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HomeMy WebLinkAboutWEST HARTFORD PUBLIC LIBRARY 1BCity of Santa i a Q�-F Clerk of the Council AGREEMENT TERMINATION FORM ton FEB -6 Please complete this form when the attached agreement and CITY OF SAN amendments (if any) are no longer in effect. CLERK OF CI Return form to the Clerk of the Council Office (M-30). Call 647-1520 if you have any questions. The agreement with No N-2015-092 was completed on (List all amendments. Use space below N needed.) !j1 Department: N _Q4 ty, _ ol) 4,—a Phone/Ext.: COTC Office Use Only N= 24 and final payment has been made. RAP Signature: ` ,� t/ o t1, C� C an Date: a ,-1 bz Revised 10-31-12 August 31, 2017 West Hartford Public Library Attn: Library Director 20 South Main Street West Hartford, CT 06107-2406 Re: "Consultant Agreement' Extension Dear Ms. Holloway: N-2015-092-02 INTERIM CITY MANAGER Cynthia J. Kurtz CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL Maria D. Huizar In accordance with the terms and conditions of the 2014 Federal Institute of Museum and Library Services (IMLS) National Leadership Grant Program, the City of Santa Ana received approval from the IMLS for a no -cost extension to extend the award dates for the Grant. Pursuant to Section 3 ("Term") of Agreement No. N-2015-092 entered into by West Hartford Public Library and the City of Santa Ana, dated December 1, 2014, the time period of said Agreement is hereby extended for an additional one (1) year period from October 1, 2017 to September 30, 2018. The insurance certificates are required to be extended and/or renewed to cover this extension, All other terms and conditions of said Agreement, and the First Amendment to the Agreement, remain unchanged and in full force and effect. Please review, sign, and return this extension letter indicating your agreement. If you have any questions regarding this matter, please contact Francisco Arroyo in the Parks, Recreation and Community Services Agency at 714-571-4218. Sincerely, � e TY OF SANTA ANA Cynthia J. K z Interim City Manager [Signatures continued on next page] ATTEST: .ii« INSUHANLG:ON FILE VVORK MAY PROt HED MAYOR Miguel A. Pulido UNIIIINSUVIUNCIL N(F EXPIFFiS MAYOR PRO TEM Michele Martinez -------- Cf -,AK OF �- "g x_ COUNCILMEMBERSOA _I P. David Benavides- Vicente Sarmiento _ Jose Solorlo Sal Tinajero '--- " Juan Villages CITY OF SANTA ANA OFFICE OF THE CITY ATTORNEY 0: PROS V ► 20 Civic Center Plaza, M29 • PA. Box 1988 Santa Ana, California 92702 Silvia Cuevas 714-647-5201 • Fax 714-647-6515 www,santa-ana.om August 31, 2017 West Hartford Public Library Attn: Library Director 20 South Main Street West Hartford, CT 06107-2406 Re: "Consultant Agreement' Extension Dear Ms. Holloway: N-2015-092-02 INTERIM CITY MANAGER Cynthia J. Kurtz CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL Maria D. Huizar In accordance with the terms and conditions of the 2014 Federal Institute of Museum and Library Services (IMLS) National Leadership Grant Program, the City of Santa Ana received approval from the IMLS for a no -cost extension to extend the award dates for the Grant. Pursuant to Section 3 ("Term") of Agreement No. N-2015-092 entered into by West Hartford Public Library and the City of Santa Ana, dated December 1, 2014, the time period of said Agreement is hereby extended for an additional one (1) year period from October 1, 2017 to September 30, 2018. The insurance certificates are required to be extended and/or renewed to cover this extension, All other terms and conditions of said Agreement, and the First Amendment to the Agreement, remain unchanged and in full force and effect. Please review, sign, and return this extension letter indicating your agreement. If you have any questions regarding this matter, please contact Francisco Arroyo in the Parks, Recreation and Community Services Agency at 714-571-4218. Sincerely, � e TY OF SANTA ANA Cynthia J. K z Interim City Manager [Signatures continued on next page] ATTEST: .ii« Signature page — Extension Letter with West Hartford Public Library APPROVED AS TO FORM: Sonia R. Carvalho City Attorney Laura A. Rossini Senior Assistant City Attorney CONSULTANT wEs'r HARTFORD PUBLIC LIBRARY r FOR APPROVAL: Gerardo A, Mouet Executive Director, Parks, Recreation and Community Services Agency SANTA ANA CITY COUNCIL Mfpei A. PaIId'o WNla Martm. Viconte Senniento Jose sotorio P. Wald Banaddas Juan vvitoas Bal Ons Mayor .Mayor pro Tam, Ward 2 Wardi wad Wmd4 WaM3 Ward Mn vjs�ott'Eg --sna ao an»aalneua7sarsb-ensnm o9er:esdti(a:4sania-a to aroisraorb ansa�rta aa.ao abenev&upm,r{i a3 m hill na ani miraterer6san Client#:160973 WESTHART ACORDn. CERTIFICATE OF LIABILITY INSURANCE DATE TYPE OF INSURANCE 912012IDOIVVYV) 12 012 017 THIS CERTIFICATE IS ISSUED ASA 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(es) 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: USI Southwest PHONE FA AIC'No, E, : 713 490-4600 A/c No : 713.490.4700 9811 Katy Freeway, Suite 500 E-MAIL Houston,77024 ADDRESS: $ 713 490.46060 0 INSURER(S) AFFORDING COVERAGE NAIC# INSURER A : Gemini Insurance Company 10833 PERSONAL SADVINJURY INSURED INSURER B: sarety National casualty Corp 15105 Town of West Hartford INSURER C: 50 South Main Street INSURER D: West Hartford, CT 06107 $ 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 TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, ILTR TYPE OF INSURANCE 'IN SRL WVDUBR POLICY NUMBER MMIDDIYVYFY MMIDDIYYEXP LIMITS A X COMMERCIAL GENERAL LI ABILITY Fvl X CLAIMS -MADE OCCUR X $250,000 PEM000000605 7/01/2017 07101/201E EACH OCCURRENCE $1 000000 PREMISES Ea occurrrence $ MED EXP (Any one person) $ Retained Limit PERSONAL SADVINJURY $ GENT AGGREGATE LIMIT APPLIES PER: PRO - POLICY 1:1JECT LOC OTHER: GENERAL AGGREGATE $1,000,000 PRODUCTS - COMPIOP AGG $ $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIREDAUTOS AO OOWNED 'e ?e ('Y /y E �A n V� V \�\O,� Eaa aacid.nfi GLE LIMIT $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident)$ PROPERTY DAMAGE Peraccldenl $ $ UMBRELLA LIAB EXCESS LIAS OCCUR CLAIMS -MADE ("' EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE YIN OFFICER/MEMBER EXCLUDED? F_N]NIA (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below SP4057079 $500,000 SIR 710112017 07/0112018 X 2PIUIE I OTH- ER E. L. EACH ACCIDENT $1000000 E. L. DISEASE - EA EMPLOYEE $ E.L. DISEASE -POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Effective Date: March 19, 2015 Description: Consultant Agreement- Institute of Museum and Library Services (IMLS) Leadership Grant City of Santa Ana, its officers, employees, agents and representatives are named as additional insured with respects to the General Liability, when required by written contract. 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 ©1988-2014 ACORD CORPORATION_ All rinhts rasaruaH ACORD 25 (2014101) 1 of 1 The ACORD name and logo are registered marks of ACORD #S215098981M21258453 BZLHA ENDORSEMENT This endorsement forms a part of the policy to which it Is attached. Please read It carefully. ADDITIONAL INSURED- DESIGNATED PERSON OR ORGANIZATION Policy Number Endorsement Effective Date Endorsement Number PEM 0000006-05 July 1, 2017 14 This endorsement modifies insurance provided under the following: GENERAL LIABILITY COVERAGE PART PUBLIC ENTITY RETAINED LIMITS POLICY SCHEDULE Name of additional insured person(s) or organization (s): The City of Santa Ana, its officers, employees, agents, and representative are named with respect to services provided as Consultant for the Institutes of Museum and Library Services Leadership Grant. $1.000.000 Occurrence Limit $1.000.000 Aggregate With respect to the General Liability Coverage Part only, it is agreed that Definition 20. Insured, contained in the Common Conditions, Definitions and Exclusions is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule but only with respect to liability for bodily injury, property damage, personal injury, or advertising injury caused in whole or in part, by acts or omissions of the named insured or the acts or omissions of those acting on behalf of the named insured: A. In the performance of the ongoing operations of the named insured; or B. In connection with the named insured's premises owned by or rented to the named insured. If, prior to an occurrence, you have specifically agreed in a written contract to provide primary insurance for any person(s) or organizations (s) shown in the Schedule, this insurance will apply on a primary basis with respect to such occurrence and will not contribute with any other valid and collectible insurance in force for such additional insured. All other terms and conditions of this policy remain unchan, Qgca Page 1 of 1 Representative a Berkley Company Includes copyrighted material of Insurance Services Office Inc. with its permission. PEN1008 01/15