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Home My WebLink AboutALLIANCE ENVIRONMENTAL GROUP, INC. (3)City of Santa F 1 Clerk of the Council D'f 5 ✓ l 2 COPE Office Use Only AGREEMENT TERMINATION FORM �9n Please complete this form in its entirety when the attached agreement 9?A 9 —6 PM L!: 2 ) amendments (if any) are no longer in effect. Note: If your agreement is grant related, please ensure that all grant retention requirements CITY O � S,` iN A A NA have been satisfied prior to signing the termination form. CLERK,OF COUNCIL Is the agreement(s) a permanent record? Yes No Return form to the Clerk of the Council Office (M-30). Call 647-1520 if you have any questions. The agreement with A�`vc�rY®P_ �v\rv�w,pri`Syj -.Ev-%r- . No. N-2017-213-03 was completed on 381laolz- and final payment has been made. (List all amendments. Use space below N needed.) /V-," 0/ r7 -, V3 - 0,9 Department: PRC,&A Phone/Ext.: Li7—IcA Signature: Date: q Revised: 10-16-16 O: PRCS (®) li,WRANCE ON PILE ,ORK MAY PROCEED Silvia Cuevas ,f-3 L INSURANCE EXPIRES N-2017-213-02 Azusa, CA 91702 Ph: 626.633.3500 Fx: 626-633-3599 Lic. # 716538 - D.O.S.H. # 630 Project City of Santa Ana-626 South Cypress - Change Order -Agreement # N-2017-213 "Prcoertv" Address: 625 South Cypress Avenue Ckv: Santa Ana State: CA Z1p:92701-5831 Contact Ron Ono Work No.: (714) 647-5400 Mobile No.: Home No.: Customer XX Billing Party City of Santa Ana Work Authorization www,alllance-onvlro.com info@alllance-onviro.00m Address: 20 Civic Center Plaza City: Santa Ana State: CA ZIp:92701-4058 Contact Ron Ono Phone No.: 714-547-5400 - Claim Number. Fax No.: Scheduled Start Date: Scheduled Completion Date: Total Bid Amount $6,621.08fsx. Deposit Ree uired $0,0�0 Balance Due ongCo.m le4tiion: $5,521.08 Q.�lA�i�eGll m�fl .W1as"111r w�&v.6'4h:e ai Estimate is for the removal of all Interior trash from building located at 625 S. Cypress 1. Notify required local regulatory agency prior to job start If applicable. 2. Isolate work areas. 3. Set up the shower decontamination system adjacent to work area(s). 4. Building Is approx. 5,000 s/f and has had issues with homeless living in the building. There are many Items to be considered trash, items will be removed from the building and placed In the dumpster provided by the city of Santa Ana. It is estimated that only one dumpater will be needed if an additional dumpster is needed it wl11 need to be provided by the cRy. 5.'There are two bathrooms the bathroom toward the back has human waste to be removed and properly disposed of. Once human waste has been disposed of the odor will be addressed. Time will determine the method used to help romedlate the odor. There Is no guarantee of full odor removal as it is subjective. 6. Carpet found In the building will be removed and disposed of. 7. Building will be left In broom swept condition, if time permits crew will begin to clean the floor to a presentable condition. S. Make shift shelving in the back building (garage) will be removed only with time permitting and space available In the dumpster. All other contents will be removed from sold area. ote 1. UNLESS OTHERWISE NOTED IN THIS CONTRACT, Homeowner or tenant is ultimately responsible to ensure that all personal items are removed from the work area prior to the arrival of Alliance. In the event that a third party company is contracted to remove the contents from that area, and not all necessary items are removed prior to Alliance's arrival, a cancellation fee or content manipulation charge to the homeowner or tenant may apply as outlined in the following paragraph. In order to prevent these charges, homeowner is responsible to ensure all necessary content manipulation has been completed or to notify Alliance of any changes prior to Alliance's arrival. 2. In the event that the work area Is not ready for abatement, the homeowner or tenant will be responsible for payment of either $70.00 per man per hour to manipulate contents (contents exclusions in subsection 3, titled exclusions, apply) or a $250 cancellation fee. In the event of a cancellation, the job will be rescheduled for the soonest opening once the work areas are prepared for abatement. Customer Initial: Payment notice: Raul Godinezr II i. in the event that the homeowner is paying Alliance directly, payment is due and payable immediately upon City Manager completion of the Job. 2. In the event that an insurance company Issues a check to the owner for payment for services performed by Alliance, the homeowner is responsible to issue payment to Alliance for full contract amount. 3. In the event that an insurance company denies all or part of the claim, the homeowner is ultimately responsible for payment for the full contract amount. Customer Initial: 0-17-151956-5 Page 1of2 II N Please Initial: li' Raul Godinez II City Manager N-2017-213-02 ' YOU, THE CUSTOMER, ARE ENTITLED TO A COMPLETELY FILLED IN COPY OF THIS CHANGE ORDER TO AGREEMENT # N-2017.213, SIGNED BY BOTH YOU AND ALLIANCE, BEFORE ANY WORK MAY BE STARTED. • YOU, THE CUSTOMER, MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION. SEE ATTACHED NOTICE OF CANCELLATION FORM FOR EXPLANATION OF THIS RIGHT. Customersignature below is acknowledgement that Customer has received THREE-DAY RIGHT TO CANCEL form. THIS CONTRACT WILL NOT BECOME BINDING ON THE PARTIES UNTIL ACCEPTED 6Y AN AUTHORIZED REPRESENTATIVE OF ALLIANCE, ATALLIANCE'S OFFICES. CUSTOMER: ALLIANCE ENVIRONMENTAL GROUP, INC.: Dated: 1L.lj` jr" Print Name: Raul Godinez !i, City Manager r(Printed Name) I Approved as to Form: -k JO& M. Funk Assistant City Attorney Attest /Marta D. Holzer Corporate Office 990 W, Tenth Street, Azusa, CA 91702 C-17-151956-5 Page 2 of 2 Repress native; BobeAMcKeever l Recommended for Approval Gerardo Mouet Exewtiva DVector,- , Parks, Recreation and Community Services Agency' Ph. 626-633-3500 Fax: 626.633-3599 Please Initial: c c �rcv CERTIFICATE, OF LIABILITY IN$URANCE � lvlreamuum>fTI 10J1�(20f THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NQT 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(Sj, AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, IMPORTANT: I}Sho Fartifioata holder is an ADDITIONAL INSURED, the polley(les) must have ADDITIONAL INSURED provtsl'ans or he endorsed. If SUEROGATFON 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 rlNhts to the certificate holder In Neu of such andorsamantfsl. Group, Inc. N-2017-213-02 N-2017-213 COVERAGES OFRTIPICATE NIJMRFR- nAknnRan ocImmulu NUIURco. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERI00 INDICATED, N07WTf RSTANDING ANY RERUIREMENT 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. �A�4�0 Y 1 S� T=QS18� , ...^�.. E1 COURHG fTR"LIM4TL16 6 ,—..—.^$O6O0Q,0O..0D_0O. NMaIAYCAIARLCaPEINNe2URRAALNLIABILITY . CAIM6MAOE OCCUR ! _.__ i I IMED E'XP IAny aMl Pnrnoa) PFRSONALa ADVINJURY s $00,040 IS _ S1,000,gOq GENIAGOREGATE LIMIT APPLJES PER. PHO POLICY I JECT LOC - OTLAS I IG7ENERAL A04REOAYfi �.PR..q tC8 RI.O_TCOM ,AGO _§ Off0,000 IS $2,OOD,000 I S _- 8 AUTOMO j ✓ 1✓ ✓ 1 '_..._ I ! AUTO OWNED O 1 AUTP5 AUTOS 2D AUT S ONLY pp WRED I NONAMNED ALTO$ ONLY AUTOS ONLY Cnm &Coll 1 UMBRBLLAVAS COO - EXeaa&LIAD I CLAIMB.MAOS. - _ ..T..._ .._.1. ._� LED I i RETENT ON �SISIPOA08264417 1 6/10/2017 16/l0/2016 I a$� NOLELIMIi a0014Y INJUhY IPerpe(bM) . ! BOC&Y INJURY (Pare6aiannq -PR2SP^R�r�AJtA7aa—' Medical Pa ments �_ EACH OCCIIRRENC2 :AOPR66ATf s 41 �C,60_0_ll 9 S .....__..,._... .._._ g 11 $5,000 ( S -^ ,_____.__ _ WORKTIRAGIg B ' ANOEEgMgr0 lµtl WAIULo oa I-d^� 110A0002915 ANYAR9PR1E4MTp0PoPAkTNER1E%EOVTIV6 Y NIA �f rYI Nyy CRIRR PF OPERA71CN84alaW I11812 7;1/2912P18 �.. qT"nHI.... l�P (f L EACH ACCIPENi j i I , ILL 01SCASE_EA EMALOY�s RISEASR - PCLC LIMIT $ __ _ $4 0O0 000 11000000 I S $i3OQ0,000 i i . _. ( i i i DESCRIPTION OFOP"WN51 LACAn10NItVaLI16L03(A0ORD19y Add1IWn4l ReMalks B<Ne4UID, Mny Ce ctlacPauilmamepam rs regWredlQ �Y The City of Santa Ana, He offlcars, employees, agents and representatives are named as additional Insureds and prlmaly/non-00numU clause applles t4 the generei liability pallcyaee attaohec endorsement$ The above po11cles contaln a 3Dday notice provision for non•renewal and cancellation, 10•day notice for nonpayment of p �G5 P Cityof Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE OF,LIVERED IR 20 Civic Canter Plaza, M-23 C$A ACQOROANCE WITH THE POLICY PROVIMONS. lc Santa Ana CA 92701 AUTHORIZED REPRESENTATIVE f1 6Alnlnnr�l Akrlrvllan �'p ��i�•^ �-^^" "'��,�`\ AUGRfO 20 1201510) The ACORD name and logo are registered marks of ACORO 363805.9 1 AIII... 1 19AB PC, 19d8 GI -AL V41•cVL•nc 1 011nrry T.V 11oy16/Daly 906,1i N1 (mml I Pa, L oe POLICY NUMBER; 1000065722171 COMMERCIAL GENERAL L€ABIXY CG 2010 07 04 THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. ADDITIONAL INSURED — OWNERS, LESSEES OR CONTRACTORS SCHEDULE PERSON OR ORGANIZATION This endorsement modifles Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Or Organization(s): I Locatlon(s) Of Covered Operations M-23 I All operations A. Section li— Who Is An Insured is amended B. to Include as an additional insured the person(s) or organlzatlon(e) shown In the Schedule, but only with respect to liability for "bodl y Injury", "property damage", or "personal and advertising Injury" caused, in whole or In part, by: 1, Your acts or omissions: or 2. The schs or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. With respect to the insurance afforded to these additional Insureds, the following additional exclusions apply: This Insurance does not apply to "bodily Injury' or "property damage" occurring after: 1, All work, Including materials, parts or equipment furnished In connection with such work, on the prajsot (other than service, maintenance or (spalra) to he performed by or on behalf of the additional Insured(s) at the location of the covered operations has been complotod; or 2, That portion of "your work" out ofwhich the Injury or damage shape hoe boon put to Its Intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. r] p�.v��abr�, i`, �OV�Ga PR GG 2010 07 04 0I80 Properties, Inc., 2004 a0300532 I Altlantle. ( >Y-ie NC 17-18 al. ne-u,-cec•4c 1 si.utxy Y,,m, I10/la/aov'I ry,y5:1^v M {P SI I en9n a " i Page 1 of 1 POLICY NO.: 1000085722171 COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, ADDITIONAL INSURED -- OWNERS, LESSEES OR CONTRACTORS- COMPLETED OPERATIONS This endorsement modifies Insurance provided under the foilowirg COMMERCIAL GENERAL LIABILITY COVERAGE PANT SCHEDULE Name of Additional Insured Person(s) Or Organlzation(s): Location(s) Of Covered Operations aTahe Glnly of Santa Ana, Its am cars. employees, agents Yo Clvlo C ntaartlaeaaa, M•23 All operations Santa Ana CA 9E7o9 nfarmatlon reGul sd ro Cmm�late this Schedule r not shown above will ha shown in the eclaratlons Section II — Who Is An Insured Is amended to Include as an additional Insured the. parson(s) or organizapon(s) shown In the Schedule, but only With respect to liability for "lrodlly Injury", "property damage" Caused, in whole or In part, by "your work" at the location designated and described In the schedule of this endorsement performed for that additional insured and Included in the "products -completed cperattons hazard:' CG 20 37 07 04 Q 180 Properties, Inc., 2004 3e10moa 1 4111. , 1 ataa. s+ , v-aa m, n�, um.rau-no I ahaeey 10 , 1 w/ie/aoxv s: xens " (ue) I sage a of e e edby'. 2 Page 1 of t