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HomeMy WebLinkAbout08 - CC-5 - Attachment 3 - 7/1/2014ATTACH M ENT = CITY OF COSTA MESA, CALIFORNIA Vendor ID: Buyer: Insurance valid thru Ship To/Location: Purchase Order Purchase Requisition FINANCE DEPARTMENT USE ONLY Number As of: Confirmed By: (Assigned by Purchasing) (Leave Blank for Time Stam Business Unit: CITY Date Requisitioned: 6/2/14 ❑ Request is for Budgeted item(s) Department: I. T. Division: Comp Operations ❑ Request is for UNBUDGETED item(s)-(Memo Attached) Ship To Address: ❑ Item(s) Pending Budget Amendment Request # Contact Person: Jim Phone Number: 5044 ❑ Requesting Sole Source (Justification Form Attached) Send Copy of P.O. to: ❑ Contact Person and / or Victoria ❑ Fixed Asset Tag Request Item Qty Unit Items (Give Full Description: Size, Catalog No. Etc.) Unit Price Estimated Amount 1 1 LOT SOFTWARE MAINTENANCE AND SERVICES RENEWAL 127,334.00 $ 127,334.00 Period of Coverage: 7/24/14 to 7/23/15 Services provided will be as described in the Software Maintenance Agreement signed on 7/23/13 between the City of Costa Mesa and 'J SunGard Public Sector Ifadditional lines are needed, please attach a second sheet Sales Tax (8.00%): 0.00 Const./Prof. Svs. Agmt. Completion Date: Include Shipping Fee: $ 127,334.00 Insurance Require ® Yes (Certificate attache ❑ No Estimated Total Cost: Item # Account Fund Dept./Org. Program Project Amount 1 525702 101 14600 50710 $ 127,334.00 Comments: Total$ 127,334.00 NOTE: Any application updates will be received and loaded electronically. Should the need arise for a system upgrade/update via tangible media, such as tape/CD/DVD, the City is to pay back sales tax for such tangible media. Suggested Vendor: SUNGARD PUBLIC SECTOR, INC. Address: 1000 BUSINESS CENTER DRIVE City, State, Zip Code: LAKE MARY, FL 32725-5585 Proper approvals are required before requisition can be processed. Ordered By: Department Director/Authorized Signature Phone: 407-304-3322 Fax: 407-304-1277 Approved By: Vendor's Contact Person: DEAN PAUR Approved By: Director of Finance/Purchasing Officer rm, Mannncr n.mo„ romp drone PURCHASING DIVISION USE ONLY Vendor ID: Buyer: Insurance valid thru Ship To/Location: I Due Date: Standard Comments: ACC - ALL -ARR-BLA- CON -DCP-DIS - FCA -FCI- FIX - INS -IS- IST -ORG -QTR - REM - SUB -T&C FINANCE DEPARTMENT USE ONLY Available Appropriation: ❑ Yes [-]No As of: Confirmed By: 2385-20 MW REV.3/10 Rev FY09/10 '� ®® CERTIFICATE OF LIABILITY INSURANCEOATE(MM/2014 Y°' DMM/2Di4 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 endorsement(s). PRODUCER Apo Risk Services Central, Inc. PA office one Liberty Place 1650 Market Street CONTACT NAME: PHONE83-]122 (800) 363-0105Philadelphia INC.(A. No. Ext): (866) o No.: E-MAIL ADDRESS: suite 1000 City Attn: Philadelphia PA 19103 USA INSURER(S) AFFORDING COVERAGE NAICN INSURED INSURER A: Charter Oak Fire Ins CO 125615 SunGard Capital Corp. its Companies & Subsidiaries 680 East Swedesford Road INSURER B: The Travelers Indemnity Co. 25658 INSURER C: The Phoenix Insurance Company 25623 Wayne PA 19087 USA INSURER D: Travelers Property Cas Cc of America 25674 �/P a/CSG' c/fJl GE4BRi9 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570053626902 RFVIAIfTN NIIMRFR• THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Limps shown are as requested LTR TYPE OF INSURANCE INSD WVp POLICY NUMBER M51JILY ItIrl- MMIpDIYYVV POLICY EXP MMIDDIYYYY LIMITS POLICY PROVISIONS. X COMMERCIAL GENERAL LIABILITY City Attn: of Costa Mesa Mike James 660OD923415 77 Fair EACHOCCURRENCE $1,000,000 CLAIMS -MADE FXX1 Costa Mesa CA 92626 USA �/P a/CSG' c/fJl GE4BRi9 �/OZ�GL�4 �/9d[x GET $1,000,000 PREMISES Ea occurrence MED EXP (Any one person) $10,000 X Cantrectusl Liability PERSONAL B ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRO - POLICY JECT X LOC GENERAL AGGREGATE $2,000,000 PROpUCTS- COMPIOP AGG $2,000,000 OTHER: Total Aggregate per policy $10,000,000 D AUTOMOBILE LIABILITY TJ-CAP-804$XOSA-TIL-14 05/01/201405/01/2015 COMBINED SINGLE LIMIT Ea accident $2,000,000 BODILY INJURY (Par parson) X ANYAUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) PROPERTY DAMAGE Per accident X HIRED AUTOS X NON -OWNED AUTOS Complooll Deductible $2,500 UMBRELLA LIAR OCCUR EACH OCCURRENCE EXCESS LIAB CLAIM&MADE AGGREGATE DEDI IRETENTION B C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORI PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? NIA TRJUB8045XO4814 CAZ, MA, WI) TC2NUB8045X01214 05 /01/2014 0$/01/2014 05/01/2015 05/01/201$ PER OTH- X STATUTE ER E. EACH ACCIDENT $1,000,000 E.L. DISEASE -EA EMPLOYEE $1,000,000 (Mandatory in Mill If yes, describe under (AOS) E.L. DISEASE -POLICY LIMIT $1,000,000. DESCRIPTION OF OPERATIONS bolas, ' DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Costa Mesa is included as Additional Insured in accordance with the policy provisions of the General Liability policy. - i L• 0 m up upda 0 0 m CERTIFICATE HOLDER CANCELLATION bi ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City Attn: of Costa Mesa Mike James AUTHORIZED REPRESENTATIVE 77 Fair Drive Costa Mesa CA 92626 USA �/P a/CSG' c/fJl GE4BRi9 �/OZ�GL�4 �/9d[x ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD For the purposes of City of Costa Mesa ONLY SunGard Capital Corp. General Liability 05/01/14 to 05/01/15 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. TECHNOLOGY XTEND ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART GENERAL DESCRIPTION OF COVERAGE — This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to this Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general cover- age description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this en- dorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. I. Blanket Additional Insured—Owners, Manag. ers Or Lessors Of Premises J. BlanketAddfionalInsured—Lessors Of Leased Equipment K. Blanket Additional Insured—PersonsOrOr- ganizations For Your Ongoing Operations As Required By Written Contract Or Agreement L. Blanket Additional Insured—Broad Form Vendors CG D417 01 12 ©2012 The Travelers Indemnity Company. All rights reserved. Page 1 of 6 Includes copyrighted material or Insurance services Office, Inc. %ith its permisslon. COMMERCIAL GENERAL LIABILITY Page 2 Of 6 ® 2012 The Travelers Indemnity Company: All rights reserved. CG Q4 17 0112 Includes copyrighted matedal of insurance Services Office, Inc, with its permission. COMMERCIAL GENERAL LIABILITY The following is added to SECTION II — WHO IS AN INSURED; Any person or organization that is a premises owner, manager or lessor is an insured, but only with respect to liability arising out of the owner- ship, maintenance or use of that part of any prem- ises leased to you. The insurance provided to such premises owner, manager or lessor does not apply to: CG D4 17 0112 © 20i2 rhe TraVelers Indemnity Company. All rights reserved. Page 3 of 6 includes copyrighted materiel of Insurance 3ervlces office, Inc, with its permission. COMMERCIAL GENERAL LIABILITY a. Any "bodily injury" or "property damage" caused by an 'occurrence" that takes place, or "personal injury" or "advertisfng Injury" caused by an offense that is committed, after You cease to be a tenant In that premises; or b. Structural alterations, new construction or demolition operations performed by or on be- half of such premises owner, manager or les- sor. J. BLANKET ADDITIONAL INSURED — LESSORS OF LEASED EQUIPMENT The following is added to SECTION II — WHO IS AN INSURED: Any person or organization that is an equipment lessor is an insured, but only with respect io liabil. ity for "bodily Injury", "property damage", "per- sonal injury" or "advertising injury" caused, in whole or in part, by your acts or omissions in the maintenance, operation or use by you of equip- ment leased to you by such equipment lessor. The Insurance provided to such equipment lessor does not apply to any "bodily injury" or "property damage" caused by an "occurrence" that takes place, or "personal injury" or "advertising injury" caused by an offense that is committed, after the equipment lease expires. K. BLANKET ADDITIONAL INSURED — PERSONS OR ORGANIZATIONS FOR YOUR ONGOING OPERATIONS AS REQUIRED BY WRITTEN CONTRACT OR AGREEMENT The following is added to SECTION 11 — WHO IS AN INSURED: Any person or organization that Is not otherwise an insured under this Coverage Part and that you have agreed in a written contract or agreement to Include as an additional insured on this Coverage Part Is an insured, but only with respect to liability for "bodily injury" or "property damage" that: a. Is caused by an "occurrence" that takes place after you have signed and executed that con- tract or agreement; and b. Is caused, in whole or in part, by your acts or omissions In the performance of your on operations to which that contract or agree- ment applies or the acts or omissions of any person or organization performing such op- erations on your behalf. The limits of insurance provided to such insured will be the limits which you agreed to provide In the written contract or agreement, or the limits shown in the Declarations, whichever are less, L. BLANKET ADDITIONAL INSURED — BROAD FORM VENDORS The following is added to SECTION II — WHO IS AN INSURED: Any person or organization that is a vendor and that you have agreed in a written contract or agreement to include as an additional Insured on this Coverage Part Is an Insured, but only with re- spect to liability for 'bodily injury" or "property damage" that: a. Is caused by an "occurrence" that takes place after you have signed and executed that con- tract or agreement; and b. Arises out of "your products" which are dis- tributed or sold in the regular course of such vendor's business. The insurance provided to such vendor is subject to the following provisions; a. The limits of Insurance provided to such ven- dor will be the limits which you agreed to pro- vide in the written contract or agreement, or the limits shown in the Declarations, which- ever are less. b. The Insurance provided to such vendor does not apply to: (1) Any express warranty not authorized by you; (2) Any change in "your products" made by such vendor; (3) Repackaging, unless unpacked solely for the purpose of Inspection, demonstration, testing, or the substitution of parts under Instructions from the manufacturer, and then repackaged in the original container; (4) Any failure to make such Inspections, ad- justments, tests or servicing as vendors agree to perform or normally undertake to perform In the regular course of business, in connection with the distribution or sale of "your products'; (5) Demonstration, installation, servicing or repair operations, except such operations Performed at such vendor's premises in connection with the sale of "your prod- ucts"; or (6) "Your products" which, after distribution or sale by you, have been labeled or re- labeled or used as a container, part or in- gredient of any other thing or substance by or on behalf of such vendor. Page 4 of 6 © 2012 The Travelers Indemnity Company. All rights reserved. CG D4 17 01 12 Includes copyrighted material of Insurance Services Office, Inc. with Its perrnisslon. COMMERCIAL GENERAL LIABILITY Coverage under this provision does not apply to: a. Any person or organization from whom you have acquired "your products", or any Ingre- dient, part or contalner entering into, accom- panying or containing such products; or b. Any vendor for which coverage asanaddi- tional Insured specifically Is scheduled by en- dorsement. CO D417 01 12 ©2012 The Travelers Indemnhy Company. All fights reserved. Page 5 of 6 Includes copyrighted matedal of Insurance services Office, Inc. with Its permission. COMMERCIAL GENERAL LIABILITY Page 6 of 6 ® 2012 The Travelers Indemnity Company. All rights reserved. CG Q4 17 61 12 Includes copyrighted materlal of Insurance Services Office, Inc. With Its permission.