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HomeMy WebLinkAboutMONUMENT ROW (6)A-2021-223-01A MAYOR Valerie Amezcua MAYOR PRO TEM Thai Vet Phan COUNCILMEMBERS Phil Bacerra Johnathan Ryan Hernandez Jessie Lopez David Penaloza Benjamin Vazquez INSURANCE ON FILE WORK MAY PROCEED UNTIL INSURANCE EXPIRES 412312o2S ._. CITY CLERK DATE. CITY OF SANTA ANA PUBLIC WORKS AGENCY 20 Civic Center Plaza • P.O. Box 1988 Santa Ana, California 92702 www.santa-ana.ora O'.QWA(.L) November 13, 2024 Amber Costello, President (jaSan II�) 111� Monument ROW 200 Spectrum Center, Suite 300 Irvine, CA 92618 CITY MANAGER Alvaro Nuflez CITY ATTORNEY Sonia R. Carvalho CITY CLERK Jennifer L. Hall Re: Extension of Agreement (A-2021-223-01) to Provide On -Call Acquisition and Relocation Services Pursuant to Section 3 ("Term") 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, Nabil Saba, PE Executive Director, Public Works Agency CITY SANTA AN A varo Nutiez City Manager APPROVED AS TO FORM K Nellesen Assistant City Attorney ATTEST MONUMENT ROW 13�:I,Amker Costello Title: President/ CEO SANTA ANA CITY COUNCIL Valerie Anne.. Thai Viet Phan Benjamin Vazquez Jessie Lopez Phil Bacena Johnathan Ryan Hernandez David Panel.. Mayor Mayor Pra Tem, Ward 1 Ward Ward3 Want Ward Wem6 aa(Asano-ana om tohanesanta-mmom b,,ommz0aantaana am iessielooeuAsanta-ena om obacerraissanta-ana om anhemandezaaartaana am doenalozaesanta-an ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 4/30/2024 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 INSURERS), 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 Venbrook Insurance Services 16815 Von Karman Avenue Suite 180 Irvine, CA 92606 CONTACT Michele Baled PHONE FAx 818-598-8900 ac No 949 652.3980 ADDRESS: certifica venbrook-com INSURERS AFFORDING COVERAGE NAICC INSURERA: Travelers Casualty Insurance Co of America 19046 www.venbrook.com CA Lie No. OD80832 INSURED Monument ROW 200 Spectrum Center, Suite 300 Irvine CA 92618 INSURER B: Travelers Properly Casualty Co of America 25674 INSURER c: Underwriters at Lloyds of London 15642 INSURER O: 11512 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 7R779Rn6 REVISION NUMRFR- 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 ADOL SUBR POLICYNUMBER POLICY EFF NIWDD POLICY UP MIND LIMITS A TVCoMMERCMU. GENERAL LIABILITY CLAIMS -MADE OCCUR ✓ ✓ 6807P4562802442 4/23/2024 4/23/2025 RENCE EACH OCCURGE $1000000 To NTED PR MSES Ea ucwmrence S300000 MEO UP (Any one person) $5 000 uctible: none PERSONAL A ADV INJURY $1 000.000 GEN'L AGGREGATE LIMIT APPLIES PER ✓ POLICY [:]ECT C- J❑LOG GENERALAGGREGATE $2,000,000 PRODUCTS-COMP/OP AGG $2000.000 $ OTHER A AUTOMOBILELIABILITY 6807P4562802442 4/23/2024 4/23/2025 OMeBYNEeDISINGLE LIMIT $1,000000 BODILY INJURY (Per Person) $ ANYAUTO OWNED LED AUTOSONLYHAUT0ESR'UHIRED BODILY INJURY Peracdtlent ( ) $ ✓ P'� AUTOS ONLY AUTOS ONLY (Pat ide DAMAGE $ B ,y UMBRELLALUUI ✓ OCCUR CUP5N8889392442 4/2312024 4/23/2025 EACH OCCURRENCE $5000.000 AGGREGATE $5000,000 EXCESS UAB CLAIM&MADE DIED I ✓ I RETENTION$0 $ B WORKERSCOMPENSATION AND EMPLOYERS' LIABILRY YIN ANYPROPRIETOWPARTNERIEXECl1TNE OFRCERIMEMBEREXCLUDED1 Y NIA ✓ UB2Y3528922442G 4/23/2024 4/23/2025 ✓1 STATUTEI I°ERTM EL EACH ACCIDENT $1,000000 EL DISEASE -EA EMPLOYEE$1 jt. 000 (Mandatory In NH) Uyes de6Crbe under DESCRIPTION OF OPERATIONS below EL DISEASE - POLICY LIMIT $1000000 C Professional Liability (Claims Made MPL444730524 4/23/2024 4/23/2025 $2,000,000 Each Claim/ Aggregate Limit 8 Reported) Retention: $5,000 Each Claim DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) 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 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 1UTHOROEDREPRE5ENTATNE n Gabriela Covarrubias ©1988-2015 ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF NOTIr'F Will I RF nri IVFRFn IN ACCORDANCE WITH THE POLICY PRC Risk MamagonmEniwinn REVEWEG&APPR AaECBY: rl ftr 444 ®'. ® Rlsk Management Specialist ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD [J2-0 C NO, UN3, WC, PL Gaoiiela Covaccobi— 1 4/30/2024 S:C2:02 Pt' PUT) I Page 1 n2 a I't'_•:.-=ic-_scat= cancels and supersed=_s 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 II) 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 Company, 1994. Includes Copyrighted Material from Insurance Services Office, In,( =Ao1.o�ll „s ri Riak MannementDh islon BEVI &APPRov®By: '® Risk Management SpeciMm 79079505 1 2024 GL, IIIiO, OMB, WC, PL vabciela C as 1 4/30/2024 1:C2:02 Poi (PDT) I Page 2 of 2 This certificate cancels aed sepersedes ALL previously iss¢ed 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. S. 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. 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 called 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: c. The first Named Insured must keep records of a. Notices that are published include material placed on the Internet or on similar electronic the information we need for premium computation, and send us copies at such times means of communication; and as we may request b. Regarding websites, only that part of a website that is about your goods, products or services 6. Representations for the purposes c By accepting this policy, you agree: supporters is consid �v"n ReviE &APPRW BY: . 'y E{�.�,t ficav4lo _91�ww_ Risk Management SpeaAut Page 16 of 21 © 2017 The Travelers indemnity Company. All rights reserved 01 Includes copyrighted material of Insurance Services Office, Inc. with its permission. 7913999H 1 2024 GL, HNO, UM, WC, FL Gabriela C - zubi14/30/2024 1:C2: 02 PPl (PDT) I Page 3 of 8 This certificate canczls acd supersedzs ALL prz-pias ously issued cextiiicates. 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 C. Who Is An Insured — Newly Acquired Or Formed Limited Liability Companies D. Incidental Medical Malpractice E. Blanket Waiver Of Subrogation PROVISIONS b. An organization other than a partnership, joint A. WHO IS AN INSURED — UNNAMED venture or limited liability company: or SUBSIDIARIES c. A trust; The following is added to SECTION II — WHO IS as indicated in its name or the documents that AN INSURED: 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 11— 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 0219 © 2018 The Travelers Indemnity Company. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permiss 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 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 II — 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 RAMvug-affDhid- RE\ EWER &APPR0 By. ctq.-a ry' a'a A-jj.eflew 4 ® Risk Management SpeoNst 79779905 1 2024 CL, END, UDIB, WC, PL Gabriela Covarrubias 1 9/3C/2029 1:C2: 02 Pbi (PDT) I Page g ai a This certificate cancels and supersedes ALL prevrously isseed 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 II — 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 I — 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 II — Who Is An Insured. E. BLANKET WAIVER OF SUBROGATION The following is added to 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 p1 Ri:vi E 6APPRW Br. A- ju Aav44 Risk Management Spedari4t 79774905 1 2024 GL, MO, UMa, WC, PL Gabriela Covairubias 14/30/2024 1-C2:02 PP. (PDT) I Page 5 "I 9 rt This ceificate 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 insured'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 02 19 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. g,, -ft, Risk Xf, &wW. M MORW Risk Managements peuAist © 2018 The Travelers Indemnity Company. All rights reserved. Includes copyrighted material of Insurance services Office, Inc., with its permiss . 7977ss us I Zoza ¢, mo, uMB, WC, eL Cabcielz C - mubiae 1 4/30/2424 I:cio= PM (PDT) I Page 6 of 8 This certificate cancels and supersedes ALL previously isoced certificates. llak 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. RkkMVWgementDnisbn REVIEWED&APPRO Br ® Risk Management SpedallsC 01 DATE OF ISSUE: 04-19-24 ST ASSIGN: PAGE 1 OF I3�)9'J C.L. T. UN-- .,- FL = i Jv292J - `z P, IPC'"I Eape T , xtl, - ���fi,t- a�,.�i, ,emu -a-=., d, A_ .-i,at=,. 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: 30 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 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 RiskMowgemWDiAsIm Renew (Nonrenewal) in RenEu 6A,w Bv: _�: effective date of nonrene :�, �= Risk Management Spedaint IL T4 00 05 19 © 2019 The Travelers Indemnity Company. All rights reserved. 79779905 2G39 GL, RNO, 0'd9, 19{, ¢G a _ 14130/2C24 !-C2-02 El'IF9T) I eeq- 9 01 o This ceitiii-ate cancels acc _zsed=s s.AiL eaiou=l, issc=d c�ztifira Cis. CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/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 endorsement(s). PRODUCER VenbLI I f enbrooklnsuranceServices DIr•DD 16815 Von Karman Avery • G N o . FAX No, 94s 65z 396Q SUjne 1C /� n b A IL certificates@verbrook.com Irvine, CA 92606 �\ L! INSURERS AFFORDING GO4ERAGE NAM:g wwwmenbrook.com CArLldlA I e o. OD80832 1 a veterS Casualty Insurance Co of America 19046 INSURED D ele€s Property ert Casual Co of America 25674 Monument ROW R L of London t642 200 Spectrum Center, Acevedo 1 . Irvine CA 92618 1562 COVERAGES _ 0 CERTIFICATE NUMBER: 7gT74gn5 RFVLCInN NIt"RCR. 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. LTR TYPE OF INSURANCE ADOL SUER POLICY NUMBER MMNDY EFF MP IDY LIMBS A j COMMERCLALGENERAL UABIUTY CLAIMS -MADE OCCUR j j 6807P4562802442 4/23/2024 4/23/2025 $1,000.000 EE TO aoccunence $3Q0Q00 rEAC1URRENCE Any one person) $5,000 Deductible: none L&ADV INJURY $1.000 000 ✓ AGGREGATE LIMIT APPLIES PER POLICY❑jECT �LOC AGGREGATE $2,000,000 GEN'L ✓ S-COMPIOP or $2000000 $ OTHER: A AUTOMOBILELMBILRY 6807P4562802442 4/2312024 4/23/2025 Ea awdeotSINGLE LI T $100000o ANY AUTO BODILY INJURY Pet Pe wn) I AWNED SCHEDULED AUTOS ONLY AUTOS HIRED AUTOS ONLY ✓ AUOS ONLDY BADILY INJURY (Per aaitleni) $ PRQPERTY DAMAGE Per accitlenl $ B f IMERELLALIAe j OCCUR CUPSN8869392442 4/23/2024 4/23/2025 EACH OCCURRENCE $5,000,000 AGGREGATE $S QQQ,000 EXCESS LIAR CLAIMSMADE DED ✓ RETENTIO100 $ B WORKERSCOMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBEREXCLUDEO? Y❑ NIA j UB2Y3528922442G 4/23/2024 4/23/2025 PER AT ✓ STATUTE ER A. EEACH ACCIDENT $i,000 OOQ E.A. DISEASE -EA EMPLOYEE - $1.000 QQ (Mandatory in NH) Ryes, describe under rr $1000000 DESCRIPPONOFOPERATIONS be. IE.L.OISEASE-POLICYLIMIT C Professional Liability (Claims Made & Reported) MPL444730524 4/23/2024 4123/2025 $2,000,000 Each Claim/ Aggregate Limit Retention: $5,000 Each Claim DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 10t, Additional Remarks Schedule, may be attached if more space Is required) 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 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. [N�:illy[N_\Iq 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 CANCELLED BEFORE THE EXPIRATION DATE THEREOF NOTIrx WD I RF nF1 IVFRFn m ACCORDANCE WITH THE POLICY PRC AUTHORIZED REPRESENTATIVE ACORD Risk MtmagaturdDifislan REVIEWED&APPROV®BY. A u ^ ' ®' Risk Management Specarast ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 79779905 2024 GL, Run, UtIB, WC, FL Gabiiala C• aziubias 1 4/30/2024 1:C2:01 P41 (PDT) I Page 1 sf 3 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 D7 05 04 94 Copyright, The Travelers Indemnity Company, 1994. Includes Copyrighted, Material from Insurance Services Office, Inc of y,„,t ec W3i�"' Risk ManagemmtDiWnion nENEWID^^6 APPROAVm��BY: qu RA Management Speaalist IN 797799,35 12024 GL, HNO, UM, WC, PL I Gab iela Cova¢ubias 1 4/30/2024 1:G2:02 Pt. RM I Page 2 "f 2 This certificate cancels and supersedes ALL previously issued certificates. Monument ROW 6807P4562802442 COMMERCIAL GENERAL LIABILITY 5. 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. 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: Page 16 of 21 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. &. 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 purpose supporters is con © 2017 The Travelers Indemnity Company. All rights reserved. Includes copyrighted material of Insurance services Office, Inc. with its permission. s sdEc xeleMnugm mtlxv einn y+ ., REMMm&AP:Mw BY: q f: +c ileau4�e Risk Management Speasiist 7977e995 1 2024 GL, HNO, UNB, WC, PL Gabriela 'e uias 1413C2024 f:E2o02 PL' (PDT( I Page 3 If 3 This certificate cancels and supersedes ALL upreviously 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 The following is added to SECTION 11— WHO IS AN INSURED: Any of your subsidiaries, other than a partnership 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% 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 14 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. B. 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.(1) 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 II — WHO IS AN INSURED: F.AMmugmtmtDtWelun Rfvle &APPRO Sy: '11IIi,11.li.LflA�4 �tW4:a Rhk Management Specralist © 2018 The Travelers Indemnity Company. All rights reserved. Includes copyrighted material of Insurance Services Ofifice, Inc., with its permiss . 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 79779905 1 2024 GL, HNO, UHB,. WC, EL i Gibriels Cuvacrubias 1 4/30/2024 L:C2:02 PMiPUTI I Page 9 of H 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 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: It. 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 II — WHO IS AN INSURED: Unless you are in the business or occupation of providing professional health care services, Paragraphs (1)(a), (b), (e) 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 5. 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. S. 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 II — Who Is An Insured. E. BLANKET WAIVER OF SUBROGATION The following is added to Paragraph 8.. Transfer 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 RiskMamganentDim[an REVIEwEO 6 APPROVED BY: ® Risk Management Specialist 79779905 1 2024 GL, HNO,. On9,. WC, PL Gabriela C ari ubias I 4/30/2029 1:02:02 PH (PDT) I Page 5 �_ " This certificate cancels and supersedes t L previously issued certificates. of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: If the insured has agreed in a contract or agreement to waive that insureds 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: CG D8 42 02 19 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. RiskMvwg..dDMsbn RENEWED^^&�APPROV®Br nP m® Rnk Management Specialist © 2018 The Travelers Indemnity Company. All rights reserved. Includes copyrighted material of Insurance services Office, Inc., with its permiss 79779905 1 2024 GL,HNO, GPIs, WC, PL Gabriela auubias 1 4/30/2024 1:02:02 PL (PDT) I Page 6 of 8 This certificate cancels and supersedes ALL previously issued certi Eicates. TRAVELERSJw ONE TOWER SQUARE HARTFORD CT 06183 WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 00 03 13 (00) - 001 POLICY NUMBER: US-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. RleltMan tDw[un REVIEWED&APPROVEDSr A� Acava�fo _91�wm_ Risk Management Specialist 01 DATE OF ISSUE: 04-19-24 ST ASSIGN: PAGE 1 OF 197-1y3i. 242d M, 3'0 ne EL Gdhriel s I S/L]/•934 x C21 .2 , Ieael I Fag- 9 ,,. o '1'tie ati iicnte a el rc =gyp=rs=d=r, 9 L acc lr ieaee, c_rt i-i cat=_s. 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: 30 WHEN WE DO NOT RENEW (Nonrenewap: 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 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. Risk Mawgan�tDlvivfmi - Rwiem-M S APPRO y: A� Rczvedo Risk Wnagemen[Speddis[ 791t99,15 1 2 02 1 GL, HNO, ORB, WC, PL Gabciela cC vublas 1 4130202-1 1:C2:02 PF (PDT) I Page 8 if 8 TFis certificate can,=_ls and suparsedes ALL�pr=_viousi'j issued certificates.