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HomeMy WebLinkAboutUS NATIONAL CORPORATION (2)IANI 2 8 2021 A-2018-005-01 MAYOR Vicente sannlento LA.15 9021 MAYOR PRO TEM David Penaloza COUNCILMEMBERS Phil Bacerra Johnathan Ryan Hemandez Jessie Lopez Nelda Mendoza Thai Viet Phan 0'.PW N (5cilluh FrAnklih)(1) L3 US National Corp. 10205 San Fernando Road Pacoima, CA 91331 Attn: Mr. Fred Jimenez CITY OF SANTA ANA PUBLIC WORKS AGENCY 20 Civic Center Plaza a P.O. Box 1988 Santa Ana, California 92702 www.santa-ana.oro (714)847-3320 January 14, 2021 CITY MANAGER Kristine Ridge CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL Delay Gomez Re: Extension of Agreement for Painting Services for Water Production Facilities Agreement No. A-201M05 Pursuant to Section 3 ("Term") of the above -referenced Agreement, entered into by US National Corp., and the City of Santa Ana, dated January 16, 2018, the time period of the Agreement is hereby extended for an additional two-year period, from January 16, 2021 through January 15, 2023. Any 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. Sincerely, Nabil Saba, P.E. Executive Director, Public Works Agency CITY OF SANTA ANA agoa� . Kristine 'dge el City Manager APPROVED AS TO FORM hn M.Funk Senior Assistant City Attorney ATTEST Datsy Uomez, MMC Clerk of the Council US NATIONAL CORP f N : Fred Jimene Title: President SANTA ANA CITY COUNCIL Vl me Senn . Da P..a T WV'm Phan Ja59ie Ltfpez Phi Beare JOM.P Ryan HameMez N.hd. M.W. Mayor Moyer Pm Tem. Wad 2 WadI Wad3 WaW4 Wa s Wad6 vamkMa®x,fl a_pr 9pS0aloy@mnlo-au ero I Awq 9g b b zldaen cenmrromaanio-av am too Dlgiolly Agnes by Frandre R. Francine R. Villareal'; .oM Date: 202o...0 17Az:15 area A� �� CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD 20Y) 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 CONTACT NAME: Kathy Williams Mt. Diablo Insurance Brokers, Inc. PHONE (925)297-4072 FAX No), 19251291-4e74 E-MAIL kath @mtdiabloinsurance.COM ADDRESS: Y 3557 Mt. Diablo Boulevard Suite 21 INSURERS AFFORDING COVERAGE NAICa INSURERA:U.S. Specialty Insurance Company 29599 Lafayette CA 94549 INSURED INSURERS: Travelers Casualty Insurance Company 19046 U S National Corp. INSURERC: DBA: Jimenez Painting INSURERD: 10205 San Fernando Road INsuRERE; INSURER F: Pacoima CA 91331 COVERAGES CERTIFICATE NUMBER:2020 A/L 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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. ILTR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF fMMIDDNYYYI POLICY EXP IMMIDDIYYYYJLIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS-MADEOCCUR EACH OCCURRENCE $ 1,000,000 DAMAGETORENTED PREMISES Ea occunence $ 100, 000 MED EXP Any one person) $ 5,000 X U20AC 12407000 4/25/2020 4/25/2021 PERSONAL &ADV INJURY $ 1,000,000 GEN-LAGGREGATE LIMITAPPLIES PER POLICY ❑ PRP ❑ LOG X JECT GENERALAGGREGATE $ 2,000,000 PRODUCTS. COMPIOPAGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ee eccitlent $ 1,000,000 X BODILY INJURY (Per person) $ B ANYAUTO ALL OWNED SCHEDULED AUTOS AUTOS X BA7ND40727 6/3 /2020 6/3/2021 BODILY INJURY (Per eccitlenl) $ HIREDAUTOS AUTOS ED Parr celtlen DAMAGE $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 A EXCESS LIAB CIAIMS-MADE U20MI2407000 4/25/2020 4/25/2021 DED I I RETENTION $ I $ WORKERS COMPENSATION I PER OTH- ANDEMPLOYERS 'LIABILITY YIN ANY PROPRIEfORIPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? ❑NIA STATUTE E E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ IMandatory In NH) If yea, describe under E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS LOCATIONS I VEHICLES (ACORD 101, Addltlonal Remarks Schedule, may be aaached If more space Is required) RE: Agreement A-2018-005 and IFB 16-092 The City of Santa Ana, its officers, agents, employees, volunteers and represenatives are recognized as additional insured, but only as respects liability arising from named insured operations. Endorsements apply and are attached hereto. *30 days written notice of cancellation. 10 days notice for non-payment of premium. CERTIFICATE HOLDER CANCELLATION City of Santa Ana Risk Management Division 20 Civic Center Plaza Santa Ana, CA 92702 ACORD 25 (2014101) INS026 (2w o1) 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 REPRESENTATIVE Robert Salvo/BECKY Risk ManagonefllDlMialan s'ANREVIEWEDdr APPROVEDST: © 1988-2014 ACORD C 8s i; P c444,6h Z V;" The ACORD name and logo are registered marks of ACORD lamp Risk Management Analyst POLICY NUMBER: U20AC124070-00 COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART FY9:I411114:4 Name Of Additional Insured Person(s) Or Organ izations : Locations Of Covered Operations Any person or organization for whom you are performing operations during the policy period when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II - Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG 2010 07 04 © ISO Properties, Inc., 2004 RkkMamagetnentWslnn REVIEWED & APPRoVEDBY. Risk Management Analyst POLICY NUMBER: U20AC124070-00 COMMERCIAL GENERAL LIABILITY HCS 040 06 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY AND BLANKET WAIVER OF SUBROGATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART A, PRIMARY AND NON-CONTRIBUTORY TO OTHERINSURANCE With respect to any person or organization that is an additional insured under this Coverage Part, the following is added to paragraph 4. of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: If you have agreed in writing in a contract or agreement that this insurance is primary and non- contributory relative to an additional insured's own insurance, then this insurance is primary and we will not seek contribution from that other insurance. For the purpose of this endorsement, the additional insured's own insurance means insurance on which the additional insured is a Named Insured. When this endorsement is attached to the policy it supersedes all other insurance conditions within. B. WAIVER OF SUBROGATION — BLANKET Under SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS, The Transfer Of Rights Of Recovery Against Others To Us Condition is amended by the addition of the following: We waive any right of recovery we may have against any person or organization because of payments we make for injury or damage arising out of: a. Your ongoing operations; or b. "Your work" included in the "products - completed operations hazard". However, this waiver applies only when you have agreed in writing to waive such rights of recovery in a contract or agreement, and only if the contract or agreement: a. Is in effect or becomes effective during the term of this policy; and b. Was executed prior to loss. HCS 04006 1013x aRAW W&anr wDwe Includes copyrighted material of Insurance Services Office, Inc., with its permiss ` - ' Risk ManagerNllt Analyst COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. AUTO COVERAGE PLUS ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GENERAL DESCRIPTION OF COVERAGE — This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to the Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general cover- age description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this en- dorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A. BLANKET ADDITIONAL INSURED B. EMPLOYEE HIRED AUTO C. EMPLOYEES AS INSURED D. SUPPLEMENTARY PAYMENTS — INCREASED LIMITS E. TRAILERS — INCREASED LOAD CAPACITY F. HIRED AUTO PHYSICAL DAMAGE G. PHYSICAL DAMAGE — TRANSPORTATION EXPENSES — INCREASED LIMIT A. BLANKET ADDITIONAL INSURED The following is added to Paragraph A.1., Who Is An Insured, of SECTION II — COVERED AUTOS LIABILITY COVERAGE: Any person or organization who is required under a written contract or agreement between you and that person or organization, that is signed and executed by you before the "bodily injury" or "property damage" occurs and that is in effect during the policy period, to be named as an addi- tional insured is an "insured" for Covered Autos Liability Coverage, but only for damages to which this insurance applies and only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Section II. B. EMPLOYEE HIRED AUTO The following is added to Paragraph A.1., Who Is An Insured, of SECTION II — COV- ERED AUTOS LIABILITY COVERAGE: An "employee" of yours is an "insured" while operating a covered "auto" hired or rented under a contract or agreement in an "em- ployee's" name, with your permission, while H. AUDIO, VISUAL AND DATA ELECTRONIC EQUIPMENT —INCREASED LIMIT I. WAIVER OF DEDUCTIBLE — GLASS J. PERSONAL PROPERTY K. AIRBAGS L. AUTO LOAN LEASE GAP M. BLANKET WAIVER OF SUBROGATION performing duties related to the conduct of your business. 2. The following replaces Paragraph b, in B.S., Other Insurance, of SECTION IV — BUSI- NESS AUTO CONDITIONS: b. For Hired Auto Physical Damage Cover- age, the following are deemed to be cov- ered "autos" you own: (1) Any covered "auto" you lease, hire, rent or borrow; and (2) Any covered "auto" hired or rented by your "employee" under a contract in an "employee's" name, with your permission, while performing duties related to the conduct of your busi- ness. However, any "auto" that is leased, hired, rented or borrowed with a driver is not a covered "auto". C. EMPLOYEES AS INSURED The following is added to Paragraph A.1., Who Is An Insured, of SECTION II — COVERED AUTOS LIABILITY COVERAGE: �,�m..,p�s RbkMan�emrnil)Ivislon CA T4 20 02 15 © 2015 The Travelers Indemnity Company. All rights reserved. .� 1 R�� & APPRI0�VeM8Y. Includes copyrighted material of Insurance Services Office, Inc, with Its permission. E%!1 intLr•cN.GuJ✓itAl Risk Management Analyst COMMERCIAL AUTO Any "employee" of yours is an "insured" while us- ing a covered "auto" you don't own, hire or borrow in your business or your personal affairs. D. SUPPLEMENTARY PAYMENTS — INCREASED LIMITS 1. The following replaces Paragraph A.2.a.(2) of SECTION II — COVERED AUTOS LIABILITY COVERAGE: (2) Up to $3,000 for cost of bail bonds (in- cluding bonds for related traffic law viola- tions) required because of an "accident" we cover. We do not have to furnish these bonds. 2. The following replaces Paragraph A.2.a.(4) of SECTION II — COVERED AUTOS LIABILITY COVERAGE: (4) All reasonable expenses incurred by the "insured" at our request, including actual loss of earnings up to $500 a day, be- cause of time off from work. E. TRAILERS— INCREASED LOAD CAPACITY The following replaces Paragraph C.1. of SEC- TION I — COVERED AUTOS: 1. "Trailers" with a load capacity of 3,000 pounds or less designed primarily for travel on public roads. F. HIRED AUTO PHYSICAL DAMAGE The following is added to Paragraph A.4., Cover- age Extensions, of SECTION III — PHYSICAL DAMAGE COVERAGE: Hired Auto Physical Damage Coverage If hired "autos" are covered "autos" for Covered Autos Liability Coverage but not covered "autos" for Physical Damage Coverage, and this policy also provides Physical Damage Coverage for an owned "auto", then the Physical Damage Cover- age is extended to "autos" that you hire, rent or borrow subject to the following: (1) The most we will pay for "loss" to any one "auto" that you hire, rent or borrow is the lesser of: (a) $50,000; (b) The actual cash value of the damaged or stolen property as of the time of the "loss"; or (c) The cost of repairing or replacing the damaged or stolen property with other property of like kind and quality. (2) An adjustment for depreciation and physical condition will be made in determining actual cash value in the event of a total "loss". (3) If a repair or replacement results in better than like kind or quality, we will not pay for the amount of betterment. (4) A deductible equal to the highest Physical Damage deductible applicable to any owned covered "auto". (5) This Coverage Extension does not apply to: (a) Any "auto" that is hired, rented or bor- rowed with a driver; or (b) Any "auto" that is hired, rented or bor- rowed from your "employee". G. PHYSICAL DAMAGE — TRANSPORTATION EXPENSES — INCREASED LIMIT The following replaces the first sentence in Para- graph A.4.a., Transportation Expenses, of SECTION III — PHYSICAL DAMAGE COVER- AGE: We will pay up to $50 per day to a maximum of $1,500 for temporary transportation expense in- curred by you because of the total theft of a cov- ered "auto" of the private passenger type. H. AUDIO, VISUAL AND DATA ELECTRONIC EQUIPMENT — INCREASED LIMIT Paragraph C.1.b. of SECTION III — PHYSICAL DAMAGE COVERAGE is deleted. I. WAIVER OF DEDUCTIBLE — GLASS The following is added to Paragraph D., Deducti- ble, of SECTION III — PHYSICAL DAMAGE COVERAGE: No deductible for a covered "auto" will apply to glass damage if the glass is repaired rather than replaced. J. PERSONAL PROPERTY The following is added to Paragraph AA., Cover- age Extensions, of SECTION III — PHYSICAL DAMAGE COVERAGE: Personal Property Coverage We will pay up to $400 for "loss" to wearing ap- parel and other personal property which is: (1) Owned by an "insured"; and (2) In or on your covered "auto". This coverage only applies in the event of a total theft of your covered "auto". No deductibles apply to Personal Property cover- age. RlskMmtagementDIVISIon Page 2 of 3 © 2015 The Travelers Indemnity Company. All rights reserved. : F RenMED rr.APPROVMBY: Includes copyrighted material of Insurance Services Office, Inc. with Its permission. 8 r r H �,ta„p,'.,y,q, Rivk Management Analyst z: K. AIRBAGS The following is added to Paragraph B.3., Exclu- sions, of SECTION III — PHYSICAL DAMAGE COVERAGE; Exclusion 3.a. does not apply to "loss" to one or more airbags in a covered "auto' you own that in- flate due to a cause other than a cause of 'loss" set forth in Paragraphs A.1.15. and A.1.c., but only: a. If that "auto' is a covered "auto" for Compre- hensive Coverage under this policy; b. The airbags are not covered under any war- ranty; and c. The airbags were not intentionally inflated. We will pay up to a maximum of $1,000 for any one 'loss". L. AUTO LOAN LEASE GAP The following is added to Paragraph AA., Cover- age Extensions, of SECTION III — PHYSICAL DAMAGE COVERAGE: Auto Loan Lease Gap Coverage for Private Passenger Type Vehicles In the event of a total 'loss" to a covered "auto' of the private passenger type shown in the Schedule or Declarations for which Physical Damage Cov- erage is provided, we will pay any unpaid amount due on the lease or loan for such covered "auto' less the following: (1) The amount paid under the Physical Damage Coverage Section of the policy for that "auto'; and COMMERCIAL AUTO (2) Any: (a) Overdue lease or loan payments at the time of the "loss"; (b) Financial penalties imposed under a lease for excessive use, abnormal wear and tear or high mileage; (c) Security deposits not returned by the les- sor; (d) Costs for extended warranties, Credit Life Insurance, Health, Accident or Disability Insurance purchased with the loan or lease; and (e) Carry-over balances from previous loans or leases. M. BLANKET WAIVER OF SUBROGATION The following replaces Paragraph A.S., Transfer Of Rights Of Recovery Against Others To Us, of SECTION IV — BUSINESS AUTO CONDI- TIONS: 5. Transfer Of Rights Of Recovery Against Others To Us We waive any right of recovery we may have against any person or organization to the ex- tent required of you by a written contract exe- cuted prior to any "accident' or 'loss", pro- vided that the "accident" or "loss" arises out of the operations contemplated by such con- tract. The waiver applies only to the person or organization designated in such contract. liielc Mat�emml Dhidon CA T4 20 02 15 © 2015 The Travelers Indemnity Company. All rights reserved. ti & APpRWm BY. Includes copyrighted material of Insurance Services Office, Inc. with its permission. 8� 'ffl f*o ao•�e >?. � � 1j Risk Wnagemant.Nnatyst ACCORD® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 1 /27/2021 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 Orr & Associates Insurance Services 28780 Single Oak Dr 255 CONTACT NAME: Certificates PHONE FAX A/C No Ext : 800-311-3081 A/c, No): 800-474-3003 E-MSte ADDRESS: certs@orrandassociates.com INSURER(S) AFFORDING COVERAGE NAIC# Temecula CA 92590 INSURERA: Insurance Company of the West 27847 License#: OE63493 INSURED USNATIO-01 US National Corp dba Jimenez Painting Company 10205 San Fernando Rd INSURER B : INSURERC: INSURER D Pacoima CA 91331 INSURER E INSURER F : COVERAGES CERTIFICATE NUMBER:205589644 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 INSD SUBR WVD POLICYNUMBER POLICY EFF MM/DD POLICY EXP MM/DD LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE1:1 OCCUR PREMISES Ea occurrence $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ POLICY ❑ PRO- JECT LOC ❑ PRODUCTS - COMP/OP AGG $ $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLALIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LAB CLAIMS -MADE DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N Y VVTX504443002 11/14/2020 11/14/2021 X PER OTH- STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? ❑ N/A E.L. DISEASE - EA EMPLOYEE $ 1,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) Certificate is subject to policy limits, conditions and exclusions. City of Santa Ana is named as the certificate holder. RE: Agreement A-2018-005 and IFB 16-092 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS. Risk Management Division 20 Civic Center Plaza AUTHORIZED REPRESENTATIVE Santa Ana, CA 92702 fn/ RA T NCR �tRCYVE �isi Y.' REVIEWED &APPROVED SY: @ 1988-2015 ACCORD C ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD _ _— Risk Management Analyst WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 34 (Ed. 8-00) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - BLANKET 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 otherwise due. Person or Organization ANY PERSON OR ORGANIZATION WHEN REQUIRED BY WRITTEN CONTRACT 2 % of the total California Workers' Compensation premium Schedule Job Description ALL CALIFORNIA OPERATIONS 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 11/14/2020 Policy No. WTX 5044430 02 Insured US NATIONAL CORP Insurance Company INSURANCE COMPANY OF THE WEST WC 99 06 34 (Ed. 8-00) Countersigned By INSURED Endorsement No. Premium $ INCL . ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY: v --� Risk janagement Analyst Ejhjubmmz!tjhofe!cz!Upsj!Qjfstpo! Upsj!Qjfstpo Ebuf;!3133/17/14!1:;58;34!.18(11( POLICY NUMBER: U22AC124070-02 COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED OWNERS, LESSEES OR – CONTRACTORS SCHEDULED PERSON OR – ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s):Location(s) Of Covered Operations Any person or organization for whom you are performing operations during the policy period when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy. 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 B.With respect to the insurance afforded to these – include as an additional insured the person(s) or additional insureds, the following additional organization(s) shown in the Schedule, but only exclusions apply: with respect to liability for "bodily injury", "property This insurance does not apply to "bodily injury" or damage" or "personal and advertising injury" "property damage" occurring after: caused, in whole or in part, by: 1.All work, including materials, parts or 1.Your acts or omissions; or equipment furnished in connection with such 2.The acts or omissions of those acting on your work, on the project (other than service, behalf;maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the in the performance of your ongoing operations for location of the covered operations has been the additional insured(s) at the location(s) completed; or designated above. 2.That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG 20 10 07 04© ISO Properties, Inc., 2004 Page 1 of 1 POLICY NUMBER: U22AC124070-02 COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED OWNERS, LESSEES OR – CONTRACTORS COMPLETED OPERATIONS – This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Location And Description Of Completed Or Organization(s): Operations Any person or organization, when you and such parties have agreed in writing in a contract or agreement pertaining to “your work” performed during the policy period. This additional insured coverage does not apply to “excluded residential construction". "Excluded residential construction" means: a)the ground-up construction of any building whose units will be individually owned and titled; and, b)“your work” performed on the conversion of any building into a condominium or townhome. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II Who Is An Insured is amended to – include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the schedule of this endorsement performed for that additional insured and included in the "products- completed operations hazard". © ISO Properties, Inc., 2004 CG 20 37 07 04Page 1 of 1 COMMERCIAL GENERAL LIABILITY POLICY NUMBER: U22AC124070-02 HCS 040 06 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY AND BLANKET WAIVER OF SUBROGATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART A.PRIMARY AND NON-CONTRIBUTORY TO B.WAIVER OF SUBROGATION – BLANKET OTHER INSURANCE Under SECTION IV – COMMERCIAL GENERAL With respect to any person or organization that is LIABILITY CONDITIONS, The Transfer Of an additional insured under this Coverage Part, Rights Of Recovery Against Others To Us the following is added to paragraph 4. of Condition is amended by the addition of the SECTION IV – COMMERCIAL GENERAL following: LIABILITY CONDITIONS: We waive any right of recovery we may have If you have agreed in writing in a contract or against any person or organization because of agreement that this insurance is primary and non-payments we make for injury or damage arising contributory relative to an additional insured’s own out of: insurance, then this insurance is primary and we a.Your ongoing operations; or will not seek contribution from that other b. “Your work” included in the “products- insurance. For the purpose of this endorsement, completed operations hazard”. the additional insured’s own insurance means insurance on which the additional insured is a However, this waiver applies only when you have Named Insured. agreed in writing to waive such rights of recovery in a contract or agreement, and only if the contract When this endorsement is attached to the policy it or agreement: supersedes all other insurance conditions within. a.Is in effect or becomes effective during the term of this policy; and b.Was executed prior to loss. HCS 040 06 10 13Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc., with its permission. POLICY NUMBER: U22AC124070-02 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: All persons or organizations with whom you have agreed to waive such right of recovery in a written contract or agreement. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV Conditions: – We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a 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 above. 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