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HomeMy WebLinkAboutUNITED STORM WATER, INC. (9) A-2021-097-02A MAYOR ACTING CITY MANAGER Valerie Amezcua Alvaro Nunez MAYOR PRO TEM �!t CITY ATTORNEY Thai Viet Phan ' Sonia R.Carvalho COUNCILMEMBERS —. _ CITY CLERK Phil Bacerra _ Jennifer L.Hall Johnathan Ryan Hernandez Jessie Lopez David Penaloza Benjamin Vazquez - CITY OF SANTA ANA INSURANCE ON FILE WORK MAY PROCEED PUBLIC WORKS AGENCY UNTIINSURANCE EXPIRES 20 Civic Center Plaza•P.O.Box 1988 l` ' Santa Ana,California 92702 CITY CLER� www.santa-ana.orq DATE: (4 12 21 JUN 1 7 2024 ( May 29, 2024 D'•( rs LZlnited Storm Water, Inc. (c F )ELAttn: Eduardo Perry,Jr. ✓✓ 14000 E. Valley Blvd. City of Industry,CA 91745 Re: Extension of Agreement(A-2021-097-02)to Provide Spill Response,Hazardous Waste Disposal,and Storm Drain Facility Maintenance Pursuant to Section 3 ("Term") of the above-referenced Agreement, entered into by United Storm Water, Inc.("Consultant"),and the City of Santa Ana,dated June 15,2021,and amended by the Parties on October 5,2021 (A-2021-199)and June 6,2023(A-2023-100),the time period of the Agreement is hereby extended for an additional two-year period through June 13, 2026. Any insurance certificates are required to be extended and/or renewed to cover this extension. All other terms and conditions of the Agreement, as amended,remain unchanged and in full force and effect. Sincerely, abil Saba,PE Executive Director, Public Works Agency CITY OF NTA ANA ATTEST 04.7-1 • Alvaro Nunez er L. 11 Acting City Manager City Cle " y APPROVED AS TO FORM UNITED STORM WATER, INC. Kylr ellesen By: Assistant City Attorney Title: Lydia Perry Secretary/Treasurer SANTA ANA CITY COUNCIL Valerie Amezcua Thai Viet Phan Benjamin Vazquez Jessie Lopez Phil Bacerra Johnathan Ryan Hernandez David Penaloza Mayor Mayor Pro Tern,Ward 1 Ward 2 Ward 3 Ward 4 Ward 5 Ward 6 vamezcualasanta-ana.orq tphan(asanta-ana.arq bvazquezalsanta-ana.orq jessielopez(dlsanta-ana.orq pbacerra(ai Santa-ana.am jryanhemandez(alsanta-ana.orq doenaloza(aisanta-ana.orq Foster, Craig From: City of Santa Ana <certificate-request@ctraxjdidata.com> Sent: Thursday,January 4, 2024 1:24 PM To: ramonm@unitedstormwater.com; Foster, Craig Subject: Internal Notice of Compliance 11� '1 SANTA ANA NOTICE OF COMPLIANCE CITY STAFF: PRINT THIS PAGE AND INCLUDE WITH AGREEMENT TO THE CLERK OF THE COUNCIL Contractor United Storm Water, Inc. Name: Project A-2021-097-02 Number: Project Agreement To Provide Spill Response, Hazardous Waste Disposal, And Name: Storm Drain Facility Maintenance 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: I TYPE OF INSURANCE POLICY EXPIRATION COI DATE FILE NAME NUMBER DATE City of Santa AUTOMOBILE LIABILITY AEC0062630 12/31/2024 12/27/2023 Ana(Agreement #A-2021-097- 02).pdf City of Santa GENERAL LIABILITY GEC3001691 12/31/2024 12/27/2023 Ana(Agreement #A-2021-097- 02).pdf City of Santa PROFESSIONAL LIAB-CLAIMS MADE PEC0048963 12/31/2024 12/27/2023 Ana(Agreement #A-2021-097- 02).pdf City of Santa WORKERS COMPENSATION AND WEC3001692 12/31/2024 12/27/2023 Ana(Agreement EMPLOYERS'LIABILITY 4411 #A-2021-097- 02).pdf 1 DATE(MM/DD/YYYY) ACOR" CERTIFICATE OF LIABILITY INSURANCE 12/30/2025 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 NAME: IMA, Inc. PHONE FAX 3475 E. Foothill Blvd., Suite 100 A/c No Ext: 626 799-7000 A/C No: 626 583-2117 Pasadena, CA 91107 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# www.imacorp.com OH64724 INSURERA: Greenwich Insurance Company 22322 INSURED INSURERB: XL Insurance America, Inc. 24554 United Storm Water, Inc. INSURERC: Indian Harbor Insurance Com an 36940 14000 East Valley Blvd. City of Industry CA 91746 INSURERD: XL Specialty Insurance Company 37885 INSURER E: AXIS Surplus Insurance Company 26620 INSURER F: COVERAGES CERTIFICATE NUMBER: 88631955 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICYNUMBER MM/DD MM/DD A / COMMERCIAL GENERAL LIABILITY ✓ GEC3001691 12/31/2025 12/31/2026 EACH OCCURRENCE $1,000,000 DA AGE To RENTED CLAIMS-MADE EVI OCCUR 'RE MIS ES(E.occurrence) $100,000 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $2,000,000 POLICY ✓� ECT LOC PRODUCTS-COMP/OP AGG $2,000,000 1� PRO- OTHER: $ B AUTOMOBILE LIABILITY ✓ AECO062630 12/31/2025 12/31/2026 (Ea aBINEDtSINGLE LIMIT $1,000,000 C ✓ ANY AUTO AECO062631 12/31/2025 12/31/2026 BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ ✓ AUTOS ONLY ✓ AUTOS ONLY Per accident C UMBRELLA LAB / OCCUR UECO062632 12/31/2025 12/31/2026 EACH OCCURRENCE $10,000,000 / EXCESS LAB CLAIMS-MADE AGGREGATE $10,000,000 DED ✓ RETENTION$10,000 $ D WORKERS COMPENSATION ✓ WEC3001692 12/31/2025 12/31/2026 / SPER TATUTE OERH AND EMPLOYERS'LIABILITY Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? FN] N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1 000 000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 C Pollution Liability-Per Occurrence PECO062633 12/31/2025 12/31/2026 $15,000,000 Each Claim/Agg/$25,000 Ded. C Professional Liab-Claims Made PECO062633 12/31/2025 12/31/2026 $15,000,000 Each Claim/Agg/$25,000 Ded. E Excess Liability ELZ677135 12/31/2025 12/31/2026 $5Mil xs of$10Mil Ea Occ/Aggregate DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) Digitallysign d Re:Agreement#A-2021-097-02&A2021-199(1 st Amendment) TUTran byTuTran GL&Auto Additional Insureds apply per CG20101219, CG20371219&XIC4141013 attached,only if required by written contract/agreement Nguyen GL Primary&Non-Contributory Wording applies per XIL4240605 attached.WC Waiver of Subrogation applies per WC0403060484 attachedN guyen Date:2026.01 35 Excess Policy follows form.Additional Insured(s):City of Santa Ana,its officers,agents,volunteers and employees. 15:07:13-08 APPROVED CERTIFICATE HOLDER CANCELLATION By Tu Tran Nguyen at 3:06 pm,Jan 05,2026 Agreement#A-2021-097-02 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Risk Management Division ACCORDANCE WITH THE POLICY PROVISIONS. 20 Civic Center Plaza Santa Ana, CA 92702 AUTHORIZED REPRESENTATIVE Cassandra Rosales ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD 88631955 1 UNITPUM-01 125-26 All Lines Nancy Cadwallader 112/30/2025 2:11:54 PM (PST) I Page 1 of 8 POLICY NUMBER: AECO062630 XIC 414 1013 AECO062631 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 WITH WHOM AS PER WRITTEN CONTRACT YOU HAVE AGREED TO PROVIDE ADDITIONAL INSURED COVERAGE ON A PRIMARY AND NONCONTRIBUTORY BASIS WHERE REQUIRED WITHIN A WRITTEN CONTRACT OR AGREEMENT, EXECUTED PRIOR TO 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. Page 1 of 1 May not be copied without permission. Includes copyrighted material of Insurance Services Office, Inc.,with its permission. 88631955 UNITPUM-01 125-26 All Lines I Nancy Cadwallader 112/30/2025 2:11:54 PM (PST) I Page 2 of 8 POLICY NUMBER:GEC3001691 COMMERCIAL GENERAL LIABILITY CG20101219 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location(s) Of Covered Operations Any person or organization where required by All Locations as required per written contract written contract provided that 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. A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional organization(s) shown in the Schedule, but only exclusions apply: with respect to liability for "bodily injury", "property This insurance does not apply to "bodily injury" or damage" or "personal and advertising injury" "property damage" occurring after: caused, in whole or in part, by: 1. All work, including materials, parts or 1. Your acts or omissions; or equipment furnished in connection with such 2. The acts or omissions of those acting on your work, on the project (other than service, behalf; maintenance or repairs) to be performed by or in the performance of your ongoing operations for on behalf of the additional insured(s) at the the additional insured(s) at the location(s) location of the covered operations has been designated above. completed; or However: 2. That portion of "your work" out of which the injury or damage arises has been put to its 1. The insurance afforded to such additional intended use by any person or organization insured only applies to the extent permitted by other than another contractor or subcontractor law; and engaged in performing operations for a 2. If coverage provided to the additional insured is principal as a part of the same project. 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 10 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 2 88631955 UNITPUM-01 125-26 All Lines I Nancy Cadwallader 112/30/2025 2:11:54 PM (PST) I Page 3 of 8 C. With respect to the insurance afforded to these 2. Available under the applicable limits of additional insureds, the following is added to insurance; Section III— Limits Of Insurance: whichever is less. If coverage provided to the additional insured is This endorsement shall not increase the required by a contract or agreement, the most we applicable limits of insurance. will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or Page 2 of 2 © Insurance Services Office, Inc., 2018 CG 20 10 12 19 88631955 1 UNITPUM-01 125-26 All Lines I Nancy Cadwallader 112/30/2025 2:11:54 PM (PST) I Page 4 of 8 POLICY NUMBER:GEC3001691 COMMERCIAL GENERAL LIABILITY CG20371219 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 where required by written All Locations as required per written contract. contract provided that 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. A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following is added to organization(s) shown in the Schedule, but only Section III— Limits Of Insurance: with respect to liability for "bodily injury" or If coverage provided to the additional insured is "property damage" caused, in whole or in part, by required by a contract or agreement, the most we "your work" at the location designated and will pay on behalf of the additional insured is the described in the Schedule of this endorsement amount of insurance: performed for that additional insured and included in the"products-completed operations hazard". 1. Required by the contract or agreement; or However: 2. Available under the applicable limits of 1. The insurance afforded to such additional insurance; insured only applies to the extent permitted by whichever is less. law; and This endorsement shall not increase the 2. If coverage provided to the additional insured is applicable limits of insurance. 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 Page 1 of 1 88631955 UNITPUM-01 125-26 All Lines I Nancy Cadwallader 112/30/2025 2:11:54 PM (PST) I Page 5 of 8 ENDORSEMENT# This endorsement, effective 12:01 a.m.,12/31/2025 , forms a part of Policy No.GEC3001691 issued to United Pumping Service, Inc. by Greenwich Insurance Company. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY INSURANCE CLAUSE ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS COVERAGE PART It is agreed that to the extent that insurance is afforded to any Additional Insured under this policy, this insurance shall apply as primary and not contributing with any insurance carried by such Additional Insured, as required by written contract. All other terms and conditions of this policy remain unchanged. XIL 424 0605 ©, 2005, XL America, Inc. 88631955 UNITPUM-01 125-26 All Lines I Nancy Cadwallader 112/30/2025 2:11:54 PM (PST) I Page 6 of 8 ENDORSEMENT# This endorsement, effective 12:01 a.m., 12/31/2025,forms a part of Policy No.GEC3001691 issued to United Storm Water, Inc. by Greenwich Insurance Company. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY INSURANCE CLAUSE ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS COVERAGE PART It is agreed that to the extent that insurance is afforded to any Additional Insured under this policy, this insurance shall apply as primary and not contributing with any insurance carried by such Additional Insured, as required by written contract. All other terms and conditions of this policy remain unchanged. XIL 424 0605 O, 2005, XL America, Inc. 88631955 UNITPUM-01 125-26 All Lines I Nancy Cadwallader 112/30/2025 2:11:54 PM (PST) I Page 7 of 8 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed.04-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT—CALIFORNIA 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.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 2 %of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description Where required by written agreement signed prior to loss All California Operations. 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 12/31/2025 Policy No.WEC3001692 Endorsement No. Insured Insurance Company XL Specialty Insurance Company United Storm Water,Inc. Countersigned By WC 04 03 06 Page 1 of 1 (Ed. 04-84) Copyright 1984 Workers'Compensation insurance Rating Bureau of California.All Rights Reserved. 88631955 UNITPUM-01 125-26 All Lines I Nancy Cadwallader 112/30/2025 2:11:54 PM (PST) I Page 8 of 8