HomeMy WebLinkAboutESSERGY 1A-2010liiiSURANCE ON - . E
WORK MAY ?RO{: H
UNPL ID'S
,??`? 11LERK OF COUNT _ AMENDMENT TO AGREEMENT UNDER
DATF (0-6- 10 THE WORKFORCE INVESTMENT ACT
(AMERICAN RECOVERY AND REINVESTMENT ACT OF 2009)
A-2010-026-01
THIS AMENDMENT, made and entered into thi&day of September, 2010, by and between Essergy
Consulting ("Contractor") and the City of Santa Ana, a charter city and municipal corporation duly organized and
existing under the Constitution and laws of the State of California ("City").
RECITALS
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A. The City and Contractor entered into that certain Agreement Under the Workforce Investment Act
(American Recovery and Reinvestment Act of 2009) effective February 1, 2010 (Agreement #A-2010-026),
hereinafter referred to as "said Agreement".
B. The parties hereto now desire to amend Exhibit F which is attached to said Agreement, in order to update and
clarify Contractor's Budget and Budget Narrative.
WHEREFORE, in consideration of the mutual and respective covenants and promises hereinafter contained and
made, and subject to all of the terms and conditions of said Agreement as hereby amended, the parties hereto do
hereby agree as follows:
1. Exhibit F to said Agreement is hereby replaced with the amended Exhibit F, attached hereto and
incorporated herein by reference. The amount of City's Obligation remains as stated in said Agreement.
2. Except as hereinabove modified, the terms and conditions of said Agreement remain unchanged and in
full force and effect.
IN WITNESS WHEREOF, the parties hereto have executed this Amendment to said Agreement the date and
year first above written.
ATTEST:
l??u; yam. ?T
Maria D. Huizar
Clerk of the Council
APPROVED AS TO FORM:
Joseph W. Fletcher
City Attorney
BY: a-
Lisa E, torck
Assistant City Attorney
CITY OF SANTA ANA, a municipal
corporation of the State of California
"CITY"
By: / I----? _
David N. Ream
City Manager
"CONTRACTOR"
1
BY:`
Name: Dr. Phi5KBorden
Title: Principal
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Policy Number:
Date Entered: 10/6/2010
'`' ° CERTIFICATE OF LIABILITY INSURANCE DATE
0
1 IDDI
1
1
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(les) 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 Adams Avenue Insurance A
enc NAME:
g
y
License # 0756665 PHONE (877) 250-8397 Fe
r Ne. (866) 832--4186
(AIG, NQ,
Ell),
9114
d
# E
MAIL
@AdamsAveIns.com
AODR S
A
ams Ave,
144 PRODUCER
M RIO M:
CUSTO
Huntington Beach, CA 92646
INSURER(S) AFFORDING COVERAGE NAICB
INSURED
G INSURERA: Sequoia Insurance Company A
WRJ-
T LLC, dba 1Essergy Consulting
INSURERB:United States Liability Insurance Co
Jill Dominguez INSURER C :
235 E Broadway #520
h INSURER D :
Long Beac
, CA 90802
INSURER E
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
6Y TH POUIOES RI EIN IS E 7 T ALL THE AN N ITIONS OF H POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
ILTR
TYPE OF INSURANCE
ADDL
SUER
POLICY NUMBER
POLICY EFF
(MMI()D)YYYYI
POLICY EXP
IMWDDIYYYYI .
LIMI S
GENERAL LIABILITY EACHOCCURRENCE S1.0001000
A I COMMERCIAL GENERAL LIABILITY X
SBP212192-3 9/1/2010 9/1 011 PREMISES Ea«axrence S 300 000
CLAIMS-MADE I>< OCCUR o t+ L MED EXP An one erson $ 10,000
T PERSONALSADVINJURY S Included
?p GENERAL AGGREGATE $ 2 000 000
= La
GEN'LAGGREGATE LIMIT APPLIES PER:
-
- PRODUCTS-COMPr'OP AGG $2 000 000
1 POLICY PR0. LOC
1 F $
A AUT OMOBILE LIABILITY
ANYAUTO
X
Assistant t At 0
IY COMBINED SINGLE LIMIT
(Ea acGdenq
$1,000,000
ALL OWNED AUTOS '12 BODILY INJURY (Per person) S
SCHEDULEDAUTOS " BODI LY ]NJ URY(Per accident S
PROPERTY DAMAGE -
$
HIREDAUTOS SBP21219201 9/1/2010 9/1/2011 (Peraccidem)
NON-OWNEDAtrrOS SBP21219201 9/1/2010 9/1/2011
-
UMBRELLA LIAR
F I OCCUR EACHOCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DEDUCTIBLE
$
RETENTION $ S
WORKERS COMPENSATION WC STATU- OTH-
ANOEMPLOYERS' LIABILITY YIN
ANY PROPRIETORIPARTNERIEXECUTIVE
OFFICER/MEMBER EXCLUDED?
NIA E.L. EACH ACCIDENT S
(Mandatory In NH)
Ilyes, desenbe under E.L DISEASE- EA IIIr1PLOYEE $
DESCRIPTION OF OPERATIONS be?a>r E.L DISEASE-POLICY LIMIT 5
B Professional SP1018037 7/13/2010 7/13/2011 Each Claim 1,000,000
Liability Aggregate 1,000,000
DESCRIPTION OF OPERATIONSI LOCATIONS I VEHICLES (Attach ACORO 101, Additional Remarks Schedule, If more space Is required)
Certificate holder is additional insured, see attached
CERTIFICATE HOLDER CANCELLATION
City of Santa Ana SHOULD ANY F THE ABOVE DESCRIBED POLIC IES arz A EL ED 13EFORE
20 Civic Center Plaza THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
Santa Ana, CA 92702 AUTHORIZED REPRESENTATIVE - + QffX?-re_
v 7988.2009 ACORD CORPORATION. All rights reserved.
ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD
ProducedusingForms BassPlussoftware,www.FormsBoss.conr nipressivePuNisHng800-2OB-Sg77
Declaration Number: 001
Effective Date: 09/01/2010
Page 81
Policy Number: SBP212192-3
WRJ-GT, LLC
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES
OR CONTRACTORS
This endorsement modifies insurance provided under the following:
BUSINESSOWNERS COVERAGE FORM
SCHEDULE*
Name of Person or Organization:
City of Santa Ana
20 Civic Center Plaza
Santa Ana, CA 92702
* Information required to complete this Schedule, if not shown on this endorsement, will be shown in the
Declarations.
The following is added to Paragraph C. Who is an
Insured in Section II - Liability:
4. Any person or organization shown in the
Schedule is also an insured, but only with
respect to liability arising out of your ongoing
operations performed for that insured.
App ®En "S TO qR
L1SA S-'ORCK
City Attorney
Assistant
,3 I)-_
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