HomeMy WebLinkAboutEAST END REALTY PARTNERSHIP, LP. AND WURSTHAUS, INC. (2)City of Santa is
Clerk of the Council S�
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amendments (if any) are no longer in effect.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.
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.
The agreement with
A-2020-213
No. was completed on
(List all amendments. Use space below if needed.)
i.lagreementslformeform - agreement termination form_goldenrod.doc
COTC Office Use Only
OF THE COUNCIL
28'23 PM-4:33
t ( t30 2\ and final payment has been made.
Department: F—C'C h
Phone/Ext.: LPIG
Signature:
Date: I �—
01
C0 >URANCE NOT ON FILE A-2020-213
*OA VORK MAY NOT PROCEED
CLERK OF COUNCIL
DATE: SECOND AMENDMENT TO TEMPORARY
P IZ (NA �1)(Yl Ivi 0. Cie vc+L) l OUTDOOR DINING LICENSE AGREEMENT
This SECOND AMENDMENT TO TEMPORARY OUTDOOR DINING LICENSE
AGREEMENT ("Second Amendment to License Agreement") is entered into this 17th day of _
November , 2020, by and between the City of Santa Ana, a charter city and municipal
corporation duly organized and existing under the Constitution and laws of the State of California
("City"), East End Realty Partnership, LP, and Wursthaus, Inc. (collectively "Licensee").
RECITALS
A. On May 7, 2019, the City and Licensee entered into the Temporary Outdoor Dining
License Agreement No. A-2019-063 ("License Agreement") to allow temporary
outdoor dining activities within a portion of Plaza Calle Cuatro ("Plaza"), adjacent
to real property located at 301-305 East Fourth Street, Suite 106, Santa Ana.
B. On November 30, 2019, the City and Licensee entered into a First Amendment to
Temporary Outdoor Dining License Agreement No. A-2019-200 to extend the term
of said License Agreement, increase the amount of the License Fee to cover the
extended term, and clarify the type of fencing that may be installed on the Licensed
Property.
C. In accordance with the terms and conditions of said License Agreement, the parties
desire to: amend said License Agreement to extend the term of said License
Agreement for an additional one year, subject to the payment of an additional
License Fee by Licensee; increase the amount of the License Fee to cover the
extended term; and, allow a five (5) foot extension of the outdoor patio to align with
the restaurant's front door.
NOW THEREFORE, in consideration of the mutual and respective promises, and subject to
the terms and conditions of said License Agreement, except as herein modified, the parties agree as
follows:
1. Section 1, Term and Purpose of License, shall be amended to extend the term of
the License Agreement from November 30, 2020, until November 30, 2021.
2. Section 1, Terms and Purpose of License, shall also be amended to increase the
size of the Licensed Premises by extending the outdoor patio by an additional five
(5) feet to the south to align with the restaurant's front door, thus increasing the
size of the Licensed Premises, as depicted in Exhibit 1 attached hereto and
incorporated herein by reference.
3. Section 2, Licensed Premises and Use, subsection (a), shall be amended to
reference Exhibit 1 attached hereto to depict the expanded Licensed Premises
under said License Agreement.
1
A-2020-213
4. Section 3, License Fee, shall be amended to reflect that, upon execution of this
First Amendment to License Agreement, Licensee shall pay to the City a one-time
non-refundable fee of Two -Thousand and Twenty -Eight dollars ($2,028) to cover
this second extended term of the License.
Except as hereinabove modified, the terms and conditions of said License
Agreement remain unchanged and in full force and effect.
IN WITNESS WHEREOF, the parties hereto have executed this Second Amendment to License
Agreement the date and year first above written.
ATTEST:
DAIW GOME
Clerk of the Codneil
APPROVED AS TO FORM:
SONIA R. CARVALHO
City Attorney
Ryap1'0. dge
Asst'8tant ity Attorney
RECOMMENDED FOR APPROVAL:
Q
MINH THAI
Executive Director
Planning and Building Agency
CITY OF SANTA ANA
KRISTINE RIDGE
CityManager
EAST END REALTY PARTNERSHIP, LP
Ryan Chase
WURSTHAUS, INC.
Signature on following page
Gabriel Ruiz
4. Section 3, License Fee, shall be amended to reflect that, upon execution of this
First Amendment to License Agreement, Licensee shall pay to the City a one-time
non-refundable fee of Two -Thousand and Twenty -Eight dollars ($2,028) to cover
this second extended term of the License.
5. Except as hereinabove modified, the terms and conditions of said License
Agreement remain unchanged and in full force and effect.
IN WITNESS WHEREOF, the parties hereto have executed this Second Amendment to License
Agreement the date and year first above written.
Signature on previous page
DAISY GOMEZ
Clerk of the Council
APPROVED AS TO FORM:
SONIA R. CARVALHO
City Attorney
/X�V'
R . dge
Assn nt 'ity Attorney
RECOMMENDED FOR APPROVAL:
Signature on previous page
MINH THAI
Executive Director
Planning and Building Agency
CITY OF SANTA ANA
Signature on previous page
ERISTINE RIDGE
City Manager
EAST END REALTY PARTNERSHIP, LP
Signature on previous page
Ryan Chase
WURSTHAUS, INC.
Gabriel Ruiar
EXHIBIT 1
EXPANDED LICENSED PREVHSES
Exhibit 1
Expanded Licensed Premises
Temporary Outdoor Dining Site Plan
at Plaza Calle Cuatro for
Wursthaus Restaurant
S
i
d
Plaza Calle Cuatro
e
Performing
w
Wursthaus
Stage
a
Restuarant
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p
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LL
S' MORE
idewalk
4th Street
\\[;Apprmed Outdoor Dining
�iftnal V requested
Francine R. ,,9,bdbyra1a—a
Villareal
ACORO® CERTIFICATE OF LIABILITY INSURANCE
DATE (MMI°D YVYY)
11 /20/2020
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.
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
Risk Stratagles Company
CONTACT
NAME: Risk Strategies Company
2040 Main Street, Suite 450
Irvine, CA 92614
PHONE
NNo Est: 949-242-9240 AIL No:
E-MAIL
ADDRESS: s oun risk -strata ies.com
INSURER($) AFFORDING COVERAGE
NAICM
INSURERA: Sompo America Insurance Company
11126
wwwAsk-strategies.com CA DOI License No. OF06675
INSURED
East End Real Partners LP
129 W. Wilson V Ste 100
INSURER B: Fireman's Fund Insurance Company
21873
INSURER C: Oak River Insurance Company
34630
INSURER D:
Costa Mesa CA 92627
INSURER E
INSURER F
COVERAGES CERTIFICATE NUMBER: 9R7nsRa1 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
OF INSURANCE
ADDLSUBRTYPE
INSD
W/D
POLICYNUMBER
EFF
MMIDDPOLICYYYYY
MMIDDPOLICY EXP
YYYY
LIMITS
A
�/
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE OCCUR
✓
CPLS1033HO
3/1/2020
3/1/2021
EACH OCCURRENCE
$1,000,000
-DAMAGE TO —RENTED
PREMISES Ea occurrence)
$1,000,000
MED EXP (Any one person)
$10,000
PERSONAL&ADV INJURY
$1,000,000
GEN'L
AGGREGATE LIMIT APPLIES PER:
POLICYjEa ✓ LOC
OTHER:
GENERAL AGGREGATE
$2,000,000
PRODUCTS-COMP/OP AGO
$2,000,000
$
A
AUTOMOBILE
LIABILITY
ANY AUTO
OWNED
AUTO$ONLY AUTOSULED
HIRED NON -OWNED
AUTO$ ONLY ✓ AUTO$ ONLY
ACVS1325ZO
3/1/2020
3/1/2021
ECOINED [SINGLE LIMIT
$1,000,000
✓
BODI LV I NJURY(Per person)
$
✓
BODILY INJURY (Per accident)$
✓
PROPERTYDAMAGE
Per accident
$
$
B
✓
UMBRELLA LIAB
EXCESS LIAB
✓
OCCUR
CLAIMS -MADE
USLOO5062201
3/1/2020
3/1/2021
EACH OCCURRENCE
$25,000,000
AGGREGATE
$25,000,000
DED RETENTION$0
$
C
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
OFFIC RANYPROPMEMBEREXCLU ED9 ECUTIVE ]
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
N/A
EAWC113725
2/1/2020
2/1/2021
�/ STATUTE ERH
E.L. EACH ACCIDENT
$1,000,000
E.L. DISEASE - EA EMPLOYEE
$1 0
E.L. DISEASE -POLICY LIMIT
$1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required)
Re: Outdoor Dining License Agreement, Adjacent to 301-305 E. 4th St., Ste 106, City of Santa Ana, CA.
City of Santa Ana, its officers, employees, agents and representatives are Additional Insureds with respect to General Liability and Auto Liability
perthe attached endorsements or as required by written contract. Insurance is Primary and Non -Contributory.
- 30 Days' Notice of Cancellation with 10 Days' Notice for Non -Payment of Premium in accordance with the policy provisions.
HOLDER
City of Santa Ana
Risk Management Division, 4th Floor
20 Civic Center Plaza
Santa Ana CA 92701
ACORD 25 (2016/03)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATNE
a
Michael Christian '
The ACORD name and logo are registered marks of ACORD
RISI2il itraganeddDiutsi°n
ram.
REVIEWED &{{A0PPRcyvED By.,
rgsi-Hr�e VsRRE/t¢afl.
® Risk Management Analyst
58705631 1 20-21 WC, 20-21 GL-AL-UL I Stacy Eickhoff 1 11/20/2020 8:21:55 AM (PST) I Page 1 of 12
POLICY NO.: CPLS1033HO
COMMERCIAL GENERAL LIABILITY
CG 82 24 05 12
PREMIER GENERAL LIABILITY COVERAGE
EXTENSION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE FORM
A. REASONABLE FORCE g. Aircraft, Auto Or Watercraft
Paragraph 2.a. Expected or Intended Injury
under COVERAGE A BODILY INJURY AND
PROPERTY DAMAGE LIABILITY of SECTION I
— COVERAGES within the COMMERCIAL
GENERAL LIABILITY COVERAGE FORM is
replaced by:
a. Expected or Intended Injury
"Bodily injury" or "property damage" expected
or intended from the standpoint of the in-
sured. This exclusion does not apply to "bod-
ily injury" or "property damage" resulting from
the use of reasonable force to protect any
person or property.
B. CONTRACTUAL LIABILITY
Paragraph 2.b. Contractual Liability under
COVERAGE A. BODILY INJURY AND PROP-
ERTY DAMAGE LIABILITY of SECTION I —
COVERAGES within the COMMERCIAL GEN-
ERAL LIABILITY COVERAGE FORM is replaced
by:
b. Contractual Liability
"Bodily injury" or "property damage" for which
the insured is obligated to pay damages by
reason of the assumption of liability in a con-
tract or agreement. This exclusion does not
apply to liability for damages:
(1) That the insured would have had in the
absence of the contract or agreement; or
(2) Assumed in a contract or agreement that
is an "insured contract', provided the "bo-
dily injury" or "property damage" occurs
subsequent to the execution of the con-
tract or agreement.
C. NON OWNED WATERCRAFT
Paragraph 2.g.(2) in the Aircraft, Auto Or Wa-
tercraft exclusion under COVERAGE A. BODILY
INJURY AND PROPERTY DAMAGE LIABILITY
of SECTION I — COVERAGES within the COM-
MERCIAL GENERAL LIABILITY COVERAGE
FORM is replaced by:
(2) A watercraft you do not own that is:
(a) less than 75 feet long; and
(b) Not being used to carry persons or
property for a charge.
D. ELECTRONIC DATA LIABILITY
1. Paragraph 2.p. Electronic Data under COV-
ERAGE A. BODILY INJURY AND PROPERTY
DAMAGE LIABILITY of SECTION I — COV-
ERAGES within the COMMERCIAL GENERAL
LIABILITY COVERAGE FORM is replaced by:
p. Electronic Data
Damages arising out of the loss of, loss of
use of, damage to, corruption of, inability
to access, or inability to manipulate "elec-
tronic data" that does not result from
physical injury to tangible property.
However, this exclusion does not apply to
liability for damages because of "bodily
injury".
2. The following definition is added to SEC-
TION V — DEFINITIONS:
"Electronic data" means information, facts or
programs stored as or on, created or used on,
or transmitted to or from computer software,
hard or floppy disks, CD-ROMS, tapes,
drives, cells, data processing devices or any
other media which are used with electronically
controlled equipment.
3. For purposes of the coverage provided for
"Electronic Data", Paragraph 17. in SEC-
TION V — DEFINITIONS is replaced by:
17. "Property damage" means
a. Physical injury to tangible property,
including all resulting loss of use of
that property. All such loss of use
shall be deemed to occur at the time
of the physical injury that caused it; or
Includes copyrighted material of Insurance Services Office, Inc.,
CG 82 24 05 12 with its permission.
Rime Management DMsian
REVIEWED&APPROVED BY:
® Risk Management Analyst
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b. Loss of use of tangible property that
is not physically injured. All such loss
of use shall be deemed to occur at
the time of the "occurrence" that
caused it; or
c. Loss of, loss of use of, damage to,
corruption of, inability to access, or
inability to properly manipulate "elec-
tronic data", resulting from physical
injury to tangible property. All such
loss of "electronic data" shall be
deemed to occur at the time of the
"occurrence" that caused it.
For purposes of this insurance, "elec-
tronic data" is not tangible property.
E. DAMAGE TO PREMISES RENTED TO YOU
1. The last paragraph after the listed exclusions
under COVERAGE A. BODILY INJURY AND
PROPERTY DAMAGE LIABILITY of SEC-
TION I — COVERAGES within the COM-
MERCIAL GENERAL LIABILITY COVER-
AGE FORM is replaced by:
Exclusions c. through n. do not apply to
"property damage" by fire; smoke from a
"hostile fire"; explosion; lightning; smoke re-
sulting from such explosion or lightning; colli-
sion by "mobile equipment" or leakage from
fire protection systems to premises while
rented to you or temporarily occupied by you
with permission of the owner. A separate limit
of insurance applies to this coverage as de-
scribed in SECTION III — LIMITS OF IN-
SURANCE.
2. Paragraph 6. of SECTION III — LIMITS OF
INSURANCE within the COMMERCIAL
GENERAL LIABLITY COVERAGE FORM is
replaced by:
6. Subject to Paragraph 5. above, the Dam-
age To Premises Rented To You Limit is
the most we will pay in any one event un-
der COVERAGE A. BODILY INJURY
AND PROPERTY DAMAGE for damages
because of "property damage" from fire;
smoke from a "hostile fire"; explosion;
lightning; smoke resulting from such ex-
plosion or lightning; collision by "mobile
equipment" or leakage from fire protection
systems to premises while rented to you
or temporarily occupied by you with per-
mission of the owner.
F. MEDICAL PAYMENTS
1. Paragraph 1.a. under COVERAGE
C. MEDICAL PAYMENTS of SECTION I —
COVERAGES within the COMMERCIAL
GENERAL LIABILITY COVERAGE FORM is
replaced by:
Includes copyrighted material of Insurance Services Office, Inc.,
Page 2 of 6 with its permission.
1. Insuring Agreement
a. We will pay medical expenses as de-
scribed below for "bodily injury"
caused by an accident:
(1) On premises you own or rent;
(2) On ways next to premises you
own or rent; or
(3) Because of your operations:
Provided that:
(a) The accident takes place in
the "coverage territory" and
during the policy period;
(b) The expenses are incurred
and reported to us within
three years of the date of the
accident; and
(c) The injured person submits to
examination, at our expense,
by physicians of our choice
as often as we reasonable
require.
G. SUPPLEMENTARY PAYMENTS
SUPPLEMENTARY PAYMENTS — COVER-
AGES A AND B of SECTION I COVERAGES
within the COMMERCIAL GENERAL LIABILITY
COVERAGE FORM is replaced by:
1. We will pay, with respect to any claim we
investigate or settle, or any "suit" against an
insured we defend:
a. All expenses we incur.
b. Up to $5,000 for cost of bail bonds re-
quired because of accidents or traffic law
violations arising out of the use of any
vehicle to which the Bodily Injury Liability
Coverage applies. We do not have to fur-
nish these bonds.
c. The cost of bonds to release attach-
ments, but only for bond amounts within
the applicable limit of insurance. We do
have to furnish these bonds.
d. All reasonable expenses incurred by the
insured at our request to assist us in the
investigation or defense of the claim or
"suit", including actual loss of earnings up
to $500 a day because of time off from
work.
e. All costs taxed against the "insured" in
any "suit".
f. Prejudgment interest awarded against the
insured on that part of the judgment we
pay. If we make an offer to pay the appli-
cable limit of insurance, we will not pay
any prejudgment interest based on that
period of time afta
Rime Management DMsian
REVIEWED&APPROVED BY:
Risk Management Analyst
58705631 120-21 NC, 20-21 GL-AL-UL I Stacy Eickhoff 111/20/2020 8:21:55 AM (PST) I Page 3 of 12
g. All interest on the full amount of any
judgment that accrues after entry of the
judgment and before we have paid, of-
fered to pay, or deposited in court the part
of the judgment that is within the applica-
ble limit of insurance.
These payments will not reduce the limits of
insurance.
2. If we defend an insured against a "suit" and an
indemnitee of the insured is also named as a
party to the "suit", we will defend that indem-
nitee if all of the following conditions are met:
a. The "suit" against the indemnitee seeks
damages for which the insured has as-
sumed the liability of the indemnitee in a
contract or agreement that is an "insured
contract";
b. This insurance applies to such liability as-
sumed by the insured;
c. The obligation to defend, or the cost of
the defense of, that indemnitee, has also
been assumed by the insured in the same
"insured contract";
d. The allegations in the "suit" and the in-
formation we know about the "occur-
rence" are such that no conflict appears
to exist between the interests of the in-
sured and the interests of the indemnitee;
e. The indemnitee and the insured ask us to
conduct and control the defense of that in-
demnitee against such "suit" and agree that
we can assign the same counsel to defend
the insured and the indemnitee; and
f. The indemnitee:
(1) Agrees in writing to:
(a) Cooperate with us in the investi-
gation, settlement or defense of
the "suit";
(b) Immediately send us copies of
any demands, notices, sum-
monses or legal papers received
in connection with the "suit":
(c) Notify any other insurer whose
coverage is available to the in-
demnitee; and
(d) Cooperate with us with respect
to coordinating other applicable
insurance available to the in-
demnitee; and
(2) Provides us with written authoriza-
tion to:
(a) Obtain records and other infor-
mation related to the "suit"; and
(b) Conduct and control the defense
of the indemnitee in such "suit"
Our obligation to defend an insured's in-
demnitee and to pay for attorneys' fees
and necessary litigation expenses as
Supplementary Payments ends when we
have used up the applicable limit of in-
surance in the payment of judgments or
settlements or the conditions set forth
above, or the terms of the agreement de-
scribed in Paragraph f. above, are no
longer met.
H. FELLOW EMPLOYEE COVERAGE —
SUPERVISOR OR HIGHER
Paragraph 2.a.(1) of SECTION II — WHO IS AN
INSURED within the COMMERCIAL GENERAL
LIABILITY COVERAGE FORM does not apply to
the following:
Your supervisory or management "employees" for
"bodily injury" only.
Damages owed to an injured co -"employee" or
"volunteer worker" will be reduced by any amount
paid or available to the injured co -"employee" or
"volunteer worker" under any other valid and
collectible insurance.
NEWLY ACQUIRED ORGANIZATIONS
Paragraph 3.a. of SECTION II — WHO IS AN
INSURED within the COMMERCIAL GENERAL
LIABILITY COVERAGE FORM is replaced by:
a. Coverage under this provision is afforded only
until the end of the current policy period.
4t1-3:iHs1177e7:1 it,I I /shtil :I III I LI 6111:1:1 �7
The following is added to SECTION II — WHO IS
AN INSURED within the COMMERCIAL GEN-
ERAL LIABILITY COVERAGE FORM:
Throughout this policy the words "you" and "your"
refer to any corporation or other business organi-
zation, other than a joint venture, in which the first
Named Insured has or acquires during the policy
period an ownership interest of more than 50%
and is subject to the management control of the
first Named Insured or its subsidiaries, and which
is domiciled within the United States of America
or its territories or possessions.
K. AMENDMENT OF AGGREGATE LIMIT OF
INSURANCE
The General Aggregate Limit Of Insurance refer-
enced in Paragraph 2. of SECTION III — LIMITS
OF INSURANCE within the COMMERCIAL
GENERAL LIABILITY COVERAGE FORM
applies separately to:
1. Each of your "locations" owned by or rented
to you; and
Includes copyrighted material of Insurance Services Office, Inc.,
CG 82 24 05 12 with its permission.
Rime Management DMsion
REVIEWED&APPROVED BY:
!® ® Risk Management Analyst
58705631 120-21 NC, 20-21 GL-AL-UL I Stacy Eickhoff 111/20/2020 8:21:55 AM (PST) I Page 4 of 12
2. Each of your projects away from premises (iii) That is insurance to cover your
owned by or rented to you. liability as a tenant for "prop -
"Location" means premises involving the same or erty damage" to premises
connecting lots, or premises whose connection is while rented to you or tempo -
interrupted only by a street, roadway, waterway or rarily occupied by you with
right-of-way of a railroad. permission of the owner; or
L. KNOWLEDGE OF OCCURRENCE
The following is added to Paragraph 2. Duties In
The Event Of Occurrence, Offense, Claim Or
Suit of SECTION IV — COMMERCIAL GENERAL
LIABILITY CONDITIONS within the COMMERCIAL
GENERAL LIABILITY COVERAGE FORM:
Knowledge of an "occurrence", offense, claim or
"suit" by your agent, servant or "employee" shall
not be considered knowledge by you unless you,
your insurance manager or any other person you
designate has received notice of the "occur-
rence", offense, claim or "suit" from your agent,
servant, or "employee."
I� f:iy�.l �:il� f.111ET_Pte3
Paragraph 4.b.(1)(a) in the Other Insurance
condition of SECTION IV — COMMERCIAL
GENERAL LIABILITY CONDITIONS within the
COMMERCIAL GENERAL LIABILITY COVER-
AGE FORM is replaced by:
4. Other Insurance
b. Excess Insurance
(1) This insurance is excess over
(a) any of the other insurance,
whether primary, excess, contin-
gent or on any other basis:
(i) That is Fire, Extended Cov-
erage, Builders Risk; Installa-
tion Risk or similar coverage
for "your work";
(ii) That is insurance covering
Fire; smoke from a "hostile
fire"; explosion; lightning;
smoke resulting from such
explosion or lightning; colli-
sion by "mobile equipment"
or leakage from fire protec-
tion systems for premises
while rented to you or tempo-
rarily occupied by you with
permission of the owner; or
(iv) If the loss arises out of the
maintenance or use of aircraft,
"autos", or watercraft to the
extent not subject to Para-
graph 2.g. Aircraft, Auto Or
Watercraft under COVER-
AGE A. BODILY INJURY
AND PROPERTY DAMAGE
LIABILITY of SECTION I —
COVERAGES within the
COMMERCIAL GENERAL
LIABILITY COVERAGE
FORM.
N. UNINTENTIONAL FAILURE TO DISCLOSE
HAZARDS
The following is added to Paragraph
6. Representations of SECTION IV — COM-
MERCIAL GENERAL LIABILITY CONDITIONS
within the COMMERCIAL GENERAL LIABILITY
COVERAGE FORM:
Any unintentional failure to disclose all exposures
or hazards existing as of the effective date of the
Commercial General Liability Coverage Form or
at any time during the policy period will not invali-
date or adversely affect the coverage for such
exposure or hazard. However, you must report
the undisclosed exposure or hazard to us as soon
as reasonably possible after the exposure or
hazard is discovered.
O. WAIVER OF SUBROGATION
The following is added to Paragraph 6. Transfer Of
Rights Of Recovery Against Others To Us of
SECTION IV — COMMERCIAL GENERAL
LIABILITY CONDITIONS within the COMMER-
CIAL GENERAL LIABILITY COVERAGE FORM:
This condition does not apply to any person or
organization to which you waived this condition by
written contract or agreement, but only to the
extent that subrogation is waived prior to the
"bodily injury" or "property damage" under a
contract with that person or organization.
P. LIMITED WORLDWIDE LIABILITY COVERAGE
The following is added to SECTION IV — CON-
DITIONS within the COMMERCIAL GENERAL
LIABILITY COVERAGE FORM:
Includes copyrighted material of Insurance Services Office, Inc.,
Page 4 of 6 with its permission.
Rime Management Diaisian
REVIEWED&APPROVED BY:
'� Risk Management Analyst
58705631 120-21 NC, 20-21 GL-AL-UL I Stacy Eickhoff 111/20/2020 8:21:55 AM (PST) I Page 5 of 12
Expanded Coverage Territory
1. If a "suit" is brought in a part of the "coverage
territory" that is outside the United States of
America (including its territories and posses-
sions), Puerto Rico or Canada, and we are
prevented by law, or otherwise, from defend-
ing the insured, the insured will initiate a de-
fense of the "suit". We will reimburse the in-
sured, under Supplementary Payments, for
any reasonable and necessary expenses in-
curred for the defense of a "suit" seeking
damages to which this insurance applies, that
we would have paid had we been able to ex-
ercise our right and duty to defend.
If the insured becomes legally obligated to
pay sums because of damages to which this
insurance applies in a part of the "coverage
territory" that is outside the United States of
America (including its territories and posses-
sions), Puerto Rico or Canada, and we are
prevented by law, or otherwise, from paying
such sums on the insured's behalf, we will re-
imburse the insured for such sums.
2. All payments or reimbursements we make for
damages because of judgments or settle-
ments will be made in U.S. currency at the
prevailing exchange rate at the time the in-
sured became legally obligated to pay such
sums. All payments or reimbursements we
make for expenses under Supplementary
Payments will be made in U.S. currency at
the prevailing exchange rate at the time the
expenses were incurred.
3. Any disputes between you and us as to
whether there is coverage under this policy
must be filed in the courts of the United
States of America (including its territories and
possessions), Puerto Rico or Canada.
4. The insured must fully maintain any coverage
required by law, regulation or other governmen-
tal authority during the policy period, except for
reduction of the aggregate limits due to pay-
ments of claims, judgments or settlements.
Failure to maintain such coverage required by
law, regulation or other governmental author-
ity will not invalidate this insurance. However,
this insurance will apply as if the required
coverage by law, regulation or other govern-
mental authority was in full effect.
For purposes of this coverage only, the following
is added to Paragraph 4.b.(1)(a) under Other
Insurance of SECTION IV — COMMERCIAL
GENERAL LIABILITY CONDITIONS within the
COMMERCIAL GENERAL LIABILITY COVER-
AGE FORM:
If the insured's liability to pay damages is deter-
mined in a "suit" brought outside the United
States of America (including its territories and
possessions), Puerto Rico or Canada; or
That is coverage required by law, regulation or
other governmental authority in a part of the
"coverage territory" that is outside the United
States of America (including its territories and
possessions), Puerto Rico or Canada.
For purposes of this coverage only, Paragraph 4.
of SECTION V — DEFINITIONS within the
COMMERCIAL GENERAL LIABILITY COVER-
AGE FORM is replaced by:
4. "Coverage territory" means anywhere in the
world with the exception of any country or ju-
risdiction which is subject to trade or other
economic sanction or embargo by the United
States of America.
O. BODILY INJURY REDEFINITION
Paragraph 3. of SECTION V. — DEFINITIONS
within the COMMERCIAL GENERAL LIABILITY
COVERAGE FORM is replaced by:
3. "Bodily injury" means bodily injury, sickness
or disease sustained by a person, including
mental anguish, injury or illness or emotional
distress and/or death resulting from any of
these at any time.
R. INSURED CONTRACT —LEASE OF PREMISES
Paragraph 9.a. of SECTION V — DEFINITIONS
within the COMMERCIAL GENERAL LIABILITY
COVERAGE FORM is replaced by:
9. "Insured contract" means:
a. a contract for lease of premises. How-
ever, that portion of the contract for a
lease of premises that indemnifies any
person or organization for "property dam-
age" by fire; smoke from a "hostile fire",
explosion; lightning; smoke resulting from
such explosion or lightning; collision by
"mobile equipment" or leakage from fire
protection systems to premises while
rented to you or temporarily occupied by
you with permission of the owner is not
an "insured contract".
S. LIBERALIZATION
If we revise this endorsement to provide more
coverage without additional premium charge, your
policy will automatically provide the coverage as
of the day the revision is effective in your state.
Includes copyrighted material of Insurance Services Office, Inc.,
CG 82 24 05 12 with its permission.
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T. GOOD SAMARITAN SERVICES
1. Under SECTION II —WHO IS AN INSURED,
paragraph 2.d., the following is added:
This exclusion does not apply to your em-
ployees or volunteer workers, other than an
employed or volunteer physician, rendering
"Good Samaritan services".
2. The following definition is added to SECTION
V — DEFINITIONS:
"Good Samaritan services" means any emer-
gency medical services for which no compen-
sation is demanded or received.
Includes copyrighted material of Insurance Services Office, Inc.,
Page 6 of 6 with its permission.
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This Endorsement Changes the Policy. Please Read It Carefully.
COMMERCIAL AUTOMOBILE ENHANCEMENT
This endorsement modifies coverage provided under the following:
BUSINESS AUTO COVERAGE FORM
f tl-I;Ivy-! Q=1 i'.I =1 ■] 1 Z I-ill104110i0lrl4;TAM 4
Under Section 11— COVERED AUTOS LIABILITY COVERAGE, the following changes
are made:
A. BROAD NAMED INSURED
The following is added to A. Coverage, paragraph 1. Who Is An Insured:
d. Any legally incorporated entity of which you own more than 50 % of the voting
stock on the effective date of this coverage part Is an Insured.
B. ADDITIONAL INSUREDS — BY CONTRACT, AGREEMENT OR PERMIT
The following is added to A. Coverage,. paragraph 1. Who Is An Insured:
e. Any person or organization, not otherwise identified as an "insured" in this
coverage or by endorsement to this coverage, that you are required by written
contract, written agreement or written permit to name as an "insured". However,
such person or organization is an "insured" only:
(1 ) With respect to the operation, maintenance or use of a covered "auto'; and
(2) For "bodily injury" or "property damage' caused by an "accident" which takes
place after:
(a) You executed the written contract or written agreement; or
(b) The permit has been issued to you.
The insurance provided under item B. above applies on a primary basis if that is
required by the written contract, written agreement or written permit. Coverage
under this provision is limited to the minimum limits of liability stipulated in that
written contract, written agreement or written permit or the amount of loss not to
exceed the Limit of Liability shown in the Declarations, whichever is less.
C. EMPLOYEES AS INSUREDS
The following is added to A. Coverage, paragraph 1. Who Is An Insured:
f. Any "employee" of yours is an "insured" while using a covered "auto' you don't
own, hire or borrow in your business or your personal affairs-
D. FELLOW EMPLOYEE COVERAGE
B. Exclusions, paragraph 5. Fellow Employee is deleted and replaced
with the following:
D718 Includes copyrighted material of
SCA01 002 (j Insurance Services Office, Inc. with its
Permission,
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"Bodily injury" to:
a. Any fellow "employee" of the "insured" arising out of and in the
course of the fellow "employee's" employment or while performing duties
related to the conduct of your business„ or
b. The spouse, child, parent, brother or sister of that fellow "employee" as a
consequence of Paragraph a, above.
However, we will cover "bodily injury caused by your "employee" to his or her
fellow "employee" if the "bodily injury" results from the use of a covered "auto".
2. ADDITIONAL SUPPLEMENTARY PAYMENTS
Section II — COVERED AUTOS LIABILITY COVERAGE, A. Coverage, paragraph 2.a,
Coverage Extensions, Supplementary Payments, items (2) and (4) are deleted and
replaced by the following:
(2) Up to $5000 for the cost of bail bonds (including bonds for related traffic law
violations) required because of an "accident" we cover. We do not have to furnish
these bonds.
(4) All reasonable expenses incurred by the "insured" at our request, including actual
loss of earnings up to $500 a day because of time off from work.
5= 1LlDF IR4rIH=F-ls?Irlk'[00I'll41 1@14
Section IV - BUSINESS AUTO CONDITIONS, A. Loss Conditions, paragraph 2.
Duties In The Event Of Accident, Claim, Suit Or Loss, item a. is deleted and replaced
by the following and item d. is added:
a. In the event of an "accident", claim, "suit" or "loss" you must give us or our authorized
representative prompt notice of the "accident" or "loss" when the "accident", claim,
"suit" or "loss" is known to:
(1) You, if you are an individual;
(2) A partner, if you area partnership or joint venture;
(3) An "executive officer" or director if you are an organization other than a
partnership, joint venture or limited liability company;
(4) A member, if you are a limited liability company;
(5) A trustee if you are a trust; or
(6) An "employee" designated by you to give us such a notice.
This notice should include:
(1) How, when and where the "accident" or "loss" occurred;
(2) The "insured's" name and address; and
(3) To the extent possible, the names and addresses of any injured persons and
witnesses.
d. Your rights afforded under this policy will not be prejudiced if you fail to give us notice
of an "accident", claim, "suit" or "loss", solely due to your reasonable and documented
belief that the "bodily injury or "property damage" is not covered under this policy.
D718 Includes copyrighted material of
SCA01 002
() Insurance Services Office, Inc. with its
permiss6on,
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4. WAIVER OF SUBROGATION
The following is added to Section IV - BUSINESS AUTO CONDITIONS, A. Loss
Conditions, paragraph 5. Transfer of Rights of Recovery Against Other To Us:
If the insured has waived those rights prior to the "accident" or "loss", our
rights are waived also.
5. UNINTENTIONAL ERRORS AND OMISSIONS
The following is added to Section IV - BUSINESS AUTO CONDITIONS, B. General
Conditions, paragraph 2, Concealment, Misrepresentation Or Fraud:
We will not disclaim coverage under this Coverage Part if you fail to disclose all hazards
existing as of the inception date of the policy, provided such failure is not intentional and
you report the (allure to us as soon as practicable after its discovery.
However, we reserve the right to charge additional premium for any such hazard.
6. BROADENED PHYSICAL DAMAGE COVERAGE
Under Section III — PHYSICAL DAMAGE COVERAGE, the following changes are made:
A. WAIVER OF DEDUCTIBLE — GLASS REPAIR
The following is added to D. Deductible:
No deductible for a covered "auto' will apply to glass damage if the glass is repaired
rather than replaced.
Lie] Q 10[a]21a1 %11:7_1"I- i•]:ifAiII.Ial :1»L,61*--1
A. Coverage, 4. Coverage Extensions, paragraph a. Transportation Expenses is
deleted and replaced by the following:
We will pay up to $50 per day to a maximum of $1500 for temporary transportation
expense incurred by you because of the total theft of a covered "auto" of the private
passenger type. We will pay only for those covered "autos" for which you carry either
Comprehensive or Specified Causes Of Loss Coverage. We will pay for temporary
transportation expenses incurred during the period beginning 48 hours after the theft
and ending, regardless of the policy's expiration, when the covered "auto" is returned
to use or we pay for its "loss".
C. ADDITIONAL LOSS OF USE EXPENSES
A. Coverage, 4. Coverage Extensions, paragraph b. Loss Of Use Expenses is
deleted and replaced by the following:
For Hired Auto Physical Damage, we will pay expenses for which an "insured"
becomes legally responsible to pay for loss of use of a vehicle rented or hired without
a driver under a written rental contract or agreement. We will pay for loss of use
expenses if caused by:
(1) Other than collision only if the Declarations indicates that Comprehensive
Coverage is provided for any covered "auto';
(2) Specified Causes of Loss only if the Declarations indicates that Specified Causes
of Lass Coverage is provided for any covered "auto"; or
(3) Collision only if the Declarations indicates that Collision Coverage is provided for
any covered "auto".
07f 8 Includes copyrighted material of
SCA 01 i702
() Insurance Services Office, Inc. with its
Permission,
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However, the most we will pay for any expenses for loss of use Is $65 per day, to a
maximum of $1500.
D. COST TO RECOVER STOLEN AUTO
The following is added to A. Coverage, 4. Coverage Extensions,
We will pay reasonable and necessary expenses incurred by you to return a stolen,
covered "auto" from the place where it is recovered to its usual garaging place. The
most we will pay for such expenses is $1000. This Coverage Extension does not
apply if your business is selling, servicing or repairing "autos".
E. PERSONAL EFFECTS COVERAGE
The following is added to A. Coverage, 4. Coverage Extensions.
In the event of a total theft of a covered "auto", we will pay for personal effects owned
by an "insured" and in or on the covered "auto" at the time of "loss". The most we will
pay for such personal effects is $500 per "loss". No deductibles apply to this Personal
Effects Coverage-
F. AIRBAGS -ACCIDENTAL DISCHARGE COVERAGE
The following is added to B. Exclusions, paragraph 3.
This exclusion does nut apply to the accidental or unintended discharge of an airbag.
The most we will pay for such "loss" is $1000. This coverage is excess over any other
collectible insurance or warranty.
€DTI =1 : I [d tl 471 J-11KO]TI =I;?Aq 14
The following is added to A. Coverage, 4. Coverage Extensions.
In the event of a total "loss" to a covered "auto" and In addition to the actual cash
value of the covered 'auto", we will pay up to $1000 to repair or replace vehicle
wraps displayed on the "auto" at the time of'loss' The most we will pay under the
Vehicle Wrap Coverage is $5000 for any one "loss", regardless of the number of
covered "autos" deemed a total "Boss". For the purpose of this coverage, vehicle
wraps are full color, graphic images printed on vinyl film and attached to an "auto".
7. ADDITIONAL DEFINITIONS
The fallowing is added to Section V - DEFINITIONS:
"Executive Officer means a person holding any of the officer positions created by your
charter, constitution, by-laws or any similar governing document.
'Phis endorsement forces a part or
Policy Number: ACV$132520 Enectivenate: 03-01-2020
Insurtd: 7 & 2A I"ANAGEMENT, LLC
D718 Includesoapvrightedmaterial of
SCA01 002 () Insurance Services Office, Inc. with its
permission.
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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY
WC 99 0410B
(Ed. 9-14)
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-CALIFORNIA
BLANKET BASIS
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.)
The additional premium for this endorsement shall be 2% of the total manual premium otherwise due on such
remuneration. The minimum premium for this endorsement is $350.
This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule.
SCHEDULE
BLANKET WAIVER
Person/Organization Blanket Waiver — Any person or organization for whom the Named Insured has
agreed by written contract to furnish this waiver.
Job Description Waiver Premium
All CA Operations 350.00
This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated.
(The Information below Is required only when this endorsement Is Issued subsequent to preparation of the policy.)
Endorsement Effective 02/01/2019 Policy No. EAWC010904
Insured
Insurance Company Oak River Insurance Company
Countersigned by
WC 99 0410B
(Ed. 9-14)
Endorsement No.
Premium $
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This Endorsement Changes the Policy. Please Read It Carefully.
NOTICE TO CERTIFICATE HOLDER OR DESIGNATED ENTITY
INDIVIDUAL
This endorsement modifies all coverage parts included in this policy.
SCHEDULE
PERSON OR ORGANIZATION:
CITY OF SANTA ANA
Risk Management
Division, 4th Floor
ADDRESS:
20 CIVIC CENTER PLAZA
SANTA ANA, CA 92702-1 8
Number of Days Notice of Cancellation: 30
(If left blank, no notice will be sent.)
Number of Days Notice of Nonrenewal:
(If left blank, no notice will be sent.)
This endorsement forms a part of
Policy Number: CPLS1033HO Effective Date: 03-01-2020
Insured: S&A MANAGEMENT, LLC
SIL 02 022 0412 Includes copyrighted material of
Insurance Services Office, Inc., with
its permission.
Rime Management Divisian
REVIEWED&APPRDVEDBy.,
faaa.o:.r.e R. Mnebd
'� Risk Management Analyst
A. If we cancel this policy for any statutorily permitted reason other than nonpayment of
premium, we will mail notice of cancellation to the Scheduled person or organization at the
address shown in the Schedule above. We will mail this notice at least the number of days
shown in the Schedule above for cancellation. However, failure to send such notice or send
it within the specified time period will not rescind the cancellation.
B. If we decide not to renew this policy for any statutorily permitted reason, we will mail notice
of nonrenewal to the Scheduled person or organization at the address shown in the
Schedule above. We will mail such notice at least the number of days shown in the
Schedule above for nonrenewal. However, failure to send such notice or send it within the
specified time period will not rescind the nonrenewal.
This endorsement forms a part of
Policy Number: CPLS1033HO Effective Date: 03-01-2020
Insured: S&A MANAGEMENT, LLC
SIL 02 022 0412 Includes copyrighted material of
Insurance services Office, Inc., with
its permission.
Rime Management Divisian
REVIEWED&APPRDVEDBY:
faaa.o:.r.e R. Mnebd
'� Risk Management Analyst