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HomeMy WebLinkAboutA1 EVENT & PARTY RENTAL (3)-2017. City of Santa `na �• Clerk of the Cou . it coTc Office use only AGREEMENT TERMINATION FORM Please complete this form in its entirety when the attached agreement and all amendments (if any) are no longer in effect.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 City of Santa Ana have been satisfied prior to signing the termination form. oz N6 Is the agreement(s) a permanent record? Yes No Clerk of the Council Return form to the Clerk of the Council Office (M-30). Call 647-1520 if you have any questions. The agreement with No. '4` ,�� '�J C was completed on I� I and final payment has been made. (List all amendments. Use space below N needed.) / 'n {4— 011— 05-.a 0 Department: PQS-4 ! ��Yy-UV\�, 4—ao I -I_ Phone/Ext.: -�C k�—r Signature: Date: -71 �a i Revised: 10-18-16 Professional Liability Insurance required if contractor is or employs it licensed professiottat MAYOR Miguel A. Pulido MAYOR PRO TEM Mlchela Martinez.- l.`}GCS ttLJ COUNCILMEMEERS .� P. David Baravides DECQ 1! Vicente Sarmiento u Jose Solorlo Sal Tinalero Juan Vlllagas CITY OF SANTA ANA PARKS, RECREATION AND COMMUNITY SERVICES AGENCY 20 Civic Center Plaza M-23 + P.O. Box 19aa Santa Ana, California 92702 wyivv santa-ana tiro November 27, 2017 Wto- Inc (dba At Party Rental) 251 E. Front Street Covina, CA 91723 A-2017-053-02 CITY MANAGER Raul Oodlnez 11 CITYATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL Maria O. Holzer Re: Extension of Contractor Agreement No. A-2017-053 to provide provision, installation and removal of rental equipment for various City events Dear Mr. Martinez: Pursuant to Section 3 ("Term") of Agreement No. A-20 t 7-053 entered into by Al Party Rental and the City of Santa Ana, dated March 21, 2017, which was modified on June 7, 2017, to modify the Contractor's name to CFW, luc. (A-2017.053-01), the lime period for said Agreement is hereby extended for an additional one (1) year period, from January 1, 2018 to December 31, 2018, The insurance certificates are required to be extended and/or renewed to cover this extension All other tenns and conditions of said Agreement remain unchanged and in full force and effect. Sincerely, Gerardo Monet' Executive Director' Parks, Recreation and Community Set -vices Agency APPROVED AS I'D FORM: Sonia R. Co rvalho City Attorney Laura A. Rossini Senior Assistant City Attorney w P10F SANTA NA Raul Godinez 11 City Manager ATTEST: ?Y Maria D. Huizar Clerk of the Council SANTA ANA CITY COUNCIL Miguel A. Pulido Michele Ma&n vlcenle Sarmlemo Josasoimro P, Ovid llgaAdas Juan Villages Selnneim Mayor Mayor Pm Tem, Went Ward We'd3 Ward Wards WON mo,l'doWsaMa-,aggg ml rii 1 sarinlpnlnlAea I - Igpteriod&;n aan,pr9 dbeaatldeehgsanl&- �sara IWleaurosaam2.ana i riinaler r�td,�n. a.ory CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIVYYY) 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 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 Rnitnn R Cmmnanv IcoNIACT Suite 100 PHONE FAX (A/C, N., Exq; (626) 7991 (AID Nq);_ (626) 5i 0008309 INSURED CWF, Inc. DBA: Al Party Rentals 251 E. Front Street Covina CA 91723 INSURER C : INSURER D : COVERAGES CERTIFICATE NUMBER: BRB41;4R7 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, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPEOFINSURANCE ADDLISUBRI 1 POLICYEFF POLICYNUMBER MMIDDM/YV POLICY EXP MMIDDM/VY LIMITS A �/'I COMMERCIAL GENERAL LIABILITY ✓ 1 PK201700007271 +� 2/1/2017 2/1/2018 IEACHOCCURRENCE _ �D�TvIAO,E $1000,000.__ CLAIMS -MADE OCCUR ✓ TO RENTED IPREMISES its occurrence)_ I 1$500000_ $10,000 I person) $1,000,000 PERSONALaADV INJUR_V_ GENT -AGGREGATE LIMIT APPLIES PER: 1i GENERAL AGGREGATE $2,000,000 POLICY'.✓ PRO- JECTPRO- '. LOCPRODUCTS JECTI✓ _ _.. PRODUCTS-COMP/OPAGG _. $2,000,000. OTHER'. $ A AUTOMOBILE LIABILITY AU201700011938 ''2/1/2017 2/1/2018 COMBINED SINGLE Ea accident) LIMIT _ � i$ I 1,000, coo BODILY INJURY (Per person) ✓ ANY AUTO 1 'I $ OWNED I SCHEDULED '' AUTOS ONLY AUTOS. ''. BODILY INJURY (Per accident) $ HIRED I I NON -OWNED ✓ AUTOS ONLY "I ✓ AUTOS ONLY PROPERTY DAMAGE (Per accident) A ✓ UMBRELLA LIAR �/ OCCUR IUM201700003772 '.. 211I2017 112/1/2018 EACH OCCURRENCE $5,000,000 I EXCESS LIAR CLAIMS -MADE I'I I AGGREGATE $5,000,000 �.. DEC ✓ RETENTION$ 10,000 ' $ A WORKERS COMPENSATION WC201700015648 11/1/2017 11/1/2018 'I, ✓ PER ANDEMPLOYERS'LIABILITY YIN STAOIL- _OIL I- SIR ANYPROPRIETOR/PARTNER/EXECUTIVE NIA EL EACH ACCIDENT $1,000,000 OFFICERIMEMBE(Mandatory in NH�EXCLUDED9 IEL DISEASE EA EMPLOYEE'.$1 QQQ,OQa If yes, describe under _ DESCRIPTION OF OPERATIONS below E L. DISEASE POLICY LIMIT $1 000 000 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACCORD 101, Additional Remarks Schedule, may be attached If more space is required) V p�� The certificate holder is included as an additional insured, but only as respects to claims arising out of the negliger-991 Named `d Insured. -. c'' GL Primary &Non -Contributory per form CG2026 attached. Additional Insured: The City of Santa Ana, it's officers, employees, agents, and representatives�tr ,,,,ssrr'+'���'"""� City of Santa Ana Finance & Management Services Agency PC Box 1988 M-16 20 Civic Center Plaza Santa Ana CA 92702 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 Jessica Poretta U 1988-ZU15 ACURU GORPURATION, All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 30645467 1 CWPINCA-01 I Copy Of 19-10 ALL Master Certificate I Aaron Alvarado 1 11/1/2017 9:53:20 AM (PDT) I Page 1 of 1 POLICY NUMBER: COMMERCIAL GENERAL LIABILITY CG 20 26 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Any person or organization when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy prior to performance of the agreement. Any Person or Organization as Required by Contract. It is agreed that this insurance is primary and non-contributory and that no insurance held or owned by the designated Additional Insured shall be called upon to cover a loss under said policy up to the limits of this policy if loss under this policy arises directly from work performed by Named Insured or if others performed on behalf of the Named Insured. A. Section II — Who Is An Insured 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" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: 1. In the performance of your ongoing operations; or 2. In connection with your premises owned by or rented to you. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 26 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 A�aKO® CERTIFICATE OF LIABILITY INSURANCE DAT5/9/2019 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 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 Bolton &Companyy 3475 E. Foothill Blvd., Suite 100 Pasadena, CA 91107 CONTACT NAME_ __ _ __ PHONE FAX A/c No E.0, 626 799-7000 A/c No: 626 583-2117 E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC# INSURER A: Fireman's Fund Insurance Company 21873 www.boltonco.com 0008309 INSURED CWF, Inc. ;q -Qo 1- O� DBA: Al Party Rentals 251 E. Front Street INSURER B INSURERC: NSURER D: Covina CA 91723 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 48593577 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 ADDLBUBR LTR rypE OF INSURANCE POLICY NUMBER MM/ODLICY/YYYY MMIDDIYYYY LIMITS A �/ COMMERCIALGENERAL LIABILITY XPK80992950 2/1/2019 2/1/2020 EACH OCCURRENCE $1,000,000 CLAIMS -MADE / OCCUR PREMISES Ea Deco once $SOO DOO MED EXP (Any one person) $10 000 _ PERSONAL BADV INJURY $1 000 000 GENT AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $2,000,000 POLICY ✓ JECT I ✓ LOG PRODUCTS -COMPIOPAGG $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY XPK80992950 2/1/2019 2/1/2020 Eeaa tleDtSINGLE LIMIT $1 OOO DOO ✓ ANY AUTO BODILY INJURY (Per person) $ OWNED — SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident), $ _ HIRED NON OWNED PROPERTY DAMAGE $ ✓ AUTOS ONLY ✓ AUTOS ONLY _(Per amden)) A `/ UMBRELLALIAB ✓ OCCUR XAU58230061 2/1/2019 2/1/2020 EACH OCCURRENCE $5,000,000 EXCESS LIAR CLAIMS -MADE AGGREGATE $5,000,000 _ DED ✓ RETENTION$10,000 $ A WORKERS COMPENSATION SCW0058721801 11/1/2018 11/1/2019 ERH AND EMPLOYERS' LIABILITY YIN �/ STATUTE _ ANYPROPRIETOR/PARTNER/EXECUTIVE EL EACH ACCIDENT $ 1,000.000 OFFICERIMEMBER EXCLUDED? NIA (Mandatory in NH) E.L. DISEASE- EA EMPLOYEE', $1 OO If yes, des0the under DESCRIPTION OF OPERATIONS below 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) The certificate holder is included as an additional insured, but only as respects to claims arising out Insured. of the negliq. 0 th\iN;amed Additional Insured: The City of Santa Ana, it's officers, employees, agents, and representatives �e �,j/� �c, Parks, Recreation SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN & Communityy Services Agency - M23 ACCORDANCE WITH THE POLICY PROVISIONS. P.O. BOX 1988 20 Civic Center Plaza Santa Ana CA 92702 AUTHORRED REPRESENTATIVE [oi F'I:I:bIri FiSK•7:7 aIK•J:71•]:&\ II hl � �.11 �7RT g S'f "-�f �2Te 1 ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 48593577 I CWFINCA-01 1 18-19 WC, 19-20 PCKG Master Certificate I Matthew Nobeiga 1 5/9/2019 9:17:18 AM (PM) I Page 1 of 3 Additional Insured - Designated Person or Organization - CG 20 26 04 13 Policy Amendment(s) Commercial General Liability Insured: CWF. Inc. Producer: Bolton & Company Policy Number: XPK80992950 Effective Date: 02/01/2019 This endorsement modifies insurance provided under the following: Commercial General Liability Coverage Part Schedule Name Of Additional Insured Person(s) Or Organization(s): All persons or organizations as required by written contract with the Named Insured Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II - Who Is An Insured 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 or personal and advertising injury caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: 1. In the performance of your ongoing operations; or 2. In connection with your premises owned by or rented to you. However: 3. The insurance afforded to such additional insured only applies to the extent permitted by law; and insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III - Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 5. Required by the contract or agreement; or 6. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. 4. If coverage provided to the additional insured This endorsement shall not increase the applicable is required by a contract or agreement, the Limits of Insurance shown in the Declarations. This Form must be attached to Change Endorsement when issued after the policy is written. 66 �6 't One of the Fireman's Fund Insurance Companies as named in the policy Secretary President CG2026 4.13 +Insurance Services Office, Inc., 2012 48593577 I CWFINCA-01 118-19 NC, 19-20 PC%G Master CertifiCate I Matthew Nobriga 1 5/9/2019 9:17:18 AM (POT) I Page 2 of 3 M.E•hYxFYi Primary and Noncontributory- Other Insurance Condition CG 20 0104 13 Policy Amendment(s) Commercial General Liability This endorsement modifies insurance provided under the following: Commercial General Liability Coverage Part Products/Completed Operations Liability Coverage Part The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. This Form must be attached to Change Endorsement when issued after the policy is written. One of the Fireman's Fund Insurance Companies as named in the policy Secretary CG200! 4-13 ed 00 Va PEGS President + Insurance Services Inc., 2012 48593591 I MVINCA-01 118-19 WC, 19-20 —.- Master Certificate I Matthew Nobriga 15/9/2019 9:17:18 AM (PDT) I Page 3 of 3