herein. where permitted by law, the Named Insured parties listed herein waive all rights against City of Santa Ana, its council members, officers and employees listed herein for recovery of damages to the extent these damages are covered by the above -referenced General Liability policy and, as further limited by written contract between the parties. CERTIFICATE HOLDER CANCELLATION d c m V 0 2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ki Risk management nt Division City Of eAnd AUTHOREED REPRESENTATIVE �� it 20 Civic Center Plaza, 4th Floor t�a>q A�16�4ysJ Santa Ana CA 92701 USA WdLMomgemalt Division 91988-2015 ACORD CO REVIEV/ED S MPRcrvBD Sr ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD ol•- fu..>;.0 Q. VJ14-d l Risk htanagencnl Analyst AGENCY CUSTOMER ID: 570000027366 LOC #: ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY NAMEDINSURED Aon Risk Services Northeast, Inc. Los Angeles SMSA LP POLICY NUMBER See Certificate Number: 570083738856 CARRIER NAIL CODE See certificate Number: 570083738856 EFFECTIVE DATE ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance INSURER(S) AFFORDING COVERAGE NAIC # INSURER INSURER INSURER INSURER ADDITIONAL POLICIES If a policy below does not include limit information, refer to the corresponding policy on the ACORD certificate form for policy limits. INSR LTR TYPE OF INSRRANCE ADDL INSD SLIBR W4'D POLICY NUMBER POLICY EFFECTIVE DATE (MMMDA'1'YY) POLICY EXPIRATION DATE (MMMDAYYV) LIMITS AUTOMOBILE LIABILITY A CA 4594301 NH - Primary 06/30/2020 06/30/2021 A CA 4594302 NH - Excess 06/30/2020 06/30/2021 WORKERS COMPENSATION g N/A wc045886579 NY 06/30/2020 06/30/2021 g N/A WC045886577 FL 06/30/2020 06/30/2021 D N/A wc045886578 MA,ND,OH,WI,WY 06/30/2020 06/30/2021 g N/A wc045886574 NJ,TX,VA 06/30/2020 06/30/2021 ACORD 101 (2008101) The ACORD name and logo are registered marks of ACORD ©2008 ACORD I Waltmoargewlclt Divist ll GReneueDspnPravv»sY: BIT VM ,J r A/NWK r.. V:L�iLIIF� ® RDk Management Analyst POLICY NUMBER: GL 172-88-90 COMMERCIAL GENERAL LIABILITY CG 20 26 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Any person or organization whom you become obligated to include as an additional insured as a result of any contract or agreement you have entered into. 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 persons) 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 your acts or omissions or the acts or omissions of those acting on your behalf: 1. In the performance of your ongoing operations; or 2. In connection with your premises owned by or rented to you. 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. Wek AWr.gc�oittxwin Reneem 6 ArPgwm Sr. �=-- Risk Mana9�nt Mrlyst CG 20 26 04 13 © Insurance Services Office, Inc., 2012 ENDORSEMENT This endorsement, effective 12:01 AM. 06/30/2020 forms a part of Policy No. GL 172-88-90 issued to VERIZON COMMUNICATIONS INC. BY NATIONAL UNION FIRE INSURANCE COMPANY OFPITTSBURGH, PA THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. LIMITED ADVICE OF CANCELLATION PROVIDED VIA E-MAIL TO ENTITIES OTHER THAN THE FIRST NAMED INSURED This policy is amended as follows: In the event that the Insurer cancels this policy for any reason other than non-payment of premium, and 1. the cancellation effective date is prior to this policy's expiration date; 2. the First Named Insured is under an existing contractual obligation to notify a certificate holder when this policy is canceled (hereinafter, the "Certificate Holder(s)") and has provided to the Insurer, either directly orthrough its broker of record, the email address of a contact at each such entity; and 3. the Insurer received this information afterthe First Named Insured receives notice of cancellation of this policy and prior to this policy's cancellation effective date, via an electronic spreadsheet that is acceptable to the Insurer, the Insurer will provide advice of cancellation (the "Advice") via e-mail to each such Certificate Holders within 30 days after the First Named Insured provides such information to the Insurer; provided, however, that if a specific numberof days is not stated above, then the Advice will be provided to such Certificate Holder(s) as soon as reasonably practicable afterthe First Named Insured provides such information to the Insurer. Proof of the Insurer emailing the Advice, using the information provided by the First Named Insured, will serve as proof that the Insurer has fully satisfied its obligations under this endorsement. This endorsement does not affect, in any way, coverage provided under this policy or the cancellation of this policy or the effective date thereof, nor shall this endorsement invest any rights in any entity not insured under this policy. The following Definitions apply to this endorsement: 1. First Named Insured means the Named Insured shown on the Declarations Page of this policy. 2. Insurer means the insurance company shown in the header on the Declarations page of this policy. All other terms, conditions and exclusions shall remain the same. 107414 (03/11) Aut orized epresentative or Countersignature (in States Where Applicable) Rink Marug"Wd Dhafm REVIEWED 6 APPROVED Br. d �r �, ® Ruk Mnnagenwnt Malys ENDORSEMENT # This endorsement, effective 12:01 A.M. 6/30/2020 forms a part of Policy No. CA 459-42-98 issued to VERIZON COMMUNICATIONS INC. By NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. LIMITED ADVICE OF CANCELLATION PROVIDED VIA E-MAIL TO ENTITIES OTHER THAN THE FIRST NAMED INSURED This policy is amended as follows: In the event that the Insurer cancels this policy for any reason other than non-payment of premium, and 1. the cancellation effective date is prior to this policy's expiration date; 2. the First Named Insured is under an existing contractual obligation to notify a certificate holder when this policy is canceled (hereinafter, the "Certificate Holder(s)") and has provided to the Insurer, either directly or through its broker of record, the email address of a contact at each such entity; and 3. the Insurer received this information after the First Named Insured receives notice of cancellation of this policy and prior to this policy's cancellation effective date, via an electronic spreadsheet that is acceptable to the Insurer, the Insurer will provide advice of cancellation (the "Advice") via e-mail to each such Certificate Holders within 30 days after the First Named Insured provides such information to the Insurer; provided, however, that if a specific number of days is not stated above, then the Advice will be provided to such Certificate Holder(s) as soon as reasonably practicable after the First Named Insured provides such information to the Insurer. Proof of the Insurer emailing the Advice, using the information provided by the First Named Insured, will serve as proof that the Insurer has fully satisfied its obligations under this endorsement. This endorsement does not affect, in any way, coverage provided under this policy or the cancellation of this policy or the effective date thereof, nor shall this endorsement invest any rights in any entity not insured under this policy. The following Definitions apply to this endorsement: 1. First Named Insured means the Named Insured shown on the Declarations Page of this policy. 2. Insurer means the insurance company shown in the header on the Declarations page of this policy. All other terms, conditions and exclusions shall remain the same. Authorized R 107414 (03/11) tmeog"Ra M-Wan t. a _-AEWED 6 Arrltw®ar. ftk Mmage tAnalyst THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. It 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 12:01 AM 06/30/2020 forms a part of Policy No. WC 0458-86-576 Issued to VERIZON COMMUNICATIONS INC- By NEW HAMPSHIRE INSURANCE COMPANY LIMITED ADVICE OF CANCELLATION PROVIDED VIA E-MAIL TO ENTITIES OTHER THAN THE NAMED INSURED (WORKERS' COMPENSATION ONLY) This policy is amended as follows: In the event that the Insurer cancels this policy for any reason other than non-payment of premium, and 1. the cancellation effective date is prior to this policy' s expiration date; 2. the Named Insured or, if applicable, any other employers named in Item 1 of the Information Page is under an existing contractual obligation to notify a certificate holder when this policy is canceled (hereinafter, the " Certificate Holder(s)" ) and the Named Insured has provided to the Insurer, either directly or through its broker of record, the email address of a contact at each such entity; and 3. the Insurer received this information after the Named Insured receives notice of cancellation of this policy and prior to this policy's cancellation effective date, via an electronic spreadsheet that is acceptable to the Insurer, the Insurer will provide advice of cancellation (the " Advice" ) via e-mail to each such Certificate Holders within 30 days after the Named Insured provides such information to the Insurer; provided, however, that if a specific number of days is not stated above, then the Advice will be provided to such Certificate Holder(s) as soon as reasonably practicable after the Named Insured provides such information to the Insurer. Proof of the Insurer emailing the Advice, using the information provided by the First Named Insured, will serve as proof that the Insurer has fully satisfied its obligations under this endorsement. This endorsement does not affect, in any way, coverage provided under this policy or the cancellation of this policy or the effective date thereof, nor shall this endorsement invest any rights in any entity not insured under this policy. The following definitions apply to this endorsement: 1. Named Insured means the insured first named employer in Item 1 of the Information Page of this policy. 2. Insurer means the insurance company shown in the header on the Information Page of this policy. All other terms, conditions and exclusions shall remain the same. lAUTHORI ` Rentswweo 6 ArrRavm Br. P. vjtv."t WC 99 00 56�' Rak Management Maryst (Ed. 04111)