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HomeMy WebLinkAboutWRIGHT, NATHAN T (2)i %RANCE ON FVLF WORK MAY PROCEED UN11L I;�SU"r,NCE Exni„_-- MAYOR 10P�J��OZla-... Valerie Amezoua MAYOR PRO TEM DEC Q 3 2015 Benjamin Vazquez '- C{IUNCILNIEMgERS Phil Bacerra Johnathan Ryan Herrandea Jessie Lopez ©avid Penaloza Thai Viet Phan 0, PWA ( I) 9ob,uI ticfno, Mez (Dz) Nathan T. Wright 1709 Buffalo Rd. West Des Moines, lA 50265 CITY OF SANT"A ANA CITY MANAGER'S OFFICE, 20 Civic Center Plaza . PA. Box 1988 Santa Ana, California 92702 vmv.santa-ana.ora September 5, 2025 N-2024-379-01 CITY MANAGER Alvaro Wiez CITY ATTORNEY Sonia R. Carvalho CITY CLERK Jennifer L, Hall Re: Extension of Agreement with Nathan T. Wright to Provide Custom Illustration Services, Agreement ND.: N-2024-379 Pursuant to Section 3 ("Term") of the above -referenced Agreement, entered into by Nathan T, Wright and the City of Santa Ana, dated October 22, 2024, the time period of the Agreement is hereby extended for an additional one (])-year period tlu•ough October 31, 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, �olfo s, RE, Acting Executive Director, Public Works Agency CITY OF AANTA 7dvaro Nunez City Manager APPROVED AS TO FORM V e Nellesen Assistant City Attorney CONTRACTOR Nathan T. Wright SANTA ANA CITY COUNCIL Valoria Amezeue Benjamin Vazquez Thai Mal Phan Jeasle Lopez Phil Bacerra Johndfhen Ryan Hernandez David Pennloza Moyar Mayor Pro Tom - Ward 2 Ward Ward Word Words Ward ynmezcunrr�santaMW" Lwymg,�@saalk!aP_-ow tahnn 0551 PAbrlcerre(l Sul. -among ivanharriandez Lq laan"o slaenelola�sgLg-a�a.orq acoRbr CERTIFICATE OF LIABILITY INSURANCE DATE (MMro DNYYY) 11/1812025 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 Mike Brown A r SfafeFarm Mike Brown PONAHC No Ext : 515-264-2626 Fn c No): 'E-MAILSS mike. brown.eyyk@statefarm.com • = 1356 E Hickman Road INSURER(S) AFFORDING COVERAGE NAIC 4 INSURER A: State Farm Fire and Casualty Company 25143 Waukee IA 502638137 INSURED INSURER e NATHAN T WRIGHT ILLUSTRATION LLC INSURER C . 1709 BUFFALO RD INSURER D: INSURER E: WDM IA 502651 fi30 INSURER F : 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 LTR TYPE OF INSURANCE ADD INSD SUB WVD POLICY NUMBER POLICY EFF MMIDD1YYYY POLICY EXP MMIDD LIMITS X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F\/1 OCCUR - EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTS❑ PREMISES Ea occurrence $ 300,000 MED EXP (Any are person) $ 5,000 PERSONAL BADVINJURY $ 1,000,000 A Y Y 95-CP-L410-0 10/31/2025 10/31/2026 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRO- �l POLICY "I'll);/� LOC PRODUCTS-COMPIOP AGG $ 2,000.000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea ac ident $ BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS HIRED NON -OWNED Per accident $ AUTOS ONLY AUTOS ONLY $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR CLAIMS -MADE DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE Y f N OFFICER]MEMBER EXCLUDED? NIA PER OTH- E.L, EACH ACCIDENT $ E.L. DISEASE- EA EMPLOYE S (Mandatory in NH) If yes, describe under E.L. DISFASE - POLICY LIMIT g DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101, Additlonal Remarks Schedule, may be attached 1f more space is required) City of Santa Ana, its City Council, officers, officials, employees, agents, and volunteers are listed as blanket and scheduled additional insureds with waiver of subrogation on policy 95-CP-L410-0 TU Tran Di,ita"Ysi9ned by Tu Tran Nguyen Nguyen084359-08'009 APPROVED By Tu Tran Nguyen at 8:43 am, Nov 19, 2025 I.CK I11- 6A I C MULLJtK UANGI=LLA I IUN 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. Attn: PWA-Water Resources 220 S Daisy Ave AUTHORIZED REPRESENTATIVE Santa Ana CA 92703 This farm was system -generated on 1111812025 O 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD 1001486 2005 155279 205 01-19-2°23 State Farm Insurance PO Box 2915 Bloomington, IL 61702-2915 CITY OF SANTA ANA, ITS CITY CO ATTN: PWA-WATER RESOURCES 220 S DAISY AVE SANTA ANA CA 92703 Amended Declarations :• StateFarm State Farm fire and Casualty Company A stock company with home offices in Bloomington, Illinois Policy number: 95-CP-1-410-0 Effective date: November 13, 2025 Policy period:12 months Expiration date: October 31, 2026 The policy period begins and ends at 12:01 am standard time at the premises location, BUSINESSOWNERS POLICY Automatic renewal - If the State Farm® policy period is shown as 12 months, this policy will be renewed automatically subject to the premiums, rules and forms in effect for each succeeding policy period. If this policy is terminated, we will give you and the Mortgagee/Lienholder written notice in compliance with the policy provisions or as required by law. NAMED INSURED NATHAN T WRIGHT ILLUSTRATION L ENTITY Limited Liability Company POLICY PREMIUM This is not a bill. Jf an amount is due, then a separate statement will be sent prior to the due date. The premiums) shown below are for the policy period and policy characteristics as described in this Declarations. Increase in premium: $77.12 Discounts applied: Automatic Sprinkler Protection Protective Devices Years in Business REASONS FOR DECLARATIONS Business Experience Rating Renewal Discount Enclosed Building or Shopping Center Your policy is amended effective November 13, 2025 due to some recent policy changes you requested. Enclosed is a copy of your new endorsements, if any. Poiicy number: 95-CP-L410-0 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP Dec 3P IA CMP-4000 Page 1 of 5 1009482 2014 153090 214 05-17-2025 State Farm SECTION I - PROPERTY SCHEDULE Location Location of described premises Limit of Insurance* Limit of Insurance* Seasonal Increase - number Coverage A- Coverage B-Business Business Personal Property Buildings Personal Property 001 900 Keosauqua Way No Coverage $5,000 25% Ste 321 Des Moines IA 50309-1524 * As of the effective date of this policy, the Limit of Insurance as shown includes any increase in the limit due to Inflation Coverage. SECTION I — INFLATION COVERAGE INDEX(ES) Cov A - Inflation Coverage Index: N/A Cov B - Consumer Price Index: 324.8 SECTION I — DEDUCTIBLES BASIC DEDUCTIBLE $1,000 SPECIAL DEDUCTIBLES: Equipment Breakdown: $1,000 Money and Securities: $250 Other deductibles may apply - refer to policy. SECTION I — EXTENSIONS OF COVERAGE - LIMIT OF INSURANCE - EACH DESCRIBED PREMISES The coverages and corresponding limits shown below apply separately to each described premises shown in these Declarations, unless indicated by "See schedule". If a coverage does not have a corresponding limit shown below, but has "Included" indicated, refer to that policy provision for an explanation of that coverage. Coverage Limit of Insurance Accounts Receivable On Premises $10,000 Off Premises $5,000 Arson Reward $5,000 Collapse Included Damage to Non -owned Buildings from Theft, Burglary or Robbery Coverage B Limit Debris Removal 25% of covered loss Equipment Breakdown Included Fire Department Service Charge $2,500 Fire Extinguisher Systems Recharge Expense $5,000 Forgery or Alteration $10,000 Glass Expenses Included Increased Cost of Construction and Demolition Costs (applies only when buildings are insured on a replacement cost basis) 10% Policy number:95-CP-L410-0 Page 2 of 5 O Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-"00 A Staieharm Coverage Limit of Insurance Money Orders and Counterfeit Money $1,000 Money and Securities On Premises $5,000 Off Premises $2,000 Newly Acquired Business Personal Property (applies only If this policy provides Coverage B - Business $100,000 Personal Property) Newly Acquired ar Constructed Buildings (applies only if this policy provides Coverage A - Buildings) $250,000 Ordinance or Law - Equipment Coverage Included Outdoor Property $5,000 Personal Effects (applies only to those premises provided Coverage B - Business Personal Property) $2,500 Personal Property Off Premises $15,000 Pollutant Clean Up and Removal $10,000 Preservation of Property 30 days Property of Others (applies only to those premises provided Coverage B - Business Personal Property) $2,500 Signs $2,500 Valuable Papers and Records On Premises $10,000 Off Premises $5,000 Water Damage, Other Liquids, Powder or Molten Material Damage Included SECTION I — EXTENSIONS OF COVERAGE - LIMIT OF INSURANCE - PER POLICY The coverages and corresponding limits shown below are the most we will pay regardless of the number" of described premises shown in these Declarations. Coverage Limit of Insurance Loss of Income and Extra Expense 12 Months Actual Loss Sustained SECTION 11- LOCATION SCHEDULE Location Location of described premises number 001 900 Keosauqua Way Ste 321 Des Moines IA 50309-1524 Policy number; 95-CP-L410-0 Page 3 of 5 O Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4aao StateFarm SECTION II - LIABILITY Coverage Limit of Insurance Coverage L - Business Liability Per Occurrence $1,000,000 Coverage M - Medical Expenses $5,000 Any One Person Damage to Premises Rented to You $300,000 Aggregate Limits Limit of Insurance General Aggregate $2,000,000 Products/Completed Operations Aggregate $2,000,000 Each paid claim for Liability Coverage reduces the amount of insurance we provide during the applicable annual period. Please refer to Section II — Liability in the Coverage Form and any attached endorsements. Your policy consists of these Declarations, the BUSINESSOWNERS COVERAGE FORM shown below, and any other forms and endorsements that apply, including those shown below as well as those issued subsequent to the issuance of this policy. FORMS AND ENDORSEMENTS CMP-4100 Businessowners Coverage Form CMP4215.2 Amendatory Endorsement (Iowa) CMP-4532 Exclusion - Cyber Incident CMP-4536 Additional Insured - Owners, Lessees or Contractors (Scheduled) CMP-4561.5 Policy Endorsement CMP-4705.2 Loss of Income and Extra Expense CMP-4709 Money and Securities CMP-4785.1 Additional Insured - Owners, Lessees or Contractors (Blanket) CMP-4787 Waiver of Transfer of Rights of Recovery Against Others To Us CMP-4788 Additional Insured - Managers or Lessors of Premises FD-6007 Inland Marine Attaching Declarations FE-3650 Actual Cash Value Endorsement FE-6999.3 Policyholder Disclosure Notice of Terrorism Insurance Coverage 'New Form Attached SCHEDULE OF ADDITIONAL INTEREST(S) Interest type: owners, Lessees, or Contractors (Schedul Endorsement number: CMP-4536 Loan number: NIA City of Santa Ana, its City Council, officers, officials, employees, agents, and volunteers Attn: PWA-Water Resources 220 S Daisy Ave Santa Ana CA 92703 FULL NAMED INSURED Named Insured: NATHAN T WRIGHT ILLUSTRATION LLC Policy rumbor.95-CP-L410-0 O Copyright, State Farm Mutual Automobile Insurance Company, 2008 Page 4 of 5 CMP-4000 $tateFarm This policy is issued by the State Farm Fire and Casualty Company. PARTICIPATING POLICY You are entitled to participate in a distribution of the earnings of the company as determined by our Board of Directors In accordance with the Company's Articles of Incorporation, as amended. In Witness Whereof, the State Farm Fire and Casualty Company has caused this policy to be signed by its President and Secretary at Bloomington, Illinois. President Secretary Policy number; 95-CP-L410-4 ©Copyright, State Farm Mutual Automobile Insurance Company, 2008 Page 5 of 5 CM P-4000 State Farm Insurance PO Box 2915 Bloomington, IL 61702-2915 CITY OF SANTA ANA, ITS CITY CO ATTN: PWA-WATER RESOURCES 220 S DAISY AVE SANTA ANA CA 92703 StateFa►rm State Farm Fire and Casualty Company A stock company with home offices in Bloomington, Illinois Inland Marine Attaching Declarations Policy number: 95-CP-1-410-0 Effective date: November 13, 2025 Policy period: 12 months Expiration date: October 31, 2026 The policy period begins and ends at 12:01 am standard time at the premises location. ATTACHING INLAND MARINE Automatic renewal - If the State Farm® policy period is shown as 12 months, this policy will be renewed automatically subject to the premiums, rules and forms in effect for each succeeding policy period. If this policy is terminated, we will give you and the Mortgagee/Lienholder written notice in compliance with the policy provisions or as required by law. Annual policy premium: Included The above premium amount is included in the Policy Premium shown on the Declarations. FULL NAMED INSURED Named Insured: NATHAN T WRIGHT ILLUSTRATION LLC Your policy consists of these Declarations, the INLAND MARINE CONDITIONS shown below, and any other forms and endorsements that apply, including those shown below as well as those issued subsequent to the issuance of this policy. FORMS, OPTIONS AND ENDORSEMENTS FE-1401 Exclusion - Cyber Incident FE-8739 Inland Marine Conditions FE•8743.1 Inland Marine Computer Property Form See below for schedule page with limits ATTACHING INLAND MARINE SCHEDULE PAGE Endorsement Coverage number Limit of insurance Deductible amount Annual premium FE-8743.1 Inland Marine Computer Property Form $25,000 $500 Inclided Loss of Income and Extra Expense $25,000 Included Other limits and exclusions may apply - refer to your policy. Poiicy number: 95-CP-L410-0 O Copyright, State Farm Mutual Automobile Insurance Company, 2008 DIM Alt Dec 3P IA FD-6007 Page 1 of 1 1009481 2002 153089 202 03-06-2021 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED — OWNERS, LESSEES, OR CONTRACTORS (Scheduled) This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number: 95-CP-L410-0 Named Insured; NATHAN T WRIGHT ILLUSTRATION LLC Name And Address Of Additional Insured Person Or Organization: City of Santa Ana, its City Council, officers, officials, employees, agents, and volunteers Attn: PWA-Water Resources 220 S Daisy Ave Santa Ana CA 92703 SECTION II — WHO IS AN INSURED of SECTION II — LIABILITY is amended to include, as an additional insured, any person or organization shown in the Schedule, but only with respect to liability for "bodily injury", "property damage", or "personal and advertising injury" caused, in whole or in part, by: a. Ongoing Operations (1) Your acts or omissions; or (2) The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for that additional insured; or CMP-4536 Page 1 of 1 b. Products -Completed Operations "Your work" performed for that additional insured and included in the "products -completed operations hazard". 2. Any insurance provided to the additional insured shall only apply with respect to a claim made or a "suit" brought for damages for which you are provided coverage. 3. Primary Insurance. The insurance afforded the additional insured shall be primary insurance. Any insurance carried by the additional insured shall be noncontributory with respect to coverage provided by you. All other policy provisions apply. CMP-4536 154972 03-20-2019 ©, Copyright, State Farm Mutual Automobile Insurance Company, 2018 Includes copyrighted material of Insurance Services Office, Inc., with its permission. CMP-4787 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number: 95-CP-L410-0 Named Insured: NATHAN T WRIGHT ILLUSTRATION LLC Name And Address Of Person Or Organization: City of Santa Ana, its City Council, officers, officials, employees, agents, and volunteers Attn: PWA-Water Resources 220 S Daisy Ave Santa Ana CA 92703 The following is added to Paragraph 10,b. of SECTION I AND SECTION II — COMMON POLICY CONDITIONS: We waive any right of recovery we may have against the person or organization shown in the Schedule because of payments we make for injury or damage arising out of: a. Your ongoing operations; or b. "Your work' done under 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. All other policy provisions apply. CMP-4787 151576 06-22-2017 ©, Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. CITY OF SANTA ANA Risk Management a division of Human Resources Managing Risk through Awareness and Action AFFIDAVIT OF EXEMPTION FOR AUTOMOBILE LIABILITY INSURANCE I Nathan Wright ("Representative'), attest that I am an authorized (Name and Title of Vendor Representative) representative of Nathan T Wright Illustration p ("Company"), and (Consnitam/Company Name) possess the authority to legally bind Company. In my capacity as Representative of Company, I represent and confirm the following, as relates to the agreement between Company and City of Santa Ana, agreement number N-2024-379 ("Agreement") to provide illustration, art and animation services C'Services"): (services to be provided tinder agreement/contract) During the course and scope of Company's agreement with the City of Santa Ana, Company employees, consultants, representatives, and agents will not use and/or drive any Company owned/rented/leased/borrowed vehicles to perform Services to, for, or on behalf of City of Santa Ana. If at any time it is found that Company is not adhering to any and/or all of the statements in this document and does not maintain the minimum automobile liability insurance coverage as required in the Agreement, it will be considered a breach of Agreement rendering the Agreement null and void and Company will be fully liable for any and all damages. 10/7/2025 Signature Date Nathan Wright Name Illustrator 515-554-0502 / nathanTwright@gmail.com Contact Information, i.e, Telephone Number and/or Email Affidavit of Exemption for Automobile Liability Insurance 11.12.2024 CITY OF SANTA ANA Risk Management a division of Human Resources Managing Risk through Awareness and Action AFFIDAVIT OF EXEMPTION FOR WORKERS' COMPENSATION INSURANCE Nathan Wright I, ("Representative"), attest that I am an authorized (Name and Title of Vendor Representative) representative of Nathan T Wright Illustration LLC (Consultant/Company Name) possess the authority to legally bind Company. ("Company'), and In my capacity as Representative of Company, I represent and confirm the following, as relates to the agreement between Company and City of Santa Ana, agreement number N-2024-379 ("Agreement") to provide illustration, art and animation services ("Services"): (Services to be provided under agreement/contract) During the course and scope of Company's agreement with the City of Santa Ana, Company wilt not employ any person many manner so as to become subject to the workers' compensation laws of California, and agree that if Company should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, Company shall forthwith comply with the provisions and provide proof of workers' compensation coverage immediately. If at any time it is found that Company is not adhering to any and/or all of the statements in this document and does not maintain the minimum workers' compensation insurance coverage as required in the Agreement, it will be considered a breach of Agreement rendering the Agreement null and void and Company will be fully liable for any and all damages. 10/7/2025 Nathan T Wright Illustrator 515-554-0502 / nathanTwright@gmail.com Coninct Information, i.e., Telephone Number midlor Einail Address WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSANT DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. Affidavit of Exemption for Workers' Compensation Insurance 11.12.2024