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HomeMy WebLinkAbout5 STAR ELEVATOR SERVICE INC. 1B-2014 °,r City of Santa Ana .p .-) ,y COTC Office Use Only L.;ii t' Clerk of the Council AGREEMENT TERMINATION FORM ,,. 7: n q { Please complete this form when the attached agreement and all C,:'flu _c a l amendments (if any) are no longer in effect.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. ) Return form to the Clerk of the Council Office (M-30). Call 647-1520 if you have any questions. The agreement with `f/ VC-;- 7� r/ V T 6 P., No. ( C' /(e) .—G , was completed on '5 1, ( and final payment has been made. (List all amendments. Use space below if neede -f(Department: ��v /q 'bE/' Al Phone/Ext.: IX 6 i 3 Signature: /24fC 7 Date: 2 ! /r g Revised:01-07-16 fftw§-T#1241 0 ,ro: From: David Cavazos Cit_Manager William Galvez, Interim Executive Director Public Works Agency Date: June17, 2014 12 -7539 Santa Ana Main Library Elevator Modernization Subject: Change Order No. 2 CONTRACTOR 5 Star Elevator 1556 N. Case Street Orange, CA 92867 PROJECT DESCRIPTION: 12 -7539 Santa Ana Main Library Elevator Modernization CHANGE ORDER NUMBER: ACCOUNTING UNIT- ACCOUNT - ACTIVITY NUMBER: JUSTIFICATION CHANGE ORDER AMOUNT: $ 1,400 13518783- 66200 - 12753901028 A -2013- 166 -02 The existing dumbwaiter, which is used to transport books between the different floors in the library, had not functioned in many years. Without the use of the dumbwaiter, staff was forced to hand carry books between floors. This Change Order pays the contractor to troubleshoot and repair the dumbwaiter. This work was done on a time & materials basis. A prior approval was granted May 13, 2014. (PCO #02) FINAL COST $ 1,400 CONTRACT COST SUMMARY Amount %of Contract Original Contract Total $ 73,216.00 Previous Change orders $ 3,919.41 Increase 3.47% Change Order #2 $ 1,400,00 Increase 0.38% Total Change Carders to Date $ 5,319.41 Increase 3.85% Adjusted Contract Total $ 78,535.41 Project 12 -7539 Request for Approval of Change Order No. 2 June 17, 2014 Page 2 of 2 SCHEDULEIMPACT No schedule impact William Galvez, Interim Lxecutive Director Public Works Agency APPROVED AS TO FUNDS AND ACCOUNTS: Francisco Gutierrez, Executive Director Finance & Management Services Agency GK WORK 0 K ONT11 -u hr EXPIRES -CLERK —OrGFUNTII DATE: A-2013-166-02 CE !OF SAN IAANA CONTRACT CHANGE ORDER Project Number 12-7539 Santa Ana Main Library Elevator Modernization Change Order Number 2 To 5 Star Elevator Services, Inc. Contractor You are hereby directed to make the herein changes from the plans and specifications or do the following described work not included in the plans and specifications on this contract, NOTE: THIS CHANGE ORDER IS NOT EFFECTIVE UNTIL APPROVED BY THE CITY COUNCILOR CITY MANAGER, Unless otherwise stated, rates for rental of equipment covet only such time as equipment is actually used and no allowance will be made for idle time. Change requested by PUBLIC WORKS AGENCY Troubleshoot and repair dumbwaiter as directed in POO #02 dated May 13, 2014 Page 1 of 2 FINAL COST $1,400 �. PUBLIC WORKS AGENCY i CONTRACT CHANGE ORDER Project Number 13 -038 Santa Ana Main Library Elevator Modernization Change Order Number To 5 Star Elevator Services, Inc. Contractor You are hereby directed to make the herein changes from the plans and specifications or do the following described work not included in the plans and specifications on this contract. NOTE: THIS CHANGE ORDER IS NOT EFFECTIVE UNTIL APPROVED BY THE CITY COUNCIL OR CITY MANAGER. Unless otherwise stated, rates for rental of equipment cover only such time as equipment is actually used and no allowance will be made for idle tune. Change requested by PUBLIC WORKS AGENCY The compensation both time and cost set forth in this change order comprises the total compensation due the Contractor, all Subcontractors, and all Suppliers for all work performed per this change order, including impact on unchanged work. By signing this change order, the Contractor acknowledges and agrees on behalf of himself, all Subcontractors, and all Suppliers, that the stipulated compensation includes payment for all work contained in this change order, plus all payment for interruption of schedules, extended field overhead, home office overhead, profit, delay, and all impact, ripple effect or cumulative impact on all other work under this Contract. The signing of this change order constitutes full mutual accord and satisfaction for all changes and work performed on this project, and that the time and cost paid per this change order constitutes the total equitable adjustments owed the Contractor, all Subcontractors, and all Suppliers for all work performed on this project. The Contractor on behalf of himself, all Subcontractors, and all Suppliers agrees to waive all rights, without exception or reservation of any whatsoever to file any further claim related to this project. TOTAL COST THIS CHANGE ORDER: DECREASE $ _ _ _ _ _ INCREASE $ 1,400 By reason of this order the CONTRACT TIME completion will be adjusted as follows: 0 working days We the undersigned contractor have given careful consideration to the change proposed and hereby agree, if this proposal is approved, that we will provide all equipment, furnish all materials, except as may otherwise be noted above, and perform all service necessary for the work above specified, and will accept as full payment therefor the prices shown above. Accepted, Date e, /;�,4.2�fL4 Contactor 5 Star Elevator Services, Inc. By Title t�at�. (r; I t < c pproval recommended by :'� Date PU RKS AGENCY EXECUT ED RECTOR Approved by Date = � � CITY MAN MANAGER ATTEST* MARIA D. HUIZA Page 2 of 2 CLERK OF THE C UNCIL I. ate ^T tay„�i'�. Fla CERTIFICATE OF LIABILITY INSURANCE 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 DATE 21 11 DI14 02121!2014 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($), 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 endorsements), PRODUCER Jackson & Jackson Insurance 2220 East Route 66 Star 206 Glendora, CA 91740 Chris E. Vandermeulen CONTA kAME: Lori Patterson _ PHONE F No E%a: 626. 914 -9944 arc No .026914.1040 _iAiC E -MAII. ADDRE,S§,:, 'INSUBER(s) APPpRpIN9 COVERA9E NAIC t{ INSURER_A:Hartford Fire Insurance _ 19662 _ 'INSURED 6 Star Elevator Services, Inc, �^ _ INSURER B; National Union Fire of PA 19445 1556 N, Case Street Orange, CA 82$67 _ _ INSURERC:Preferred Employers 10900 INSURER D: Sentinel Ins. Cc Limited 11000 INSURER E _... _ PREMISES (E . "L.,$ INSURER FI T_ A 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 T TYPE OR INSURANCE Santa Ana, CA 92701 THORIIZED REPP�R�E,S�EN�TTATITTIIIVEf AUTHORIZED POLICY NUMBER LIC E F � 0/Y Y I LIMITS GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 _ PREMISES (E . "L.,$ _ 300,000 A X COMMERCIAL GENERAL LIABILITY �D CLAIMS -MADE FAI OCCUR X X 13UENOJ6065 02125/2014 0212512016 MED E %P An ane arson $ 10,000 PERSONAL &ADV INJURY $ 1,000,000 a^ GENERAL AGGREGATE $ 3,000,00 CE42 AGGREGATE LIMIT APPLIES PER: PRODUCTS- COMPIOPAGG > 3,000,00 $ POLICY X PRO- LOO AUTOMOBILE LIABILITY OMBI ED SING E L 1 __ Jggl odtlentl 1,000,000 BODILY INJURY (Per person) s D ANY AUTO 13UENOJ6085 02/25/2014 02125 12016, BODILY INJURY (For exAdoet) $ ALLOWNED SCHEDULED Avr03 AUTOS NON-OWNED X HIRED AUTOS X AUTOS PROPERTY DAMAGE tPF.R ACCIDENT? S _ $ UMBRELLA L7A8 X OCCUR EACH OCCURRENCE $ 5,000,00 _ AGGREGATE £ 6,000,000 B X EXCESS LIAR CLAIMSWADE EBU016483148 02/26120140212512015 I PEP I X RF1'EN1'ION$ NIL. $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUUVE Y� OrF CEMMEMBER EXCUUDEOI (Mandatory in NR) NIA KN144421.3 08/01/2013 08/0112014 A `NCy TATU- OTN•; E.L. EACH ACCIDENT - $ 1,000,000 E.t. DISEASE - EA EMPLOYE $ 1,000,000 EL DISEASE - POLNOY LIMIT 1,000,00 Eyes, iesalbe ender OESCRtPtTON OP OP RATl6Ns belay k DESCRIPTION OF OPERATIONS! LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) - RL: Project 813 -070 - Elevator Maintenance. The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, CA 92703, its officers, employees, agenx'R R.t.)VkL , d volunteers and representatives are named as additional insureds with regar _ Cc general liability and defense of suits arising from the operations and uses performed by or on behalf of the named insured, per attached (over) y /,_ -.- _.. - Laura SC.eltuy'_ As3istanL (_ it:Y AI1IWIe CERTIFICATE HOLDER CANCELLATION O 1988 -2010 ACORD CORPORATION, All rights reserved, ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cl Of Santa Ana City THE EXPIRATION DATE THEREOF, NOTICE WELL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 20 Civic Center Plaza, M36 Santa Ana, CA 92701 THORIIZED REPP�R�E,S�EN�TTATITTIIIVEf AUTHORIZED q� Z�ff�� O 1988 -2010 ACORD CORPORATION, All rights reserved, ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD POLICYNUMBER; 13UENOJ6085 COMMERCIAL GENERAL LIABILITY CO 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): Loosilon s Of Covered Operations Any person or organization for whom you are performing Any location within the "coverage territory" operatlonswhen you have agreed that such parson or Organization be added as an additional Insured on your policy under I . A written contract or agreement that is In effect dur- Ing the term of this policy and such contract is en- tered Into prior to the "occurrence" of any "bodily in- jury", "property damage ", "personal injury", or "ad- vertising Injury" or, 2. An oral contract or oral agreement with a.person or organization when a certificate of Insurance showing that person or organization as an Addi- tional Insured has been issued; and such oral eon- tract or oral agreement is in effect during the term of this policy and is entered Into prior to the "oocur- rance" of any "bodily Injury", "property damege" "personal injury", or "advertising injury." Information required to complete this Schbdulei If not shown above, will be shown In the Declarations. 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: t. 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 edditional insured(s) at the location(s) desig- nated above, B. Wth 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 ccmploted; or CG 20 10 07 04 0 ISO Properties, Inc., 2004 Pagel of 2 q 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 engaged in performing operations for a princi- pal as a part of the some project. Page 2 of 2 0 ISO properties, Inc„ 2004 CG 2010 07 04 0 POLICY NUMBER: 13U ENOJ6085 COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY, ADDITIONAL INSURED -- OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Nama Of Addltlonat Insured Person(s) Or Or anlzatlon s : Location And Description Of Completed Opera. tlons Any parson or organization for whom you are perform- Any location within the "coverage territory", and for all Ing operations when you have agreed that such person completed operations or orgenizatlon be added as an additional insured on your policy under: 1. A written contract or agreement that Is in affect during the term of this policy and such contract Is entered Into prior to the "occurrence" of any "bodily injury", "property damage ", "personal in- jury", or "advertising injury"; Or, 2, An oral contract or an oral agreement with a person or organization where a certificate of insurance showing that person or organization as on Additional Insured has been Issued; and such oral contract or oral agreement is in effect during the term of this policy and such contract is entered into prior to the "occurrence" of any "bodily injury" "property damage ", "personal in- juriP, or' advertising Injury"; Information required to complete this schadule If not shown above, will be shown in the Declarations, Seotton II — Who Is An Insured is amended to Include as an additional Insured the person(s) or orgahlzation(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, In whole or in part, by "your work" at the location designated and described in the schedule of this endorsement performed for that additional insured and included In the "products- completed operations hazard ". CG 20 37 07 04 0 160 Properties, Inc., 2004 Page 1 of 1 0 THIS EXTRACT OF COVERAGE IS ISSUED AS AN ATTACHEMENT TO THE CERTIFICATE OF INSURANCE ATTACHED HERETO. THIS EXTRACT IS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS EXTRACT DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, ALTER, EXTEND THE COVERAGE AFFORDED BY THE POLICIES, THIS EXTRACT OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, OR THE CERTIFICATE HOLDER. (7)When You Add Others As An Additional Insured To This Insurance Any otherinsurance available to an additional insured. However, the following provisions apply to other insurance available to any person or organization who Is an additional Insured under this coverage part. (a) Primary Insurance When Required By Contract This insurance Is primary If you have agreed in a written contract or written agreement that this insurance be primary. If other insurance is also primary, we will share with all that other Insurance by the method described In c. below. (b) _Primary_ And Non - Contributory To Other Insurance When Required By Contract _ . If you have agreed in a written contract, written agreement, or permit that this insurance is primary and non-contributory with the additional insured's own insurance, this insurance is primary and we will not seek contribution from that other Insurance, Paragraphs (a) and (b) do not apply to other insurance to which the additional insured has been added as an additional insured. When this Insurance is excess, we will have no duty under Coverages A or B to defend the insured against any "suit" if any other insurer has a duty to defend the insured against that "suit". If no other insurer defends, we will undertake to do so, but we will be entitled to the Insured's rights against all those other insurers. When this Insurance is excess over other Insurance, we will pay only our share of the amount of the loss, if any, that exceeds the sum of: (1) The total amount that all such other insurance would pay for the loss In the absence of this insurance; and (2) The total of all deductible end self- Insured amounts under all that other insurance, We will share the remaining loss, If any, with any other insurance that Is not described in this Excess Insurance provision and was not bought specifically to apply in excess of the Limits of Insurance shown In the Declarations of this Coverage Part. POLICY NUMBER: 13UENOJ6085 COMMERCIAL GENERAL LIABILITY CG 24 04 06 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: APPLICABLE ONLY TO ANY PERSON OR ORGANIZATION WHERE THERE IS A WRITTEN CONTRACT /AGREEMENT IN EFFECT. The following is added to Paragraph 8. Transfer Of Rights of Recovery Against Others To Us of Section IV w Conditions: We waive any right of recovery we may have again at 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 © Insurance Services Office, Inc„ 2008 Page 1 of 9 M 5STAR -1 OP Ifs: LP CERTIFICATE OF LIABILITY INSURANCE DATE (M'duIDDiYYYY) ... CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 15 SUBJECT TO ALL THE TERMS, 0712212016 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 p'ol'icy, 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 wAMI : r Lori Patterson Jackson & Ja'.cksonInsurance 302 E Foothill Bivd -PHGNe m .............. .. . . .- PAx ..�..m ........ Ac.t+® 625- 914 -9944 arc No:625- 914 -9040 _ " E -MAIL ADDRESS:. San Dimas, CA 91773 Lori Patterson EAOFIOCOURRENCE INSURER(S) AFFORDING COVERAGE NAIO 4 INSURER A:. Hartford Fire Insurance 1.9682 X INSURED 5 Star Elevator Service, Inc. INSURERS National Union Fire of PA 19445 1556 N. Case Street __.._... _ INSURER C; Preferred Employers 10900 Orange, CA 82867 INSURERDJrurribull.Insurance Company ...27120 INSURER 2: .. INSURER. F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE IPOLICIES OF INSURANCE L18TED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWVTH!STANDING ANY RIFQUIRFMENT, 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 15 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR LTR TYPE OfINSURANCI; ADD INSO WVD - _- _..... POLICY NUMBER 0611CY FrF (MMIDD,rYYYY POLICY EXP 'TdMIDDIYYYY ( _._.........._ ( LIMITS A X GOMMERCIALGE.NERALLIA ®ILP.'TY EAOFIOCOURRENCE $ 1,000,000 CLAIM MACE 7x cccuR X X 13UENOJ6085 02/251 2016 0212 x12016 PREMISE SE a uccu trice s 300,000 MED EXP (Any one parson) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 _ AGGREGATE LUMIT APPLIES PER " GENERAL AGGREGATE $ 3,000,000 GEN'L POLICY 1 -" E'CY ❑ LOC PRODiUCTS - COMPIOPAGG $ 3,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Pd pccldentj $: 1 .0'00 000 _. BODILY INJURY (Her Per5017) . -..r $ D ANY AUTO 13UENOJ6085 0212512015' 02125/2016 ALL OWNED SCHEDULED AUTOS AUTOS "..._ BODILY INJURY (Per accldent),$ - ...._ "_-. NiON -OWNED " HIRED AUTOS AUTOS PRCSPERTY DAMAGE F"eraceldent $ UMBRELLA LIAR " ` OCCUR � EACH OCCURRENCE. $ ...... 9,000,000 E T EXCESS LAB CLAIMS -MADE I EBU060293123 02125/2015 0212512016 AGGREGATE '' GProdlOpS $ 9,000,000 _. Den X RFTENTIOIU$ NIL $ 9,000,000 C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y N ANY PROPRIETORWARTNERIEXECUTIVE OFFICERRYIEMBER EXCLUDED? FT {Ma,ndatory In NH) N d A WKN144421 -5 09101/2015 0810112016 X SEATUTE ORTH» EL EACH ACCIDENT E.L. DISEASE -CA F.MPLOYLE $ 1,000,000 -- $ 1,000,000 If Yes, describe under DESCRIPTION OF OPERATIONS holow E.L, DISHASH - POLICY I..IM.rf I $ 1,000,000 DESCRIPTION OF OPERATIONS I LO'CATION'S 1 VEHICLES QACORD 10, Additional Remarks Schedule, may be adached if more space is regWred) RE: Project #13 -070' _ Elevator Maintenance. The City of Santa Ana, 20 Civic Center Plaza„ Santa Ana, CA 92701; its officers, employees, agents, volunteers and representatives are named as additional insureds with regard to general liability and defense of suits arising from the operations and uses performed by or on behalf of the named insured, per attached (over) CERTIFICATE HOLDER CANCELLATION Q 1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (20'14101) The ACORD name and logo are registered onarks �,'7- 5 ST AR ELEVATOR SERVICE A- 2013 - 166 -C2 ` C REREVIEWED BY: l /, . EUNIC,E H Rf DIA (PG °I OF 2) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 20 CIVIC Center Plaza, M -36 Santa Ana, CA 92701 AUTHORIZED REPRESENTATIVE Q 1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (20'14101) The ACORD name and logo are registered onarks �,'7- 5 ST AR ELEVATOR SERVICE A- 2013 - 166 -C2 ` C REREVIEWED BY: l /, . EUNIC,E H Rf DIA (PG °I OF 2)