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HomeMy WebLinkAboutARDENT ERGONOMICS (JORGE MELGOZA)INSURANCE ON FILE A-2023-193 WORK MAY PROCEED UNTIL INSURANCE EXPIRES C;.T Laa CITY CL RK DATE: NOV 1 % Z0Z3 FIRST AMENDMENT TO AGREEMENT WITH O• H Q C t JORGE MELGOZA DBA ARDENT ERGONOMICS (i l-yrra►d TO PROVIDE PREVENTATIVE ERGONOMICS ASSESSMENTS THIS FIRST AMENDMENT to the above -referenced agreement is entered into on November 7, 2023, by and between Jorge Melgoza, an individual, doing business as Ardent Ergonomics ("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"). (Consultant and City are also referred to as the "Parties.") RECITALS A. The Parties entered into Agreement No. N-2022-027 ("Agreement') dated November 23, 2021, to provide preventative ergonomics assessments. The Agreement term runs until November 22, 2024 and is current and in effect. B. The parties now wish to amend the Agreement to increase the overall compensation to the Agreement. No other changes are contemplated by this First Amendment. The Parties therefore agree: Section 2.a., Compensation, is hereby amended to increase the total compensation by fifty - thousand dollars ($50,000). The total compensation amount for this Agreement shall not exceed one hundred thousand dollars ($100,000). 2. Except as modified by this First Amendment, all terms and conditions of the Agreement shall remain in full force and effect. IN WITNESS WHEREOF, the parties hereto have executed this First Amendment to the Agreement on the date and year first written above. ATTEST: CITY OF SANTA ANA j Jennifer L. 2�1 \ Steven Mendoza V Acting City Manager APPROVED AS TO FORM SONIA R. CARVALHO City Attorney LA WA, kco-g nrr Laura A. Rossini Chief Assistant City Attorney CONSULTANT A G J Melgoza Lynch, Breanna From: City of Santa Ana <certificate-request@ctraxjdidata.com> Sent: Wednesday, October 25, 2023 10:04 AM To: Lynch, Breanna; Acevedo, Angie; HR Admin Subject: Internal Notice of Compliance NOTICE OF COMPLIANCE CITY STAFF: PRINT THIS PAGE AND INCLUDE WITH AGREEMENT TO THE CLERK OF THE COUNCIL Contractor Jorge B Melgoza Name: Project N-2022-027 Number: Project Agreement With Jorge Melgoza, DBA Ardent Ergonomics, To Provide Name: Preventative Ergonomics Assessments 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 COI DATE FILE NAME NUMBER DATE BUS CERT AUTOMOBILE LIABILITY 5837885DI555 04/15/2024 10/02/2021 CITY OF SANTA ANA 2023.pdf GENERAL LIABILITY 90E3K8745 10/15/2024 10/02/2023 jorge.pdf Affidavit of Exemption for WORKERS COMPENSATION AND Workers EMPLOYERS' LIABILITY WAIVER 01/03/2024 01/05/2023 Compensation Insurance 2021.pdf Thank you, City of Santa Ana Risk Management Division in partnership with CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 06/25/2024 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT LAZARO NETO NAME: StateFarm LAZARO NETO q/ No E 619) 29- 99 FAX No : (619)-229-6796 3924 EL CAJON ..� nq i Ao F'E I 6 t NSURER(S�AFFOR NG COVERAGE NAIC # INs /,'E a r I I n 25151 SAN DIEGO C 2105 INSURED It SURLB: tate FarmMfutual Automobile Insurance Company 25178 MELGOZA, JORGE BASURE ate• URER D : 6867 GOLFCREST D5 UREqf) • Q • 1 l ceved INSURER : • • SAN DIEGO CA 921 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 I SUBR POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE � OCCUR RETE ,REM SES ( DAMAGE ToEa oNcur ence) $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 A Y Y 90-E3-K874-5 10/15/2023 10/15/2024 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY PRO LOC El JECT PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY 583 7885-D15-55A 04/15/2024 10/15/2024 COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ 1,000,000 ANY AUTO A OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ 1,000,000 PROPERTY DAMAGE Per accident $ 1,000,000 HIRED NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN PER OTH- STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N I A E.L. DISEASE - EA EMPLOYE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 1D1, Additional Remarks Schedule, may be attached if more space is required) City of Santa Ana , its officers, officials, employees, and volunteers are to be covered as additional insureds and waiver of subrogation on the CGL policy with respect to liability arising out of work or operations performed by or on behalf of the Consultant including materials, parts, or equipment furnished in connection with such work or operations CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF Nr)TICF WH I RF nFl IVFRFn IN City of Santa Ana ACCORDANCE WITH THE POLICY PR( ian 20 Civic Center Plaza i R[ele D & APPROgmwntVED ED BY. AUTHORIZED REPRESENTATIVE i' REVIEWED Fz P:PPROVED BY. A+-�:e Acevaolo Santa Ana CA 92702 / %a 1 _ ®' Risk Management Specialist © 1988-2015 ACORD ACORD 25 (2016/03) The ACORD name and logo are regis red marks of ACORD 1001486 132849.12 03-16-2016