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HomeMy WebLinkAboutPACIFIC COAST CABLING INC. (2) INSURANCE ON FILE ORK MAY PROCEFD UiVrh. INSII}�i:l'!CE r_'{P'lka A-2022-153-02A i; ry CLERK n}TF MAYOR + CITY MANAGER AUG 2 7 �� ValerieAmezcua y.•?t�' Alvaro Nunez YOR PRO TEM CITY ATTORNEY Benjamin Vazquez Sonia R.Carvalho COLINCILMEMBERS CITY CLERK o: T(0) Phil Bacerra TA Cjut10(�pz) Johnathan Ryan Hernandez Jennifer L.Hall Jessie Lopez David Penaloza Thai Viet Phan CITY OF SANTA ANA INFORMATION TECHNOLOGIES DEPARTMENT 20 Civic Center Plaza•P,O.Box 1988 Santa Ana,California 92702 www.santa-ana.oru August 22, 2025 Pacific Coast Cabling Inc. Attn: Philip Buckley 2017 Prairie St. Chatsworth,CA 91311 Re: Extension of Agreement#A-2022-153-02 to Provide On-Call Network, Cablin8 Services Pursuant to Section 3 ("Term") of the above-referenced Agreement, entered into by Pacific Coast Cabling, Inc. and the City of Santa Ana, dated August 16, 2022, the time period of the Agreement is hereby extended for an additional one-year period through August 16,2026. Any insurance certificates are required to be extended and/or renewed to cover this extension. All other terms and conditions of the Agreement remain unchanged and in full force and effect. Sincerely, ZA ck Ci ulla ahief Technology Innovations Officer CITY S TA AN ATTEST Alvaro Nunez e e a W" City Manager City Cler APPROVED AS TO FORM PAC IC C AST CABLING,INC. Jonathan T. Marti Philip Buckley Assistant City Attorney Owner SANTA ANA CITY COUNCIL Veerie Amezcua Benjamin Vazquez That Viet Phan Jessie Lopez Phil Bacerria Johnathan Ryan Hemandez David Penalaza Mayor Mayor Pro Tem-Ward 2 ward) Ward 9 Ward 4 Ward 5 Ward 6 vamezcua an -ana.o gy9Anlez9Wn6tWa.ora tohariftsanta-ana.cr® essiela a san -an _Oro cerra®santa-ana.am Iryanhemandep,C2santa-2naora daenabizalpsanta-anamro CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD1YYYY) 04112/2025 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 CONTACT NAME: Marsh Affinity PHONE 8007436130 FAX Marsh Affinity A1C,Na EXt: A1C No): a divisionof Marsh USA LLC. BOX14404 ADDRESS:PO BOX ADPTotalSource@marsh.com Des Molnes,IA 50306-9696 INSURER(S)AFFORDING COVERAGE NAIL# INSURER A: AIU insurance Company 19399 INSURED INSURER B: ADP TotalSource DE IV,Inc. INSURER C: 5800 Windward Parkway INSURER D' Alpharetta,GA 30005 LICIF: INSURER E: PACIFIC COAST CABLING,INC INSURER F: 20717 PRAIRIE ST Chatsworth,CA 913110000 COVERAGES CERTIFICATE NUMBER: 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 ADDLSUBR POLICY EFF POLIO XP LTR TYPEOFINSURANCE INSD WVD POLICY NUMBER (MM1DD IYYYY) (MMIDDfYYYY) LIMITS COMMERCIALGENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR PREMISES Ea occu ence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY jECT ❑LOG PRODUCTS-COMPIOP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS ONLY AUTOS � ( ) HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I RETENTION$ $ WORKERS COMPENSATION PER - AND EMPLOYERS'LIABI LITY YIN XISTATUTE ER ANYPROPRIETORfPARTNERJIXECUTIVE F.L.EACH ACCIDENT $ 2,000,000 OFFICEMMEMBER EXCLUDED? N 2025 NIA X WC 063633556 CA 0710112025 07/011 14 (Mandatory In NH) E,L,DISEASE-EA EMPLOYEE $ 2,000,000 f yes,describo under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 2,000,000 ? NglWlysigned Tu DESCRIPTION OF OPERATIONS I LOCATIONS[VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) bys—a Nguyen All worksite employees working for PACIFIC COAST CABLING,INC paid under ADP TOTALSOURCE,INC.'s payroll,are covered under the above stated policy.ProprietorlPartnerlExecutive OfficerlMember are N g u\fed oater2025.08.22 not excluded as IonrJ as they are In the ADPTS payroll or have completed the SO Participation 7 M2123 A7'00' Addendum.WAIVER OF SUBROGATION IN FAVOR OF The Clty of Santa Ana,its officers,employees,a ent%, volunteers and representatives AS RESPECTS OF JOB PERFORMED BY PACIFIC COAST CABLING,INC AS REQUIRED BY WRITTEN CONTRACT. APPROVED By Tu Tran Nguyen at 3�22�, CERTIFICATE HOLDER CANCELLATION City of Santa Ana Risk Management Division 20 Civic a, CA Plaza 4th Floor Santa SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Santa Ana,CA 9270Z THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25(2016103) O 1988-2016 ACORD CORPOFMIGN. All rights reserved. The ACORD name and logo are registered marks o(ACORD WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 43 03 06 Ed.4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-CALIFORNIA 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.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be_%of the California workers' compensation premium otherwise due on such remuneration. Schedule WAIVER OF SUBROGATION IN FAVOR OF The City of Santa Ana, its officers, employees, agents, volunteers and representatives AS RESPECTS OF JOB PERFORMED BY PACIFIC COAST CABLING, INC AS REQUIRED BY WRITTEN CONTRACT. Person or Organization City of Santa Ana Risk Management Division 20 Civic Center Plaza 4th Floor Santa Ana, CA 92702 UNITED STATES Job Description Notes: 1. This endorsement may be used to waive the company's right of subrogation against named third parties who may be responsible for an Injury. 2. The sentence in O is optional with the company. It limits the endorsement to apply to specific jobs of the insured,and only to the extent that the insured Is required to obtain this waiver. This endorsement changes the policy to which it is attached and Is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 07101/2025 Policy No.WC 063533556 CA Endorsement No. Insured Insurance Company AIU Insurance Company ADP TotalSource bE IV,Inc. 5800 Windward Parkway Alpharetta,GA 30005 LIC/F: PACIFIC COAST CABLING,INC 20717 PRAIRIE 5T Chatsworth,CA 913110000 Countersigned by ©1998 by the Workers'Compensation Insurance Rating Bureau of California.All rights reserved. From the WCIRB's California Workers'Compensation Insurance Forms Manual©2001. i