HomeMy WebLinkAboutUNITED STORM WATER, INC. 4A-2009 City of Santa ? a
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eta r 1 Clerk of the Council COTC Office Use Only
AGREEMENT TERMINATION FORM
Please complete this form in its entirety when the attached agreement and all
amendments (if any) are no longer in effect.
Note: If your agreement is grant related, please ensure that all grant retention requirements
have been satisfied prior to signing the termination form.
Is the agreement(s)a permanent record?Yes No
Return form to the Clerk of the Council Office (M-30). •
Call 647-1520 if you have any questions. •
The agreement with i'!N4
S‘MitetrAtel4 •
No. .'`� _ �� ? 66 7 was completed on 7(�c /(7 and final payment has been made.
(List all amendments. Use space below if needed.)
/47 2O0 eQ , Department: Nill
fI A, f squat, Phone/Ext.:ark
2`
Signature:
71/' �AOCf� 4725-S�Q� ✓ Date: ! (3/r7
Revised: 10-13-10 /9 r.�//): — /O
INSURANCE ON FLE N- 2008 - 122 -001
WORK MAY PROCEED
UNTIL INSURANCE EXPIRES
-
CLERK OF COUNCIL
DATE: g- b —0 9
6 PWA/Desen CZ') FIRST AMENDMENT TO AGREEMENT
&Oe_ ParcO THIS FIRST AMENDMENT TO AGREEMENT is entered into on June 29, 2009, by
and between United Storm Water, Inc., a California corporation ( "Contractor ") and the City of
Santa Ana, a charter city and municipal corporation of the State of California ( "City").
RECITALS:
A. The parties entered into Agreement # N- 2008 -122, dated July 1, 2008, (hereinafter "said
Agreement ") by which Contractor has provided storm drain and catch basin inspection and
cleaning as necessary for City compliance with NPDES requirements.
B. In accordance with the terms and conditions of said Agreement, the parties wish to extend the
term and increase compensation to pay for services during the extended term.
WHEREFORE, in consideration of the covenants contained in said Agreement, and subject to all
the terms and conditions of said Agreement, except those amended in this First Amendment to
Agreement, the parties agree as follows:
1. Section 2.a., COMPENSATION, shall be deleted in its entirety and replaced with the
following language:
"a. City agrees to pay, and Consultant agrees to accept as total payment for its
services, the following rates and charges:
Unit Cost
VACTRON WITH OPERATOR 8 HOUR
VACTRON W /OPERATOR 2 HOUR
O.T. RATE
SUPERVISOR (Emergency
Situations or
Large Cleaning job( upon
approval)
SUPERVISOR O.T. RATE
TECHNICIAN
TECHNICIAN O.T. RATE
STAKEBED TRUCK WITH
LIFTGATE
JETTER UNIT
(TOWABLE) /4000 PSI
WASH UNIT
Transposal & Disposal Non
Hazardous waste
8 HOUR
Total
78.00/hr 624.00 /day
98.00 /hr 196.00
55.00 /hr 440.00 /day
2 HOUR 69.00/hr 138.00
8 HOUR
2 HOUR
1 DAY
1 HOUR
1 EACH
40.00 /hr 320.00 /day
54.00 /hr
108.00
160.00 /day
160.00 /day
60.00 /hr
60.00/hr
60.00 /ton
60.00 /ton
15% FUEL /INSURANCE
SURCHARGE
DAY 118.50 /day 118.50 /day
The total sum to be expended under this Agreement shall not exceed $25,000.00, per fiscal
year, during the term of this Agreement."
2. Section 3, TERM, shall be amended to extend the term for an additional one -year period,
through June 30, 2010.
3. Except as hereinabove amended, all terms and conditions of said Agreement shall remain in
full force and effect.
IN WITNESS WHEREOF, the parties hereto have executed this First Amendment to Agreement
on the date and year first written above.
1 , PATRICIA E. HEALY
Clerk of the Council
APPROVED AS TO FORM:
JOSEPH W. FLETCHER
City Attorney
'Executive Director —
Public Works Agency
CITY OF SANTA ANA
DAVID N. REAM
City Manager
UNITED STORM WATER, INC.
C,�Q ��
ED PERRY V q
President
DATE (MMIDDIYYYY)
' ALDRD, CERTIFICATE OF LIABILITY INSURANCE 01/23/2008
PRODUCER (213) SS3 -8400 FAX (213) SS3 -8466 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Wilshire Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
835 Wilshire Blvd 4th Floor ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Los Angeles, CA 90017 -2603
INSURERS AFFORDING COVERAGE NAIC p
INSURED United Storm Water, Inc. INSURERA Nautilus Insurance Co.
14000 East Valley Blvd. INSURERS: Great Divide Ins. Co. -
City of Industry, CA 91746 INSURER C:
E:
COVERAGES
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
W R
D'
TYPE OFINSURANCE
POLICY NUMBER
POLICY EFFECTIVE
POLICY EXPIRATION
LIMITS
GENERAL LIABILITY
X COMMERCIALGENERALLIABILITY
CLAIMS MADE OOCCIIR
ECPCO20D00411
11/16/2007
11/16/2008
EACH OCCURRENCE
S 1,000,00
DAMAGETORENTED
ARFMIRFS OF,
5 50,00(
MEO E%P (Any a n. PAj
5 5100
PERSONAL B ADV INJURY
S 1,000,00C
A
GENERAL AGGREGATE
5 1,000,00C
PRODUCTS • COMP/OP AGG
S 11000 QQ
GENL AGGREGATE LIMIT APPLIES PER
X POLICY r7 MO. LOC
JECT
AUTOMOBILE
LIABILITY
ANY AUTO
BAP020000311
11/16/2007
11/16/2008
��� yy
.,_.;2.�VT
COMBINED SINGLE LIMIT
(Eascod nt)
S
1.000,00
X
BODILY INJURY
IPUro N
S
B
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON-0WNED ALn03
I
-..'S
".,.
i "�
BODILY INJURY
S
X
X
X
MCS -90
PROPERTY DAMAGE
(P.,AwaAm)
S
X
EA-9948
GARAGE LIABILITY
,%
-
AUTO ONLY - EA ACCIDENT
S
OTHER THAN EA ACC
AUTO ONLY: AGO
S
ANY AUTO
S
EXCESSNMBRELLALIABILITY
X OCCUR ❑ CLAIMS MADE
FFX020000511
11/16/2007
11716/2008
EACH OCCURRENCE
S 5,000'00
AGGREGATE
5 5,000,000
S
A
5
DEDUCTIBLE
X WC STA U• 01 H•
S
X RETENTION 5 10.00
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
WCA020001811
01/01/2Q08
Q1/01/2009
E.L. EACH ACCIDENT
5 1 . QQQ, OO
B
OPFICERIMEMSERf EXCLUDED? ECIffNE
El DISEASE - EA EMPLOYE
5 1.000,00
E.A. DISEASE- POUCYI.]MIT S 1, QQQ, OQ
51,000,000 total limit &
Annual Agg S/T $25,000 Ded
A
0 Taa, dm tx Vn001
SPECIAL PROVISIONS bYoM
ro�`Liability/
&0 (Claims Made)
POL
ECPCO20000411
UTION LIAR (OCC FORM)
11/16/2007
11/16/2008
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES) EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS
HE CITY OF SANTA ANA, ITS OFFICERS, AGENTS, VOLUNTEERS AND EMPLOYEES ARE NAMED AS
ODITIONAL INSUREDS WITH RESPECTS TO ALL 706 OPERATIONS PERFORMED BY THE NAMED INSUREDS.
HIS INSURANCE IS PRIMARY TO ANY INSURANCE.
`EXCEPT 10 DAY NOTICE OF CANCELLATION FOR NONPAYMENT OF PREMIUM.
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL K4=00W)i MAIL
'30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.
CITY OF SANTA ANA i( IXrXXO( dfAR75�X�dK% yd4XeXitX' 14XW} IYXIQ1fif AGXi'LBiCk,1( %�6d(�(IXDHG)hXXX)
20 CIVIC CENTER PLAZA M -93 KMdNfrUMXil(LW(%#€7W61NMKXY,5mx*WM)(*Xx*xokmxXXXXXXX)
SANTA ANA, CA 92701 AUTHORIZED RP. V NT "`E I f/n r11 in nn
,._... 1 OACORD CORPORATION 1988
VE- CF6020000410
United Pumping Service, Inc.
ENDORSEMENT United Storm water
This endorsement forms a part of the policy to which it is attached. Please read it carefully.
This endorsement modifies insurance provided under the following:
ENVIRONMENTAL COMBINED POLICY
Section III — Who is an Insured is amended to include as an insured, with respect to Coverage A and B, any person(s) or
organizalion(s) when you and such person(s) or organizations) have agreed in a written contract or written agreement that
such person(s) or organization(s) be added as an additional insured on your policy. Such written contract or written
agreement must be In effect prior to the occurrence giving rise to the claim or suit for which the person(s) or
organization(s) seeks coverage.
Such additional insured status applies only:
1. With respect to your work performed for such person(s) or organizations) In the performance of your ongoing
operations for the additional insured; or
.2. With respect to your work performed for such person(s) or organizations(s) and included in the products -
completed operations hazard, only when required by the written contract or written agreement.
With respect to damages caused by your work, as described above, the coverage provided hereunder shall be primary
and not contributing with any other insurance available to those person(s) or organization(s) with which you have so
agreed in a written contract or written agreement.
02008 by aehby SpedW Und w dit Mangam U.C. an ai UWA of Naualuc Insumn Uwany and Gmat DNfoe Insurance Company. All 6" taserved-
O 1985-2009 by Insurance SGNIc Clfica, Inc.. mateMl used by pafnllSSIIX4 Page 1 of 1
ECP 1004 10 O6
IV- ce CCcl? - 1,22
A CERTIFICATE OF LIABILITY INSURANCE
— — - ------- . ..... '7--TH S CERTIFICATE is iSSUED AS A MATTER OF INFOM
RATIO*
...... . . ....
FAX (2-13)5S3-8466 CERTIF1 j I sii i re, Insu rance Agency
ONLY AND CONFERS NO RIGHTS UPON I HE CER71FICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ijsj -,jr-e BI,,d 4th Floor At TER THE COVERAGE AFFORDED BY THE POLICIES BELOW'
INSURERS AFFORDING COVERAGE NAIC
Nautilus Ins -o.
Lirxite III Water, Inc, C
11000 East Valley Blvd. Great Divide Ins. Co.
City of Industry, CA 91-46
- —
— — ------------- —
E
E
A
T�PL 3� N
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PCKA�,Y EXP�HPMON
I I GO, .
ECKO-10000412 11/'1.6/200$ i
1116/2009
.011
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X
1,000, 0010
77 7
000,
P, _E _.I;. R
RAP020000312 11/16,12008 1
111/16/2009
1 000, 000
CA9948
. . .... ..... .
. ....... . ....... . . 7
7
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F-F)(020000512 11/16/2008 1
11/16/2009
S 600, Om
5,000,001
CERTIFICATE HOLDER CANCt,-I,1A-T,I-QN,
,a,,PPROVJ�J) AS To FIC
CTT) OF SANTA ANA
20 CIVIC CENTER PLAZA M-93
SANTA ANA. CA 92701
i-auia SLILL Sheedy
ACORD 25 12001 "OF) T""
\s,iSWIlt City tor
AW, CT1�tLl AEOVE 0ESCFZ!9,-
J:
EAP.RA-, 10N\LA�
HERLOF, I HL '$S'j�NG iNSAJkifPV
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OF A114y K INII 4E j4c�E 4,iAiw t, ",,Rf �S_c N 7AI �VF
REPRE `WN;ZATlVlz
.,ACCRO CORPORATION
.,ACCRO CORPORATION
AQDITIONAL INSURED ENDORSEMENT
FOR COMMERCIAL GENERAL LIABILITY POLICY
Insurance Company Nautilus Insurance Company
This endorsement modifies such insurance as is afforded by the provisions of Policy
ECPCO20000412 relating to the following:
1. The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701; its
officers, employees, agents, volunteers and representatives are named as additional insureds
("additional insureds ") with regard to liability and defense of suits arising from the operations
and uses performed by or on behalf of the named insured.
2. With respect to claims arising out of the operations and uses performed by or on
behalf of the named insured, such insurance as is afforded by this policy is primary and is not
additional to or contributing with any other insurance carried by or for the benefit of the
additional insureds.
3. This insurance applies separately to each insured against whom claim is made or
suit is brou;ht except with respect to the company's limits of liability. The inclusion of any
person or organization as an insured shall not affect any right which such person or organization
would have as a claimant if not so included.
4. with respect to the additional insureds, this insurance shall not be cancelled, or
materially reduced in coverage or limits except after thirty (30) days written notice has been
given to the City of Santa Ana, 20 Civic Center Plaza, Santa Ana, Califomia 92701.
(Completion of the following, including countersignature, is required to melee this endorsement
effective.)
Effective 6/23/09 , this endorsement form as a part of
Policy * ECPCO20000412
Issued to
cP() 0 '4/— A[ - 2
ACOR0, CERTIFICATE OF LIABILITY INSURANCE DATE OMM;CD YyYy)
01/25/2010
213.553.8400 FAX 213.553,8466 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
_ . . ........... I
Wilshire Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
835 Wilshire Blvd 4th Floor HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
Los Angeles, CA 90017-2603 ALTER THE COVERAGE AFFORDED BY THE POLICIES EELOW,
INSURER,%-AFFORPI 11 COQ! NAIC #
nited St
soi� IJ� I Nautilus Ins.Co
14000 East Valley Blvd.
mat City of Industry, CA 91746 -.Cfr At Divide Ins.
. ......... .. ..... ....... . . .............. ..... . ..... .. . .... .. . ....... . ............ . .. . .................
---- ._ ........ . ...... ..... ....... . . ................ ...... . . ......
Ti__ iN, URA AC--_ L!srED p 0-V%,' KA, IE SEE"" TO THE JNSjRzD NANAIEED ABOVE FOR THE POLICY PER Of) INDICATED NQTV,,)THS1,Ar,,r_,!NG_
R T C C ^ 40 I T "", 0 A N A� C T 0 R ' T I - 4 F P icy
kIENT Vii-HqES7,�_CT TOV"HICH TH�S CEr-TIrICATE ,�AY EE!S_�,
P0 n*: -Luz r
S 0 E S --,R I 6;� �'�jN Is SUB'- 3 AND '_13NZ)j7.C,1 r, r
HE _ 1� E C T T 0 A, H E TE R �,! 5, EXr_
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XP-,,Aj
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LIMITS NUMBER
G E PL A I ECPCO20000T311/16i 9 11/16)2010 :
1-1, 000, 00
50,00
A
5 on,
SHOULD AIIYOF THE ABOVE DESCRIBED PO,,cjfiS BE CANCELLED BEFORE. TI-E
"
-.P.RA." DATE THEREOF, THE ISSUING INSURER WILL *UX�16 4AIt
D
CITY OF SANTA ANA DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.
20 CIVIC CENTER PLAZA M-93
SANTA ANA, CA 92701 KAXX x x x x X)o
ACORD 25 (2001108)
IDACORD CORPORATION 1988
. ...... . ... .......... . ........
. . ......... . ..........
.......... . .
000 00
11000.00
............
1.000,00
AL ii}l63Ok31.6 Y
BAP0200003131 11/16/2009.....1I/16/2010 11/16/2010 1
1,900,00
APPRON/' 0 A S TO FORM
X
X
X MCS-90
... . ............
X Cd99 8
Laura S Shee
GARAGE MLITY
UA
7 iDI, I y
EXCESSUMBRELLA LIABILITY
-7,
FFX0200005131 11/16/2009 11/16/2010
X �F
1,�A
EACI OCCU;04,,', -E
5,000,00C
5,000,00€3
X D 10,000
WORKERS COMPENSATION AjN0
WCA0200018131 01101120 01/01/2011
%
X U! i_
uOu . 0"
LO00100
060 "06
1,000,00
�pllrlollwl Liabi I i ty/
I, c: A S; ;E POL I C L I t, I T
ECPCO20000413,: 11/16/2009 1 11/16/2010 1
000,00
E&O (claims made)
$1,000 000 total
limit
m it &
POLLUTION LIAR
Annual Agg S/T S25,060 Ded
OCC FORM)z
0:::
OESCRIPTiON OF OPERATIONS LOCATION s,, VEHICLES I EXCLL)Sto� ADDED By ENCORSEMENT f SPECIAL PROVISIONS
'HE CITY OF SANTA ANA, ITS OFFICERS,
DDITIONAL INSUREDS WITH
AGENTS, VOLUNTEERS AND EMPLOYEES ARE NAMED AS
RESPECT TO ALL 308 OPERATIONS PERFORMED BY THE NAMED INSURED. THIS
NSURANCE IS PRIMARY TO ANY INSURANCE,
EXCEPT 10 DAY NOTICE OF CANCELLATION
FOR NON PAYMENT OF PREMIUM,
SHOULD AIIYOF THE ABOVE DESCRIBED PO,,cjfiS BE CANCELLED BEFORE. TI-E
"
-.P.RA." DATE THEREOF, THE ISSUING INSURER WILL *UX�16 4AIt
D
CITY OF SANTA ANA DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.
20 CIVIC CENTER PLAZA M-93
SANTA ANA, CA 92701 KAXX x x x x X)o
ACORD 25 (2001108)
IDACORD CORPORATION 1988
-1 A.
ADDITIONAL INSI-RED ENDORSE,%4ENT
l-,NERAL Ll,-�—
—0-1111TON-1 141 1—:1—AL -C fill -ITT pOLjCy
Insurance Company Nautilus Insurance Co.
This ClldorsCIWIIZ 1110dilk, such itl,UranLCIS i.;atforded by the prL)ViSjojj.,; of Pk)!jcV
ECPCO20000413 "eldt"IL"(0 the following;
I - The (Atv ot'Santa,,kna, 20 Civic Center Plaza. Santa Ana, California
92 01 it,, ofificer,,, emPlOvecv. 4111clits. Volunteers and represeenwives are named as
3ddilional insureds C' additit-m'-d insureds") with r",ard to liabilit y a d defense o! -suit
S
trom [Ile r3ttC 21
iind Il y Pert'(wined by or on behal Cor
the named M.,ured,
NV ith respect to ckmns arismLy Out ol'the operations and uses pertonned by
(In bchall-Of the narned inset -ed. such in-surance as is affordcd by this policy is
pnman
and I-S 1101 additional to or contrtht,10(10 with an% other 111SUrance carried by or for the
b,:ricfjt of'the additional lnsurcds.
This Insurance applies separately to each insured against whom claim is
-1
nl.l& ot mlit is brought excel-n with respect to (i
lie company's litnits of liability. The
Inclusion ofany person or (-1rg3T1W31*A-)r1 aN All. iivstircd shall not affect an% riOlt WhiCh SLIQ11
a claimant ji'llot so included.
Im'son or orgamzjtikjrj I'Llve as
4. With respect to the additiotial insureds- this insurance shall not be
cancelled. or materially reduced in coverage or limits except atIter thirty (30) days written
1106c�-has 'Peen given to the CitN oi'Santa Ana, 20 Civic Center Plaza. Santa Ana,
('al i iornia 9 -`01,
i Completion of the follo-,N ing, including coulters I
tive�) Ignaturc, is required to make thi
endorsement eft ec s
f-!'1`ec tip e- 111/16/09-10 th,
Is ertdOrSenlent 6-)rm as a pan., ot-
Pulicv -, !~CPC( �200004 13
lssu�cd to United Storm Water, Inc.
Narned Insured
G, 3u n let's i1gried bi
A t t rh �on d �Re p entative
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LOS nyules, CA 80017 7603 > n - - _1
" INSURFJiS AFFORO!NG COVERAGE NAIL' #
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i 40C10 East .Valley Blvd_ O7u7d�'
City of-`klidusteY, CA 91 746
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