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HomeMy WebLinkAboutRJM DESIGN GROUP INC. (2) -2014City of Santa A, a r t Clerk of the Council AGREEMENT TERMINATION FORM Please complete this form when the attached agreement and all amendments (if any) are no longer in effect.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 (' J 114 COTC Office Use Only � Cie V No. � �b ��_ �� was completed on and final payment has been made. (List all amendments. Use space below if needed.) J 0/7 A)-7 63 2> Revised: 01-07-16 Department: G- i oe Phone/Ext.: Signature: -?74 " r✓�� / 1 6� Date: MAYOR INSURANCE NOT ON F1L Miguel A. Puifdo t,�n pyo MAYOR PROTEtvt RKuN-QTPRCCEE Vicente Sarmien o CLERK {}F COUNCIL I1 \ 1 COUNCILMEMBERS Cdr, , ill Angelica Amezcua DATE: 4x1_ P David Senavides 2r'� Michele Martinez Roman Reyna �y SalTinajero CITY OF SANTA ANA PUBLIC WORKS AGENCY 20 Civic Center Plaza M-36 a P.O. Box 1988 M-36 Santa Ana, California92702 � www.santa-ana.orqrg June 28, 2016 Mr. Robert J. Mueting, Principal RJM Design Group 31591 Camino Capistrano San Juan Capistrano, CA 92675 Re: RJM Design Group Consultant Agreement "Extension" Dear Mr. Mueting: CITY M,#TR L -223-02 David Cavazos CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL Maria D. Holzer Pursuant to Agreement #A-2014-223 entered between RJM Design Group and the City of Santa Ana, dated September 16, 2014, and as amended by agreement #A-2014-223-01, Section S "Term", the time period of said Agreement is hereby extended for an additional one (1) year period, through September 30, 2017. The insurance certificates are required to be extended and/or renewed to cover this extension. All other terms and conditions of said Agreement remain unchanged and in full force and effect. If you have any questions regarding this matter, please contact Jason Gabriel, Principal Civil Engineer, at 714-647-5664. Sineer y, Pred ousavipour-�" Executive Director Public Works Agency APPROVED AS TO FORM: Sonia R. Carvalho City Attorney Jo e Sandoval hief Assistant Cily Attorney cc: Clerk of the Council CITY OF SANTA ANA David Cavazos Ciity'vana, r , ATTEST: Maria D. Huizar Clerk of the Council AMA lk&ol SANTA ANA CITY COUNCIL krg7 1 A. Pui`do i Yronta Sarmiento i M li; aie Manlez i ?c:;ei:ca Anxmua P. Dat l Bela 'des Roman Ra,,a Sat T atem F,tera 4teygr Pra Tem, Nam i Ward 2 Vtard a Wal 5 � 9artl 5 LVarJ a 1. R,hivtrm3aPta d`aM �IS]rT�an[amxrta 33otp t Mblar'[ - a}„@"U3•'SdCt3 dn3$-0 Q.P�ytL1 ;.a ttd 3('a Y. ftft:en3mna 132Ra _Yj 5 3.8!_^-b)s"aOta- 3^tm ACCDIR®' �,. CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 2/3/2017 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 Dealey, Renton & Associates DRA License 0020739 P. O. Box 10550 CONTACT NAME: PHONEFAX A/C, Na, Ext)• 714-427-6810 A/C Ne): 714-427-6818 E DRIESS: INSURERS AFFORDING COVERAGE NAIC # Santa Ana CA 92711-0550 INSURERA:Travelers Property Casualty Co of 25674 6802H913436 INSURED INSURERB:Travelers Casualty & Surety Co. Ame 31194 RJM Design Group, Inc. INSURERC:Travelers Indemnity Co. ofConnecti 25682 31591 Camino Capistrano San Juan Capistrano CA 92675 INSURER D :_ INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 33303936 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. ILTR TYPE OF INSURANCE IAN D y VD� POLICY NUMBER MM DD/YYYY ICY EFF POLICY EX LIMITS A X COMMERCIAL GENERAL LIABILITY Y Y 6802H913436 9/30/2016 9/30/2017 EACH OCCURRENCE $2,000,000 CLAIMS -MADE ❑X OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $1,000,000 MED EXP (Any one person) $10,000 X Contractual Liability PERSONAL & ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000 POLICY IA PE LOC PRODUCTS -COMP/OP AGG $4,_000,000 _ $ OTHER: C AUTOMOBILE LIABILITY Y BA5D394305 9/30/2016 9/30/2017 BINED SINGLE LIMIT Ea accident $1,00_0,000 BODILY INJURY (Per person) $ ANY AUTO '.. AUTOWNED SCHEDULED BODILY INJURY (Per accident) $ NON -OWNED X 'HIRED AUTOS X AUTOS PROPERTY DAMAGE Per accident $ $ A X UMBRELLA LAB X OCCUR CUP6E235883 9/30/2016 9/30/2017 EACH OCCURRENCE $1,000,000 AGGREGATE '... EXCESS LAB CLAIMS -MADE DED RETENTION $ _$1,000,000 $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN UB413OT960 9/30/2016 9/30/2017 PER OTH- X STATUTE ER E.L. EACH ACCIDENT —_ $1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? N / A -- E.L. DISEASE - EA EMPLOYEE .__._ $1,000,000 (Mandatory in NH) If yes, describe under - — -------- DESCRIPTION OF OPERATIONS below E.L. DISEASE: POLICY LIMIT $1,000,000 B Professional Liability 105991919 10/1/2016 10/1/2017 Per Claim $1,000,000 Claims Made , 1 1 Annual Aggr. $2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) General Liability policy excludes claims arising out of the performance of professional services. Re: A-2009-023 and A-2014-223-01. The City of Santa Ana, its officers, employees and representatives are Additional Insured as respects to General and auto Liability coverage as required by written contract. Primary and Non -Contributory applies to General Liability as required by written contract. Waive47ofS gation for Work Comp is included as required by written contract. _. I___^ __.._......_._.. _.......________._._...____..._ See Attached... FtEVkLVVED BY' i t1NICE k IRw..REI..)BA 111191MI:an20Ka��iL•Jtta:I City of Santa Ana Attn: Marilyn Boothe P.O. Box 1988 Santa Ana, CA 92702-1988 CELI_ATION ou uay INuu/ I u uay Tor IvonF-ay OT [-rem 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 I © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: LOC #: ACCW?" ADDITIONAL REMARKS SCHEDULE Pogo 1 of 1 _ AGENCY Dealey, Renton & Associates NAMEDINSURED RJIVI Design Group, Inc. 31591 Camino Capistrano San Juan Capistrano CA 92675 POLICY NUMBER CARRIER EFrECTIVE DATE: THIS ADDITIONAL REMARKS FORM oaASCHEDULE TnAconoFORM, FORM NUMBER: 25FORM TITLE: CERTIFICATE OFLIABILITY INSURANCE � Separation of Insureds - general liability Except with respect to the Limits of Insurance, and any rights or duties specifically assigned in this Coverage Part to the first Named Insured, this insurance applies: a. As if each Named Insured were the only Named Insured; and b. Separately to each insured against whom claim is made or suit is brought. AL,uxu`m(Zvvvmn eznooACowoCORPORATION. All rights reserved. Agbk TRAVELERS, WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 99 03 76(00) — 001 POLICY NUMBER: UB413OT960 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT CALIFORNIA (BLANKET WAIVER) We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 3.00 % of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description ALL PERSONS OR ORGANIZATIONS THAT ARE PARTIE TO A CONTRACT THAT REQUIRES YOU TO OBTAIN THIS AGREEMENT, PROVIDED YOU EXECUTED THE CONTRACT BEFORE THE LOSS. DATE OF ISSUE: 2 / 3 / 2 017 ST ASSIGN: CA 111951110141 REVIEWED BY, E L J NICE - f ER - EM -- I - ' G 0 --F- J THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect (ocoverage provided bythis endorsement, the provisions ofthe Coverage Form apply unless modified bythe endorsement. Paragraph 5.Transfer ofRight 0f Recovery Against Others ToUsofthe CONDITIONS section iureplaced bythe following: 5. Transfer Of Rights 0fRecovery Against Others To Us We waive any right ofrecovery wemay have required ofyou byawritten contract executed prior hzany ^aoodent"or^|oao,provided that the "aouideny'or^|000^arises out ofthe operations contemplated bysuch contract. The waiver applies only tothe person or organization designated insuch contract. CA T3 40 08 08 @2008 The Travelers Companies, Inc. POLICY NUMBER: BA -5D394305 -16 -GRP COMMERCIAL AUTO ISSUE DATE: 08-30-16 DESIGNATED INSURED FOR COVERED AUTOS LIABILITY COVERAGE This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modi- fied by this endorsement, This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form, This endorsement does not alter coverage pro- vided in the Coverage Form. SCHEDULE Name Of Person(s) Or Organization(s). ANY PERSON OR ORGANIZATION THAT YOU ARE REQUIRED TO INCLUDE AS AN ADDITIONAL INSURED ON THIS COVERAGE FORM IN A WRITTEN CONTRACT OR AGREEMENT THAT 19 SIGNED AND EXECUTED BY YOU BEFORE THE "BODILY INJURYK OR 9PROPERTY DAMAGE" OCCURS AND THAI' IS IN 'EFFECT DURING THE POLICY PERIOD. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Each person or organization shown in the Schedule is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An insured provi- sion contained in Paragraph A.1. of Section 11 — Cov- CA 20 48 10 t 3 ered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section I — Covered Autos Coverages of the Auto Dealers Coverage Form, 0 Insurance Services Office, Inc., 2011 Page I of 1 ------------ REVIEW ED BY:DSNI CE i IEREDA (PG5 OF—/ I . ... ..... .... . __.. ------ F--] COMMERICAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. The following is added to WHO IS AN INSURED (Section 11): Any person or organization that you agree in a "contract or agreement requiring insurance" to in- clude as an additional insured on this Coverage Part, but only with respect to liability for "bodily in- jury", "property damage" or "personal injury" caused, in whole or in part, by your acts or omis- sions or the acts or omissions of those acting on your behalf: a. In the performance of your ongoing opera- tions; b. In connection with premises owned by or rented to you; or c. In connection with "your work" and included within the "products -completed operations hazard". Such person or organization does not qualify as an additional insured for "bodily injury", "property damage" or "personal injury" for which that per- son or organization has assumed liability in a con- tract or agreement. INSURANCE (Section 111) for this Coverage Part. B. The following is added to Paragraph a. of 4. Other Insurance in COMMERCIAL GENERAL LIABILITY CONDITIONS (Section IV): However, if you specifically agree in a "contract or agreement requiring insurance" that the insurance provided to an additional insured under this Cov- erage Part must apply on a primary basis, or a primary and non-contributory basis, this insurance is primary to other insurance that is available to such additional insured which covers such addi- tional insured as a named insured, and we will not share with the other insurance, provided that: (1) The "bodily injury" or "property damage" for which coverage is sought occurs; and (2) The "personal injury" for which coverage is sought arises out of an offense committed; The insurance provided to such additional insured is limited as follows: d. This insurance does not apply on any basis to any person or organization for which cover- C age as an additional insured specifically is added by another endorsement to this Cover- age Part. e. This insurance does not apply to the render- ing of or failure to render any "professional services". f. The limits of insurance afforded to the addi- tional insured shall be the limits which you agreed in that 'contract or agreement requir- ing insurance" to provide for that additional insured, or the limits shown in the Declara- tions for this Coverage Part, whichever are less. This endorsement does not increase the limits of insurance stated in the LIMITS OF after you have entered into that 'contract or agreement requiring insurance". But this insur- ance still is excess over valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that is available to the insured when the insured is an additional insured under any other insurance. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us in COMMERCIAL GENERAL LIABILITY CON- DITIONS (Section IV): We waive any rights of recovery we may have against any person or organization because of payments we make for "bodily injury", "property damage" or "personal injury" arising out of "your work" performed by you, or on your behalf, under a "contract or agreement requiring insurance" with that person or organization. We waive these rights only where you have agreed to do so as part of the "contract or agreement requiring insur- ance" with such person or organization entered into by you before, and in effect when, the "bodily CG D3 81 09 07 O 2007 The Travelers Companies, Inc. Page 1 of 2 Includes the copyrighted material of Insurance Services Office, Inc with its permis on. EVIr vert I,r tf v r I, NKr I It Inc DIA (PG0-F.1 _..._.... ..... _ _ ._._.. __ . _ ..._. _.. COMMERICAL GENERAL LIABILITY injury" or "property damage" occurs, or the "per- sonal injury" offense is committed. D. The following definition is added to DEFINITIONS (Section V): "Contract or agreement requiring insurance" means that part of any contract or agreement un- der which you are required to include a person or organization as an additional insured on this Cov- erage Part, provided that the "bodily injury" and "property damage" occurs, and the "personal in- jury" is caused by an offense committed: a. After you have entered into that contract or agreement; b. While that part of the contract or agreement is in effect; and c. Before the end of the policy period. Page 2 of 2 © 2007 The Travelers Companies, Inc. CG D3 81 09 07 Includes the copyrighted material of Insurance Services Office, Inc., with i e rhission. REVIEWED By EUNICE HERE- DIA (PG -70F —.... _ ..._._...._ _ _ ............ ......._