Loading...
HomeMy WebLinkAboutMONUMENT ROW (5)A-2021-222-01 MAYOR Valerie Amezcua MAYOR PRO TEM Thai Viet Phan COUNCILMEMBERS Phil Bacerra Johnathan Ryan Hernandez Jessie Lopez David Penaloza Benjamin Vazquez INSURANCE ON FILE WORK MAY PROCEED UNTIL INSURANCE EXPIRES pU �23�25 CITY CLERK DATE, DEC 17 2024 Q%an C10VA'a Amber Costello, President Monument ROW 200 Spectrum Center, Suite 300 Irvine, CA 92618 CITY OF SANTA ANA PUBLIC WORKS AGENCY 20 Civic Center Plaza . P.O. Box 1988 Santa Ana, California 92702 wwW.santa-ana.orq November 21, 2024 CITY MANAGER Alvaro Nunez CITY ATTORNEY Sonia R. Carvalho CITY CLERK Jennifer L. Hall Re: Extension of Agreement (A-2021-222) to Provide On -Call Acquisition and Relocation Services Pursuant to Section 4 ("Performance Period") of the above -referenced Agreement, entered into by Monument ROW ("Consultant"), and the City of Santa Ana, dated November 16, 2021, the time period of the Agreement is hereby extended for an additional one-year period through November 15, 2025. 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, Aabil Saba, PE Executive Director, Public Works Agency CITY OF SANTA AN ATTEST Alvaro Nunez conifer L. all City Manager City Cl APPROVED AS TO FORM MONUMENT ROW K Nellesen Am er Costello A�sistant City Attorney Title: President/ CEO SANTA ANA CITY COUNCIL Valerie Anna.. Thai Viet Phan Beryamin Vazquez Jessie Lopez Phil Bacena Mayor Mayor Pre Tern, WrN t Word Word Word! 4 viianazixiiazarlaaraa toM1anesanta-ana om bvaznaezesaMa-anaom sielaoez015anta-ana om obacenaesanta-ana ne Johnathan Ryan Hernandez David Penaloza Wards Ward ivanhemandezesent.naom doenalnzaesants-anaora CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDOIYYYY) 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 endomementfsl. PRODUCER wY ci rl Venbrook Insurance Services Di FAx 16815 Von Karman Ave • Irvine 180 Angie L. c Ne E : o uc No: 94s-652-39BO n L certficates venbrpok.Com Irvine, CA 92606 AJ mslm AFFaRomscovERAeE Naca www.venbrook.com C o. OD80832 I velers Casual Insurance Cc of America 19046 INSURED Monument ROW I u elem Property Casualty Co of America 25674 200 Irvine Spectrum Center, CA 92618 Acevedo o ri of London 15642 11512 COVERAGES CERTIFICATE NUMBER: 79779905 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW RAVE 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 SUBR POUCYNUMBER POLICY EFF M DDNYYY) POLICY EXP (MWDDNYYYI LIMITS A ✓ COMMERCIAL GENERAL LIABILITY ✓ ✓ 6807P4562802442 4/2312024 4/23/2025 EACH OCCURRENCE $1.000,000 CLAIMS -MADE 1J OCCUR OHMAGE TO PREMISES Eao vnence $300,000 MED EXP(My one person) $5,000 ✓ Deductible: none PERSONALSADVINJURY $1.000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $2,000,000 ✓ POLICY � JET n LOC PRODUCTS-COMPfOPAGG $2000000 $ OTHEk A AUTOMOBILEMBILITY 6807P4562802442 4/23/2024 4/23/2025 aBINNED SINGLE LIMIT $1000000 BODILY INJURY (Per person) $ ANYAUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Pera x ident) $ ✓ HIRED NE AUTOS ONLY ✓ AUTOS ONLY (ParraaEAnOAMAGE $ $ 8 ri UNBRELIA LU\B ✓ OCCUR CUP5N8889392442 4/23/2024 4/23/2025 EACH OCCURRENCE $5000,000 AGGREGATE $5000,000 IXCE55lJAB CLAIMS -MADE DEO I ✓ I RETENTION$0 $ B WORKERS COMPENSATION AND EMPLOYERW LIABILITY YIN OFFILE PRJE EREXCLUDED ECUTIVE � NIA ✓ UB2Y3528922442G 4/23(2024 4123/2025 ✓ STartrrE °Erz E.L. EACH ACCIDENT ' $1000000 EL DISEASE -EA EMPLOYE $1 QS10 000 -" - (Mandatory In NH) Ryyeess,, describe under OESCRIPTION OF OPERATIONS below EL DISEASE -POLICY LIMIT $1 000 000 C Professional Liability (Claims Made MPL444730524 4/23/2024 4123/2025 $2,000,000 Each Claim/ Aggregate Limit & Reported) Retention: $5,000 Each Claim DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe aHached itmore space Is required) RE: The City of Santa Ana, its officers, employees, agents, and representatives are named as Additional Insured in respects General Liability perform CGD105 0494. Primary/Non-Contributory form CGT1000219, Waiver of Subrogation form CGD842 0219, WC040306 4-84 applies in favor of the Additional Insured when required by written contract. 30 Day Notice of Cancellation per policy provisions. Subject to policy terms, conditions and exclusions. City Of Santa Ana Risk Management Division 20 Civic Center Plaza, 4th Floor Santa Ana CA 92701 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE THE EXPIRATION DATE THEREOF NnTIP.F wu I ACCORDANCEWITH THE POLICY PRL 4UTHORVEDREPRESENTATME I Gabriela Covarrubias ©1988-2015 ACORD RF nF1 nIFRFn IN .,yam y .'te. �' ' ] 111aleMMugoarnlD[uiefan REVIEWED&APPRcIW®Br ✓�'N�s=flr.Wflta J Risk Management spedalm 00 ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 7EleB9D- 2021 G , HNUS, S, WC, EL Gabriela C - s 1 4/30/2024 1-02:02 PM (FCTI I Page I of 8 This certificate cancels and supersedes ALL previonslp issued certificates, Monument ROW 6807P4562802442 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PROVISIONS: 1. WHO IS AN INSURED (SECTION 11) is amended to include as an insured any person or organiza- tion (called hereafter "additional insured") whom you have agreed in a written contract, executed prior to loss, to name as additional insured, but only with respect to liability arising out of "your work" or your ongoing operations for that addi- tional insured performed by you or for you. 2. With respect to the insurance afforded to Addi- tional Insureds the following conditions apply: a. Limits of Insurance — The following limits of liability apply: 1. The limits which you agreed to provide; or 2. The limits shown on the declarations, whichever is less. b. This insurance is excess over any valid and collectible insurance unless you have agreed in a written contract for this insurance to apply on a primary or contributory basis. 3. This insurance does not apply: a. on any basis to any person or organization for whom you have purchased an Owners and Contractors Protective policy. b. to "bodily injury," "property damage," "per- sonal injury," or "advertising injury" arising out of the rendering of or the failure to render any professional services by or for you, in- cluding: 1. The preparing, approving or failing to prepare or approve maps, drawings, opinions, reports, surveys, change or- ders, designs or specifications; and 2. Supervisory, inspection or engineering services. CG D1 05 04 94 Copyright, The Travelers Indemnity Comlpany, 11994. Includes Copyrighted Material' from Insurance Services Office, In w"t<Mten��pn IaE+nE &APPeov®Br: m Rhk Management Spedrd t 79774905 [2021 GL, HNO, UM3, WC, FL Gabriala ' arrubias 14/30/2024 1:G2:02 Fl] (PDT) I eaae 2 f a This certificate cancels and supersedes ALL o previously issued certificates. Monument ROW 6807P4562802442 COMMERCIAL GENERAL LIABILITY c. Method Of Sharing If all of the other insurance permits contribution by equal shares, we will follow this method also. Under this approach each insurer contributes equal amounts until it has paid its applicable limit of insurance or none of the loss remains, whichever comes first. If any of the other insurance does not permit contribution by equal shares, we will contribute by limits. Under this method, each insurer's share is based on the ratio of its applicable limit of insurance to the total applicable limits of insurance of all insurers. Primary And Non -Contributory Insurance If Required By Written Contract If you specifically agree in a written contract or agreement that the insurance afforded to an insured under this Coverage Part must apply on a primary basis, or a primary and non- contributory basis, this insurance is primary to other insurance that is available to such insured which covers such insured as a named insured, and we will not share with that other insurance, provided that: (1) The 'bodily injury" or "property damage" for which coverage is sought occurs; and (2) The "personal and advertising injury" for which coverage is sought is caused by an offense that is committed; subsequent to the signing of that contract or agreement by you. 5. Premium Audit a. We will compute all premiums for this Coverage Part in accordance with our rules and rates. b. Premium shown in this Coverage Part as advance premium is a deposit premium only. At the close of each audit period we will compute the earned premium for that period and send notice to the first Named Insured. The due date for audit and retrospective premiums is the date shown as the due date on the bill. If the sum of the advance and audit premiums paid for the policy period is greater than the earned premium, we will return the excess to the first Named Insured. c. The first Named Insured must keep records of the information we need for premium computation, and send us copies at such times as we may request. fi. Representations By accepting this policy, you agree: a. The statements in the Declarations are accurate and complete; b. Those statements are based upon representations you made to us; and c. We have issued this policy in reliance upon your representations. The unintentional omission of, or unintentional error in, any information provided by you which we relied upon in issuing this policy will not prejudice your rights under this insurance. However, this provision does not affect our right to collect additional premium or to exercise our rights of cancellation or nonrenewal in accordance with applicable insurance laws or regulations. 7. Separation Of Insureds Except with respect to the Limits of Insurance, and any rights or duties specifically assigned in this Coverage Part to the first Named Insured, this insurance applies: a. As if each Named Insured were the only Named Insured; and b. Separately to each insured against whom claim is made or "suit' is brought. 8. Transfer Of Rights Of Recovery Against Others To Us If the insured has rights to recover all or part of any payment we have made under this Coverage Part, those rights are transferred to us. The insured must do nothing after loss to impair them. At our request, the insured will bring "suit' or transfer those rights to us and help us enforce them. 9. When We Do Not Renew If we decide not to renew this Coverage Part, we will mail or deliver to the first Named Insured shown in the Declarations written notice of the nonrenewal not less than 30 days before the expiration date. If notice is mailed, proof of mailing will be sufficient proof of notice. SECTION V — DEFINITIONS 1. "Advertisement' means a notice that is broadcast or published to the general public or specific market segments about your goods, products or services for the purpose of attracting customers or supporters. For the purposes of this definition: a. Notices that are published include material placed on the Internet or on similar electronic means of communication; and b. Regarding websites, only that part of a website that is about your goods, products or services for the purposes c supporters is co nslde Page 1: b of 21 © 2017 The Travelers Indemnity Company. All rights reserved.. Includes copyrighted material of Insurance Services Office, Inc, with its permission. xulrMan ganmtDhi ion Iiiiinaveo S APPRci Br. ® Risk Management Spernfut 79779905 1 2024 GL, MNO, UM, WC, FL G" Ec la Co auas "bi1 4/30/2024 1:C2:02 PM (POT) I Fags 3 of 0 This certificate cancels and supersedes ALL paecrieusly issued certificates. Monument ROW COMMERCIAL GENERAL LIABILITY 6807P4562802442 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. XTEND ENDORSEMENT FOR SMALL BUSINESSES This endorsement modes insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART GENERAL DESCRIPTION OF COVERAGE — This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to this Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general coverage description only. Read all the provisions of this endorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A. Who Is An Insured — Unnamed Subsidiaries B. Who Is An Insured — Employees And Volunteer Workers — Bodily Injury To Co -Employees And Co -Volunteer Workers PROVISIONS A. WHO IS AN INSURED — UNNAMED The following is added to SECTION II — WHO IS AN INSURED: C. Who Is An Insured — Newly Acquired Or Formed Limited Liability Companies D. Incidental Medical Malpractice E. Blanket Waiver Of Subrogation b. An organization other than a partnership, joint venture or limited liability company; or c. A trust; as indicated in its name or the documents that govern its structure. Any of your subsidiaries, other than a partnership B. WHO IS AN INSURED — EMPLOYEES AND or joint venture, that is not shown as a Named VOLUNTEER WORKERS — BODILY INJURY Insured in the Declarations is a Named Insured TO CO -EMPLOYEES AND CO -VOLUNTEER if: WORKERS a. You are the sole owner of, or maintain an ownership interest of more than 50% in, such subsidiary on the first day of the policy period: and b. Such subsidiary is not an insured under similar other insurance. No such subsidiary is an insured for "bodily injury" or "property damage" that occurred, or "personal and advertising injury" caused by an offense committed: a. Before you maintained an ownership interest of more than 50% in such subsidiary; or b. After the date, if any, during the policy period that you no longer maintain an ownership interest of more than 50% in such subsidiary. For purposes of Paragraph 1. of Section II — Who Is An Insured, each such subsidiary will be deemed to be designated in the Declarations as: a. A limited liability company; The following is added to Paragraph 2.a.(1) of SECTION II — WHO IS AN INSURED: Paragraphs (1)(a), (b) and (c) above do not apply to "bodily injury" to a co -"employee" while in the course of the cc -"employee's" employment by you or performing duties related to the conduct of your business, or to "bodily injury" to your other "volunteer workers" while performing duties related to the conduct of your business. C. WHO IS AN INSURED — NEWLY ACQUIRED OR FORMED LIMITED LIABILITY COMPANIES 1. The following replaces the first sentence of Paragraph 3. of SECTION 11 — WHO IS AN INSURED: Any organization you newly acquire or form, other than a partnership or joint venture, and of which you are the sole owner or in which you maintain an ownership interest of more than 50%%, will qua CG D8 42 0219 © 2018 The Travelers Indemnity Company. All rights reserved. Includes copyrighted material of Insurance services Office, Inc.., with its p1 Rtvlexm 6 AP.P,ROvD BY: ' Risk Management Specialist 79779905 1 2024 GL, ONO, UM, WC, PL Gabriel. ' - —bias 1 4/30/20-4 1:02:02 PN (PDT) I Page 4 of 9 This certificate cancels acd aupersed=_s ALL previously issued certificates. COMMERCIAL GENERAL LIABILITY there is no other similar insurance available to that organization. 2. The following replaces the last sentence of Paragraph 3. of SECTION II - WHO IS AN INSURED: For the purposes of Paragraph 1. of Section 11 - Who Is An Insured, each such organization will be deemed to be designated in the Declarations as: a. A limited liability company; b. An organization other than a partnership, joint venture or limited liability company; or c. A trust; as indicated in its name or the documents that govern its structure. D. INCIDENTAL MEDICAL MALPRACTICE 1. The following replaces Paragraph b. of the definition of "occurrence" in the DEFINITIONS Section: b. An act or omission committed in providing or failing to provide "incidental medical services", first aid or "Good Samaritan services" to a person, unless you are in the business or occupation of providing professional health care services. 2. The following replaces the last paragraph of Paragraph 2.a.(1) of SECTION It - WHO IS AN INSURED: Unless you are in the business or occupation of providing professional health care services, Paragraphs (1)(a), (b), (c) and (d) above do not apply to "bodily injury" arising out of providing or failing to provide: (a) 'Incidental medical services" by any of your "employees" who is a nurse, nurse assistant, emergency medical technician, paramedic, athletic trainer, audiologist, dietician, nutritionist, occupational therapist or occupational therapy assistant, physical therapist or speech -language pathologist; or (b) First aid or "Good Samaritan services" by any of your "employees" or "volunteer workers", other than an employed or volunteer doctor. Any such "employees" or "volunteer workers" providing or failing to provide first aid or "Good Samaritan services" during their work hours for you will be deemed to be acting within the scope of their employment by you or performing duties related to the conduct of your business. 3. The following replaces the last sentence of Paragraph S. of SECTION III - LIMITS OF INSURANCE: For the purposes of determining the applicable Each Occurrence Limit, all related acts or omissions committed in providing or failing to provide "incidental medical services", first aid or "Good Samaritan services" to any one person will be deemed to be one "occurrence". 4. The following exclusion is added to Paragraph 2., Exclusions, of SECTION 1 - COVERAGES - COVERAGE A - BODILY INJURY AND PROPERTY DAMAGE LIABILITY: Sale Of Pharmaceuticals "Bodily injury" or "property damage" arising out of the violation of a penal statute or ordinance relating to the sale of pharmaceuticals committed by, or with the knowledge or consent of, the insured_ 5. The following is added to the DEFINITIONS Section: "Incidental medical services" means: a. Medical, surgical, dental, laboratory, x- ray or nursing service or treatment, advice or instruction, or the related furnishing of food or beverages; or b. The furnishing or dispensing of drugs or medical, dental, or surgical supplies or appliances. 6. The following is added to Paragraph 4.b., Excess Insurance, of SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS: This insurance is excess over any valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that is available to any of your "employees" for "bodily injury" that arises out of providing or failing to provide "incidental medical services" to any person to the extent not subject to Paragraph 2.a.(1) of Section 11 - Who Is An Insured. E. BLANKET WAIVER OF SUBROGATION The following is added to Paragraph Of Rights Of Recovery Page 2 of 3 © 2018 The Travelers Indemnity Company. All rights reserved.. Includes copyrighted material of Insurance Services Office, Inc., with its permissiol Transfer Riala Ma)ugemmt D itieian R�& APPRw®Br: ' I� It(tivtrlu ® Ruk Management Speo Print 01 79779905 1 2024 GL, BNn, UMB, Nq PL Gabziela Co zz"!i 1 4/30/2024 1:02:02 PM (PDT) I Page 5 of 6 This certificate cancels and supersedes ALL pzeviously issued certificates. COMMERCIAL GENERAL LIABILITY of SECTION IV — COMMERCIAL GENERAL a. "Bodily injury" or "property damage" that LIABILITY CONDITIONS: occurs; or If the insured has agreed in a contract or b. "Personal and advertising injury" caused by agreement to waive that insured's right of an offense that is committed: recovery against any person or organization, we subsequent to the execution of the contract or waive our right of recovery against such person agreement. or organization, but only for payments we make because of: CG D8 42 02 19 © 2018 The Travelers Indemnity Company. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc., withits permis v >< RiskMnugmwd DWI= REVIEWEDY: A&APPROVED B if(u ®' Risk Management Spedali,t Is 79719905 1 2424 GL, HUD, UM, WC, FL Gabriela rrubias 1413OY2024 1:02:02 Fi( IFCTI I Fage 6 of a This certificate cancels and supersedes ALL previously issued certificates. TRAVELERSJW ONE TOWER SQUARE HARTFORD CT 06183 WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 00 03 13 (00) - 001 POLICY NUMBER: UB-2Y352892-24-42-G WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT 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.) This agreement shall not operate directly or indirectly to benefit any one not named in the Schedule. SCHEDULE DESIGNATED PERSON: DESIGNATED ORGANIZATION: ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS WAIVER. Renewo & APPRw Or. ,? A,juilc4,44 �. ® Risk Management Spedalis[ DATE OF ISSUE: 04-19-24 ST ASSIGN: PAGE 1 OF1 191('yD ? GL HHG RL1HC, FL GaLciea = I d/302)2d 1 :':02 Pc (PT) Ttie certificate ca:.cels acl s _xs_c_s ALL o ioosLy i.,.,ve,. _e rtiEicates. Monument ROW POLICY NUMBER: 680-7P4s6280-24-42 ISSUE DATE: 02/14/2024 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED PERSON OR ORGANIZATION - NOTICE OF CANCELLATION OR NONRENEWAL PROVIDED BY US This endorsement modifies insurance provided under the following: ALL COVERAGE PARTS INCLUDED IN THIS POLICY SCHEDULE CANCELLATION: Number of Days Notice: WHEN WE DO NOT RENEW (Nonrenewal): Number of Days Notice: PERSON OR ORGANIZATION: CITY OF SANTA ANA RISK MGMT DIVISION ADDRESS: 20 CIVIC CENTER PLAZA SANTA ANA CA 92702 PROVISIONS A. If we cancel this policy for any legally permitted reason other than nonpayment of premium, and a number of days is shown for Cancellation in the Schedule above, we will mail notice of cancellation to the person or organization shown in such Schedule. We will mail such notice to the address shown in the Schedule above at least the number of days shown for Cancellation in such Schedule before the effective date of cancellation. 30 30 B. If we do not renew this policy for any legally permitted reason other than nonpayment of premium, and a number of days is shown for When We Do Not Renew (Nonrenewal) in the Schedule above, we will mail notice of nonrenewal to the person or organization shown in such Schedule. We will mail such notice to the address shown in the Sc number of days showr Renew (Nonrenewal) In effective date of nonrene IL T4 00 05 19 © 2019 The Travelers Indemnity Company. All rights reserved. .t RldeMnuganmtDWm Rvoe&ED 6 APPROvED By: Risk Management Spn Cdki5tt /9]79905 1 0029 GL, HNO, OM3, WC,. PL Gabriel. Cova... bias 1 4/30/2024 1:02:02 Pe, (POT) I Page a o£ a This certificate cancels and supersedes ALL previously issued certificates. CERTIFICATE OF LIABILITY INSURANCE DATE IMMIDD)YYYY) 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 endorsementfs). PRODUCER r� Venbrook Insurance Services L Suite j� Von Karman Ave n Spite 160 b i e Irvine, CA 92606 ~.venbrook.com CA , D_ OD80832 INSURED Monument ROW 200 Spectrum Center, Acevedo Irvine CA 9261,8 0 COVERAGES CERTIFICATE NUMBER: 79779905 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 ADDLSUBR POLICY NUMBER POLICYEFF MMIDD POLICY EXP MNVDD LIMITS COMMERCtA GENERALLIABIUTY CLAIMS -MADE Iii I OCCUR ✓ ✓ 6807P4562802442 4/23/2024 4123/2025 EACH OCCURRENCE $1.000,000 PREMISES E.Eccc� en $300,000 MEDEXP(Any Oneperson) $5,000 ✓ Deductible: Hone PERSONAL & ADV INJURY $1,000 000 GERM AGGREGATE LIMIT APPLIES PER: POLICY ECT EILOC GENERAL AGGREGATE 52,000,000 PRODUCTS-COMPIOPAGG $2000000 $ OTHER: A AMOMDSLELIABILRY 6807P4562802442 4/23/2024 412312025 COMBINED aiSINGLELM 51000,000 BODILY INJURY(Perperson) S ANYAUTO OWNED UTOSHEDIED A AUTOS ONLY AUTOS BOOILYINJURY Peraceident, ( ) & ✓ AUTOS ONLY ✓ AUTOS ONLY HIRED K0N,OWNED TY Per ac Itle DAMAGE $ $ B ✓ UMBRELLALIAB ✓ OCCUR CUP5N8889392442 4/23/2024 4/2312025 EACH OCCURRENCE $5.000.000 AGGREGATE E5000.000 EXCESSUAB CLAIMS -MADE DIED I ✓ I RETENTION$() $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYPROPRIETORIPARTNEREXECUTIVE OFFICERMEMSEREXCLUDED1 N/A ✓ UB2Y3528922442G 4/23/2024 412312025 ,r sin UTE ERH El. EAGHACCIDEW -- $1,000.000 E.L.OISEASE-EAEMPLOYEE_ '-' $1000,00' (Mandatory In Ni If yes, describe under E.L. DISEASEPOLICYLIMIT $1 000 000 DESCRIPTION OF OPERATIONS below C Professional Liability (Claims Made & Reported) MPL444730524 4/23/2024 4/23/2025 $2,000,000 Each Claim/ Aggregate Limit Retention: $5,000 Each Claim DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD in, Additional Remarks Schedule, may be attached If more apace is requlretl{ RE: The City of Santa Ana, its officers, employees, agents, and representatives are named as Additional Insured in respects General Liability per form CGD105 0494. Primary/Non-Contributory form CGTI 000219, Waiver of Subrogation form CGD842 0219, WC040306 4-84 applies in favor of the Additional Insured when required by written contract. 30 Day Notice of Cancellation per policy provisions. Subject to policy terms, conditions and exclusions. City Of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Y THE EXPIRATION DATE THEREOF NOTICE Van I RF ri NRRFn IN Risk Management Division ACCORDANCE WITH THE POLICY PR( 20 Civic Center Plaza, 4th Floor RiakMmugadatilD9tiwt Santa Ana CA 92701 RevleiaaD&APPROVED Sr AUTHORIZED REPRESENTATIVE1 °3.ui131,�d -L R+;e f AA4 Gabriela Covarrubias Riser Management Spedalist ©1988-20115 ACORD ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 79775905 1 2024 GL, HND, DPI9, WC, FL Gabriala Covarrubias 1 4/30/2014 1:C2:02 PM Per) I Page 1 of B This certificate cancels and supersedes ALL previously issued certificates.. Monument ROW 6807P4562802442 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PROVISIONS: 1. WHO IS AN INSURED (SECTION 11) is amended to include as an insured any person or organiza- tion (called hereafter "additional insured") whom you have agreed in a written contract, executed prior to loss, to name as additional insured, but only with respect to liability arising out of your work" or your ongoing operations for that addi- tional insured performed by you or for you. 2. With respect to the insurance afforded to Addi- tional Insureds the following conditions apply: a. Limits of Insurance — The following limits of liability apply: 1. The limits which you agreed to provide; or 2. The limits shown on the declarations, whichever is less. b. This insurance is excess over any valid and collectible insurance unless you have agreed in a written contract for this insurance to apply on a primary or contributory basis. 3. This insurance does not apply: a. on any basis to any person or organization for whom you have purchased an Owners and Contractors Protective policy. b. to "bodily injury," "property damage," "per- sonal injury," or "advertising injury" arising out of the rendering of or the failure to render any professional services by or for you, in- cluding: 1. The preparing, approving or failing to prepare or approve maps, drawings, opinions, reports, surveys, change or- ders, designs or specifications; and 2. Supervisory, inspection or engineering services. CG D1 08 0494 Copyright, The Travelers Indemnity Company, 1994. Includes Copyrighted Material from Insurance Services Office, Inc o„� w.kM.„.g�R�tocw.wt AEVMM&O S`: OVL ,.APPPPR�J dediist RBk Management Spy 79779905 1 2024 GL„ RNO, OMB,WC, PL I Gsbviela etf=las 1 4/30/2024 1:02:02 PO (PDT) I Page 2 of 0 This certificate ua¢usls and supersedes ALL peeviously issued certificates. Monument ROW 6807P4562802442 COMMERCIAL GENERAL LIABILITY c. Method Of Sharing If all of the other insurance permits contribution by equal shares, we will follow this method also. Under this approach each insurer contributes equal amounts until it has paid its applicable limit of insurance or none of the loss remains, whichever comes first. If any of the other insurance does not permit contribution by equal shares, we will contribute by limits. Under this method, each insurer's share is based on the ratio of its applicable limit of insurance to the total applicable limits of insurance of all insurers. d. Primary And Non -Contributory Insurance If Required By Written Contract If you specifically agree in a written contract or agreement that the insurance afforded to an insured under this Coverage Part must apply on a primary basis, or a primary and non- contributory basis, this insurance is primary to other insurance that is available to such insured which covers such insured as a named insured, and we will not share with that other insurance, provided that: (1) The "bodily injury" or "property damage" for which coverage is sought occurs; and (2) The "personal and advertising injury" for which coverage is sought is caused by an offense that is committed; subsequent to the signing of that contract or agreement by you. 5. Premium Audit a. We will compute all premiums for this Coverage Part in accordance with our rules and rates. b. Premium shown in this Coverage Part as advance premium is a deposit premium only. At the close of each audit period we will compute the earned premium for that period and send notice to the first Named Insured. The due date for audit and retrospective premiums is the date shown as the due date on the bill. If the sum of the advance and audit premiums paid for the policy period is greater than the earned premium, we will return the excess to the first Named Insured. c. The first Named Insured must keep records of the information we need for premium computation, and send us copies at such times as we may request. 6. Representations By accepting this policy, you agree: a. The statements in the Declarations are accurate and complete; b. Those statements are based upon representations you made to us; and c. We have issued this policy in reliance upon your representations. The unintentional omission of, or unintentional error In, any information provided by you which we relied upon in issuing this policy will not prejudice your rights under this insurance. However, this provision does not affect our right to collect additional premium or to exercise our rights of cancellation or nonrenewal in accordance with applicable insurance laws or regulations. 7. Separation Of Insureds Except with respect to the Limits of Insurance, and any rights or duties specifically assigned in this Coverage Part to the first Named Insured, this insurance applies: a. As if each Named Insured were the only Named Insured; and b. Separately to each insured against whom claim is made or "suit" is brought. 8. Transfer Of Rights Of Recovery Against Others To Us If the insured has rights to recover all or part of any payment we have made under this Coverage Part, those rights are transferred to us. The insured must do nothing after loss to impair them. At our request, the insured will bring "suit" or transfer those rights to us and help us enforce them. 9. When We Do Not Renew If we decide not to renew this Coverage Part, we will mail or deliver to the first Named Insured shown in the Declarations written notice of the nonrenewal not less than 30 days before the expiration date. If notice is mailed, proof of mailing will be sufficient proof of notice. SECTION V — DEFINITIONS "Advertisement" means a notice that is broadcast or published to the general public or specific market segments about your goods, products or services for the purpose of attracting customers or supporters. For the purposes of this definition: a. Notices that are published include material placed on the Internet or on similar electronic means of communication; and b. Regarding websites, only that part of a website that is about your goods, products or services for the purposes c supporters is consld Page 1':6 of 21 © 2017 The Travelers Indemnity Company. All rights reserved. Includes copyrighted material. of Insurance Services Office, Inc. with its permission. it7skMostgonml.Disislon r �`w- �� f�nEweo6MPRaBr. ®� A-14Acweda �=�W_=_ ' Ruk Management Spedalist 79779905 1 2024 GL, HNO, UNS,WC, PL Gabrllla C. arrubiss 1 4/30/20241 1:02:01 PN. (POTS I Page 3 of 0 This certificate cancels and supersedes ALL previously issued certificates.. Monument ROW COMMERCIAL GENERAL LIABILITY 6807P4562802442 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. XTEND ENDORSEMENT FOR SMALL BUSINESSES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART GENERAL DESCRIPTION OF COVERAGE — This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to this Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general coverage description only. Read all the provisions of this endorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A. Who Is An Insured — Unnamed Subsidiaries B. Who Is An Insured — Employees And Volunteer Workers — Bodily Injury To Co -Employees And Co -Volunteer Workers PROVISIONS A. WHO IS AN INSURED — UNNAMED SUBSIDIARIES C. Who Is An Insured — Newly Acquired Or Formed Limited Liability Companies D. Incidental Medical Malpractice E. Blanket Waiver Of Subrogation The following is added to SECTION It — WHO IS AN INSURED: Any of your subsidiaries, other than a partnership B. or joint venture, that is not shown as a Named Insured in the Declarations is a Named Insured if: a. You are the sole owner of, or maintain an ownership interest of more than 50% in, such subsidiary on the first day of the policy period: and b. Such subsidiary is not an insured under similar other insurance. No such subsidiary is an insured for "bodily injury" or "property damage" that occurred, or "personal and advertising injury" caused by an offense committed: a. Before you maintained an ownership interest of more than 50% in such subsidiary: or b. After the date, if any, during the policy period that you no longer maintain an ownership interest of more than 50%P in such subsidiary. For purposes of Paragraph 1. of Section II — Who Is An Insured, each such subsidiary will be deemed to be designated in the Declarations as: a. A limited liability company; CG D8 42 02 19 b. An organization other than a partnership, joint venture or limited liability company: or c. A trust; as indicated in its name or the documents that govern its structure. WHO IS AN INSURED — EMPLOYEES AND VOLUNTEER WORKERS — BODILY INJURY TO CO -EMPLOYEES AND CO -VOLUNTEER WORKERS The following is added to Paragraph 2.a.0) of SECTION 11— WHO IS AN INSURED: Paragraphs (1)(a), (b) and (c) above do not apply to "bodily injury" to a co -"employee" while in the course of the co -"employee's" employment by you or performing duties related to the conduct of your business, or to "bodily injury" to your other "volunteer workers" while performing duties related to the conduct of your business. C. WHO IS AN INSURED — NEWLY ACQUIRED OR FORMED LIMITED LIABILITY COMPANIES 1. The following replaces the first sentence of Paragraph 3. of SECTION It — WHO IS AN INSURED: Any organization you newly acquire or form, other than a partnership or joint venture, and of which you are the sole owner or in which you maintain an ownership interest of more than 50%, will qua (9 2018 The Travelers Indemnity Company. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permiss „ n`' RleleMnagema&D[vislon RIMEW D&APPRW 9Y: i Ruk Management Specialist 79779405 1 2024 GL,NNO,NMa, WC, PL Gabriela Ccvarrubias 1 4/30/2024 1:C2:02 PM (PDT) I Page 4 of Z This certificate cancels and supersedes ALL previously issued certificates. COMMERCIAL GENERAL LIABILITY there is no other similar insurance available to that organization. 2. The following replaces the last sentence of Paragraph 3, of SECTION 11 — WHO IS AN INSURED: For the purposes of Paragraph 1. of Section II — Who Is An Insured, each such organization will be deemed to be designated in the Declarations as: a. A limited liability company; b. An organization other than a partnership, joint venture or limited liability company; or c. A trust: as indicated in its name or the documents that govern its structure. D. INCIDENTAL MEDICAL MALPRACTICE 1, The following replaces Paragraph b. of the definition of "occurrence" in the DEFINITIONS Section: b. An act or omission committed in providing or failing to provide "incidental medical services", first aid or "Good Samaritan services" to a person, unless you are in the business or occupation of providing professional health care services. 2. The following replaces the last paragraph of Paragraph 2.a.(1) of SECTION It — WHO IS AN INSURED: Unless you are in the business or occupation of providing professional health care services, Paragraphs (1)(a), (b), (c) and (d) above do not apply to 'bodily injury" arising out of providing or failing to provide: (a) 'Incidental medical services" by any of your "employees" who is a nurse, nurse assistant, emergency medical technician, paramedic, athletic trainer, audiologist, dietician, nutritionist, occupational therapist or occupational therapy assistant, physical therapist or speech -language pathologist; or (b) First aid or "Good Samaritan services" by any of your "employees" or "volunteer workers", other than an employed or volunteer doctor. Any such "employees" or "volunteer workers" providing or failing to provide first aid or "Good Samaritan services" during their work hours for you will be deemed to be acting within the scope of their employment by you or performing duties related to the conduct of your business. 3. The following replaces the last sentence of Paragraph S. of SECTION Ill — LIMITS OF INSURANCE: For the purposes of determining the applicable Each Occurrence Limit, all related acts or omissions committed in providing or failing to provide "incidental medical services", first aid or "Good Samaritan services" to any one person will be deemed to be one "occurrence". 4. The following exclusion is added to Paragraph 2., Exclusions, of SECTION 1 — COVERAGES — COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE LIABILITY: Sale Of Pharmaceuticals "Bodily injury" or "property damage" arising out of the violation of a penal statute or ordinance relating to the sale of pharmaceuticals committed by, or with the knowledge or consent of, the insured. 5. The following is added to the DEFINITIONS Section: "Incidental medical services" means: a. Medical, surgical, dental, laboratory, x- ray or nursing service or treatment, advice or instruction, or the related furnishing of food or beverages: or b. The furnishing or dispensing of drugs or medical, dental, or surgical supplies or appliances. 6. The following is added to Paragraph 4.b., Excess Insurance, of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: This insurance is excess over any valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that is available to any of your "employees" for "bodily injury" that arises out of providing or failing to provide 'Incidental medical services" to any person to the extent not subject to Paragraph 2.a.(1) of Section 11 — Who Is An Insured. E. BLANKET WAIVER OF SUBROGATION The following is added to Paraoraph Of Rights Of Recovery, Page 2 of 3 © 2018 The Travelers Indemnity Company. All rights reserved. Includes copyrighted material. of Insurance Services Office, Inc., with, its permissiol Transfer ¢„yv"^•.Fe"` Risk Mnugement Divis1en RENEWED&APPRcwm BY: {%a f)ca 44 911�mml_' Rhk Management SpeaJot 79739905 1 2024 GL, HBO,. UM , WC, FL GaLriela C�,vairabias 1 4/30/2024 I:02:02 PH (PDT) I Fage 5 of o This certificate cancels and supersedes ALL previously issued certificates. of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: If the insured has agreed in a contract or agreement to waive that nsured's right of recovery against any person or organization, we waive our right of recovery against such person or organization, but only for payments we make because of: CIS D8 42 0.219 COMMERCIAL GENERAL LIABILITY a. 'Bodily injury" or "property damage" that occurs; or b. "Personal and advertising injury" caused by an offense that is committed; subsequent to the execution of the contract or agreement. Rlelt ManagemadDivisian REvleNED&APPRI BY: Risk Management SpedAist © 2018 The Travelers Indemnity Company. All rights reserver, Includes copyrighted material of Insurance Services Office, Inc., with its permiss 79 79905 1 2029 GL,HNO,. Uea, WC, PL i Gabriela Covaaublas 1 4/30/2024 1:C2:03 PM (PDT) I Page 6 of B This certificate cancels and supersedes ALL previously issued certificates.. © 2018 The Travelers Indemnity Company. All rights reserver, Includes copyrighted material of Insurance Services Office, Inc., with its permiss 79 79905 1 2029 GL,HNO,. Uea, WC, PL i Gabriela Covaaublas 1 4/30/2024 1:C2:03 PM (PDT) I Page 6 of B This certificate cancels and supersedes ALL previously issued certificates.. TRAVELERS/ J WORKERS COMPENSATION AND ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY HARTFORD CT 06183 ENDORSEMENT WC 00 03 13 (00) - 001 POLICY NUMBER: UB-2Y352892-24-42-G WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT 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.) This agreement shall not operate directly or indirectly to benefit any one not named in the Schedule. SCHEDULE DESIGNATED PERSON: DESIGNATED ORGANIZATION: ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS WAIVER. RiekMffJgenimtDMsian ReWe DSAPPRD Br. Risk Management SpeG.Ant DATE OF ISSUE: 04-19-24 STASSIGN: PAGE 1 OF Ig71I'D- ?011 GL, -NO, �3 ,C , FL Gab—1 .as I 1/30/.0''_1 1 , eD 3 ee 'ITTI 1 Ee9= r3 a i= _ c -�.-�e� _ _1_ a =up=r's=a=g �o�, ,�i. t .,» -' iaa �rr_.'_�o3tes. Monument ROW POLICY NUMBER: 680-7P456280-24-42 ISSUE DATE: 02/14/2024 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED PERSON OR ORGANIZATION - NOTICE OF CANCELLATION OR NONRENEWAL PROVIDED BY US This endorsement modifies insurance provided under the following: ALL COVERAGE PARTS INCLUDED IN THIS POLICY CANCELLATION: SCHEDULE Number of Days Notice: WHEN WE DO NOT RENEW (Nonrenewal): Number of Days Notice: PERSON OR ORGANIZATION: CITY OF SANTA ANA RISK MGMT DIVISION ADDRESS: 20 CIVIC CENTER PLAZA SANTA ANA CA 92702 PROVISIONS A. If we cancel this policy for any legally permitted reason other than nonpayment of premium, and a number of days is shown for Cancellation in the Schedule above, we will mail notice of cancellation to the person or organization shown in such Schedule. We will mail such notice to the address shown in the Schedule above at least the number of days shown for Cancellation in such Schedule before the effective date of cancellation. 30 30 B. If we do not renew this policy for any legally permitted reason other than nonpayment of premium, and a number of days is shown for When We Do Not Renew (Nonrenewap in the Schedule above, we will mail notice of nonrenewal to the person or organization shown in such Schedule. We will mail such notice to the address shown in the Sc number of days showr Renew (Nonrenewal) In effective date of nonrene IL T4 00 05 19 © 2019 The Travelers Indemnity Company. All rights reserved. 5 L ° Risk Mvwgemad:DMelon REMI DS1 APPRC�r1 Sr. 1' Risk Management Specialist r.5 19T1 P905 2021 GL, HNO, GMB, WC, PL Gotriela C - rublas 1 4/30/2024 I: 02: 02 Poi t(PDT) I Pass 6 of 2 This certificate cancels and superssd=_s ALL previously issued certificaes.