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HomeMy WebLinkAboutALLIED UNIVERSAL JANITORIAL (5)INSURANCE ON FILE A-2019-190-04 WORK MAY PROCEED UNTIL INSURANCE EXPIRES �• 1-23 CLERK OF COUNCIL FOURTH AMENDMENT TO AGREEMENT TO PROVIDE DATN JANITORIAL SERVICES AT VARIOUS LOCATIONS 0 �s THIS FOURTH AMENDMENT to the above -referenced agreement is entered into on June 27, 2022 by and between Universal Building Maintenance, LLC, dba Allied Universal Janitorial Services ("Contractor"), 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"). 6: PWA( Va41,1cI, P74)�3J�-L RECITALS A. The parties entered into Agreement No. A-2019-190, dated October 15, 2019, by which Contractor agreed to provide janitorial services at various city facilities, including City Hall, the Main Library, and the Santa Ana Regional Transportation Center ("Agreement"). B. On March 1, 2020, the parties entered into First Amendment No. A-2019-190-01, by which the Agreement was amended to expand the scope of services to include enhanced cleaning services on an as -needed basis due to the COVID-19 pandemic and to increase the amount to be expended under the Agreement accordingly. C. On April 1, 2021, the parties entered into Second Amendment No. A-2019-190-02, by which the Agreement was amended to include additional cleaning services on an as -needed basis made necessary by the relocation of Water Resources Division staff from the City's Corporate Yard to various other water facilities because of the COVID-19 pandemic, including mobile offices and restrooms. D. On January 3, 2022, the parties entered into Third Amendment No. A-2019-190-03 by which the agreement was amendment to increase the compensation for said pandemic services and extend the term for provision of same said services through June 30, 2022. The current term of the original Agreement runs through October 31, 2022 and the Agreement is current and in - effect. E. The parties now wish to further amend the Agreement specific to the pandemic related services stemming from the Second Amendment to the Agreement, increase the compensation for said pandemic services, and extend the term for provision of same said services through December 31, 2022. The Parties therefore agree: 1. Section 1, Scope of Services, is amended to include the services and locations described in Exhibit A to this Fourth Amendment, attached hereto. 2. Section 2.a, Compensation, is amended to increase the total amount to be expended under the Agreement by $36,000 for the period from July 1, 2022 through December 31, 2022. The sum of this amount includes the monthly costs, as detailed in Exhibit A, for a total base amount of $29,790 with a contingency amount of $6,210 for additional services as requested at the sole discretion of the City. Page 1 of 2 3. Section 3, Term, is amended to provide for the services described in Exhibit A to the Fourth Amendment and increase the overall term of the Agreement through December 31, 2022. The options to extend the term of Agreement for up to two (2) one (1) year periods remains unchanged and can be exercised by the parties prior to December 31, 2022. 4. Except as modified by this Fourth Amendment, and all prior amendments, all terms and conditions of the Agreement shall remain in full force and effect. IN WITNESS WHEREOF, the parties hereto have executed this Fourth Amendment to the Agreement on the date and year first written above. ATTEST Daisy Gomez � Clerk of the Council APPROVED AS TO FORM Sonia R. Carvalho City Attorney Jose Montoya Assistant City Attorney FOR APPROVAL Nabil Saba Executive Director Public Works Agency CITY OF SANTA ANA Kristine City Manager CONTRACTOR Allied Universal Janitorial Services Name: M k E. Olivas Title: President Page 2 of 2 ei'LLIEDUNIVERSAINITORIAL SERVICES May 31, 2022 City of Santa Ana Water Resources Division Attn: Kathia Reyes 215 S. Center Street Santa Ana Ca 92703 Dear Kathia: Here's our proposal for the Janitorial Employee. Monthly Basis Pricing Services will include Cleaning; Disinfecting Daily Task Services cover the following: * Clean office tables, Clean brake room areas, wiping kitchen areas, sweeping, mopping. Santa Ana City Yard Disinfecting Job Description Cost Total Cost Santa Ana City Yard Disinfecting Monday — Friday 8 hrs per day. 4,025.00 Thank you forgiving Allied Universal Janitorial Services the opportunity to provide you with a proposal. This is the quote for the City Yard Disinfecting. If this quote meets your approval, please sign and email to Francisco.Arellano(aus.com Sincerely, Name and Title Francisco Arellano Signature Allied Universal Janitorial Services Date e'1111UNIVERSAL NITORIAL SERVICE5 May 31, 2022 City of Santa Ana Water Resources Division Attn: Kathia Reyes 215 S. Center Street Santa Ana Ca 92703 Dear Kathia: Here's our proposal for the Janitorial Employee for the 2 mobile offices sites. Monthly Basis Pricing. 1. Site 1: 2401 N. Bristol Street 2. Site 2: 1727 W. Alton Street Services will include Cleaning; Disinfecting Daily Task Services cover the following: * Clean office tables, Clean brake room areas, wiping kitchen areas, sweeping, mopping. * Clean Restrooms, Showers. Santa Ana Water Resources Job Description Cost Total Cost: Cleaning Two Times Per Week Services. 940.00 Thank you for giving Allied Universal Janitorial Services the opportunity to provide you with a proposal. This is the quote for the Water Resources Devision. If this quote meets your approval, please sign and email to Francisco.Arellano()aus.com Sincerely, Name and Title Francisco Arellano Signature Allied Universal Janitorial Services Date Villareal CERTIFICATE OF LIABILITY INSURANCE area Dat$AYEOt125120222022tMMIDDrYY" 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 MARSH USA INC 1717 Arch Street Philadelphia, PA 19103 Attn: Philadelphia.certs@marsh.com I Fax: (212) 948.0360 CONTACT MarshIU.S. Operations PHONN Sam E 866-96fi-0fi64 FnC No: E-MAIL ss: Philadelphia.Ceds@marsh.com INSURERS AFFORDING COVERAGE NAIC# INSURERA: Indian Harbor Insurance Company 36940 CN1 I 8025105-ALL-STAND-22-23 INSURED Allied Universal Topco, LLC INSURER B : Greenwich Insurance Company22322 INSURER C : XL Insurance America 24554 (See Attached for Additional Named Insureds) 161 Washington Street, Suite 600 Conshohocken, PA 19428 INSURER D : Naitonal Fire & Marine Insurance Company20079 INSURER E : NIA hUA NS uRER F: COVERAGES CERTIFICATE NUMBER: CLE-006844453-01 REVISION NUMRFR- 9 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 INSD Me POLICY NUMBER POLICY EFF (MMUDDITYYY1 POLICY UP WIMIDDYYYYJ LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE EXI OCCUR RES943799402 01/0112022 01101/2023 EACH OCCURRENCE $ 30,000,000 -DAIJFGETORENTED PREMISES fEa occurrence $ 30,000,000 X MED EXP (Any one person) $ CONTRACTUAL LIABILITY X SIR$1,750,000 PERSONAL&ADV INJURY $ 30,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X PRO - POLICY ❑ JECTPRO- � LOG GENERALAGGREGATE $ 40,000,000 PRODUCTS - COMP/OP AGG $ 40,000,000 It OTHER: B AUTOMOBILE LIABILITY RAD943781805 01101/2022 01101/2023 COMBINED SINGLE LIMIT Ea accident $ 5,000,000 X BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident) ( ) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTYDAMAGE Per accident $ UMBRELLA LIAB X OCCUR 42XSF10009009 01101/2022 01/0112023 EACH OCCURRENCE $ 10,000,000 X AGGREGATE $ 10,000,000 EXCESS LIAB CLAIMS -MADE Excess of General Liability, DIED I I RETENTION $ $ Auto Liability, and Workers' Comp C C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYPROPRIETORIPARTNERIEXECUTIVE OFFICEWMEMBEREXCLUDED9 NIA RWD3001203-06(AOS) RWR300120406W1 ( ) 0110112022 01101/2022 01/01/2023 01/01/2023 X STATUTE oTRH- E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,01)0 (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 A Professional Liability RES943799402 01/0112022 0110112023 Limit 2,000,000 SIR 1,750,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Santa Ana is included as additional insured where required by written contract with respect to General Liability and Auto Liability. Liability coverage shall be primary and non-contributory where required by written Contract. Waiver of subrogation is applicable where required by written contract. City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Risk Management Division THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 Civic Center Plaza ACCORDANCE WITH THE POLICY PROVISIONS. Santa Ana, CA 92702 AUTHORIZED REPRESENTATIVE 01966-2016 ACORD C1 1 ° fIMI�,,q JZ, W1,1114il( ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD ©MM Risk Ntanagemenr Analyst AGENCY CUSTOMER ID: CN118025105 LOC #: Philadelphia AGENCY MARSH USA INC POLICY NUMBER CARRIER ADDITIONAL REMARKS SCHEDULE NAIC CODE NAMED INSURED Allied Universal Topco, LLC (See Attached for Additional Named Insureds) 161 Washington Street, Suite 600 Conshohocken, PA 19428 EFFECTIVE DATE: THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance Excess Workers Compensation Policy No.: RWE943548206 Insurer. XL Specialty Insurance Company Effective Dales: 11112022- V112023 Limit: Employers Liability Each Accident: $1.000,000 Employers Liability Disease -Policy Limit: $1,000,000 Employers Liability Disease -Each Employee: $1,000,000 SIR: $1,000,000 Crime Policy No.: 01-602-29-33 Insurer: National Union Fire Insurance Co. Effective Dates: 091152021- 09/15/2022 Limit: Employee Theft or Dishonesty: $2,000,000 Clients' Property: $2,000,000 Deductible: $1,000,000 Contractors Pollution Liability Policy Nu: CP013303734 Insurer: Commerce and Industry Insurance Company Effective Dates: 1110112021-111012022 Limit:$5,000,000 Deductible:$250,000 The General Liability and Professional Liability policies evidenced above share in the limits shown. The limits do not apply separately to the individual coverages Page 2 of 2 REVIEV/ED&APPROVED Hv: ACORD 101(2008/01) ©2008 ACORDC 3 The ACORD name and logo are registered marks of ACORD '�' Ristc Management Maryst Named Insured: Michael Stapleton Associates, Ltd., dba MSA Allied Universal Topco LLC Security Millard Mall Services Holdco LLC Additional Named Insured: MSA Investigations, Inc. Adesta LLC MSA Security, Inc. Advent Systems, LLC MSA Security Canada Limited Advent Systems, LLC, dba Allied Universal MSA Security Limited Technology Services NAKI Cleaning Services, LLC Allied Security Holdings LLC Peoplemark, Inc. Allied Universal Compliance and Investigations, RONCO Consulting Corporation Inc. SecurAmerica, LLC Allied Universal Compliance and Investigations, Securadyne Systems Intermediate LLC Inc., fka G4S Compliance & Investigations, Inc. Securadyne Systems Intermediate LLC, dba Allied Universal Executive Protection and Allied Universal Technology Services Intelligence Services, Inc. Securadyne Systems Texas LLC Allied Universal Finance Corporation Securadyne Systems Texas LLC, dba Allied Allied Universal Holdco LLC Universal Technology Services Allied Universal Risk Advisory and Consulting SFI Electronics, LLC Services, Inc. SFI Electronics, LLC, dba Allied Universal Allied Universal Sideco, LLC Security Systems AlliedBarton (NC) LLC SFI Electronics, LLC, dba Allied Universal AlliedBarton (NC) LLC, dba Allied Universal Technology Services Security Services SFI Electronics, LLC, dba Universal Protection AlliedBarton Security Services LLC Security Systems AlliedBarton Security Services LLC, dba Allied SOS Security LLC Universal Security Services SOS Security LLC, dba Allied Universal Risk AMAG Technologies, Inc. Advisory and Consulting Services American Security Programs, Inc. SOS Security LLC, dba Allied Universal Security Central Defense Services, LLC Services ERMC LLC Spectaguard Acquisition LLC ERMC of America, LLC Staff Pro Inc. FJC Security Services, Inc. Staff Pro Inc., dba Allied Universal Event FJC Security Services, Inc., dba Allied Universal Services Security Services Titania Insurance Co. of America G4S Holding One LLC TMG Facilities Management, LLC G4S Retail Solutions (Canada) Inc. U.S. Security Associates Holding Corp. G4S Retails Solutions (USA) Inc. Universal Building Maintenance, LLC G4S Secure Integration LLC Universal Building Maintenance, LLC, dba Allied G4S Secure Integration LLC dba Allied Universal Janitorial Services Universal Technology Services Universal Building Maintenance, LLC, dba Allied G4S Secure Solutions International Inc. Universal Landscaping Services G4S Secure Solutions (USA) Inc. Universal Protection GP, Inc. G4S Secure Solutions (USA) Inc., dba Allied Universal Protection Security Systems, LP Universal Universal Protection Security Systems, LP, dba 04S Technology Software Solutions LLC Allied Universal Security Systems Intelligent Access Systems of North Carolina, Universal Protection Security Systems, LP, dba LLC Allied Universal Technology Services Intelligent Access Systems of North Carolina, Universal Protection Service of Canada LLC, dba Allied Universal Technology Services Corporation Intelligent Access Systems of North Carolina, Universal Protection Service of Canada LLC, dba Securadyne Systems Mid -Atlantic Corporation, dba Allied Universal Security Michael Stapleton Associates, Ltd. Services of Canada c RukMamgmedEliviaim Reneum 6 ArrRw® Br. F,%A . P1. ViL wd Risk Management Analyst Universal Protection Service of Canada Corporation, dba Allied Universal Technology Services Universal Protection Service of Seattle, LLC Universal Protection Service of Seattle, LLC, dba Allied Universal Security Services Universal Protection Service, LLC Universal Protection Service, LLC, dba Allied Universal Risk Advisory and Consulting Services Universal Protection Service, LLC, dba Allied Universal Security Services Universal Protection Service, LLC, dba Allied Universal Security Services, LLC Universal Protection Service, LP Universal Protection Service, LP, dba Allied Universal Risk Advisory and Consulting Services Universal Protection Service, LP, dba Allied Universal Security Services Universal Protection Service, LP, dba Allied Universal Security Services, LP Universal Services of America, LP Universal Services of America, LP, dba Allied Universal Universal Thrive Technologies, LLC Universal Thrive Technologies, LLC, dba Allied Universal Monitoring and Response Center Universal Thrive Technologies, LLC, dba Allied Universal Technology Services Universal Thrive Technologies, LLC, dba Thrive Intelligence USAGM Acquisition, LLC Rw1Mauganot1DiYi REvwEweo fi MrRov®Br. Risk Management Analyst POLICY NUMBER: RAD943781805 XIC 414 1013 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM AUTO DEALERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. Schedule Additional Insureds Work Any person or organization you have agreed to All Operations include as an additional insured under written contract, provided such contract was executed prior to the date of loss. COVERED AUTOS LIABILITY COVERAGE, Who Is An Insured, is amended to include as an "insured" the person or organization listed in the Schedule above, but only with respect to liability for "bodily injury" or "property damage" otherwise covered under this policy caused, in whole or in part, by the negligent acts or omissions of: 1. You, while using a covered "auto"; or 2. Any other person, except the additional insured or any employee or agent of the additional insured, operating a covered "auto" with your permission; in the performance of your work as described in the Schedule above. In no event shall any person or organization listed in the Schedule become an "insured" pursuant to this Endorsement if such person or organization is solely negligent. IT IS FURTHER AGREED THAT IN NO EVENT SHALL ANY CONTRACT OR AGREEMENT ALTER THE CONDITIONS, COVERAGES OR EXCLUSIONS SET FORTH IN THIS POLICY. All other terms and conditions of this policy remain unchanged. XIC 414 1013 © 2013 X.L. America, Inc. All Rights Reserved. Reknt�.gwwto ;, VHAR 02/01/2021 May not be copied without permission. z REVIEWED&APPR EDBr. Includes copyrighted material of Insurance Services Office, Inc., with its permis °�, , Risk Management Analyst POLICY NUMBER: RAD943781805 COMMERCIAL AUTO CA04441013 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: ALLIED UNIVERSAL TOPCO, LLC Endorsement Effective Date: January 1, 2022 SCHEDULE Name(s) Of Persons) Or Organization(s): Any person or organization where waiver of our right to recover is required by written contract with such person or organization provided such contract was executed prior to the date of loss. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident' or the "loss" under a contract with that person or organization. CA 04 44 10 13 @ Insurance Services Office, Inc., 2011 RmA Mmogen ad Division �s (rR�EvEwED 6nAP'PIRovm By., �� Risk Management Analyst ENDORSEMENT #050 This endorsement, effective 12:01 AM 01/01/2022 Forms part of policy number: RES943799402 Issued to: ALLIED UNIVERSAL TOPCO, LLC By: INDIAN HARBOR INSURANCE COMPANY ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided by the following: EXCESS GENERAL LIABILITY POLICY A. SECTION II - Who Is an Insured is amended to include as an additional insured a person(s) or organization(s) who is required to be added by written contract or written agreement which does not require that a specific form number be used. B. The insurance provided to additional insureds applies only to "bodily injury", "property damage", "professional liability" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The ads or omissions of those acting on your behalf In the performance of your ongoing operations for the additional insured; or "your work" 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. 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: c=atw owl.\ REvEwED&APPRovED19r. ion fvt� R. Vj& dd Risk Management Analyst 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 a shown in the Declarations. D. The additional insured must see to it that: We are notified as soon as practicable of an "occurrence or offense that may result in a claim. 2. We receive written notice of a claim or "suit' as soon as practicable; and 3. A request for defense and indemnity of the claim or "suit' will promptly be brought against any policy issued by another insurer under which the additional insured also has rights an insured or additional insured. E. This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: The additional insured is a Named Insured under such other insurance; and 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. All other terms and conditions remain as written. MANUS Rid1Mvrgmw1D'nuon ReAtwmfiMrkam3)Br. �� Rzkklanagem nt Analyst ENDORSEMENT #24 This endorsement, effective 12:01 AM O1/O1/2022 Forms part of policy number: RES943799402 Issued to: ALLIED UNIVERSAL TOPCO, LLC By: INDIAN HARBOR INSURANCE COMPANY WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY POLICY SCHEDULE Name of person or Organization: Where required by written contract. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement) The TRANSFER OF RECOVERY AGAINST OTHERS TO US Condition (Section IV — CONDITIONS) is amended by the addition of the following: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products -completed operations hazard." This waived applies only to the person or organization shown in the Schedule above. All other terms and conditions remain as written. MANUS RielcMan"nad DMman cRt EwEo 6DAPPR vED Sr. ® Rak Management Analyst WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 (Ed.4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule Any person or organization where waiver of our right to recover is required by written contract with such person or organization provided such contract was executed prior to the date of loss. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective Insured Allied Universal Topco, LLC Insurance Company XL Insurance America, Inc. WC 00 03 13 (Ed.4-84) _, 1993 National Council on Compensation Insurance. Policy No. Endorsement No. RWD3001203-06 Premium Included Countersigned by Dtwwt REviEwED ® ArrRov f,64"" R. Vats"" A�. Risk Management Analyst NOTICE OF COMPLIANCE CITY STAFF: PRINT THIS PAGE AND INCLUDE WITH AGREEMENT TO THE CLERK OF THE COUNCIL Contractor Allied Universal Topco, LLC Name: Project A-2019-190-05 Number: Project Extension of Agreement #A-2019-190 to Provide Janitorial Name: Services 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: EXPIRATION COI TYPE OF INSURANCE POLICY NUMBER FILE NAME DATE DATE cert_CLE_City of AUTOMOBILE LIABILITY RAD943781806 01/01/2024 01/13/2023 Santa Ana_6844453_8.pdf cert_CLE_City of GENERAL LIABILITY RES943799403 01/01/2024 01/13/2023 Santa Ana_6844453_8.pdf cert_CLE_City of PROFESSIONAL LIABILITY RES943799403 01/01/2024 01/13/2023 Santa Ana_6844453_8.pdf WORKERS ALLIED COMPENSATION AND RWD300120307AOS 01/01/2024 12/29/2022 UNIVERSAL EMPLOYERS' LIABILITY TOPCO, LLC.pdf Thank you, City of Santa Ana Risk Management Division in partnership with CTrax Plus Services Team 1/18/2023 12:49 PM