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HomeMy WebLinkAboutKNOWLWOOD ENTERPRISES (2) -2014City of Santa A t Clerk of the Council AGREEMENT TERMINATION FORM COTC Office Use Please complete this form when the attached agreement and all 20-70 FEB '6 PM 3-- 37 amendments (if any) are no longer in effect. Note: If your agreement is grant related, please ensure that all grant retention requirements CITY OF' S ` N TA ANA have been satisfied prior to signing the termination form. CLERK JOF COUNCIL Return form to the Clerk of the Council Office (M-30). Call 647-1520 if you have any questions. The agreement with Kruk,., A xy-(� 1 c x i .S, 7Lrnc', No. —�Q\y —Q\ Z —p\ was completed on 11,3i 1 j1 and final payment has been made. (List all amendments. Use space below N needed.) Department: PPC;S } Phone/Ext.: Signature: Date: Revised: 01-07-16 I14 UTiOIGi ON I L, WOF1K MAY PrindEr) January 5, 2016 ` Knowlwood Enterprises, Inc. Thanh D. Nguyen, President 17654 Newhope Street, Suite H Fountain Valley, CA 92708 Re: Extension of Concession Agreement Agreement No. A- 2010 -239 Dear Mr. Nguyen: A- 2014 - 012 -01 CITY MANAGER David Cavazos CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL Maria D. Hulzar Pursuant to Section 3, of Agreement No. A- 2010 -239, entered between Knowlwood Enterprises, Inc, and the City of Santa Ana, elated January 20, 2011, and extended by First Extension No. A- 2014 -012, the teen of the Agreement is hereby extended for an additional two (2) year period, from February 1, 2016 through January 31, 2018. The insurance certificates are required to be extended and/or renewed to cover this extension, All other terms and conditions of the Agreement and First Amendment, remain unchanged and in full force and effect. Sincerely, Gerardo Monet a Executive Director of Parks Recreation and Community Services Agency APPROVED AS TO FORM: Sonia R. Carvalho City Attorney t M. Frank ssistant City Attorney CITY OF SANTA ANA David Cavazos City Manager ATTEST: Maria D. Huizar Clerk of the Council Cf SANTA ANA CITY COUNCIL Miguel A. Pulitlo Vincent F. Sermlenlo Michele Martinez i Angelica Amezous P David eenw,de5 Roman Rayne Sal Tlnalero Mayor Mayor Pro Tam, Ward i Ward 2 Ward 3 Ward 4 Ward 5 Ward 6 MP I'd (&sanl - a.org �llplgp_19fssaota -ana org MMarlian@sonta.ana,ora AA mezcuarasanta- ana grg DeenaNtlesnpsanl5„r�pg:4r� RRevna(d!ssnla -am ire STnaero(cbaflnta- r MAYOR MtgueIA.Pulido / UNTIL INSIJMAN(I f XPIR I'U ^i— i'°�j+ ~ MAYOR PRO TEM Vincent F, SarmlenEO COUNCILMEMBERS CLERK O GUUNCR OATE- O AiE. = r ry Angelica Amezcua r P. David Benavldes Michele Martinez _ Q-11 °� Roman Rayne SalTinajero 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 ffivwsanta- ana.ora January 5, 2016 ` Knowlwood Enterprises, Inc. Thanh D. Nguyen, President 17654 Newhope Street, Suite H Fountain Valley, CA 92708 Re: Extension of Concession Agreement Agreement No. A- 2010 -239 Dear Mr. Nguyen: A- 2014 - 012 -01 CITY MANAGER David Cavazos CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL Maria D. Hulzar Pursuant to Section 3, of Agreement No. A- 2010 -239, entered between Knowlwood Enterprises, Inc, and the City of Santa Ana, elated January 20, 2011, and extended by First Extension No. A- 2014 -012, the teen of the Agreement is hereby extended for an additional two (2) year period, from February 1, 2016 through January 31, 2018. The insurance certificates are required to be extended and/or renewed to cover this extension, All other terms and conditions of the Agreement and First Amendment, remain unchanged and in full force and effect. Sincerely, Gerardo Monet a Executive Director of Parks Recreation and Community Services Agency APPROVED AS TO FORM: Sonia R. Carvalho City Attorney t M. Frank ssistant City Attorney CITY OF SANTA ANA David Cavazos City Manager ATTEST: Maria D. Huizar Clerk of the Council Cf SANTA ANA CITY COUNCIL Miguel A. Pulitlo Vincent F. Sermlenlo Michele Martinez i Angelica Amezous P David eenw,de5 Roman Rayne Sal Tlnalero Mayor Mayor Pro Tam, Ward i Ward 2 Ward 3 Ward 4 Ward 5 Ward 6 MP I'd (&sanl - a.org �llplgp_19fssaota -ana org MMarlian@sonta.ana,ora AA mezcuarasanta- ana grg DeenaNtlesnpsanl5„r�pg:4r� RRevna(d!ssnla -am ire STnaero(cbaflnta- r ACC)RO CERTIFICATE OF LIABILITY INSURANCE DATE IMMIDD Y) �� 01/08/2016 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 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 Erika Schmidt NAME: Tagrisk Insurance Services (AHONNa Exll: t714) 699 -9345 FAX Nol: (716)613 -0911 7755 Center Avenue E-MAIL ADDRESS: eschmidt @tagrisk.com Suite 605 Huntington Beach CA 92647 INSURERAAllied Insurance _ INSURED �. .. �, `�.„�'X rl I - - - NOT Inc. and Knowlwood Enterprises Inc. DBA: Knowlwood 17564 Newhope Street Suite H Fountain Valley CA 92708 -- -- -- - INSURERS_______ C_:_ _INSURER INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMSER:15 -16 GL - Fullerton 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 'AOOL. SIIBR. - - -- ',. POLICYEFF POLICY EXP LTR TYPE OF INSURANCE POLICYNUMBER MMIDONYVY MWDOIYYYY -- LIMITS X COMMERCIAL GENERAL LIABILITY'S EACH OCCURRENCE $ 2,000,000 A �' CLAIMS -MADE X ' OCCUR ''. _. DANA R�'FE TED PREMISES Ea occurrence) I$ 300,000 X MP BPF 7892162960 4/1/2015 4/1/2016 MEO EXP(Anyone person)_ ;$ - - 5,000 'PERSONAL &ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE S 4,000,000 X POLICY PRO- JECT LOG PRODUCTS -COMPIOPAGG $ 4,000,000 OTHER', LIQUOR LIABILITY $ 2,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (EaaccidenU $ 1,000,000 ANY AUTO BODILY INJURY (Per person) $ A ALL UONMEO X SCHEDULED AUTOS AUTOS BODILY INJURY(Peraccibent'$ ) .._.-.. _ X X NON -OWNED X ACP BPF 7892162960 4/1/2015 4/1/201fi PROPERTY DAMAGE $ _ HIRED AUTOS _ '. AUTOS (Par accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ J EXCESS LIAB CLAIMS -MADE GGREGATE $ DED RETENTION $ p�$ WORKERS COMPENSATION V �� STATUTE OERH YIN N e�\ _ _ — ,/Y ANY PROPR EEORIP RBINERIEXECUTIVE h q OFFICER /MEMBER EXCLUDED? NIA \ _E.L. EACH ACCIDENT $ - tl (Mandatory in NH) - E DISEASE EA EMPLOYEE$ Vw� f yes, describe under \�. . DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT' $ S��G� I 4 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Location: 1601 East Chestnut Avenue Santa Ana, CA 92701 The Certificate Holder is included as Additional Insured. The City of Santa Ana and Their Respective Officers, Employees, Agents, Volunteers, and Representatives 20 Civic Center Plaza Santa Ana, CA 92701 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 It f I t/ ika Schmidt /ERIKA 4 ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 (201401) All rights reserved. ® ACC) ® CERTIFICATE OF LIABILITY INSURANCE OATE(MMIODPYYYY) 1/21/2016 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 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 GLENN A LEVINE 104 Cloudcrest Aliso Viejo, CA 92656 NAME: _ PHONE ac N Ext1', (714) 865 -1408 _ FAX Not(949) 305 -0266 A60 "a'Ess:galinsurance @yahoo.com INSURER(Sh AFFORDING COVERAGE NAICN _ INSURER A: CYPRESS INSURANCE COMPANY 10855 INSURED NDT INC. S KNOWLWOOD ENTERPRISES, INC. DSA: KNOWLWOOD 17654 NEWHOPE ST. SUITE H FOUNTAIN VALLEY, CA 92708 714 429 9356 INSURER B. INSURER C: INSURER D. 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 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. _ irn TYPE OF INSURANCE AINSD VWD POLICY NUMBER MMID�� MM%DCNYVV LIMITS it - -- COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR � EACH OCCURRENCE $ AGE PREMISES (Ea occurrence ) $ _ MED EXP (Any one person) $ GENL AGGREGATE LIMIT APPLIES PER: POLICY JECOT D LOO OTHER: PERSONAL BADV INJURY GENERAL AGGREGATE _$ $ PRODUCTS - COMPIOPA_G_G $ $ AUTOMOBILE LIABILITY _ ANVAUTO ALL OWNED SCHEDULED _ AUTOS AUTOS _ HIRED AUTOS _ AUTOS n��QU ,� p ,\� C �.r �� (� i Ea accidenq $ BODILY INJURY (Par person) $ BBOODIILY NJURY(PParE. dl $$ -- Peramident - $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE a Q EACH OCCURRENCE $ AGGREGATE $ DED RETENTION$ A WORKERS COMPENSATION IAND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNER/E%ECUTIVE ❑ OFFICERIMEMBER E%CWDEOI Y (Man4ewry in NRI DESCRIPTION under I yes, CRIPTION OFO OPERATIONS below NIA KAIWC 609938 02/01/2015 02/01/2016 j[ - STATUTE ER E L, EACH ACCIDENT $ 1,000,000 _ E . DISEASE - EA EMPLOYE $ 1,000 , 000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) ITHE INSURED OPERATES A RESTAURANT LOCATED AT 1801 E. CHESTNUT AVE., SANTA ANA, CA 92701 I THE CITY OF SANTA ANA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 2O CIVIC CENTER PLAZA THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. SANTA ANA, CA 92701 '. AUTHORIZED REPRESENTATIVE © 1988 -2014 ACORf D/CCOf `RPOt RRA`ATT'IOON..� All rights reserved. ACORD25 (2014/01) The ACORD name and logo are registered marks of ACORD EFFECTIVE DATE: 12:01 AM Standard Time, (at your principal place of business) BUSINESSOWNERS PIS 25 00 (01 -01) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY NUMBER: ACP BPR 7872182980 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AMENDMENT OF OTHER INSURANCE CONDITION: PRIMARY INSURANCE FOR NAMED INSURED PRIMARY INSURANCE FOR NAMED INSURED IN THE PREMIER BUSINESSOWNERS COMMON POLICY CONDITIONS, UNDER CONDITION H. OTHER INSURANCE, THE FOLLOWING IS ADDED: WITH RESPECT ONLY TO THE PERSONS OR ORGANIZATIONS SHOWN IN THE SCHEDULE OF THIS ENDORSEMENT, WHO HAVE BEEN ADDED BY SEPARATE ENDORSEMENT AS ADDITIONAL INSUREDS, THE INSURANCE AFFORDED TO YOU NDT INC AND KNOWLWOOD ENTERPRISES INC DBA KNOWLWOOD BY THIS POLICY SHALL BE PRIMARY INSURANCE WITH RESPECT TO ANY CLAIM OR SUIT AGAINST YOU ARISING OUT OF YOUR ONGOING OPERATION PERFORMED FOR SUCH PERSONS OR ORGANIZATIONS. WITH RESPECT TO SUCH PERSONS' OR ORGANIZATIONS' LIABILITY ARISING SOLELY OUT OF YOUR ONGOING OPERATIONS PERFORMED FOR THEM, ANY OTHER INSURANCE MAINTAINED BY SUCH PERSONS OR ORGANIZATIONS WITH RESPECT TO SUCH LIABILITY SHALL BE NON - CONTRIBUTING WITH YOUR INSURANCE UNDER THIS POLICY. SCHEDULE OF PERSONS OR ORGANIZATIONS: THE CITY OF SANTA ANA AND THEIR RESPECTIVE OFFICERS, EMPLOYEES, AGENTS, VOLUNTEERS, AND REPRESENTATIVES 20 CIVIC CENTER PLZ SANTA ANA, CA 92701- 4058��w���ta i All terms and conditions of this policy apply unless modified by this endorsement. PB 25 00 (01 -01)