HomeMy WebLinkAboutPSOMAS - 2006-03-14 Su Ity Contracts Submittal to
City Clerk's Officer 0 E I V E D
H m H h
2006 MAR 14 PM 3 09
To City Clerk C iT Y O�
HUt4TIFIG rWJ I7z f CH
1 Name of Contractor PSOMAS
2 Purpose of Contract For Example Audit Scrucer or li ater Oialm T sting Hrantingron Lobe-Huntington Central Park
Special Tax Consulting Sei vices Pacific City CFD
3 Amount of Contract S14,600
Copy of contract distributed to The ORIGINAL insurance certificate/waiver sent to Risk
Management
Initiating Dept
City Treasurer ORIGINAL bonds sent to Treasurer
CITY CLERK S OFFICE USE ONLY
i��m Eaten, n Category Data Entry"
City Attoiney's Office Al ha N ID .4
00 1 or *600 30 Pending
Date -)/14/06
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9/Attymisc/forms/city clerk contract transmittal doc
PROFESSIONAL SERVICES CONTRACT BETWEEN
THE CITY OF HUNTINGTON BEACH AND
PSOMAS
FOR
SPECIAL TAX CONSULTING SERVICES
PACIFIC CITY COMMUNITY FACILITIES DISTRICT
THIS AGREEMENT ('Agreement') is made and entered into this / day of
2000 , by and between the City of Huntington Beach, a municipal
corporation of the State of California, hereinafter referred to as "CITY and
PSOMAS a CALIFORNIA CORPORATION
hereinafter referred to as "CONSULTANT
WHEREAS, CITY desires to engage the services of a consultant to
PROVIDE SPECIAL TAX CONSULTING SERVICES and
Pursuant to documentation on file in the office of the City Clerk, the provisions of
the Huntington Beach Municipal Code, Chapter 3 03, relating to procurement of
professional service contracts have been complied with, and
CONSULTANT has been selected to perform these services,
NOW THEREFORE it is agreed by CITY and CONSULTANT as follows
1 SCOPE OF SERVICES
CONSULTANT shall provide all services as described in Exhibit "A"
which is attached hereto and incorporated into this Agreement by this reference These
services shall sometimes hereinafter be referred to as the PROJECT '
CONSULTANT hereby designates MICHAEL D SWAN who shall
represent it and be its sole contact and agent in all consultations with CITY during the
performance of this Agreement
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2 CITY STAFF ASSISTANCE
CITY shall assign a staff coordinator to work directly with CONSULTANT
in the performance of this Agreement
3 TERM, TIME OF PERFORMANCE
Time is of the essence of this Agreement The services of CONSULTANT
are to commence as soon as practicable after the execution of this Agreement by CITY (the
Commencement Date") This Agreement shall expire on DECEMBER 31 2007 unless
sooner terminated as provided herein All tasks specified in Exhibit "A" shall be
completed no later than ONE YEAR from the Commencement Date of this
Agreement These times may be extended with the written permission of CITY The time
for performance of the tasks identified in Exhibit "A" are generally to be shown in
Exhibit "A " This schedule may be amended to benefit the PROJECT if mutually agreed
to in writing by CITY and CONSULTANT
4 COMPENSATION
In consideration of the performance of the services described herein, CITY
agrees to pay CONSULTANT on a time and materials basis at the rates specified in
Exhibit "B," a fee including all costs and expenses, not to exceed
FOURTEEN THOUSAND SIX HUNDRED Dollars ($ 14,6()o
5 EXTRA WORK
In the event CITY requires additional services not included in Exhibit "A"
or changes in the scope of services described in Exhibit "A," CONSULTANT will
undertake such work only after receiving written authorization from CITY Additional
agree/forms/prolsery 10/1,)/01 2
compensation for such extra work shall be allowed only if the prior written approval of
CITY is obtained
6 METHOD OF PAYMENT
CONSULTANT shall be paid pursuant to the terms of Exhibit "B," which
is attached hereto and incorporated by reference into this Agreement
7 DISPOSITION OF PLANS, ESTIMATES AND OTHER DOCUMENTS
CONSULTANT agrees that title to all materials prepared hereunder,
including, without limitation all original drawings designs, reports both field and office
notices, calculations, computer code language data or programs, maps memoranda
letters and other documents shall belong to CITY, and CONSULTANT shall turn these
materials over to CITY upon expiration or termination of this Agreement or upon
PROJECT completion, whichever shall occur first These materials may be used by CITY
as it sees fit
8 HOLD HARMLESS
CONSULTANT hereby agrees to protect, defend, indemnify and hold
harmless CITY, its officers elected or appointed officials employees, agents and
volunteers from and against any and all claims, damages, losses, expenses, judgments,
demands and defense costs (including, without limitation, costs and fees of litigation of
every nature or liability of any kind or nature) arising out of or in connection with
CONSULTANT's (or CONSULTANT's subcontractors, if any) negligent performance of
this Agreement or its failure to comply with any of its obligations contained in this
Agreement by CONSULTANT its officers, agents or employees except such loss or
damage which was caused by the sole negligence or willful misconduct of CITY CITY
a ree/forms/profsery 10/1 D/01
shall be reimbursed by CONSULTANT foi all costs and attorneys fees incurred by CITY
in enforcing this obligation CONSULTANT will conduct all defense at its sole cost and
expense and CITY shall approve selection of CONSULTANT s counsel This indemnity
shall apply to all claims and liability regardless of whether any insurance policies are
applicable The policy limits do not act as limitation upon the amount of indemnification
to be provided by CONSULTANT
9 PROFESSIONAL LIABILITY INSURANCE
CONSULTANT shall obtain and furnish to CITY a professional liability
insurance policy covering the work performed by it hereunder This policy shall provide
coverage for CONSULTANT s professional liability in an amount not less than One
Million Dollars ($1,000,000 00) per occurrence and in the aggregate The above-
mentioned insurance shall not contain a self-insured retention, "deductible" or any other
similar form of limitation on the required coverage except with the express written consent
of CITY A claims-made policy shall be acceptable if the policy further provides that
A The policy retroactive date coincides with or precedes the initiation
of the scope of work (including subsequent policies purchased as
renewals or replacements)
B CONSULTANT shall notify CITY of circumstances or incidents
that might give rise to future claims
CONSULTANT will make every effort to maintain similar insurance during
the required extended period of coverage following PROJECT completion If insurance is
terminated for any reason CONSULTANT agrees to purchase an extended reporting
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provision of at least two (2) years to report claims arising from work performed in
connection with this Agreement
10 CERTIFICATE OF INSURANCE
Prior to commencing performance of the work hereunder, CONSULTANT
shall furnish to CITY a certificate of insurance subject to approval of the City Attorney
evidencing the foregoing insurance coverage as required by this Agreement the certificate
shall
A provide the name and policy number of each carrier and policy
B shall state that the policy is currently in force and
C shall promise that such policy shall not be suspended, voided or
canceled by either party, reduced in coverage or in limits except
after thirty (30) days' prior written notice however, ten (10) days'
prior written notice in the event of cancellation for nonpayment of
premium
CONSULTANT shall maintain the foregoing insurance coverage in force
until the work under this Agreement is fully completed and accepted by CITY
The requirement for carrying the foregoing insurance coverage shall not
derogate from CONSULTANT's defense hold harmless and indemnification obligations as
set forth in this Agreement CITY or its representative shall at all times have the right to
demand the original or a copy of the policy of insurance CONSULTANT shall pay in a
prompt and timely manner, the premiums on the insurance heremabove required
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11 INDEPENDENT CONTRACTOR
CONSULTANT is and shall be acting at all times in the performance of
this Agreement as an independent contractor herein and not as an employee of CITY
CONSULTANT shall secure at its own cost and expense and be responsible for any and
1
all payment of all taxes, social security, state disability insurance compensation,
unemployment compensation and other payroll deductions for CONSULTANT and its
officers agents and employees and all business licenses if any in connection with the
PROJECT and/or the services to be performed hereunder
12 TERMINATION OF AGREEMENT
All work required hereunder shall be performed in a good and workmanlike
manner CITY may terminate CONSULTANT's services hereunder at any time with or
without cause and whether or not the PROJECT is fully complete Any termination of this
Agreement by CITY shall be made in writing, notice of which shall be delivered to
CONSULTANT as provided herein In the event of termination, all finished and
unfinished documents, exhibits, report, and evidence shall, at the option of CITY, become
its property and shall be promptly delivered to it by CONSULTANT
13 ASSIGNMENT AND DELEGATION
This Agreement is a personal service contract and the work hereunder shall
not be assigned delegated or subcontracted by CONSULTANT to any other person or
entity without the prior express written consent of CITY If an assignment, delegation or
subcontract is approved all approved assignees delegates and subconsultants must satisfy
the insurance requirements as set forth in Sections 9 and 10 hereinabove
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14 COPYRIGHTS/PATENTS
CITY shall own all rights to any patent or copyright on any work, item or
material produced as a result of this Agreement
15 CITY EMPLOYEES AND OFFICIALS
CONSULTANT shall employ no CITY official nor any regular CITY
employee in the work performed pursuant to this Agreement No officer or employee of
CITY shall have any financial interest in this Agreement in violation of the applicable
provisions of the California Government Code
16 NOTICES
Any notices, certificates or other communications hereunder shall be given
either by personal delivery to CONSULTANT's agent (as designated in Section 1
hereinabove) or to CITY as the situation shall warrant or by enclosing the same in a sealed
envelope postage prepaid, and depositing the same in the United States Postal Service, to
the addresses specified below CITY and CONSULTANT may designate different
addresses to which subsequent notices certificates or other communications will be sent by
notifying the other party via personal delivery a reputable overnight carrier or U S
certified mail-return receipt requested
TO CITY TO CONSULTANT
City of Huntington Beach Mr Michael D Swan, PE
ATTN STANLEY SMALEWITZ Psomas
2000 Main Street
Huntington Beach, CA 92648 3187 Red Hill Avenue, Ste 250
Costa Mesa, CA 92626
Phone (714) 751-7373
-igreedorms/protsery 10/1 D/01 7
17 CONSENT
When CITY s consent/approval is required under this Agreement, its
consent/approval for one transaction or event shall not be deemed to be a consent/approval
to any subsequent occurrence of the same or any other transaction or event
18 MODIFICATION
No waiver or modification of any language in this Agreement shall be valid
unless in writing and duly executed by both parties
19 SECTION HEADINGS
The titles, captions section paragraph and subject headings, and descriptive
phrases at the beginning of the various sections in this Agreement are merely descriptive
and are included solely for convenience of reference only and are not representative of
matters included or excluded from such provisions and do not interpret, define limit or
describe, or construe the intent of the parties or affect the construction or interpretation of
any provision of this Agreement
20 INTERPRETATION OF THIS AGREEMENT
The language of all parts of this Agreement shall in all cases be construed
as a whole, according to its fair meaning, and not strictly for or against any of the parties
If any provision of this Agreement is held by an arbitrator or court of competent
jurisdiction to be unenforceable void, illegal or invalid, such holding shall not invalidate
or affect the remaining covenants and provisions of this Agreement No covenant or
provision shall be deemed dependent upon any other unless so expressly provided here
As used in this Agreement, the masculine or neuter gender and singular or plural number
shall be deemed to include the other whenever the context so indicates or requires
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Nothing contained herein shall be construed so as to requite the commission of any act
contrary to law and wherever there is any conflict between any provision contained herein
and any present or future statute law, ordinance or regulation contrary to which the parties
have no right to contract, then the latter shall prevail and the provision of this Agreement
which is hereby affected shall be curtailed and limited only to the extent necessary to bring
it within the requirements of the law
21 DUPLICATE ORIGINAL
The original of this Agreement and one or more copies hereto have been
prepared and signed in counterparts as duplicate originals, each of which so executed shall,
irrespective of the date of its execution and delivery, be deemed an original Each
duplicate original shall be deemed an original instrument as against any party who has
signed it
22 IMMIGRATION
CONSULTANT shall be responsible for full compliance with the
immigration and naturalization laws of the United States and shall, in particular comply
with the provisions of the United States Code regarding employment verification
23 LEGAL SERVICES SUBCONTRACTING PROHIBITED
CONSULTANT and CITY agree that CITY is not liable for payment of any
subcontractor work involving legal services, and that such legal services are expressly
outside the scope of services contemplated hereunder CONSULTANT understands that
pursuant to Huntington Beach City Charter Section 309 the City Attorney is the exclusive
legal counsel for CITY and CITY shall not be liable for payment of any legal services
expenses incurred by CONSULTANT
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24 ATTORNEY S FEES
Except as expressly set forth in Section 8 of this Agreement in the event
suit is brought by either party to construe interpret and/or enforce the terms and/or
provisions of this Agreement or to secure the performance hereof each party shall bear its
own attorney s fees such that the prevailing party shall not be entitled to recover its
attorney's fees from the non-prevailing party
25 SURVIVAL
Terms and conditions of this Agreement, which by their sense and context
survive the expiration or termination of this Agreement shall so survive
26 GOVERNING LAW
This Agreement shall be governed and construed in accordance with the
laws of the State of California
27 ENTIRETY
The parties acknowledge and agree that they are entering into this
Agreement freely and voluntarily following extensive arm's length negotiation and that
each has had the opportunity to consult with legal counsel prior to executing this
Agreement The parties also acknowledge and agree that no representations, inducements,
promises, agreements or warranties, oral or otherwise, have been made by that party or
anyone acting on that party's behalf which are not embodied in this Agreement, and that
that party has not executed this Agreement in reliance on any representation, inducement,
promise agreement warranty fact or circumstance not expressly set forth in this
Agreement This Agreement and the attached exhibits contain the entire agreement
between the parties respecting the subject matter of this Agreement and supercede all prior
agree/tones/profserv10/1)/01 10
understandings and agreements whether oral or In writing between the parties respecting
the subject matter hereof
IN WITNESS WHEREOF the parties hereto have caused this Agreement to be
executed by and through their authorized offices the day month and year first above
written
CONSULTANT
CITY OF HUNTINGTON BEACH
Psomas a municipal corporation of the State of California
a California Corporation
B Director of Econo is Development
y (Pursuant To C§3 03 100)
J hn R Thornton
print name
ITS (circle one)Chairman/Presiden ice President APPROVED AS TO FORM
AND M
Ly' City A torney
By %abl
Loren Sokolow _ REVIEWED A D APPROVED
print name
ITS (circle on ecretary hief Financial Office Asst
Secretary reasurer
C ty Ad inistrator
(only fo contracts ver$.)0 000 00)
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ATTACHMENT A
PACIFIC CITY COMMUNITY FACILITIES DISTRICT
SPECIAL TAX CONSULTANT
SCOPE OF SERVICES
A Prepare the Rate Method of Apportionment (RMA) based on the proposed
development After the financing team reviews it, finalize the RMA This service will
involve the calculation of special taxes necessary to support the proposed financing
B The preparation of a CFD Report containing descriptions of the proposed public
facilities their estimated costs, projected bonded indebtedness the anticipated
issuance date and estimated annual special tax rates
C Assistance to Disclosure Counsel with the preparation of the Official Statement
D Preparation and execution upon closing of the transaction of a Special Tax Consultant
Certificate confirming the adequacy of special taxes based upon absorption studies to
meet debt service requirements for the CFD bonds
Additional tasks that you may be asked to perform in relation to the financing and
administration of the District include
i Testifying on behalf of the City at a public meeting or
ii Preparing a detailed value-to-lien or overlapping debt analysis
ATTACHMENT B
PACIFIC CITY COMMUNITY FACILITIES DISTRICT
SPECIAL TAX CONSULTANT
FEE SCHEDULE*
Rate &Method $6 800
CFD Report 3 600
Coordination of Documents (Resolutions
Documents and Official Statement) 3 800
Certification 400
TOTAL $14 600
*Consultant fees are paid with the deposit provided to the City from the developer
su 4 PROFESSIONAL SERVICE CONTRACTS
Hnnn i B Beeh� PURCHASING CERTIFICATION
1 Requested by Carol Runzel
2 Date February 2 2006
3 Name of consultant Psomas
4 Description of work to be performed Special Tax (Economic) Consulting
5 Amount of the contract $14 600 00
6 Are sufficient funds available to fund this contract?' ® Yes ❑ No
7 Company number and object code where funds are budgeted 10080501
8 Is this contract generally described on the list of professional service contracts
approved by the City Council'? ® Yes ❑ No
9 Is this contract within $25 000 or 25% (whichever is less) of the amount stated on
the list of professional service contracts approved by the City Council?'
® Yes ❑ No
10 Were (at least) informal written proposals requested of three consultants?
® Yes ❑ No
Explanation
11 Attach list of consultants from whom proposals were requested (including a
contact telephone number)
12 Attach proposed scope of work
13 Attach proposed payment schedule
4V �
-IAR AMADRIL Manag r
Purchasing/Central Services
If the answer to any these questions is No the contract will require approval from the City Council
Purchasing Cert Psomas 2/2/2006 11 17 AM
I
Request for Proposals
Pacific City Community Facilities District
Special Tax Consultant List
1/19/06
Psomas
Attn Mike Swan
3187 Red Hill Ave Ste 250
Costa Mesa CA 92626
Phone (714) 751-7373
FAX (714) 545-8883
mswan psomas com
Albert A Webb & Associates --- NO RESPONSE
Attn Paul Thompson
3788 Mccray Street
Riverside CA 92506-2927
Phone (951) 686 1070
FAX (951) 788 1256
Harris & Associates
Attn Joan Cox
34 Executive Park#150
Irvine CA 92614
(949) 655-3900
jcox2harns-assoc com
S INSURANCE AND INDEMNIFICATION WAIVER
MODIFICATION REQUEST
1 Requested by Christi Mendoza, Risk Management F- B 2 8 1006
2 Date February 23, 2006 City of HumnaCit ��� :�e ch
3 Name of contractor/permittee PSOMAS y Y s Of`rce
4 Description of work to be performed Special tax consultanting requiring analysis (to
include mathematical calculations and report writing) of the special tax funds to be
allocated to the properties within the Community Facilities District
5 Value and length of contract $14,600, Ending December 31, 2007
6 Waiver/modification request $250,000 deductible/professional liability insurance
7 Reason for request and why it should be granted Unable to comply with the city's zero
deductible insurance requirements
8 Identify the risks to the City in approving this waiver/modification None
oZ, .2 2z&
Departme t ead Signature Date
APPROVALS
Approvals must be obtained in the order listed on this form Two approvals are required
for a request to be granted Approval from Pe City Admmist ator's Office is only required if
Risk Management and th ity Attorneys ff i agree
1 Rt k Management 1
Approved ❑ Denied
Si nature Date
2 City Attorney's Office
pproved ❑ Deni
Signatureu Date
3 City Administrator's Office
❑ Approved ❑ Denied
Signature Date
If approved the completed waiver/modification request is to be submitted to the
City Attorney s Office along vnth the contract for approval Once the contract has been approved
this form is to be filed with the Risk Management Division of Administrative Services
f Client# 6184 PSOMAS
CERTIFICATE OF LIABILITY INSURANCE o2;o;,os
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Dealey Renton&Associates ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
P O Box 10550 HOLDER THIS CERTIFICATE DOES NOT AMEND EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW
Santa Ana CA 92711 0550
714 427 6810 INSURERS AFFORDING COVERAGE
INSURED INSURER Hartford Fire Ins Co
PSOMAS INSURER B Travelers Property Casualty Co of Am
11444 West Olympic Blvd Suite 750 INSURER c American Automobile Ins Co
West Los Angeles CA 90064 1549 INSURER US Specialty Insurance Company
INSURER E
COVERAGES
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 AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
LTR DATE MMIDD DATE MW
A GENERAL LIABILITY 57CESOA1659 10/15/05 10/15/06 EACH OCCURRENCE $1 000000
X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(A y one f ) $1 000 000
CLAIMS MADE FX OCCUR INDP CONTRACTORS MED EXP(Any P so ) —$10 000
X CONTRACTUAL INCLUDED PERSONAL&ADV INJURY $1, 000,000
X BFPD,XCU GENERAL AGGREGATE $2,000,000
GEN L AGGREGATE L IM IT APPL IES PER PRODUCTS COMP/OP A $2s 00000
POLICY X JE° LOC Deductible $25 000
B AUTOMOBILE LIABILITY P810153D8928TIL05 10/15/05 10/15/06 COMBINED SINGLE LIMIT
ANY AUTO (E d 1) $1 000 000
ALL OWNED AUTOS
— BODILY INJURY $
CHEDULED AUTOS (P peso )
X HIRED AUTOS
BODILY INJURY $
X NON OWNED AUTOS (P d 1)
FORM
J _
A D AS TO r PROPERTY DAMAGE
IF c de 1) $
FGARAGE LIABILITY N ER Sr��'L�T�V AUTO ONLY EA ACCIDENT $
l ANY AUTO oru,E x EA ACC $
r 1 OTHER THAN
AUTO ONLY AGG $ _
LEXC,ESS LIABILITY EACH OCCURRENCE $
OCCUR ❑CLAIMS MADE AGGREGATE $
r $
DEDUCTIBLE $
RETENTION $ $
C WORKERS COMPENSATION AND WZP80934662 10/15/05 10/15/06 X WC STATU I IOYH
EMPLOYERS LIABILITY
E L EACH ACCIDENT $1 000 000
E L DISEASE EA EMPLOYEE $1 000 000
E L DISEASE POLICY LIMIT $1 000 000
D OTHER Professional US051170301 10/15/05 10/15/06 $1 000 000 per claim
Liability $1 000 000 annl aggr
$250 000 Deductible
DESCRIPTION OF OPERATIONS/LOCATIONSA/EHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
General Liability policy excludes claims arising out of the performance of professional
services
2HUN011400
Provide professional special tax consultant services Pacific City
(See Attached Descriptions)
CERTIFICATE HOLDER ADDITIONAL INSURED INSURERLETTER CANCELLATION Ten Day Notice for Non Payment of Premium
SHOULD ANYOF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City of Huntington Beach DATE THEREOF THE ISSUING INSURER WIC( J(M TO MAIL 30 DAYS WRITTEN
Attn Risk Mgmt NOTICETOTHE CERTIFICATE HOLDER NAMED TO THE LEFTx k
19001 Huntington Street xslwr;loLa�axaxocairxiaezxoc�a xxoaax$t><atalncoiooc�c
Huntington Beach CA 92648 xarxRexecotvn�c
AUTHORIZED REPRESEJNTATIVE
ACORD 25 S(7/97)1 of 2 #M140586 RLL 0 ACORD CORPORATION 1988
a
r DESCRIPTIONS (Continued from Page'I)
Community Facilities District
City of Huntington Beach its agents officers and employees and the
Redevelopment Agency of the City of Huntington Beach are Additional
Insured as respects to General&Auto Liability
Primary and Non Contributing coverage applies to GL Cross Liability
coverage Waiver of Subrogation apply to GL Waiver of Subrogation for
Work Comp is included
(GL AI/AU AI/PR/SBGL/CRS/SUB/X)
AMS 25 3(07197)2 of 2 #M140586
POLICY NUMBER 57CESOA1659 COMMERCIAL GENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY PLEASE READ IT CAREFULLY
ADDITIONAL INSURED - OWNERS, LESSEES or
CONTRACTORS (FORM B)
This endorsement modifies insurance provided under the following
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name of Person or Organization
City of Huntington Beach
Attn Risk Mgmt
19001 Huntington Street
Huntington Beach CA 92648
(If no entry appears above information required to complete this endorsement will be shown in the Declarations
as applicable to this endorsement)
WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the
Schedule but only with respect to liability arising out of your work for that insured by or for you
Name of Person or Organization its agents officers and employees
and the Redevelopment Agency of the City of Huntington Beach
PRIMARY INSURANCE
IT IS UNDERSTOOD AND AGREED THAT THIS INSURANCE IS PRIMARY
AND ANY OTHER INSURANCE MAINTAINED BY THE ADDITIONAL INSURED
SHALL BE EXCESS ONLY AND NOT CONTRIBUTING WITH THIS
INSURANCE
WAIVER OF SUBROGATION
IT IS UNDERSTOOD AND AGREED THAT THE COMPANY WAIVES THE RIGHT OF
SUBROGATION AGAINST THE ABOVE ADDITIONAL INSURED (S) BUT ONLY AS RESPECTS
THE JOB OR PREMISES DESCRIBED IN THE CERTIFICATE ATTACHED HERETO
SEVERABILITY OF INTEREST
IT IS AGREED THAT EXCEPT WITH RESPECT TO THE LIMIT OF INSURANCE THIS
COVERAGE SHALL APPLY AS IF EACH ADDITIONAL INSURED WERE THE ONLY INSURED
AND SEPARATELY TO EACH INSURED AGAINST WHOM CLAIM IS MADE OR SUIT IS
BROUGHT
CG201011 85
POLICY NUMBER P810153D8928TIL05 BUSINESS AUTOMOBILE LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY PLEASE READ IT CAREFULLY
DESIGNATED INSURED ENDORSEMENT (CA 20 48)
Name of Person(s) or Organization(s)
City of Huntington Beach
Attn Risk Mgmt
19001 Huntington Street
Huntington Beach CA 92648
BUSINESS AUTO COVERAGE
Each person or organization indicated above is an insured for Liability Coverage but only to
the extent that person or organization qualifies as an insured under the Who Is An Insured
provision contained in SECTION II of the Coverage Form
Name of Person or Organization its agents officers and employees
and the Redevelopment Agency of the City of Huntington Beach
I
I
i
I
i
I
I
CA20 48 07 97
4�
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT
This endorsement changes the policy to which it is attached effective on the Inception date of the policy unless a different
date is indicated below
(The following attaching clause needs to be completed only when this endorsement is issued subsequent to preparation of the policy)
This endorsement forms a part of Policy No WZ P 8 0 9 3 4 6 6 2
Issued to PSOMAS
By American Automobile Ins Co
Premium (if any)TBD
We have a 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 2 5%of the California workers compensation premium otherwise
due on such remuneration
Schedule
Person or Organization Job Description
City of Huntington Beach Person or Organization its
Attn Risk Mgmt agents officers and employees and the
19001 Huntington Street Redevelopment Agency of the City of
Huntington Beach CA 92648 Huntington Beach
WC 04 03 06 Countersigned by
(Ed 4 84) Authorized Representitive