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HomeMy WebLinkAboutVENTURA BUSINESS SYSTEMS, INC. (4)City of Santa Ana Clerk of the Council AGREEMENT TERMINATION FORM COTC office Use Only C2,03 Please complete this form in its entirety when the attached agreement and all amendments (if any) are no longer in effect. Nate; If your agreement is grant related, please ensure that all grant retention requirements have been satisfied prior to signing the termination form. , SI- B A ANA C Tiy="LYE. K Is the agreement(s) a permanent record? Yes No -Lila Return form to the Clerk of the Council Office (M-30). E Call 647-1520 if you have any questions. The agreement with No N-2017-094-03 was completed on (List all amendments. Use space below if needed.) 02- --0j ctagreementsftrmsftrm - agreement termination form_goldenrod.doc Department: Phone/Ext.: Signature: Date: and final payment has been made. LA 6 S INSURANCE ON FILE WORK MAY PROCEED UNTIL INSURANCE EXPIRES �I•IT(•2O22 CLERK OF COUNCIL DATE: N-2017-094-03 THIRD AMENDMENT TO CONSULTANT AGREEMENT WITH VENTURA BUSINESS SYSTEMS, INC. THIS THIRD AMENDMENT to the above -referenced agreement is entered into May 30, 2022, by and between Ventura Business Systems, Inc., a California corporation ("Consultant"), and the City of Santa Ana, a charter city and municipal corporation organized and existing under the Constitution and laws of the State of California ("City" ). o'. L bre rMetrle,3,t)�3µ�� RECITALS A. The parties entered into Agreement No. N-2017-094, dated June 1, 2017, by which Consultant agreed to provide copy and printing services for the public at the Santa Ana Library and its branches ("Agreement"). The Agreement is current and in effect.. B. On May 1, 2020, the Parties executed a first amendment the Agreement to add additional services and compensation. C. On September 1, 2020, the Parties executed a second amendment to the Agreement to add additional services and compensation. D. The Parties now wish to increase the compensation and extend the term of the Agreement. The Parties therefore agree: 1. Section 2(a), Compensation, is hereby amended to increase the not -to -exceed amount by $5,950.00, per the costs and rates identified in Exhibit A-3 to this Third Amendment. The total amount to be expended under the Term of this Agreement shall not exceed $39,367.95. 2. Section 3, Term, is hereby extended to May 31, 2023, unless terminated earlier in accordance with Section 15 of the Agreement. The term of this Agreement may be extended upon a writing executed by the City Manager and the City Attorney. 3. Except as modified by this Third Amendment, all terns and conditions of the Agreement, shall remain in full force and effect, IN WITNESS WHEREOF, the parties hereto have executed this Second Amendment to the Agreement on the date and year first written above. ATTEST CITY OF SANTA ANA DAISY GOM RZ KRISrTINE RIDGE ` Clerk of the Council City Manager [signatures continued on the next page] Page 1 of 2 N-2017-094-03 APPROVED AS TO FORM SONIA R. CARVALHO City Attorney By. B on Salvatierra Deputy City Attorney ROMMENDS FORAPPROVAL Brian Sternberg Executive Director Library Services Agency VENTURA BUSINESS SYSTEMS, INC. Teyol-Yater Trevor Yates (Apr 24, 202216:15 PDT) Trevor Yates President Page 2 of 2 EXHIBIT A-3 SCOPE OF SERVICES EQUIPMENT OBLIGATIONS OF Ventura Business SVstems VBS will maintain and operate the following public access machines: • 1 Sharp black and white copier 1,000 sheet paper capacity, automatic document feeder for the main Library equipped with a coin/bill box. 1 Sharp black and white copier 1,000 sheet paper capacity, automatic document feeder for the branch Library equipped with a coin/bill box. 4 coin and bill boxes, one with credit card for visa, MasterCard, American Express, Discover, apply pay and google pay. • Maintain 5 Library owned HP Printers, 2 Scannx scanner hardware and software 1 Contingency fund that Library will pay VBS for staff override Prints/Copies up to $1,000.00 per year. SOFTWARE The Santa Ana Public Library Uses TLC as its integrated library system vendor. Through this system, individuals access a wide variety of products including the Library's catalog, the Internet, and proprietary data bases for public use. The Santa Ana Public Library also utilizes print management software, Envisionware LPTOne, that queues print jobs sent from public PCs to print stations throughout the Library These print jobs are released when a patron logs into a print station and pays for their print job IPTOne is compatible software system. Ventura Business Systems, Inc. is the only copy/printing vender in California that is an authorized Tier One Envisionware Dealer Ventura Business Systems, Inc., will provide copy/printing machines which are compatible with the Santa Ana Public Library's current and future integrated Library system and print management software. Total Compensation $4,500.00 EXHIBIT B (CONT.) VENTURA BUSINESS SYSTEMS INC. 2582 Fig Street Simi Valley, CA 93063 Phone (805) 583-3299 Fax (719) 470-2122 Federal Tax ID# 77-0508735 I Name / Address I Attn: Lynn Nguyen Santa Ana Public Library 20 Civic Center Plaza Santa Ana, CA 92701 Quote Date Quote # 4/7/2022 265726 Terms Rep Pre Pay 7vY Description Qty Cost Total ENVISIONWARE ANNUAL MobilePrint Service RENEWAL 2 725.00 1,450.00 INVOICE - This invoice renews your annual mobile print subscription coverage For twelve (12) months to end one year from the DUE DATE indicated above. Any exceptions will be indicated at the bottom of the invoice. Please confirm your receipt of this invoice. PLEASE NOTE: MobilePrint Service IS A SUBSCRIPTION PRODUCT; YOU WILL BE GRANTED A 30 DAY GRACE PERIOD AFTER THE DUE DATE FOR YOUR RENEWAL PAYMENT TO BE RECEIVED, BUT IF IT IS NOT RENEWED BY 30 DAYS AFTER THE DUE DATE, THE SERVICE WILL BE DEACTIVATED. For questions, please contact Trevor @ tyates@vbsl.com Thank you for your continued use of EnvisionWare. We value your business. 1 LPT-MPS-IYR-U SUBSCRIPTION (I -Year Prepaid) MobilePrint Service(tm) -Print from virtually any patron device via App, Email or Custom Web Subtotal Sales Tax (9.25%) Signature Total Page t VENTURA BUSINESS SYSTEMS INC. 2582 Fig Street Simi Valley, CA 93063 Phone (805) 583-3299 Fax (719) 470-2122 Federal Tax ID# 77-0508735 Name / Address Attn: Lynn Nguyen Santa Ana Public Library 20 Civic Center Plaza Santa Ana, CA 92701 Date Quote 4/7/2022 265726 Terms Rep Pre Payy Description Qty Cost Total Portal. Pick up at LPT:Oue Print Release Terminals. No additional hardware required. - Licensed by the number of Buildings or Job Queue Engines, whichever is greater. ++ REQUIRES LPT:One EnvisionWare Print Management v4.9+ Subtotal $1,450.00 Sales Tax (9.25%) $0,00 Signature Total $1,450.00 Page 2 olgmlly sgmd by Ton Pierson Tori Piersonp°Isn.12..D 13:I3:38 07W A� CERTIFICATE OF LIABILITY INSURANCE °4/07i 022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER DARRYL NIND INSURANCE AGENCY 4378 EILEEN ST SIMI VALLEY, CA 93063 t NAME. DARRYL NIND AGENT PHcoNN 805823-8373 1 ac No: 805823-8377 EMDOAIL ARess:dar l.nind.rebiGstateferm.com INSURERS AFFORDING COVERAGE NAIL If INSURER A: State Farm General Insurance Company 25151 INSURED VENTURA BUSINESS SYSTEMS, INC C/O TREVOR YATES 2582 FIG ST SIMI VALLEY CA 93063-2416 INSURER : State Farm Mutual Automobile Insurance Company 25178 INSURER C: NSURER D: INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMRFR- 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 ADDLSUB POLICY NUMBER POLICY EFF MWDD POLICY EXP MMIOO LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMB-MADE IOCCUR ❑ ❑ 92-W4-0493-7 04126/2022 04/26/2023 1,000,000 $ $ 5,000 n$ rAL $ 1,000,000$ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PR0.El LOG $ 2,000,000 $ B AUTOMOBILE X X LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS AUOTNOSWNED ❑ ❑ 051 5512-AIB-75N 01118/2022 07/18/2022 IWNGLE LIMB $ BODILY INJURY (Per person) $ 1,000,000 Y I ) BODILY (Per accltlent $ 1,000,000 (Perrac ident OPERTY -DAMAGE $ 1,000,000 UMBRELLA LIAR EXCESS LIAR OCCUR CLAIMS -MADE ❑ EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNER/EXECUTIVE OFFICUMEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS Imbry N/A❑ WC STATU- OTH- O E E.L. EACH ACCIDENT $ E.L. DIBEABE-EA EMPLOYE $ E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Addith nal Remarks Schedule, if more space is required) There is no Workers Compensation policy for Ventura Business Systems as all employs are officers of the corporation. Officers of the Corporation are not required to have a Work Comp policy in the State if California. ADDITIONAL INSURED: City of Santa Ana Risk Management Division 20 Civic Center Plaza, 4th floor SANTA ANA, CA 92701 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ptl'IYIBRIZEDR RE NTATIVE Rlai Msr�mw{Dhidon /,(f/// Ren[wm6MPRw® er. r d� Jj ''. %du Pecwdx I U 1988-2U1t1 ACORD CC ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD ,,,,, ,,,,, ,,,_.. ,,, _„ .0 Policy No. 92 W40493 7 CMP-4786.1 Page 1 of 2 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CMP-4786.1 ADDITIONAL INSURED — OWNERS, LESSEES, OR CONTRACTORS (Scheduled) This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number: 92 W40493 7 Named Insured: VENTURA BUSINESS SYSTEMS INC Name And Address Of Additional Insured Person Or Organization: THE CITY OF SANTA ANA ITS OFFICERS AGENTS & EMPLOYEES 20 CIVIC CENTER PLZ SANTA ANA CA 92701 4058 1. SECTION II — WHO IS AN INSURED of SECTION II — LIABILITY is amended to in- clude, as an additional insured, any person or organization shown in the Schedule, but only with respect to liability for "bodily injury", "property damage', or "personal and advertis- ing injury" caused, in whole or in part, by: a. Ongoing Operations (1) Your acts or omissions; or (2) The acts or omissions of those acting on your behalf; in the performance of your ongoing opera- tions for that additional insured; or b. Products — Completed Operations "Your work" performed for that additional insured and included in the "products - completed operations hazard". However, Paragraph 1. above is subject to the following: a. The insurance afforded to the additional insured only applies to the extent permit- ted by law; b. If coverage provided to the additional in- sured is required by a contract or agree- ment, the insurance provided to the additional insured will not be broader than that which you are required by the contract or agreement to provide for such addition- al insured: and c. If the contract or agreement between you and the additional insured is governed by California Civil Code Section 2782 or 2782.05, the insurance provided to the additional insured is the lesser of that which: (1) Is allowed for the satisfaction of a de- fense or indemnity obligation by Cali- fornia Civil Code Section 2782 or 2782.05 for your sole liability; or (2) You are required by contract or agreement to provide for such addi- tional insured. We have no duty to defend or indemnify the additional insured under this endorsement un- til a claim or "suit' is tendered to us. O, Copyright, State Farm Mutual Automobile Insurance Company, 2013 Includes copyrighted material of Insurance Services Office, Inc., with its permission. CONTINUED yy,q Y9,wd.< {i I1,y IRvlEmtn6/Nrrtw®BY: Rkk M1bnagemm[OmolAitle 2. Any insurance provided to the additional in- sured shall only apply with respect to a claim made or a "suit' brought for damages for which you are provided coverage. 3. With respect to the insurance afforded to the additional insured, the following is added to SECTION II — LIMITS OF INSURANCE: If coverage provided to the additional insured is required by contract or agreement, the most we will pay on behalf of the additional insured will be the lesser of the amount of insurance: a. Required by the contract or agreement; or b. Available under the applicable Limits Of Insurance shown in the Declarations. This endorsement shall not increase the ap- plicable Limits Of Insurance shown in the Declarations. 4. With respect to the insurance afforded to the additional insured, the following is added to Paragraph 3. Duties In The Event Of Occur- rence, Offense, Claim Or Suit of SECTION II — GENERAL CONDITIONS: The additional insured must: a. See to it that we are notified as soon as practicable of an `occurrence" or an of- fense which may result in a claim. To the extent possible, notice should include: (1) How, when and where the "occur- rence' or offense took place; CMP-4786.1 Page 2 of 2 (3) The nature and location of any injury or damage arising out of the 'occur- rence" or offense; b. Tender the defense and indemnity of any claim or "suit' to us and to all other insur- ers who may have insurance potentially available to the additional insured; and c. Agree to make available any other insur- ance the additional insured has for de- fense or damages for which we would provide coverage under SECTION II — LIABILITY. 5. With respect to the insurance afforded the ad- ditional insured, the following replaces SEC- TION II —LIABILITY of Paragraph 7. Other Insurance of SECTION I AND SECTION II — COMMON POLICY CONDITIONS: a. This insurance is primary to and will not seek contribution from any other insurance available to the additional insured, provided that the additional insured is a named in- sured under such other insurance. b. Regardless of any agreement between you and the additional insured, this insur- ance is excess over any other insurance whether primary, excess, contingent or on any other basis for which the additional in- sured has been added as an additional in- sured on other policies. There will be no refund of premium in the event this endorsement is cancelled. (2) The names and addresses of any in- jured persons and witnesses; and All other policy provisions apply. CMP4786A 1007033 148011 08-21-2014 ®, Copyright, State Farm Mutual Automobile Insurance Company, 2013 Includes copyrighted material of Insurance Services Office, Inc., with its permission. � Rid Mo.geiwd %W. ILEnE & AYYRC Sr. `,adl t1 It)` 7.0 a&.a,r Rck Mavgemml C)--)Ad, Ventura Business Systems, Inc 2582 Fig Street Simi Valley CA (805) 583-3299 Fax (719) 470-2122 Trevor Yates 2582 Fig Street Simi Valley, CA 93063 tyates@vbsl.com (805)501-8515 4/7/2022 City of Santa Ana Risk Management Division, 41 floor 20 Civic Center Plaza Santa Ana, CA 92702 Re: Professional Liability Insurance Requirement. Dear City of Santa Ana Risk Management Division: I, Trevor Yates, Ventura Business Systems, Inc, am not a licensed professional and will not employ a licensed professional during my course of my contract with the City of Santa Ana, CA. Sincerely, re�ates President Wi Mm.g..dM an ll gw6Av Or. Huk Maru9enmtOm¢Ihde� Dinitally Sinnpd ' CERTIFICATE OF LIABILITY INSU ATE(MM/DD/YYYY) �..� Y �022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHISQUPON C ", IFI THIS �aTHE fj��}EC�R.. BELOW. THIS CERTIFICATEATE DOES NOT FOFMATIVELY INS RANCERDOESATIVELY AMEND, EXTEND OR NOT CONSTITUTE A CONTRACT TBET'WEENY'F4FLL OAWY tTTAU %&Egl REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. 20:17:21-07'00' IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGA PION 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 DARRYL NIND INSURANCE AGENCY 4378 EILEEN ST O SIMI VALLEY, CA 93063 NAME: DARRYL NIND, AGENT AIC. PHONE Ext : 805 823-8373 FVC No): 805 823-8377 E-MAIL ADDRESS: darryl.nind.rebi@statefarm.com INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: State Farm General Insurance Company 25151 INSURED VENTURA BUSINESS SYSTEMS, INC INSURER B: State Farm Mutual Automobile Insurance Company 25178 INSURERC: C/O TREVOR YATES INSURERD: 2582 FIG ST SIMI VALLEY CA 93063-2416 INSURERE: 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 ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A GENERAL LIABILITY ❑ ❑ 92-W4-0493-7 04/26/2022 04/26/2023 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE ( RENTED PREMISES Ea occurrence) $ CLAIMS -MADE � OCCUR MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 X POLICY PRO LOC JECT $ B AUTOMOBILE LIABILITY 1-1 ❑ 051 5512-A18-75N 07/18/2022 01/18/2023 COMBINED SINGLE LIMIT Eaaccident $ X ANY AUTO BODILY INJURY (Per person) $ 1,000,000 X ALLOWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ 1,000,000 NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE Per accident $ 1,000,000 UMBRELLA LIAB OCCUR ❑ ❑ EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N WC STATU- OTH- TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICE/MEMBER EXCLUDED? ❑ N / A ❑ E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) E.L. DISEASE - POLICY LIMIT $ If yes, describe under DESCRIPTION DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) There is no Workers Compensation policy for Ventura Business Systems as all employs are officers of the corporation. Officers of the Corporation are not required to have a Work Comp policy in the State if California. CERTIFICATE HOLDER ADDITIONAL INSURED: City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Risk Management Division ACCORDANCE WITH THE POLICY PROVISIONS. 20 Civic Center Plaza, 4th floor AUTHORIZED REPRESENTATIVE e'er yn as 1218k kluagment DlRReiOR REVIEWED & APPROVEDBY: © 1988-2010 ACORD I ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD Risk Management specialist Policy No. 92 W40493 7 CMP-4786.1 Page 1 of 2 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CMP-4786.1 ADDITIONAL INSURED — OWNERS, LESSEES, OR CONTRACTORS (Scheduled) This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number: 92 W40493 7 Named Insured: VENTURA BUSINESS SYSTEMS INC Name And Address Of Additional Insured Person Or Organization: THE CITY OF SANTA ANA ITS OFFICERS AGENTS & EMPLOYEES 20 CIVIC CENTER PLZ SANTA ANA CA 92701 4058 1. SECTION II — WHO IS AN INSURED of b. If coverage provided to the additional in - SECTION II — LIABILITY is amended to in- sured is required by a contract or agree- clude, as an additional insured, any person or ment, the insurance provided to the organization shown in the Schedule, but only additional insured will not be broader than with respect to liability for "bodily injury", "property "personal that which you are required by the contract damage", or and advertis- or agreement to provide for such addition- ing injury caused, in whole or in part, by: al insured; and a. Ongoing Operations c. If the contract or agreement between you (1) Your acts or omissions; or and the additional insured is governed by (2) The acts or omissions of those acting California Civil Code Section 2782 or on your behalf; 2782.05, the insurance provided to the additional insured is the lesser of that in the performance of your ongoing opera- which: tions for that additional insured; or (1) Is allowed for the satisfaction of a de- b. Products — Completed Operations fense or indemnity obligation by Cali - "Your work" performed for that additional fornia Civil Code Section 2782 or insured and included in the "products- 2782.05 for your sole liability; or completed operations hazard". (2) You are required by contract or However, Paragraph 1. above is subject to the agreement to provide for such addi- following: tional insured. a. The insurance afforded to the additional We have no duty to defend or indemnify the insured only applies to the extent permit- additional insured under this endorsement un- ted by law; til a claim or "suit' is tendered to us. ©, Copyright, State Farm Mutual Automobile Insurance Company, 2013 Includes copyrighted material of Insurance Services Office, Inc., with its permission. CONTINUED Risk Mougment DiMsian E REVIEWED & APPROVED BY. e Aeevaa '�--'Risk Management Specialist CMP-4786.1 Page 2 of 2 2. Any insurance provided to the additional in- sured shall only apply with respect to a claim made or a "suit" brought for damages for which you are provided coverage. 3. With respect to the insurance afforded to the additional insured, the following is added to SECTION II — LIMITS OF INSURANCE: If coverage provided to the additional insured is required by contract or agreement, the most we will pay on behalf of the additional insured will be the lesser of the amount of insurance: a. Required by the contract or agreement; or b. Available under the applicable Limits Of Insurance shown in the Declarations. This endorsement shall not increase the ap- plicable Limits Of Insurance shown in the Declarations. 4. With respect to the insurance afforded to the additional insured, the following is added to Paragraph 3. Duties In The Event Of Occur- rence, Offense, Claim Or Suit of SECTION II — GENERAL CONDITIONS: The additional insured must: a. See to it that we are notified as soon as practicable of an "occurrence" or an of- fense which may result in a claim. To the extent possible, notice should include: (1) How, when and where the "occur- rence" or offense took place; (3) The nature and location of any injury or damage arising out of the "occur- rence" or offense; b. Tender the defense and indemnity of any claim or "suit' to us and to all other insur- ers who may have insurance potentially available to the additional insured; and c. Agree to make available any other insur- ance the additional insured has for de- fense or damages for which we would provide coverage under SECTION II — LIABILITY. 5. With respect to the insurance afforded the ad- ditional insured, the following replaces SEC- TION II —LIABILITY of Paragraph 7. Other Insurance of SECTION I AND SECTION II — COMMON POLICY CONDITIONS: a. This insurance is primary to and will not seek contribution from any other insurance available to the additional insured, provided that the additional insured is a named in- sured under such other insurance. b. Regardless of any agreement between you and the additional insured, this insur- ance is excess over any other insurance whether primary, excess, contingent or on any other basis for which the additional in- sured has been added as an additional in- sured on other policies. There will be no refund of premium in the event this endorsement is cancelled. (2) The names and addresses of any in- jured persons and witnesses; and All other policy provisions apply. CMP-4786.1 1007033 148011 08-21-2014 ©, Copyright, State Farm Mutual Automobile Insurance Company, 2013 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Risk Muagment Division zREVIEWED & APPROVED BY. e e '�--'Risk Management Specialist Policy No. 92 W40493 7 Page 1 of 9 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY CMP-4787 WAIVER OF TRANSFER OF RIGHTS OR RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number: 92 W40493 7 Named Insured: VENTURA BUSINESS SYSTEMS INC Name And Address Of Person Or Organization: THE CITY OF SANTA ANA ITS OFFICERS AGENTS & EMPLOYEES 20 CIVIC CENTER PLZ SANTA ANA CA 92701 4058 The following is added to Paragraph 10.b. of SECTION I AND SECTION II — COMMON POLICY 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. CMP-4787 1006225 137715.1 11-19-2013 ©, Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Risk Muagment DlMsian ZW REVIEWED & APPROVED BY. e eev'� Risk Management Specialist CITY OF SANTA ANA RISK MANAGEMENT diuidiaa 4HUMAN RESOURCES WORKERS' COMPENSATION DECLARATION Trevor Yates (Name/Title) following declaration: certify on behalf of hereby affirm under penalty of perjury, the Ventura Business Systems, Inc (Consultant/Company Name) of my contract for I Year (Type of service provided) that during the term services with the City of Santa Ana, will not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with the provisions and provide proof of workers' compensation coverage immediately. Date: 4/7/2022 Print Name: Trevor Yates Print Title: President Signature: , Telephone: 805-501-8/515 WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. 1: Risk Mgmt�lnsurance Requirements�WC Declaration 08152019 RA Muaigmad DMs� E o N,`P' REVIEWED & APPROVED BY: '�--'Rfsk Management Specialist Ventura Business Systems, Inc 2582 Fig Street Simi Valley CA (805) 583-3299 Fax (719) 470-2122 Trevor Yates 2582 Fig Street Simi Valley, CA 93063 tyates@vbsl.com (805)501-8515 4/7/2022 City of Santa Ana Risk Management Division, 41" floor 20 Civic Center Plaza Santa Ana, CA 92702 Re: Professional Liability Insurance Requirement. Dear City of Santa Ana Risk Management Division: I, Trevor Yates, Ventura Business Systems, Inc, am not a licensed professional and will not employ a licensed professional during my course of my contract with the City of Santa Ana, CA. Sincerely, Trevor Yates President RAMuaigmadDlMsian ZREVIEWED & APPROVED BY. e Aeevaa '�--'Risk Management Specialist NOTICE OF COMPLIANCE CITY "A,AM I1111RINT I'III I Pi I1111A E AND INCLUDE Ck I 111 1AGREEMENTTOT111I➢C CLERK CSC 1111IE COUNCIL Contractor Ventura Business Systems, Inc Name: Project N-2017-094-03 Number: Project Third Amendment To Consultant Agreement With Ventura Business Name: Systems, Inc. The Certificate of Insurance (COI) submitted indicates that the coverages are in compliance with the insurance requirements. No further action is required at this time. The compliant coverage(s) are: TYPE OF INSURANCE POLICY EXPIRATION COI DATE FILE NAME NUMBER DATE Ventura Business AUTOMOBILE LIABILITY 0515512AI875N 07/18/2023 07/06/2022 Systems Inc COI Exp 4-26-23 RMD07182022.pdf GENERAL LIABILITY 92W404937 04/26/2023 07/06/2022 Ventura Updated COLpdf Pages from PROFESSIONAL LIABILITY WAIVER 04/07/2023 08/02/2022 Ventura Updated COI-2.pdf WORKERS COMPENSATION AND Pages from EMPLOYERS' LIABILITY WAIVER 04/07/2023 08/02/2022 Ventura Updated .............. COLpdf .............. Thank you, City of Santa Ana Risk Management Division in partnership with CTrax Plus Services Team 1/27/2023 8:09 PM NOTICE OF COMPLIANCE CITY . "A ,AM I1111RI T I'III I IPi 1111AGE ,CCp INCLUDE Ck I 111 1AGREEMENTTOT111IE CLERK CSC 111I➢C COUNCIL Contractor Ventura Business Systems, Inc Name: Project N-2017-094-03 Number: Project Third Amendment To Consultant Agreement With Ventura Name: Business Systems, Inc. The Certificate of Insurance (COI) submitted indicates that the coverages are in compliance with the insurance requirements. No further action is required at this time. The compliant coverage(s) are: POLICY EXPIRATION TYPE OF INSURANCE NUMBER DATE COI DATE FILE NAME AUTOMOBILE LIABILITY 2947361D2875 10/28/2023 03/30/2023 Insurance Certificate , .............. 2023.pdf GENERAL LIABILITY 92KJX0429 01/26/2024 03/30/2023 Insurance Certificate , 2023.pdf Professional Liability PROFESSIONAL LIABILITY WAIVER 03/30/2024 04/03/2023 Insurance Release.pdf WORKERS COMPENSATION AND WAIVER 03/30/2024 04/10/2023 WC Declaration EMPLOYERS' LIABILITY Rev.2022.pdf .................... Thank you, City of Santa Ana Risk Management Division in partnership with CTrax Plus Services Team 4/20/2023 2:10 PM