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HomeMy WebLinkAboutBENTON, BETSY 4A (2)-2013February 3, 2014 Betsy Benton 2750 Artesia Blvd., #465 Redondo Beach, CA 90278 RE: Extension of Standard Consultant Agreement Dear Ms. Benton: N -2013- 023 -001 CITY MANAGER David Cavazos CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL Maria D. Huizar Pursuant to the Consultant Agreement you entered with the City of Santa Ana on April 1, 2013, Section 3 - "Term ", the time period of the agreement is hereby extended from December 31, 2013, until December 31, 2014. The insurance certificates and Additional Insured Endorsement are required to be extended and /or renewed to cover this extension. All other terms and conditions of the original agreement remain unchanged and in full force and effect. If you have any questions in this regard, please feel free tg,,contact my office. Evr� Karen en Hal Haluza ��� Interim Executive Director Planning and Building Agency Edwin "William" 6alvez, P.E. Interim Executive Director Public Works Agency Rya Assi Betsy Ben Hearing 0, cer SANTA ANA CITY COUNCIL rney Miguel A, Pulido Sal Tinajero Vincent F. Sarmiento Michele Martinez Angelica Amezcua P. David Benavides Roman Rayne Mayor Mayor Pro Tem, Ward 6 Ward 1 Ward 2 Ward 3 Ward 4 Ward 5 MP011d.n..rta -ana ora STIna'erofrdsanta -ane oro V arm entofalsanta- ana.ara MMartinezOlsanta -ana oro AAmezaualalsanta- ana org p@anevitleet -santa -ana ore RRevnafolsanta- ana.ora INSURANCE ON FILE MAYOR Miguel A. Pulido wOR� MAY PROCEED INSURANCE EXPIRES UNTIL MAYOR PRO TEM Sal Tinajero COUNCILMEMBERS CLERK OF COUNCIL Angelica Amezcua P. David Benavides DATE' VAR 4 2014 Michele Martinez �. P113A, CI, Roman Rayne M �.�. Vincent F.Sarmiento CITY OF SANTA ANA PLANNING & BUILDING AGENCY 20 Civic Center Plaza P.O. Box 1988 • Santa Ana, California 92702 www.santa-ana.org/pba February 3, 2014 Betsy Benton 2750 Artesia Blvd., #465 Redondo Beach, CA 90278 RE: Extension of Standard Consultant Agreement Dear Ms. Benton: N -2013- 023 -001 CITY MANAGER David Cavazos CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL Maria D. Huizar Pursuant to the Consultant Agreement you entered with the City of Santa Ana on April 1, 2013, Section 3 - "Term ", the time period of the agreement is hereby extended from December 31, 2013, until December 31, 2014. The insurance certificates and Additional Insured Endorsement are required to be extended and /or renewed to cover this extension. All other terms and conditions of the original agreement remain unchanged and in full force and effect. If you have any questions in this regard, please feel free tg,,contact my office. Evr� Karen en Hal Haluza ��� Interim Executive Director Planning and Building Agency Edwin "William" 6alvez, P.E. Interim Executive Director Public Works Agency Rya Assi Betsy Ben Hearing 0, cer SANTA ANA CITY COUNCIL rney Miguel A, Pulido Sal Tinajero Vincent F. Sarmiento Michele Martinez Angelica Amezcua P. David Benavides Roman Rayne Mayor Mayor Pro Tem, Ward 6 Ward 1 Ward 2 Ward 3 Ward 4 Ward 5 MP011d.n..rta -ana ora STIna'erofrdsanta -ane oro V arm entofalsanta- ana.ara MMartinezOlsanta -ana oro AAmezaualalsanta- ana org p@anevitleet -santa -ana ore RRevnafolsanta- ana.ora AC"R®® CERTIFICATE OF LIABILITY INSURANCE lzj2(4 %ZO12) 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 pollcy(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 COMPLETE EQUITY MARKETS INC 1190 Flex Court Lake Zurich, IL 60047 CONTACT NAME: a"ENO ExI: (847) 541 -0900 FAX A/C, Ne,(847)541 -0444 E-MAI ADDRESS.� INSURERI6) AFFORDING COVERAGE NAICp INSURER A: Underwriters at Lloyds London INSURED Betsy Benton INSURER B: INSURER C' 2750 Artesia Boulevard #465 INSURER D: Redondo Beach, CA 90278 INSURERE - 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 I�TR TYPE OF INSURANCE AINSR IWO POLICY NUMBER MMIDD;Ym 901D/YYY'I LIMITS GENERAL LIABILITY EACH OCCURRENCE $ PREMISES BE occurrence $ COMMERCIAL GENERAL LIABILITY CLAIMS -MACE CI OCCUR MEDEXP(Anyonepea.n) $ PERSONAL &ADV INJURY $ GENERAL AGGREGATE $ GENT AGGREGATE LIMIT APPLIES PER: POLICY PRo LOC PRODUCTS - COMPIOP AGG $ P R E TO FM M IS AUTOMOBILE LIABILITY O B NE SINGLE LIMIT (Ed $ BODILY INJURY (Per person) $ ANYAUTO� ALL OWNED SCHEDULED AUTOS AUTOS ( q (7 BODILY INJURY (Pereccitlznq $ .NON -OWNED HIRED AUTOS AUTOS ■ YA M YaM ps�acoldarnlDAMAGE 5 -- UMBRELLA LIAB _ OCCUR 1 EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE /1 LED RETENTIONS I $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNERVE%ECUTIVE ❑ OFFICER/MEMBER EXCLUDED] NIA _ WC STATU- OTH- TORY LIMITS ER E. L. EACHACCIDENT $ E.L, DISEASE - EA EMPLOYEE S IManddIII, in NR If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMB S $1,000,000 Each Claim A Professional 716120 01/01/1301/01/14 $1,000,000 Aggregate Liability DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Ailanh ACORD 101, Atltlilionel Remarks Schodd., If more space is required) Please see pages 2 -4 for additional information. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. For Informational Purposes OnlyP AUTHORIZED REPRESENTATIVE���Y,r���//��,,,�, ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD25(2010 /05) The ACORD name and logo are registered marks of ACORD 2 Certificate of Insurance BETSY BENTON Policy Number: 716120 Subject to all policy terms conditions, exclusions and endorsements SURPLUS LINES NOTICE TO POLICYHOLDER - PLEASE SEE ATTACHED i �i A i i Lawrence T.P. Molloy binder5'138 NOTICE: 1. THE INSURANCE POLICY THAT YOU HAVE PURCHASED IS BEING ISSUED BY AN INSURER THAT IS NOT LICENSED BY THE STATE OF CALIFORNIA. THESE COMPANIES ARE CALLED " NONADMITTED" OR "SURPLUS LINE" INSURERS. 2. THE INSURER IS NOT SUBJECT TO THE FINANCIAL SOLVENCY REGULATION AND ENFORCEMENT THAT APPLY TO CALIFORNIA LICENSED INSURERS. 3. THE INSURER DOES NOT PARTICIPATE IN ANY OF THE INSURANCE GUARANTEE FUNDS CREATED BY CALIFORNIA LAW. THEREFORE, THESE FUNDS WILL NOT PAY YOUR CLAIMS OR PROTECT YOUR ASSETS IF THE INSURER BECOMES INSOLVENT AND IS UNABLE TO MAKE PAYMENTS AS PROMISED. 4. THE INSURER SHOULD BE LICENSED EITHER AS A FOREIGN INSURER IN ANOTHER STATE IN THE UNITED STATES OR AS A NON - UNITED STATES (ALIEN) INSURER. YOU SHOULD ASK QUESTIONS OF YOUR INSURANCE AGENT, BROKER, OR "SURPLUS LINE" BROKER OR CONTACT THE CALIFORNIA DEPARTMENT OF INSURANCE AT THE FOLLOWING TOLL -FREE TELEPHONE NUMBER: 1- 800 -927 -4357. ASK WHETHER OR NOT THE INSURER IS LICENSED AS A FOREIGN OR NON - UNITED STATES (ALIEN) INSURER AND FOR ADDITIONAL INFORMATION ABOUT THE INSURER. YOU MAY ALSO CONTACT THE NAIL'S INTERNET WEB SITE AT WWW.NAIC.ORG. 5. FOREIGN INSURERS SHOULD BE LICENSED BY A STATE IN THE UNITED STATES AND YOU MAY CONTACT THAT STATE'S DEPARTMENT OF INSURANCE TO OBTAIN MORE INFORMATION ABOUT THAT INSURER. 6. FOR NON- UNITED STATES (ALIEN) INSURERS, THE INSURER SHOULD BE LICENSED BY A COUNTRY OUTSIDE OF THE UNITED STATES AND SHOULD BE ON THE NAIC'S INTERNATIONAL INSURERS DEPARTMENT QID) LISTING OF APPROVED NONADMITTED NON - UNITED STATES INSURERS. ASK YOUR AGENT, BROKER OR "SURPLUS LINE" BROKER TO OBTAIN MORE INFORMATION ABOUT THAT INSURER. binders'138 7. CALIFORNIA MAINTAINS A LIST OF APPROVED SURPLUS LINE INSURERS. ASK YOUR AGENT OR BROKER IF THE INSURER IS ON THAT LIST, OR VIEW THAT LIST AT THE INTERNET WEB SITE OF THE CALIFORNIA DEPARTMENT OF INSURANCE: WWW.INSURANCE.CA.GOV. 8. IF YOU, AS THE APPLICANT, REQUIRED THAT THE INSURANCE POLICY YOU HAVE PURCHASED BE BOUND IMMEDIATELY, EITHER BECAUSE EXISTING COVERAGE WAS GOING TO LAPSE WITHIN TWO BUSINESS DAYS OR BECAUSE YOU WERE REQUIRED TO HAVE COVERAGE WITHIN TWO BUSINESS DAYS, AND YOU DID NOT RECEIVE THIS DISCLOSURE FORM AND A REQUEST FOR YOUR SIGNATURE UNTIL AFTER COVERAGE BECAME EFFECTIVE, YOU HAVE THE RIGHT TO CANCEL THIS POLICY WITHIN FIVE DAYS OF RECEIVING THIS DISCLOSURE. IF YOU CANCEL COVERAGE, THE PREMIUM WILL BE PRORATED AND ANY BROKER'S FEE CHARGED FOR THIS INSURANCE WILL BE RETURNED TO YOU. D -2 (Effective July 21, 2011) binders -138 ENDORSEMENT NO.: 853228 TRANSACTION NO.: N/A PREVIOUS ENDORSEMENT NO.: 716120 AUTHORIZATION NO.: (UMR) B1294CP103613 CUSTOMER NO.: 10021992 Endorsement to Master Certificate No. CEM 14 -13 DECLARATIONS ARBITRATORS, HEARING OFFICERS AND MEDIATORS PROFESSIONAL LIABILITY INSURANCE issued to the NATIONAL ASSOCIATION OF SALARIED PROFESSIONALS PURCHASING GROUP, INC. and SPECIFIED MEMBERS EVIDENCE OF INSURANCE affected with certain UNDERWRITERS AT LLOYD'S, LONDON PARTICIPATION HEREON: 100% ..- - - - - -- Specified BETSY BENTON Member 2750 Artesia Boulevard #465 Redondo Beach CA 90278 LIMITS OF LIABILITY: Coverage A - Professional Liability and Personal Injury Coverage Each claim: $110001000,00 Aggregate: $1,000,0)0,00 Coverage B - Defense Cost Coverage Each claim: $1,000,000.00 Aggregate: $1,000,000,00 Aggregate Limit of Liability Maximum insurance available for Coverages A and B combined $2,000,000.00 Deductible - each claim including Cost of Defense: $1,000.00 Retroactive Date: NONE PREMIUM (Including endorsements): $468.00 pp VE AS TO FORM Purchasing Group Tax for CA @ 3% $14.04 � I R N .HODGE TOTAL LLOYD'S PREMIUM (Including Texas): $482.04 ---ass istant itv Atternev PERIOD OF INSURANCE: From January 1, 201412:01 a.m. to January 1, 201512:01 a.m., at the Specified Member's address, above. Special Conditions: See attached Summary page In consideration of the premium paid and in reliance upon the statements in the application attached hereto, the above specified member is an Assured under the Master Certificate ( "Cartificate'9 issued to the National Association of Salaried Professionals Purchasing Group, Inc. of Illinois by Underwriters at Lloyd's, London (not incorporated) for the Period of Insurance and Limits of Liability specified above. All other terms, conditions, and exclusions rs the of Certificate are unchanged. This certifies that the attached Cortificate is a true copy of the original document issued to the Association, which is hereby issued to the Specified Member. Dated: December 16, 2013 LII 14.1 Dec (01113) medforms*g66 (PO) FILE COPY UNDERWRITERS AT LLOYD'S, LONDON Complete Equity Markets, Inc. dba Complete Equity Markets Insurance Agency, Inc. (CASL#OD44077) By Lawrence T.P. Molloy