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HomeMy WebLinkAboutMIDORI GARDENS (3)City of Santa f a Clerk of the Council 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TERMINATION FORM Please complete this form in its entirety when the attached agreement and all amendments (if any) are no longer in effect.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 have been satisfied prior to signing the termination form. 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. Office Use Only City of Santa Ana 5. 02 c Clerk of the Council The agreement with No. A-Za DI was completed on \� �JI I l�1 and final payment has been made. (List all amendments. Use space below if needed.) Department: {'Q-(��'� I�C:tim'Lv\"" Phone/Ext.: �v Signature: Date: 7 13G1 L Revised: 10-18-16 MAYOR Miguel A. Pulido MAYOR PRO TEM Michele Martinez COUNCILMEMBERS P. David Benavldes Vicente Sarmlento Jose Solorlo Sal Tira*ero Juan Villages }PS AiZA, C) J t (Vt. Y* lam. L&CVPC'` INSURANCE NOT ON FILE WORK MAY NQT PROCEED -\ CLERK OF COUNCIL DATE: FEB 0 1 2,018 December 28, 2017 Midori Gardens, Inc. 3231 S. Main Street 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 wvrw.santa-ana.rim A-207-215-01 CITY MANAGER Raul Godlnez II CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL Maria D. Hulzar Re: Extension of Contractor Agreement No. A-2017-215 to provide landscape maintenance services for District 1 Dear Mr, Hamamoto: Pursuant to Section 3 ("Term") of Agreement No. A-2017-215 entered into by Midori Gardens, Inc. and the City of Santa Ana, dated August 15, 2017, the time period for said Agreement is hereby extended for an additional one (1) year period, from February 1, 2018 to January 31, 2019, 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 Community Services Agency APPROVED AS TO FORM: Sonia R. Carvalho City Attorney .Laura A. Rossini Senior Assistant City Attorney CITY OF SANTA. ANA Raul Godinez II City Manager ATTEST: wlh- . & Maria Clerk of the Council SANTA ANA CITY COUNCIL Miguel A. Nice Michele Martinez Vicente Sormiento Jose solodo P, David BenaOdes Juan Villages Sal Tinajero Mayor Mayor Pro Tem, Ward 2 Ward 7 Ward 3 Ward 4 Ward G Ward 6 rals-fid Ne-m�gord an'm�YSgy,3jganta-ana era vsarmtantongQry;eana wa of otdsanla-a 5a or0 ra avldes�santaar5a pre ivtilanasg5anfvana wa ,ajipgkrot�seniaar'a�o�g CERTIFICATE OF LIABILITY INSURANCE DATE (MMlOONYYY) 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 INSURERIS), AUTHORIZEC REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: if the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. It SUBROGATION IS WAIVED, subject to the tome and conditions of the policy, certain policies may require an endorsement. F, statement on this certificate does not confer rights to the James G Parker Insurance Associates Liosnas #05540591 P 0 Box 3947 rresno CA 93650 INSURED _ tdidori Gardens Inc Kidori Landscape Inc 3231 Main 9troat Santa Ana CA 92707 PRONE--(1;61)294-17011 Pk� 8s1!IT,122-1724 __1616,._ •EMAIL mam`ri@ arker'.Com � .�•� INSURERI8) AFFCA IND COVERAQE _._ NAM INBURHRA:A SOnaUt Great_Central Insurance 1986E INkR!q" Cypress Tnsurance,.Cnmpany� 10855 , ,w„avAc. INSURER O: COVERAGES CERTIFICATE NUMSER:17-18 GL,auto E WC REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUE) TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY RECUIREMENT, 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 CLAIM$. IN"- CODB08R"'—`-'�"""'� fVPEOFINSUMNCE -- POITY''FF POLICYEX VYVI IMMlDDIYnY OMITS X COMMERCIAL OEnGML WBILITY !I EACH OCCURRENCE b 1, 000, ORD I� AJ CLAIMS -MADE X❑ OCCUR ItlAMACk'r'O PE47EtI.-_...Is .__._ 100r000 III�I LW29010]]03 i_PR�M166SJaeH,rtnxp}T.-__,__.,�._, 6/112C 17 6/1/2018 MED ENP l�n1?+!Pnwgl_0, �4'PERSONAL a AOV[t JRRr 1, 000, ODD AGGREGATE UMMAPPLIES PER; 1IS I�r-GENT POLICY E12& CFI LOG I PROOU9ENEMC�TS GOMPIOP A(14 1 { _^ 2, 000,00E ._ _ _ .. a I OTHER' EmlNgroe Sen�nS f.... 1, GOO, OC'0 AOTOMOeIIE LPaILIIY 4 L M—^ IN uMtT @8a d6eE11 __ iS 1, OOOr0G0 A X ANY AItI'O i i SODILYWJVRY(PAA;N ) 7 S -. _. AUTOSMED I AUTOEaULED LI !LAN29010]703 I 6/1/2Cll 6/1/2018 sODILY INJURY (PanKCWnt) RR K) HIRED AUTOS R . AUTOS i I 1 rlPa_e�a,RdryeNDAMAGE II. UMBRELLA OAS OCCUR EACH OCCURRENCE _ fI EXCEea1w__-_�_ CUIM6•MAOE� �ACGREGATE' f 11 I _ __I 1 OEtl RETENTION Is MVRNERSCEMPENSATION � - j X PE D H• ; TATI TES_ ,WD EMPLOYERS DASIOtY YIN. ANY PROPRIETOR I _:. DER EL Ib_ EXCLUDEDOCECUnVE OFFX:ERa1EMBER EXCLUDED? NIA EACH ACCIDENT 1I(IOQy 000 B (Mandataryn NH) ;WW708663 6/1/201T 6/1/2010 C.L. OISCASE•EA EMPLOYEE g__i,,000,L000 __ E ppa UprnEe VnErt OEBbRIPTION Of PEPAnON6 btlow G.L DISEASE •POLICY LIMIT I S 1.Op0 q00 I I � OESCNFTION OF 0KRATIONe l LOOAdONaI VEHICLES PAXN 0181, M MIRIna Ramrrhs echa6Ule, MAY as aMaahatl if mare s6aPv is m9ulnm Job: City of Santa Ana The City of Santa Ana, its officers, agents and employees are included as additional, l�urads as p r o attached endorsamnt OAGCG2010BPN 0104. e 2nd copy s-soiled to insured omn 6/19/2017 14\e (714)571-4211 scuovas@santa-ana.org G,O� G,P"' SHOULD ANY OF THE ABOVE C IBEC I ks BE CANCELLED BEFORE City Of Santa Ana THE EXPIRATION DATE REOF, WILL BE DELIVERED IN Parka, Recreation G Commt3nity ACCORDANCIS WITH THEP UCY PROl NS, Services Agency Attn: Silvia Cuevas AUTHORIZED REPRESENTATIVE 20 Civic Cantor Plata Santa Ana, CA 92701 James Parkor IlS/MARY ACORD 26 (2014101) The ACORD name and logo are registered marks of ACORC iNS02612maol I POLICY NUMBER: LAN2901077-09 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION BLANKET, PRIMARY, OR NON -CONTRIBUTORY — AS REQUIRED BY WRITTEN CONTRACT This endorsement modifies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Policy Effective Date 6/1/2017 Policy Expiration Date 6/112018 Named Insured Midod Gardens & Midori Landscape no f the required policy m ermatlon Is not shown above, It will be shown it the Declarations. SCHEDULE Name Of Additional Insured Parson(s) Name of Person or Oreanization� Locatlor Any person or organization with whom you agreed, because of a written 'insured contract", written agreement Blanket as required by written "insured contract", or permit, is an insured during the policy period. A. Section II — Who Is An Insured Is amended to Include as an additional insured the persons) 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: 1. Your acts or omissions; or 2. The acts or emissions of those acting on your behalf; This insurance is excess over any other insurance available to the additional insured(s) as an insured whether primary, excess, contingent or on any other basis, unless E written 'insured contract" or written agreement specifically requires that this insurancx be either primary or non-contributing, This Insurance applies as respects any claim, loss or liability allegedly arising out of the operations of the named Insured, provided howevyr that this'. insurance will not apr4y to any claim, loss or liability' which is determined to be solely the result of the additional insureds negligence or solely the additional insured's re*ponsibility. in the performance of your ongoing operations for the additional insureds) at th��boation(s) desigrated above. 2a AG CG 2010 BPN 0704 Argo Group Page 1 of 2 Includes copyrighted material of Insurance Services Office, Inc. with its permission. H. Wth 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, inoluding materlals, parts or equipment furnished in connection with such work, on the project (othar than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the looatlon of the covered operations has been completed; or 2. That portion of 'your work" out of which the injury or damage arlses has been put to Its Intended use by any person or organization other then another contractor or suboontractor engaged in performing operations for a principal as a part of the same project. AG CG 201013PN 0704 Argo Group Page 2 of 2 Includes copyrighted material of Insurance Services Cffl(e, (no. with Its permission. ACORa CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) `.� 06/01/2018 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 CONTACT Meredith MCCaleb CISR NAME: James G Parker Insurance Associates PHONE (559)222-7722 Fax (559)222-1724 A/C No Ext: AIC, No: License #0554959 E-MAIL mmocaleb@jgparker.com ADDRESS: P O Box 3947 INSURER(S) AFFORDING COVERAGE NAIC N Fresno CA 93650 INSURER a: Financial Pacific ins Co 31453 INSURED INSURER B: State Compensation Ins Fund 35076 Midori Gardens Inc INSURER C: 3231 Main Street INSURER D: INSURER E : Santa Ana CA 92707 INSURER F: COVERAGES CERTIFICATE NUMBER: 18-19 GUBAM/C 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 LTR TYPE OF INSURANCE AUDI. INSR SUUR WVD POLICYNUMBER POLICY EFF MMIDDIYI'YY POLICY UP MMIDDIYI'YY LIMITS X COMMERCIAL GENERALLIABILITY CLAIMS -MADE ❑X OCCUR EACH OCCURRENCE $ 1,000,000 JAMAUIE PREMISES Ea NIED occurrence) 100,000 $ MED UP (Any one Person) $ 5,000 PERSONAL SADV INJURY $ 1,000,000 A 60505090 06/01/2018 06/01/2019 GENTAGGREGATE LIMITAPPLIES PER POLICY ❑ PRO- ❑ JECT LOC GENERALAGGREGATE g 2,000,000 PRODUCTS-COMPIOPAGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 X BODILY INJURY (Per person) $ ANYAUTO A OWNED SCHEDULED AUTOS ONLY AUTOS 60505090 06/01/2018 06/01/2019 BODILY INJURY (Per accident) $ X HIRED NON -OWNED AUTOS ONLY H AUTOSONLY PROPERTY DAMAGE Per accident $. 8 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOWPARTNER/EXECUTIVE Y❑ IM OFFICEREMBER EXCLUDED? (Mandatory in NH) If yes. describe under DESCRIPTION OF OPERATIONS bekrx NIA 9232562-2018 06/01/2018 06/01/2019 XSTATUTE EORH E.L. EACH ACCIDENT $ 1,000.000 E. L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be aaached if more space is required) VvV Job: City of Santa Ana The City of Santa Ana, its officers, agents and employees are included as additional insureds as per attached endorsement CG 2 `11Z1P1. 111 a City of Santa Ana Parks, Recreation & Community Arm Silvia Cuevas 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 AI � li" `� ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 60505090 CG 20 10R 12 11 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS (WITH LIMITED COMPLETED OPERATIONS COVERAGE) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART BUSINESSOWNERS COVERAGE FORM SCHEDULE NAME OF PERSON OR ORGANIZATION Any person or organization to whom or to which the named insured is obligated by a virtue of a written contract to provide insurance that is afforded by this policy. Where required by contract, the officers, officials, employees, directors, subsidiaries, partners, successors, parents, divisions, architects, surveyors and engineers are included as additional insureds. All other entities, including but not limited to agents, volunteers, servants, members and partnerships are included as additional insureds, if required by contract, only when acting within the course and scope of their duties controlled and supervised by the primary (first) additional insured. If an Owner Controlled Insurance Program is involved, the coverage applies to off - site operations only. If the purpose of this endorsement is for bid purposes only, then no coverage applies. WHO IS AN INSURED: (Section Ip This section is amended to include as an insured the person or organization within the scope of the qualifying language above, but only to the extent that the person or organization is held liable for your acts or omissions in the course of 'your work" for that person or organization by or for you. The "products - completed operations hazard" portion of the policy coverage as respects the additional insured does not apply to any work involving or related to properties intended for residential or habitational occupancy (other than apartments). This clause does not affect the "products - completed operations" coverage provided to the named insured(s). WAIVER OF SUBROGATION: We waive any right of recovery, when required by written contract, that we may have against the person or organization within the scope of CG 20 30R 1211 the qualifying language above because of payments we make for injury. LOCATION OF JOB: The job location must be within the State of domicile of the named insured, or within any contiguous State thereto. DESCRIPTION OF WORK: The type of work performed must be that as described under classifications in the CGL Coverage Part Declarations. PRIMARY CLAUSE: When this endorsement applies and when required by written contract, such insurance as is afforded by the general liability policy is primary insurance and other insurance shall be excess and shall not contribute to the insurance afforded by this endorsement. EXCLUSION This insurance provided to the additional insured does not apply to "bodily injury", "property damage" or "personal and advertising injury" arising out of an architect's, engineer's or surveyor's rendering or failure to render any professional services, including: 1. The preparing, approving, or failing to prepare or approve, maps, designs, shop drawings, opinions, reports, surveys, field orders, change orders, or drawings and specifications; and 2. Supervisory, inspection, architectural or engineering activities. 6vi Endorsement EFFECTI��A�TE: Endorsement EXPIRATION DAT 9C. Includes copyrighted material of Insurance Services office, Inc., with its VN �taP`�l,de 1 of 1 gOG- AC-"R"., rn/vrt-a li*.,,_...--- CERTIFICATE OF LIABILITY INSURANCE DATEIMMIDDIYYYY) 09/13/2018 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 PONCY(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 ri hts to the certificate holder In lieu of such endorsemen s . PRODUCER VDI-ZUU-5040 Ins. Svc: c Tasman c ACT Bill Frederick LicISU License# OE63467 3467 25220 Hancock Ave. #200 PHONE ac, No, Bad: 951.290.5040 F� No) 951-278-0664 - - Murrieta, CA 92662 Press BIII Frederick _ INS 11_REA1$jAFFQROINO COVERAgE N I S Priority Landscape Services �CDD0 tQ -,. LLC INS HERA_Financial Pacific Ins. Co. AXI Capitol INSURERS: P Indemnity Corp, I_X__ 31453 `— .. 525 B Mercury Lane ` Brea, CA 92821 ap4U•- INSURER C: INSURER E COVERAGES rcomrcrn arc .,, ,..,.,-.... INSURER F: THIS IS TO CERTIFY THAT TNc SEVISION NUMBERL CE LISTED OtLVW HAVE BEEN ISSUED OOR INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY THE ITHER NAMED �THERESPECT FOR THE LWHICH CONTRACT DOCUMENT WNSURED THIRIGS DTO CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL EXCLUSIONS AND CONDITIONS OF SUCH THE TERMS, POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INS R TYPE OF INSURANCE ADO SUB POLICY NUMBER POLICY EFF POLICY E%P _ A X COMMERCIAL GENERAL LL481LITY LIMITS EA H 0 URRENCE DAMAGE 1,000,000 CLAIMS -MADE 51OCCUR Y 60503512 04121/2018 04/2112019 aE TEDPREOfec, 100,000 ^�L EXxP (AnY9ne verso __ $ 5,000 GEML PE_ 9NALBADV INJURY 11000,000 ------ AGGREGATE LRIM�ITAPPLIES PER X POOGV jEGT LOC GE ERAL GREGATE $000,000 $.____—_-.__-_.._- TH' PR DUCTS-COMPIOPAGG 2,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO EaIlttideS$!..e,®�^ AWNEp UIppOS ONLY SCHEDULED ADUTNOpSyy BODILY INJURY fPe! r J IT���p AUT03 ONLY AUTOS ONLY BpOOF RN�U AMAGE Y Par kl nt are do 8 B UMBRELLA Lb1S OCCUR X EXCESS UAB CLAIMS -MADE XS18000406-746522 0412112018 04/21/2019 EACH OCCURRENCE $ 5,000,000 OEO RETENTION$ A RE ACE 5,000,000 WORKERS COMPENSATION AND EMPLOYERS'LIABILITY PESERRT I� OTBH- ApFACER/MEMTORIEXCLUDEo�ECUTIVE Y/N ilBandrtary In %E NIA l_L_ET EL EACH ACCIDENT _ $ If es, desalbe urAer IPT N F P RATI N IMv EL DISEASE -EA EMPLOYEE S ^-'"------------ E.DI -P I Y WIT DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) The City are incluof Santa Ana, It's Officers, Employees, Agents, and Representative ded as additional insured to General Liability per form CG201OR 1211. .`eSS�' . \`'x a5 '00 CERTIFICATE Hof FIER .. - City of Santa Ana 20 Civic Center Plaza Santa Ana, CA 92701 SHOULD ANY OF THE ABOVE DESCRIgeYPOLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE -REESIEENNTA-TIV-E r ACORD 25 (2016/03) 01988.2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 'bllb.�CERTIFICATE OF LIARILITY MCU10Atiro DDM YY, DA E(MM 09/13/2018 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 INSURERS), 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 endomement(s). PRODUCER 11111111 Capital Providers Insurance NAME: Rochelle Air mloPHONE (818) 67&0026 License #0H52316INC No (818) 676-0015 20750 Ventura Blvd., Ste 305 gojj�83, CERTSWCPISGroup.com Woodland Hills INSURER(S) AFFORDING COVERAGE NAIL9 CA 91364 INSURERA: AmTrust Financial Services, Inc. INSURED PriorityBuilding Services LLC INSURERS: Priority Landscape Services LLC NSURERC: 521 Mercury Ln INSURER D: Brea INSURERE: CA 928T1 INSURER F: COVERAGES CERTIFICATE NUMBER: 1718 AUTO ( INFO ONLY) THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED RESION NUMBER: INDICATED, TO THE INSURED NAMED AVI FOR THE PERIOD NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 IN R PAID CLAIMS. LTR TYPE OFINSURANCE INSD WVD POLICY NUMBER LIC EFF MMIDO FOLIC COMMERCIAL GENERAL LIABILITY MMfo LIMITS CI -AIMS -WOE EACH OCCURRENCE $ PREMISES Eaaccumenrs $ MEDEXP An one non) $ GENLAGGREGA TE LIMITAPPUES PER: PERSONAL S ADV INJURY S POLICY ❑ PRO- ❑ Loc JECTOTHER: GENERAL AGGREGATE $ PRODUCTS - COMPIOP AGO $ AUTOMOBILE LIABILITY $ ANYAUTO Eaeml of ntSINGLE LIMIT x $ 1,000,000 A OWNED SCHEDULED AUTOS ONLY AUTOS SPP153186200 1010=017 10/03/2018 BODILY INJURY (Per person) $ HIRED NON-0WNED BODILY INJURY(PereoCCenp s AUTOSONLY AUTOS ONLY PROPERTY DAMAGE Pereccitlent $ $ UMBRELLA LMB OCCUR s EXCESS LNB CLAIMS -MADE EACH OCCURRENCE OED RETENTION $ AGGREGATE $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ER OTH ANY PROPRIETORIPARTNEWEXECIRIVE STATUTE ER OFFICERMIEMSER EXCLUDED' ❑ (Manaatury in NH) NIA E.L. EACH ACCIDENT $ E.L. OISEASE � EA EMPLOYEE E If yes, desaite wider DESCRIPTION OF OPERATIONS WI. E.L DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD IOI, AddiEoml Remarks SoM1 ule, may W aMCa Bmo®emoe is r u,r I THE CITY OF SANTA ANA, IT'S OFFICERS, EMPLOYEES, AGENTS, AND REPRESENTATIVE ,,t G\Y CERTIFICATE HOLDER ., CITY OF SANTA ANA 20 CIVIC CENTER PLAZA SANTA ANA CA 92701 SHOULD ANY OF THE A&VE DESCOXD POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ACORD 25 (2016103) ©1988-2015 The ACORD name and logo are registered marks of ACORD All rights reserved. CERTIFICATE OF LIABILITY INSURANCE 7m --T �---- — 6— _W r - I CR Vr IR rURMAt1UN 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 ORDER BY AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATF Hnl nro ' u Mre cenlTicate nOlOer is an endorsed: If SUBROGATION IS WAIVED, But Aon Risk Services, Inc of Florida 1001 Bnckell Bay On., Suite p1100 Miami. FL 331314937 ADP TotalSource FL XVIII, Inc. 102M Sunset Drive Miami, FL 33173 Landscape Services LLC rcury Ln to the terms and conditions I to the certifrcata hnlrfnr In It A: INSURER E: INSURER F I must have ADDITIONAL INSURED provisions or be pollcy, certain policies may require an endorsement. A Risk Services, Inc of Flonda Assurance ""0by THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED INDICATED. REVISION NUMBER: NAMED ABOVE FOR THE POLICY PERIOD 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 INS AFFORDED BY THE POLICIES DESCRIBED EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. HEREIN IS SUBJECT TO ALL THE TERMS, LTR TYPE OF INSURANCE ADDL SUBR INSR Me POLICY NUMBER POLICY EFF POLICY EXP LIMITS SHOWN ARE AS REQUESTED. MM/DD MM/OD/YYY COMMERCIAL GENERAL LIABILITY LIMITS CLAIMS -MADE DOCCUR EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES Es eccurrence $ MEDEXP An one Scion $ GEN'L AGGREGATE LIMIT APPLIES PER: PERSONAL 6 ADVINJURV $ POLICY ❑ PROJECT ❑ LOC GENERAL AGGREGATE $ OTHER PRODUCTS - COMP/OP AGG $ AUTOMOBILE LIABILITY MR D M $ $ ANY AUTO Ea accident BODILY INJURY Per rson $ OWNED SCHEDULED AUTOS ONLY AUTOS DIMLY INJURY Per so i; Inl $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accident It UMBRELLA LIAB OCCUR $ EXCESS LIAB CLAIMS -MADE EACH OCCPENCE $ UR DEC RETENTION $ AGGREGATE $ WORKERS COMPENSATION A AND EMPLOYERS' LIABILITY Y/ N WC 047019003 CA ANYPROPMETORIPARTNEWEXECUTIVE 07/01/18 07/01/19 PER OTH- X STATUTE ER OFFICER/MEMBER NH)EXCLUDED? ❑ N/A (MandatoryinE.L. in NH) EACH ACCIDENT $ 2,000,000 I,;CRe�,meondn DESCRIPTION OF OPERATIONS below E.L. DISEASE - EA EMPLOYEE $ 2,000.000 E.L. DISEASE -POLICY LIMIT $ 2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, mIf re spaces requiretl) All worksite employees working for PRIORITY i aybe ahachetlNC'spayroll,are mamOretluntlemeabove LANDSCAPE SERVICES LLC, Paid under ADP TOTALSOURCE, Istated policy. ed� CERTIFICATE HOLDER ,....__.. -_._-- CITY OF SANTA ANA 20 CIVIC CENTER PLAZA SANTA ANA, CA 92701 ACORD 25 (2016/03) The ninon _.. SHOULD ANY OF THE ABOVE DESCRIBED THE EXPIRATION DATE THEREOF, NI ACCORDANCE WITH THE POLICY PROWA AUTHORIZED REPRESENTATIVE 17 POLICY NUMBER:60503512 CG 20 10R 1211 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS (WITH LIMITED COMPLETED OPERATIONS COVERAGE) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART BUSINESSOWNERS COVERAGE FORM PREMIUM Incl SCHEDULE NAME OF PERSON OR ORGANIZATION Any person or organization to whom or to which the named insured is obligated by a virtue of a written contract to provide insurance that is afforded by this policy. Where required by contract, the officers, officials, employees, directors, subsidiaries, partners, successors, parents, divisions, architects, surveyors and engineers are included as additional insureds. All other entities, including but not limited to agents, volunteers, servants, members and partnerships are included as additional insureds, if required by contract, only when acting within the course and scope of their duties controlled and supervised by the primary (first) additional insured. If an Owner Controlled Insurance Program Is Involved, the coverage applies to off - site operations only. If the purpose of this endorsement is for bid purposes only, then no coverage applies. WHO IS ANINSURED. (Section II) This section is amended to include as an insured the person or organization within the scope of the qualifying language above, but only to the extent that the person or organization is held liable for your acts or omissions in the course of "your work" for that person or organization by or for you. The "products - completed operations hazard" portion of the Policy coverage as respects the additional insured does not apply to any work involving or related to properties intended for residential or habitational occupancy (other than apartments). This clause does not affect the °products - completed operations" coverage provided to the named insured(s). the qualifying language above because of Payments we make for injury. LOCATION OF JOB - The job location must be within the State of domicile of the named insured, or within any contiguous State thereto. DESCRIPTION OF WORK The type of work performed must be that as described _under classifications in the CGL When this endorsement applies and when required by written contract, such insurance as is afforded by the general liability policy is primary insurance and other insurance shall be excess and shall not contribute to the insurance afforded by this endorsement. EXCLUSION This insurance provided to the additional insured does not apply to "bodily injury", "property damage" or "personal and advertising injury" arising out of an architect's, engineer's or surveyor's rendering or failure to render any Professional services, including: 1. The preparing, approving, or failing to prepare or approve, maps, designs, shop drawings, opinions, reports, surveys, field orders, change orders, or drawings and specifications: and 2. Supervisory,�ifspection, architectural or WAIVER OF SUBROGATION o11 We waive any right of recovery, when required Endorser by written contract, that we may have against the person or organization within the scope of Endorsement CG 20 1013 12 11 Includes copyrighted material of Insurance services Office, Ine SEE DEC SEE DEC Page 1 of 1 PRIOR-5 OF IDJS DA04/19/2019Y) 04/19/2019 ACORO' CERTIFICATE OF LIABILITY INSURANCE 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 951-290-5040 ISU Ins. Svc. Cormarc Tasman License# OE63467 25220 Hancock Ave. #200 Murrieta, CA 92562 cpNTACT Bill Frederick `NBME;.— - - - - II PHONE EatJ:951-290.5040 FAX Ne).951-278.0664 E-MAIL - AD REss: INSURER LSJ AFFORDING COVERAGE NAIC# Bill Frederick _ INSURER A: Financial Pacific Ins. Co.,AXI 31453 Fr URED ✓� _�O-�� I�—y/' INSURERS, Capitol Indemnity Corp, A, IX n(((8rity Landscape Services rr tt INSURERC: _ J21Mercury LaneLL Brea, CA 92821 OI tv 4�1 - D1 'INSURER D: INSURER E: INSURER F : COVFRAGFS CFRTIFICATF NIIMRFR• RFVLCInM NI IIVIRFR- 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 rypE OF INSURANCE ADDL WDR POLICY NUMBER POLICY EFF POLICY E%P Yyy LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR 60503512 04I21I2019 04/21/2020 X DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 $ 5,000 M ED EXP LAny one pemom $ 1,000,000 __- PERSONAL B ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIM IT APPLIES PER: GE NERAL AGGREGATE X POLICY ',J JEET L- LOC PRODUCTS - COMP/OP AGO $ 2,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accitlem $. ANY AUTO OWNED (SCHEDULED BODILY INJURY Per arson $ AUTEEO��S ONLY —!AUTOS BODILY INJURY Per aaiaem $ AUTOS �I gUTOS ONED P�20PERdYtDAMAGE $ ONLY B _ UMBRELLALIAB OCCUR EACH OCCURRENCE_ 5,000,000 X EXCESS LIAB 'CLAIMS -MADE XS18000406-01-746522 04/21/2019 04/21/2020 �DED _$ AGGREGATE $ 5,000,000 I I RETENTION$ $ i WORKERS COMPENSATION AND EMPLOYERS' LIABILITY PER OTH- 'STATUTE ER Y / N �AAOFFICERPRIETgORqIEXCLUDED?ECUTIVE - NIA E L. EACH ACCIDENT _ _$_ (Mantlatory In NH) - E.L. DISEASE - EA EMPLOYEE $ If yes, tlescbbe untler DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be aMchetl if more space Is requinun The City of Santa Ana, It's Officers, Employees, Agents, and Representative are included as additional insured to General Liability per form CG201 OR 1211. Eby 1 City of Santa Ana 20 Civic Center Plaza Santa Ana, CA 92701 SHOULD ANY OF THE ABOVE DESCRIBED Q, I 'BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, N E WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ACORD 25 (2016/03) 01988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AC(:>Ro® CERTIFICATE OF LIABILITY INSURANCE F GAl/JMM1DD119Y) 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 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 endomement(s). PRODUCER CONTACTLai Dig NAME: Larry per Colony West Financial Insurance Services PHONES (714)542-4870 FAX No: 01USU-e71 License li OC42420 EMAfL ADDRESS: P Y ldra Br@Colon Me9t.COID 201 East Sandpoints Dr X360 INSURERS AFFORDING COVERAGE NAIC9 INSURER A: Ore On Mutual Insurance Compary 14907 Santa Ana CA 92707 INSURED INSURER B: Priority Landscape Services, LLC INSURER C: 521 Mercury Lane INSURER O: INSURER E: INSURER F: Brea CA 92821-4831 COVERAGES CERTIFICATE NUMBER: CLIS10323940 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 LTR TYPE OF ADDL BUBR POLICY NUMBER POLICY EFF MM/00/YYYY POLICY EXP MMIDONYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 3 CLAIMS MADE OCCUR DAMAGE TO RENTED PREMISES adccurm $ MED EXP (My one pwaM ) 3 PERSONAL aADV INJURY 5 LIMITAPPUES PER: GENERALAGGREGATE S GEN'LAGGREGATE ❑PRO- ❑ POLICY ECT LOC PRODUCTS-COMPIOPAGG IS 5 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT E,a x ide 5 1,000,000 BODILY INJURY (Par pxson) $ A X ANY AUTO ALL OWNED AUTOSSCHEDIED AUTOS AUTOS CHO919473 10/3/2018 10/3/2019 BODILY INJURY (Pm amld") 3 X HIREDAUTOS x NON-OYYNED AUTOS PROPERTY DAMAGE Pe acad S R Medlin PaYn $ 5,000 UM UMBRELLA LIAB OCCUR EACH OCCURRENCE 5 AGGREGATE $ EXCESS LIAB C ZMAOE DED I I RETENTION 5 $ WORHERSCOMPENSATION PER OTH- ANDEMPLOYERVLIABILITY YIN T R EL EACH ACCIDENT 5 ANYCERIMEETORIPARTNDED' THE OFFIOERIMEMBEI EXCWOfp7 ❑NIA EL DISEASE -EA EMPLOYEE 3 IM90drt9ry In NH) M. E.L. DISEASE-PoLICV LIMIT S IPTION DESCRIPTION FO DESCRIPTION OF OPERATIONSbdox DESORIPnONOFOPERATICNSILOGATIONSIVEHICLES(ACORD 101, Addilioml RIMA&S SchedUle. may beamahed if mom spa �G5 P City of Santa Ana. Parks, Recreation Community Services Agency 20 Civic Center Plaza M-23 P.O. Box 1988 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. AUTHORIZEO REPRESENTATIVE Draper/LARRY FM ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD INS025 po14o1) "u a' CERTIFICATE OF LIABILITY INSURANCE DATE 1W, THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATO IN ONLY AND IF ''AD 4",RS 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 11 11c11,11 '' must have ADDITIONAL INSURED provisions or be stat PRendorsed. It SUBROGATION IS WAIVED, subJecl to the terms and conditions of the Policy, certain Policies may require an endorsement A ement on this certificate does not confer rights hts to the certiRcate holder In Ileu of such entlanement s . ODUCER APn R.k SON"$, Inc PI FIMpa CONTACT 1001 S.ke. Bay D. Suite p11W NAME: ADD Risk Service.. Ilse of Fbnde Palau" FL XNII. IN Z.ON` FL.91]D LxMPrepe Semca. LLC 'MCATE MAY BE ISSUED OR ,! SION$ ANO CONDI TIONS OF TYPEOF INSURANCE COMMERCIAL GENERAL LIABILITY ] CLAIMS MAOE .00CUR 'L AGGREGATE LIMIT APPLIES PER. POLICY ❑ PROJECT ❑ LOC OTHER DMOBILE LIABILITY ONLY OCCUR A wuksre Nnpbyez. wnon9 CITY OF SAWA ANA W CIVIC CENTER PI SANTA ANA, CA Wnj TERM OR CONDITION OF AN, i INSURANCE AFFORDED BY IITS SHOWN MAY HAVE BEEN 1 POLCYNUMBER INC U7019003 CA 074111a 1 07/01/19 HEREIN SHOULD ANY OF THE ABOVE DESCRIBED THE EXPIRATION DATE THEREOF, NI ACCORDANCE WITH THE POLICY PROVNdi AUTHORREDREPRESENTATNE ACORD 25 (2016103) The ACORD name and 1090 are registeredIS) 1988-2015 ACC marks of ACORD IECT TO WHICH THIS TO ALL THE TERMS. ARE AS REQUESTED LIMITS IN POLICY NUMBER:6D5o3512 CG 2010R 1211 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS (WITH LIMITED COMPLETED OPERATIONS COVERAGE) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART BUSINESSOWNERS COVERAGE FORM PREMIUM Incl SCHEDULE NAM_ EOFpIRygONOROR�t�n„�T Any person or organization or to which the named insured Is obligated by a virtue of a written contract to provide Insurance that is afforded by this policy. Where required by contract, the officers, officials, employees, directors, subsidiaries, partners, successors, parents, divisions, architects, surveyors and engineers are included as additional insureds. All other entities, including but not limited to agents, volunteers, servants, members and partnerships are Included as additional Insureds, If required by contract, only when acting within the course and scope of their duties controlled and supervised by the primary (first) additional insured. If an Owner Controlled Insurance Program Is involved, the coverage applies to off - site operations only. If the purpose of this endorsement is for bid purposes only, then no coverage applies. WHO IS AN INSURED (Section II) This section is amended to include as an insured the person or organization within the scope of the qualifying language above, but only to the extent that the person or organization is held liable for your acts or omissions in the course of 'your work' for that person or organization by or for you. The 'products. completed operations hazard" portion of the Policy coverage as respects the additional Insured does not apply to any work involving or related to properties intended for residential or habitational occupancy (other than apartments). This clause does not affect the ^products - completed operations" coverage provided to the named Insured(s). the qualifying language above because of Payments we make for Injury. LOCATION OF JOB: The job location must be within the State of domicile of the named insured, or within any contiguous State thereto, DESCRIPTION OF WORK: The type of work performed must be that as described under classifications In the CGL Covers a Part Declarations. PRIMARY C a tg •' When this endorsement applies and when required by vrtitten contract, such Insurance as Is afforded by the general liability policy Is Primary insurance and other insurance shall be excess and shall not contribute to the insurance afforded by this endorsement. EXCLUSION This insurance provided to the additional insured does not apply to 'bodily injury", 'property damage' or 'personal and advertising injury - arising out of an architect's, engineer's or surveyor's rendering or failure to render any professional services, Including: 1. The preparing, approving, or failing to prepare or approve, maps, designs, shop drawings, opinions, reports, surveys, field orders, change orders, or drawings and specifications; and 2. SupervisoN ifspection, architectural or WAff&ZA&R0GATI0N end We waive any right of recovery, when required Endorser by written contract, that we may have against the person or organization within the scope of Endorsement CG 20 IOR 12 11 Includes copyrighted material of Inswance Services Ofitce. SEE DEC SEE DEC Page 1 of 1