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HomeMy WebLinkAboutANGUIANO LAWN CARE INC. (2) INSURANCE r,)N FILE � N-2025-168-01 WORK MAY'rr"I"! r[4 MAYOR UNIft a CITY MANAGER Valerie Amezcua i Alvaro Nunez MAYOR PRO TEM -;,yt�+ CITY ATTORNEY Benjamin Vazquez 91T� _`"r - Sonia R.Carvalho COUNCILMEMSERS � I Phil Bacerra NOV � 5 2g25 clry cl_�Rst p 4 Jennifer L-Hall Johnathan Ryan Hernandez Jessie Lopez David Penaloza Thai Viet Phan CITY OF SANTA ANA Huyit� G i 4(0 (Dx) PUBLIC WORKS AGENCY 20 Civic Center Plaza a P.O.Box 1988 Santa Ana,California 92702 wwW.santa-ana.ora October 20,2025 Anguiano Lawn Care, Inc. Attn:Gregg Kessler PO Box 2849 Seal Beach,CA 90740 Re: Extension to License and Right of Entry Agreement(#N-2025-158)— 1725 N. Bristol St., Santa Ana,California Dear Mr.Kessler, Pursuant the terms of the above referenced Agreement entered into between Anguiano Lawn Care,Inc. and the City of Santa Ana, dated June 5, 2025, the parties hereby agree to extend the term of the Agreement through December 2,2025.All other terms and conditions of the Agreement remain unchanged and in full force and effect. Sin odolf ,P.E. Acting Executive Director Pf Public Works Agency CITY OF S A ANA ATTEST Alvaro Nunez en ' Hall City Manager City CI r APPROVED AS TO FORM ANGUI AN LAWN CARE s - Kyle Nellesen Gregg Kessler Assistant City Attorney President SANTA ANA CITY COUNCIL Valerie Am-- Benpmin Veygaez Thai Viet Phan Jessie Loper Phil Bamra Johnalhan Ryan Hemande David Pe aioza Mayor Mayor Pro Tens-Ward 2 Ward 1 Ward 8 Ward 4 Ward 5 Ward 6 vamamahTl9anl qa am byaZouez6bSanta.na.am 4hant6laartta-ana am jeeS�ClppeZ�T58nla-ana.era Rba Cef[a. �n�l -arta_drA irv®nhemandeZf�sanla-ana ora dpynalcmaganto-ana orF1 �►coR©® CERTIFICATE OF LIABILITY INSURANCE r (MMiDDIYYYY)aTE 10/14/2025 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 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 NAME: Brandon Dempster JVRC Insurance Services PHONE. No,Ext: 81 873 5 7600 C. No): 818-69B-6401 5707 Corsa Ave ADDRESS: services@jvrcinsurance.com Ste 105 INSURER(S)AFFORDING COVERAGE NAIC p Westlake Village CA 91362 INSURER A: Ategrity Specialty Insurance Company 16427 INSURED INSURER B: Omaha National Casualty Company 32107 Anguiano Lawn Care Inc INSURER C PO Box 2849 INSURER D INSURER E Seal Beach CA 90740 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW NAVE 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 INSD WVD POLICY NUMBER (MMlDDlYYYY) (MMIDDM'YY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 �OCCUR PREMISES REMISES(Ea occurrence) $ 100,000 MED EXP(Any one person) $ 5,000 A Y Y 01-C-PK-P20084995-02 08/25/2025 08/25/2026 PERSONAL BADVINJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICYLIII� JEt° LOC PRODUCTS-COMPlOPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMUINLU $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY Per accident AUTOS AUTOS ( ) $ PROPERTY DAMAG17- HIRED AUTOS NON-OWNED AUTOS (Peraccidenl) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X STATUTE ER AND EMPLOYERS'LIABILITY Y I N ANY PROPRIETORlPARTNERIEXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 B OFFICERIMEMBEREXCLUDED? NIA Y ONCC11838-05 09/29/2025 09/29/2026 If In NH)and E.L.DISEASE-EA EMPLOYE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS r LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) City of Santa Ana,its City Council,officers,officials,employees,agents,and Volunteers are named as additional insureds With respect to the general Digitallysi ed liability policy.Waiver of subrogation applies with respect to the general liability and workers'compensation policies. TU Tran by T.Tran Nguyen Nguyen Date:zaz5 0.17 I Q45:57-0'00' APPROVED CERTIFICATE HOLDER CANCELLATION By Tu Tran Nguyen at 10.44 am,Oct 17,2025 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS. Attention: CIP Engineering AUTHORIZED REPRESENTATIVE 20 Civic Center Plaza,M-36 Santa Ana CA 92701 �t� /� O 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD AC®a CERTIFICATE OF LIABILITY INSURANCE DATE[MMlil01Y YYI 10/15/2025 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 Keegan Ferraro FAX SfafeFarm Keegan Ferraro PHONE Ext: 562-431-3933 lAfC No: •cm) 7923 Warner Ave Suite A EMAIL - keegan.ferraro.vaavhh@statefarm-eom INSLIRER(S)AFFORDING COVERAGE NAIC# Huntington Beach CA 92647 INSURERA: State Farm Mutual Automobile Insurance Company 25178 INSURED INSURER B: Anguiano,Juan INSURER C: PO BOX 2849 INSURER D: INSURER E: SEALBEACH CA 907401849 INSURERF: 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. NSR ADD SUB POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDDIYYYY MMIDDf= LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE s DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISFS(Ea occurrence S MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENT AGGREGATE LIMIT APPLIES PER; GENERAL AGGREGATE $ PRO- POLICY JECT F7 LOG PRODUCTS-COMPICP AGG $ OTHER, $ AUTOMOBILE LIABILITY COMRINFO SINGLE LIMIT 648 9314-FO6-75A 06/06/2025 12/06/2025 Fa accident s 1,000,000 ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED 4 AUTOS ONLY AUTos N N 648 2854-1706-75A 06/06/2025 12/06/2025 BODILY INJURY(Per accident) $ HIRED NON-OWNED AUTOS ONLY AUTOS ONLY Per accident $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE g DED I I RETENTION $ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY $ ANY PROPRIETOR/PARTNERIEXECUTIVE Y f N OFFICERIMEMBER EXCLUDED? NIA E.L.EACH ACCIDENT $ (Mandatory In NHI E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS f VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached If more space is requlredl City of Santa Ana, its City Council,officers,officials,employees,agents,and volunteers are named as additional insureds with respect to the general liability policy.Waiver of subrogation applies with respect to the general liability and workers'compensation policies, APPROVED BY Tu Tran NB�Y�r at iF:44 am,Oct 17,2025 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Santa Ana Attm CIP Engineering ACCORDANCE WITH THE POLICY PROVISIONS. 20 Civic Center Plaza,M-36 AUTHORIZED REPRESENTATIVE Santa Ana CA 92701 This form was system-generated on 10/15/2025 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD 1001486 2005 155279 205 01-19-2023 COMMERCIAL GENERAL LIABILITY CG 20 33 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY" ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II-Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured any person or additional insureds,the following additional organization for whom you are performing exclusions apply: operations when you and such person or This insurance does not apply to: organization have agreed in writing in a contract or agreement that such person or organization be 1. "Bodily injury", "property damage"or"personal added as an additional insured on your policy. and advertising injury"arising out of the Such person or organization is an additional rendering of,or the failure to render, any insured only with respect to liability for"bodily professional architectural, engineering or injury", "property damage"or"personal and surveying services, including: advertising injury" caused, in whole or in part,by: a. The preparing,approving, or failing to 1. Your acts or omissions; or prepare or approve, maps, shop drawings, 2. The acts or omissions of those acting an your opinions, reports, surveys,field orders, change orders or drawings and behalf; specifications; or in the performance of your ongoing operations for b. Supervisory, inspection,architectural or the additional insured. engineering activities. However, the insurance afforded to such additional This exclusion applies even if the claims against Insured: any insured allege negligence or other wrongdoing 1. Only applies to the extent permitted by law; in the supervision, hiring, employment, training or and monitoring of others by that insured, if the 2. Will not be broader than that which you are "occurrence" which caused the "bodily injury" or required by the contract or agreement to "property damage", or the offense which caused provide for such additional insured. the "personal and advertising injury", involved the rendering of or the failure to render any A person's or organization's status as an additional professional architectural, engineering or insured under this endorsement ends when your surveying services. operations for that additional insured are completed. CG 20 33 04 130 Insurance Services Office, Inc., 2012 CG 20 33 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 2 2. "Bodily injury" or"property damage"occurring C. With respect to the insurance afforded to these after: additional insureds,the following is added to a. All work, including materials, parts or Section H[-Limits Of Insurance: equipment furnished in connection with The most we will pay on behalf of the additional such work, on the project(other than insured is the amount of insurance: service, maintenance or repairs)to be 1. Required by the contract or agreement you performed by or on behalf of the additional have entered into with the additional insured; insured(s) at the location of the covered or operations has been completed; or 2. Available under the applicable Limits of b. That portion of"your work" out of which the Insurance shown in the Declarations; injury or damage arises has been put to its whichever is less, intended use by any person or organization other than another contractor or This endorsement shall not Increase the applicable subcontractor engaged in performing Limits of Insurance shown in the Declarations, operations for a principal as a part of the same project. CG 20 33 04 13 0 Insurance Services Office, Inc., 2012 Page 2of 2 POLICY NUMBER:0I-C-PK-P20084995-02 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: Any person or organization with whom the insured has agreed to waive rights of recovery, provided such agreement is made in writing and prior to the loss Information required to com lete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV- Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products- completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 0 Insurance Services Office, Inc.,2008 Page I of 1 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC ON 04 WS A (Ed.01-19) 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. Blanket Waiver:The additional premium for this endorsement shall be 2%of the California workers'compensation premium otherwise due on such remuneration. Specific Waiver:The additional premium for this endorsement shall be 5%of the California workers'compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description Blanket Waiver of Subrogation As respects to all CA jobs performed by the named insured during the policy period where by written contract a waiver of subrogation is required prior to the commencement of work. 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 09/29/2025 Policy No. ONCC11838-05 Endorsement No. Insured Insurance Company Omaha National Casualty Company Anguiano Lawn Care, Inc. Countersigned By _ � f� 6196AA WAIVER OF SUBROGATION UNDER THE LIABILITY COVERAGE This endorsement is a part of the policy. Except for the changes this endorsement makes, all other provisions of the policy remain the same and apply to this endorsement. It is agreed that we have no right of subrogation under Liability Coverage against the person or or- ganization whose name is shown immediately following the title of this endorsement on the Decla- rations Page to the extent that you have waived your legal right to recover from that person or organization pursuant to a written contract you had duly executed with that person or organization prior to the accident or loss. Person/Organization:"City of Santa Ana, its City Council,officers,officials,employees,agents,and volunteers" Page 1 of 1 6196AA ©,Copyright,State Farm Mutual Automobile Insurance Company,2013 6028-BU Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. 6028BU ADDITIONAL INSURED(Prior Notice of Termination) This endorsement modifies insurance provided under the following: AUTOMOBILE INSURANCE COVERAGE FORM SCHEDULE POLICY NUMBER: 648 9314-1`06-75A&648 2854-F06-75A NAMED INSURED: Anguiano,Juan DBAAnguiano Lawn Care PO BOX 2849 Seal Beach,CA 90740 Name and Address of Additional Insured Person or Organization: City Of Santa Ana Attention:CIP Engineering 20 Civic Center Plaza,M-36 Santa Ana,Ca 92701 "City of Santa Ana, its City Council,officers,officials, employees,agents,and volunteers" This endorsement is a part of the policy. Except for the changes this endorsement makes, all other provisions of the policy remain the same and apply to this endorsement. 1.A person or organization shown on the Declarations Page as an Additional Insured is provided Liability Coverage, but only to the extent that person or organization qualifies as an insured as defined in Liability Coverage. 2. An Additional Insured has the same right of recovery under Liability Coverage as if they had not been shown on the Declarations Page as an Additional Insured. 3.If Liability Coverage is changed or terminated as to the interest of the Additional Insured,unless another number of days notice is shown on the Declarations Page, we will provide the Additional Insured: a. 10 days notice of such change or termination if the policy is nonrenewed or the cancellation is for nonpayment of premium; and b.20 days notice of such change or termination if the cancellation is for any reason other than All other policy provisions apply. 6028-BU CO,Copyright,State Farm Mutual Automobile Insurance Company,2008 includes copyrighted material of Insurance Services Office, Inc.,with its permission