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HomeMy WebLinkAboutDFK SOLUTIONS GROUP, LLC (2)N-2021-106-01 MAYOR N Vicente Samiento c� o MAYOR PRO TEM c� Phil Bacerra d' COUNCILMEMBERS .--I David Penaloza Johnathan Ryan Hernandez Gz Jessie Lopez ¢ Nelida Mendoza Thai Vet Phan INSURANCE ON FILE WORK MAY PROCEED UNTIL INSURANCE EXPIRES CLERK OF COUNCIL DATE: DKF Solutions Group, LLC 164 Robles Way, Suite 274 Vallejo, CA 94591 Attn: David Patzer CITY OF SANTA ANA PUBLIC WORKS AGENCY 20 Civic Center Plaza • P.O. sox 198a Santa Ana, California 92702 w .santa-ana.oro (714) 647-3320 March 1, 2022 CITY MANAGER Kristine Ridge CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL Daisy Gomez Re: Extension of Agreement for environmental and safety trainin courses Agreement No. N-2021-106 Pursuant to Section 3 ("Term") of the above -referenced Agreement, entered into by DKF Solutions Group, LLC, and the City of Santa Ana, dated April 12, 2021, the time period of the Agreement is hereby extended for an additional one-year period, from April 12, 2022 through April 11, 2023. Any insurance certificates are required to be extended and/or renewed to cover this extension. All other terms and conditions of the Agreement remain unchanged and in full force and effect. Sincerely, b � G If Nabil Saba, P.E. Executive Director, Public Works Agency CITY OF SANTA ANA Kristine Ridge—— City Manager APPROVED AS TO FORM Sonia R. Carvalho CityAttome Bya Brrfh6/�� Salvatierra Deputy City Attorney Virema saalhnh. Davie Peanam Phan vier Phan Mayor Wind Wank a.l ... U. a oN loza�asantaan m �h nmsanUana ATTEST Daisy Gomez, MMC Clerk of the Council DYF Solutions Group, LLC David Patzer Managing Partner SANTA ANA CITY COUNCIL Jsssie Lopez MR eararre JohneNan Ryan HemeMez Nalida Meadow Wan3 Maw Pro Teln. Wan i Wahl Wan6 ssielooez&lsanlaaera.am h N,2nllenun�z(nlsa nme�Nossuasa rrdiricine n. Digitally signed by tranane N. Villareal ® Villareal Date: 2021.06,14 16:42:51 -07'00' ACC)RCERTIFICATE OF LIABILITY INSURANCE °"o6V0712021 THIS CERTIFICATE Is ISSUED AS AMATTER OF INFORMATION ONLY ANDCONFERS NO RIGHTS UPON THECERTIFICATE HOLDER. THISCERTIFICATE DOES NOTAFNRMATIVELYOR NEGATIVELY AMEND, EXTEND ORALTERTHE COVERAGE AFFORDED BYTHE POLICIES BELOW THIS CERTIFICATE OF INSURANCE DOES NOTCONSTITUTE ACONTRACT BErWEENTHE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, ANDTHE CERTIFICATE HOLDER. IMPORTANT. IftheceRietate halderis an ADDITIONALINSURED, the Policy(les) must have ADDITIONAL INSURED provisions or be endorsed. if SUBROGATION IS WAIVED, subjecttothe terms and conditiomof the policy, certain policies may require anendorsement. Astatementon thlsoerti6tatedoes notmnferrights to thecenifmte holder in lieu ofsuch endorsement(&). PRODUCER CONTACT NAME: Tina Jang 1131 Howard Avenue PHONE FAx (A/c, No, EXT): 650-995-3499 (a/c, No): 650-37fi-5546 Burlingame CA 94010 E-AW L ADDRESS: tjang@farmersagent.com INSURER(S)AFFORDING COVERAGE NAIL# INSURED 170 SOLUTIONS GROUP LLC 170 DOGWOOD LN VALLEJO CA 94591 INSURERA: Tnrck Insurance Exchange 21709 INSURER B: Farmers Insurance Exchange 21652 INSURERC: Mid Century Insurance Company 21687 INSURER D: INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISIONNUMBER: THIS 15 TO CERTIFY THATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUEDTO THE INSURED NAMEABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDINGANY REQUIREMENT, TERM OR CONDITION OFANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUEDTR MAY PERTAIN, THE INSURANCE AFFORDED BYTHE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALLTHE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POUCIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CIAIMS. INSR LTR TYPEOFINSURANCE ADOTL INSO 91BR WVD POLICYNUMBER POLICY FEE (MM/DD/YYYY) POLICY EXP (MM/DD/YYVY) LIMITS COMMERCIAL GENERAL LABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS.MADE OCCUR DAMAGETORENTED PREMISES (Ea Occurrence) § 75,00 MEDEXP(Anyoneperson) $ 5,00 PERSONAL&ADV INJURY $ 1,000,00 A Y N 604713332 03/19/2021 03/19/2022 GEN'L AGGREGATE LIMIT APPLIESPER: X POLICY ❑ PROJECT ❑ LOC GENERALAGGREGATE $ 2,000,000 PRODUCTS-COMP/OPAGG $ 2.000,000 OTHER: $ AUTOMOBILELIABILITY COMBINED SINGLE LIMIT (EaacddenU $ 1,000,00 ANYAUTO BODILY INJURY (Per Person) $ A OWNEDAUTOS SCHEDULED ONLY AUTOS Y 604713332 03/19/2021 03/19/2022 BODILY IN JURY(Peracddent) $ X HIREDAUTOS INON-OWNED ONLY ALITOSONLY PROPERTY DAMAGE (Per accident) $ $ OCCUR EACH OCCURRENCE $ AGGREGATE § EXCESS LIAB CLAIMS -MADE DED RETENTION$ § -4UMBRELLAUAB WORKERSCOMPENSAT10N AND EMPLOYERS'LIABILITY STATUTE OTHER $ ANY PROPRIETOR/PARTNER/ Y/N EXECUTIVE OFFICER/MEMBER N/A E.L. EACH ACCIDENT $ E.L. DISEASE- EA EMPLOYEE EXCLUDED] (Mandatary in NH) Ifyes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPDON OFOPERATIONS/LOCATIONS/VEHICLES(ACORD 101, Additional Remarks Schedule, may beattached If more space Is required) City of Santa Ana, its officers, employees, agents and representatives are Additional Insureds with respect to General and Auto Liability per the attached endorsements as required by written contract. Insurance is Primary and Non -Contributory. 30 Days Notice Of Cancellation with 10 Days Notice for Non -Payment of Premium in accordance with the policy provisions. Agreement Number (N-2021-106) CERTIFICATE HOLDER CANCELLATION "r w. """ "" SHOULDANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Risk Management Division DATE THEREOF. NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 20 Civic Center Plaza AUTHORIZED REPRESENTATIVE Tina Jang Aard, Ana CIA 92702 Rmk Men%vA dDividen s` REAEwED 6 APPROVED Sill ACORD25(2016/03) ©1988-2015ACOR 31-1769 11-15 The ACORD name and logo are registered marks of ACORD ® Risk Management Analyst THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Policy Number: 60471-33-32 POLICY CHANGES Effective Date of Change: 05/11/21 Change Endorsement No.: 005 Named Insured: DKF SOLUTIONS GROUP LLC PATZER RISK CONTROL SERVICES 170 DOGWOOD LN C/O DAVID PATZER VALLEJO CA 94591-8056 The following item(s): Expiration Date: 03/19/22 Agent: 96-82-34H E4277 Ist Edition Insured's Name Inures Mailing Address Policy Number Company Effective / Expiration Date Insured's Legal Status / Business of Insured Payment Plan Premium Determination X Additional Interested Parties Coverage Forms and Endorsements Limits / Exposures Deductibles Covered Property / Location Description Classification / Class Codes Rates Underlying Insurance is (are) changed to read {See Additional Page(s)): The above amendments result in a change in the premium as follows: X I No Changes I I To Be Adjusted At Audit Authorized Representative Signature: 914977 M NNN 7.09 E4277{Nl Indudm Copyrighted Malarial, Imuion, Services Office, Inc, with i6 penntsim. Additional Premium I Return Premium �'•`� N S Risk MompnodDMd,, RE:Mew &APPROVED Sr. v3.1d111i_li_L, ��Ir<r.c;,E,e �. (7:,(Lvlut[ '. Rlsk Management Analyst Policy Changes Endorsement Description CHANGE ADDITIONAL INTEREST PRIMARY & NONCONTRIBUTORY INSURANCE - J7100-ED2 CITY OF SANTA ANA, ITS OFFICER, AGENTS AND EMLOYEES 20 CIVIC PL SANTA ANA, CA 92701 LOCATION: 170 DOGWOOD LN VALLEJO, CA 94591 ADD ADDITIONAL INTEREST ADDITIONAL INSURED-J7237-ED1 VENDORS CITY OF SANTA ANA, ITS OFFICERS, AGENTS AND EMPLOYEES 20 CIVIC PLAZA SANTA ANA, CA 92701 LOCATION: 170 DOGWOOD LN VALLEJO, CA 94591 Removal If Covered Property is removed to a new location that is described on this Policy Permit Change, you may extend this insurance to include that Covered Property at each location during the removal. Coverage at each location will apply in the proportion that the value at each location bears to the value of all Covered Property being removed. This permit applies up to 10 days after the effective date of this Policy Change: after that, this insurance does not apply at the previous location. 9IA277 1SIEDI7ION 701 Indudes(Tplghled*leriol hwmna Sereins Office, Inc, ssilhdspenrivdon. 14277al o REmEwEn �Br. i® F'cr.o:.s•¢ k. vj&,VAI �� ftk Management Analyst THIS CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY NUMBER: 60471-33-32 M FARMERS INSURANCE ADDITIONAL INSURED -VENDORS This endorsement modifies insurance provided under the following: BUSINESSOWNERS LIABILITY COVERAGE FORM BUSINESSOWNERS COVERAGE FORM APARTMENTOWNERS LIABILITY COVERAGE FORM CONDOMINIUM LIABILITY COVERAGE FORM SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) (Vendor): CITY OF SANTA ANA, ITS OFFICERS, AGENTS AND EMPLOYEES Your Products: CONSULTING SERVICE Information required to complete this Schedule, if not shown above, will be shown in the Declarations. 17237 1 st Edition A. The following is added to Paragraph C. Who Is An Insured of the applicable Coverage Form: Any person(s)or organization(s) (referred to throughout this endorsement as vendor) shown in the Schedule is also an additional insured, but only with respect to "bodily injury" or "property damage" caused, in whole or in part, by .your products" shown in the Schedule which are distributed or sold in the regular course of the vendor's business. However: a. The insurance afforded to such vendor only applies to the extent permitted bylaw; and b. If coverage provided to the vendor is required by a contract or agreement, the insurance afforded to such vendor will not be broader than that which you are required by the contract or agreement to provide for such vendor. B. With respect to the insurance afforded to these vendors, the following additional exclusions apply: 1. The insurance afforded the vendor does not apply to: a. "Bodily injury" or "property damage" for which the vendor is obligated to pay damages by reason of the assumption of liability In a contractor agreement. This exclusion does not apply to liability for damages thatthe vendor would have in the absence of the contractor agreement; b. Any express warranty unauthorized byyou; c. Any physical or chemical change in the product made intentionally by the vendor; d. Repackaging, except when unpacked solely for the purpose of inspection, demonstration, testing or the substitution of parts under instructions from the manufacturer, and then repackaged in the original container; e. Any failure to make such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the xN products; f. Demonstration, installation, servicing or repair operations, except such operations performed at the vendor's premises in connection with the sale of the product; g. Products which, after distribution or sale by you, have been labeled or relabeled or used as a container, part or ingredient of any other thing or substance by or for the vendor; or j7237 02-19 Includes copyrighted material of Insurance Services office, Inc., with its permission. 937237 v [RenEwm6o m�Br, u Risk Management Malyst h. "Bodily injury" or "property damage" arising out of the sole negligence of the vendor for its own acts or omissions or those of its employees or anyone else acting on its behalf. However, this exclusion does not apply to: (1) The exceptions contained in Subparagraph d.orf.;or (2) Such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products. 2. This insurance does not apply to any insured person or organization from whom you have acquired such products, or any ingredient, part or container entering into, accompanying or containing such products. C. With respect to the insurance afforded to these vendors, the following is added to Paragraph D. Liability And Medical Expenses Limits Of Insurance of the applicable Coverage Form: If coverage provided to the vendor is required by a contract or agreement, the most we will pay on behalf of the vendor is the amount of insurance: 1. Required by the contractor 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. This endorsement is part of your policy. It supersedes and controls anything to the contrary. it is otherwise subject to all the terms of the policy. j7237 02-19 Includes copyrighted material of Insurance services office, Inc., with its permission. ;' Renenm&APPRovm Br. ` F4.c,. ,e z V.11�n 9Z7237 - � RoWa Rlsk Management Analyst THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. klh FARMERS INSURANCE PRIMARY AND NONCONTRIBUTORY INSURANCE This endorsement modifies insurance provided under the: BUSINESSOWNERS POLICY SCHEDULE Name of Additional Insured CITY OF SANTA ANA, ITS OFFICER, AGENTS AND EMLOYEES to 17l 00 2nd Edition The following is added to Paragraph H. Other Insurance of the Businessowners Common Policy Conditions and supersedes any provision to the contrary: Primary and Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to the additional insured shown in the Schedule, provided that: 1. The additional insured shown in the Schedule is a Named Insured under such other insurance; 2. You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured; and 3. The additional insured shown in this Schedule is also an Additional Insured on this policy. The coverage provided under this endorsement is subject to the terms and conditions of the applicable, underlying Additional Insured endorsement. This endorsement is part of your policy. It supersedes and controls anything to the contrary. It is otherwise subject to all the terms of the policy Rh1M-%an0dDMsbn J7100-ED205-18 Includes copyrighted of Insurance Services Office, Inc., with its RenEwm6pAPrRovIDBr. 93-7100 F�c..� Z UtUa MM Rnk Management Anatyrt . 6. O CERTIFICATE OF LIABILITY INSURANCE `� TE DA03/172021 v) 03/17/2021 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(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 NAME: Paragon Commercial Insurance Brokers One Sansome Street Suite 3500 PHON o Ext: 415 971-9111 FAX N0: 415)358-9410 AEMSS_ info@colmmercialriskgrou .00m INSURER(S) AFFORDING COVERAGE NAICM INSURERA: RLI Insurance Company 13056 San Francisco CA 94104 INSURED INSURERS: DKF Solutions Group, LLC INSURER C : 170 Dogwood Lane INSURER D : INSURERE: Vallejo CA 94591 1 INSURER F: COVERAGES CERTIFICATE NUMBER- RuvlslnM Munnwcw. 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 OFINSURANCE ADDL SUER POLICY NUMBER POLICY EFF IMMIDDNYYYI POLICY EXP I IMMIDDITYYY1LIMITS COMMERCIAL GENERAL LABILITY CLAIMShMADE OCCUR EACH OCCURRENCE $ D EN 1% PREMISES Ea occurrence $ MED EXP(Any one person) $ PERSONAL &ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- JECT LOC GENERALAGGREGATE $ PRODUCTS-COMP!OP AGO $ I; - OTHER- AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANYAUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(PeraccitlenB $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Peracadar $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR CLAIMS -MADE DED I I RETENTION $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? NIA STATUTE ER E.L. EACH ACCIDENT $ EL DISEASE -EA EMPLOYE $ (Mandatory in NH) ffWs under EL. DISEASE -POLICY LIMIT $ DESCRIPTION OPERATIONS below DESCRIPTION A Professional Liability Y RTPOO21994 03/19/2021 03/19/2022 Aggregate Occurrence $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) 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. 20 Civic Center Plaza AUTHORIZED REPRESENTATIVE tl�e Santa Ana CA 92701 REVIEWED&APPaov®Br. -aX: Email: OO 1988-2015 ACORD C " F4A., 41 z v:♦'liln d ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD Risk Managenwrt Analyst 170 Dogwood Lane Vallejo, CA 94591-8056 www.d0solutions.com WORKERS' COMPENSATION INSURANCE CERTIFICATION TO: City of Santa Ana, Risk Management Division RE: Agreement 4-12-2021 The Consultant shall execute the following form as required by the California Labor Code, Sections 1860 and 1861: I am aware of the provisions of Section 3700 of the California Labor Code that requires every employer to be insured against liability for workers' compensation or to undertake self-insurance in accordance with the provisions of that code. As a Managing Partner of DKF Solutions Group, LLC, I verify that we do not have any employees who will perform work under this agreement. In the event that DKF Solutions Group hires any employees to perform work under this agreement, I will comply with the provisions of Section 3700 of the California Labor Code before commencing or continuing the performance of the work under this contract, including supplying City of Santa Ana with proof of Workers' Compensation Insurance and a Waiver of Subrogation thereto. Name ofEjrm—kPersorjJirm, or Representative David Patzer, Managing Partner Name & Title of Authorized Representative _5 May 2021_ Date of Signing Rick Marugernenf Division REmEwEo & APPRov® By. mmmffm ® Risk Management Analyst Digitally signed A ACOORDr — D. T n IYYYY) CERTIFICATE OF LIABILITY INS A �Or-oF��2 THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HO ER. THIS CERTIFICATE DO ' ,OTAFF,-MATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BYTHEPOLICIES BELOW. THIS CERTIFICATE OFINSURANCE DOFt;�NJr11E/1)CO�I(Y�a}'p1rN�ttpEr[(6k1,/� C AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. 1 CC VV CC ( l lJ L L �J` F IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. IfS1'BP JGATION IS ��� �rf conditions of the policy, certain policies may require an endorsement. Astatement anthis certificate does not confer rights tothe certificate hr.de' in lieu ofsucht=d eh sj) PRODUCER CONTACT NAME: Tina Jang PHONE FAX 1131 Howard Avenue (A/C, NO, EXT): 850-995-3499 (A/C, No): 650-376-5546 E-MAIL Burlingame CA 94010 ADDRESS: tjang@farmersagent.com INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURERA: Truck Insurance Exchange 21709 INSURER B: Farmers Insurance Exchange 21652 170 DOGWOOD LN SOLUTIONS GROUP LLC 70 INSURERC: Mid Century Insurance Company 21687 INSURERD: INSURER E: VALLEJO CA 94591 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURAN CE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAME ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BYTHE POLICIES DESCRIBED HEREIN IS SUB] ECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDTL INSO SUBR FDOCYAWWOER WVD POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LMWS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE a OCCUR DAMAGE TO RENTED PREMISES (Ea Occurrence) $ 75,000 MED EXP (Any one person) $ 5,000 PERSONAL& ADV INJURY $ 1,000,000 A Y N 604713332 03/19/2022 03/19/2023 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY ❑ PROJECT ❑ LOC PRODUCTS-COMP/OPAGG $ 2,000,00 OTH ER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY(Per person) $ v� ANYAUTO BODI LY INJURY (Per accident) $ A OWNEDAUTOS SCHEDULED ONLY AUTOS Y 604713332 03/19/2022 03/19/2023 PROPERTY DAMAGE (Per accident) $ HIREDAUTOS X NON -OWNED ONLY AUTOSONLY UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY PER STATUTE TOT HER $ E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/ Y/N EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N/A E.L. DISEASE - EA EMP LOYE E E.L. DISEASE -POLICY LIMIT If yes, describe under DESCRIPTION OF ffA5K7ri5bw DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached If mare space is required) City of Santa Ana, its officers, employees, agents and representatives are Additional Insureds with respect to General and Auto Liability per the attached endorsements as required by written contract. Insurance is Primary and Non -Contributory. 30 Days Notice of Cancellation with 10 Days Notice for Non -Payment of Premium in accordance with the policy provisions. Agreement Number (N-2021-106) CERTIFICATE HOLDER CANCELLATION City of Santa Ana SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Risk Management Division DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE,WITH THE POLICY PROVISIONS. 20 Civic Center Plaza AUTHORIZED REPRESENTATIVE Tina Jang Risk kluagementDMsian +� \@ REVIEWED & APPROVED BY: ACORD 25 (2016/03) @ 1988-2015 ACOR t 31-1769 11-15 TheACORD nameand logoare registered marks ofACORD Ifl5K Management Specialist THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY NUMBER: 60471-33-32 INSURANCE ADDITIONAL INSURED - VENDORS This endorsement modifies insurance provided under the following: BUSINESSOWNERS LIABILITY COVERAGE FORM BUSINESSOWNERS COVERAGE FORM APARTMENTOWNERS LIABILITY COVERAGE FORM CONDOMINIUM LIABILITY COVERAGE FORM SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) (Vendor): CITY OFSANTAANA, ITS OFFICERS, AGENTS AND EMPLOYEES Your Products: CONSULTING SERVICE Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. The following is added to Paragraph C. Who Is An Insured of the applicable Coverage Form: 17237 1 st Edition Any person(s) or organization(s) (referred to throughout this endorsement as vendor) shown in the Schedule is also an additional insured, but only with respect to "bodily injury" or "property damage" caused, in whole or in part, by "your products" shown in the Schedule which are distributed or sold in the regular course of the vendor's business. However: a. The insurance afforded to such vendor only applies to the extent permitted bylaw; and b. If coverage provided to the vendor is required by a contract or agreement, the insurance afforded to such vendor will not be broader than that which you are required by the contract or agreement to provide for such vendor. 13. With respect to the insurance afforded to these vendors, the following additional exclusions apply: 1. The insurance afforded the vendor does not apply to: a. "Bodily injury" or "property damage" for which the vendor is obligated to pay damages by reason of the assumption of liability in a contractor agreement. This exclusion does not apply to liability for damages that the vendor would have in the absence of the contract or agreement; b. Any express warranty unauthorized by you; c. Any physical or chemical change in the product made intentionally by the vendor; d. Repackaging, except when unpacked solely for the purpose of inspection, demonstration, testing or the substitution of parts under instructions from the manufacturer, and then repackaged in the original container; e. Any failure to make such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products; f. Demonstration, installation, servicing or repair operations, except such operations performed at the vendor's premises in connection with the sale of the product; g. Products which, after distribution or sale by you, have been labeled or relabeled or used as a container, part or ingredient of any other thing or substance by or for the vendor; or Risk MwaganadDhisian +� \@ REVIEWED & APPROVED BY: j7237 02-19 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 937237 RukManagement Specialist C« h. "Bodily injury" or "property damage" arising out of the sole negligence of the vendor for its own acts or omissions or those of its employees or anyone else acting on its behalf. However, this exclusion does not apply to: (1) The exceptions contained in Subparagraph d. orf.; or (2) Such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products. 2. This insurance does not apply to any insured person or organization from whom you have acquired such products, or any ingredient, part or container entering into, accompanying or containing such products. With respect to the insurance afforded to these vendors, the following is added to Paragraph D. Liability And Medical Expenses Limits Of Insurance of the applicable Coverage Form: If coverage provided to the vendor is required by a contract or agreement, the most we will pay on behalf of the vendor is the amount of insurance: 1. Required by the contractor 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. This endorsement is part of your policy. It supersedes and controls anything to the contrary. It is otherwise subject to all the terms of the policy. Risk ManagementDhisian J7237 02-19 Includes copyrighted material of Insurance Services Office, Inc., with its permission. ReAexrEo & APPROVED Bv: 927237 �_r- RukManagement Specialist THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READO[CAREFULLY. no INSURANCE PRIMA���U ���� ��A�����������N�UN����0���NN ��� RY m����� NONCONTRIBUTORY m�mm��� m��m�m mm�^�°�m�m�m�n�u� This endorsement modifies insurance provided under the: BUSINESSOWNERS POLICY SCHEDULE Name of Additional Insured Persons(s) or Organization(s): CITY OF SANTA ANA, ITS OFFICER, AGENTS AND EMLOYEES -I rifon� �tion ieii:: �uireidto complete this Schedule, if not shown above, will be shown in the Declarations. 1^����� ���0���� 2md Edition The following is added to Paragraph H.Other Insurance of the Businessowners Common Policy Conditions and supersedes any provision 10the contrary: Primary and Noncontributory Insurance This insurance isprimary to andwU|noiseekconthbutionfrumanyotherinsuranceavoi|ab|etotheaddiUona|insunedshown inthe Schedule, provided that: 1. The additional insured shown in the Schedule is a Named Insured undersuch other insurance; 2' You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured; and 3' The additional insured shown in this Schedule is also an Additional Insured on this policy. The coverage provided under this endorsement issubject to the terms and conditions ofthe applicable, underlying Additional Insured endorsement. This endorsement ispart ufyour policy. It supersedes and controls anything tothe contrary. Kis otherwise subject toall the terms of the policy [7100-ED205-18 Includes copyrighted material ofInsurance Services Office, |nc,with its es'v1uo Digital) signed 0 nab Y '�' CERTIFICATE i�F LIABILITY INS AIVE e b A ry��t�re f. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS N R�3M o ik n •i I �T OR NEGATIVELY AMEND, EXTEND OR AL CERTIFICATE DOES ATIVELY FOFMINSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSJIAG INSUw& , RIZTPr BELOW. THIS CERTIFICATE 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: AaCONNo Ext: (4I5)97I-9111 FAXNot: (415)358-9410 Paragon Commercial Insurance Brokers EMAIL if no commercalrisrou ADDRESS: � ik g p.com One Sansome Street Suite 3500 INSURER(S) AFFORDING COVERAGE NAIC # INSURER : RLI Insurance Company 13056 San Francisco CA 94104 INSURED INSURER B : INSURER C: DKF Solutions Group, LLC INSURERD: 170 Dogwood Lane INSURER E : INSURER F : Vallejo CA 94591 COVERAGESREVISION 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 ADDLSUBR POLICY NUMBER MMfDDNYYY ICY EXP MMFF LDDNYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS -MADE OCCUR PREMISES 'Ea occurrence' $ MED EXP (Anyone person) $ PERS013AL &ADV I13JURY $ GEN'LAGGREGATE LIMIT APPLIES PER : GENERAL AGGREGATE $ POLICY ❑ PRO- JECT ❑ LOG PRODUCTS-COMP,'OPADS $ $ OTHER AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO BODILY INJURY (Per person) $ OVJPEED SCHEDULED AUTOS ONLY AUTOS BODILY 114JURY (Per accident) $ PROPERTY DAMAGE Paraccidenf $ 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 t. N PER OTH- STATUTE ER ANY PROPRIETOR!PARTNERlEXECUTIVE E.L. EACH ACCIDENT $ OE:RCER;MEMBEREXCLUDED? NIA EL.DISEASE- EAEMPLOYEE $ (Mandatary in NH) If yes, describe under DESCRIPTION OF OPERATIONS below EE_ DISEASE - POLICY LIMIT $ A Professional Liability RTP0025302 03/19/2022 03/19/2023 Aggregate Occurrence $2,000,000 $2,000,000 DESCRIPTION OF OPERATIONS t LOCATIONS i VEHICLES IACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Santa Ana 20 Civic Center Plaza Fax- Email: ACORD 25 (2016103) 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 Risk Mougement DIMsian CA 92701 + a\@ REVIEWED & APPROVED BY: O 1988-2015 ACORD i The ACORD name and logo are registered marks of ACORD Ruk1 Management Specialist oil