Loading...
HomeMy WebLinkAboutSANDWOOD ENTERPRISES, INC. (2)INSURANCE ON FILE WORK MAY PROCEED UNTIL INSURANCE EXPIRES Uei -_. CLERK OF COUNCIL DATE:- i —L(�✓ MAYOR Miguel A. Pulido MAYOR PRO TEM Vicente Sanniento COUNCILMEMBERS Angelica Amazons P. David Benavides Michele Martinez Roman Rema Sal Tinaiero July 28, 2016 Jason Vos Sandwood Enterprises, Inc. 2424 N. Batavia Orange, CA 92865 CITY OF SANTA ANA 20 Civic Center Plaza e P.O. Box 22030 Santa Ana, California 92702 714- 667 -2200 wwvv figVa- ana.arg Re: Agreement A -2016 -153 Contractor Agreement Extension Dear Mr. Vos: A- 2016- 153 -01 CtTY MANAGER David Cavazos CITY ATTORNEY Sonia R. Carvaiho CLERK OF THE COUNCIL Maria D. Hulzar Pursuant to Contractor Agreement A- 2016 -153, entered between Sandwood Enterprises, Inc. and the City of Santa Ana, dated July 1, 2016, Section 3 - Term, the expiration of the time period of said Agreement is hereby extended to October 31, 2016. The insurance cortificates and Additional Insured Endorsement are required to be extended and/or renewed to cover this extension, All other terms and conditions of said Agreement remain unchanged and in Hill force and effect. If you have any questions, please contact Ray Lirette in the Connnunity Development Agency at 714- 667 -2256. Sincerely, Cl'y OT SANTA AN David Cavazos City Manager APPROVED AS TO FORM: ATTEST: —_� Maria D. 1-luizar Clerk of the Council SANTA ANA CITY COUNCIL Miauad R. Pulido Vlctlnle samslenio Mldann, Martinez kniev"a Amezcua P. Dawd aanavitles Roman Reyna SW, c.,an;o Manx Mayor Pro Toni, Ward i Ward2 Ward3 Watd4 Winds 4v.N6 m uiid ,sanla -ana ora 'e I ({� t x: n n!mpi{jr ez(nlsanln -Hna wa aemazcuaCrDSngte@ na oro tlhenav dee(b)ea V2 -nna o,� «q�n}q,ganta -a tang sin' eo Santa -a ta.prg ACORV CERTIFICATE OF LIABILITY INSURANCE 1.-- DATE(MMIDONM) 6/10/2016 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(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 Brenda Durham Little S Smith Inc. 202 Church Street PHONE (990)429 -9395 N , EAIL 0EBg ,bdurhamOlittleandamith I com P. O. Box 1089 Marietta GA 30061 -_ INSURER1S) AFFORDING COVERAGE NAIC4 INSURER ASIECUrit National Ins.Cc. INSURED HR Outsourcing Hold: LLC L /C /F INSURERS: EACH OCCURRENCE Sandwaod Enterprises, Inc. INSURER C: - ATvT�GE`f6N -Nl S PREMISES PHA Orange County Sandbagger INSURER D: MED EXP(Anyone peson ) 1588 Atkinson Road Ste 201 INSURER E: _ Lawrenceville GA 30043 INSURER F: GENE AGGREGATE LIMIT APPLIES PER: POLICV[::] JEST � LOC OTHER: COVERAGES CERTIFICATE NUMBER:2015 /2016 Orange Countv RFVICIr3m mu MRGR: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE L18TED 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. - ILTR TYPE OF INSURANCE A LS D POLICY NU BER MOpI EFF MMI00MP LIMITS Community Development Agency 20 Civic Center Plaza, M -25 Santa Ana, CA 92701 COMMERCIAL GENERAL LIABILITY CL AIMS -MADE ❑OCCUR EACH OCCURRENCE - ATvT�GE`f6N -Nl S PREMISES MED EXP(Anyone peson ) $ PERSONAL &ADV INJURY $ GENE AGGREGATE LIMIT APPLIES PER: POLICV[::] JEST � LOC OTHER: GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ $ AUTOMOBILE LIABILITY ANY AUTO AUTOS NED gUTO5ULED NONAWNED HIRED AUTOS _ AUTOS 0 cc d nl N LE L A T $ BODILY INJURY (Per person) $ BODILY INJURV (Paracddenl) $ PROPERTY AMAGE Par esdtlen $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAI -MADE EACH OCCURRENCE $ AGGREGATE $ DEO EN ION $ A WORKERS COMPENSATION ANDEMPLOYERS'LIABILIT PIN ANY PROPRIETOWPARTNEtlEXECUTIVE OFFICERIMEMSER EXCLUDE[9 (Mandatary in NH) If yes dasadlle under OES RIF IONOF OPERATIONS below NIA SWC1098315- ORANGE COUNTY 12/31/2015 12/31/2016 X PER T OTH- E.L. EACH ACCIDENT $ 1 000, 00 El, DISEASE - EA EMPLOYE $ 1, 000 000 E.L. DISEASE - POLICY LIMIT $ 1 000 000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may heaeached if more space is required) UEK I II-ICA l t HULUtK CANCELLATION ©19882014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD INSD25i n1dmi SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Santa Anst/ Attn: Sonia Carvalho /City Attorney THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Administrative Services Division AUTHOR1250 REPRESENTATIVE Community Development Agency 20 Civic Center Plaza, M -25 Santa Ana, CA 92701 Eugene Northcutt /ItEC ©19882014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD INSD25i n1dmi A� v CERTIFICATE OF LIABILITY INSURANCE D06/19,1201 Y, 0 611 9/2 0 1 6 THIS CERTIFICATE IS ISSUED AS A MAT €R OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVEL OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, THIS CERTIFICATE OF INSURA 4CF DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND T IE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is ar ADDITIONAL INSURED, the pollcy(ies) must be endorsed. It SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, Can Iln policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorse m t(s), PRODUCER 800 287 3467 760 630 5222 1 NAMEp° RON BELL INSURANCE SERVICE LLC RON BELL INSURANCE SERVICE PNONE - 800 287 3467 P o Na: 760 630 5222 PO BOX 278 E "AIL RONBELINS @AOL.COM Daess: INSURED 7146372000 SANDWOOD ENTERPRISES INC 2424 BATAVIA ORANGE �n - n.nr•n !`GOTICIII'ATIe Ln IMRFR• REVISION NUMBER: w THIS IS TO CERTIFY THAT THE POLICIES OF INDICATED. NOTWITHSTANDING ANY REOUI CERTIFICATE MAY BE ISSUED OR MAY PER EXCLUSIONS AND CONDITIONS OF SUCH POL NSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD EMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS AIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, IES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IL SR TYPEOFINSURANCE ADD B R POLICY NUMEEft POLICYEFF MMDDIYYYY P I YEXP MIDDVYYYY LIMITS A COMMERCIAL GENERAL LIASIUTY CLAIMS -MAO, ❑✓ OCCUR MP00004002005 04117/2001 04/17/2017 EACH OCCURRENCE S 1.00q,DOO MES fE�oaNr carte ce S 100 000 2121 AN, one arson s 5 000 PERSONAL SADV INJURY b 1.000,000 GSN'L AGGREGATE LIIMIT APPLIES PER: POLICY M PRQ LOG GENERAL AGGREGATE 52000000 PRODUCTS- COMP /OPAGG $2,000,000 $ / OTHER: AVTOMOSLELIABIUTY ANY AUTO AVT09NEU SCHEDULED NON -OWNED HIRED AUTO5 AUTOS !' I� ,/ COMeI ED SINGL LIMI Eeec dent! $ BODILY INJURY (Per person) $ BODILY INJURY (Par accitlent) --- S P °eidaanl MA E $ b UMERELLA UAB OCCUR EACH OCCURRENCE 3 AGGREGATE b EXCESS LIAS CLAIMS -MADE DEC RET €N IONS �— WORKERS COMPENSATION ER T ERH S E.L. BAD H ACCIDENT AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORMARTNERIEXECUTIVE ❑ OFFICERIMEMBER EXCLUDED? (Mandatary In NHi II yes deACdba under DESitBJPTION OF QPER8TIObLE below NI FL, DISEASE -EA EMPLOYE 5 E.L. DISEASE -POUCV LIMIT S 5 DESCRIPTIONOF °PERATIONSILOCATIONS /VEHICLES THE CERTIFICATE HOLDER IS AN ADD ACORD 101, AddAlonalRamerks SChedula, rmy be Reached It more apace is required! IONAL INSURED PER THE ATTACHED ENDORSEMENTS INCLUDING LIABILITY AND DEFENSE ARISING FROM THE OPERATION ANS USES PERFORMED 8 OR BEHALF OF THE NAMED INSURED. PRIMARY AND NON CONTRIBUTORY APPLIES AND IS NOT ADDITIONAL TO ANY OTHER INSURANCE CARRIED BY GR FOR THE BENEFIT OF THE ADDITIONAL INSURED. 10 DAYS NOTICE FOR NONPAYMENT AND 30 DAYS FOR ALL OTHER. ITS OFFICERS, EMPLOYEES, AGE 4TS, AND SHOULD ANY OF THE ABOVE DESCRIBED POLIMES OF CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN REPRESENTATIVES ACCORDAN TH THE POLICY PROVISIONS, PO BOX 1988 SANTA ANA, CA 92702 A CRIZED REP ENTATIVE I _ ©tsa0.201aA coRPDRA o . reGelvea, ACORD 25 (2014101) �he ACORD name and logo are registered marks of ACORD POLICY NUMBER: MP00004 02005 COMMERCIAL'WSNERAL LIABILITY 00 20150704 THIS ENDORSEM CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADC ITIONAL INSURED - VENDORS This endorsement modifies Ira Iranre provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETE OPERATIONS LIABILITY COVERAGE PART SCME9ULE Name t f Addiponel l or ni d Watson(st Or ender Lout Pmducts CITY OF SANTA ANA ITS OFFICERS, EMPLOYEf S, AGENTS AND product made intentionally by the vendor, organizations) (referred to 'below as vendor) d. Repackaging, except when unpacked so* REPRESENTATIVES ut only oath respect to for the purpose of lnepectbn'de rxx stra- P 0 BOX 1988 SANTA ANA; CA 92702 damage" arising cut of v/G6i Irrformatlon i ed to cornile this Schedule if not shown abom will be shown in the Declarations, A, Seclfon 11 — WW Is An nsured is amended to c. Any physical or chemical ct"a in the Include as an additional Ir sured any person(s) or product made intentionally by the vendor, organizations) (referred to 'below as vendor) d. Repackaging, except when unpacked so* shown in the Schedule, I ut only oath respect to for the purpose of lnepectbn'de rxx stra- bodily Injury" or' damage" arising cut of tion, testing, or the sutWoltlon of parts un. "your products" shown In he Schedule which are der instructions from the manufacturer, and distributed or sold in the ri gular course of the ven- then repackaged In the ordinal container, dots business, subject to the following additional a Any failure to make such inspections, ad exclusions; jushrenta, ,tests or servichg as the vendor 1. The insurance afford the vendor does not has agreed to make or normally undertakes apply to: to make in the usual course of business, in a. "Bodily injury" or property damage" for connection with the distribution or sale of which the oerxior L obligated to pay dam - the Products; ages by reason oft assunptlonorfiability Ir Demonstration, installation, seryicing or in a Contract or ag Eve ment This exclusion repair, operations, except such operations does not apply to I lity, for damages that pertormad of the vendors premises in can - the vendor would in the absence of nection'wkh the "aof the product; the contract or agre nt; b. Any express warrar y unauthorized by yew; µ: Co 20 15 07 04 11 0 ISO Properties, Inc., 2004 Paige 1 of 2 ❑ L.___. g. Products which, site distribution or Gallo by (2) Such Inspection$, adjustments, tests or servicing the vendor has agreed to you, have been label as a container, pal d or relabeled or used as or ingredient of any moire or normally undertakes to make In other thing or subsUnCe by or for the Van- ton with thus se distribution f or sale nnec- the cor; or h. "bodily Injury or "pr out of the sole nogil petty damage' arising products. anon of the vendor for 2. This insurance do" not apply to arty Insured its own sole or orr sslons or those of its person or organization, from whom you have else acting on its be. acquired such products, or any ingredient, part employees at snyo hall, Rw&var this lusion does not apply or container, entering into, acobrnpomft or to: containing such preaUCt9. (A) The excW10l1 contained In Sub- naranrabtis d. or IN, or . Page 2 of 2 0150 Properties, Inc., 2W4 CO 20116 07 04 ❑ POLICYNUMBER; MP00 04002005 COMMERCIAL GENERAL LIABILITY CG 20 10 10 as THIS ENDORS MENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITI NAL INSURED - OWNERS, LESSEES OR CONTRACTORS (FORM B) This endorsement modifies i urance provided under the following: COMMERCIAL GENE LIABILITY COVERAGE PART lame of Person or Organi non: A premium charge may 10 associated with this form. Primary Insurance Applies The Issuance of this form a Person or Organization Is It Is agreed the insurance is as afforded by this poi - SubJectto company guideli as and approval. Icy ne the additional Insured shown shell 6 dmary Insurano , and any other insurance main. tain the a nal insured(s) shall be excess and non•conu ry„ but only as respects any claim, bas or liability arlsing out of the named Insured(s) or its subcon- tractors, and only If such claim, loss of liability Is deter- mined to be solely the negligence or responsibility of the named insured. p / appears cable WHO IS AN INSURED (Se ule, but only with respect to endorsement as 10 is amended to Include as an Insured the person or organization shown in the Schad - ty arising out of your ongoing operations performed for that Insured. CG 20 10 10 93 (PnnryPI4 Copyright, Insurance Services Ofllce, Inc., 1992 Page 1 of 1 Q® CERTIFICATE OF LIABILITY INSURANCE 7 DATE(MWOWY -M ADDL I 06/20/2016 PRODUCER STATE FARM INSURANCE - Jeff Biddle, AGENT 543 S GLASSELL STREET THIS CERTIFIC TIE IS ISSUED AS MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ORANGE, CA 92866 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. . INSURERS AFFORDING COVERAGE NAIC # INSURED Sandweod Ent Inc. INSURERA state US= Mutual Auto Insurance Company 25178 EACH OCCURRENCE 5 INSURER PREMISES Ea owvmw S OBA Orange County Sandbagger 2424 N Batavia Street NIURERC: —" Orange, Ca 92865 INSURER D: INSURER E: MEDEXPIAM",Rnon j $ nm,ee A nec THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY RBOUIREMENT, 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. AGGREGATE LIMITS SHOWN MAV HAVE BEEN REDUCED BY PAID CLAIMS. SIM A ADDL I TYPE OF INSURANCE P POLICY NUMBER D ID 6FPEG 0 0 RA L11.9T4 GENERALLIABILITY E EACH OCCURRENCE 5 5 PREMISES Ea owvmw S S COMMERCIALGENERAL LIABILITY P MEDEXPIAM",Rnon j $ $ WIIMSMADE FOCCUR M PERSONAL E AOV INJURY S S GENERAL AGGREGATE ; ; GBTLAOGREGATEUMfAPPJHSPER: I I PM S- COMPICPAGO $ $ A X X A AUTO M MOBILE LIABILITY 1 132 9265- D28 -75K 0 04 -28 -16 0 04 -2B -17 C COMBINED SINGLE LIMIT S 1, 000, 000 X A ALL OWNED AUTOS B BODILY INJURY $ 1, 000 X H HIREDAUTOS B BODILY INJURY (Para0dam) $ $ PROPERTYOAMAGE S S GARAOELMUILJTY A AUTO ONLY- EAACCIDENT $ $ OTHER THAN EAACC $ $ ANYAUTO O AUTO ONLY: AGO S S EXCESSIUMBRELLAIJABBJTY E EACH OCCURRENCE ; ; AGGREGATE �S OCCUR CLAIMS MADE A ; DEDUCTIBLE 5 RETENTION ; EMPLOYERS' LIABILITY AND ] ] WOaTATU- OTH- E.L. EACHACOIOENT S S ANY PROPRIETORLPARTNERJEXECUTIVE E EL DISEASE -EA EMPLOYEE S S If yes, desulbe under E ELOISEASE- POLICY LIMIT S S JOTHER DESCRIPTION OF OPERATIONS? LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVIS 4 Job description: All .Operations A/ 74 TI d d 4 .cnIir, lcnu> -ucn L;ANL:CLLATIUN City of Santa Ana SHOULD ANY OF THE ABOVE DESCRISEO POLICIES OE CANCELLED BEFORE THE ExMRATIoN its elected and appointed officials, offorers, DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ]D oWSWRITTEN employees and volunteers. NOTICE TOTHE CERTIFICATE HOLDER NAMED TO THE LEFT, BW FAILURE TO DO SO SHALL Engineering Department IMPOSE NO OBLIGATION OR LIABILITY OF ANY RIND UPON THE INSURER, ITS AGENTS OR 20 Civic Center Plaza REPRESENTATIVES, Santa Ana, CA 92701 AUTHORIZED REPRESENTATIVE Jeff Biddle, AGENT ~ T $2844 OS-1'5 -2017 vl On "B"+ra0 °O 53CUS 15all c y+- .++c,au+y w tnn um, ns uy a Ielr respective owners VAUV Ku UUKPORATION 1B ZS, 2 if'j All rights reserved ~ T $2844 OS-1'5 -2017 vl On "B"+ra0 °O 53CUS 15all c y+- .++c,au+y w tnn um, ns uy a Ielr respective owners VAUV Ku UUKPORATION 1B ZS, 2 if'j All rights reserved