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HomeMy WebLinkAboutMVR CONSULTING (4) INSURANCE ON FILE WORK MAY PROCEED UNTIL INSURANCE EXPIRES N-2022-357-01 PSI fizz_ CITY CLERK( DATE. OY,(He 2+.'- t 5Aty MAYOR 4. CITY MANAGER Valerie Amezcua � wr, r Alvaro Nunez MAYOR PRO TEM CITY ATTORNEY cJ Thai Viet Phan _ Sonia R.Carvalho COUNCILMEMBERS * . _ * CITY CLERK Phil Bacerra Jennifer L.Hall Jessie Lopez Johnathan Ryan Hernandez t'rr 011. David Penaloza Benjamin Vazquez CITY OF SANTA ANA Public Works Agency 20 Civic Center Plaza•P.O.Box 1988 Santa Ana,California 92702 0: pwol(2) www.santa-ana.orq Cellar (KF) October 15,2024 MVR Consulting P.O. Box 236 Calimesa, California 92320 Attn: Martha van Rooijen, Principal Re: Extension of Agreement(N-2022-357)for Software Maintenance Support Dear Martha van Rooijen: Pursuant to Section 3 ("Term") of the above-referenced Agreement,entered into by MVR Consulting and the City of Santa Ana, dated November 29, 2022, the time period of the Agreement is hereby extended for an additional and final one(1)year period,from November 29,2024 through November 28, 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, • q �a Nabil Saba Executive Director cublics Works Agency CITY OF SANTA A ATTEST A varo Nunez ennifer L. all City Manager City Cl- APPROVED AS TO FARM r MVR CONSULTING . 14/t/t/(4/ 1etAI—S2-17- nathan T.Martinez By: Assistant City Attorney Title:�%l(�Piir SANTA ANA CITY COUNCIL Valerie Amezcua Thai Vier Phan Benjamin Vazquez Jessie Lopez Phil Bacerra Johnalhan Ryan Hernandez David Penaloza Mayor Mayor Pro Tern,Ward I Ward 2 Ward 3 Ward 4 Ward 5 Ward 6 vamezcuacrsanta-ana.org tphannsania.ana.orq bvazquezasanla- jessielopez{Hisanta-ana.orq pbacerrai®sanla•ana.orq Jryanhernandezlwsanta- dpenaiozansanta•ana.orq a ,rids 8n8.gfq DATE(MMIDD/YYYY) ALt7C- FtiOr CERTIFICATE OF LIABILITY INSURANCE 05/20/2024 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 be endorsed. If SUBROGATIONIS 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 HUB INTL MOUNTAIN STATES LTD/PHS NAME: 41451261 PHONE (866)467-8730 FAX The Hartford Business Service Center (Arc,No,at): (AJC,No): 3600 Wiseman Blvd E-MAIL Digitally i g n e d San Antonio,TX 78251 � ADDRESS: V in \FOy}pING COVERAGE NAIC1t INSURED �RER A: Sel ine I n n^' 11000 MARTHA VAN ROOIJEN DBA MVR C NSU In URER B: PO BOX236 Acevedo CALIMESA CA 92320-0236 INSURER C: INSURER D: ai6R.41 - • 2024.07. 11 • COVERAGES IS CERTIFY THAT THE POLICES OF INSURANCE LISTED BELOW.1AV'.BEEN ISSUED TiviiIARR NA 1 4BCv TO T ICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDIT,ON'JF 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 SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR WVD IMMIDD/YYYY) ,LMMIDDIYYYYI COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $2,000,000 CLAIMS-MADE OCCUR DAMAGE TO RENTED $1,000,000 PREMISES(Ea occurrence) x General Liability MED EXP(My one person) $10,000 A X X 41 SBA AC2507 05/19/2024 05/19/2025 PERSONAL&ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000 POLICY El PRO- 17 LOC PRODUCTS-COMP/OP AGG $4,000,000 JECT OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $2,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) A ALL OWNED SCHEDULED X 41 SBA AC2507 05/19/2024 05/19/2025 BODILY INJURY(Per accident) AUTOS AUTOS HIRED NON-OWNED PROPERTY DAMAGE X AUTOS X AUTOS (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS- AGGREGATE MADE DED RETENTION$ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER ANY YIN E.L.EACH ACCIDENT PROPRIETORIPARTNER/EXECUTIVE - OFFICER/MEMBER EXCLUDED? Nl A E.L.DISEASE-EA EMPLOYEE (Mandatory In NH) If yes,describe under E.L.DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Those usual to the Insured's Operations. CERTIFICATE HOLDER CANCELLATION City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 20 CIVIC CENTER PLZ BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED SANTA ANA CA 92702 IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE U ic6Q'? (lad RtlA1B t�,e RiskManagmnmstDivislon o �. REVIEWED&APPROVED BY: ©1988-2015 ACORD COI' ` : ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD jam,, A �� Risk Management Specialist AGENCY CUSTOMER ID: LOC#: s4C'�a ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED HUB INTL MOUNTAIN STATES LTD/PHS MARTHA VAN ROOIJEN DBA MVR CONSULTING POLICY NUMBER PO BOX 236 SEE ACORD 25 CALIMESA CA 92320-0236 CARRIER NAIC CODE SEE ACORD 25 EFFECTIVE DATE:SEE ACORD 25 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM FORM NUMBER: ACORD 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE Notice of Cancellation will be provided in accordance with Form SS1223, attached to this policy. Waiver of Subrogation applies in favor of the Certificate Holder per the Business Liability Coverage Form SS0008, attached to this policy. Certificate holder is an additional insured per the Business Liability Coverage Form SS0008, attached to this policy. Certificate holder is an additional insured per the Business Liability Coverage Form SS0008 and the Hired Auto and Non Owned Auto Endorsement SS0438, attached to this policy. IN Risk ManagemenEDtviston REVIEWED&APPROVED BY: imasimit Risk Management Specialist ACORD 101 (2014/01) ©2014 ACORD CORPOft. The ACORD name and logo are registered marks of ACORD • WORKERS' COMPENSATION DECLARATION Martha Van Rooijen hereby affirm under penalty of perjury,the (Name/Title) following declaration: I certify on behalf of MVR Consulting that during the term of my (Consultant/Company Name) contract for On-Call Software Maintenance services with the City of Santa Ana, I will and Development Support Services not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions and provide proof of workers' compensation coverage. DATE: July 11, 2024 By: MVR Consulting Name: Martha van Rooijen 2Vd,( Title: Owner Telephone: 909 709 7505 WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST,AND ATTORNEY'S FEES. ,, „ RieleManegemealDivisian 3i% li‘ REVIEWED&APPROVED BY: 'I' p ' A ACZ1/441 Risk Management Specialist 1