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HomeMy WebLinkAboutDMS FACILITY SERVICES, LLC (3)City of Santa A. j Clerk of the Council AGREEMENT TERMINATION FORM Please complete this form when the attached agreement and all amendments (if any) are no longer in effect. Return form to the Clerk of the Council Office (M-30). Call 647-6520 if you have any questions. The agreement with No. A -ac, 11` Hy was completed on (List all amendments. Use space below if needed.) P�---5L0l A- 1C11y� A-- 3� & I., SANTA ANA OF COUNCIL 1 and final payment has been made. Department: Phone/Exf.:a Signature: �111Ci t.t�l� Date: Revised 08-23-10 INSURANCE ON FILE 1, WORK MAY PROCEED UNTIL INSURANCE EXPIRES `C CLERK OF COUNCIL DATE: � d FOURTH AMENDMENT TO LANDSCAPE MAINTENANCE AGREEMENT A-2015-027-01 THIS FOURTH AMENDMENT TO LANDSCAPE MAINTENANCE AGREEMENT is entered into this 14TH day of January 2016, by and between DMS Facility Services, LLC, a California limited liability Company ("Contractor"), and 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'. RECITALS A. The parties entered into Landscape Maintenance Agreement No. A-2011-148 ("Agreement") dated June 6, 2011, by which Contractor has provided park landscape maintenance services for Santa Ana Parks District 2. B. The parties have executed three amendments to the Agreement, Nos. A-2012-112, A-2014-026, and A-2015-027, respectively, through which the scope of services, compensation, and term have been amended. C. The current tern of the Agreement is for the period from February 1, 2015 through January 31, 2016, and the Agreement remains in effect. D. The parties now wish to further amend the Agreement for the purpose of extending the term of the Agreement for one year and providing for the compensation for such extension. The Parties therefore agree: 1. Section 3, COMPENSATION, is amended to include the following: "City agrees to pay, and Contractor agrees to accept as total payment for its services covering District 2, compensation in the amount of $318,331.20, which includes a 10% contingency for unanticipated work needed, for the term of February 1, 2016 through January 31, 2017." 2. Section 4, TERM, is amended to extend the term of the Agreement for an additional one (1) year period, from February 1, 2016 to January 31, 2017. 3. Except as modified by this Fourth Amendment, and all prior amendments, all terms and conditions of the Agreement remain unchanged and in full force and effect. IN WITNESS WHEREOF, the parties hereto have executed this Fourth Amendment to the Agreement the date and year first above written. ATTEST: Maria D. Huizar Clerk of the Council Fuel i r it, # / Page I of 2 APPROVED AS TO FORM: Sonia R. CarvaRio, City Attorney B 7olm M. Funk Assistant City Attorney RECOMMENDED FOR APPROVAL: Gerardo Monet Executive Director of Parks, Recreation, and Coimnunity Services Agency DMS FACILITY SERVICES, LLC Name: Grso�za� e 5 Title:(R„��r,k Page 2 of 2 ... ��m� ..... 4190. ln& 19/ r . nme S. Fjg a Strew, Swte 1 ry cr»nwer ® `H, 6015. Figueroa Street, Sui[e 1600, Lm Angeles. tali/omia 9001] mtin310"90990 be mle310"90a16 Bond No. 1001018541 Premium: $ 6,367.00 Public Works —Payment KNOW ALL MEN BY THESE PRESENTS, That we, DMS FACILITY SERVICES, LLC. 2861 EAST CORONADO STREET, ANAHEIM, CA 92806 as Principal, and AMERICAN CONTRACTORS INDEMNITY COMPANY, a Corporation organized and existing under the laws of the State of California, and authorized to transact a general surety business in the State of CA as Surety, are held and firmly bound unto CITY OF SANTA ANA, CA , as Obligee, in the sum of ONE HUNDRED FIFTY- NINE THOUSAND, ONE HUNDRED SIXTY SIX AND 00/100 Dollars ($ 159,166.00 ), lawful money of the United States of America, for the payment whereof, well and truly to be made, we hereby bind ourselves, our heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents. THE CONDITION OF THIS OBLIGATION IS SUCH, that WHEREAS, the above -bounden Principal has entered into a contract dated with said Obligee to do and perform the following work, to wit: JANUARY 14, 2016 LANDSCAPE MAINTENANCE FOR DISTRICT 2, PER LANDSCAPE MAINTENANCE AGREEMENT NO. A-2011-148. THIS AMEMDED TERM EXTENSION IS FROM FEBRUARY 1, 2016 THROUGH JANUARY 31, 2017. ANY TERM AMENDMENT OR EXTENSION TO THIS AGREEMENT SHALL REQUIRE A CONSENT OF SURETY TO SUCH FUTURE AMENDMENT OR EXTENSION. NOW, THEREFORE, if the above -bounden Principal shall faithfully pay all laborers, mechanics, subcontractors, materialmen and all persons who shall supply such person or persons, or subcontractors, with materials and supplies for the carrying on of such work, then this bond shall be null and void, otherwise it shall remain in ful force and effect. Signed, sealed and dated this 4TH day of FEBRUARY 2016 DMS FACT Y SERVICES, LLC AMERICAN CONTRACTORS INDEMNITY COMPANY Principal By Ov/ I C� Giff�_ Mich t R. Langan, Attomey-in-Fact HCCSZZ811B04/10 ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of Los Angeles ) On _ - � Q� 1 lo before me, (insert name and title of the officer) personally appeared Michael R. Langan who proved to me on the basis of satisfactory evidence to be the person( whose name is/arm subscribed to the within instrument and acknowledged to me that helc6 46 uexecuted t e same in his/hefrel?Wuthorized capacit and that by his/hadtheir signaturej on the instrument the person, or the entity upon behalf of which the person ($] acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Signature (Seal) RAQUEL ROTAS COMM. #1980954 z Notary Public • California C z Los Angeles County M Comm. Doha June 27 2016 POWER OF ATTORNEY AMERICAN CONTRACTORS INDEMNITY COMPANY UNITED STATES SURETY COMPANY U.S. SPECIALTY INSURANCE COMPANY KNOW ALL MEN, BY THESE PRESENTS: That American Contractors Indemnity Company,a-California corporation, United States : — �urety�om}tan Maryland corporation l,, and U.S Specialty Insurartee=t-ompnyft as corporation 06 leeuve� e - pan' Ty_ P constitute and appoint: - Cam ies �o —_these resents make, eonI t Michael R. Langan of Pasadena, California its true and lawful Attorney(s)-in-fact, each in their separate capacity if more than one is named above, with full power and authority hereby conferredinits name, place and stead, to-executtMeknowledge and deliver any and all bonds, recognizances, undertakings nst--- !6Mhepiruments or contracts�suret30ifi J#ghIde riders, amendments, on of surety, pro dIGI&O and - n_ eaalty does not exceed ***** "UhaMMOrnMight Hundred Sixty Three Thousand*****'* s Dollars ($ M,$Ci3MOl* ) -- TIdrpower 61 Attorney shall expt hamt f—hrtlier-action on December 08, 2016. This Powell of Attorney is granted-ali cr ao-�iy— authority of the following resolutions adopted by the Boards of Directors of the Companies: Be it Resolved, that the President, any Vice -President, any Assistant Vice -President, any Secretary or any Assistant Secretary shall be and is hereby vested with full power and authority to appoint any one or more suitable persons as Atlomey(s)-in-Fact to represent and act for and on behalf of the Company subject to the following pmv\smns - ttnrn n iaetmaKhe given full power anauthority fir any mlthe lame of and on behalf Frhr-romp" tcfta�knowledge and deliver ar 5Znd311 bow �cgGn2A=e9;=onlmets_agreements or indemnify and other co�tlditimal,, or obligatory undertalung�,tniff(diffia an�----all consents for the reletiOcil etmned Pere ntages-and/o nal estimates on engineering and clonstmethat contracts, and any and aft" a ildounmEntseanceling or terminating Bte= ffiy's limMi§= thereunder, and any such instruments so executed by any such Attorney -in -Fact shall be binding upon the Company as if signed by the President and sealed and effected by the Corporate Secretary. Be it Resolved, that the signature of any authorized officer and seal of the Company heretofore or hereafter affixed to any power of attorney or any certificate relating thereto by facsimile_ud any power of attorney or certificate bearing-f=imile signature or facsimile seal shall be valid and binding upon the Company with respect to - fafLfind. undertakingto which it isanached II I' �NWITNSS WHEREOF The Compame iav caasetft i(j instrument to Ilbe sig11 �ted land their corporate seals to beltewm-a fixg�k_ rs= --=10thday of December, 2012. - — AMERICAN CONTRACTORS INDEMNITY COMPANY UNITED STATES SURETY COMPANY U.S. SPECIALTY INSURANCE COMPANY COrpOr-a'a1S tancroas �i Fp� �I o sCPA it _ Daniel P. Aguilar, Vice President State of California "-`' County of Los Angeles SS: - - O��&iuriber 2012, b r&615 nessa V Tight a notary pui personally appeared Daniel P. Agutfiiay ire I� Am-erican ebflfractors Indemnity C nTMmled7S aces Surety Company and U.S.ISp'ecialty,Insurance Company�rhittpe�ved-tune on the basis of satisfactory evidence to be the person whose name is subscribed to the within instrument and acknowledged to me that he executed the same in his authorized capacity, and that by his signature on the instrument the persons or the entity upon behalf of which the persons) acted, executed the instrument. certt1Euit-rMe LTY OF PER}URY midler thell la II s of the State of EffliSrifiR tlf�a t�ng paragraph 4rm im correct WITNESS i fflmnFand official seal, V. WRIGHT Consensus t ttlgg377� Signature - """ (Seal) @onry Petite -61411 tas Angeles Co my Canm. Es "roaCeG 3. 2618r .�JeanngMe distant Secretary c of Atneticat��gartidsrs Indemnity Company., United $tatesl'Surety Company and S � hmtda�e �inpaa} . do hereby. cerErfMatthcabo,m�n&regoing is a ttueland correct oli',y of a Power of Attxile- T"fflfegE _ td_Comp ntea, w1unch is still in full of cee�nd t�c`t;flrthyermore, the resolutions of the Boards of Directors, set�tfi&fsb cow _Attorney are in full force and effect. -- _ In W itn ss Whereof, I have hereunto set my hand and affixed the seals of said Companies at Los Angeles, California this L9 In day of — 2f — `pO��aaCi0a9ry a.N...... ... I bb l O I £35�{ E Bond No. �' `"�_ fig : 3=_ _ E + 3' Jeannie Lee, / ssistant Secretary Agency No. 3129 :br rMV DMSFA-1 OP ID: KU 11�"k..a ' ' CERTIFICATE OF LIABILITY INSURANCE DATE (MMIOD YYY) o2�zslaols 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 fs 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 Phone: 714-7.1400 32 Andreint & Company -South Coast License 0208825 Fax: 714-327-1499 One MacArthur Place, 927EES; South Coast Metro, CA 92707 CONTACT NAME: PHONE NE Exll FAX A/C Holt A DRMAIL — INSURER(Sl AFFORDING COVERAGE NAIC N INSURED DMS Landscaping DMS Facility Services, LLC INSURER A: Liberty Mutual Fire Ins. Co. INSURER e: 23035 INSURER C: 417 E. Huntington Drive INSURER 0: Monrovia, CA 91016 INSURER E : INSURER F : COVERAGES CF_RTIFICATF NI IMRFR• 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 AO B POLICV NUMBER MMI�DNOY YYY MMIDOYIYEVXYY LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY X TB7-Z91-458727-015 03101/2015 03/01/2016 EACH OCCURRENCE $ 1,000,000 PREMISES Ea occunance S 100,ODO MED EXP(Anyone arson) $ EXCLUDED CLAIMS -MADE aOCCUR PERSONAL a ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER; POLICY X PRO LOC PRODUCTS - COMPIOP AGG $ 2,000,000 $ A AUTOMOBILE X X X LIABILITY ANY AUTO ALL AUTOS OWNED X BCHEBULED AUTOS HIRED AUTOS AS2-Z91.458727.025 03/01/'2015 03/0112016 COMBINED SINGLE LIMIT Ea accfdntt $ 1,000,DOO DCDILY INJURY (Per person) 3 BODILY INJURY (Per accident) 3 PROPERTY DAMAGE Peraccident $ EXCESS UMBRELLA EXCESS LIAR 25L Reviewedby. EACH OCCURRENCE $ AGGREGATE $ DEO _ S WORKERS COMPENSATION. ANDEMPLOYERS'LIABILITY VIN ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? NIA Silvia Cu WC STATU- OTH- TQRY LIMIT ER vas E.L. EACH ACCIDENT $ (Myandatory in NHl le DESCRIPTION OF OPERATIONS below PRCSA/A min. E.L. DISEASE-EA EA EMPLOYEE S E.L. DISEASE - ICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Romarhs Schedule, If more space Is required) SEE ATTACHED HOLDER NOTES SANSANI City of Santa Ana Attn: Purchasing Department 20 Civic Center Plaza Santa Ana, CA 92701 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 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD 8016785 ACC>1? o® CERTIFICATE OF LIABILITY INSURANCE DATE YY) 2/2012015 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(tes) 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 Beu of such endorsement(s). PRODUCER Commercial Lines Wells Fargo Insurance Services USA, Inc. CONTACT NAME: PHONE FAX 888-572-2412 E-MAIL i t cers trnet.com ADDRESS: Q 6100 Fairview Road INSURERIS)AFFORDING COVERAGE _ NAIC_q_ _ INSURER A : ACE American Insurance Company 667 Charlotte, NC 28210 _ INSURED _ INSURER B: Strategic Outsourcing, Inc. INSURER C L/C/F DMS Facility Services, LLC dba DMS Facility INSURER D: Services, LLC - Landscaping Services, LLC INSURER E: PO Box 2414481 Charlotte, NC 28224 INSURER F COVERAGES CERTIFICATE NUMBER: 8751678 REVISION NUMBER: See below 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.r INSR LTRPOLICY TYPE OF INSURANCE ADOLSUBR NUMBER POLICY EFF MMIDDIYYT( POLICY EXP MMIDDIYVYV LIMITS COMMERCIAL GENERAL LIABILITY $ --- RCLAIMS-MADE OCCUR Ea occurrence $ny one person) $ VERRENCE ADV INJURYGENL AGGREGATE LIMIT APPLIES PER: GREGATEPOLICY PRO- �• JECT 1 .l LOG Reviewed Y: -COMP/OP AGE $ $ OTHER: i AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ _ BODILY INJURY (Per person) $ ANY AUTO - ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIREDAUTOS -___!AUTOS -____ Q a C SIIVia CUe �r pRCSAIAd vas 0+`D "� jn. BODILY INJURY (Per accident)!$ - PROPERTY DAMAGE -(Per accident) $ ._ _ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE! DED RETENTION$ $ A WORKERS COMPENSATION YIN AND EMPLOYERS' LIABILITY ANY PROPRIETOWPARTNEWEXECUTIVE OFFICER/MEMBER EXCLUDED? NIA X VVLRC48561116A 03/01/2015 03/01/2016 x STATUTE I - E.L.EACH ACCIDENT $ 1,000,000 - -- E.L_DISEASE - EA EMPLOYEE - $ 1.000,000 (Mandatory lnNH) 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 It more space is required) RE: Districts 1, 4 and 5 Park Landscape RFP Workers' Compensation Coverage is limited to employees leased to DMS Facility Services, LLC dba DMS Facility Services, LLC-Landscaping Services by Strategic Outsourcing, Inc. pursuant to the terms of a fully executed service agreement. City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Attn: Purchasing Department THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 20 Civic Center Plaza Santa Ana, CA 92701 AUTHORIZED REPRESENTATIVE 9/t�-- The ACORD name and Innn are rP.rngtered mark. of ACnRD n 19RA-901d ACr1Rn ('.r)PPr1RATInN AN •Ini.re .e�e...ea ACORD 25 (2014/01) NOTEPAD: . HOLDER CODE SANSANI DMSFA-1 PAGE 2 INSURED-S NAME DMS Landscaping OP ID: KU DATE _. 02/25N 5 of Santa, it;s officers, employees agents and representative are as an additional insured as respec�s General Liability only per hed forms CG 20 10 04 13 and CG 20 37 04 13 which are part of the policy shown above, wording is included pursuant to the attached is part of the insurance policy shown above, Day Notice of Cancellation applies per attached form GL0200, F,eviewed by: �PRCSAJA DMS Facility Services, LLC, etal POLICY NUMBER: TB7-Z91458727-015 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 lr. OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) As specified in a written agreement which is signed in advance of the "occurrence" or offense for which the additional insured seeks coverage. 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 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: 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the addllional insured(s) at the locations) designated above. However: 2. 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. 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 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. Reviewed by: Silvia Cuevas tr18 PRCSA/Admin. CG 20 10 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 2 C. 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 Insurance shown in the Declarations; whichever Is less. This endorsement shall not increase applicable Limits of Insurance shown in Declarations. Reviewed by: Silvia Cuevas�� PRCSAIAdmin. of the the Page 2 of 2 Insurance Services Office, Inc., 2012 CG 2010 04.13 DMS Facility Services, LLC, eta] POLICY NUMBER: TB7-291-458727-015 COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Or, anizat]on s Location And Descri 4ion Of Com IeYed O erations As specified in a written agreement which is signed in advance of the "occurrence' or offense for which the additional insured seeks coverage. 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' 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: 1. The insurance afforded to such additional insured only applies to the extent permitted by law.; and 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. 2. If coverage provided to the additional insured is required by a contract or agreement, the Reviewed by: 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. Silvia Cuevas PRCSA/Admin. L 13 CG 20 37 04 13 po Insurance Services Office, Inc., 2012 Page 1 of 1 Policy Number TB7-Z81.458727-015 Issued by Liberty Mutual Fire Ins, Co. Insured: DMS Facility Services, LLC, etal THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. OTHER INSURANCE AMENDMENT —SCHEDULED ADDITIONAL INSURED This.endorsement mortifies inswanr..e provided under,the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART LIOUOR LIABILITY COVERAGE PART Schedule Eta rganiza:coverag d in a wgreement which is signed in advance of the "occurrence" or offense for which the insured se. It you are obligated under a written agreement to provide (lability insurance on a primary, excess, contingent, or any other basis for any person or organization shown in the Schedule of this endorsement that qualifies as an additional insi fired on this policy, this policy will apply solely on the. basis required by sunh written agreement and Paragraph 4, Other Insurance of Section IV - Conditions will not apply. If the applicable written agreement does not specify on what basis the liability insurance will apply, the provisions of Paragraph 4. Other Insurance of Section IV - Conditions will govern. However, this Insurance Is excess over any other Insurance available to the additlonal insured forwhich it is also covered as an additional insured by attachment of an endorsement to another policy providing coverage forithe same. "nccurrenre", claim or "suit". Reviewed by: Silvia Cuevas PRCSAIAdmin. Lc 24 20 02 10 cc»in8 Liberty Munmi Instiranna. All rights reserved. Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Insured: DMS Facility Services, LLC, at al Policy Number: TB7-Z91-457727-025 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Notice of Cancellation or Coverage Change Endorsement This endorsement modifies insurance provided under the following: COMhIERCIAL GENERAL LIABILITY COVERAGE PART In the event orranceilation or material change that reduces or restricts the insurance afforded by the Coverage Part, we agree to mail prior mitten notice of cancellation or material change to the name and address shown in the schedule. Schedule Mr. of days advance Name Address notice City of Santa Ana, Attn; Purchasing Dept, 20 Civic Center Plaza 30 its officers, employees, agents and representatives -Santa Ana, CA 92701 Reviewed by: Silvia Cuevas J PRCSAIAdmin. / GLO200 Page 1 of 1 03-92