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HomeMy WebLinkAboutSERVICE FIRST CONTRACTORS DBA SERVICE 1STc; MAYOR Miguel A. Pulldo MAYOR PRO TEM �.J Juan Viliegas COUNCILMEMBERS F— �-� Phil Became G Nelida Mendoza David Penaloza Vicente Sannlento Jose SOlOda I?SdRAkv !:UriFu WORK MAY PF; ! ; UNTIL INSIJI CLERK OF COUNCIL SATE CITY OF SANTA ANA PARKS, RECREATION, AND COMMUNITY SERVICES AGENCY 20 Civic Center Plaza • P.O. Box 1988 Santa Ana, California 92702 w .sanlaana.oro September 25, 2020 Service First Contractor's Network dba Service la` 2510 North Grand Avenue, Suite 110 Santa Ana, California 92705 Attention: Frank Vandenberg, President A-2017-350-02 CITY MANAGER Kristine Ridge CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL Daisy Gomez, MMC Re: Extension of Agreement No. A-2017-350 to Provide Fountain Maintenance and Repairs. Dear Mr. Vandenberg: Pursuant to Section 3 ("Term") of the above -referenced Agreement, entered into by Service First Contractor's Network dba Service 1" and the City of Santa Ana, dated December 19, 2017, the term of the Agreement is hereby extended for the second and final one-year period, from January 1, 2021 through December 31, 2021. Any insurance certificates are required to be extended and/or renewed to cover this extension. All other terms and conditions of the Agreement, remain unchanged and in full force and effect. Please sign below and return this extension to the City at your earliest convenience. Sincerely, 6,4 V. Rudloff Executive Director, Parks, Recreation, and Community Services Agency CITY OF SANTA ANA I{ristine Ridge ` City Manager APPROVED AS TO FORM A.Rt Laura A. Rossini Acting Chief Assistant City Attorney ATTEST r t Daisy Gomez, CMC Clerk of the Council / IST 'i Francine R. Digitallly mnd signed by Fneit Villarl Villareal Dace 202e.11006 1034.13-07ba' •""" N12KVICE FI JEANA CERTIFICATE OF LIABILITY INSURANCE �` OATEiMNiODNYYY) �_ - Tisel2ozo THIS CERTIFICATE 1$ ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON •rHE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND EXTEND OR ALTER THE COVERAGE AFFORDED BYTHE POLICIES BELOW, THIS CERTIFICATE OF INSURANCE GOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. ^If IMPORTANT: kh0 cardB orde holder Is an ADDITIONAL INSURED, the policy{les) must have ADDITIONAL INSURED Provisions or be endorsed. If $UBROGATION IS WAIVED, aubloct to the terms and conditions Of the pWlny, oartaln policies may require an endorsement. A statement on this Ce�N6oete days not confer dable to lhS eartifiuste holder in Rau of auoh andoraemenl PROD11Oaa CT The Woudltch Company Insuranue Services, Inc, °t"q 848�559•BBDU Na 1 SA9 853A870 1 Park Plains Suite 400 -— _-____�I _ kvine, CA Rd14 ...._.-._ 11auR_9K91.AEE9SpINQMRS9.gG9 ___--__ 9_._ iNauREERA,GuldaOneNationallnaurance00mnan,r��14167_,___ -_-.•_--..-.-..__...._.-__--_� .�._.._._____..—_ Service FIB: I ��--- 2910 North Grand Ave, Ste. 110 fN$URER II t ^ Santa Ana, CA 92705jKli---•----------_.����______....— u ER a: WBURIm is CERTIFICATE NUMBER• O. NUMBER: THIS IS TO CERTIFY THAT THE PUUOIES OF INSURANCE LISTED OELOW HAVE SEEN ISSUED TOTHE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM ON CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIPICATE MAY BE ISSUED OR MAY EXCLUSIONS ANb CONbnIONS bP SUCH_ PERTAIN, THE INSURANCE AFFORDED BY THE POUCIES POLICIES. LIMITS SHOWN MAY HAVE SEEN REDUCED_B_Y DESCRISED HEREIN IS SUBJEOTTO ALL THETERMS, PAID CLAIMS, a Tvaa OPINaURANCa DL sue PtlCPY NOMOaR P— — _ (d P A X oMMONOIAL09NERALLMEMITY �1r0•�0,000 _ cLAM0.5.NADE ! X j OCCUR X 583000008.00 9/1l2020 Q5',GLRRENOR 51112021 7ORRNTIRD �— 100,0 0 ..I—.-'---------------- .NP.ue�IMyo_ngla+lBgnL._.!-_-- t0,00A . _ aaHa4NL,.A-Nt�'IN�43Y .t.___-91-•g00'a00 .OWL AOGREGATFLIMn APPIJaa PER: "PWOYiX,W& '., LOT: I��I.AOrnPnA16... i.� A,000,$AA 2,1—ifibb00 _-. BDJ1...____. .fHOIYB:.�DSOP.KHir GG —___ AUMMOOLa LAwnry — 1 ORINGLE MI7 — : AppNWmVNyAnTD EOHFSUk.ED ,�,(�,yLYIPLIpRy.{-nor j ads 9F.v o LB .9BWInYIWORY .a iltal a"l nil AGE a 1 §...___ .. .!-. _.. —.1 r uasaaLlA use RXmla3 WAe 4 OCCLA OLAIMRAIADa RAC Qc IyR�ENCR __ Y ggaRRGn'fE-___,._,._,_�.—._.._._ ------------___ Wppap�EOg 1 ALTpE�Nrtax6 �� T'pa pA�NypagNPLOV}CpReygpLplAAe�iILS YIN. aPFi�E MBEB EXCLUDff?* I__ NIA Wan war n Ilyyaaa,, Eaeorlb, ualw CL, 019EABn _EA F,MPL _u-- pEBCI PT 710NB below I I I 8 DE6G PTNNl OP aPGRAT10Ne/L GAT ONafyaNlCLft4 IACORp 1FlrAadlaenal Remerb BaheUWe may be munsom VmareapaaP le raeulrml RE: IUy opamtloro performoby the Named Insured during SlS currant policy period, DIa1p Cityy itSW Ana d e Managemendorsement It's afNcers, employees, SPARS. represordathers, and vSlumoore are included as Addldonal Ineureds me respects General LIAhiXty per altaalred endorsement This iasU m ano shell apply as Primary and N n-COIndbutory per atlachad endorsement. City of Santa Ana Rlok Managarnenf Division 20 Civic Center Plaza, 4th Floor Santa Ana, CA 02702 SHOULD ANY OF THE ABOVE OI:aCR10EO POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE 1NERROP, NOTICS WILL HE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ®1988.201 S ACORD CDR The ACORD name and logo are registered marks of ACORD Rtek Margemenh 1>Meton. Mit; ROVEMO le APPROVED BY: Fn6.F�&%m8 .P, Il;�k0g Rbk Management Analyst rl COO" CERTIFICATE OF LIABILITY INSURANCE DATRINM DD YYYYI 0130/2020 THIS CERTIFICATE 18 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS 09RTIRCATE 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 poi cy(les) most have ADDTIONAL INSURED ArVlsiOnspOr he endorsed. If SUBROGATION IS WAIVED, subteat tb the terms and conditions of the policy, Certain policies may require an endorsement. A statement on thin certificate dam not confer rights to the Certificate holder In lieu of auCA ondomement(s). PRODUCER CO G1?A Solutions, Inc. P" ,,. a6a•sBt Da07 10 Plaza Real South :_ceAs�gjgasnNeR.corn _-------.....__._— . $to 201 Soon Piston FL33432 INSURSR(S)AFFORDINOCOVERAOR INIUMERA, STATE NATL INS CO INC — 12831 INe ry SarviclDe First M&WIRRaY 2510 North Grand Ave Santa Ana CA92705_-- COVERAGES CERTIFICATE NUMBER: 360056837 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. NOTIMYHSTANDING 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 APFORDEO BY THE POLICIES CESCRISED HEREIN 18 SUBJECT TO ALL THE TERMS, EXC_LVSIONSAND CONDITIONSOF SUCH POLICIES. LIMITS SHOWN MAY HAVE REENREDUCFDBYPAIO CLAIMS.__-_ TYPO OFINSURANOR ICY U O 0 Icm"'"' -- OOMMERiNALODNERALLIADIUTY EACHOCCURRENCE S CLAIMS MADE L]OCCUR PREMISESISES iC INT50 my _ b 5__-- PERSONALARW INJURY --___� OENLAQeRE TGP(LAIR�MOpI.TAP''P'L'I-EOPER:� OENEAAL AO,QRECMTE S _ POLN:Y JECT L__.f LOO PRODUCTS-CDMEIPA00_ OTHER:— S AUTOMOBII. MAUILI1Y ANYAUrO RWILV INJURY S+afpeMOn) d DANEtl� SCHEDULED AUTOSONLY AUTOS '�"� 6001LY INJURY (PeraeeMe00 $ --- ----- HIRED OWOMEO P M ,_.. AUTOS ONLY _. AUTOBbNLY aracN, ql— S UmM9UAUAe OCCUR —eT EAOIOCOU NGE EKOESSUAB OLNM&MADE AOORSWIR S 1-yea I I SUCH A WORKERS COMPENSATION AN17(.W2-ODG7.00M1 10/irdU2o SM1r2021 X ANORMPLOVERS'LIAWMY ViN —_ ANYPROPRIE'n YARTNERIEAECUTNF. MIA aL. RACH ACCIOEM 8,,,QW r100 OFPICEPoMEMBP.n E%OLUDEtl1 ❑ INendaterYD1NIO _ — R.L,mBEAea-OA EMPLOYER ^- i2Ig0i000—___ III FIPaI'IONOFOPE�ATIONS R.L. DIG-POLIOYUMIT St000000 066091PTION OF OPERATIONS ILOCATIONS IVEHIOLES IACORD101.AddiftalRemarks 00odeie, MyOnafthed RMON ymae bmgMMdi City of Santa Ana Rlsk Management Division 20 Civic Center Plaza, 4th Floor Santa Ana CA 92702 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE T'HE EXPIRATION DATE THEREOF, NOTICE WILL BB DELPIERED IN ACCORDANCE MTN THE POLICY PROVISIONS, ACORD 25 (20116103) Thu ACORD name and logo are registered marks of ACORD NlekMmrgYnxntDNlelon REVIEWED &APPRovQI aw. Rkk Managemftl Analyst AGUNCY CUSTOMER ID; SERVICE FI JEANA ADDITIONAL REMARKS SCHEDULE Page 1 of 1 WHO 110 5E_E PASSE 1 -,._____----------------- .---- .] aAIC Cena 312E PACE 1 SEE P 1 THIS AbOITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: A6009.91 FORM TITLE: Cattlllcate of LlohiiN lnsuranoe Cancellation: "Except for 1 S days notice of cancellation for non payment of premium. *Should this policy be cancelled before the expiration date, The Wooditch Company will mall 30 (thirty) daya written notice to those Certificate Holders which require such action per contract or agreement,* The ACORD name and logo are registered marks of ACORD aRick ManagmmanE Aiadcm ,:REVIEWEn&ArPaoven OrFAA$O c Z vabwd t hk MAnayclmnt Analyst POLICY NUMBER: 563000006-00 COMMERCIAL GENERAL LIABILITY CG 20 37 0413 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 PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Parson(s) Or 0 antzation a Location And Description Of Completed Operations All locations. As required by written contract. If anyone, otter than the Additional Insured, provides similar Insurance for the Additional Insured, then this Insurance Oil apply as outlined in SECTION IV - COMMERICAL LIABILITY CONDITIONS, paragraph 4. Other Insurance, subparagraph c. Method of Sharing. The Inclusion of one or more Insured(s) under the terms of this endorsement does not increase our limits of liability. All other farms and conditions remain unchanged. Information required to complete this Schedule, If nat shnwn above will be shown In the Declarations. A. Section II — Who Is An Insured is amended to Include as an additional Insured the peraon(s) or organizatlon(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 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. CO 20 37 0413 0 Insurance Services Office, Inc., 2012 .". Rk4Mu+sgetnantDWlelan gaEmwE0&APP1R'oIvCw8yI.. 3 1'�d�'MFst'PQ �, Y+�SN+aPw ". 1 MManagement Analyst S. 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 requlred 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. Page 2 of 2 0ISO properties, Inc., 2004 RlskkMnnageaklitnt�lelon. AlmjRWOMD&APPROVEDBy.. P. V Risk klanagement Analyst POLICY NUMBER: 508000006-00 COMMERCIAL GENERAL LIABILITY 0020100413 THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. ADDITIONAL INSURED ^ OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modules Insurance provided under the following; COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) OrOrnanlzaUon(s) Location & Of Covered Operations Any Location As required by written oontracL If anyone, other than the Additional Insured, provides similar Insurance for the Additional Insured, then this Insurance will apply as outlined in SECTION IV — COMMERICAL LIABILITY CONDITIONS, paragraph 4. Other Insurance, subparagraph c. Method of Sharing. The Inclusion of one or more Inau'ed(s) under the terns of this endorsement does not increase our limits of liability. All other terms and conditions remain unchanged. Information re uired to complete this Schedule if not shown above vdll be shown in the Declarations. A. Section ll - Who is An insured is amended to Include as an additional Insured the person(s) or organizalon(s) shown In the Schedule, but only with respect to Ilability for "bodily injury", "properly damage" or "personal and advertising injury" Caused, in whole or In part, by: 1, Your acts or omissions; or 2. The acts or omissions of those acting on your behalf in the performance of your onglotng operations for the additional Insured(s) at the location(s) deslgnated 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 then that which you are required by the contract or agreement to provide for such additional insured. CC" 2010 0413 0Insurance Services Office, Inc., 2012 Rlek Marag�n"nEDIWeIvn REAMED&APPR'D�vex BYe, t Risk MnnaVMa0tAnalySt S. 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 insursd(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: 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. Page 2 of 2 0 Insurance Services Office, Inc., 2012 _ RlakMawgemenklxWeWn Aewex�q & Aaraovrn BY: +' ^' R[sk Managemen[Mnlysl r� Policy Number: 668000006.00 COMMERCIAL GENERAL LIABILITY 0020010413 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 PRODUCTS/COMPLETED OPERATIONS LIAWLITY 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 01 0413 0 Insurance Services Office, Inc., 2012 trekMV4PRQ4DW6n a—'s REMMAD&APPROVH0aV: Riskfulanagein¢n4Malyst AC"UW7 CERTIFICATE OF LIABILITY INSURANCE n0913012020' .; THIS CERTIFICATE IS ISSUED AS A MATTER QF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFIGATE 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($), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. MPORTANTI If the CartlOcste holdor Is an ADDITIONAL INSURED, the polioy(les) must ha-11 endorsed. If SUBROGATION IS WAIVED, suhlect to the terns and Conditions of the po0oy, certain polioles may require an endorsement. A statamant an tills oertlRaate dose not confer rights to the certificate holder In ilea of such ondorsomont s . Pnanuaas STATE FARM INSURANCE ,4teteFafrn 1370 BREA SLVD STE. 150 FULLERTON, CA 92835 -,,,,..,. _�, C,01ACTJOrYMONTGOMERY 011 .714-028-7001 .714-525.0348 MAIL COM D s JOEY�JOEYMONTO INSURkR13)AFFORDINgRBINO COVPJtAaa NNC e�RBRA State Farm Mutual Automobile lAsurence Compelry 2g170 INSURED SERVICE FIRST 2510 N GRAND AVE SUITE 110 SANTA ANA, CA 92705-8754 INSURERa 219e9S9 0; INSURER D 1 SURBRB: .._. [WROR THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITII$TANDINO ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT'IMTH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONSAND CONDITIONS OFSUCH POLICIES. LIMITS SHOWN MAY HAVEBEEN REDUCED BY PAID CLAIMS. TR Type OF INSURANCE MUL am WOR In POLICYM IR P I C BX LIMn'e ,-•_— DOMNF.RCIALOENRRALLIAe1LBY _. MAIMS•MADa ❑OCCUR �_.,.-,..,.,. CACHgDCURRENaB S 'MISE __ _� •-_^�-� MEO EXP Ln we Person)$ .--� PERBONALBAVI INJURY $ OEN'L AGORCOATE LIgM0IT.APPLIESPan; POLICY�jEOT EILOO CR GENERALAOaREeATE $ PRODUCTS-OOMPIOPAGO $ $ A AUTOMOBILE X LIABILITY ANY AUTO ALLOMO I V I SCHEDULED AUTOS NqN OWNCtl tNRRDAUTOS X AUTOS Y Y 1333423-FOO.75 ow"t2020 OW07J202t BODILY INJURY(Porper+on) $ 1,000,Oso $ BODILY INJURY (ParaccMaN) $ _ S $ UaBRELLALIAB EXCESS LIAR mm I OCCUR CIAIMSJMOE EACH OCCURRMIC15 S AOOREOATE $_ DIED I I RKMUTION _ $ . WCRRIRBCOMPaNeATWN AND EMPLOYERS' LIABILITY ANY PNOPRIETORIPNRTNERJEXEOVrIVe YIN lFFIC fry InBER CLUDED? 0 NHI I d NO order CT ttOFOIONSoelow NtA F.L. EACH ACCIDgff $M — &L. DISEASE- FA ElOtOYE ,., $ E.L. DISFAIB-POLICY LIMIT DEaoMPMN OF OPERATIONS/ 1.00ATIORB IV914MO(ACOR0101. Addilonal Commas$ahedulo, may No oaxohod if more spoeo is mjulred) The City City of Santa Ana, Risk Management, Its officers, employees, agents, representatives, and volunteers as additional Inureds. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED OR REDUCTION IN COVERAGE BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL MAIL a30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED BELOW. City of Santa Ana Risk Management Division 20 Civic Center plaza, 4th floor Santa Ana, CA 92702 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE OANOML50 eEFORF THE EXPIRATION DATE THEREOP, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ACORD 25 (2014101) -: The ACORD name and logo are regletorad marks of ACORD Rtek M1MIAgmlalE nMe1mL REVIEWED &APPROVE] EYa. „ f4m-d Ha R, Mwd RUkMnnnOemenl Analyst RAM SECTION 11 ADDITIONAL INSURED ENDORSEMENT Policy No.. 133 3423•F09.75 Named Insured. SERVICE FIRST 2510 N GRAND AVE SUITE 110 SANTA ANA, CA 92705 Additional Insured (include address): The City of Santa Ana, Risk Management, its officers, employees, agents, representatives, and volunteers as additional inureds. City of Santa Ana Risk Management Division 20 Civic Center plaza, 411 floor Santa Ana, CA 92702 WHO IS AN INSURED, under SECTION it DESIGNATION OF INSURED, is amended to include as an insured the Additional insured shown above, but only to the extent that liability is Imposed on that Additional Insured solely because of your work performed for that Additional Insured shown above. Any Insurance provided to the Additional Insured shall only apply with respect to a claim made or a suit brought for damages for which you are provided coverage. The primary Insurance coverage below applies only when there Is an "X" in the box. ® primary Insurance. The Insurance provided to the Additional Insured shown above shall be Primary insurance. Any insurance carried by the Additional Insured shall be noncontributory with respect to coverage provided to you. All other policy provisions apply. MOOD printed in U.SA. a°,. RlekManagssner�tl3tvtelon --, RiWanagemenl Anal9st FE-6671 PAGE IOFI WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US SCHEDULE Policy Number: 133 3423-FO9-75 Named Insured: SERVICE FIRST 2510 N GRAND AVE SUITE 110 SANTA ANA, CA 92705 Name and Address of Person or organization: City of Santa Ana Risk Management Division 20 Civic Center Plaza, 0 floor Santa Ana, CA 92702 The following is added to Paragraph 10.b of SECTION [AND SECTION 11— COMMON CONDITIONS: We waive any right of recovery we may have against the person or organization shown In the Schedule because of payments we make for Injury or damage arlsing out of: a. Your ongoing operations; or b. Your work done under contract with that person or organization and included in the products- completed operations hazard. This waiver applies only to the person or organization shown in the Schedule. All other policy provisions apply FE-6671 (6, Copyright, State Farm Mutual Automoblle Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc. with Its permission FE•6671(04-09i Printed In USA "A%nugx+ne HxV*bbn RE�vIE%ED & Mle!lp�ovw By., I—®r, c RISI, Mana94ment Malys[ signed Tori Pierson Wtt'ea21021.10.11308:15:25e0700' SERVICE FI JEANA ,d►coRO CERTIFICATE OF LIABILITY INSURANCE DAT/13/2D/Y 1 813/2021 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 CONTACT NAME: (A/CC,Nro, Ext): (949) 553-9800 FAX No):(949) 553-0670 The Wooditch Company Insurance Services, Inc. 1 Park Plaza, Suite 400 Irvine, CA 92614 A DD E-MAIL INSURERS AFFORDING COVERAGE NAIC # INSURERA:United Specialty Insurance Co. 12537 INSURED INSURER B : INSURER C7 Service First INSURER 7 2510 North Grand Ave, Ste. 110 Santa Ana, CA 92705 INSURER E INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 1 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR X ATN2118412 8/1/2021 $/1/2022 DAMAGE TO RENTED PREMISES Ea occurrence 100,000 $ MED EXP (Any oneperson) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X 71 PEA LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY Perperson) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ PROPERTY DAMAGE ccident Per accident) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N PER OTH- STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) N / A E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: All operations performed by the Named Insured during the current policy period. glaip City of Santa Ana, Risk Management, it's officers, employees, agents, representatives, and volunteers are included as Additional Insureds as respects General Liability per attached endorsement. This Insurance shall apply as Primary and Non -Contributory per attached endorsement. City of Santa Ana Risk Management Division 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 PROM—— Rie(r Mowganenf Division AUTHORIZED REPRESENTATIVE 4 ' -. NEVIEwEo & APPROVED BY: %mri Pe`err ww Risk Management Clerical Aisle ACORD 25 (2016/03) © 1988-2015 ACORD CC6r y The ACORD name and logo are registered marks of ACORD AFRO AGENCY CUSTOMER ID: SERVICE FI LOC #: 1 ADDITIONAL REMARKS SCHEDULE AGENCY NAMED INSURED Service First 2510 North Grand Ave, Ste. 110 POLICY NUMBER Santa Ana, CA 92705 EE PAGE 1 CARRIER NAIC CODE EE PAGE 1 SEE P 1 EFFECTIVE DATE: SEE PAGE 1 LDDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance JEANA Page 1 of 1 Cancellation: *Except for 10 days notice of cancellation for non payment of premium. *Should this policy be cancelled before the expiration date, The Wooditch Company will mail 30 (thirty) days written notice to those Certificate Holders which require such action per contract or agreement.* Ri.k Manag�neni Division ReAEwED 6 APPROVED 8": +i laze Pe ACORD 101 (2008/01) © 2008 ACORD COR Risl(Manage RnE Ci enralA dz The ACORD name and logo are registered marks of ACORD POLICY NUMBER:ATN2118412 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: As Required By Written Contract, Fully Executed Prior To The Named Insured's Work (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applica- ble 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 liabil- ity arising out of your ongoing operations performed for that insured. B. With respect to the insurance afforded to these addi- tional insureds, the following exclusion is added: 2. Exclusions 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 ser- vice, maintenance or repairs) to be per- formed by or on behalf of the additional insured(s) at the site of the covered opera- tions 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 organiza- tion other than another contractor or sub- contractor engaged in performing opera- tions for a principal as a part of the same project. CG 20 10 10 01 © ISO Properties, Inc., 2000 Ri&>,i Dhiakm ReoEwm & APPROVED BY' Risk NFanagement Cl eriral Aide r wyc I VI I LJ POLICY NUMBER: ATN2118412 COMMERCIAL GENERAL LIABILITY CG 20 37 10 01 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: As Required By Written Contract, Fully Executed Prior To The Named Insured's Work Location And Description of Completed Operations: As Required By Written Contract, Fully Executed Prior To The Named Insured's Work Additional Premium: Included (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applica- ble to this endorsement.) 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 work" at the location designated and described in the schedule of this en- dorsement performed for that insured and included in the "products -completed operations hazard". CG 20 37 10 01 © ISO Properties, Inc., 2000 Ri&>,i Dhiakm ReoEwm & APPROVED BY' Risk NFanagement Cl eriral Aide POLICY NUMBER: ATN2118412 United Specialty Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. VEN 051 00 (02/20) PRIMARY AND NON-CONTRIBUTING INSURANCE ENDORSEMENT This endorsement modifies the Conditions provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART The following is added to SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS of the COMMERCIAL GENERAL LIABILITY COVERAGE PART, and supersedes any provision to the contrary: Primary and Non -Contributory Insurance Any coverage provided to an Additional Insured under this policy shall be excess over any other valid and collectible insurance available to such Additional Insured whether primary, excess, contingent or on any other basis unless: a. (1) The Additional Insured is a Named Insured under such other insurance; and (2) A fully written contract fully executed prior to the Named Insured's commencement of work for such Additional Insured for the specific project that is the subject of the claim, "suit," or "occurrence" expressly requires that this insurance: (i) apply on a primary and non-contributory basis; and (11) would not seek contribution from any other insurance available to the additional insured. or b. Prior to a loss, you request in writing and we agree in writing that this insurance shall apply on a primary and non-contributory basis. Name Of Person(s) Or Oraanization(s) Required By Written Contract, Fully Executed Prior To The Named Insured's R ek Beni nrvisim All other terms, conditions and exclusions under this policy are applicabl( R"E10eD6 APPROY®BY: Endorsement and remain unchanged. `' I lazeP - Risk Management ❑erir lAide Is VEN 051 00 (02/20) Page 1 of 1 CERTIFICATE OF LIA THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONL CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND. BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITU' REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the the terms and conditions of the policy, certain policies may require an 4 certificate holder in lieu of such endomement(s). PRODUCER STATE FARM INSURANCE fatefa m 1370 BREA BLVD STE. 150 A FULLERTON, CA 92835 W � INWKEa SERVICE FIRST 2510 N GRAND AVE SUITE 110 SANTA ANA, CA 92705-8754 COVERAGES CERTIFICATE NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSUR INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBE EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS TYPE OF INSURANCE COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR GENT AGGREGATE LIMIT APPLIES PER: POLICY u JEQ LOC A AUTOMOBILE LIABILITY G Y I Y 1 133 3423-17094S ANY AUTO ALLOSMED � SCHEDULED Ix AUTOS H3RED AUTOS X NON -OWNED AUTOS UMBRELLA LIAR OCCUR EXCESS LIAR CLAIMS -MADE DED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS" LIABILITY Y I N ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBEREXCLUOED? ❑ NIA (Mandatory in NH) If yes, describe under 06/0712021 1 06/07/2022 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Addttiooal Remarks Schedule, may be attached If more space Is requlr The City of Santa Ana, Risk Management, its officers, employees, agents, representatives, and volunteers as add) SHOULD ANY OF TrIE ABOvE aE5GRIBImU POLICIES BE CANCELLED OR REDUCTION IN COVERAGE BEF THE ISSUING INSURER WILL MAIL *30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED 8 HOLDER City of Santa Ana Risk Management Division 20 Civic Center Plaza Santa Ana, CA 92702 ACORD 25 (2014101) TION BILITY INSURANCE OATE 1- 08/19/29/2IY1 021 Y AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES rE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to Indorsement A statement on this certificate does not confer rights to the NAME: JOEY MONTGOMERY PHONE o Ext 714-528-7001 _ AIC �1 AAic No :714-526-fl34$ ADDRESS, JOEY@JOEYMONTGOMERY.COM INSURERS AFFORDING COVERAGE NAIC q iNSURERA:State Farm Mutual Automobile Insurance Company 25178 INSURERS:^_ INSURERC: - INSURER D : INSURER E INSURER F NUMBER: !ED NAMED ABOVE FOR THE POLICY PERIOD DOCUMENT WITH RESPECT TO WHICH THIS ED HEREIN IS SUBJECT TO ALL THE TERMS, LIMITS EACH OCCURRENCE $ G TOR—LKT 0 — PREWSES Ea occurrence) $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE _— $ _ PRODUCTS- COMPIOP AGG $ COMBINE SINGLELIMIT Ea accident $ 1,OOO,D00 BODILY INJURY (Per person) $ BODILY INJURY (Peraccadent) $ PROPERTY DAMAGE $ ;Per accident) EACH OCCURRENCE $ AGGREGATE $ STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE -POLICY LIMIT $ ad) tional inured. ORE THE EXPIRATION DATE THEREOF, ELOW. SHOULD ANY OF THE ABOVIE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. REPRESENTATIVE 0 1988.2014 AC The ACORD name and logo are registered marks of ACORD Rhie Mawgonort Divhian LI-LLk1 RsAEIV® & Br yAmovE� GIIa�., %aTG Y[f/tP.ar6 Risk Marugemeni CI erica) Aide F E-6609 SECTION II ADDITIONAL INSURED ENDORSEMENT Policy No.: 133 3423-Fo9-75 Named Insured: SERVICE FIRST 2510 N GRAND AVE SUITE 110 SANTA ANA, CA 92705 Additional Insured (include address): The City of Santa Ana, Risk Management, its officers, employees, agents, representatives, and volunteers as additional inured. City of Santa Ana Risk Management Division 20 Civic Center Plaza Santa Ana, CA 92702 WHO IS AN INSURED, under SECTION II DESIGNATION OF INSURED, is amended to include as an insured the Additional insured shown above, but only to the extent that liability is imposed on that Additional Insured solely because of your work performed for that Additional Insured shown above. Any insurance provided to the Additional Insured shall only apply with respect to a claim made or a suit brought for damages for which you are provided coverage. The Primary Insurance coverage below applies only when there is an "X" in the box. Primary Insurance. The insurance provided to the Additional Insured shown above shall be Primary insurance. Any insurance carried by the Additional Insured shall be noncontributory with respect to coverage provided to you. All other policy provisions apply. FE-6609 Printed in U.S.A. rc;�k Beni nrvisiort 1, R"EwED 6 APPROVED BY: + ,ze Risle Management Cierir lAide FE-6671 PAGE 1 OF 1 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US SCHEDULE Policy Number: 133 3423-1`09-75 Named Insured: SERVICE FIRST 2510 N GRAND AVE SUITE 110 SANTA ANA, CA 92705 Name and Address of Person or Organization: City of Santa Ana Risk Management Division 20 Civic Center Plaza Santa Ana, CA 92702 The following is added to Paragraph 10.b of SECTION I AND SECTION II — COMMON CONDITIONS: We waive any right of recovery we may have against the person or organization shown in the Schedule because of payments we make for injury or damage arising out of: a. Your Ongoing operations; or b. Your work done under contract with that person or organization and included in the products - completed operations hazard. This waiver applies only to the person or organization shown in the Schedule. All other policy provisions apply FE-6671 V, Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc. with its permission FE-6671(04-09) Printed in USA . Risk M¢nagemeni Division wR"EwED 6 APPROVED BY: + laze P Risle Management Cierir lAide / A� " CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 9/21/2021 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 CONTACT NAME: GIGA Solutions, Inc. HONEFA PHONE 101 Plaza Real South No Ext : 888_581-0807 AIC, No ADMDRESS: cents@gigasolves.com Ste 201 INSURER(S) AFFORDING COVERAGE NAIC# Boca Raton FL 33432 INSURER A: State National Insurance Company, Inc 12831 INSURED INSURER B : Service First 2510 North Grand Ave INSURER C INSURER D Santa Ana CA 92705 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER:1450847933 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MMIDDIYYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE T CLAIMS -MADE 1:1OCCUR PREM SESOE. occurrDence $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY ❑ PRO ❑ LOC JECT PRODUCTS - COMP/OP AGG $ $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY L $ UMBRELLALIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LAB CLAIMS -MADE DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN AMX-082-0021-005 10/1/2021 10/1/2022 X PER OTH- STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? ❑ NIA E.L. DISEASE - EA EMPLOYEE $1,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION City of Santa Ana Risk Management Division 20 Civic Center Plaza, 4th Floor Santa Ana CA 92702 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 Rik Meapruni Dhiei. A I iZEYIE�WjE77 &yA® 7 PPROVBY: @ 1988-2015 ACORD C( - .—nogemen"1e ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Service -� 1ST September 27, 2021 City of Santa Ana Risk Management Division 20 Civic Center Plaza Santa Ana, Ca 92702 Re: Professional Liability Insurance Requirement Dear City of Santa Ana Risk Management Division: I Richard Rohr, Service First has intent to enter into an agreement with the City of Santa Ana. Throughout the course of this agreement, Service First attest that I am not a licensed professional (other than Service First contractor's license) and will not employ a licensed professional during the course of my contract with the City of Santa Ana. By signing below, I attest that I possess the legal authority to enter into an agreement with the City of Santa Ana as well as the legal author' o attest to the statements above. If at any time it is found that Service First is not adhering t y/all statements in this document, the contract will be considered null and void and t4 comp will be held fully liable for any and all damages. Richard U �� Commercial P I Systems Manager Service First Contact Phone: 714-573-2253 Email Address: PoolsLaservice-1st.com G�L��� ■.. W1Jll�t1.� %nu Y�Q�6 Risk Management CI erical Aide 2510 N. Grand Avenue, Suite 110 • Santa Ana, California 92705 • (714) 573-2200 • FAX (714) 573-2297 • License #556812