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HomeMy WebLinkAboutWALSH CONSTRUCTION COMPANY II, LLC (4) N-2023-306-01 MAYOR ACTING CITY MANAGER Valerie Amezcua 4,. } 0v Alvaro Nunez •rR"',` MAYOR PRO TEM - .:4•<; •�:•,_,,�� , CITY ATTORNEY Thai Viet Phan Sonia R.Carvalho COUNCILMEMBERS R111LI CITY CLERK Phil Bacerra •• F 1 t is Jennifer L.Hall Johnathan Ryan Hernandez Jessie Lopez David Penaloza Benjamin Vazquez CITY OF SANTA ANA INSURANCE ON FILE PUBLIC WORKS AGENCY WORK MAY PROCEED UNTIL INSURANCE EXPIRES 20 Civic Center Plaza•P.O.Box 1988 I ( ZO Z S Santa Ana,California 92702 WWW-santa-ana.orq CITY CLERK DATE: AUG 1 5 2024 0.• Pw - c2) June 11,2024 Walsh Construction Company II, LLC Attn: Marco Perez 1000 E. Santa Ana Blvd., Ste 200 Santa Ana,CA 92701 Re: Extension of License Agreement O .-2023-306) Pursuant to Section 1 ("License") of the above-referenced Agreement, entered into by Walsh Construction Company II, LLC and the City of Santa Ana, dated September 28, 2023,the time period of the Agreement is hereby extended for an additional six (6) months from June 10, 2024 through December 9, 2024. 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, a ljd. Nabil Saba, PE Executive Director, Public Works Agency CITY OF SANTA AN ATTEST Alvaro Nunez ennifer L. .. City Manager City Cl- • APPROVED AS TO FORM WALSH CONSTRUCTION COMPANY II,LLC ifl z� se Montoya v J Titus Assistant City Attorney roject Manager SANTA ANA CITY COUNCIL Valerie Arnezcua 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 vamezcua(esantaana.orq lohanr@sanla-ana.orq bvazqueziDisanta-ana.orq jessieloaez(ssanla-ana.orq pbacerraWsanta-ana.orq jrvanhernandez{dlsanta-ana.orq doenalozai5santa-ana.orq i—"/ ® DATE(MMIDD/YYYY) AFRO CERTIFICATE OF LIABILITY INSURANCE 05/22/2024 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 zo 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 4w—' certificate does not confer rights to the certificate holder in lieu of such endorsement(s). .c PRODUCER CONT.0 • • . L Aon Risk Services ntral, Inc. NAME: ]/yz�3 I��'2z \' signed >_ Chicago IL Office (A/C. o.Ext �1.I� l2`a 1 " 9 200 East Randal E-MA 1 Chicago IL 6060p ngie ADDR'�S: , _ _ A r� e°AGcev e d o NAIL# INSURED INS)' ER, Arch urance company 11150 Walsh Construction company II, LLC IN£ KERB:Ouch ndemnit n r ce amp y 0830 1260 Corona Point ourt Ste 201 ate•• Corona CA 42879 u I, SURER C: C e v e o ,Ns'uR;H D: INSURER E: 1� . ^soot INSURER F: w COVERAGES CERTIFICATE NUMBER: 57(10',d06543 -• ' �ON NR: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. Limits shown are as requested INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM/DD/YYYY) IMM/DDIYYYY1 LIMITS A X COMMERCIAL GENERAL LIABILITY 41PKG8901918 06/O1/2024 06/01/2025 EACH OCCURRENCE $2,000,000 CLAIMS-MADE X OCCUR SIR applies per policy terns & conditions DAMAGE TO RENTED $1,000,000 PREMISES(Ea occurrence) MED EXP(Any one person) $2 5,000 PERSONAL&ADV INJURY $2,000,000 7 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $4,000,000 0 POLICY I X I�E X LOC CT PRODUCTS-COMP/OP AGG $4,OOO,OOO o OTHER: o r` A 41PKG8901918 06/01/2024 06/01/2025 COMBINED SINGLE LIMIT `r' AUTOMOBILE LIABILITY $5,000,000 AOS (Ea accident) ,, A X ANY AUTO 41CAB8902018 06/01/2024 06/01/2025 BODILY INJURY(Per person) Z — OWNED SCHEDULED MA only BODILY INJURY(Per accident) N AUTOS ONLY AUTOS HMEDAUTOS NON-OWNED PROPERTY DAMAGE Ti ONLY AUTOS ONLY (Per accident) w w - d A UMBRELLALIAB X OCCUR 41UFP1992101 06/01/2024 06/01/2025 EACH OCCURRENCE $5,000,000 V X EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000 DED RETENTION B WORKERS COMPENSATIONAND 44WC18937511 06/01/2024 06/01/2025 X PER STATUTE OTH- EMPLOYERS'LIABILITY Y/N A05 ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT 51,990,009 /M A OFFICEREMBEREXCLUDED? N N/A 41WC18910411 06/01/2024 06/01/2025 (Mandatory in NH) FL E.L.DISEASE-EA EMPLOYEE 51,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000— A Excess workers compensation 41WCX8901818 06/01/2024 06/01/2025 EL Each Accident $1,000,000 IL,IN,WA,OH EL Disease - Policy $1,000,000 SIR applies per policy terns & condi-ions EL Disease - Ea Bap. $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Re: Encroachment Permit, Job 218132. _--- See Attached. /r....i M CERTIFICATE HOLDER CANCELLATION ed SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE -r.rd POLICY PROVISIONS. City of Santa Ana, M-93 AUTHORIZED REPRESENTATIVE 20 Civic Center Plaza Santa Ana CA 92702 USA t o�2 cJ�V ( RieltMnrmgefPROV iDBy: ��tL_YG/l r,oa..t� ie444a1 y REVIEWED&APPROVED BY: al1n1111►�c' A4 Acwes4 ' ®. Risk Management Specialist ©1988-2015 ACORD CC, NA ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 10774508 LOC#: A ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY NAMED INSURED Aon Risk Services Central, Inc. Walsh Construction Company II, LLC POLICY NUMBER See Certificate Number: 570105806543 CARRIER NAIC CODE see Certificate Number: 570105806543 EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance Excess Liability Policy No. 47xSF30256809 Carrier: Berkshire Hathaway Specialty Ins Company Policy Term: 06/01/2024 to 06/01/2025 Limit: $5,000,000 Each occurrence / $5,000,000 Aggregate excess of primary $5,000,000 N Risk Management Division 3+,. REVIEWED&APPROVED BY: = ;= A4sp AGv '® Risk Management Specialist ACORD 101(2008/01) ©2008 ACORD CORPORA/ The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 10774508 LOC#: A ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY NAMED INSURED Aon Risk Services Central, Inc. Walsh Construction Company II, LLC POLICY NUMBER See Certificate Number: 570105806543 CARRIER NAIC CODE See Certificate Number: 570105806543 EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance Continuation The City of Santa Ana, its officers, employees, agents, and volunteers are an Additional Insured pertaining to General Liability with respects to liability arising out of the Named Insured's operations on the referenced project. Professional services for Architects, Engineers, Consultants, etc. are excluded. This insurance will be Primary and Non-Contributory to the General Liability policy with respect to any other available insurance to the Additional Insureds for the negligence of the insured on the referenced project. General Liability includes Severability of Interests / Cross Liability. Risk Management Division 3'. ` REVIEWED&APPROVED BY: • A immuzzi. rty A o Risk Management Specialist ;} ACORD 101(2008101) ©2008 ACORD CORPORA/ The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 41 PKG8901918 COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 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, you have agreed by means of a written contract or agreement, to add as an additional in- sured; such person or organization is an additional insured on this policy. When required by a written contract or agreement, cover- age afforded to these additional insured parties will be primary to and non-contributory with any other insurance available to that person or organization. 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 exclu- organization(s) shown in the Schedule, but only sions 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 equip- 1. Your acts or omissions; or ment furnished in connection with such work, 2. The acts or omissions of those acting on your on the project (other than service, maintenance behalf; or repairs) to be performed by or on behalf of in the performance of your ongoing operations for the additional insured(s) at the location of the the additional insured(s) at the location(s) desig- covered operations has been completed; or nated above. 2. That portion of "your work" out of which the injury or damage arises has been put to its in- tended use by any person or organization other than another contractor or subcontractor en- gaged in performing operations for a principal as a part of the same project. \ / Risk 1vtYnagemenf D vis an __ REVIEWED&APPROVED BY: __ -) Risk Management Specialist / \ CG 20 10 07 04 ©ISO Properties, Inc., 2004 Page 1 of 1 12 POLICY NUMBER: 41PKG8901918 COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 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 SCHEDULE Name Of Additional Insured Person(s) Or Organization(ss: Location And Description Of Completed Operations ANY PERSON OR ORGANIZATION, YOU HAVE AGREED BY MEANS OF A WRITTEN CONTRACT OR AGREEMENT, TO ADD AS AN ADDITIONAL INSURED; SUCH PERSON OR ORGANIZATION IS AN ADDITIONAL INSURED ON THIS POLICY. WHEN REQUIRED BY A WRITTEN CONTRACT OR AGREEMENT, COVERAGE AFFORDED TO THESE ADDITIONAL INSURED PARTIES WILL BE PRIMARY TO AND NON— CONTRIBUTORY WITH ANY OTHER INSURANCE AVAILABLE TO THAT PERSON OR ORGANIZATION. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II —Who Is An Insured is amended to in- clude as an additional insured the person(s) or or- ganization(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- o ,r RiskMarmganeniDivis(c, completed operations hazard". o=' REVIEWED&APPROVED BY: ' ii A4•f:c Aca.veki Risk Management Specialist CG 20 37 07 04 ©ISO Properties, Inc., 2004 . ..y,, . ... . THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION-CERTIFICATE HOLDERS (SPECIFIED DAYS) The person(s) or organization(s) listed or described in the Schedule below have requested that they receive written notice of cancellation when this policy is cancelled by us. We will mail or deliver to the Person(s) or Organization(s) listed or described in the Schedule a copy of the written notice of cancellation that we sent to you. If possible,such copies of the notice will be mailed at least 60 days, except for cancellation for non-payment of premium which will be mailed 10 days, prior to the effective date of the cancellation, to the address or addresses of certificate holders as provided by your broker or agent. Schedule Person(s)or Organization(s) including mailing address: All certificate holders where written notice of the cancellation of this policy is required by written contract, permit or agreement with the Named Insured and whose names and addresses will be provided by the broker or agent listed in the Declarations Page of this policy for the purposes of complying with such request. This notification of cancellation of the policy is intended as a courtesy only. Our failure to provide such notification to the person(s) or organization(s) shown in the Schedule will not extend any policy cancellation date nor impact or negate any cancellation of the policy. This endorsement does not entitle the person(s) or organization(s) listed or described in the Schedule above to any benefit, rights or protection under this policy. Any provision of this endorsement that is in conflict with a statute or rule is hereby amended to conform to that statute or rule. All other terms and conditions of this policy remain unchanged. Endorsement Number: Policy Number: 41PKG890191 8 Named Insured:WALSH CONSTRUCTION GROUP, LLC This endorsement is effective on the inception date of this Policy unless otherwise stated herein: Endorsement Effective Date: 06-01-24 ^-M. RigokmagementDkvision 111� REVIEWED&APPROVED BY: ' • j A44ia Aal/44 00 ML0087 00 11 10 Risk Management Specialist / t THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION—CERTIFICATE HOLDERS (SPECIFIED DAYS) The person(s) or organization(s) listed or described in the Schedule below have requested that they receive written notice of cancellation when this policy is cancelled by us. We will mail or deliver to the Person(s) or Organization(s) listed or described in the Schedule a copy of the written notice of cancellation that we sent to you. If possible,such copies of the notice will be mailed at least 60 days, except for cancellation for non-payment of premium which will be mailed 10 days, prior to the effective date of the cancellation, to the address or addresses of certificate holders as provided by your broker or agent. Schedule Person(s)or Organization(s)including mailing address: All certificate holders where written notice of the cancellation of this policy is required by written contract, permit or agreement with the Named Insured and whose names and addresses will be provided by the broker or agent listed in the Declarations Page of this policy for the purposes of complying with such request. This notification of cancellation of the policy is intended as a courtesy only. Our failure to provide such notification to the person(s) or organization(s) shown in the Schedule will not extend any policy cancellation date nor impact or negate any cancellation of the policy. This endorsement does not entitle the person(s) or organization(s) listed or described in the Schedule above to any benefit, rights or protection under this policy. Any provision of this endorsement that is in conflict with a statute or rule is hereby amended to conform to that statute or rule. All other terms and conditions of this policy remain unchanged. Endorsement Num ber: Policy Number: 44WCI8 937511 Named Insured: WALSH CONSTRUCTION GROUP, LLC This endorsement is effective on the inception date of this Policy unless otherwise stag\ Endorsement Effective Date: 0 6—01-2 4 Qr RskM&APPROnagement APPROVED BY: II����c'? REVIEWED&APPROVED BY: Risk Management Specialist 00 ML0087 00 11 10