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Insurance Certificates 2016/17 Bengal EngineeringMEMORANDUM TO: Frank J. Spevacek, City Manager FROM: Timothy R. Jonasson, Design and Development Director/City Engineer DATE: April 18, 2017 RE: Amendment No. 1 to a Professional Services Agreement with Bengal Engineering, Inc. in the amount of $34,200 for the Dune Palms Road Widening Project. Attached for your review and signature is a PSA between Bengal Engineering, Inc. and the City of La Quinta for the services referenced above. Reviews and signatures are being conducted electronically via the TRAKiT system. Please provide your electronic signature and advise the City Clerk once you have done so. The City Clerk will continue with full execution and final distribution of the PSA. Requesting department shall check and attach the items below as appropriate: x Contract payments will be charged to account number: 401-1806-551.45010-D x Amount of Agreement, Amendment, Change Order, etc.: AMENDMENT NO. 1 - $32,400 A Conflict of Interest Form 700 Statement of Economic Interests from Consultant(s) is attached with no reportable interests in LQ or reportable interests x A Conflict of Interest Form 700 Statement of Economic Interests is not required because this Consultant does not meet the definition in FPPC regulation 18701(2). Authority to execute this agreement is based upon: x Approved by the City Council on _April 18, 2017_ (date) City Manager's signature authority provided under Resolution No. 2015-045 for budgeted expenditures of $50,000 or less N/A Initial to certify that 3 written informal bids or proposals were received and considered in selection The following required documents are attached to the agreement: x Insurance certificates as required by the agreement (initialed by Risk Manager on date) N/A Performance bonds as required by the agreement (originals) x City of La Quinta Business License No. LIC-0100872 ; Expires: 6/30/17 AoC"R" CERTIFICATE OF LIABILITY INSURANCE fi- DATE (MM/DD/YYYY) 04/13/2017 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(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 NAME: Tina Jackson Tina Jackson Insurance Services, Inc a/CONNxt E: 8059662500 FAX No: 8055635328 E-MAIL ADDRESS: tina@tinajacksonins.com 3834 Pemm PI INSURER(S) AFFORDING COVERAGE NAIC# Santa Barbara, CA 93110 INSURERA: Hanover Insurance Company INSURED INSURERB: U.S. Specialty Insurance Company Bengal Engineering, Inc INSURERC: The Hartford INSURER D : 250 Big Sur Drive Goleta CA 93117 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL SUER POLICY NUMBER MM/DDPOLICY/YYYY MM IDDNYYY LIMITS A X COMMERCIAL GENERAL LIABILITY Y Y OB3-A316654-00 06/15/16 06/15/18 EACH OCCURRENCE $ 2,000,000 CLAIMS -MADE �X OCCUR DAMAGE TO RETE PREMISES Ea occur ence $ 300,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 NPOLICY PRO JECT ❑ LOC PRODUCTS - COMP/OPAGG $ 4,000,000 $ OTHER: A AUTOMOBILE LIABILITY AW3A50250500 12/12/15 12/12/16 COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ ANY AUTO OWNED X AUTOS SCHEDULED AUTOS ONLY BODILY INJURY (Per accident) $ X PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY X AUTOS ONLY $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBEREXCLUDED? ❑ (Mandatory in NH) NIA Y 72WECKZ2053 05/15/16 05/15/18 X SPER TATUTE ERH E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 B Professional Liability USS1425181 109/17/1609/17/11 $1,000,000 Per Occurrence $2,000,000 Agg egate DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of La Quinta, it's officer and employees are listed as additional insured in respects to general liability. Coverage is primary and non-contributory. The Dune Palms Road widening improvement Project No. 2009-04 **10 days notice of cancellation of non-payment of premium** CERTIFICATE HOLDER CANCELLATION City of La Quinta Attn: Frank Spevacek SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City Manager ACCORDANCE WITH THE POLICY PROVISIONS. 78-495 Calle Tampico AUTHORIZED REPRESENTATIVE La Quinta, CA 92253 © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA Policy Number: 72 WEC KZ2053 Endorsement Number: Effective Date: 05 / 15 / 17 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: BENGAL ENGINEERING, INC 513 STANLEY DR SANTA BARBARA, CA 93105 We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be premium otherwise due on such remuneration. Person or Organization ANY PERSON OR ORGANIZATION FROM WHOM YOU ARE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT TO OBTAIN THIS WAIVER OF RIGHTS FROM US. SCHEDULE Countersigned by 2 % of the California workers' compensation Job Description AS REQUIRED BY WRITTEN CONTRACT. Authorized Representative Form WC 04 03 06 (1) Printed in U.S.A. Process Date: 03/25/17 Policy Expiration Date: 05/15/18 Hanover Insurance Group- 0133 A316654 1001257 OTHER INSURANCE - PRIMARY AND NON-CONTRIBUTORY (ADDITIONAL INSURED) ENDORSEMENT THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM The following is added to SECTION III - COMMON POLICY CONDITIONS: M. Other Insurance 1. Additional Insureds If you agree in a written contract, written agreement or permit that the insurance provided to any person or organization included as an Additional Insured under SECTION II - LIABILITY, Part C - Who is An Insured, is primary and non-contributory, the following applies: If other valid and collectible insurance is available to the Additional Insured for a loss we cover under SECTION II - LIABILITY, Part A. Coverages, Paragraph 1., Business Liability our obligations are limited as follows: a. Primary Insurance This insurance is primary to other insurance that is available to the Additional Insured which covers the Additional Insured as a Named Insured. We will not seek contribution from any other insurance available to the Additional Insured except: (1) For the sole negligence of the Additional Insured; (2) When the Additional Insured is an Additional Insured under another primary liability policy; or (3) When b.(2) below applies. If this insurance is primary, our obligations are not affected unless any of the other insurance is also primary. Then, we will share with all that other insurance by the method described in b.(3) below. b. Excess Insurance This insurance is excess over: (1) Any of the other insurance, whether primary, excess, contingent or on any other basis: (a) That is Fire, Extended Coverage, Builder's Risk, Installation Risk or similar coverage for "your work"; (b) That is Fire insurance for premises rented to the Additional Insured or temporarily occupied by the Additional Insured with permission of the owner; (c) That is insurance purchased by the Additional Insured to cover the Additional Insured's liability as a tenant for "property damage" to premises rented to the Additional Insured or temporarily occupied by the Additional Insured with permission of the owner; or (d) If the loss arises out of the maintenance or use of aircraft, "autos" or watercraft to the extent not subject to Exclusion g. of SECTION II - LIABILITY, Part A. Coverages, 1. Business Liability. When this insurance is excess, we will have no duty under SECTION II - LIABILITY, Part A. Coverages, 1. Business Liability to defend the insured against any "suit" if any other insurer has a duty to defend the insured against that "suit". If no other insurer defends, we will undertake to do so, but we will be entitled to the insured's rights against all those other insurers. When this insurance is excess over other insurance, we will pay only our share of the amount of the loss, if any, that exceeds the sum of: (2) The total amount that all such other insurance would pay for the loss in the absence of this insurance; and (3) The total of all deductible and self -insured amounts under all that other insurance. We will share the remaining loss, if any, with any other insurance that is not 391-1331 06 09 Includes copyrighted material of Insurance Services Offices, Inc., with its permission Page 1 of 2 described in this Excess Insurance provision and was not bought specifically to apply in excess of the Limits of Insurance shown in the Declarations of this Coverage Part. c. Method Of Sharing If all of the other insurance permits contribution by equal shares, we will follow this method also. Under this 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 ratio of its applicable limit of insurance to the total applicable limits of insurance of all insurers. 391-1331 06 09 Includes copyrighted material of Insurance services Offices, Inc., with its permission Page 2 of 2 Hanover Insurance Group- 0133 A316654 1001257 IIIIa6-14fl1191Z6,y4itil:4►yis]ImFMM MRSICI:1011I]'A»:f-'NIA:W-A911MCI :41111114Wo ADDITIONAL INSURED- DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Name Of Additional Insured Person(s) Or Oroanization(s): CITY OF LA QUINTA, IT'S OFFICERS AND EMPLOYEES Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph C. Who Is An Insured in Section II - Liability: 3. Any person(s) or organization(s) shown in the Schedule is also an additional insured, 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 in the performance of your ongoing operations or in connection with your premises owned by or rented to you. BP 04 48 0106 Copyright, ISO Properties, Inc., 2004 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE* Name Of Person Or Organization: CITY OF LA QUINTA, IT'S OFFICERS AND EMPLOYEES * Information required to complete this Schedule, if not shown on this endorsement, will be shown in the Declarations. Paragraph K. Transfer Of Rights Of Recovery Against Others To Us in Section III - Common Pol- icy Conditions is amended by the addition of the following: 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 op- erations 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. BP 04 97 07 02 Copyright, ISO Properties, Inc., 2001 Page 1 of 1