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HomeMy WebLinkAboutCALIFORNIA BARRICADE RENTALS, INC (3)Su CN Fl ,��iC�, L. t^:ORK MAY PROCEEri Uf -111 INSIJRANCE EXPIRES MAYOR CLERK Or• COUNCIL Valerie Amezcua ',' E, MAYOR PRO TEM FEB 2 7 1013 Jessie Lopez COUNCILMEMBERS Phil Bacerra Johnathan Ryan Hernandez David Penaloza Thai Viet Phan Benjamin Vazquez A-2020-038-01 CITY OF SANTA ANA PUBLIC WORKS AGENCY 20 Civic Center Plaza a P.O. Box 1988 Santa Ana, California 92702 www.santa-ana.orc Av February 1, 2023 California Barricade Rentals, Inc. Attn: David Tangitau, President 1550 E. Saint Gertrude Place Santa Ana, CA 92705 CITY MANAGER Kristine Ridge CITY ATTORNEY Sonia R. Carvalho ACTING CLERK OF THE COUNCIL Norma Orozco Re: Extension of Agreement for on -call traffic control services ALrreement No A-2020-038 Pursuant to Section 3 ("Term") of the above -referenced Agreement, entered into by California Barricade Rentals, Inc., and the City of Santa Ana, dated March 3, 2020, the time period of the Agreement is hereby extended for an additional two-year period, from March 3, 2023 through March 2, 2025. 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, i_ -_,__ S-r'4"' Nabil Saba, P.E. Executive Director, Public Works Agency CITY OF SANTA ANA l�i�ist�� City Manager APPROVED AS TO FORM / Jonathan T. Martin i Assistant City Attorney ATTEST "Norma Orozco Acting Clerk of the Council CALIFORNIA BARRICADE RENTALS, INC. David Tangitau President SANTA ANA CITY COUNCIL Valerie Anna. Jaii topaz Thai Viet Phan Benjamin Vazquez PhJ ea[ana Jahnaban Ryan He,andaz 0i id Penal000 Mayor Mayor Phi Waid3 Wad Wind Wade Wad5 wand va,ezooa aansana.am InhasMininb-aria n, bvazoue2(dlsanlaana o, 01acena9sanlaana 0 irvanhe,aldanmsant,-anon, tl flo f - Tori Pierson oa9e,2022,0628;osa,;-07'00 ACORO' CERTIFICATE OF LIABILITY INSURANCE F DATE (MM'-Iy) 06122/2022 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 pollty(les) must be endorsed. If SUBROGATION IS WANED, 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 endoreemenl(s). PRODUCER Ph r (714)973-143a Fax (714)973o811 =Aor ELMCO INSURANCE, INC. ELMCO INSURANCE, INC. 1905 N. MAIN STREET SANTA ANA CA 92706-2779 PRONE (714 973.1436 PA11 . (714) 973-0811 nD ESfi contact@Elmcoinsumnce.com INSURERS) AFFORDING COVERAGE NAIC0 INSURMA : SCOTTSDALE INSURANCE COMPANY 41297 Agency UdF. 050B747 CALIFORNIA BARRICADE RENTALS INC. INSURERS : INFINITY SELECT INSURANCE COMPANY 20260 1650 E. SAINT GERTRUDE PLACE SANTA ANA CA 92706 iNsuReRc : TRISURA SPECIALTY INSURANCE COMPANY 16188 iNSURERo STATE COMPENSATION INSURANCE FUND 36076 iReuRPAE : WESTCHESTER SURPLUS LINES INSURANCE CC 10172 Wsunsl F : HISCOX INSURANCE COMPANY INC 10200 COVERAGES CERTIFICATE NUMBER: 71107 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. MR TYPE OF INSURANCE ADDL MO aUBriIn IAIk/O POLICY NUMBER PouCY EPP PWCY FJw LIMBS A I X COMMERCIALGENFJW.LMILITY CLAIMS -MADE FXIOCCUR Y X BCS0039983 07/01/22 07/01/23 EACH OCCURRENCE $ 1,000.000 PREJAME9 sa oo . $ 100,000 MED. EXP(Any one pani $ EXCLUDED PERSONAL SADVINJURY $ 1,000,000 GENL AGGREGATE LIMIT APPLIES PER: X POLICY PRO- JECT F—] LOC OTHER: GENERAL AGGREGATE S 2,000,000 PRODUCTS - COMPIOP AGG S 2,000,000 EMPLOYEE BENEFITS $ 1,000,000 B AerOMOSul UAINUTY ANY AUTO ALL OWNED SCHEDULED HIRED AUTOS AUTO NONWNED HIRED AUTO$ X -O AUTOS Y X 804-61015.8309-001 07101/22 07/01/23 cokal"EoaxsLE uurt (Eaemas,W E 1,000,000 X X BODILY INJURY (Per person) $ BODILY INJURY (Per eaitlent) S PROPIanYDAMAOE s m $ 8 C uuaaeua UAe IXee99 Line X OCCUR CLAIMAMADE TX50001452-03 07101122 07101/23 EACH OCCURRENCE $ 5,000,000 X AGGREGATE $ 5.000,000 DED RETENTIONS S D mum coMPeWsanoN AND MPLOMS' UAaIUTY ANY PROPRaTORRAIITNERIIXECUTNE YIN OFFICERa1EMBER IXCWDED7 Ixknamn Is NMIFl nvas.IU MMunder DEBCmPTION of OPERATIONS eebw NIA /� 831316422 07/01/22 07101123 X eTATure E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE -EA EMPLOYEE S 1,000,000 E.L. DISEASE -POLICY LIMIT E 1,000,000 E F POLLUTION LIABILITY PROFESSIONAL LIABILITY GT3640124002 MPL7863490.22 07/01/22 07/01122 07101/23 07101/23 Each Pollution Condition $1,000,000 Each Claim $2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be aeamed If more space is required) SEE SUPPLEMENTAL CERTIFICATE INFORMATION CERTIFICATE HOLDER CANCELLATION City of Santa Ana Risk Management Division 20 Civic Center Plaza 4th Floor Santa Ana, CA 92702 Attention: SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. The ACORD name and logo are registered marks of ACORD RbkMi. lgNtm RENFN3)6 NRiUYEDBy: (��\, �.. Risk Mann -1 9enerp UniUlPiAe SUPPLEMENT TO CERTIFICATE OF LIABILITY INS # 71107 JUN222022 i DESCRIPTION OF OPERATIONS, LOCATIONS, VEHICLES The Clry of Santa Ana, Risk Management, It's officers, employees, agents, representatives, and volunteers are named as additional Insured per form CG 20 12 1219 on the GL policy. Primary and Non -Contributory wording applies. Waiver of Subrogation In Favor of The Clry of Santa Ana per forth CG 24 04 12 19. Additional Insured, Primary & Non -Contributory Wording, and Waiver of Subrogation applies perform (50461AIS01, 600PNCV01, 50461SWF01) on the Auto policy. Waiver of Subrogation on the WC Policy per form #10217 Certificate of Insurance shall provide thirty (30) day prior written notice of cancellation per attached form UTS-410g (2-11). Those usual to the Insured's operations. RenEwm6Awrtw Ru4 Mvugavmt Diwton ,' `: mev: %u i7lG:Joor COMMERCIAL GENERAL LIABILITY CG 20 3812 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS FOR OTHER PARTIES WHEN REQUIRED IN WRITTEN CONSTRUCTION AGREEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section 11 — Who Is An Insured is amended to include as an additional insured: 1. Any person or organization for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy; and 2. Any other person or organization you are required to add as an additional insured under the contract or agreement described in Paragraph 1. above. Such person(s) or organization(s) is an additional insured only with respect to liability for "bodily injury', "property damage" or "personal and advertising injury' caused, in whole or in part, by: a. Your acts or omissions; or b. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured described in Paragraph 1. or 2. above. However, the insurance afforded to such additional insured described above: a. Only applies to the extent permitted by law; and b. Will not be broader than that which you are required by the contract or agreement to provide for such additional insured. A person's or organization's status as an additional insured under this endorsement ends when your operations for the person or organization described in Paragraph 1. above are completed. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to: 1. "Bodily injury', "property damage" or "personal and advertising injury" arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, including: a. The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or b. Supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily Injury' or "property damage", or the offense which caused the "personal and advertising injury", involved the rendering of, or the failure to render, any professional architectural, engineering or surveying services. 2. "Bodily injury' or "property damage" occurring after: a. 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 insured(s) at the location of the covered operations has been completed; or CG 20 38 12 19 © Insurance Services Office, Inc., 2018 w.t thaw Rok MarugemmtUmcnlNde b. 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 111— Limits Of Insurance: The most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement described in Paragraph A.1.; or 2. Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the applicable limits of insurance. Page 2 of 2 @ insurance Services Office, Inc., 2018 Rbk A1n�rgenmt Dh; By. Rensv�ED a /VPRw®Bv: Rrtk NUrugertn,l CImuIPoJv POLICY NUMBER: BCS0039983 COMMERCIAL GENERAL LIABILITY CG 20 3712 19 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 Person(s) Or Organization(s) Location And Description Of Completed Operations ANY PERSON OR ORGANIZATION WHEN ALL LOCATIONS REQUIRED BY WRITTEN CONTRACT OR AGREEMENT, EXECUTED PRIOR TO THE OCCURRENCE TO WHICH THIS INSURANCE APPLIES, THAT SUCH PERSON OR ORGANIZATION BE ADDED AS AN ADDITIONAL INSURED ON YOUR POLICY Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(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. CG 20 37 12 19 © Insurance Services Office, Inc., 2018 \, w.tnm.g� Dti �. NenEwEn S Ar" Sr JI-��� \: lYl� r(1� �Rak %u {7rcxtox Mana9e,m,tOme�INtle .' B. 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; whichever is less. This endorsement shall not increase the applicable limits of insurance. Page 2 of 2 0 Insurance Services Office, Inc., 2018 11 RIAMm.gm dViw R+nEwm L APPRW® Or. Risk NU,u9enm, Um W Ntle COMMERCIAL GENERAL LIABILITY CG 20 01 1219 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 LIQUOR LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY 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 1219 © Insurance Services Office, Inc., 2018 one FakW—g—tGr ralNtle POLICY NUMBER: SCS0039983 COMMERCIAL GENERAL LIABILITY CG 240412 19 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: COMMERCIAL GENERAL LIABILITY COVERAGE PART ELECTRONIC DATA LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART DESIGNATED SITES POLLUTION LIABILITY LIMITED COVERAGE PART DESIGNATED SITES PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICY DESIGNATED TANKS SCHEDULE Name Of Person(s) Or Organization(s): ANY PERSON OR ORGANIZATION FOR WHOM THE INSURED HAS AGREED TO WAIVE RIGHTS OF RECOVERY, PROVIDED SUCH AGREEMENT IS MADE IN WRITING AND PRIOR TO THE LOSS shown in The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV — Conditions: We waive any right of recovery against the person(s) or organization(s) shown in the Schedule above because of payments we make under this Coverage Part. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person(s) or organization(s) prior to loss. This endorsement applies only to the person(s) or organization(s) shown in the Schedule above. CG 24 04 12 19 © Insurance Services Office, Inc., 2018 Rmlloml� ..In� 7ou 7�rc+now i Ruk Mana9e,rem OniulPitle Customer Service: (800) 722-3391 Infinity Commercial Auto 11700 Great Oaks Way, Suite 450 Alpharetta, GA 30022 Underwritten by: Infinity Select Insurance Company ADDITIONAL NAMED INSURED ENDORSEMENT Claims Service: (800) 334-1661 Copy To I Policy ID Number Expiration Date 504-61017-5691-001 07/01/2023 12:01 a.m. City of Santa Ana Named Insured 20 Civic Center Plaza 4th Floo Santa Ana, CA 92702 CALIFORNIA BARRICADE RENTALS This endorsement is attached to and forms a part of the listed policy. No changes will be effective prior to the time changes are requested. Additional Insured City of Santa Ana Part A - Liability Coverage, is changed as follows: The definition of insured is changed to include the additional insured named above. Adding an insured will not increase the limit of our liability. The insurance provided by this endorsement will be excess over any other valid and collectible insurance. All other parts of this Policy remain unchanged. 50461AIS01 \ wa �w„q�r o� At (��� ) ae.,E�nsnr�,�,ar. �,( %u Pl ,,o.: END eaw ra„�vn,Rnam�naae KEMPERAuto nINFINITY Infinity Commercial Auto 11700 Great Oaks Way, Suite 450 Alpharetta, GA 30022 Underwritten by: Infinity Select Insurance Company Customer Service: 800-722-3391 Claims Service: 800-334-1661 WAIVER OF SUBROGATION CALIFORNIA Copy To Policy ID Number Expiration Date CALIFORNIA BARRICADE RENTALS 504-61017-5691.001 07/01/2023 12:01 AM 6481 Coronado Ave Named Insured Long Beach, CA 90805 Califomia Barricade Rentals This endorsement is attached to and tons a pad of the listed policy. No changes will be effective prior to the time changes are requested. In return for your premium payment shown below, we agree that our rights of subrogation or rights of recovery under the policy will not apply against the following person or organization: City of Santa Ana 20 Civic Center Plaza 4th Floo Santa Ana, CA 92702 Additional premium in the amount of $25.00 will be retained by us regardless of any early termination of this endorsement or the policy. All other policy provisions remain unchanged. 50461SWF01 Amend Date: U6/21r2022 Nem�wm aAra+ojd� m,wrw,agrne,,.um Customer Service: (600) 722-3391 Infinity Commercial Auto 11700 Great Oaks Way, Suite 450 Alpharetta, GA 30022 Underwritten by: Infinity Select Insurance Company PRIMARY AND NONCONTRIBUTORY ENDORSEMENT Claims Service: (600) 334-1661 Copy To Policy ID Number Expiration Date City of Santa Ana 20 Civic Center Plaza 4th Floo Santa Ana, CA 92702 504.61017-5691-001 07/01/2023 12:01a..m. Named Insured California Barricade Rentals This endorsement is attached to and forms a part of the listed policy. The following endorsement applies only if Form Number 500PNCV01 appears on your Declarations Page. This endorsement modifies the insurance provided under your COMMERCIAL AUTO POLICY. PART A — LIABILITY COVERAGE OTHER INSURANCE — PART A ONLY The following is added to this section: The coverage afforded under yyour Commercial Auto Policy is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: a. You have agreed in writing in a contract or agreement that the coverage afforded under your Commercial Auto Policy would be primary and would not seek contribution from any other insurance available to such additional insured; and b. Such additional insured is a named insured under such other insurance. ALL OTHER TERMS, LIMITS, CONDITIONS, AND PROVISIONS OF THE POLICY REMAIN UNCHANGED. ADDL INSURED COPY 500PNCV01 Rbk Ma+ga,mt7l N _. RenEv/m 6 AYPRw® ar NOW Ro k Nlarugennrt Clm ril Ai Je EN ENDORSEMENT AGREEMENT WAIVER OF SUBROGATION BLANKET BASIS HOME OFFICE SAN FRANCISCO ALL EFFECTIVE DATES ARE AT 12:B1 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME CALIFORNIA BARRICADE RENTALS, INC 1550 E SAINT GERTRUDE PL SANTA ANA, CA 92705 HE HAVE THE RIGHT TO RECOVER OUR PAYMENTS FROM ANYONE LIABLE FOR AN INJURY COVERED BY THIS POLICY. WE WILL NOT ENFORCE OUR RIGBT 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. THE ADDITIONAL PREMIUI4 FOR THIS ENDORSEMENT SHALL BE 2.001 OF THE TOTAL POLICY PREMIUM. SCHEDULE PERSON OR ORGANIZATION JOB DESCRIPTION ANYANY PERSON OR ORGANIZATION BLANKET YIPIVER OF FOR WHOM THE NAMED INSURED SUBROGATION HAS AGREED BY WRITTEN CONTRACT TO FURNISH THIS VIAI VER RENEWAL NA 3-67-17-77 PAGE 1 OF NOTHING IN THIS ENDORSEMENT CONTAINED SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY. ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS OF THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SAN FRANCISCO. AIrHORRED Rc'PRESENT IV`c SClr FORM. 1-1217 IREV.7'20W 1 v/�^•'+r•^• ><��irr.,tti. ?RESIDENT A,\7 CEO __ Ri.k Mu�1�11vt Diwicw A Rev�ea�m6MrxwmBr: nix ma„aseinn, u..�w a ne Ai SCOTTSDALE INSURANCE COMPA.NYO Attached to and forming a part of Policy No. BCS0039983 Named Insured r.AT,TFORNTA 1102 Endorsement Effective Date 07-01-22 12:01 A.M., Standard Time Agent No. 04743 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AMENDMENT OF CANCELLATION NOTICE TO FIRST NAMED INSURED AND SCHEDULED PARTY(IES) The following Conditions are added to the Cancellation Condition: 1. If we cancel this policy for any reason other than nonpayment of premium, we will mail written notice of cancellation to the first Named Insured and to any party(ies) at their designated mailing address(es), shown in the Schedule below, at least 30 days before the effective date of cancellation. 2. If we fail to mail such notice as indicated in 1. above, any coverage afforded to the party(ies) will re- main in effect: a. For the number of days shown in 1. above from the date a written notice of cancellation is actually mailed; b. Until the effective date of replacement coverage is obtained elsewhere by the first Named Insured; or c. Until the termination date requested by the Named Insured, whichever occurs first. SCHEDULE Name and Address of Party(ies): CITY OF SANTA ANA RISK MANAGEMENT DIVISION 20 CIVIC CENTER PLAZA, 4TH FLOOR SANTA ANA, CA 92702 CITY OF SANTA ANA, RISK MANAGEMENT, IT'S OFFICERS, EMPLOYEES, AGENTS, REPRESENTATIVES, AND VOLUNTEERS AUTHORIZED REPRESENTATIVE UrS-4109 (2-11) Page 1 of 1 DATE Rhk M.%.i ondm - REnE 6AvrRw®ar. 1iLL� kf.L' 70:� f�rc�o�r �aakmar..de,nmmrnraaae . Insured Copy