Written materials relating to an item on this agenda that are distributed to the legislative bodies within 72 hours before the item is to be considered at its regularly scheduled meeting will be made available for public inspection at the City Clerk’s Office, 300 West Third Street 4th Floor during customary business hours. Agenda reports are also on the City of Oxnard web site at www.oxnard.org.
In compliance with the Americans with Disabilities Act, if you require special assistance to participate in a meeting, please contact the City Clerk’s Office at 385-7803. Notice at least 72 hours prior to the meeting will enable the City to reasonably arrange for your accessibility to the meeting.
Agenda Item time estimates: (Presentation / Committee Discussion / Public Comment) AGENDA
OXNARD CITY COUNCIL
PUBLIC WORKS AND TRANSPORTATION COMMITTEE
Council Chambers, 305 West Third Street
June 14, 2022
Regular Meeting - 8:30 to 10:00 PM
Zoom details to call-in for public comment during a meeting:
1. Dial Phone Number: (888) 475-4499
2. Enter Meeting ID: 893 1575 9566
3. Passcode: 954201
If you wish to speak during public comments or a particular item on the agenda, please sign-on by following the zoom calling in steps listed above. Once the Mayor calls for public speakers, press *9 to raise your hand to inform the City Clerk you would like to speak during the public speaking section for that particular item on the agenda, while in the zoom waiting room.
The public may view the meeting from home on Spectrum channel 10, Frontier channel 35, or YouTube at Youtube.com/oxnardnews.
Video recordings of the meeting are typically available online following the meeting at the City’s website at www.oxnard.org/city- meetings.
*Please see the link for the Measure M pre-recorded presentation video for each item listed on this agenda.
YOU MAY PARTICIPATE IN THE MEETING IN THE FOLLOWING WAYS:
1. ATTEND THE MEETING AT THE LOCATION LISTED ABOVE: Submit a speaker card to the City Clerk.
2. EMAIL COMMENTS OR SIGN UP TO SPEAK REMOTELY BEFORE THE MEETING a. Submit a request to speak by no later than 3 p.m. on the day of the meeting by using the form available at www.oxnard.org/citymeetings.
b. Submit an email to [email protected] no later than 3 p.m. on the day of the meeting (indicate the agenda item number in the subject line). All email correspondence will be forwarded to the City Council prior to the start of the meeting and made part of the legislative record. c. Contact the City Clerk’s Office at (805) 385-7803 to submit your request.
3. PROVIDING PUBLIC COMMENTS REMOTELY DURING THE MEETING a. To provide public comment during the meeting dial (888) 475-4499 and enter the Meeting ID and Passcode listed above as the Zoom details for this meeting. When the Mayor announces the particular item on the agenda you want to speak on, press *9 to raise your hand while in the zoom waiting room. Once called on, press *6 to unmute your phone.
b. Public comments on agenda items will be taken following the announcement of the item. After the item is announced, members of the public may register or otherwise be recognized for the purpose of providing public comment.
Detailed participation instructions can be found at www.oxnard.org/city-meetings. 1 OXNARD CITY COUNCIL: PUBLIC WORKS AND TRANSPORTATION COMMITTEE June 14, 2022 - Page 2
* The City has filed pre-election and post-election lawsuits regarding the validity of Measure M.
A. ROLL CALL, POSTING OF AGENDA, FLAG SALUTE
B. PUBLIC COMMENTS ON ITEMS NOT ON THE AGENDA
A person may address the legislative body only on matters not appearing on the agenda and within the subject matter jurisdiction of the legislative body. Speaker requests shall be submitted as set forth on the first page of this agenda. Speakers are limited to three minutes. After 30 minutes, if all speakers have not had the opportunity to speak, the remaining speakers will be given an opportunity to speak prior to adjournment of the meeting. The legislative body cannot enter into a detailed discussion or take action on any items presented during public comments at this time. Such items may only be referred to the City Manager/Executive Director/Secretary for administrative action or scheduled on a subsequent agenda for discussion. Persons wishing to speak on public hearing items should do so at the time of the hearing.
C. CONSENT AGENDA
1. City Clerk Department
SUBJECT: Approval of Minutes.
RECOMMENDATION: That the Public Works & Transportation Committee approve the minutes of the May 24, 2022 regular meeting as presented.
Contact: Rose Chaparro, (805) 385-7805
D. REPORTS
1. Public Works Department
SUBJECT: Agreement A-8471 with Taft Electric Company for On-Call Traffic Signals Repairs and Maintenance Services, Specification No. PW 22-103. (0/5/5)
RECOMMENDATION: That the Public Works and Transportation Committee recommend that the City Council approve and authorize the Mayor to execute Agreement A-8471 with Taft Electric Company in the amount of $300,000 for a three year term for On-Call Traffic Signals Repairs and Maintenance Services, Specification No. PW 22-103.
Please click the following link to view the required Measure M pre-recorded presentation video: https://youtu.be/oZahCNj5jeU
Contact: Michael Wolfe, (805) 385-8055
2. Public Works Department
SUBJECT: Agreement A-8468 with Parkhouse Tire, Inc. for Tire Retreading and Repair Services. (0/5/5)
RECOMMENDATION: That the Public Works and Transportation Committee recommend that the City Council approve and authorize the Mayor to execute Agreement A-8468 with Parkhouse Tire, Inc. in an amount not to exceed $600,000 for a three year term, with each year renewable in one year increments beginning September 4, 2022 and ending September 3, 2025 upon agreement by both parties for tire retreading and repair services.
Please click the following link to view the required Measure M pre-recorded presentation video: https://youtu.be/fI3t5el2usQ
Contact: Michael Wolfe, (805) 385-8055
E. ITEMS FOR FUTURE AGENDAS
2 OXNARD CITY COUNCIL: PUBLIC WORKS AND TRANSPORTATION COMMITTEE June 14, 2022 - Page 3
F. ADJOURNMENT
3 PUBLIC WORKS AND TRANSPORTATION COMMITTEE
AGENDA REPORT
CONSENT AGENDA
AGENDA ITEM NO. C.1
DATE: June 14, 2022
TO: Public Works and Transportation Committee
FROM: Rose Chaparro, City Clerk, (805) 385-7805, [email protected]
SUBJECT: Approval of Minutes.
RECOMMENDATION
That the Public Works & Transportation Committee approve the minutes of the May 24, 2022 regular meeting as presented.
BACKGROUND
Approval of Minutes.
STRATEGIC PRIORITIES
This agenda item is a routine operational item.
FINANCIAL IMPACT
There is no financial impact.
Prepared by: Rose Chaparro, City Clerk
ATTACHMENTS
1. MINUTES 05 24 2022 Public Works & Transportation
4 AGENDA
OXNARD CITY COUNCIL
PUBLIC WORKS AND TRANSPORTATION COMMITTEE
Council Chambers, 305 West Third Street
MAY 24, 2022
A. ROLL CALL, POSTING OF AGENDA, FLAG SALUTE
At 8:3 0 p.m., Chair Bert E. Perello called to order the regular meeting of the Oxnard City Council Public Works & Transportation Committee in the City Hall Council Chambers at 305 W. Third Street, Oxnard, California. The City Clerk called the roll and announced the posting of the agenda. Member Vianey Lopez, Member John C. Zaragoza, and Chair Bert E. Perello were present in person.
Staff members Alexander Nguyen, City Manager; Kenneth Rozell, Chief Assistant City Attorney; Michael Wolfe, Public Works Director; Joseph Marcinko, Assistant Public Works Director; Tatiana B.
Arnaout, P.E., City Engineer; and Rose Chaparro, City Clerk were also present in person.
B. PUBLIC COMMENTS ON ITEMS NOT ON THE AGENDA (None received.)
C. CONSENT AGENDA
1. City Clerk Department SUBJECT: Approval of Minutes.
RECOMMENDATION: That the Public Works & Transportation Committee approve the minutes of the May 10, 2022 regular meeting as presented.
It was moved by Member Lopez , seconded by Chair Perello, to approve the Information/Consent item as presented. VOTE: Lopez, Perello, and Zaragoza voted in favor, the motion carried 3-0.
D. REPORTS
1. Public Works Department
SUBJECT: First Amendment to Agreement A-8126 for Delivery of Bulk Fuel (Unleaded Gasoline, Clear Diesel and Red Dye Diesel) to City Facilities. (0/5/5)
RECOMMENDATION: That the City Council approve and authorize the Mayor to execute a first amendment to Agreement A-8126 with Conico Toro, Inc., to increase the not to exceed amount from $1,420,200 to $3,120,200 and extend the term two additional years from June 30, 2022 to June 30, 2024, and incorporate the Water Campus, Blending Stations 3, 4 and 5, and Advanced Water Purification Facility (AWPF) location sites.
Michael Wolfe, Public Works Director, presented and introduced Jose Arreola, Fleet Services Manager, who answered the Committee’s qu estions. No public comments were received. Discussion ensued among the Committee and staff.
It was moved by Chair Perello , seconded by Member Zaragoza , to approve the recommended action as
presented. VOTE: Lopez, Perello, and Zaragoza voted in favor; the motion carried 3-0.
2. Public Works Department SUBJECT: Third Amendment to Agreement A-8221 with Big Truck Rental, LLC for Short Term 5 MAY 24, 2022 OXNARD CITY COUNCIL PAGE 2
PUBLIC WORKS & TRANSPORTATION COMMITTEE
Rental of Compressed Natural Gas (CNG) Residential Refuse Collection Vehicles for the Environmental Resources Division. (0/5/5)
RECOMMENDATION: That the Public Works and Transportation Committee recommend that the City Council approve and authorize the Mayor to execute a Third Amendment to Rental Agreement No. A-8221 with Big Truck Rental, LLC to increase the not to exceed amount from $1,707,200 to $3,168,800 and extend the term from June 30, 2022 to June 30, 2023 for the short term rental of 15 compressed natural gas (CNG) residential and commercial refuse collection vehicles.
Michael Wolfe, Public Works Director , presented and introduced Todd Vasquez -Housley, Environmental Resources Div ision Manager, who answered the Committee’s qu estions. No public comments were received. Discussion ensued among the Committee and staff.
It was moved by Member Zaragoza, seconded by Member Lopez , to approve the recommended action as
presented. VOTE: Lopez, Perello, and Zaragoza voted in favor; the motion carried 3-0.
E. ITEMS FOR FUTURE AGENDAS (No requests were made.)
F. ADJOURNMENT
There being no further business on the agenda, and without objection, Chair Perello adjourned the meeting at 8:52 p.m.
ROSE CHAPARRO BERT E. PERELLO
City Clerk Chair
6 PUBLIC WORKS AND TRANSPORTATION COMMITTEE
AGENDA REPORT
REPORTS
AGENDA ITEM NO. D.1
DATE: June 14, 2022
TO: Public Works and Transportation Committee
FROM: Michael Wolfe, Public Works Director, (805) 385-8055, [email protected]
SUBJECT: Agreement A-8471 with Taft Electric Company for On-Call Traffic Signals Repairs and Maintenance Services, Specification No. PW 22-103. (0/5/5)
RECOMMENDATION
That the Public Works and Transportation Committee recommend that the City Council approve and authorize the Mayor to execute Agreement A-8471 with Taft Electric Company in the amount of $300,000 for a three year term for On-Call Traffic Signals Repairs and Maintenance Services, Specification No. PW 22-103.
Please click the following link to view the required Measure M pre-recorded presentation video: https://youtu.be/oZahCNj5jeU
BACKGROUND
The On-Call Traffic Signal Services will provide City Traffic Engineering staff with much-needed support during day-to-day operations, and emergency issues. The on-call contractor will supplement staff’s capabilities with the ability to perform repairs that City staff does not have the capacity or the equipment to perform.
Further, during emergency situations, the on-call contract will respond within 1 hour to an incident to make repairs, assisting City staff at locations where traffic collisions damage signal equipment, or where equipment has failed.
This will be a not-to-exceed agreement amount up to $300,000 and the term will be for three years. All work will be issued through task orders at the direction of the City Traffic Engineer. The work under this agreement will be at prevailing wage rates through task orders issued prior to the start of any work. The work includes furnishing all labor, materials, equipment and other incidentals to provide on-call traffic signals repairs, maintenance, replacement, construction and electrical services as directed by City staff.
Projects to be completed by Contractor are categorized as follows:
Non-Scheduled Urgent Repair Work
Contractor must verbally respond within 30 minutes of telephone notification by the City. Contractor must be on the site within one hour of the notification and begin work immediately. Urgent repairs are those where public interest and necessity demand the immediate response to avoid harm to or to safeguard life, health or property.
Scheduled Repair and Maintenance Work
7 Contractor must verbally respond within four hours of telephone notification by the City. The scope of work and schedule shall be mutually agreed to between City staff and the Contractor before work begins. Work under this category shall be planned and scheduled Monday through Friday between the hours of 8:00 am and 5:00 pm unless otherwise agreed to by the City.
DISCUSSION
The notice inviting formal bids (NIFB) on the Project was published on April 28, 2022, and all bids were due on May 17, 2022. The City received the following bid which is based on a summary of hourly rates for various services and equipment:
Taft Electric Company: $3,346.04
The lowest bidder is Taft Electric Company (Taft) and its bid is responsive to the City’s NIFB. Following this determination, procurement staff reviewed all documentation received from Taft. Procurement staff verified possession of required currently valid licenses, reviewed the federal Occupational Safety and Health Administration (OSHA) website for safety violations, and verified registration with the California Department of Industrial Relations (DIR). Based upon the available information and research performed to date, staff believes that the contractor is capable of satisfactorily completing the project. Thus, staff recommends that the City Council award the contract for this Project to Taft.
STRATEGIC PRIORITIES
This agenda item supports the Infrastructure and Natural Resources strategy. The purpose of the Infrastructure and Natural Resources strategy is to preserve and improve our roads, utilities, parks, trees, water supply and natural resources through effective planning, prioritization, and an equitable and efficient use of available funding.
FINANCIAL IMPACT
The total cost for this agreement with Taft Electric Company shall not exceed $300,000 over three years commencing in Fiscal Year 2022-23. Staff has projected the annual budget for this work of approximately $100,000 per year. Funds for Fiscal Year 2022-23 have been included in the Proposed Budget in the General Fund Traffic Signal Maintenance Division (Account No. 101-3102-803-8209) for these on-call services.
Prepared by: Tatiana Arnaout, City Engineer
ATTACHMENTS
1. A-8471
2. Presentation
8 Agreement No. A-8471
1 CITY OF OXNARD CONTRACT FOR
ON-CALL TRAFFIC SIGNALS REPAIRS AND MAINTENANCE SERVICES SPECIFICATION NO. PW 22-103
THIS CONTRACT (“Contract”) is made and entered this ______ day of _____________, 2022 (“Effective Date”), by and between the CITY OF OXNARD, a California municipal corporation (“City”) and TAFT ELECTRIC COMPANY (“Contractor”). Contractor’s license number is 772245.
In consideration of the covenants set forth herein, the parties hereto agree as follows:
1. Incorporation. The Contract consists of all Contract Documents, which shall include the General Provisions, Special Provisions and all do cuments referenced in either the General or Special Provisions as well as the Cont ractor’s Bid Response. These documents are incorporated herein by reference.
2. Scope of Services. Contractor shall perform all Tasks in a good and workmanlike manner for the project identified as On-Call Traffic Signals Repairs and Maintenance Services Specification No. PW 22-103 (“Project”), as described in this Contract and in the Contract Documents, throughout the Contract Term. The Bid Sheets from the Contractor’s Bid Response are attached hereto as “Exhibit A” and incorporated herein by this reference. The Special Provisions from the Contract Documents are attached hereto as “Exhibit B” and incorporated herein by this reference.
3. Compensation. In consideration of the serv ices rendered pursuant to the requirements listed in the Contract Documents, City shall pay Contractor for each Task in accordance with the Contract Unit Prices submitted in the Bid and included in the attached Exhibit A, which in any case shall not exceed three hundred thousand dollars ($300,000) during the Contract Term.
4. Contract Term. The Contract Term shall begin on the Effective Date and end three (3) years thereafter, unless sooner terminated pursuant to the Contract Documents.
5. Antitrust Claims. In entering into this Contract, Contractor assigns to City all rights, title, and interest in and to all causes of action it may have under Section 4 of the Clayton Act (15 U.S.C.
Section 15) or under the Cartwright Act (Business and Professions Code Section 16700 et seq.) arising from purchases of goods, services, or materials pursuant to the Contract Documents.
This assignment shall be made and become effectiv e at the time City tenders final payment to Contractor without further acknowledgment by the parties.
6. Prevailing Wages. City and Contractor acknowledge that the Tasks comprising the Project are public works to which prevailing wages appl y. Once the Project Manager issues a Task Order, copies of the prevailing rate of per diem wages for each craft, classification, or type of worker needed to perform the corresponding Task will be on file with the Project Coordinator at City Hall and will be made available to any in terested party on request. Contractor and all Subcontractors are not qualified to bid on, be listed in a Bid proposal, or engage in the performance of any contract for public work, as defined in Labor Code Sections 1720 through 1861, unless registered and qualified to perform public work pursuant to Labor Code Section 1725.5 at the time of Bid submission.
7. Workers’ Compensation. Labor Code Sections 1860 and 3700 provide that every contractor will be required to secure the payment of compensation to its employees. In accordance with the provisions of Labor Code Section 1861, by signi ng this Contract, the Contractor certifies as 9 Agreement No. A-8471
2 follows: “I am aware of the provisions of Section 3700 of the Labor Code which require every employer to be insured against liability for workers’ compensation or to undertake self-insurance in accordance with the provisions of that Code, and I will comply with such provisions before commencing the performance of the Work of this Contract.”
8. Titles. The titles used in this Contract are for convenience only and shall in no way define, limit or describe the scope or intent of this Contract or any part of it.
9. Authority. Any person executing this Contract on behalf of Contractor warrants and represents that he or she has the authority to execute this Contract on behalf of Contractor and has the authority to bind Contractor to the performance of its obligations hereunder.
10. Entire Agreement. This Contract, including all incorporated documents, constitutes the entire agreement between the parties hereto with respect to the Project and all related Tasks and supersedes all previous agreements, promises, proposals, representations, understandings and negotiations, whether written or oral, between the parties regarding the subject matter.
11. Amendment. No modification, amendment or supplement to this Contract other than Change Orders or Task Orders shall be binding unless made in writing and signed by the duly authorized representatives of both parties.
12. Counterparts. This Contract may be executed in one or more counterparts, each of which shall be deemed an original, but all of which together shall constitute one and the same instrument. A signed copy of this Contract tran smitted by facsimile, email or other means of electronic transmission shall be deemed to have the same legal effect as delivery of an original executed copy of this Contract for all purposes . This provision shall likewise apply to all Task Orders and other Contract Documents.
[signatures on following page]
10 Agreement No. A-8471
3 IN WITNESS WHEREOF, the parties hereto have executed the Agreement on the first written above.
CITY OF OXNARD TAFT ELECTRIC COMPANY
John C. Zaragoza, Mayor1 Date Jim Marsh, CEO 2 Date Alexander Nguyen, City Manager
Jennifer Yates, Purchasing Manager
[ n a m e ] , B u y e r
C a r o l S m i t h , S e c r e t a r y D a t e A T T E S T :
Rose Chaparro, City Date
Clerk (only if Mayor signs)
APPROVED AS TO FORM:
Stephen M. Fischer, City Date
Attorney (always required)
1 The City Council must authorize and the Mayor must sign any agreement over $200,000 annually. The City Manager may authorize and sign any agreement over $100,000 but up to $200,000 annually. The Purchasing Manager may authorize and sign any agreement up to $100,000 annually. A Buyer may authorize and sign any agreement up to $25,000 annually.
2 The City requires the following for any contract:
For a corporation, the signatures of the Board President, CEO or Vice President and of the Board Secretary, Assistant Secretary, CFO or Assistant Treasurer; For an LLC, the signatures of at least two managers of the LLC (company directors, not lower-level managers); or
For a partnership, the signature of a partner. If the partnership is a limited partnership, the signer must be a general partner.
If the company has a different struct ure, or if the above-listed person s are not the appropriate signers, please submit to the City Attorney legally-bindi ng documentation stating who can sign and bind your company.
11 Exhibit INS-D
INSURANCE REQUIREMENTS FOR SMALL/MEDIUM CONSTRUCTION AND SERVICES CONTRACTS (WITHOUT BUILDER’S RISK REQUIREMENT)
1. Contractor shall obtain and maintain during the performance of any servi ces under this Contract the following insurance against claims for injuries to persons or damage s to property which may arise from or in connection with the performance of services hereunder by Contractor, its agents, representatives, employees or subcontractors.
a. Commercial General Liability Insurance, including Contractual Liability, in an amount not less than $1,000,000 combined single limit for bodily injury and property damage for each claimant for general liability with coverage equivalent to Insurance Services O ffice Commercial General Liability Covera ge (Occurrence Form CG 0001). If a general aggregate limit is used, that limit shall apply separately to the project location or shall be twice the occurrence amount;
b. Business Automobile Liability Insurance in an amount not less than $1,000,000 combined single limit for bodily injury and property damage for each claimant fo r automobile liability with coverage e quivalent to Insurance Services Office Automobile Liability Coverage (Occurrence Form CA0001) covering Code No. 1, “any auto;”
c. If architectural, engineering, or electr ical work will be performed under the Contract, Professional Liability/Errors and Omissions Insurance appropriate to the work being done in an amount not less than $1,000,000, with neither Contractor nor listed subcontractors having less than $500,000 indivi dually. The Professional Li ability/Errors and Omissions Insurance must be project specific with at least a one-year extended reporting period, or longer upon request.
d. Workers’ Compensation Insurance in compliance with the laws of the State of California, and Employer’s Liability Insurance in an amount not less than $1,000,000 per claimant.
2. Contractor shall, prior to performance of any ser vices, file with the Risk Manager certificates of insurance with original endorsements effecting coverage required by this Exhibit INS-D. The certificates and endorsements for each insurance policy are to be signed by a person authorized by that insurer to bind coverage on its behalf. The certifi cates and endorsements are to be on the attached forms or on other forms approved by the Risk Manager. All certificates and endorsements are to be received and approved by the Risk Manager before work commences. City reserves the right to require complete certified copies of all required insurance policies at any time. The certificates of insurance and endorsements shall be sent via email (or fax if necessary) to the Risk Manager, addressed as follows (do not send hard copies):
City of Oxnard
Insurance Compliance
Reference No. A-8471
P.O. Box 100085 – OX
Duluth, GA 30096
Via Email: [email protected]
Via Fax: 678-259-1007
3. Contractor agrees that all insurance coverages shall be pr ovided by a California admitted insurance carrier with an A.M. Best rating of A:VII or better and shall be endorsed to state that coverage may not be suspended, voided, canceled by either party, or reduced in coverage or limits w ithout 30 days’ prior written notice to the Risk Manager. The Risk Manager shall not approve or accept any endorsement if the endorsement contains “best effort” modifiers or if the insurer is relieved from the responsibility to give such notice.
4. Contractor agrees that the Commercial General Liability a nd Business Automobile Liability Insurance policies shall be endorsed to name City, its City Council, officers, employees and volunteers as additional insureds as respects: liability aris ing out of activities performed by or on behalf of Contractor; pr oducts and completed operations of Contractor; premises owned, occupied or used by Contractor; or autom obiles owned, leased, hired or borrowed by Contractor. The coverage shall contain no special limitations on the scope of protection afforded to City, its City Council, officers, employees and volunteers. The General Liability Special Endorsement Form and Automobile Liability Special Endorsement Form attached to this Exhibit INS-D or substitute forms containing the same information and acceptable to the Risk Manager shall be used to provide the endorsements (ISO form CG 2010 11/85 or if not available, CG 2010 with an edition date prior to 01/04 and CG 2037).
5. The coverages provided to City shall be primary and not cont ributing to or in excess of any existing City insurance or self-insurance coverages (this must be endorsed). Additionally, the workers’ compensation policy shall include a waiver of all rights of subrogation which the insurer may have against the Ci ty. Any failure to comply with reporting provisions of the policies shall not affect coverage provided to City, its City Council, officers, empl oyees and volunteers. The insurance shall 12 apply separately to each insured against whom claim is made or suit is brought, except with respect to the limits of the insure r’s liability.
6. Any deductibles or self-insured retentions must be declared to and approved by the Risk Manager. At the option of the Risk Manager, either the insurer shall reduce or eliminate such deductibles or self-insured rete ntions as respects City, its Ci ty Council, officers, employees and volunteers, or the Contractor shall procure a bond gua ranteeing payment of losses and related investigations, claim administration and defense expenses.
7. All insurance standards applicable to Contractor shall also be applicable to Contractor’s subcontractors. Contractor agrees to maintain appropriate agreements with subcontractors and to provide prope r evidence of coverage upon receipt of a written request from the Risk Manager.
13 INSTRUCTION FOR SUBMITTING INSURANCE CERTIFICATES AND ENDORSEMENT FORMS
Certificates of Insurance
The sample accord form on the following page is provided to facilitate your preparation and submission of certificates of insurance. You may use this or any industry form that shows coverage as broad as that shown on the attached sample. Please note the certificate holder address must be as shown on the attached sample accord form with the contract number and insurance exhibit identification information completed. Improperly addressed certificates may delay the contract start-up date because the City’s practice is to return unidentifiable insurance certificates to the insured for clarification as to the contract number.
Cancellation provisions must be endorsed to the policy. Modifying the certificate does not change coverage or obligate the carrier to provide notice of cancellation.
Endorsement Forms
Original endorsements are required for general liability and automobile liability insurance policies and must be attached to the applicable certificate of insurance. City preference is that you use the endorsement forms which are attached. Substitute forms will be accepted, however, as long as they include provisions comparable to the attached.
14 SAMPLE
ACORD CERTIFICATE OF INSURANCE ISSUE DATE (MM/DD/YY)
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
CODE SUB-CODE
COMPANIES AFFORDING INSURANCE COVERAGE
INSURED
COMPANY
LETTER A SPECIFY COMPANY NAMES IN THIS SPACE
COMPANY
LETTER
B
COVERAGES
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIO D INDICATED, NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUM ENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MA Y PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOW N MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO
LTR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE (MM/DD/YY)
POLICY EXPIRATION
DATE (MM/DD/YY)
LIMITS
A
GENERAL LIABILITY
[x] COMMERCIAL GENERAL LIABILITY
[x] CLAIMS MADE [x] OCCUR.
[x] OWNER'S & CONTRACTOR'S PROT.
GENERAL AGGREGATE
$1,000,000
PRODUCTS COMP/OP AGG. $1,000,000
PERSONAL & ADV. INJURY $1,000,000
EACH OCCURRENCE $1,000,000
FIRE DAMAGE (Any one fire) $
MED. EXPENSE (Any one person) $
A
AUTOMOBILE LIABILITY
[x] ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON-OWNED AUTOS
GARAGE LIABILITY
COMBINED SINGLE
$1,000,000
LIMIT
BODILY INJURY $
(Per person)
BODILY INJURY
$
(Per accident)
PROPERTY DAMAGE
$
A
EXCESS LIABILITY
UMBRELLA FORM
OTHER THAN UMBRELLA FORM
EACH OCCURRENCE
$
AGGREGATE $
A
WORKERS' COMPENSATION
AND
EMPLOYERS' LIABILITY
STATUTORY LIMITS
EACH ACCIDENT $1,000,000
DISEASE-POLICY LIMIT $1,000,000
DISEASE-EACH EMPLOYEE $1,000,000
A
OTHER
Errors and omissions insurance or malpractice insurance available for the insured's profession; if architectural, engineering or electrical work will be
performed under the Agreement
Minimum coverage $1,000,000
Each consultant/ $500,000
& listed sub-consultant
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS
CERTIFICATE HOLDER
CITY OF OXNARD
Attn: Insurance Compliance
Reference No.
A-8471
P.O. Box 100085 – OX
Duluth, GA 30096
Via Email: [email protected]
Via Fax: 678-259-1007
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE
CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
15 GENERAL LIABILITY SPECIAL ENDORSEMENT
FOR THE CITY OF OXNARD (the “City”)
SUBMIT IN DUPLICATE
ENDORSEMENT NO.
ISSUE DATE (MM/DD/YY)
PRODUCER
POLICY INFORMATION:
Insurance Company:
Policy No.:
Policy Period: (from) (to)
LOSS ADJUSTMENT EXPENSE Included in Limits