HomeMy WebLinkAboutULTRASYSTEMS ENVIRONMENTAL, INC.-2014INSURANCE ON FILE
wORK MAY PROCEED A-2014-263
UNTIL. INSURANCE EXPIRES
1
CLERK OCOUNCIL
DATE: I-/) , 0 CONSULTANT AGREEMENT
THIS AGREEMENT, made and entered into this 21St day of October, 2014 by and between
UltraSVstems Environmental. Inc., a California corporation (hereinafter "Consultant"), and the City of Santa
Ana, a charter city and municipal corporation organized and existing under the Constitution and laws of the
State of California (hereinafter "City").
RECITALS
A. The City desires to retain a consultant having special skill and knowledge in the field of
environmental services and related technical studies.
B. Consultant represents that Consultant is able and willing to provide such services to the City.
C. In undertaking the performance of this Agreement, Consultant represents that it is knowledgeable in
its field and that any services performed by Consultant under this Agreement will be performed in
compliance with such standards as may reasonably be expected from a professional consulting firm
in the field.
NOW THEREFORE, in consideration of the mutual and respective promises, and subject to the terms and
conditions hereinafter set forth, the parties agree as follows:
1. SCOPE OF SERVICES
Consultant shall provide environmental study and related technical study services related to analyses
of the California Environmental Quality Act and the National Environmental Policy Act, as set forth in City's
Request for Qualifications for Environmental Consultants, incorporated to this Agreement by reference, and
Consultant's Proposal, attached hereto as Exhibit A and incorporated by reference to this Agreement. Said
services shall be provided at the request of the City Manager and Executive Director of the Planning and
Building Agency, as evidenced by a writing signed by the City Manager, Executive Director and the City
Attorney.
2. DELIVERY OF WORK PRODUCT
Consultant shall deliver to City all work product which results from the services provided. Said work
product shall be submitted in hard copy and produced in a form compatible with City's computer system, as
agreed between the Project Manager and Consultant.
In regard to all copyrightable material produced as a deliverable under this Agreement, including but
not limited to books, reports, plans, photographs, drawings, films, recordings, videotapes, and computer
programs, Consultant agrees, for itself and for its affected officers, employees, agents, contractors, and
volunteer workers, that (a) other such material may not be copyrighted without prior review from the City,
and (b) the authors of all such material, whether copyrighted or not, award to the City, and to its officers,
agents and employees acting within the scope of their official duties, as a condition of payment to the
Consultant, a royalty -free, nonexclusive, irrevocable license throughout the world for governmental purposes
to disclose, publish, translate, reproduce, and use such materials.
3. COMPENSATION
a. City agrees to pay, and Consultant agrees to accept as total payment for its services, the rates and
charges identified in Exhibit A. The total sum to be expended under this Agreement shall be set in the
writing authorizing Consultant to perform a specific project pursuant to this Agreement.
b. Payment by City shall be made within thirty (30) days following receipt of proper invoice
evidencing work performed, subject to City accounting procedures. Payment need not be made for work
which fails to meet the standards of performance set forth in the Recitals which may reasonably be expected
by City.
4. TERM
This Agreement shall commence on the date first written above and terminate on October 21, 2017,
unless terminated earlier in accordance with Section 13, below. The term of this Agreement may be
extended upon a writing executed by the City Manager, Executive Director of Planning and Building and the
City Attorney.
5. INDEPENDENT CONTRACTOR
Consultant shall, during the entire term of this Agreement, be construed to be an independent
contractor and not an employee of the City. This Agreement is not intended nor shall it be construed to
create an employer-employee relationship, a joint venture relationship, or to allow the City to exercise
discretion or control over the professional manner in which Consultant performs the services which are the
subject matter of this Agreement; however, the services to be provided by Consultant shall be provided in a
manner consistent with all applicable standards and regulations governing such services. Consultant shall pay
all salaries and wages, employer's social security taxes, unemployment insurance and similar taxes relating to
employees and shall be responsible for all applicable withholding taxes.
G. INSURANCE
Prior to undertaking performance of work under this Agreement, Consultant shall maintain and shall
require its subcontractors, if any, to obtain and maintain insurance as described below:
a. Commercial General Liability Insurance. Consultant shall maintain commercial general liability
insurance naming the City, its officers, employees, agents, volunteers and representatives as additional
insured(s) and shall include, but not be limited to protection against claims arising from bodily and personal
injury, including death resulting therefrom and damage to property, resulting from any act or occurrence
arising out of Consultant's operations in the performance of this Agreement, including, without limitation,
acts involving vehicles. The amounts of insurance shall be not less than the following: single limit coverage
applying to bodily and personal injury, including death resulting therefrom, and property damage, in thetotal
amount of $1,000,000 per occurrence. Consultant shall supply City with a fully executed additional insured
endorsement in substantially the form attached hereto as Exhibit B upon execution of this Agreement and
shall be approved in form by the City Attorney.
b. Business automobile liability insurance, or equivalent form, with a combined single limit of not
less than $1,000,000 per occurrence. Such insurance shall include coverage for owned, hired and non -owned
automobiles.
c. Worker's Compensation Insurance. In accordance with the provisions of Section 3300 of the
Labor Code, Consultant, if Consultant has any employees, is required to be insured against liability for
worker's compensation or to undertake self-insurance. Prior to commencing the performance of the work
under this Agreement, Consultant agrees to obtain and maintain any employer's liability insurance with
limits not less than $1,000,000 per accident.
d. Professional liability (errors and omissions) insurance, with a combined single limit of not less
than $1,000,000 per claim.
e. The following requirements apply to the insurance to be provided by Consultant pursuant to this
section:
(i) Consultant shall maintain all insurance required above in full force and effect for the
entire period covered by this Agreement.
(ii) Certificates of insurance shall be furnished to the City upon execution of this
Agreement and shall be approved in form by the City Attorney.
(iii) Certificates and policies shall state that the policies shall not be canceled or reduced in
coverage or changed in any other material aspect without thirty (30) days prior written
notice to the City.
f If Consultant fails or refuses to produce or maintain the insurance required by this section or fails
or refuses to furnish the City with required proof that insurance has been procured and is in force and paid
for, the City shall have the right, at the City's election, to forthwith terminate this Agreement. Such
termination shall not effect Consultant's right to be paid for its time and materials expended prior to
notification of termination. Consultant waives the right to receive compensation and agrees to indemnify the
City for any work performed prior to approval of insurance by the City.
W�1I01 MOV lci-r 01 [OF 1 Y (-1]U
Consultant agrees to and shall indemnify and hold harmless the City, its officers, agents, employees,
consultants, special counsel, and representatives from liability: (1) for personal injury, damages, just
compensation, restitution, judicial or equitable relief arising out of claims for personal injury, including
health, and claims for property damage, which may arise due to negligent acts, omissions or willful
misconduct in the performance, from the direct or indirect operations of the Consultant or its contractors,
subcontractors, agents, employees, or other persons acting on their behalf which relates to the services
described in section 1 of this Agreement; and (2) from any claim that personal injury, damages, just
compensation, restitution, judicial or equitable relief is due by reason of the terms of or effects arising from
negligent acts, omissions or willful misconduct in the performance of this Agreement. The Consultant
further agrees to indemnify, hold harmless, and pay all costs for the defense of the City, including fees and
costs for special counsel to be selected by the City, regarding any action by a third party asserting that
personal injury, damages, just compensation, restitution, judicial or equitable relief due to personal or
property rights arises by reason of effects arising from this Agreement. City may make all reasonable
decisions with respect to its representation in any legal proceeding.
CONFIDENTIALITY
If Consultant receives from the City information which due to the nature of such information is
reasonably understood to be confidential and/or proprietary, Consultant agrees that it shall not use or disclose
such information except in the performance of this Agreement, and further agrees to exercise the same degree
of care it uses to protect its own information of like importance, but in no event less than reasonable care.
"Confidential Information" shall include all nonpublic information. Confidential information includes not
only written information, but also information transferred orally, visually, electronically, or by other means.
Confidential information disclosed to either party by any subsidiary and/or agent of the other party is covered
by this Agreement. The foregoing obligations of non-use and nondisclosure shall not apply to any
information that (a) has been disclosed in publicly available sources; (b) is, through no fault of the Consultant
disclosed in a publicly available source; (c) is in rightful possession of the Consultant without an obligation
of confidentiality; (d) is required to be disclosed by operation of law; or (e) is independently developed by
the Consultant without reference to information disclosed by the City.
9. CONFLICT OF INTEREST CLAUSE
Consultant covenants that it presently has no interests and shall not have interests, direct or indirect,
which would conflict in any manner with performance of services specified under this Agreement.
10. NOTICE
Any notice, tender, demand, delivery, or other communication pursuant to this Agreement shall be in
writing and shall be deemed to be properly given if delivered in person or mailed by first class or certified
mail, postage prepaid, or sent by telefacsimile or other telegraphic communication in the manner provided in
this Section, to the following persons:
To City: Clerk of the City Council
City of Santa Ana
20 Civic Center Plaza (M-30)
P.O. Box 1988
Santa Ana, CA 92702-1988
telefacsimile (714) 647-6956
With courtesy copies to:
Executive Director of Planning and Building
City of Santa Ana
20 Civic Center Plaza (M-20)
P.O. Box 1988
Santa Ana, California 92702
telefacsimile (714) 973-1461
City Attorney
City of Santa Ana
20 Civic Center Plaza (M-29)
P.O. Box 1988
Santa Ana, California 92702
telefacsimile (714) 647-6515
To Consultant: UltraSystems Environmental, Inc.
16431 Scientific Way
Irvine, CA 92618
Telefacsimile (949) 788-4901
A party may change its address by giving notice in writing to the other party. Thereafter, any
communication shall be addressed and transmitted to the new address. If sent by mail,
communication shall be effective or deemed to have been given three (3) days after it has been
deposited in the United States mail, duly registered or certified, with postage prepaid, and addressed
as set forth above. If sent by telefacsimile, communication shall be effective or deemed to have been
given twenty-four (24) hours after the time set forth on the transmission report issued by the
transmitting facsimile machine, addressed as set forth above. For purposes of calculating these time
frames, weekends, federal, state, County or City holidays shall be excluded.
11. EXCLUSIVITY AND AMENDMENT
This Agreement represents the complete and exclusive statement between the City and Consultant,
and supersedes any and all other agreements, oral or written, between the parties. In the event of a conflict
between the terms of this Agreement and any attachments hereto, the terms of this Agreement shall prevail.
This Agreement may not be modified except by written instrument signed by the City and by an authorized
representative of Consultant. The parties agree that any terms or conditions of any proposal or other
instrument that are inconsistent with, or in addition to, the terms and conditions hereof, shall not bind or
obligate Consultant nor the City. Each party to this Agreement acknowledges that no representations,
inducements, promises or agreements, orally or otherwise, have been made by any party, or anyone acting on
behalf of any parties, which are not embodied herein.
12. ASSIGNMENT
Inasmuch as this Agreement is intended to secure the specialized services of Consultant, Consultant
may not assign, transfer, delegate, or subcontract any interest herein without the prior written consent of the
City and any such assignment, transfer, delegation or subcontract without the City's prior written consent
shall be considered null and void. Nothing in this Agreement shall be construed to limit the City's ability to
have any of the services which are the subject to this Agreement performed by City personnel or by other
consultants retained by City.
13. TERMINATION
This Agreement may be terminated by the City upon thirty (30) days written notice of termination. In
such event, Consultant shall be entitled to receive and the City shall pay Consultant compensation for all
services performed by Consultant prior to receipt of such notice of termination, subject to the following
conditions:
a. As a condition of such payment, the Executive Director may require Consultant to deliver to the City
all work products completed as of such date, and in such case such work product shall be the property of the
City unless prohibited by law, and Consultant consents to the City's use thereof for such purposes as the City
deems appropriate.
b. Payment need not be made for work which fails to meet the standard of performance specified in the
Recitals of this Agreement.
14. DISCRIMINATION
Consultant shall not discriminate because of race, color, creed, religion, sex, marital status, sexual
orientation, age, national origin, ancestry, or disability, as defined and prohibited by applicable law, in the
recruitment, selection, training, utilization, promotion, termination or other employment related activities.
Consultant affirms that it is an equal opportunity employer and shall comply with all applicable federal, state
and local laws and regulations.
15. JURISDICTION - VENUE
This Agreement has been executed and delivered in the State of California and the validity,
interpretation, performance, and enforcement of any of the clauses of this Agreement shall be determined and
governed by the laws of the State of California. Both parties further agree that Orange County, California,
shall be the venue for any action or proceeding that may be brought or arise out of, in connection with or by
reason of this Agreement.
16. PROFESSIONAL LICENSES
Consultant shall, throughout the term of this Agreement, maintain all necessary licenses, permits,
approvals, waivers, and exemptions necessary for the provision of the services hereunder and required by the
laws and regulations of the United States, the State of California, the City of Santa Ana and all other
governmental agencies. Consultant shall notify the City immediately and in writing of its inability to obtain
or maintain such permits, licenses, approvals, waivers, and exemptions. Said inability shall be cause for
termination of this Agreement.
17. MISCELLANEOUS PROVISIONS
a. Each undersigned represents and warrants that its signature herein below has the power, authority
and right to bind their respective parties to each of the terms of this Agreement, and shall indemnify City fully,
including reasonable costs and attorney's fees, for any injuries or damages to City in the event that such
authority or power is not, in fact, held by the signatory or is withdrawn.
b. All Exhibits referenced herein and attached hereto shall be incorporated as if fully set forth in the
body of this Agreement.
IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first
above written.
ATTEST:
MARIA D. HUIZAR
Clerk of the Council
APPROVED AS TO FORM:
SONIA R. CARVALHO
City Attorney
By:
for -Ryan Mdge
Assistant City Attorney
RECOMMENDED FOR APPROVAL:
KAREN HAL
Interim Executi Director
Planning & Building Agency
HAS, AN HAGHANI
Executive Director
Planning and Building Agency
CITY OF SANTA ANA
DAVID CAVAZO
City Manager
CONSULTANT: U1traSystems Environmental
etsy A.f indsay
Title: President/CEO
Tax ID# 33-0623499
EXHIBIT A
CONSULTANT'S PROPOSAL
AND
FEESCHEDULE
LlltraSystems ULTRASYSTEMS ENVIRONMENTAL
STANDARD RATE SCHEDULE
Principal
$175
$180
$185
Director
$170
$175
$180
Senior Project Manager
$155
$160
$165
Project Manager
$139
$143
$147
Senior Principal Engineer
$155
$160
$165
Senior Scientist/Engineer
$139
$143
$147
Scientist/Engineer
$129
$133
$137
Staff Scientist/Engineer
$103
$106
$109
Senior Biologist II
$129
$133
$137
Senior Biologist l
$108
$111
$114
Staff Biologist II -
$98
$101
$104
Staff Biologist 1
$88
$91
$94
Associate Biologist
$77
$79
$81
Senior Planner
$103
$106
$109
Associate Planner
$93
$96
$99
Planner/Envi ro n mental Analyst
$88
$91
$94
Cultural Specialist
$129
$133
$137
Archaeologist
$93
$96
$99
Cultural Monitor
$77
$79
$81
GISAnalyst
$98
$101
$104
GIS Technician
$88
$91
$94
Word Processor
$67
$69
$71
Intern
$52
$54
$56
Up to 100 pages
No Charge
101 to 500 pages
501 to 1,000 pages
Over 1,000 pages ($150 plus above rates)
4-
Excavation Screen
Field Supplies (shovels, health and safety, flagging, binoculars, etc.)
Garmin GPS (non -Trimble)
Fad Data Tablet
Kestrel Anemometer (or equivalent)
Photoionization detector (PID) or equivalent
Quest SoundPro SP -DL -1-1/3 Sound Level Meter (or equivalent)
RKI GX-2003 Multi -Gas Meter (or equivalent)
Trimble 2008 GeoXH GPS Unit (or equivalent)
GPSTruPulse 360R Laser Range Finder (or equivalent)
Walkie-talkie
$15
$5
$20
$25
$100
$5
$20
$100
$400
$110
$440
$65
$260
$115
$460
$100
$400
$5
$20
Consultant support (printing, reproduction and other direct expenses) will be billed at a rate of cost plus ten (30) percent. Automobile
mileage will be charged at IRS standard rates. Travel time will be billed as indicated in the hourly rate schedule above.
Invoices will be submitted monthly for work in progress and at completion of contract obligations, and are payable upon receipt. Fees
not paid within thirty (30) days of invoice date may be assessed an interest charge of one and one-half (1.5) percent per month, from
the date due (net 30). Attorney fees and court costs incurred for collection of delinquent accounts will be borne by the client.
ADDITIONAL INSURED ENDORSEMENT
FOR COMMERCIAL GENERAL LIABILITY POLICY
Insurance Company
This endorsement modifies such insurance as is afforded by the provisions of Policy
0
relating to the following:
1. The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701; its officers,
employees, agents, volunteers and representatives are named as additional insureds ("additional insureds")
with regard to liability and defense of suits arising from the operations and uses performed by or on behalf of
the named insured.
2. With respect to claims arising out of the operations and uses performed by or on behalf of the
named insured, such insurance as is afforded by this policy is primary and is not additional to or contributing
with any other insurance carried by or for the benefit of the additional insureds.
3. This insurance applies separately to each insured against whom claim is made or suit is
brought except with respect to the company's limits of liability. The inclusion of any person or organization
as an insured shall not affect any right which such person or organization would have as a claimant if not so
included.
4. With respect to the additional insureds, this insurance shall not be cancelled, or materially
reduced in coverage or limits except after thirty (30) days written notice has been given to the City of Santa
Ana, 20 Civic Center Plaza, Santa Ana, California 92701.
(Completion of the following, including countersignature, is required to make this endorsement effective.)
Effective
Policy #
Issued to
this endorsement form as a part of
Named Insured
Countersigned by
Authorized Representative
CITY OF SANTA ANA
OFFICE OF THE CITY ATTORNEY
Certificate of Liability Insurance
Checklist for Consultant/Sub-recipient Policies
Name of Consultant/Sub-recipient: _, J , g STV±, j V.
Date Certificate of Liability Insurance Submitted: t z Ila A (r
Steps: (a) Obtain Copy of (Current) Contract; (b) Identify Insurance Paragraph in Contract;
(c) Review Insurance Requirements Stated in the Contract and Compare with the Certificate of
Insurance Submitted for Approval; and (d) Check -off Each Item Below During Your Review of
the Submitted Certificate of Insurance:
[v]/1. Name and Address of a Producer
[V�'2. Name and/or Telephone Number for
Producer Contact
[vf"3. Name and Address of Consultant/Sub
4. Name of the Insurance Company(ies)
[ `] 5. Boxes Checked Identifying the Type of
Coverage
L/T"' 6. Additional Insured Box May be Checked
and Separate Additional Insured
Endorsement Pone Must Be Attached
(make sure the endorsement lists the
insurance policy #) and Verify Primary
Language on Acceptable Additional Insured
Endorsement
�7. Policy Number and Check to Verify
Insurance is Effective During Project Date
or Contract Term
[. Correct Coverage Dollar Amounts Listed
P_r9, Professional Liability Insurance Listed (if
architect, engineer, attorney or accountant)
11�1 0. Project Description by Number or Location
(if applicable)
[v]� 11. Name of City and Address
[s/) 12. Insurer's Signature Required
(not the consultant's signature)
[ ] 13. To Approve, Write "Reviewed by [sign
your name]" on Every Page of Certificate
of Insurance and All Endorsements and
Write the Number of Pages (ex. 1/4 or 4/4)
Contact the City Attorney's Office if you have any questions — Lisa Storck x5207.
II TRENV-01
IRI ISCPI 1
acoez® CERTIFICATE OF LIABILITY INSURANCE
Cr1VPRARFSt CFRTIFI(:ATF NIIMRFR• 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.
DATE 9/2 01 6
12/29/2016
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 have ADDITIONAL INSURED provisions or 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
Roger Stone Insurance Agency
5015 Birch Street
CONT
PHONE FAX
AIC, Ne, E4): (949) 757.0270 Aid, Nc):(949) 757-0375
A2bmuA'LE$,,customerservice@stoneins.com
Newport Beach, CA 92660
INSURER(S) AFFORDING COVERAGE NAIC p
11/10/2017
INSURER A: Admiral Insurance Co. 24656
DAEMGEETORENTED nCe 50,000
INSURED
INSURER BIRepublic IndemnitCompany 22179
INSURER C
Ultrasystems Environmental Inc
INSURER D:
16431 Scientific Way
Irvine, CA 92618
INSURER E:
INSURER F:
HAUTOMOBILE LIABILITY
ANYAUTO
OWNED SCHEDULED
AUTOS ONLY ANUUYIECW
AIRTOS ONLY X AUTOS ONLY
Cr1VPRARFSt CFRTIFI(:ATF NIIMRFR• 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
TYPE OF INSURANCE
ADDLSUBR
JUM
D
POLICY NUMBER
POLICYEFF
DD
POLICY EXP
M D❑
LIMITS
A
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE ®OCCUR
X Contr Poll Liability
X
FEIECC1110704
11/10/2016
11/10/2017
EACH OCCURRENCE $ 5,000,000
DAEMGEETORENTED nCe 50,000
MEO EXP An one arson 5'000
PERSONAL &ADV INJURY $ 5,000,000
GEHL AGGREGATE LIMIT APPLIES PER:
X POLICY E jEOT D LOC
OTHER:
GENERALAGGREGATE $ 5'000'000
PRODUCTS - COMP/OPAGG $ 5,000,000
A
HAUTOMOBILE LIABILITY
ANYAUTO
OWNED SCHEDULED
AUTOS ONLY ANUUYIECW
AIRTOS ONLY X AUTOS ONLY
FEIECC1110704
11/10/2016
11110/2017
EOegdNtleotSINGLE LIMIT $ 1,000,000
BODILY INJURY Per ersan $
BORRDILY INJURY Per accident $
Pe�acclden�AMAGE $
UMBRELLA LIAR
EXCESS LIAB
OCCUR
CLAIMS -MADE
EACH OCCURRENCE
AGGREGATE $
DED RETENTION$
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR)PARTNERIEXECUTIVE YIN
O0FFICERIMEMDER� EXCLUDED? �
(Mantlatory in NN)
If yes, describe under
DESCRIPTION OF OPERATIONS below
N/A
16319314
0910112016
0910112017
X I PEAT UTE OTRH-
1,000,000
E.L. EACH ACCIDENT $
E.L. DISEASE - EA EMPLOYE $ 1,000,000
1000000
E.L. DISEASE - POLICY LIMIT , ,
A
A
Professional Liab
Professional Liab
FEIECC1110704
FEIECC1110704
11/1012016
11/10/2016
11/10/2017
11/1012017
Each Occurrence 5,000,000
Aggregate 5,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may he attached If mere spat. Is mgdindi
RE: On -Call Environmental Services
he City of Santa Ana, Its officers, employees, agents, volunteers and representatives are named Additional Insured as respects General Liability
per form ECC -319.0712 attached. Insurance is primary/non-contributory per form ECC -548-0712 attached.
✓6W -
City of Santa Ana
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
ACORD 25 (2016103) @ 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
Ultrasystems Environmental Inc
ABMIRA*MMV'
Automatic Primary and Non -Contributory
Insurance Endorsement
Designated Work Or Project(s)
This endorsement, effective 11/10/2016 attaches to and forms a part of Policy Number
FEI-ECC41107-04. This endorsement changes the Policy. Please read it carefully.
SCHEDULE
Name of Person or Organization:
Any person(s) or organization(s) whom the Named Insured agrees, in a
written contract, to provide Primary and/or Non-contributory status of this
insurance. However, this status exists only for the project specified in that
contract.
In consideration of an additional premium of $A lied and notwithstanding
anything contained in this policy to the contrary, it is hereby agreed that this
policy shalt be considered primary to any similar insurance held by third parties
in respect to work performed by you under any written contractual agreement
with such third party. It is flrrthor agreed that any other insurance which the
person(s) or organization(s) named in the schedule may have is excess and non-
contributory to this insurance.
1014MI[:IIiUM
Ultrasystems Environmental Inc
Automatic Additional Insured — Owners, Lessees or Contractors
This endorsement, effective 11/10/2016 attaches to and fonns apart of Policy Number
FEI-ECC-11107-04. This endorsement changes the Policy. Piease read it carefully.
ECC -319-0712
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
CONTRACTORS POLLUTION LIABILITY COVERAGE PART
SCHEDULE
Name of Person or Organization:
Any person(s) or organization(s) whom the Named Insured agrees, in a
written contract, to name as an additional insured. However, this status
exists only for the project specified in that contract.
The person or organization shown in this Schedule is included as an insured, but
only with respect to that person's or organization's vicarious liability arising out
of your ongoing operations performed for that insured.
Farm
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Request for Taxpayer
Give Form to the
(Rey.,a,,a)Identification
Treasury
Number and Certification
I
requester. Re notlm
Internal Revenue Service
send to: the IRS.
Name (as shown on your Income tax return)
Ultras stems Environmental, Inc.
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Business aameldigregarded entity name, if different from above
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Cheek appropriate box for federal lax classification:
Exemptions (too Instructions):
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❑ Individual7sde proprietor ❑ Ccorporation 0a Corporation ❑ Partnership ❑Tmst/osete
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N
❑ Limitedliablfty company,Enter(lie tax classification(C=a corporation. Corporation, P=parinershp)0_
Exempt payee code (if any)
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Exemption from FATGA reporting
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IVti
El Other (see Instructions) '
Cddelitany)¢na)r�`
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Address (number. street, and apt. or suite no.)
Requomer'6 name end addross (optional)
h
16431 Scientific Way
City,: state; and ZIP code
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Irvine, CA 92618
List account numbor(s) here (optional)
Note. If the account Is in more than one name, see the chart on page 4 for guidelines on whose
Under penalties of perjury, I:certify that;
1. The number shown on this form is my correct taxpayer identification number (or l am waiting for anumber to be, issued to me), and
2. lam not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue
Service (IRS) that I am subject to backup withholding Asaresult of a fallureto report all interest or dividends, or (c) the IRS has notified me that I am
no longer subject to backup withholding,, and.
3. 1 am a U.S.: citizen or other U.S. person (defined below),. and
4. The FATCA code(s) entered on this form Of any) Indicating that I am exempt: from FATGA reporting Is correct.
Certification Instructions. You must cross out item 2 above if you have been notified by the IRS that you are c
because you have failed torecon all interest and diiridands nh vmrr tau rat„rn c„r mmi name r -.,—o,,.... u—
, an
....,
General Instructions 1
section references are to the Internal Revenue Code unless Onim4se acted.
Future developments. The Ins has created a page onlRS.gov for information
about Form W-91, at wonrarsgavywg. Information about anypAure developments
affecting Form W-0 (such as legislation enacted after we release h) wig be posted
on that page.
Purpose of Form
Aperson who Is required to file an information return with the IRS must obtain your
correct taxpayer Identification number (TIN) to report, for example, income paid to
YOU, payments made to you In schoo nl of payment card and third party network
transactions, real estate transactions, mortgage Interest you paid, aaqulsltlon or
abandonment of secured property, Cancellation of debt, or Contributions you made
to an INA,
Use form W0 only if you are a U.S. person imoluding a resident alien), to
provide your correct TIN to the person requesting It (the requester) and, when
applicable, lo:
I. Codify that the TIN you aro giving Is correct for you are waiting for a number
to be Issued),
2, Codify that you are not subject to backup withholding. or
3. Claim exemption from backup withholding if you aro a U.S. exempt payee,. It
applicable, you are also certifying that as a US, person,. your allocable short of
any partnership Income from:a U.S. trade or business Isnot subject to the
,an fnravlouat retirement arrangement (IM); and
but you must provide your correct TIN. See the
4. Certify that FATGA code(6) entered on this form if any) indicating that you are
exempt from the FATGA reporting, is Correct.
Note. If you are a U.S person and a requester gives you a form other than Form
W-0 to request your TIN, you must use the tequester's form if it Is substantially
sioiliar to this Form W -g,
Definition of a U.S. person. For federal tax purposes, you are Considered 0 U.S,
person if you are:
.:An individual who is U.S. citizen or U.6, resident alien,
• A partnership, corporation, Company, or asspclanoa created ororganized in the
Ursted States or under the laws of the United States;
• An estate (other than a foreign estate), or
• A domestic trust (as defined in Regulations section 301.7701-7),.
Sgeclal rules for 00rt"mrshlies. Partnerships that conduct a trade or business in
the United States are generally required to pay a withholding tax under section
1446 on any foroign partners' share of effectively connected taxable Income from
such business. Further, In certain cases whore a Form MID has not boon received,
the rules under section 1446 requires partnership to presume that a partner Is a
foreign person, and pay the section 1446 withholding' tax. Therefore, if area
U.S: parson that is a partner in a partnership conducting a trade or business in the.
United States, provide Form W -g to the partnership to establish your VS. status
and avoid section 1446 VAthholding on yourshare of partnership income,
Cat; No. 10231X Form