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HomeMy WebLinkAboutRUEVAC PROPERTY SERVICES (2) -2011City of Santt- ,Ana Clerk of the Council AGREEMENT TERMINATION FORM Please complete this form in its entirety when the attached agreement and all amendments (if any) are no longer in effect. Note: If your agreement is grant related, please ensure that all grant retention requirements have been satisfied prior to signing the termination form. Is the agreement(s) a permanent record? Yes _ No Return form to the Clerk of the Council Office (M-30). Call 647-1520 if you have any questions. The agreement with l ff t V No. A - 20 )Sr I vrr 7 was completed on (iis€a!1amend ments. Use space below Mneeded.) Department: Phone/Ext.: Signature: Date: i:{806mensVarWOm - agmememtarminallon fOM _galdsrad,doa COTC Office Use OnN and final payment has been made. d 4 GC 6 FIRST AMENDMENT TO AGREEMENT A- 2011- 011 -01 THIS FIRST AMENDMENT TO AGREEMENT is entered into on December 15, 2011, by and between RUE VAC PROPERTY SERVICES, INC., a California corporation ( "Consultant ") and the City of Santa Ana, a charter city and municipal corporation organized and existing under the Constitution and laws of the State of California ( "City "). RECITALS: A. The parties entered into Agreement A- 2011 -01 1, dated January 4, 2011, (hereinafter "said Agreement ") by which Consultant has provided power sweeping services. B. In accordance with the terms and conditions of said Agreement, the parties wish to exercise the first of two extension options to extend the term for an additional twelve -month period. 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 First Amendment to Agreement, the parties agree as follows: 1. Pursuant to Section 3, TERM, the parties hereby exercise the first option, to extend the term of said Agreement through December 31, 2012. 2. Except as hereinabove amended, all terms and conditions of said Agreement shall remain in full force and effect. IN WITNESS WHEREOF, the parties hereto have executed this First Amendment to Agreement on the date and year first written above. ATTEST: MARIA D. HUIZAR Clerk of the Council APPROVED AS TO FORM: By: La Assistant City Attorney RECOMMENDED FOR APPROVAL: RA L GODINEZ, q Executive Director WA CITY OF SANTA ANA PAUL M. WALTERS Interim City Manager RUE VAC PROPERTY SERVICES, INC. KATHLEEN PACKER C.F.O. ,acoRo CERTIFICATE OF LIABILITY INSURANCE DATE IM""I°°"'"'I 3/1/2012 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 terns 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 SPIB Insurance Agency, Inc. License Number 0719264 26441 Crown Valley Parkway #200 Mission Viejo CA 92691 - CONTACT Amy Alberding PHONE (949)T582 -5220. FA (949)582 -3312 AMESS:amy8spib..COm RODUCERI 00000369 INSURER(S) AFFORDING COVERAGE - NAIC8 FRED Rue Vac Property Services Inc 600 W. Taft Avenue �Q a ©!! I /) _ D/ . Orange CA 92865 J� INSURERA:Peerless Insurance Co 24198 ' GE INsURERB:The Netherlands Insurance Co 24171 GE INSURER c :Golden Eagle Insurance" Corp. 10836 INSURER D: EACH OCCURRENCE INSURER E INSURER F: 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 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPEOFINSURANCE POLICY NUMBER WD EFF MMYEXP- IY LIMITS GENERAL LIABWTY EACH OCCURRENCE $ 1'000,000 X COMMERCIAL GENERAL LIABILITY PREMI�adcurrence $ 100,000 A CLAIMS-MADE a OCCUR =9558563 /1/2012 /1/2013 MED EXP (Any one person ) $ PERSONAL S:ADVINJURY S 1,000,000 - - _ -- GENERAL AGGREGATE '$ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - CONIMP AGG $ 2,000,000 X POLICY PRD LOC $ AUTOMOBILE LIABILITY COMBINED.3INGLE LIMIT $ 1, 000 000 XANY AUTO (Ea accident) , BODILY INJURY (Per parser) $ B ALL OWNED AUTOS 79.7086 ./l/2012 /1/2013 BODILY INJURY (Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE X HIRED AUTOS (Per acadent) $ X NON-OWNED AUTOS - Underinsured motwst property S Medical payments $ - C UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 1,000,000 X EXCESS LIAB CLAIMS-MADE U9558863 AGGREGATE S 1,000,000 DEDUCTIBLE S RETENTION S /1/2012 /1/2013 $ WORKERS COMPENSATION - tM1IC STATU- OTH- AND EMPLOYERS LIABILITY YIN E.L. EACH ACCIDENT $ ANY PROPRDFrCRJPARTNER/EXECUTNE OFFICERIMEMBER EXCLUDED? NIA EE SCIF CERT - (Mandatory in N U yyeess descrbe Und i nd er D IPTION OF OPERATIONS beiwi E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY UMrr $ A PROPERTY SPECIAL FORM , =W9558563 /1/2012 /1/2013 BUILDING 3.,2.48,480 REPL COST $1000 DED BUS PERSONAL PROPERTY 104,000 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, it more space is required) RE: SANTA ANA REGIONAL TRANSPORTATION CENTER, 1000 S. SANTA ANA BLVD., SANTA ANA, CA. - TEE CITY OF SANTA ANA, ITS OFFICERS, EMPLOYEES, AGENTS, _VOLUNTEERS AND RESPRESENTATIVES ARE NAMED AS ADDITIONAL INSUREDS WITH RESPECT TO GENERAL LIABILITY AS PER COMPANY FORM GECG 602 (09/04) SECTION V, A 6 B. PRnOM AND NON - CONTRIBUTORY WORDING I3 PROVIDED IN FORM # 22 -111 01/07. ✓ SHO=ANY OF THE ABOVE: DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOp, NOTICE WILL BE DELIY£RED IN THE CITY OF SANTA812ii1 ,`+;:Lt i,e�cy ACCORDANCEVVITHTHEPOLICYPROVISIONS. 20 CIVIC CENTER PLAZAP, tS15Ec ^OC �i,ii.Y !'�tTGiT',ne3' SANTA ANA, CA 92701 AUTHORIZED REPRESENTATIVE Hines, CPCU ARM CIM '� y Amnon os: iannmmn, --� lJ- I`Jaa -LYuV AUUK1) UUKPOKATION. All rights reserved. INS026 ( ma The ACORD name and logo are registered rks of ACORD V104W W''p-MENT-04AW V5PQUO'"Y,,Pl't-A Thl&endommeri madfRes-lawma prw ulader -L 'M SEGMW "ONERA �A a ka v. pmreo*$� W- . " -- Oaoh m , tit 4t a w tees gs;. QOM M rA-'MEDlGAUPAYWNw TAW a, $41kWtfor v p WOM rvrlf " radut Ball rtr i p se ' ' mWiFe : i 3MV � of o p,� #. . + ![ ofri iips ;spa POP .01 VNIR la: Thor" Gt- iseg no iif'isafiio a we Mae, a 't . wwd I :Waded to,-sus: dW iw WDvw.pe ed.. kD b� co"bai r asa k 0*00o Pr ice; sl * ?nS ,d m mg PSI tip d Air masomme Mwfmd Im N at uw uwpusf-k asAst. usla, "m T arrrw aF�#aataF'`r�i�'�rti3 i ! ark fry= ikc�rk:. _ AMM U- M" All INWWP ::= I t st F�f K' � tt t '� cf g POOR quw 40 o Nam lohv if': 0 wow, % !cRa w t3�s °ixlitrra,ai€}tid t�z[le ►T X11- f Ilie S., 0"Mq,�Od OAW m*r"W . jW r-40V A *,mug'as Wow- OT PWW 40 to VXMISSA "Oft M aw: 1,10 Im"llemp.0 WSW % ,w Mo. .lo f 6 wea �m TJW. SMOW4 Aowl RI.&M, Dadam"00'a'". t VOW.M.110, , �im,l JW P-44" _wftosgr4po more te t 4aw44 KOO- ;*Optw*r.i-i�hkwowp"To��"gmdontc,o�*sjmo-n.00.m-*b-l-test-o,vld =ao. ?hie amp dr> m w w w*- I ao, m--; ow, Old WCUIN. 4.14 Stapes , fit_ ,dwTAWp. OAVAIO. � ...... �01.`_* W, I b_p~ - is nazow --& lls 0. Taul tomp3m*T, Gorviod. 16tm of Darw., or nwmar& by,ytw, wndav a A vz# 4.9 W-Owl WA-WIM' 9. klolo*ila dt- ow"V W.-Wage wow fh*�P"Ms A* . W"kw4as -*th it affi4Lt" wft T' Aft. W& ft, Ift Mgll* out w4u* w:u� %M b G—Wo w rVWn r ww"m !" wn* 4kum ftaftd"A-an llt we addq& 14. awqkilgcy 0904000 tr, wfftO htft of 4iOWNWtO W� lMwW'i0Mm:% 4 conwilacm 0, ars bir rye cif t6 400"o V.- M-MMVMN* 4- A gigtWO.U. o NOWe4f SAT ipm" OU i*��: W,. amiop by Ark dvo, A -rL *kWer bto� e -b PWO&OS, mwe Abd hp yea to you- ar - 1plwiwk len mpq mm wo P W.W. or �Wwfft h4f"- WIN TOM&T 00040k OWWWWOW OMOWOM 41M ith�� can bi5, 0 10 46NOWOW. r 004pag NOW - 0. M. k vow immov 4pamiamwiptav .l - W--'Torllot Iait $g 0.0 �ias an MMMd andmIM& Oes- UP in Or This ma n kdom not apply. *4110f. ,hp$ 0 009 4) At A 4. "so Og w0*0 fm-perq.WMqW bi 16%adl*, fi� P,"�- e , *vy',ar#`,,qr.s darnag acowni-spa.fier, -AE -wbm Ot*g* ke: vNeg'W"a ''1d -0 OR 0, Or WATO.W. O*M"5,1*4ww Uato Qtfl ww;4A*WfttO 'Taf p©r -,hkh the .jury jury arLmshaeliam! tailorwnded h rdon-afNvurvmW:sr-A.3&fw k PEA NOS."WIM ftl u. 6 wm—.. f -11~0--gayemi . ft 0 NO low, rov-p dam} i RO, mim_ m6oftAwym. ge" Dow wo )vopertj dmnage or �,j* amw w Y-Oqw,-t*z 44142. YMT I W -WO R� O.M.-I ON* .0 - -a I I a MIKW �.qfi ifm -led" W a sepias l all : imail4*= arldimifts part "TRP;Z under IF"CU-Sm-WHO 13 AN ZMLVZ& is WWW"UmeNt. . u Pro _yX. e. Aoftw *Yrl .11:; t cl. mW t It 1h Th Owa won 0%. .G wo! -amou a -Of Varna t >h 0. iaiieiss, att tai 4ekft�N OFED imdoMalmsto FrrakeLlia ft tea; dIbLswen, dY�rsr�rt�mt��t� ata�.pr�o�tr�sr f �i� ilatiati , er ct 4tr i ig; Pr.�x�w�s u��i�4 xd�r,QSa ©f sai� �ra carrWrm,. �rt� irgmdierd of a�ey Qftr�, substance or c9ojm nai.. fa• ihaunezd porsIm or THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AMENDMENT OF OTHER INSURANCE CONDITION This. endorsement modifies insurance provided under the following:. COMMERCIAL GENERAL LIABILITY COVERAGE PART A. The following is added to provision a. Primary Insurance of paragraph 4. Other Insurance under SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: However, when an additional insured has been added to this Coverage Part by attachment of an endorsement, we will not seek contribution from the "additional insured's own insurance" provided that: (1) You and the additional insured have agreed in a written contract that this insurance is primary and non- contributory; and (2) The "bodily injury" or 'property damage" occurs, orthe "personal and advertising injury" is committed, subsequent to the execution of such contract. B. For the purposes of this endorsement the following is added to SECTION V — DEFINITIONS: `Additional insured's own insurance' means other insurance forwhich the additional insured is designated as a Named Insured. Includes copyrighted material of Insurance Services Office, Inc., with its permission_ 22 -111 (01/07). Page 1 of 1 CERTHOLDER COPY SG P.O. BOX 420807, SAN FRANCISCO,CA 94142 -0807 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 03 -01 -2012 GROUP:_ 000496 POLICY NUMBER: 0500488-2011 CERTIFICATE ID. 288 CERTIFICATE EXPIRES: 01 -01 -2013 01 -01- 2012/01 -01 -2013• THE CITY OF SANTA ANA SG JOB:SANTA ANA REGIONAL TRANSPORTATION CTR 10000 E.SANTA ANA BLVD. 20 CIVIC CENTER PLZ SANTA ANA SANTA ANA CA 92701 -4058 CA 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 - LYONS, RONALD PRESIDENT SECRETARY - EXCLUDED. ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 01 -06 -2012 IS �.� ATTACHED TO AND FORMS A PART OF THIS POLICY. EMPLOYER RUE VAC PROPERTY SERVICES INC 600 W TAFT AVENUE ORANGE CA 92865 SG OVED AS TO FW<Ml [B17,SG1 PRINTED : 03 -01 -2012 (REV.8 -2010) A` °R°® CERTIFICATE OF LIABILITY INSURANCE D 3 /2013 /6 6'MMJDDJYYYY) 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 TE 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 NAME: 'a'mY Alberding SPIB Insurance Agency, Inc. PHOI� (949)582 -5220 FAx AIC N License Number 0719264 o:(949)582 -3512 amy @spib.com 26441 Crown Valley Parkway #200 MLSSiOII Viejo CA 92691 INSURER(S) AFFORDING COVERAGE f4l Is INSURERA:Peerless Insurance Co INSURED INsuRERB:The Netherlands Insurance Co Rue Vac Property Ser vices Inc INSURERC:Golden Ea le Insurance Co 600 W. Taft Avenue INSURERD:State Insurance Fund l / II'1JV1{CR C Orange CA 92865 I�O // —V tL «.Jf INSURER COVERAGES CERTIFICATE NUMBER:3MSTR 13 -14. INCR. UMB 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. IN LTR TYPE OF INSURANCE POLICY NUMBER MMJDOO�Y MMIOOIYYYV LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1, 00,000 X COMMERCIAL GENERAL LOBfLITV PREM SES Ea occurr<nro $ 100,000 A CLAiMSn1ADE OCCUR BP9558563 /1/2013 /1/2014 MFD EXP (Any one parson) $ 5,000 PERSONAL 6 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENL AGGREGATE LIMIT APPLIES PER X POLICY P R 7 LO" PRODUCTS - COMP /0P AGG $ 2,000,000 AUTOMOBILE LIABILITY WMCilt7 poNGLC LMii X Fa arr..dnnl AtJV 11000,000 B AU'C BODIL'i INJURY (Fer person) $ AUTOS AUTOS SCHECULED 797086 /1/2013 /1/2014 ){ NON -ONMED BODILY INJURY (Par acc�ienq $ HIRED ALIT -.s X AUTOS PROPERTY CAMAGE Per a: GC?rd X COMP PER SCH X CCLL PER S .H UMBRELLA UAB [I OCCUR UrKJenr r ;umd metot arooerty $ EACH OCCURRENCE $ 2.000.000 C X EXCESS LIAR CLAIMS.MADE AGGREGATE $ 2,000,000 DED I I RETENT ION $ C119558863 /1/2013 /1/2014 D WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YtC S7ATU- OTH- AtdY PROPRIETOR!PARTT�ER�ENECUTIVE V / N X TOR' I AITR R OFFICEFL'MEMBER ExCLL:DECY? ❑ NIA EL EACH ACCIDENT $ 1 000 000 (Mandatory In NH) 038319 -13 /1/2013 /1/2014 it yes. CesmDa unAa- EL DISEASE- EAEMFLOYE $ 1,000,000 DESCRI-TION OF OPERATIONS De4ow E L DISEASE - POLICY LIMIT $ 11000,000 A PROPERTY, SPECIAL FORM BP9558563 /1/2013 /1/2014 BUILDING 1'248,480 REPL.COST $1000 DID BUSINESS FEP,S PROPERTY 104,040 DESCRIPTION OF OPERATIONS LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more apace la required) RE: SANTA ANA REGIONAL TRANSPORTATION CENTER, 1000 E. SANTA ANA BLVD., SANTA ANA, CA. THE CITY OF SANTA ANA, ITS OFFICERS, EMPLOYEES, AGENTS, VOLUNTEERS AND RESPRESENTATIVES ARE NAMED AS ADDITIONAL INSUREDS WITH RESPECT TO GENERAL LIABILITY AS PER COMPANY FORM CG2010 07/04 AND CG2037 07/04, PER WRITEN CONTRACT PRI"p"�i Vt9yT k]RU'11( Foy fWgR?* IS PROVIDED IN FORM # 22 -111 01 /07. CERTIFICATE HOLDER Laura St Shccd CANCELLATION Assistant City Attorne} SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN THE CITY OF SANTA ANA ACCORDANCE WITH THE POLICY PROVISIONS. 20 CIVIC CENTER PLAZA SANTA ANA, CAL 92701 AUTHORIZED REPRESENTATIVE L Hines , CPCU ARM CLU —K iwy,► ACORD 25 (2010/05) INS025 i olooslo' O 1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD RUE VAC PROPERTY SERVICES INC POLICY NUMBER: CBP955856: COMMERCIAL GENERAL UABIUTY CG 2010 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS -SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Locations Of Covered Operations THE CITY OF SANTA ANA, ITS OFFICERS, EMPLOYEES SANTA ANA REGIONAL TRANSPORTATION AGENTS, VOLUNTEERS & REPRESENTATIVES ARE CENTER, 1000 E SANTA ANA BLVD AMES AS ADDITIONAL INSUREDS AS PER WRITTEN SANTA ANA, CA 90214 ONTRACT Information required to complete this Schedule, if not shown above will be shown in the Declarations. A. Section II — Who Is An Insured Is amended to include as an additional insured the person(s) or organization(s) 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: 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 the additional insured(s) at the location(s) desig- nated above. B. With respect to the insurance afforded to these additional insureds, the following additional exclu- sions apply: This insurance does not apply to "bodily injury' or "property damage" occurring after. 1. All work, including materials, parts or equip- ment furnished in connection with such work. on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional Insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its in- tended use by any person or organization other than another contractor or subcontractor en- gaged in performing operations for a principal as a part of the same project. CG 2010 07 04 0 ISO Properties, Inc., 2004 Page 1 of 1 0 RUE VAC PROPERTY SERVICES INC POLICY NUMBER: CBP955856: COMMERCIAL GENERAL LIABILITY CG 2010 07 04 THIS ENDORSEMENT CHANGES THE POLICY.. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional insured Person(s) THE CITY OF SANTA ANA, ITS OFFICERS, EMPLOYEE AGENTS, VOLUNTEERS & REPRESENTATIVES ARE JAMES AS ADDITIONAL INSUREDS AS PER WRITTEN A. Section 11 — Who Is An Insured is amended to include as an additional insured the person(s) or organizations) 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. 1. Your ads or omissions; or 2. The acts or omissions of those acting on your behalf, in the performance of your ongoing operations for the additional insured(s) at the locations) desig- nated above. LocaUonis) Of Covered Operations SANTA ANA REGIONAL TRANSPORTATION CENTER, 1000 E SANTA ANA BLVD SANTA ANA, CA 90214 B. With respect to the Insurance afforded to these additional insureds, the following additional exclu- sions apply. This insurance does not apply to "bodily injury' or "property damage" occurring after. 1. All work, including materials, parts or equip- ment furnished In connection with such work. on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its in- tended use by any person or organization other than another contractor or subcontractor en- gaged in performing operations for a principal as a part of the same project. CG 2010 07 04 ® ISO Properties, Inc., 2004 Page 1 of 1 Cl �Bsjl'4�rnti�: CeP TM RSENIENT C-!F ANA$ THE fpl ICY. RLEA145E' D.iT 4R vtxy, ADDFnONAL INSURED *- OWNF. W LESSEES iM CONTRAC70RS - COMPLETED OPERATIONS OtA en tes su ce: pna a cuade rt fatty % C RCUL GOMMALLAORM CQVBtAMi.*RT .i II r WhoAs.An h anad 6; [ire �f'Ad�cira����d P:gts�[(s� Qr Qr�esfiC�atfon(�� ADM AS Ah1AUM:1til.SURI:D ONADW. PO 1 IG TQ PROtDE I MJtAKC- E:;S JCH A$' IS AFFOFMEO UNDER-7M -M COVERAM RAR-T Lin lend Dasgilp Qi Ctnplte¢Ip; N 4R ��A;'Rt�f+i�T»T k}�IS SEk'�t;Ql AIDO MIGNAL 1NS1ED 1N THIS ENDORSEMENT: ..:. mss) .>'.C�1rtth Shy ►:rt:Siodam;a6s, WI:'ise#n'.1rf;Ieda�ativ�s: _ _. �!1�� his: hoc.. Y404• CG 20v (D?Al THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AMENDMENT OF OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. The following is added to provision a. Primary Insurance of paragraph 4. Other Insurance under SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: However, when an additional insured has been added to this Coverage Part by attachment of an endorsement, we will not seek contribution from the "additional insured's own insurance" provided that: (1) You and the additional insured have agreed in a written contract that this insurance is primary and non- contributory; and (2) The "bodily injury" or "property damage" occurs, or the "personal and advertising injury" is committed, subsequent to the execution of such contract B. For the purposes of this endorsement the following is added to SECTION V — DEFINITIONS: "Additional Insured's own Insurance" means other Insurance for which the additional insured is designated as a Named Insured. Iru:ludes copyrighted malarial of Insunmee Services Otlice. Inc., with its permission. 22 -111 {01/071 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AMENDMENT OF OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. The following is added to provision a. Primary Insurance of paragraph 4. Other Insurance under SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: However, when an additional insured has been added to this Coverage Part by attachment of an endorsement, we will not seek contribution from the "additional insureds own insurance" provided that: (1) You and the additional insured have agreed in a written contract that this insurance is primary and non- contributory; and (2) The "bodily Injury' or - property damage" occurs, or the "personal and advertising injury' Is committed, subsequent to the execution of such contract B. For the purposes of this endorsement the following Is added to SECTION V — DEFINITIONS: Additional Insureds own insurance- means other insurance for which the addivoriai insured is designated as a Named Insured. 22-111 (01 Inuludes copyrighted material orInsumnee Serviocs O1Tice, Inu., with its permission. ro� . Page 1 of 1