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HomeMy WebLinkAboutJOHNSON FRANK AND ASSOCIATES -2009City of Santa Ana "r=<' Clerk of the Council AGREEMENT TERMINATION P09 JUL 19 Pit 3: n 9 Please complete this form when the attached agreement is no longer in elefTY OF SAN TA ANA Return form to the Clerk of the Council Office (M-30). CLERK OF COUNCIL Call 647-6520 if you have any questions. NOTE: PLEASE INCLUDE �7A-LL, AMENDMENS IF ANY. THANK YOU. The agreement with �/ n M ge n 1jefh e OL AFSe c No. ',�nQ f!(ag was completed on l and final payment has been made. Department: Phone/Ext.: x cJ 6 Signature: jZ �„ r Date: aavis 1a7.07 rx ORES u^lf. Ci.EHK' F C .il!NCI!— SECOND AMENDMENT TO AGREEMENT A-2009-168-001 THIS SECOND AMENDMENT TO AGREEMENT is entered into on October 5, 2009, by and between Johnson-Frank and Associates, Inc., a California corporation ("Consultant") and the City of Santa Ana, a charter city and municipal corporation of the op State of California ("City"). o RECITALS A. The parties entered into Consultant Agreement A-2008-086, dated May 5, 2008, U (hereinafter "said Agreement") by which Consultant has provided aerial mapping and digital surveying services. B. On October 5, 2009, the parties amended said Agreement to add compensation to provide for continuous services. However, the parties inadvertently failed to acknowledge their agreement that Consultant's fees shall be increased for the duration of the term. C. In accordance with the terms and conditions of said Agreement, the parties wish to amend the Fee Schedule to reflect the new rates and charges. 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 Second Amendment to Agreement, the parties agree as follows: 1. Section 3, COMPENSATION, shall be amended to reflect that commencing September 1, 2009, the hourly rates and charges set forth in Exhibit C, will be replaced by those fees and charges set forth in the Fee Schedule attached hereto as Exhibit C-1, and incorporated by this reference. 2. Except as herein amended, all terms and conditions of said Agreement shall remain in full force and effect. IN WITNESS WHEREOF, the parties hereto have executed this Second Amendment to Agreement on the date and year first written above. ATTEST: MARIA D. HUIZAR Clerk of the Council CITY OF SANTA ANA 1 DAVID N. REAM City Manager APPROVED AS TO FORM: JOSEPH W.FLETCHE City Attorney RECOMMENDED FOR APPROVAL RAUL GODINE Executive Directo Public Works Agency JOHNSON FRANK AND ASSOCIATES, INC. ALAN D. FRANK, PLS Vice President EXHIBIT C-I FEE SCHEDULE Effective 9-1-09 ¦ J ti Johnson-Frank & Associates, Inc. Professional Consulting Services Schedule of Current Hourly Rates for Services Performed by our Company for the City of Santa Ana Public Works Design Engineering Effective September 1, 2009 through December 31, 2010 Licensed Surveyor $168.00 Senior Technician $124.00 Technician/CAD Operator $112.50 One Person Survey Party w/equipment $154.00 Two Person Survey Party w/equipment $255.00 Three Person Survey Party w/equipment $340.00 Per Diem Rate Per Department of Defense Per diem rate listings (www.dtic.mil/perdiem/pdrates.htmi) Clerical /Delivery $45.00 Prints, research material & other incidental supplies Cost + 10% 3D Laser Scanner 51,250.00/day Dual Frequency GPS Equipment - 2 Units 5200/day 3 Units 5300/day 4 Units 5400/day Survey Vehicle Mileage 50.60/mile The above rates shall be charged portal to portal (time spent on job site plus travel time) excluding lunch breaks. Overtime shall be charged at 1.35 times the regular rate except for Sundays and/or holidays. Rates for Sunday shall be 1.75 times the regular rate and for holidays it shall be 2.5 times the regular rates. Daily overtime billing for field survey work during Monday through Friday does not commence until 8 hours of on-site work has been completed. (Travel time is not charged at overtime rates.) 5150 E. Hunter Ave. Anaheim CA 92807 (714) 777-8877 FAX: (714) 777-1641 Ae Ra CERTIFICATE OF LIABILITY INSURANCE PRODUCER 11130L200 ? IOA Insurance Services THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 1 30 Vantis, Suite 165 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Aliso 130 Viejo, CA 92165 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 949-680-1790 OE67768 www.ioausa.com INSURERS AFFORDING COVERAGE INSURED Johnson-Frank & Associates, Inc. NA # INSURER A: Travelers Property Casual Ins Co of America 25674 74 5150 E. Hunter Avenue Anaheim CA 92807 INSURER B: INSURER C: - INSURER D: INSURER E: 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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. .a nnn A GENERAL LIABILITY 6806825L007 1211/2009 12/1/2010 LIMBS ? COMMERCIAL GENERAL LIABILITY Scheduled Al Endt EACH OCCURRENCE D $ 1 ,0( CLAIMS MADE ? occuR #CGD3820907 AMAG TO R NTED PREMISES E occurrence $ 1,0C PrimarvlNonContrib MED EXP (Any one person) $ 1 ? Waiver Subro PERSONAL & ADV INJURY $ 1,Or GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,00 POLICY '/ PRO- v/ LOC ECT F1 PRODUCTS - COMP/OP AGG $ 2,00 A AUTOMOBILE LIABILITY BA68191_639 12/112009 12/1/2010 ANY AUTO Designated Insured COMBINED SINGLE LIMIT ALL OWNED AUTOS Endf #CA20480299 (Ea accident) $ 1,001 SCHEDULED AUTOS BODILY INJURY (Per person) $ HIRED AUTOS NON-OWNED AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY ANY AUTO AUTO ONLY- EA ACCIDENT $ OTHER THAN EA ACC $ A EXCESS / UMBRELLA LIABILITY CUP7915Y817 AUTO ONLY: AGG $ ? OCCUR CLAIMS MADE 12/1/2009 12/1/2010 EACH OCCURRENCE $ 4,000 ._ V AGGREGATE $ 4,000 ? DEDUCTIBLE $ RETENTION $ 0 $ WORKERS COMPENSATION $ AND EMPLOYERS' LIABILITY Y/N WC STATU- OTH- ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? -ter (Mandatory in NH) < E.L. EACH ACCIDENT $ H as. describe under SPECULL PROVISIONS be. - E.L. DISEASE - EA EMPLOYE $ OTHER '0 A C. - E.L. DISEASE POLICY LIMIT c DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Certificate Holder is Additional Insured as respects General Liability but only if requiredofbInyte wriresttt& en agreementContractwith the Namlimited Insured prior to an occurrence per coverage form #CGD3820907. General Liability includes Severability Liabili coverage form #CG00011001. Auto Liability Designated Insured included perform #CA20480299. Coverage subject to all policy terms, conditions, limitations and exclusions. tY Per ations in Liab City of Santa Ana, Its Officers, Employees, and Representatives Attn: Sherry Barkley PO Box 1988 Santa Ana CA 92702 ACORD 25 (2009/01) CERT NO.: 6330699 (AVC) Betty Tran 11/30/2009 9:39:11 AM Page 1 of 4 SHOULDANYOF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL 03NDOOD(M MAIL 30 - DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, ,?Bf( -10 Days for Non-Payment of Premium AUTHORIZED REPRESENTATIVE (AVC) Alicia K. Igram ©1988-2009 ACCORD CORPORATION. A.I.I. rights reserved. Johnson-Frank & Associates, Inc. POLICY NUMBER: 68068251-007 COMMERICAL GENERAL LIABILITY ISSUE DATE: - - 11/30/2009 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED (ARCHITECTS, ENGINEERS AND SURVEYORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE NAME OF PERSON(S) OR ORGANIZATION(S): City of Santa Ana, Its Officers, Employees, and Representatives PROJECT/LOCATION OF COVERED OPERATIONS: PROVISIONS A. The following is added to WHO IS AN INSURED (Section II): The person or organization shown in the Sched- ule above is an additional insured on this Cover- age Part, but only with respect to liability for "bod- ily injury", "property damage" or "personal injury" caused, in whole or in part, by your acts or omis- sions or the acts or omissions of those acting on your behalf: a. In the performance of your ongoing opera- tions; b. In connection with premises owned by or rented to you; or c. In connection with "your work" and included within the "products-completed operations hazard". Such person or organization does not qualify as an additional insured for "bodily injury", "property damage" or "personal injury" for which that per- son or organization has assumed liability in a con- tract or agreement. The insurance provided to such additional insured is limited as follows: d. This insurance does not apply to the render- ing of or failure to render any "professional services". e. The limits of insurance afforded to the addi- tional insured shall be the limits which you agreed in that "contract or agreement requir- ing insurance" to provide for that additional insured, or the limits shown in the Declara- tions for this Coverage Part, whichever are less. This endorsement does not increase the limits of insurance stated in the LIMITS OF INSURANCE (Section III) for this Coverage Part. The following is added to Paragraph a. of 4. Other Insurance in COMMERCIAL GENERAL LIABILITY CONDITIONS (Section IV): However, if you specifically agree in a "contract or agreement requiring insurance" that, for the addi- tional insured shown in the Schedule, the insur- ance provided to that additional insured under this CG D3 82 09 07 © 2007 The Travelers Companies, Inc. Includes the copyrighted material of Insurance Services Office, Inc., with its permission Page 1 of 2 CERT NO.: 6330899 (AVC) Betty Tran 11/30/2009 9:39:11 AM page 2 of 4 COMMERICAL GENERAL LIABILITY Coverage Part must apply on a primary basis, or a primary and non-contributory basis, this insur- ance is primary to other insurance that is avail- able to such additional insured which covers such additional insured as a named insured, and we will not share with the other insurance, provided that: (1) The "bodily injury" or "property damage" for which coverage is sought occurs; and (2) The "personal injury" for which coverage is sought arises out of an offense committed; after you have entered into that 'contract or agreement requiring insurance" for such addi- tional insured. But this insurance still is excess over valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that is available to the additional in- sured when the additional insured is also an addi- tional insured under any other insurance. C. The following is added to Paragraph S. Transfer Of Rights Of Recovery Against Others To Us in COMMERCIAL GENERAL LIABILITY CON- DITIONS (Section IV): We waive any rights of recovery we may have against the additional insured shown in the Schedule above because of payments we make for "bodily injury", "property damage" or "personal injury" arising out of "your work" on or for the pro- ject, or at the location, shown in the Schedule above, performed by you, or on your behalf, un- der a "contract or agreement requiring insurance" with that additional insured. We waive these rights only where you have agreed to do so as part of the "contract or agreement requiring insur- ance" with that additional insured entered into by you before, and in effect when, the "bodily injury" or "property damage" occurs, or the "personal in- jury" offense is committed. D. The following definition is added to DEFINITIONS (Section V): "Contract or agreement requiring insurance" means that part of any contract or agreement un- der which you are required to include the person or organization shown in the Schedule as an ad- ditional insured on this Coverage Part, provided that the "bodily injury" and "property damage" oc- curs, and the "personal injury" is caused by an of- fense committed: a. After you have entered into that contract or agreement; b. While that part of the contract or agreement is in effect; and c. Before the end of the policy period. L r?LY r?SSISt'?OL .. Page 2 of 2 © 2007 The Travelers Companies, inc. Includes the copyrighted material of insurance Services Office, Inc., with its permission CG D3 82 09 07 CERT NO.; 6330099 (AVC) Betty Tran 11/30/2009 9:39:11 AM page 3 of 4 POLICY NUMBER: BA68191.639 Johnson-Frank & Associates, Inc. COMMERCIAL AUTO ISSUE DATE: 11/30/2009 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" under the Who Is An Insured Provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. SCHEDULE NAME OF PERSON(S) OR ORGANIZATION(S): City of Santa Ana, Its Officers, Employees, and Representatives (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to the end orsement.) Each person or organization shown in the Schedule is an "insured" for Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured Provision contained in Section II of the Coverage Form. APPRO V :. , 1'0 P'OR M Laura Stitt Sheedy Ass ;taut City Attorney CA 20 48 02 99 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1 CERT NO.: 6330099 (AVC) Betty Tran 11/30/2009 9:39:11 AM page 4 of 4 DATE (MM/DD/YYYY) ACO CERTIFICATE OF LIABILITY INSURANCE III? 12/2/2010 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If 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 Insurance Office of America CONTACT NAME: 130 Vantis, Suite 250 PHONE A/C No Ext: 949-297-5962_ FAX AIC N.949-297596Q Aliso Viejo, CA 92656 INSURERS AFFORDING COVERAGE NAIC # www.ioausa.com CA License #OE67768 INSURER A : Travelers Property Ins Co of America 25674 INSURED Johnson-Frank & Associates, Inc. INSURER B: BeaZle Insurance Company 37540 5150 E. Hunter Avenue Anaheim CA 92807 INSURER C : INSURER D : INSURER E : --- -- - --- -- INSURER F : COVFRAI CFRTIPIRATF Kit IMRFR• QQno7no owr?rnu w uae?r.. 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 ADDL SUBR POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DDfYYYY LIMITS A GENERAL LIABILITY ? 68068251-007 12/1/2010 12/1/2011 EACH OCCURRENCE $ 1,000,000 ? COMMERCIAL GENERAL LIABILITY Scheduled Al Endt #CGD3820907 DAMA? E TO RENTED PREMISES (Ea occurrence) $ 1,000,000 ? CLAIMS-MADE L v' J OCCUR Professional Services MED EXP (Any one person) $ 10,000 Primary/Non-Contributory performed by the insured PERSONAL BADV INJURY $ 1,000,000 ? Waiver of Subrogation are Excluded GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER'. PRODUCTS- COMP/OP AGG $ 2,000,000 POLICY PRO- ? T ? LOC $ A AUT OMOBILE LIABILITY ? BA68191_639 121112010 12/1/2011 B l NE D SINGLE LIMIT COM a o e t $ 1,000,000 ? ANY AUTO Designated Insured BODILY INJURY P Endt #CA20480299 ( er person) $ ALL OWNED AUTOS SCHEDULED Auros , Blanket Waiver of BODILY INJURY (Per accident) $ ? HIREDAUTOS NON-OWNED ? Subrogation #CAT3400808 PROPERTY DAMAGE _ _ AUTOS ' der accident) $ A ? UMBRELLA LIAB OCCUR CUP7915Y817 12/1/2010 12/1/2011 EACH OCCURRENCE $ 4,000,000 EXCESS LIAB CLAIMS-MADE Excludes Professional AGGREGATE $ 4,000,000 V/ RE DED TENTION$O Liability ?g/; r " P ?_(? h ',t tl. $ $ WORKERS COMPENSATION _ -?- TAU TH O Y AND EMPLOYERS' LIABILITY Y / N .._.? _ t fi TOR L MITS ANY PROPRIETOR/PARTNER/EXECUTIVE ?9 dufY / ? z ?' ,t ' OFFICER/MEMBER EXCLUDED? ? N/A . .. E.L. EACH ACCIDENT $ (Mandatory in NH) If yes describe under A,jj15t2t1 t E.L. DISEASE - EA EMPLOYEE $ , DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ B Professional Liability V15PR3100301 121112010 12/1/2011 $1,000 000 Per Claim Claims-Made , $2,000,000 Aggregate DESCRIPTION OF OPERATIONS /LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Certificate Holder is an Additional Insured with respect to General Liability and Automobile Liability but only when required by written contract with Named Insured prior to an occurrence as per Endorsement(s) noted above. General Liability includes Separation of Insureds and Contractual Liability per limitations in the Liability Coverage form #CG00011001. Coverage is subject to all policy terms, conditions limitations and exclusions , . 30 Day Notice of Cancellation/10 Day Notice for Non-Payment of premium. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Santa Ana, Its Officers and Employees THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN P.O. Box 1988 ACCORDANCE WITH THE POLICY PROVISIONS. Santa Ana CA 92702 AUTHORIZED REPRESENTATIVE (AVC) Alicia K. Igram W IV05-ZUTU At-UKU L;UKFUKA I IUN. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD CERT NO.: 8898708 Teresa Frank 12/2/2010 1:13:50 PM Page 1 of 5 Johnson-Frank & Associates, Inc. POLICY NUMBER: 68068251-007 COMMERICAL GENERAL LIABILITY ISSUE DATE: - - 12/2/2010 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED (ARCHITECTS, ENGINEERS AND SURVEYORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE NAME OF PERSON(S) OR ORGANIZATION(S): City of Santa Ana, Its Officers and Employees PROJECT/LOCATION OF COVERED OPERATIONS: PROVISIONS A. The following is added to WHO IS AN INSURED (Section II): The person or organization shown in the Sched- ule above is an additional insured on this Cover- age Part, but only with respect to liability for "bod- ily injury", "property damage" or "personal injury" caused, in whole or in part, by your acts or omis- sions or the acts or omissions of those acting on your behalf: a. In the performance of your ongoing opera- tions; b. In connection with premises owned by or rented to you; or c. In connection with "your work" and included within the "products-completed operations hazard". Such person or organization does not qualify as an additional insured for "bodily injury", "property damage" or "personal injury" for which that per- son or organization has assumed liability in a con- tract or agreement. CG D3 82 09 07 © 2007 The Travelers Companies, Inc. Includes the copyrighted material of Insurance Services Office, Inc., with its permission The insurance provided to such additional insured is limited as follows: d. This insurance does not apply to the render- ing of or failure to render any "professional services". e. The limits of insurance afforded to the addi- tional insured shall be the limits which you agreed in that "contract or agreement requir- ing insurance" to provide for that additional insured, or the limits shown in the Declara- tions for this Coverage Part, whichever are less. This endorsement does not increase the limits of insurance stated in the LIMITS OF INSURANCE (Section III) for this Coverage Part. B. The following is added to Paragraph a. of 4. Other Insurance in COMMERCIAL GENERAL LIABILITY CONDITIONS (Section IV): However, if you specifically agree in a "contract or agreement requiring insurance" that, for the addi- tional insured shown in the Schedule, the insur- ance provided to that additional insured under this Page 1 of 2 CERT NO.: 8898708 Teresa Frank 12/2/2010 1:13:50 PM Page 2 of 5 COMMERICAL GENERAL LIABILITY Coverage Part must apply on a primary basis, or a primary and non-contributory basis, this insur- ance is primary to other insurance that is avail- able to such additional insured which covers such additional insured as a named insured, and we will not share with the other insurance, provided that: (1) The "bodily injury" or "property damage" for which coverage is sought occurs; and (2) The "personal injury" for which coverage is sought arises out of an offense committed; after you have entered into that "contract or agreement requiring insurance" for such addi- tional insured. But this insurance still is excess over valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that is available to the additional in- sured when the additional insured is also an addi- tional insured under any other insurance. C. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us in COMMERCIAL GENERAL LIABILITY CON- DITIONS (Section IV): We waive any rights of recovery we may have against the additional insured shown in the Schedule above because of payments we make for "bodily injury", "property damage" or "personal injury" arising out of "your work" on or for the pro- ject, or at the location, shown in the Schedule above, performed by you, or on your behalf, un- der a "contract or agreement requiring insurance" with that additional insured. We waive these rights only where you have agreed to do so as part of the "contract or agreement requiring insur- ance" with that additional insured entered into by you before, and in effect when, the "bodily injury" or "property damage" occurs, or the "personal in- jury" offense is committed. D. The following definition is added to DEFINITIONS (Section V): "Contract or agreement requiring insurance" means that part of any contract or agreement un- der which you are required to include the person or organization shown in the Schedule as an ad- ditional insured on this Coverage Part, provided that the "bodily injury" and "property damage" oc- curs, and the "personal injury" is caused by an of- fense committed: a. After you have entered into that contract or agreement; b. While that part of the contract or agreement is in effect; and c. Before the end of the policy period. Page 2 of 2 © 2007 The Travelers Companies, Inc. Includes the copyrighted material of Insurance Services Office, Inc., with its permission CG D3 82 09 07 CERT NO.: 8898708 Teresa Frank 12/2/2010 1:13:50 PM Page 3 of 5 POLICY NUMBER: BA68191_639 Johnson-Frank & Associates, Inc. COMMERCIAL AUTO ISSUE DATE: 12/2/2010 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" under the Who Is An Insured Provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. SCHEDULE NAME OF PERSON(S) OR ORGANIZATION(S): City of Santa Ana, Its Officers and Employees (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to the end orsement.) Each person or organization shown in the Schedule is an "insured" for Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured Provision contained in Section II of the Coverage Form. CA 20 48 02 99 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1 CERT NO. 8898708 Teresa Frank 12/2/2010 1:13:50 PM Page 4 of 5 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET WAIVER OF SUBROGATION This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorse- required of you by a written contract executed ment, the provisions of the Coverage Form apply prior to any "accident" or "loss", provided that the unless modified by the endorsement. "accident" or "loss" arises out of the operations Paragraph 5. Transfer of Rights Of Recovery contemplated by such contract. The waiver ap- Against Others To Us of the CONDITIONS section plies only to the person or organization desig- is replaced by the following: nated in such contract. 5. Transfer Of Rights Of Recovery Against Oth- ers To Us We waive any right of recovery we may have against any person or organization to the extent CA T3 40 08 08 © 2008 The Travelers Companies, Inc. Page 1 Of 1 CERT NO.: 8898708 Teresa Frank 12/2/2010 1:13:50 PM Page 5 of 5 POLICYHOLDER COPY P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 01-04-2011 CITY OF SANTA ANA SG BUILDING & SAFETY DEPT PO BOX 1988 SANTA ANA CA 92702-1988 GROUP: 000092 POLICY NUMBER: 0000678-2010 CERTIFICATE ID: 340 CERTIFICATE EXPIRES: 01-01-2012 01-01-2011/01-01-2012 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer. We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. Authorized Representative President and CEO EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #1600 - ROGER FRANK PRIES - EXCLUDED. ENDORSEMENT #1600 - ALAN FRANK S,T - EXCLUDED. ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 01-01-2008 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. ENDORSEMENT #2570 ENTITLED WAIVER OF SUBROGATION EFFECTIVE 2011-01-04 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. THIRD PARTY NAME: CITY OF SANTA ANA EMPLOYER JOHNSON-FRANK & ASSOCIATES (A CORP) SG 5150 E HUNTER AVE ANAHEIM CA 92807 (PMF,CSj SG (REV.8-2010) PRINTED : 01-04-2011