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Home My WebLink AboutBELL BUILDING MAINTENANCE INC. 3A-2014City of Santa : a as t Clerk of the Cou,.cil AGREEMENT TERMINATION FORM Please complete this form when the attached agreement and all amendments (if any) are no longer in effect. Return form to the Clerk of the Council Office (M-30). Call 647-6520 if you have any questions. The agreement with COTC Office Use Only €d� f_k of Ih No. A-9014—\C�5-0\ was completed on p and final payment has been made. (List all amendments. Use space below if needed.) ,,� ( j �w e'r"I, Revised 08-23-10 Department:�A Phone/Ext.: ' _5 Signature: ac til� t l v�.N(o Date: 7 1 -7 b-, ui,URANCF ON FILE tNORK MAY PROCEED MAYOR UNTIL INSURANCE EXPIRESS Miguel A. PUildo MAYOR PRO TEM Vincent F. Sarmiento GLER{ CLERI COUNCILMEMBERS Angelica Amozoua P. David Benavides Michele Martinez Roman Rayne Sal Tinalero W c, . q -1.5 CITY OF SANTA ANA PARKS, RECREATION AND COMMUNITY SERVICE 20 Civic Center Plaza M-23 . P.O. Box 1988 M-23 Santa Ana, California 92702 w w ,sante-ana.org May 27, 2015 Bell Building Maintenance Company, Inc. Attn: Chan H. Yang -President 5170 Sepulveda Blvd. #180 Shennan (talcs, CA 91403 Re: Bell Building Maintenance Comysanv, Inc. Consultant Agreement 8°Extension" Dear Mr. Yang: 1;6g7LIiHF 111 Pursuant to Section 4 ("Term") of the Agreement No. A-2014-105, entered into by Bell Building Maintenance Company, hie. and the City of Santa Ana, dated June 1, 2014, the time period of said Agreement is hereby extended for an additional one (1) year period, from June 1, 2015 to May 31, 2016. The insurance certificates are required to be extended and/or renewed to cover this extension. All other terns and conditions of said Agreement remain unchanged and in full force and effect, Sincerely, Gerardo Mouct Executive Director of Parks, Recreation and Community Services Agency APPRO'VFD AS TO FORM: Sonia R, Carvalho City Attorney J t M, Funk ssistarrt City Attorney cc: Cleric of the Council CITY OF SANTA ANA David Cavazos MC'er ATTEST: Maria D. Huiza2 Clerk of the Council SANTA ANA CITY COUNCIL Wgeel A. Pardo V9xant F.Sarmlento ' Whele Malim t Anga ica Amamua I P. David eemnA as Roman Reyna I Sal Tinalero Mayor I Mayor Pro Tom, Ward a s Ward ± word l Word I Ward t Ward MP 41tla�sa rta•ana ora � Y rrMaMoa`bsanta-anaara � MMerilrlezR4sanin•W1e.ara � AhmrceuaGSsssre as-ara ma I g@,sryavr'�smtta-ans ara I Ri?emeaBsame•ana wa I Sajin{+jrno�santa- aflAM -�1 BELLB-1 OP ID: SO GERTIF r,�ATE OF LIABILITY INS.�RANCE DATpMMIDDI5YY) 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(ies) 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)• Inc. (M) 636 e.110 Phone: Fax: Ortiz —_- )arc IN 951-297-2415 IBmeuua,4A CLOY I Ed Hollander -_. - _ — -... __ __. _._- INSURER(S)AFFORDINGCOVERAGE NAIC4 INSU_RERA:A_mTrustInternational INSURED Bell BuildingMaintenance Co. - - -_ wsuREZB:Oak River Insurance Company_ 34630 Mrs. Yang Chanhee 5170 Sepulveda Blvd., #180 _ -_ INSURER C: ShermanOaks, CA 91403 INSURERD: A-1J'-i.�itf INSURERS:.... INSURER F : COVFRAGES CERTIFICATE NUMBER: REVISION NUMBER: 1 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 PERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IL- --_. - SBA C308� _....... _.. _.. L Y EFF POLICY EXP ; MMIDDIYYYY iYYYY TRR; TYPE OF INSURANCE ''INSR_LW POLICY NUMBER MMtOD ... -_ LIMITS I GENERAL LIABILITY II EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY X X EN102474100 01110/15 j 01/10/16 O A E T RENTED PREMISES (Ea occurrence) '$ _ 100,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) s 6,000 � .. _�I I PERSONAL&ADV INJURY I g 1,000,000 GENERAL AGGREGATE. 2,000,00 GENI, AGGREGATE LIMIT APPLIES PER: (PRODUCTS - COMP/OP AGG $ 1,000,00 X POLICY PRO. .__ LOC JECT �... .:........Irt t*, ...._ $ '. AUTOMOBILE LIABILITY '... ! COMBINEU SINGLE LIMIT (Ea accident)_ $ _. ANY AUTO BODILY INJURY (Per person) $ ALL OWNED—, SCHEDULED l [ AUTOS AUTOS ( .BODILY INJURY(Po[acddenq $ - - - ....1 NON OWNED ! (HIRED AUTOS Silvia Cuevas PROPERTY DAMAGt _'Para—dsn?} $ __.AUTOS UMBRELLA LIAB EACH OCCURRENCE is OCCUR MADE'. EXCESS LIAB AGGREGATE $ LIED RETENTION.$ $ - WORKERS COMPENSATION ! X WC STATU- OTH-'I - AND EMPLOYERS LIABILITY YIN B % ANY PROPRIErORlPAftrhIERtEx£CUTIVE !2200066789-141 05102114 06102115 ( � TORY LIMIT$ �T_. E.L. EACH ACCIDENT • $ 1,000,00 — OFFICER(MEMBER EXCLUDED? .IN (Mandatory in NH) E L DISEASE EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS beow l EL DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS t LOCATIONS t VEHICLES (Attach ACORD 101, Addittonal Remarks Sebadulel, d more space Is required) Certificate holder, its officers, employees, agents, and representatives are named as Additional Insured in regards to the general liability where required by written contract, with primary and non-contributory wording in respects to the operations of the Name Insured. CITYOFS City of Santa Ana Parks, Recreation and Community Services 20 Civic Center Plaza Santa Ana, CA 92702 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZED REPRESENTATIVE @ 1988.2010 ACORD CORPORATION. All rights reserved. ACORD 26 (2010/05) The ACORD name and logo are registered marks of ACORD ACC)RV® CERTIFICATE OF LIABILITY INSURANCE km�THIS DA3E(MMIDO 5 NWY) 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 CONTACT NAME: Ken Palk KP Insurance Services 1331 5th Street Ste 12 QPHONE . 213)820-3943 ac No: R-MAIL ADDRESS: kGn.paik@yahoo.com ken. ahoo.com INSURERS AFFORDING COVERAGE NAICR Glendale, Ca 91201 INSURER A: Infinity Insurance Company INSURED INSURER a: Bell Building Maintenance INSURERC: -INSURER 0: 5170 Sepulveda Blvd. INSURER E: Sherman Oaks, Ca 91403 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 A BR POLICY NUMBER POLICY EFF MMIDO POLICY EXP IDO LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑ OCCUR EACH OCCURRENCE $ DAMAGE TO ENTEO PREMISES E pccurre ce $ MED ExP LAny one person) $ _ OR PERSONAL &ADV INJURY $ I_ AGGREGATE LIMIT APPLIES PER: POLICY JECOT LOG OTHER: GENERAL AGGREGATE $ PRODUCTS - GOMP/OP AGG $ $ A AUTOMOBILE LIABILITY ANY AUTO ALL UTOS ANED f( gUTOSULED HIRED AUTOS NON -OWNED �Ir - $045129902 04/14/201404114E2015 COMBINEDSINGLE LIMIT Es accident $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) .$ PROPERTY accident DAMAGE $ UMBRELLA LIAR EXCESS LIAR OCCUR CLAIMS -MADE wed Rev(ewed - y. EACH OCCURRENCE $ AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN ANY PROPRIETORIPARTNERIE%ECUTNE OFRCERIMEMBER EXCLUDEDT (Myyandatory in NH) 0ES RIPTION OF OPERATIONS below der N/A Gm f STATUTE ERH E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ Silvia Cuevas E. L. DISEASE -POLICY LIMIT I $ PRCSA/Ad in. DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Romarks Schedule, may be aaacnad if more space is requirod) Insured is a janitorial service contractor. The certificate holder is named as an additional insured of the policy. City of Santa Ana Purchasing Department 20 Civic Center Plaza Santa Ana, Ca 92702 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVES 01988-2014 ACORD CORPORATION. All rolvIR renamed. ACORD 26 (2014/01) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: EN102474100 COMMERCIAL GENERAL LIABILITY NX GL 189 05 11 R -. T0141"'. F 20 4 �, - • �. Y t. W. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Policy Number: EN102474100 Endorsement Effective: 1l1012015 12 O mat mat Named Insured: Counter Signed By: Bell Building Maintenance Inc., QBA: Bell Building Maintenance SCHEDULE Name of Person or Organization: Any person or organization that the named insured is obligated by virtue of a written contract or agreement to provide insurance such as is afforded by this policy. Location: (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) A. Section 11— Who Is An Insured is amended to include as an insured the person or organization shown in the Schedule, but only to the extent that the person or organization shown in the Schedule is held liable for your acts or omissions arising out of your ongoing operations performed for that insured. B. With respect to the insurance afforded to these additional insureds, the following exclusion is added: 2. Exclusions This insurance does not apply to"bodily injury" or "property damage" occurring after: (1) All work, including materials, parts or equipment furnished in connection with such work, on the project (other than services, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the site 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 intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. C. The words "you" and "your' refer to the Named In red shown in the Declarations. Reviewed �Y: NX GL 189 05 11 Silvia Cuevas Page 1 of 2 Includes copyrighted matopRll ft� ,$-a ices Office, Inc., with its permission POLICY NUMBER: D. The following are added to SECTION V — DEFINITIONS: COMMERCIAL GENERAL. LIABILITY NX GL 189 0511 "Your work" means work or operations performed by you or on your behalf; and materials, parts or equipment furnished In connection with such work or operations, E. The following additional provisions apply to any entity that is an insured by the terms of this endorsement; 1. Primarywording With respect to the Third Party shown above, this insurance is primary and non-contributing, Any and all other valid and collectable Insurance available to such Third Party in respect of work performed by you under written contractual agreements with said Third Party for loss covered by this policy, shall in no instance be considered as primary, co-insurance, or contributing insurance. Rather, any such other insurance shall be considered excess over and above the Insurance provided by this policy. 2. waver of Subrooatiot If required by written contract or agreement; we waive any right of recovery we may have against an entity that is an additional insured per the terms of this endorsement because of payments we make for injury or damage arising out of "you work" done under a contract with that person or organization. Reviewed by: Silvia Cuevas PRCSA/Admin. NX GL 189 05 11 Page 2 of 2 Includes copyrighted material of Insurance Services Office, Inc., with its permission