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HomeMy WebLinkAboutINSURE PROTECTIVE SECURITY (6)City of Santa P-+a t Clerk of the Cou!.._il 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TERMINATION FORM Please complete this form in its entirety when the attached agreement and all amendments (if any) are no longer in effect. Ct=y of manta Ana Note: If your agreement is grant related, please ensure that all grant retention requirements have been satisfied prior to signing the termination form•-1J o 2 Ems' Is the agreement(s) a permanent record? Yes No Cierk 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�� A-2017-217-02 No. _ was completed on L and final payment has been made. (List afi amendments. use space below if needed.) 1 Pr_,—I_�� Department: �•05W (t`y�YYytV� (�--(3r)11--:;)-`-1-0 i Phone/Ext.: 5DS� 14—aoll` l)SS— Signature: ��izliA,�C1/�il� Date: 7 !oZ% I---,,\-1 Revised: 10-18-16 Professional Liability Insurance required if contractor is or employs a licensed professional A-2017-217-01 MAYOR Miguel A. Pulido MAYOR PRO TEM Michele Martinez COUNCILMEMBERS P. David Benavides Vicente Sarmiento Jose Solrio Sal Sal Tinajero Juan Villeges o A(!) Srlr,ta Cu,c✓«r.� INSURANCE NOT ON FILE WORK MAY Nff PROCEED CLERK OF COUNCIL DATE:DEC 1 S 2017 November 27, 2017 ]PS Security, Inc. 6 Button Centre Suite 600 Santa Ana, CA 92707 CITY OF SANTA ANA PARKS, RECREATION AND COMMUNITY SERVICES AGENCY 20 Civic Center Plaza M-23 • P.O. Box 1988 Santa Ana, California 92702 w .santa-ana.orq CITY MANAGER Raul Godinez It CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL Maria D, Huizar Re: Extension of Contractor Agreement No. A-2017-055 to provide security services for City hosted events bearMi. Sayed: Pursuant to Section 3 ("Term") of Agreement No. A-2017-055 entered into by IPS Security, Inc, and the City of Santa Ana, dated March 21, 2017, which was amended on July 31, 2017, to increase the compensation amount (A-2017-217), the time 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 terms and conditions of said Agreement remain unchanged and in full force and effect. Sincerely, Gerardo Mouet . . Executive Director Parks, Recreation and Convnunity Services Agency APPROVED AS,rO FORM: Sonia R, Carvalho City Attorney Laura A. Rossini Senior Assistant City Attorney Crry OF SAN A Raul Godinez 1I City Manager A`I ITST. Fr Maria I). I�luizar Clerk of the Council SANTA ANA CITY COUNCIL Miguel A. Pulido Michele Malicn wante sMMealo Jose Soirnio P. David Benaddes Juan villegas Sal Tinajero Mayor Mays Pro Terc, WwJ 2 Wahl Ward Ward Ward5 Ward6 ffiapfdo(D i —am rtdccxr, ez( -s rl-ana am ysarpJi gnig({r2»» riwains oeo (sNwiot�sa7laena wa At>At si NQQs�lsanta ara am piHeoas{�santaan2 cro grn kalo l q ir.>.'1C•l Ur IU: Lr AGC7/2d CERTIFICATE OF LIABILITY INSURANCE DATE(MMIODnYYYI 10125/2017 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(ios) 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 NAME CT Central Insurance Agency Central Insurance Agency, Inc. PHONE -- FAA East Main Street Sarq.Ne, U 877-242-9600 �prc,_No): 877-243-8995 Smithtown, NY 11787 E-MAIL -- _ -- George Gavaris ADDRESS: certificates@ciainsures.com INSURER(S) AFFORDING COVERAGE _ NAICA INSURER A: Acceptance Casualty Ins Co '10349 _ INSURED IPS Security, Inc. INSURERS:Employers Assurance Company 25402 6200 Stoneridge Mail Rd,Ste300 — — -- - . --- - -- ---" Pleasanton, CA 94588 INSURER c:Hartford Casualt Insurance Co, 29424 rnT/VQAON=s rFRTIFIr1ATF NIIMRFP- 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 ADDCSUBR-- LTRTYPEOFINSURANCE _w „yyy;D POLICY NUMBER POLICY EFF ` POLICY BAR - -- _--- (MMILIDIVYYVI (MMIDDIIYYY)' LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 .___ CLAIMS -MADE X_ OCCUR CL00960530 ,IMAGE TO RENTE1.. 09/2212017.0912212018 ' PREMISES(Eaoccurrence_;-$ _ 100,000 X Assent & Battery ", WED EXP (Any one person) '._$ 5,000 X Errors & Orm slon - PERSONAL SADAINJURY $ 1,000,000 OEN'L AGGREGATE UM(r APPLIES PER: 'GENERALAGGREGArF $ 2,000,00 X' POLICY PRO. TOO JECT .— PRODUCTS-COMP/OP ROD 5 '.,. 1,000,000 - OTHER:.--._. $ AUTOMOBILE LIABILITY Ee accident) SINGLELIMIT $ -- - ANY AUTO BODILY INJURY (Per person)'5 ALL OWNED' SCHEDULED .BODILY INJURY (Per accltlanQ. $ . - AUTOS AUTOS .—' .-- NON -OWNED -_ _— �i ROPERTY DAMAGE-$ - HIRED ALTOS AUTOS '. rPer ecaden@ _ UMBRELLALIAB X OCCUR EACH OCCURRENCE $ 4,000,000 A X EXCESS LIAO CLAIMS MADE XL00450349 09/22/2017 0912212018' AGGREGATE S 4,000,000 RED RETENTION$ $ WORKERS COMPENSATION �� X PEATUT_° ERH AND EMPLOYERS' LIABILT Y Y t N B ANY PROPRiETORNARTNERiEXECUTiVE EIG 2418484.01 1012812017 j 1012812918. E.L. EACH ACCIDENT S 1r000,00 NIA (Mandatory InN ftEXCLUOED9 ❑ (Mandatory 3n NH) EL. DISEASE - EA EMPLOYEE _ 12000,0 ityas. tlascribe under DE SCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT -$ 1,000,000 C Property Section 91 SBA BY3163 _ 03/08/2017', 03/081201$ BPP 78,400 DESCRIPTION OF OPERATIONS I LOCATIONS i VEHICLES IACORD ioi, Atldaionai RanwrAa Scbetluie, may ha attached if more space is regUiratl} Proof of Insurances' ° it a r7 10 9` N fi; PROOF-2 I "' .i1tiJ" Proof of Insurance SHOULD ANY OF THE A9 E DESCRi6 POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ©1988-2014 ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: CL00960530 — COMMERCIAL GENERAL LIABILITY CG 20 26 07 04 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 Persons Or Organization(s) Automatic Status Included Where Required by Written Contract. Automatic Status Included Where Required by Written Contract. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II — Who Is An Insured is amended to in- clude as an additional insured the persons) or organi- zation(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 omis- sions of those acting on your behalf: A. In the performance of your ongoing operations; or B. In connection with your premises owned by or rented to you. CG 20 26 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 ❑ THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NON-CONTRIBUTING INSURANCE ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART To the extent that this insurance is afforded to any additional insured under this policy, SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS, 4. Other Insurance, is deleted in its entirety and replaced with the following condition: 4. Otherinsurance If all of the other insurance permits contribution by equal shares, we will follow this method unless the insured is required by written contract signed by both parties, to provide insurance that is primary and non-contributory, and the "insured contract" is executed prior to any loss. Where required by a written contract signed by both parties, this insurance will be primary and non-contributing only when and to the specific extent required by that contract. However, under the contributory approach each insurer contributes equal amounts until it has paid its applicable limit of insurance or none of the loss remains, whichever comes first. If any of the other insurance does not permit contribution by equal shares, we will contribute by limits. Under this method, each insurer's share is based on the proportional ratio of its applicable limit of insurance to the total applicable limits of insurance of all insurers. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. This endorsement forms a part of the Policy to which attached, effective on the inception date of the Policy unless otherwise stated herein. (The following information is required only when this endorsement is issued subsequent to preparation of the Policy.) Endorsement effective Policy No, Endorsement No. Named Insured Countersigned by CIGL 30 01 14 /'- N IPSSE-1 OP ID, , is.I CERTIFICATE OF LIABILITY INSURANCE DATE IMMIDDIYYYYI `01124/2019 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 endorsements . PRODUCER 877.242.9600 CONTACT George Gavaris Central Insurance Agency, Inc. NPHONEAME, 93 East Main Street AIC,, No, ExU: 877-242-9600- FAX No):877.243-8995 Smithtown, NY 11787 E-MAIL certifies&lainsures.com cat - - -- George Gavaris ADDRESS: __..... _ INSURER SAFFORDING COVERAGE NAIC N /� C-� INSURER A: Acceptance Casualty Ins Co 10349 INSURED IPS,Inc. A-��%QI �D1w INSU_RERa Employers Assurance Company - 25402 - -- 3002 Dow Avenue, Ste 512 Scottsdale Insurance Company--41297 Tustin, CA 92780 Fp1,'—gyp(��$�•% T INSURER CJ r, +O.r INSURERD: INSURER E : COVERAGES CERTIFICATE NUMBER- RFVISION NIIMRFR. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LIPTYPE OF INSURANCE ADDL BURR POLICY NUMBER POLICY EFF POLICY EXP vMIDOVYI LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 CLAIMSMADE X OCCUR CLOO960530 09/22/2018 09/22/2019 Y DAMAGE TO RENTED PREMISES(Ea occurrence) S 100,000 _ X Assault&Battery- 5,000 MED EXP(Any one person) S _ X Errors & Omission 1,000,000 PER$ONALBADVINJURY S GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE S 2,000,000 X POLICY JERET LOG PRODUCTS COMPIOPAGG S 2,000,000 OTHER: S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea_accitlent) _ _______$ ANY AUTO _ BODILY INJURY (Per person) __ S OWNED SCHEDULED ' AUTOS ONLY _AUTOS -BODILY INJURY (Per accitlenl) S HIRED NON -OWNED rggOPERTY DAMAGE AUTOS ONLY _. _ AUTOS ONLY PPeeraccdentl__ $ S A UMBRELLA LIAB X OCCUR EACH OCCURRENCE $. 5,000,000 X EXCESS LIAB CLAIMS -MADE XL00450516 09/22/2018 09/22/2019 AGGREGATE S 5,000,000 DED RETENTIONS $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY PER OTH- X -STATUTE _ OR YIN ANY PROPRIETORIPARTNERIEXECUTIVE EIG 2418484 02 10/28/2018 10/28/2019 E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED' NIA (Mandatory in NH) ---- 1,000,000 If yes, describe under E. L. DISEASEEAEMPLOYEES ---- -' 1,000,000 DESCRIPTION OF OPERATIONS below EL DISEASE - POLICY LIMIT S C Excess Umbrella XLS0108378 10/19/2018 09/22/2019 Occ/Agg 4,000,000 VEHICLESDESCRIPTION OF OPERATIONS I LOCATIONS I Schedule, maybe The CitvofSanta Ana, tsOfficers,employees, DAdditionalRemarks anaoneaxmoreaPaoalaragairaa) and representative e,�u \� are itu �fuded as an additional insured under the general liability with respect to the liability created by the negligent ats, errors and omissionsP' of the named insured herein as required by written contract on a and primary non-contributory basis. yrdS ��`rX. CITYSA3 City of Santa Ana Its officers Employees, Agents, Volunteers and Representatives 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. ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD lil111NYa!L111P,I-*I 0111i IIII1101I11-vol COMMERCIAL GENERAL LIABILITY CIGL 79 03 18 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART FIr3:l:1r1114 Name Of Additional Insured Person(s) Or Organization(s) Location(s) Of Covered Operations Automatic Status Included Where Required by Written Automatic Status Included Where Required by 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 or organization shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" arising out of: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your operations for the additional insured at the location shown in the Schedule. However: a. The insurance afforded to such additional insured only applies to the extent permitted by law; b. 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; and c. Regardless of the date of occurrence or when the injury or damage first occurs or is first discovered, a person's or organization's status as an additional insured under this endorsement ends upon the earliest of: (1) The completion or termination of the contract or agreement between you and the additional insured for the location shown in the Schedule; (2) The date you cease actively performing operations for the additional insured at the location shown in the Schedule; or (3) The expiration or termination date of the policy or this endorsement. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to liability or damages for "bodily injury", "property damage", or .per Ell and advertising injury": e ii�� CJ/ 1. Caused by, arising from, or included in the "products -completed operations hazard"; �e� "�v e� 2. Arising out of the additional insured's sole negligence; � 5 3. Arising out of work or operations performed by you that were completed prior to the effective daG�wo , endorsement; or P 4. Which continues or progressively deteriorates after you cease actively performing o i6�%�lra'r,` additional insured at the location shown in the Schedule, even if the injury or da a first �grt`3(ut�d, or is alleged to have first occurred, during the course of your operations for the additional injured. C. Solely for purposes of this endorsement, the following definition is deleted in its entirety and replaced by the following: CIGL 79 03 18 Includes copyrighted material of Insurance Services Office, Inc. Page 1 of 2 1. "'Products -completed operations hazard": a. Includes all "bodily injury' and "property damage" occurring away from premises you own or rent and arising out of "your product' or "your work' except: (1) Products that are still in your physical possession; or (2) Work that has not yet been completed or abandoned. However, "your work' will be deemed completed at the earliest of the following times: (a) When all of the work called for in your contract has been completed; (b) When all of the work to be done at the location shown in the Schedule has been completed if your contract calls for work at more than one location; or (c) When that part of the work done at the location shown in the Schedule has been put to its intended use by any person or organization other than another contractor or subcontractor working on the same project. Work that may need service, maintenance, correction, repair or replacement, but which is otherwise complete, will be treated as completed. D. 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. CIGL 79 03 18 Includes copyrighted material of Insurance Services Office, Inc. Page 2 of 2 POLICY NUMBER: CL00960530 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: Any Person or Organization for whom the insured, prior to a claim, occurrence or incident for which the insured could reasonably expect a claim or occurrence to arise, was required via written agreement or contractual obligation, to waive such rights. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV — Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products - completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. Q�G CG 24 04 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 1 0 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, PRIMARY AND NON-CONTRIBUTING INSURANCE ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART To the extent that this insurance is afforded to any additional insured under this policy, SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS, 4. Other Insurance, is deleted in its entirety and replaced with the following condition: 4. Other Insurance If all of the other insurance permits contribution by equal shares, we will follow this method unless the insured is required by written contract signed by both parties, to provide insurance that is primary and non-contributory, and the "insured contract' is executed prior to any loss. Where required by a written contract signed by both parties, this insurance will be primary and non-contributing only when and to the specific extent required by that contract. However, under the contributory approach each insurer contributes equal amounts until it has paid its applicable limit of insurance or none of the loss remains, whichever comes first. If any of the other insurance does not permit contribution by equal shares, we will contribute by limits. Under this method, each insurer's share is based on the proportional ratio of its applicable limit of insurance to the total applicable limits of insurance of all insurers. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. 7 �ed�7 �e _,o Guv -1ct 4�G This endorsement forms a part of the Policy to which attached, effective on the inception date of the Policy unless otherwise stated herein. (The following information is required only when this endorsement is issued subsequent to preparation of the Policy.) Endorsement effective Policy No. CL00960530 Endorsement No. Named Insured Countersigned by CIGL 30 01 14