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HomeMy WebLinkAboutSLS PROPERTY SOLUTIONS, INC. (2)�- INSURANCE ON FILE o WORK MAY PROCEED �+ UNTIL INSURANCE EXPIRES cat _ 1o.1.102.► - N CLERK OF COUNCIL DATE: FIRST ANIENMN p: FA g bessi (a McAv) (0) L13 AND BOARD-LiP SERVICES EXHIBIT 1 A-2021-032 THIS FIRST AMENDMENT to the above -referenced agreement is entered into on March 16, 2021. by and between SLS Property Solutions. Inc., a California corporation ("Consultant"), and the City of Santa Ana, a charter city and municipal corporation organized and existing under the Constitution and laws of the State of California ("City"). RECITALS A. The parties entered into Agreement No. A-2018-184, dated August 21, 2018, by which Consultant agreed to provide weed removal, rubbish abatement. and board -up services ("Agreement'). The term of the Agreement continues through .tune 30. 2021, and is current and in effect. B. Consultant was one of three selected vendors to provide on -call services at a fixed amount over a three year period. During the initial term of the Agreement. Consultant provided consistent, effective, and reliable services to the City. C. The parties wish to amend the Agreement to extend the term of the Agreement. provide an optional extension period for the term of the .Agreement, and increase the overall amount to be expended under the Agreement in consideration of the extended term and remove the fixed amount during the cunent term of this Agreement. The Parties therefore agree: Section 2.a., Compensation, is amended to increase the overall compensation to the Consultant by $160.000. The total amount to be expended during the term of the Agreement shall not exceed $205.000. Parties agree that costs Ibr services beginning July 1, 2021, shall reflect the rates and charges as detailed in Exhibit B-1 to this First Amendment to the Agreement. 2, Section 3, Term, is amended to extend the temi of the Agreement until ,Tune 30, 2022. with the option for the City to grant up to a one (I) year renewal, exercisable by a writing by the City Manager and the City .Attorney, unless terminated earlier in accordance with the terms of the Agreement. 3. Except as modified by this First Amendment, all terms and conditions of the Agreement shall remain in full force and effect. [signature page to follow] Pace 1 01,2 A-2021-032 IN WITNESS WHEREOF. the parties hereto have executed this First Amendment to the Agreement on the date and year first written above. ATTEST CITY OF SANTA ANA 9 I �1 's. t Dais� Gomez Krigline Ridge Clerk of the Council City Manager I APPROVED AS TO FORM Sonia R. Carvalho City Attorney 14q, By: Ryan . H ge Assis nt City Attorney CONSULTANT Page 2 of 2 Exhibit B-I to 1st Amendment i 1l.A PHI fall % N I ( Ift)��. l�( Section 5 - Rate and Service Structure - items a) through i) are priced per the Attachments 1, Scope of Work of the RFP 18-060 Total a) Board up cost 1st standard window $190.19 (1) each additional window thereafter $167.97 b) Board up cost of 1st single door opening $190.19 (1) each additional door thereafter $167,97 C) board up cost of a garage - our pricing assumes a single car garage (B' wide by 7' tall) roll up door $355.41 d) Bolt, screw door, garages and windows $127.51 e) Chain and lock fee (3' of 5/16 galvanized chain and one combination lock) $119.16 f) weed abatement service: includes mow, hand weed, abatement, blow off sidewalks, edging and handwork of perimeter, disposal etc (primarily neglected residental property) per hour rate $79.45 f) weed abatement service: includes mow, hand weed, abatement, blow off sidewalks, edging and handwork of perimeter, disposal etc (primarily neglected residental property) flat rate per sq. ft. of parcel. Minimum charge of $128.00 per parcel/lot $0.15 g) Debris removal service: cost per ton. Incudes clean-up debris by hand, disposal (no heavy equipment) $508.29 h) Travel Charge per hour $148.12 1) After hour charge per hour $189.00 AC"RDr CERTIFICATE OF LIABILITY INSURANCE F DATE(MMIDDIYYYY) lh.� 1 0811712021 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 of 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 endorsomont(s). PRODUCER CSIS Insurance Services coNTAcr - C519 Insurance Serving NAME: ?h ONE Em,($$$} 561-2747 Nd (805)446-4881 ADDRESS: CertfiFCates@csisOnllne. oorn 3315 Old ConejO Road Thousand Oaks CA 91320 INSURERISI AFFORDING COVERAGE NAIC INSURER A Benchmark Insurance Company 41394 INSURED ER B SLS Property Solutions Inc ER C 1776 Park Ave. R O LINSURER Suite 4-Z71 R E: Park City UT 84060 F GQVERAGES CERTIFICATE NUMBER: Maste as of 7/1S2021 QFVLcInNI M11NaRFa! THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN 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 HE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TOALL THE TERMS, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED 8Y PAID CLAIMS. INSR LTR TYPE OF INSURANCE INSO WVD POLICY NUMBER POLICYEFF MMIDD?YYYY) POLICYEXP (MMJD UMtrS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S PREMISES En osaurrenoo _ S CLAIMS -MADE OCCUR MED EXP iAny one parson) S PERSONAL A ADV INJURY S AGGREGATE LIMIT APPLIES PER. GENERALAGGREGATE $ GEN'L ❑ Q ❑ POLICY JPE LOC PRODUCTS -COMP14P AGG S $ OTHER AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT i Ea accklsnt ANY AUTO BODILY INJURY (Per parson) $ OWNED SCHEDULED BCD ILYINJURY (Per accaent) $ AUTOS ONLY AUTOS HIRED NON -OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Par acctide.Id UMBRELLA UAa HCLAIMS-MADE OCCUR EACH OCCURRENCE S EXCESS LIAB ACGREGATE $ DEC) RETENTION S $ WORKERS COMPENSATION PER OTH- AND EMPLOYLKWLIABILITY YIN STATUTE ER EL EACH ACCIDENT $ 1,000,006] A ANY PROPRIETOROPARTNERIEXECUTIVE OFF ICERIMEMSER EXCLUDED? NIA Y CST5021968 07128/2021 07128/2022 E.L. DISEASE - EA EMPLOYEE S 1 •D�,{]7}D (Mandatary In NH) If Yes, dascriha under E.L. DISEASE - POLICY LIMIT S 1.00C,000 DESCRIPTION CF OPERATIONS below DESCRIPTION OF OPERATIONS 1 LOCATIONS) VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more apace is required) City of Sam[a Ana. A Waiver of Subrogation is granted for Workers' Compensation it accordance with the policy's provisions, per attached. re: Agreement# A-20147-219 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 AUTHORIZED REPRESENTATIVE 20 Civic Center Plaza 4ttn FI Santa Ana CA 92701 CI) 1988-2015ACORD COI ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD Risk ManaginminrtfD^+sio^ RrmE%rrED 6 APPROVED BY.' Risk Managerrcnt Genes) Aide WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA (Ed. 04.84) 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.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 200 % of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description Any person or organization as required by written contract 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 Date: 07128/2020 Policy Effective Dates: 4712812020 - 07/28/2021 Insured: Si Property Solutions, Inc. Policy No.: CST5019729 Endorsement No. Carrier Name 1 Code: Benchmark Insurance CompanyA WC 04 03 06 Countersigned by (Ed. 04-84) @ Copynght 1984 National Council on Compensation Insurance, Inc. . R;ak Manage i DMsim RwEWEO s�APPROVED BY.' cl'W' i� /ate Pec,-v2 -""-- RiskM..g rmit Cl--IAide ike— R CERTIFICATE OF LIABILITY INSURANCE DAT8/1 12021 Y} L� 0��161zaz1 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 andorsement(s). PRODUCER CONTACT Edward Taber NAME: Edward Taberinsurance PHONE 949_421.3493 FAx 737-212-6650 Eatlr AIC No 1312 CHALK LN E•MAfLe• ADDRESS: EdwardOTaborinsurance;com INSU S AFFORDING COVERAGE NAICrr CEDAR PARK TX 78613.1429 INSURERA: Evanston Insurance Company INSURED INSURER f3 SLS Property Management Solutions Inc. INSURERC: 1776 Park Ave Ste 4-271 INSURER D : INSURER E Park City UT 841060 1 INSURER F: L,VVCKHtJr-Z ULMIIFIGATE NUM IFR� RGIIICIr1N N1II611I71=0 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, LTR TYPE OF INSURANCE �i L 911 - POLICY NUMBER POLICY EFF MID POLICY EXP MIDD LIMITS X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR EACH OCCURRENCE DAMAGE TO RENTED PREMISES(Ea occurrence) $ 1 •000,000 $ 1�, • $ 5,000 WO5 _ MED EXP {Airy one Denson PNC Wording Y $ 1,000,0W X Y 3AA491490 07/25/2021 07/25/2022 PERSONAL BADV INJURY GENERAL AGGREGATE PRODUCTS-CCMPJOP AGG _GEN.L AGGREGATE LIMIT APPLIES PER: POLICY E] JPERC LOG $ 2,000,000 $ 2,000,OW S OTHER: AUTOMOBILE LIABILrTY CMBINFD SINGLE LIMIT- Ea accident $ ANY AUTO BODILY INJURY (Per perm) $ OWNED SCHEDULED AUTOS ONLY _ AUTOS HIRED NON -OWNED AUTOS ONLY .. AUTOS ONLY BODILY INJURY erao"nt BODILY ] $ PROPERTY DAMAGE Per acedderlt $ UMBRELLALIA11 OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS -MADE AGGREGATE ; DED RETENTION s WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYPROPRIETORIPARTNErttEXECUTryE OFF ICERIMEMBER EXCLUDED? N1A PER 5TATIJTE L—LER E.L. EACH ACCIDENT $ .. E,L. DISEASE -EA EMPLOYEE - (Mandatory In NH) If yes. descnh. under $ E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS below null DESCRIPTION OF OPERATIONS f LOCATIONS; VEHICLES (ACORD 101, Add Monal Remarks Schedule, may be attached if mare space Is r"ulredr City of Santa Ana Risk Management Division, its officers, employees agents and representatives are named as additional insured as respects general liability far services proved by the named insured Coverage Is Primary and Nan-CDntrtbutory Certificate holder will be given 30 day Cancellation notice In writing if the above policy Is changed and Cancelled. City Of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Risk Management Division ACCORDANCE WITH THE POLICY PROVISIONS. 20 Civic Center Plaza, 4th Floor Santa Ana Ca 92701 AUTHORIZED REPRESENTATIVE (D 1988-2015 ACORD CORP ACORD 25 (2016103) The ACORD name and logo are registered marks of ACID RE) Rick htanagernenf DiAsion RSVIEWM 6 APPROVED BY: all,. 7au -""-- Risk N>ana�ermit ❑eriral /lids POLICY NUMBER: 3AA491490 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 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) Locationi Of Covered Operations City of Santa Ana, its officers, employees and Various representatives, 20 Civic Center Plaza, Santa Ana, CA 92705 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 organizations) 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 an your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. 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. CG 20 10 04 13 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. C. With respect to the insurance afforded to these additional insureds, the following is added to Section III - Limits Of Insurance:. © Insurance Services Office, Inc., 2012 . .. Rik Nlanagem i DMsim RrmEwm 6 arvRovm BY: %au Pec,,o. -""-- Risk Nunag-t❑e 1Elide 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 Page 2 of 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. © Insurance Services Office, Inc., 2012 . Rik Menage i DMsim RrmEwm 6 APPROVED ®v: Tau Pec,,o. —""-- � Risk Nuna�ermit ❑eriral Flide POLICY NUMBER: 3AA491490 COMMERCIAL GENERAL LIABILITY CG20370413 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 PRODUCTSfCOMPLETFD OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Persons) Or Organization(s) Location And Descri ation Of Completed Operations_ City of 'Santa Ana, its officers, employees and representatives, 20 Civic Center Plaza, Santa Ana, CA 92705 All Commercial andlor Residential - RemodellRepair work as required by written contract with the Insured. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section 16 — 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". However: The insurance afforded to such additional insured only applies to the extent permitted by law, and If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured wili not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 37 04 13 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. C Insurance Services Office, Inc., 2012 Risk Menage i DMsim RrmEwm 6 APPROVED ®v: Tau Pec,,o. —""-- � Risk Nuna�ermit ❑eriral Flide COMMERCIAL GENERAL LIABILITY CG 20 01 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following-, COMMERCIAL GENERAL LIABILITY COVERAGE PART PROD UCTSICOMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance (2) You have agreed in writing in a contract or Condition and supersedes any provision to the agreement that this insurance would be contrary: primary and would not seek contribution Primary And Noncontributory Insurance from any other insurance available to the This insurance is primary to and will not seek additional insured. contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and CG 20 0104 13 O Insurance Services Office, Inc., 2012 Risk Mowgowd MvWm ( RmEWED fi ArrRovm Br. Risk M—g—1 Clerical Aide COMMERCIAL GENERAL LIABILITY III POLICY NUMBER: 3AA491490 MAWU EVANST©N INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM LIQUOR LIABILITY COVERAGE FORM OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE FORM PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE FORM SCHEDULE Additional Premium: $Included (Check box if fully earned ®) Please refer to each Coverage Form to determine which terms are def ned. Words shown in quotations on this endorsement may or may not be defied in all Coverage Forms. A. Who Is An Insured is amended to include as an additional insured any person or entity to whom you are required by valid written contract or agreement to provide such coverage, but only with respect to "bodily injury", "property damage" (including "bodily 'injury" and "property damage" included in the "products -completed operations hazard"), and "personal and advertising injury" caused, in whole or in part, by the negligent acts or omissions of the Named Insured and only with respect to any coverage not otherwise excluded in the policy. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. The insurance afforded to such additional insured will not be broader than that which you are required by the valid written contract or agreement to provide for such additional insured. Our agreement to accept an additional insured provision in a valid written contract or agreement is not an acceptance of any other provisions of such contract or agreement or the contract or agreement in total. When coverage does not apply for the Named Insured, no coverage or defense will apply for the additional insured. No coverage applies to such additional insured for injury or damage of any type to any "employee" of the Named Insured or to any obligation of the additional insured to indemnify another because of damages arising out of such injury or damage. B. With respect to the insurance afforded to these additional insured, the following is added to limits of insurance: The most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the valid written 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. All other terms and conditions remain unchanged. MEGL 0009-01 09 18 Includes copyrighted material of Insurance Services Office, Inc. with its permission. Page 1 of 1 Risk Mcnagem i DMsim RrmEwm 6 APPROVED ®v: Tau Pec,,o. -""-- Risk Nunag-t❑er 1Elide COMMERCIAL GENERAL LIABILITY III POLICY NUMBER: 3AA491490 RKEr EVANSTON INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE REAL) IT CAREFULLY, BLANKET WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM SCHEDULE Name Of Person Or Organization: Any persons) or organization(s) with whom the Named Insured agrees, in a written contract executed prior to the °occurrence", to waive rights of recovery Additional Premium: $ Included The following is added to Condition 8. Transfer Of Rights Of Recovery Against Others To Us under Section IV — Commercial General Liability Conditions: We waive any right of recovery we may have against any person or organization shown in the Schedule of this endorsement. This waiver applies only to the person or organization shown in the Schedule of this endorsement. All other terms and conditions remain unchanged. MEGL 0241-01 05 16 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 1 with its permission. Risk Mcn.ge i DMsim RrmEwm 6 APPROVED ®v: `I ui 7a e Pec,,o. -""-- Risk Nunag-t❑er 1Elide A� D® CERTIFICATE OF LIABILITY INSURANCE Dare t02/2021rc) 12/0/2021 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 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 JOSE GASTELUM LiC# OD10779 CONTACT Jose Gastelum, Agent OE PNCN o .714 557 3344 Fnc N0:714-327-0198 STATE FARM INSURANCE ADDRESS: jose.gastelum,L8LS@statefarm.com State farm 1780 E MCFADDEN AVE STE 114 INSURER(S) AFFORDING COVERAGE NAIC # SANTA ANA, CA 92705 wSURERA:State Farm Mutual Automobile Insurance Company 25178 INSURED INSURER B : INSURERC: SLS PROPERTY SOLUTIONS INC. INSURER D : 919 E SANTA ANA BLVD INSURER E: SANTA ANA, CA 92701 INSURER F : COVFRAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE A L U POLICY NUMBER EFF MWDDNYYY MALICY MIDDIIYYYY LIMITS COMMERCIAL. GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE1-1 OCCUR DAMAGE TO RENT PREMISES lFa occurrence $ M ED EXP (Any one person) $ PERSONAL & ADV INJURY $ LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ PRODUCTS-COMPIOPAGG $ JECTPOLICY PRO LOC. M'OTHER: $ A AUTOMOBILE LIABILITY Y Y 535 513ti-F01-75A 12/01/2021 0610112022 Eaacc+de0t fN LE LIMIT $ 1,000,000 BODIL.YINJURY (Perpersori) $ AUTO 4733354-F13-75G 12113/2021 06/1312022 BODlLYINJURY (Per accident) $ IANY ALL OWNED X SCHEDULED AUTOS NON -OWNED X H[REDAOS UT05 X AUTOS PROPERTY DAMAGE Per accident $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ '$ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRiETOR1PARTNERIEXECUTIVE RH- STATUTE ER E.L. EACH ACCIDENT S E,L. DISEASE - EA EMPLOYE $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) NIA E.L. DISEASE - POLICY LIMIT $ If yes, describe under DESCRIPTION OF OPERATIONS below A 2006 Ford F250 SD 1FTSX21P96EB68260 Y Y 535 5136-F01-75A 12/01/2021 06/01/2022 2018 Ford F150 Pick Up 1FTMFICBJKE76591 473 3354-F13-75G 12/13/2021 06/13/2022 DESCRIPTION OF OPERATIONS I LOCATIONS! VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more apace Is required) 2006 Ford F250 SD & 2018 Ford F150 Pickup: Hired autos is only for rented vehicles Additional Insured with Endorsement 6028BU: City of Long Beach Public Works - Public Service Bureau 1651 San Francisco Ave CANCELLATION CITY OF LONG BEACH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Attn: TERI LUCE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PUBLIC WORKS- PUBLIC SERVICE BUREAU ACCORDANCE WITH THE POLICY PROVISIONS. 1651 SAN FRANCISCO AVE AUTHORIZED LONG BEACH, CA 90813 ESENT vE O 1988-2014 ACORD ORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD 1001486 132849.9 02-04-2014 Digitally signed by Francine R. Francine R. Villareal Villareal Date: 2022.02.16 15:36:06 I TE (MMMD/yyyyI CERTIFICATE OF LIABILITY INSURANCE 08116/2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION' ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS HOLDER. CERTIFICATE DOES NIO,T AFFIRMATIVELY OR NEGATIVELY AMENID, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING IINSUIPER('S), AUTH701RIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, IMPORTANT: if the certificate holder Is an ADDITIONAL INSURED, the pollcy(les) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and: conditions of the policy, certain polities 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 Edward T, her -NAME, . ....... ........... . Edward Taber Insjranoe PHONE 949-42'-1 ... 3493- FAX ,W,C,jh%,9x* 737-212-16650 1312 C>iALK LN E-MAIL,�, EdWar . . ... ........... �Annl= d C07abeni n su rance,co m, . ...... .... . . ....... . . . . ........... ---- CEDARPAFI< TX 78613-1429 ---Ev" a n"S,t"o­n'Ilisu'rance Compaiy ............ ..... . .. INSUIFER.&:.-- .. .. ......... ... ..... .... . lNSURED INSURER Br. .... . ..... ....... .... . . ..... .......... .......... . . .. . . ....... 81-SRoperty Management SclutionsInc, INSURER C : . . ............................ ............. . . ..... . 1776 Park Ave Re 4-271 ... ......... ....... INSURER D . . .. . . ........ - ------ INSURER E Park Oty IT 84060 INSURER f . . . .... . ............ ..... .. . ......... COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS 7 0 CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED A13OVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONCHION 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. l-WiTS SHOWN MAY HAVE BEEN REDUCED BY PAC CLAIMS NNSRAUDC'SUBA . . ... . ... . ... . ..... . ....... . ...... . . . .... . ......... . ....... POLIOYEI" LTR --'TY-P-E OF ­INSURANCE POLICYNUMBER (MWDDIYYYY� lMM/DU(YyYY) LIMITS X. COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 1 0100,000 X OCCUR DAMAGE TO RENTED ... ......... . - CIAIMS-MADE I 00,OW ... ... . ...... VV06 ........ .. . . ..... MED EXF �Any on, porsan) 5,000 XI PNCVVcrding y y 3AA491490 07125/2021 07/2512022 , ............... . ... PERSONAL 6 ADV INA)HY $ 1,11M0,000 (.3ENT AG(3REGATE LIWT APPLIES PER AGGREIjATE 2,000,,000 PIP -T----y666 X 1 PRODUCTS - COMPIOP AGC, $ 0 IECT LOC TITHER. AUTOMOBILE LIABILITY OBINED, SINGLE LINUT $ ANY AUTO a,DrLY NJ6RY , (Po, perwr,t OVNED SCHEDIJI ED AUTC)$ ' )NL - y AUTOS BODR.Y INJURY (Per aedems s, NONOWNED . ....... .. - R 6-PT'. wff D--AMA -G-E - -- ------- . .............. . ..... . AUTOSONLY AUTOS ONLY S �,Pwarryciden� ....... . ..... ...... . .... . . - — - -- ------ .... ... ........... . .... F S UMBRELLA UAB OCCUR EACHOCCURRENCE $ . .......... . . ............ . . . ........... EXCESS LIAR AGGREGAIE .... .. ........... .. CLAIMS,MADE --- --------------- WORKERS COMPENSATION PER FH AND EMPLOYERS'UABILITY ANYPIROPFIETOR,IP4kR'rrJER/E'XE"IJTI'VE VAN ......... ... $TATU.T.E I ........ ........ . .... . ....... �NIA E L EACH ACCIDENT $ OFFICEWMENSERCX( oFE�­'­' . . ...... �MandatOry in NH) El s if yes sa"be und& -,Di-EASE-EAEMPLOYEEI $ DF9CRJPrI0N OF OPERATRONS belIew E. I. DISEASE - PUDUY LIMIT $ null DESCRIPTION OF OPERATIONS J LOCATIONSP VEHICLES eACORD 101, Additional Remarks Schedule, maybe stlached Urnore space is reqmredp aty of Santa Ana Rsk Management Division, its officers, eMpf0yees agents and represent atives are narned as additionad insored asrespectsgeneral Irabibty for services proved by the narned insured Coverage is Primary and Non -Contributory. Cartificate holder will be given 30 day cancellation notice 17 wirting if the above poiicy is chaiged and cancelled, CERTIFICATE HOLDER CANCELLATION City of Santa Ana: SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Risk Management DwSion THE 1 EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACC0RDANCE WITH THE POILICY PROVISIONS 20 Civic Center Plaza, 4th Floor Santa Area Ca 92701 A UTHORIZEDIREPRESENTATIVE 6 ZQ C 1988-2015 ACORD COI , Rlsk MwIagernad DMsian ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD REVIEWED & APPROVED BY.- 1Z. V14"a Risk Management Analyst COMMERCIAL, GENERAL LIABILITY CG 20 37 014,13 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) . . . .... ................. Or Organization(s) .......... Location And Description, Of Completed qp2Latlons. City of Santa Ana, its officers, employees and All Commercial and/or Residential - representatives, 20 Civic Center Plaza, Santa Ana, Remodel/Repair work as required by written CA 92706 contract with the Insured. Information required to corn2lete this Schedule, if not shown above, will be shown in the Declarations. A. Section 11 — 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 our work" at the location designated and described in the Schedule of thiis end•rsement! performed for that additional insured and iincluded in the "products -completed operations hazard". 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 iinsureds, 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 arnount 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, CG 20 37 0413 Insurance Services Office, Inc., 2012 Risk Mwwgmad Dmsian �Z� 5 RmAEwED&APPROVEDBY.' 1Z. V14"a �Ww Risk Management Analpt V7 COMMERCIAL GENERAL LIABILITY CG 20 0104 13 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS,/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance (2) You have agreed in, writing in a contract or Condition and supersedes any provision to the agreement that this insurance would be contrary: primary and would not seek contribution Primary And Noncontributory Insurance from any, other insurance available to the This insurance is primary to and will: not seeadditional insured, k contribution from any other insurance available to an additional insured under your policy provided that, (1) The additional insured is a Named Insured under such other insurance; and R.19k Mwwgmad Dmsim �Z� 5 CG 20 01104 13 Q Insurance Services Office, Inc,, 2012 RmAEwE D & APPROVED BY.' Risk Management Analpt V7 C�OMIIMERCIAL GENERAL LIABILITY III POLICY NUMBER, 3AA4914910 MMKEr EVANSTON INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY., PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under this following, COMMERCIAL GENERAL LIABILITY COVERAGE FORM LIQUOR LIABILITY COVERAGE FORM IN U401 pig M FROM ITA I zMallIA 2:11" MA IM IN I SCHEDULE Additional Prem�um$Included (Check box if fully earned ........ .......... Please refer to, each Coverage Form to determine which terms are defined. Words shown; in quotations on this endorsement may or may not be defined in ail Coverage Forms. A. Who Is An Insured is amended to include as an additional insured any person or entity to whom: you are required by valid written contract or agreement to provide such coverage, but only with respect to "bodily injury", "property damage"" (including "bodily injury" and "property damage" included in the "prod LA cts-completed operations hazard"), and ""personal and advertising injury" caused, in whole or in part, by the negligent acts or omissions of the Named Insured and only with respect to any coverage not otherwise excluded in the policy. 1. The insurance afforded to such additional insured only applies to the extent permitted : by law„ and 2. The insurance afforded to such additional insured will not be broader than that which, you are required by the valid written contract or agreement to provide for such additional insured, Our agreement to accept an additional insured provision in a valid written contract or agreement is not an acceptance of any other provisions of such contract or agreement or the contract or agreement in total. When coverage does not apply for the Named Insured, no coverage or defense will apply for the add'itionali insured. No coverage applies to such additional insured for injury or damage of any type to any "employee"' of the Named Insured or to any obligation of the additional! insured to indemnify another because of damages arising out of such injury or damagie. B, Withl respect to the insurance afforded to these additional insured, the following is, added to limits of insuraince-1 The most we will pay on behalf of the additional insured is the amounit of insurance: 1, Required by the valid written contract or agreement" or 2. Available under the applicable limits of insurance shown in the Declarations", whichever is less. This endorsement' hall not increase the applicable limits of insurance, shown in the Declarations MEGL 00,09-01 09 18 Includes copyrighted material of Insurance Services Office, Inc, with its permission. el oti Risk Mwwgmad DMsian REVIEWED & APPROVED BY: 1z. V14"a Risk Management Analpt COMMERCIAL GENERAL LIABILITY III POLICY NUMBEk 3AA491490 ANARKEI: EVANSTON INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY., BLANKET WAIVER OF TRANSFER OF RIGHTS OF'RECOVERY AGAINST OTHERSTO US 2 t 1xviraft COMMERCIAL GENERAL LIABILITY COVERAGE FORM 0193M . . . ........... . — — - - — ------------ - - — ----- --- Name Of Person Or Organization: Any personi(s) or organization(s), with whom the Named Insured agrees, in a written contract executed prior to the "occurrence"', to waive rights of recovery Additional Premium. $ 1ncluded . ........ . . The following is added to Condition B. Transfer Of Rights Of Recovery Against Others To IUS Under Section IV — Commercial General Liability, Conditions: We waive any right of recovery we may have against any person or organization shown in the Schedule of this endorsement. This waiver applies only to the person or organization shown in the Schedule of this endorsement, All other terms and, conditions remain unchanged, MEGL 0241-011 05 16 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 1 with its permission. Risk Mwwgmad DMsian REVIEWED & APPROVED BY: V,46,wl V7 Risk Management Analpt POLICY NUMBER� 3AA4490 COMMERCIAL GENERAL LIABILITY CG 20 10i Oi 13 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: 14103 ITA R Name Of Additional Insured Person(s) Or 0 -anization(s) Locations) Of Covered 01 erations City of Santa Ana, its officers, employees and Various representatives, 20 Civic Center Plaza, Santa Ana, CA 92705 Information require J to complete this Schedule, if not shown above, will be shown in the Declarations A. Section 11 - Who Is An Insured is amended to, include as an additional insured the person(s) or orgaown in the Schedule, but only wlth respe ct to lialol I�Ity for "bodily injuiirproperty damage " or "personial and advertising injury" caused, in whole or in part, by: 1. Your acts or ornissions; or 2. The acts or omissions of those acting on your behalf', in the performance of your ongioinig operations for the additional insured�s) at the location(s) designated above. However� 1. The iinsuirance afforded to such addftional i�nsured only applies to the extent permitted by law� and coverage provided to the additional insured is required by a contract or agreemenit, 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 tc these additilonial� insureds, the following additional exclusions apply: This insurance does not apply to "bodily, injury" or "property damage" occurring after. 11 , All work, including materials, parts or equipment furinus,h,ed in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additionall insured(s) at the iocation 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 C. With respect to the, insurance afforded to these additional insureds, the following is added to Section III - Limits Of Insurance., CG 20 10 04 13 Q Insurance Services Office, Inc., 20112 Risk Mwwgment DMsbn j;?!` 5 REVIEWED & APPROVED BY.' N Q910—W-2 Risk Management Analpt If coverage provided to the addlitional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured i�s t�he amount of insuralce: 1. Required by the contract or agreement, or Available under the applicable Lints of Insurance shown in the Declarationis, whichever is less This endorsement shall not increase the applicable Lim,its, of Insurance shown in the Dieclarafions. Page 2 of 2 0 Insurance Services Office, Inc,, 20,12 Risk Mwwgment Dmsian REVIEWED & APPROVED BY.- 1z. V4"a Risk Management Analpt V7 A1CdRQ® �..r CERTIFICATE OF LIABILITY INSURANCE DATE 1312022Yj o1i�siza�2 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 JOSE GASTEI_UM, AGENT LiC# QD10779 STATE FARM INSURANCE 5tatel=arr►t 1780 E MCFADDEN AVE STE 114 WW SANTA ANA CA, 92705 CONTACT NAME: Jose Gastelum, Agent AHCNNa xt •7t4-557-3344 we No :714-327-0198 ADDRESS: Jose.gastelum.L8LS@statefarm.com INSURER(S)AFFORDING COVERAGE NAIC N INSURER A :State Farm Mutual Automobile Insurance Company 25178 INSURED INSURER B : INSURERC: SLS PROPERTY SOLUTIONS, INC. INSURER D : 919 E SANTA ANA BLVD INSURER E: SANTA ANA, CA 92701 INSURER F : COVERAGES CERTIFICATE NUMBER- REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADIDL SuBR POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MMIDDNYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S CLAIMS-MADE OCCUR DAMAGE TO RENTru- PREMISES Ea occurrence S MED EXP (Any one person) $ PERSONAL & ADV INJURY $ OTHER: $ A AUTOMOBILE LIABILITY Y 535 5136-F01-75C 12101/2021 06/01/2022 Ea MEIN ecudent SINGLE LIMIT S 1,000,000 BODILY INJURY (Per person) S ANY AUTO 473 3354-F13-75F 12113/2021 06/13/2022 BODILY INJURY (Per accident) S ALL OWNED X SCHEDULED AUTOS AUTOS NON -OWNED x HIREDAUTOS X AUTOS PROPERTY DAMAGE Per accident $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I I RETENTIONS $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y 1 N ANY PROPRIETORIPARTNERIEXECUTIVE STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE S OFFICERIMEMBER EXCLUDED? ❑ (Mandatory in NH) N 1 A E.L. DISEASE - POLICY LIMIT $ If yes, describe under DESCRIPTION OF OPERATIONS below A 2006 Ford F250 SO 1FTSX21P96EB68260 Y 5355136-F01-75C 12/01/2021 06101/2022 2000 Ford F150 Pickup 1FTZX1728YN861176 473 3354-F73-75F 12/13/2021 06/13/2022 DESCRIPTION OF OPERATIONS f LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Agreement number: A-20147-219 City of Santa Ana, its officers, agents, and employees and representatives are named as Additional Insured as respects With AUTOMOBILE LIABILITY for services provided by the named insured. Coverage is primary and non-contributory 30 days notice of cancellation applies. CERTIFICATE HOLDER CANCELLATION _ CITY OF SANTA ANA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE RISK MANAGEMENT DIVISION THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 CIVIC CENTER PLAZA, 4th FLOOR ACCORDANCE WITH THE POLICY PROVISIONS. SANTA ANA CA, 92702 AUTHORRED REPR ENTATiVE 01988-2014 AC C ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD F ` 1°F R`s`�Dt`�101L REVIEWED & APPROVED BY.- ��/ i -- Risk Management Analyst A. DATE (MM/DDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 07/29/2021 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 NTA T CSIS Insurance Services NAME: CSIS Insurance Services PHONE 888 501-2747 FAX vc. No. Extl ( ) IAIc„ No (805) 446-4881 AIL ......... certificates@csisonline.com 3315 Old Conejo Road INSURER(S) AFFORDING COVERAGE NAIC M Thousand Oaks CA 91320 INSURERA: Benchmark Insurance Company 41394 ......._ _. INSURED INSURER B SLS Property Solutions Inc INSURER C t 919 East Santa Ana Blvd INSURER D INSURER E .. Santa Ana CA 92701 INSURER F COVFRAr;FS rFRTIFICATF MI IMRFR• Maste as of 711912021 r.0 1saoeo. 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 WWW AUUL r bUtSIJPOLICY POLICY NUMBER ....w EFF MMIDD/YYYY POLICY EXP MMIDDIYYYY ......... LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE DOCCUR EACH OCCURRENCE $ Aa0E_"iTl7 1ffN ED PREMISES (Ea occurrence) S MED EXP (Any one person) ''. S PERSONAL&ADV INJURY s GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY D IECPRO- ILOC '.. PRODUCTS - COMP/OP AGO S OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accidenk) S BODILY INJURY (Per person) '.. S ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per aocidenl) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY rJAMA.GE. Pxr acrritwrv@. $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE'' S DED RETENTION S $ WORKERS COMPENSATION X1 PER OTH- '4 AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? �Y (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA CST5021968 07/28/2021 07/28I2022 STATUTE I I ER. E.L EACH ACCIDENT $ 1,000000 E.L, DISEASE - EA EMPLOYEE S 1,000,000 E.L. DISEASE -POLICY LIMIT --- S 1,OOQ000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) A Waiver of Subrogation is granted in favor of the additional insured with respects to Workers' Compensation in accordance with the policy's provisions, per attached, SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Santa Ana Risk Management Division ACCORDANCE WITH THE POLICY PROVISIONS. 20 Civic Center Plaza 4th FI AUTHORIZED REPRESENTATIVE 11 Santa Ana CA 92701 cF"o Is:isieManagmenti?iviaian WSW ©1988-2015 ACORD C REVIEWED & APPROVE D SY: ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD ' Yf' --� Risk Management Analyst WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 04-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA 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.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 2% of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description Any person or organization as required by written contract 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 Date: 07/28/2021 Policy No.: CST5021968 Endorsement No. Policy Effective Dates: 07/28/2021 - 07/28/2022 Insured: SLS Property Solutions, Inc. Carrier Name / Code: Benchmark Insurance Company WC 04 03 06 Countersigned by o,R F Risk Mouganent Divislan (Ed. 04-84) raenEWED & APPRovm BY. ®Copyright 1984 National Council on Compensation Insurance, Inc. I` R. —� Risk Management Analyst N August24,2021 City of Santa Ana Rick Management SLS Property Solutions, Inc. is a General Contractor that provides board -up services and some weed abatement services for the City of Santa Ana. We provide no design services or any type of testing services. We will not be hiring any firm that wHI provide professional services as that is not in our scope of work, SLS Property Solutions, Inc. Rlsk Mwwgmad DMsian REVIEWED & APPROVED BY: V'46wl V7 Risk Management Analpt