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HomeMy WebLinkAboutENTERPRISE AUTOMATION (3)C� INSURANCE ON FILE VVORK MAY PROCEED UNTIL INSURANCE EXPIRES CLERK 6F COUNCIL DATE: A-2021-025 b:CPta/i) C/{�rnew�a ftrl1Anelez) (1)SM FIRST AMENDMENT TO AGREEMENT WITH ENTERPRISE AUTOMATION THIS FIRST AMENDMENT to the above -referenced agreement is entered into on March 2, 2021, by and between Enterprise Automation ("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-2018-024, dated February 6, 2018, by which Consultant agreed to provide functional specifications and SCADA source and change control services for the City's water production and control facilities ("Agreement"). B. The Agreement remains in effect through February 5, 2023. C. The parties now wish to expand the scope of services and increase the amount to be expended under the Agreement in consideration of the expanded scope. The Parties therefore agree: I. Section 1, Scope of Services, is amended to include services for the following water production and control facilities: • Pressure Regulating Vault 1 • Pressure Regulating Vault 2 • Pressure Regulating Vault 3 • SA-1 • Well 19 • Well 38/Cambridge Station 2. Section 2.a., Compensation, is amended to increase the total sum to be expended for the remaining term of the Agreement by $500,000 and to remove the following sentence: "The annual amount to be expended shall not exceed $200,000." 3. Except as modified by this First Amendment, all terms and conditions of the Agreement shall remain in full force and effect. IN WITNESS WHEREOF, the parties hereto have executed this First Amendment to the Agreement on the date and year first written above. ATTESTt CITY OF SANTA ANA Daisy Gomez Kristine Ridge Clerk of the Council City Manager Page 1 of 2 APPROVED AS TO FORM Sonia R. Carvalho City Attorney By: � ! ,- -fL An M. Funk Senior Assistant City Attorney RECOMMENDED FOR APPROVAL 4 � --33 4 h� Nabil Saba Executive Director Public Works Agency CONSULTANT w By Joshua Riley Title: principal Page 2 of 2 Dlgltally signed by Frandne R. Francine R. Villareal Ylllareal "Date 202D.101 11 3L34.p -01 ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE (MMNDD YYYY) `.� 06/14/2020 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) 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 CONTACT Je((FOrb¢S NAME; ECBM, LP PHONE (610)668-7100 FAX INC No Ext : pNq No (610)667-2208 1400 N Providence Road E-MAIL (orbes ecbm.com ADDRESS; I Suite 5025 INSURER(S) AFFORDING COVERAGE NAIC N Media PA 19063 INSURER A; Lloyds of London INSURED INSURERS: Evanston Insurance Company 35378 Partners in Control, Inc., DBA: Enterprise Automation INSURER c: Federal Insurance Company 20281 210 Goddard INSURER D INSURER E : Irvine CA 92618 INSURER F: COVERAGES CERTIFICATE NUMBER: 20 M RF_VISInN NI)MRFR- 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 AIJUL INSD bonaPOLICY MD POLICY NUMBER EFF MMIDOMIYY I POLICY EXP MM/DDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE %C OCCUR EACH OCCURRENCE $ 1,000,000 GE TORE PREMISES Ea occurrence $ 1,000,000 X MED EXP(Anyone Person) $ 5,000 Contractual Liability I PERSONAL aADV INJURY $ 1,000,000 A Y ARG11212A20 06/15/2020 06/15/2021 GEN'LAGGREGATE LIMITAPPLIES PER: POLICY 19 PRO FX LOG JECT GENERALAGGREGATE $ 2,000,000 PRODUCTS $ 2,000,000 $ OTHER: AUTOMOSILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 X ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS A00006433 06/15/2020 06/1512021 BODILY INJURY (Per aeclden0 $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accident $ UMBRELLA LIAa X OCCUR EACH OCCURRENCE $ 2,000,000 X _EIOED AGGREGATE $ 2,000,000 B EXCESS LIAe CLAIMS -MADE MKLV7EUL100820 06/15/2020 06/15/2021 RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFMCEWMEMBER EXCLUDED? NNA PER OTIT STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NHt If yes, E.L. DISEASE - POLICY LIMIT $ DESCRIPTION DESCRIPTION OF OPERATIONS below A Professional Liability ARG11212A20 06/15/2020 06/15/2021 Each Claim Aggregate $2,000,000 $2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) Re: Contract: 17-112 - The City, its officers, employees, agents, volunteers and representatives are included as additional Insured on the General Liability as required by written contract. The policy includes a 30 days' notice of cancellation, except for non-payment of premium, which is 10 days plus mailing. 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, 4Ih FI AUTHORIZED REPRESENTATIVE Santa Ana CA 92702 yyina RAMAnagmlrntDtWslorL ReAEWEO S APPROVED Sr. ©1988.2015 ACORD� ACORD 2b (2016/03) The ACORD name and logo are registered marks of ACORD R�€k.ManagementMalyxt AGENCY CUSTOMER ID: LOC ADDITIONAL REMARKS SCHEDULE Page of AGENCY ECBM, LP NAMED INSURED Partners in Control, Inc., DBA: Enterprise Automation POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS POLICY NUMBER: ARG11212A20 COMMERCIAL GENERAL LIABILITY CG 20 10 10 01 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 Person or Organization: Blanket as required by written contract. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) A. Section II — Who Is An Insured is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of your ongoing operations performed for that insured. B. With respect to the insurance afforded to these additional insureds, the following exclusion is added: 2. Exclusions This insurance does not apply to "bodily in- jury" 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 addi- tional insured(s) at the site of the cov- ered 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 con- tractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG 20 10 10 01 0 ISO Properties, Inc., 2000 t�^x liieltMxnagemrntD[Wefon a REVIEWED&APPRovm By: SR, VIM �'�—..._---' Rult Management Analyst Policy Number (20)7361-57-65 COMMON POLICY CHANGE ENDORSEMENT Endorsement No. 001 Named Insured PARTNERS IN CONTROL INC Effective Date: 06-15-2020 12:01 A.M., Standard Time Agent Name ECBM LP Agent No. 50215-999 This endorsement will not be used to decrease coverages, increase rates or deductibles or alter any terms or conditions of coverage unless at the sole request of the insured. COVERAGE PART INFORMATION -Coverage parts affected by this change as indicated by x❑ below. ❑ Commercial Property ❑ Commercial General Liability ❑ Commercial Crime ❑ Commercial Inland Marine ❑ COMMERCIAL AUTOMOBILE $ 72.00 The following item(s): ❑ Insured's Name ❑ Insured's Mailing Address ❑ Policy Number ❑ Company Effective/Expiration Date ❑ Insured's Legal Status/Business of Insured ❑ Payment Plan Premium Determination ❑ Additional Interested Parties ❑ Coverage Forms and Endorsements ❑ Limits/Exposures ❑ Deductibles ❑ Covered Property/Located Description Classification/Class Codes ❑ Rates ❑ Underlying Exposure is (are) changed to read (See Additional Page(s) ) SEE NEXT PAGE The above amendments result in a change in the premium as follows: This premium does not include taxes and surcharges. ❑ No Changes ❑ To be Adjusted at Audit I Additional $ 72.00 1 Return Tax and Surcharge Changes Additional Return AUTHORIZE 16-02-0212 (01197) wary, xlek M1lasugnnaiEDNie[an REVIEWED & APPRovED By. RLsk Management Analyst I Policy Number (20)7361-57-65 COMMON POLICY CHANGE ENDORSEMENT Endorsement No. 001 Named Insured PARTNERS IN CONTROL INC Effective Date: 06-15-2020 12:01 A.M., Standard Time Agent Name ECBM LP Agent No. 50215-999 POLICY CHANGES ENDORSEMENT DESCRIPTION (CONT'D) THE POLICY IS AMENDED AS FOLLOWS: ADD BROAD FORM COMMERCIAL AUTO BROAD FORM COVERAGE HAS BEEN ADDED TO THE POLICY. COMMERCIAL AUTO BROAD FORM COVERAGE HAS BEEN ADDED TO THE POLICY. THE FOLLOWING FORM(S) HAS BEEN ADDED: 16-02-0292 11-16 CHUBB BROAD FORM ENDORSEMENT ALL OTHER TERMS AND CONDITIONS REMAIN THE SAME Esc RIBk ManognneeetU[vlefcm REMEXED&APPR4VE?Rr:.. Ruk onagement AnalyA COMMERCIAL AUTOMOBILE THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COMMERCIAL AUTOMOBILE BROAD FORM ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM This endorsement modifies the Business Auto Coverage Form. 1. EXTENDED CANCELLATION CONDITION Paragraph A.2.1b. - CANCELLATION - of the COMMON POLICY CONDITIONS form IL 00 17 is deleted and replaced with the following: b. 60 days before the effective date of cancellation if we cancel for any other reason. 2. BROAD FORM INSURED A. Subsidiaries and Newly Acquired or Formed Organizations As Insureds The Named Insured shown in the Declarations is amended to include: 1. Any legally incorporated subsidiary in which you own more than 50% of the voting stock on the effective date of the Coverage Form. However, the Named Insured does not include any subsidiary that is an "insured" under any other automobile policy or would be an "insured" under such a policy but for its termination or the exhaustion of its Limit of Insurance. 2. Any organization that is acquired or formed by you and over which you maintain majority ownership. However, the Named Insured does not include any newly formed or acquired organization: (a) That is an "insured" under any other automobile policy; (b) That has exhausted its Limit of Insurance under any other policy; or (c) 180 days or more after its acquisition or formation by you, unless you have given us written notice of the acquisition or formation. Coverage does not apply to "bodily injury" or "property damage" that results from an "accident" that occurred before you formed or acquired the organization. B. Employees as Insureds Paragraph A.1. - WHO IS AN INSURED - of SECTION II - LIABILITY COVERAGE is amended to add the following: d. Any "employee" of yours while using a covered "auto" you don't own, hire or borrow in your business or your personal affairs. C. Lessors as Insureds Paragraph A.1. - WHO IS AN INSURED - of SECTION II - LIABILITY COVERAGE is amended to add the following: e. The lessor of a covered "auto" while the "auto" is leased to you under a written agreement if: (1) The agreement requires you to provide direct primary insurance for the lessor; and (2) The "auto" is leased without a driver. Such leased "auto" will be considered a covered "auto" you own and not a covered "auto" you hire. However, the lessor is an "insured" only for "bodily injury" or "property damage" resulting from the acts or omissions by: 1. You; 2. Any of your "employees" or agents; or 3. Any person, except the lessor or any "employee" or agent of the lessor, operating an "auto" with the permission of any of 1. and/or 2. above. Rs eSso�i� r0'9; ht � S4 �Wfk6_ff1—_e45 Udd''e?A Whitten .IffsfTifdd,06fi raet E",Ar0gr9pf &J WaWJN,$ VMRJrs SEGT.ION IL LIABILrTY,-G,GUERAt36 is �rl�l fRd4t?.I)�.14!IP!NS! 7 (1� Qp4C�t,14rl,,itlain��lar"'� �j�e, �f ?,ych 0000 pfgoC zatfgn=Wve ag— ffrtder.affieitprgss I)CegiSig(r avritterf Written R?tMA VW50 d W Y9u pV A �`gy�rr�iei�t�l br P�t��t���tl!o�ft�jtdadd §fi%tlP$r ofi Qriargedzgtr 'fAEl i4p0KY, s§ AN"Ih§U-r-eid" t-Ip6GWOKW040IS 00W-0 o fa690h!1 00Wf)Js Aft. irS WmT010 Form: 16-02-0292 (Rev. 11-16) Page "Includes copyrighted material of Insurance Services Office, Inc. with its per REMEWEDM &AAPPRrnem BY. � ftipp Management:NnalyiS 3. 4. 5. (1) with respect to the operation, maintenance or use of a covered "auto"; and (2) for "bodily injury" or "property damage" caused by an "accident" which takes place after: (a) You executed the "insured contract" or written agreement; or (b) The permit has been issued to you. FELLOW EMPLOYEE COVERAGE EXCLUSION B.5. - FELLOW EMPLOYEE — of SECTION II — LIABILITY COVERAGE does not apply. PHYSICAL DAMAGE — ADDITIONAL TEMPORARY TRANSPORTATION EXPENSE COVERAGE Paragraph A.4.a. — TRANSPORTATION EXPENSES — of SECTION III — PHYSICAL DAMAGE COVERAGE is amended to provide a limit of $50 per day for temporary transportation expense, subject to a maximum limit of $1,000. AUTO LOAN/LEASE GAP COVERAGE Paragraph A. 4. — COVERAGE EXTENSIONS - of SECTION III — PHYSICAL DAMAGE COVERAGE is amended to add the following: c. Unpaid Loan or Lease Amounts In the event of a total "loss" to a covered "auto", we will pay any unpaid amount due on the loan or lease for a covered"auto" minus: 1. The amount paid under the Physical Damage Coverage Section of the policy; and 2. Any: a. Overdue loan/lease 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 lessor: 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. We will pay for any unpaid amount due on the loan or lease if caused by: 1. Other than Collision Coverage only if the Declarations indicate that Comprehensive Coverage is provided for any covered "auto 2. Specified Causes of Loss Coverage only if the Declarations indicate that Specified Causes of Loss Coverage is provided for any covered "auto"; or 3. Collision Coverage only if the Declarations indicate that Collision Coverage is provided for any covered"auto. 6. RENTAL AGENCY EXPENSE Paragraph A. 4. — COVERAGE EXTENSIONS — of SECTION III — PHYSICAL DAMAGE COVERAGE is amended to add the following: d. Rental Expense We will pay the following expenses that you or any of your "employees" are legally obligated to pay because of a written contract or agreement entered into for use of a rental vehicle in the conduct of your business: MAXIMUM WE WILL PAY FOR ANY ONE CONTRACT OR AGREEMENT: 1. $2,500 for loss of income incurred by the rental agency during the period of time that vehicle is out of use because of actual damage to, or "loss" of, that vehicle, including income lost due to absence of that vehicle for use as a replacement; 2. $2,500 for decrease in trade-in value of the rental vehicle because of actual damage to that vehicle arising out of a covered "loss" and 3. $2,500 for administrative expenses incurred by the rental agency, as stated in the contract or agreement. 4. $7,500 maximum total amount for paragraphs 1., 2. and 3. combined. 7. EXTRA EXPENSE — BROADENED COVERAGE Paragraph A.4. — COVERAGE EXTENSIONS — of SECTION III — PHYSICAL DAMAGE COVERAGE is amended to add the following: e. Recovery Expense We will pay for the expense of returning a stolen covered "auto" to you. 8. AIRBAG COVERAGE Paragraph B.3.a. - EXCLUSIONS — of SECTION III — PHYSICAL DAMAGE COVERAGE does not apply to the accidental or unintended discharge of an airbag. Coverage is excess over any other collectible insurance or warranty specifically designed to provide this coverage. 9. AUDIO, VISUAL AND DATA ELECTRONIC EQUIPMENT - BROADENED COVERAGE Paragraph C.1.b. — LIMIT OF INSURANCE - of SECTION III - PHYSICAL DAMAGE is deleted and replaced with the following: b. $2,000 is the most we will pay for "loss" in any one "accident" to all electronic equipment that reproduces, receives or transmits audio, visual or data signals which, at the time of "loss", is: (1) Permanently installed in or upon the covered "auto" in a housing, opening or other location that is not normally used by the "auto" manufacturer for the installation of such equipment; (2) Removable from a permanently installed housing unit as described in Paragraph 2.a. above or is an integral part of that equipment; or (3) An integral part of such equipment. 10. GLASS REPAIR— WAIVER OF DEDUCTIBLE Form: 16-02-0292 (Rev. 11-16) Pa 1 REV EWED&APP20VED BY: "Includes copyrighted material of Insurance Services Office, Inc. with its p F4"4-Ue Rwk Mhnagement Analyst Under Paragraph D. - DEDUCTIBLE — of SECTION III — PHYSICAL DAMAGE COVERAGE the following is added: No deductible applies to glass damage if the glass is repaired rather than replaced. 11. TWO OR MORE DEDUCTIBLES Paragraph D.- DEDUCTIBLE — of SECTION III — PHYSICAL DAMAGE COVERAGE is amended to add the following: If this Coverage Form and any other Coverage Form or policy issued to you by us that is not an automobile policy or Coverage Form applies to the same "accident", the following applies: 1. If the deductible under this Business Auto Coverage Form is the smaller (or smallest) deductible, it will be waived; or 2. If the deductible under this Business Auto Coverage Form is not the smaller (or smallest) deductible, it will be reduced by the amount of the smaller (or smallest) deductible. 12. AMENDED DUTIES IN THE EVENT OF ACCIDENT, CLAIM, SUIT OR LOSS Paragraph A.2.a. - DUTIES IN THE EVENT OF AN ACCIDENT, CLAIM, SUIT OR LOSS of SECTION IV - BUSINESS AUTO CONDITIONS is deleted and replaced with the following: a. In the event of "accident", claim, "suit" or "loss", you must promptly notify us when the "accident" is known to: (1) You or your authorized representative, if you are an individual; (2) A partner, or any authorized representative, if you are a partnership; (3) A member, if you are a limited liability company; or (4) An executive officer, insurance manager, or authorized representative, if you are an organization other than a partnership or limited liability company. Knowledge of an "accident", claim, "suit" or "loss" by other persons does not imply that the persons listed above have such knowledge. Notice to us should include: (1) How, when and where the "accident" or "loss" occurred; (2) The "insured's" name and address; and (3) To the extent possible, the names and addresses of any injured persons or witnesses. 13. WAIVER OF SUBROGATION Paragraph A.S. - TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US of SECTION IV —BUSINESS AUTO CONDITIONS is deleted and replaced with the following: 5. We will waive the right of recovery we would otherwise have against another person or organization for "loss" to which this insurance applies, provided the "insured" has waived their rights of recovery against such person or organization under a contract or agreement that is entered into before such "loss". To the extent that the "insured's" rights to recover damages for all or part of any payment made under this insurance has not been waived, those rights are transferred to us. That person or organization must do everything necessary to secure our rights and must do nothing after "accident" or "loss" to impair them. At our request, the insured will bring suit or transfer those rights to us and help us enforce them. 14. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS Paragraph B.2. — CONCEALMENT, MISREPRESENTATION or FRAUD of SECTION IV — BUSINESS AUTO CONDITIONS - is deleted and replaced with the following: If you unintentionally fail to disclose any hazards existing at the inception date of your policy, we will not void coverage under this Coverage Form because of such failure. 15. AUTOS RENTED BY EMPLOYEES Paragraph B.S. - OTHER INSURANCE of SECTION IV —BUSINESS AUTO CONDITIONS - is amended to add the following: e. Any "auto" hired or rented by your "employee" on your behalf and at your direction will be considered an "auto" you hire. If an "employee's' personal insurance also applies on an excess basis to a covered "auto" hired or rented by your "employee" on your behalf and at your direction, this insurance will be primary to the "employee's" personal insurance. 16. HIRED AUTO— COVERAGE TERRITORY Paragraph B.7.b.(5). - POLICY PERIOD, COVERAGE TERRITORY of SECTION IV — BUSINESS AUTO CONDITIONS is deleted and replaced with the following: (5) A covered "auto" of the private passenger type is leased, hired, rented or borrowed without a driver for a period of 45 days or less; and 17. RESULTANT MENTAL ANGUISH COVERAGE Paragraph C. of - SECTION V — DEFINITIONS is deleted and replaced by the following: "Bodily injury" means bodily injury, sickness or disease sustained by any person, including mental anguish or death as a result of the "bodily injury" sustained by that person. Form: 16-02-0292 (Rev. 11-16) Pa I - rs o� oVED BY. "Includes copyrighted material of Insurance Services Office, Inc. with its p s (t '"NOND Risk Management Pna(pt THE HARTFORD td BUSINESS SERVICE CENTER THE 3600 WISEMAN BLVD HARTFORD SAN ANTONIO TX 78251 City of Santa Ana Risk Management Division 20 CIVIC CENTER PLAZA FL 4 SANTA ANA CA 92701-4058 Account Information: PARTNERS IN CONTROL INC DBA Policy Holder Details : ENTERPRISE AUTOMATION October 15, 2019 %Q Contact Us Business Service Center Business Hours: Monday - Friday (7AM - 7PM Central Standard Time) Phone: (877) 287-1312 Fax: (888) 443-6112 Email: agencv.services(o).thehartford.com Website: https://business.thehartford.com Enclosed please find a for the above referenced Policyholder. Please contact us if you have any questions or concerns. Sincerely, Your Hartford Service Team WLTRO05 0.'— Risk MpnagtmadlxNalon RkVIEW®&APPROVm BY: Risk Management Analyst `'10�1b CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDNYYY) 10/15/2019 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(les) must be endorsed. If SUBROGATIONIS 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 PAYCHEX INSURANCE AGENCY INC CONTACT NAME: PHONE (877)266-6850 (AIC, No, Exl): FAX (585)389-7894 (I No): 76210705 150 SAWGRASS DRIVE E-MAIL ADDRESS: ROCHESTER NY 14620 INSURER(S) AFFORDING COVERAGE NAIC# INSURER A: Property and Casualty Insurance Company of Hartford 34690 INSURED INSURER B : PARTNERS IN CONTROL INC DBA ENTERPRISE INSURER C: AUTOMATION INSURER D: 210 GODDARD INSURER E : IRVI NE CA 92618-4625 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 ADOL INSR SUBR Me POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MMIDDIYYYV LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE CLAIMS -MADE OCCUR DAMAGE TO RENTED PREMISES Ea occurrencel MED EXP (Any one person) PERSONAL & ADV INJURY GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE POLICY ❑ PRO- ❑ JECT LOC PRODUCTS - COMPIOP AGO OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident BODILY INJURY (Per person) ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) HIRED NONOWNED PROPERTY DAMAGE AUTOS AUTOS (Per accident) BRELLALIgB OCCUR EACH OCCURRENCECESS LIAB J CLAIMS -AGGREGATE MADE RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY X IPER ISTATUTE I OTH- HER E.L. EACH ACCIDENT $1,000,000 A ANY YIN PROPRIETORIPARTNERIEXECURVE OFFICEWMEMBER EXCLUDED? NIA X 76 WEG G81737 11/13/2019 11/13/2020 E.L. DISEASE -EA EMPLOYEE $1,000,000 (Mandatory, In NH) If yes, describe under E.L. DISEASE -POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) Those usual to the Insured's Operations. Blanket Waiver of Subrogation applies in favor of the Certificate Holder per the Waiver of Our Right to Recover from Others Endorsement WC040306, attached to this policy. CERTIFICATE HOLDER CANCELLATION City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED Risk Management Divislon BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED 20 CIVIC CENTER PLAZA FL 4 IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE SANTA ANA CA 92701-4058 �S Or C�&121, © 1968-2015 ACORD COR ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD ,,ae ^awe lttekManegenlentDlvieton REVIEWED&pAPrPFRovEDBY: Risk Management Analyst Ul THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA Policy Number: 76 WEG GB1737 Endorsement Number: Effective Date: 11/13/19 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: PARTNERS IN CONTROL, INC. 210 GODDARD IRVINE CA 92618 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 % of the California workers' compensation premium otherwise due on such remuneration. SCHEDULE Person or Organization Job Description Blanket Coverage Countersigned by Syr —a RiskMarwgementlAisim on{pa4 REMEWEDSAPPRW@BY: Form WC 04 03 06 (1) Printed in U.S.A. s Process Date: 10/03/19 Policy E R kMrnasrmenc uniyse