HomeMy WebLinkAbout2024-11-21 Morales, Randy - 9461
Gloria Sanchez
From:Gloria Sanchez
Sent:Friday, November 22, 2024 11:02 AM
To:Janice Baluyut; Damian Olivares
Cc:Andrea Staehle; Amber Molina
Subject:RE: CJP-3052858 - City of Palm Desert - 946 - Randy Morales
Attachments:C47160 - Executed Agreement - American Asphalt South, Inc..pdf; C47160 - COI.pdf
Hi,
Attached is the executed agreement C47160 and certificate of insurance.
From: Janice Baluyut <jbaluyut@carlwarren.com>
Sent: Friday, November 22, 2024 10:51 AM
To: Gloria Sanchez <gsanchez@palmdesert.gov>; Damian Olivares <dolivares@palmdesert.gov>
Cc: Andrea Staehle <astaehle@palmdesert.gov>; Amber Molina <amolina@palmdesert.gov>
Subject: RE: CJP-3052858 - City of Palm Desert - 946 - Randy Morales
Good morning, Claimant, Randy Morales alleged his vehicle lost control on roadway that was recently repaved allegedly due to gravel. Please provide us with a copy of the agreement and COI. Thank you. Janice Baluyut Claims Examiner jbaluyut@carlwarren.comTel: (657) 622-4
CGBANNERINDICATOR
Good morning,
Claimant, Randy Morales alleged his vehicle lost control on roadway that was recently repaved allegedly
due to gravel.
Please provide us with a copy of the agreement and COI.
Thank you.
Janice Baluyut
Claims Examiner
jbaluyut@carlwarren.com
Tel: (657) 622-4326 | Fax: (866) 254-4423
Carl Warren & Company, LLC
CA Entity License No: 2607296
www.carlwarren.com
PO Box 2411, Tustin, CA, 92781
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CONTRACT FOR CONSTRUCTION
This Contract for Construction ("Contract"), No. C47160 , is made and entered into this 23 rd day of
May, 2024, by and between City of Palm Desert, a Charter City and municipal corporation,
organized under the laws of the State of California, with its principal place of business at 73-510
Fred Waring Drive, Palm Desert, California 92260 , sometimes hereinafter called the "City" and
American Asphalt South, Inc., sometimes hereinafter called "Contractor."
WITNESSETH: That the parties hereto have mutually covenanted and agreed, and by these
presents do covenant and agree with each other as follows :
ARTICLE 1. SCOPE OF WORK.
The Contractor shall perform all Work within the time stipulated in the Contract, and shall provide
all labor, materials, equipment, tools, utility services, and transportation to complete
all of the Work required in strict compliance with the Contract Documents as specified
in Article 5, below, for the following Project:
CV LINK ENHANCEMENTS AND SLURRY SEAL PROJECT
PROJECT NUMBER CST00021
The Scope of Work consists of making improvements to the CV Link cycle track and
constructing slurry seal improvements . The work items include mobilization, traffic
control, various removals, application of slurry seal , construct paint and thermoplastic
striping and markings, installation or relocation of flashing LED and other signage ,
installation of delineators and pavement markers , traffic signal modifications,
construction of concrete curb ramps , and installation of truncated domes.
Contractor is an independent contractor and not an agent of the City. The Contractor and its
surety shall be liable to the City for any damages arising as a result of the Contractor's failure to
comply with this obligation .
ARTICLE 2. TIME FOR COMPLETION.
Time is of the essence in the performance of the Work. The Work shall be commenced on the
date stated in the City's Notice to Proceed. The Contractor shall complete all Work
required by the Contract Documents within 120 Calendar Days from the
commencement date stated in the Notice to Proceed. By its signature hereunder,
Contractor agrees the time for completion set forth above is adequate and reasonable
to complete the Work.
ARTICLE 3. CONTRACT PRICE.
The City shall pay to the Contractor as full compensation for the performance of the Contract,
subject to any additions or deductions as provided in the Contract Documents, and
including all applicable taxes and costs , the sum of Three million forty-eight thousand
nine hundred fifty-two and 10/100 Dollars ($3,048,952.10). Payment shall be made as
set forth in the General Conditions . The City will pay to Contractor compensation
based upon the prices set forth in the Bid Schedule.
Contract No. C47160
ARTICLE 4. LIQUIDATED DAMAGES.
Contractor acknowledges that the City will sustain actual damages for each and every Day
completion of the Project is delayed beyond the Contract Time. Because of the nature
of the Project, it would be impracticable or extremely difficult to determine the City's
actual damages . Accordingly, in accordance with Government Code section
53069.85, it is agreed that the Contractor will pay the City the sum of $1,000.00 for
each and every Day of delay beyond the time prescribed in the Contract Documents
for finishing the Work, as Liquidated Damages and not as a penalty or forfeiture. In the
event this is not paid , the Contractor agrees the City may deduct that amount from any
money due or that may become due the Contractor under the Contract. This Section
does not exclude recovery of other damages specified in the Contract Documents.
Liquidated damages may be deducted from progress payments due Contractor,
Project retention or may be collected directly from Contractor, or from Contractor's
surety. These provisions for liquidated damages shall not prevent the City, in case of
Contractor's default, from terminating the Contractor.
ARTICLE 5. COMPONENT PARTS OF THE CONTRACT.
The "Contract Documents" include the following :
Notice Inviting Bids
Instructions to Bidders
Bid Forms
Bid Acknowledgement
Bid Schedule
Bid Guarantee
Designation of Subcontractors
Information Required of Bidders
Non-Collusion Declaration Form
Iran Contracting Act Certification
Public Works Contractor DIR Registration Certification
Performance Bond
Payment (Labor and Materials) Bond
Contract for Construction
General Conditions
Special Conditions
Specifications
Addenda
Construction Plans and Drawings
Standard Specifications for Public Works Construction "Greenbook", latest edition , Except
Sections 1-9
Standard Plans of the City of Palm Desert, latest edition
Standard Plans for Public Works Construction , latest edition
Caltrans Standard Specifications , latest edition , Except Division 1
Caltrans Standard Plans , latest edition
California Manual on Traffic Control Devices for Streets and Highways (CAMUTCD), latest
edition
Work Area Traffic Control Handbook , latest edition
Reference Specifications
Approved and fully executed Change Orders
Contract No. C47160
Permits
Any other documents contained in or incorporated into the Contract
The Contractor shall complete the Work in strict accordance with all of the Contract Documents.
All of the Contract Documents are intended to be complementary . Work required by one of the
Contract Documents and not by others shall be done as if requ ired by all. In the event of conflict ,
the various Contract Documents will be given effect in the order set forth in the General
Conditions. This Contract shall supersede any prior agreement of the parties .
ARTICLE 6. PROVISIONS REQUIRED BY LAW AND CONTRACTOR COMPLIANCE.
Each and every provision of law required to be included in these Contract Documents shall be
deemed to be included in these Contract Documents . The Contractor shall comply
with all requirements of appl icable federal , state and local laws , rules and regulat ions ,
including , but not limited to , the provisions of the California Labor Code and California
Public Contract Code which are applicable to this Work.
ARTICLE 7. INDEMNIFICATION AND INSURANCE
A. Indemnification
1. To the fullest extent permitted by law , Contractor shall immed iately defend (with
counsel of the City 's choosing), indemnify and hold harmless the City , the
Coachella Valley Water District, the Desert Community College District , Coachella
Valley Association of Governments and its member agencies , and their respective
officers , officials , employees , agents , and representatives , and each of them from
and against:
(a) Any and all claims , demands , causes of action, costs , expenses , injuries ,
losses or liabilities, in law or in equi ty, of every kind or nature whatsoever, but
not lim ited to , injury to or death , including wrongful death , of any person , and
damages to or destruction of property of any person , arising out of, related to ,
or in any manner directly or indirectly connected with the Work or this Contract,
including claims made by subcontractors for nonpayment , including without
limitation the payment of all consequential damages and attorney's fees and
other related costs and expenses , however caused , regardless of whether the
allegations are false , fraudulent , or groundless , and regardless of any
negligence of the City , the Coachella Valley Water Distr ict , the Desert
Community College District , Coachella Valley Association of Governments and
its member agencies , and the ir respective officers, offic ials , employees ,
agents , or authorized volunteers and representatives (including passive
negligence), except the sole negligence or willful misconduct or active
negligence of the City , the Coachella Valley Water District , the Desert
Community College District , Coachella Valley Association of Governments and
their respective officers , offic ials , employees , agents , and authorized
volunteers ;
(b) Contractor's defense and indemn ity obligat ion herein includes , but is not
limited to damages , fines , penalties , attorney 's fees and costs arising from
claims under the Americans with Disab ilities Act (ADA) or othe r federal or state
Contract No. C47160
disability access or discrimination laws arising from Contractor's Work during
the course of construction of the improvements or after the Work is complete ,
as the result of defects or negligence in Contractor's construction of the
improvements ;
(c) Any and all actions, proceedings , damages, costs, expenses , fines, penalties
or liabilities , in law or equity, of every kind or nature whatsoever, arising out of,
resulting from, or on account of the violation of any governmental law or
regulation , compliance with which is the responsibility of Contractor;
(d) Any and all losses, expenses, damages (including damages to the Work itself),
attorney 's fees, and other costs, including all costs of defense which any of
them may incur with respect to the failure, neglect , or refusal of Contractor to
faithfully perform the Work and all of Contractor's obligations under Contract.
Such costs , expenses , and damages shall include all costs , including
attorney 's fees , incurred by the indemnified parties in any lawsu it to which they
are a party.
2 . Contractor shall immediately defend , at Contractor's own cost , expense and risk ,
with the counsel of the City choosing , any and all such aforesaid suits , actions or
other legal proceedings of every kind that may be brought or instituted against the
City, the Coachella Valley Water District , the Desert Community College District ,
Coachella Valley Association of Governments and its member agencies, and their
respective officers, officials, employees , agents, and authorized volunteers.
Contractor shall pay and satisfy any judgment, award or decree that may be
rendered against the City, the Coachella Valley Water District , the Desert
Community College District , Coachella Valley Association of Governments and its
member agencies , and their respective officers , officials, employees , agents, and
authorized volunteers, in any such suit, action or other legal proceeding .
Contractor shall reimburse the City, the Coachella Valley Water District, the Desert
Community College District, Coachella Valley Association of Governments and its
member agencies , and their respective officers, officials , employees , agents, and
authorized volunteers for any and all legal expenses and costs incurred by each
of them in connection therewith or in enforcing the indemnity herein provided . The
only limitations on this provision shall be those imposed by Civil Code section
2782.
3. The provisions of this Article shall survive the termination of this Contract
howsoever caused, and no payment , part ial payment , or acceptance of occupancy
in whole or part of the Work shall waive or release any of the provisions of this
Article .
B. Insurance
1. Without limiting Contractor's indemnification of City , and prior to commencement
of Work, Contractor shall obtain , provide and maintain at its own expense during
the term of this Contract, policies of insurance of the type and amounts described
below and in a form that is satisfactory to City.
2 . General Liability Insurance. Contractor shall maintain commercial general
liability insurance with coverage at least as broad as Insurance Services Office
Contract No. C47160
form CG 00 01, in an amount not less than $2,000,000 per occurrence, $4,000,000
general aggregate, for bodily injury, personal injury, and property damage, and a
$4,000,000 completed operations aggregate . The policy must include contractual
liability that has not been amended . Any endorsement restricting standard ISO
"insured contract" language will not be accepted.
3. Automobile Liability Insurance. Contractor shall maintain automobile insurance
at least as broad as Insurance Services Office form CA 00 01 covering bodily injury
and property damage for all activities of the Contractor arising out of or in
connection with Work to be performed under this Contract, including coverage for
any owned, hired, non-owned or rented vehicles, in an amount not less than
$1,000 ,000 combined single limit for each accident.
4. Umbrella or Excess Liability Insurance. Contractor may opt to utilize umbrella
or excess liability insurance in meeting insurance requirements. In such
circumstances , Contractor may obtain and maintain an umbrella or excess liability
insurance policy with limits that will provide bodily injury, personal injury and
property damage liability coverage at least as broad as the primary coverages set
forth above , including commercial general liability, automotive liability and
employer's liability. Such policy or policies shall include the following terms and
conditions:
A drop down feature requiring the policy to respond in the event that any
primary insurance that would otherwise have applied proves to be uncollectible
in whole or in part for any reason ;
(a) Pay on behalf of wording as opposed to reimbursement ; and
(b) Concurrency of effective dates with primary policies; and
(c) Policies shall "follow form " to the underlying primary policies ; and
(d) Insureds under primary policies shall also be insureds under the umbrella
or excess policies.
5. Workers' Compensation Insurance. Contractor shall maintain Workers '
Compensation Insurance (Statutory Limits) and Employer's Liability Insurance
(with limits of at least $1,000 ,000) for Contractor's employees in accordance with
the laws of the State of California , Section 3700 of the Labor Code. In addition,
Contractor shall require each subcontractor to similarly maintain Workers'
Compensation Insurance and Employer's Liability Insurance in accordance with
the laws of the State of California, Section 3700 for all of the subcontractor's
employees. Contractor shall submit to City, along with the certificate of insurance ,
a Waiver of Subrogation endorsement in favor of the City, its officers, agents,
employees and volunteers .
6. Pollution Liability Insurance .
7 . Builder's Risk Insurance.
RESERVED
RESERVED
Contract No. C47160
C. Other Provisions or Requirements
1. Proof of Insurance. Contractor shall provide certificates of insurance to City as
evidence of the insurance coverage required herein, along with a waiver of
subrogation endorsement for workers ' compensation. Insurance certificates and
endorsements must be approved by City's Risk Manager prior to commencement
of performance . Current certification of insurance shall be kept on file with City at
all times during the term of this contract. City reserves the right to require complete,
certified copies of all required insurance policies , at any time .
2. Duration of Coverage . Contractor shall procure and maintain for the duration of the
contract insurance against claims for injuries to persons or damages to property,
which may arise from or in connection with the performance of the Work hereunder
by Contractor, its agents , representatives , employees or subcontractors.
Contractor must maintain general liability and umbrella or excess liability insurance
for as long as there is a statutory exposure to completed operations claims. The
City and its officers , officials , employees , and agents shall continue as additional
insureds under such policies .
3. Primary/Non-Contributing. Coverage provided by Contractor shall be primary and
any insurance or self-insurance procured or maintained by City shall not be
required to contribute with it. The limits of insurance requ ired herein may be
satisfied by a combination of primary and umbrella or excess insurance . Any
umbrella or excess insurance shall contain or be endorsed to contain a provision
that such coverage shall also apply on a primary and non-contributory basis for the
benefit of City before the City 's own insurance or self-insurance shall be called
upon to protect it as a named insured .
4 . Products/Completed Operations Coverage . Products/completed operations
coverage shall extend a minimum of three (3) years after project completion .
Coverage shall be included on behalf of the insured for covered claims arising out
of the actions of independent contractors. If the insured is using subcontractors,
the Policy must include work performed "by or on behalf' of the insured. Policy
shall contain no language that would inval idate or remove the insurer's duty to
defend or indemnify for claims or suits expressly excluded from coverage . Policy
shall specifically provide for a duty to defend on the part of the insurer. The City,
its officials , officers , agents, and employees , shall be included as additional
insureds under the Products and Completed Operations coverage.
5. City's Rights of Enforcement. In the event any policy of insurance required under
this Contract does not comply with these requirements, or is canceled and not
replaced , City has the right , but not the duty, to obtain the insurance it deems
necessary and any premium paid by City will be promptly reimbursed by
Contractor, or City will withhold amounts sufficient to pay premium from Contractor
payments . In the alternative , City may cancel this Contract.
6 . Acceptable Insurers. All insurance policies shall be issued by an insurance
company currently authorized by the Insurance Commissioner to transact
business of insurance or is on the List of Approved Surplus Line Insurers in the
State of California, with an assigned policyholders ' Rating of A-(or higher) and
Financial Size Category Class VII ( or larger) in accordance with the latest edition
Contract No. C47160
of Best's Key Rating Guide , unless otherwise approved by the City 's Risk
Manager.
7. Waiver of Subrogation . All insurance coverage maintained or procured pursuant
to this agreement shall be endorsed to waive subrogation against the City , its
elected or appointed office rs, agents , officials , employees and volunteers , or shall
specifically allow Contractor or others prov iding insurance evidence in compliance
with these specifications to waive their right of recovery prior to a loss. Contractor
hereby waives its own right of recovery against the City , its elect ed or appointed
officers, agents , officials , employees and volunteers and shall require similar
written express waivers and insurance clauses from each of its subcontractors.
8. Enforcement of Contract Provisions (non estoppel). Contractor acknowledges and
agrees that any actual or alleged failure on the part of the City to inform Contractor
of non-compl iance with any requirement imposes no additional obligations on the
City nor does it waive any rights hereunder.
9. Requirements Not Limiting . Requiremen ts of specific coverage features or limits
contained in this Section are not intended as a limitation on coverage , limits or
other requirements , or a waiver of any coverage normally provided by any
insurance . Specific reference to a g iven coverage feature is for purposes of
clarification only as it pertains to a given issue and is not intended by any party or
insured to be all inclusive , or to the exclusion of other coverage , or a waiver of any
type. If the Contractor maintains higher limits than the minimums shown above ,
the City requires and shall be entitled to coverage for the higher limits maintained
by the Contractor. Any available insurance proceeds in excess of the specified
minimum limits of insurance and coverage shall be available to the City.
10 . Notice of Cancellation . Contractor agrees to oblige its insurance agent or broker
and insurers to prov ide to City with a thirty (30) Day notice of cancellation (except
for nonpayment for which a ten (10) Day notice is required) or nonrenewal of
coverage for each required coverage .
11. Additional Insured Status. General liability, automobile liability , and if applicable ,
pollution liability policies shall provide or be endorsed to provide that the City , the
Coachella Valley Water District, the Desert Community College District , Coachella
Valley Association of Governments and its member agencies , and their respective
officers , officials , employees , agents , and authorized volunteers shall be add itional
insureds under such policies. Th is prov ision shall also apply t o any
excess/umbrella liability policies . Coverage shall be at least as broad as coverage
provided by ISO 's Owners , Lessees , or Contractors Add itional Insured
Endorsement for the ongoing (i.e. ISO Form CG 20 10 07 04) and completed
operations (i.e . ISO Form CG 20 37 07 04) of Contractor.
12 . Prohibition of Undisclosed Coverage Limitations . None of the cove rages required
herein will be in compliance with these requirements if they include any limiting
endorsement of any kind that has not been first submitted to Ci ty and approved of
in writing .
13 . Separation of Insureds . A severabil ity of interests prov ision must apply for all
additional insureds ensuring that Contractor's insurance shall apply separately to
Contract No. C47160
each insured against whom claim is made or suit is brought , except with respect
to the insurer's limits of liability . The pol icy(ies) shall not contain any cross-liability
exclusions .
14 . Pass Through Clause. Contractor agrees to ensure that its sub-consultants , sub -
contractors , and any other party involved with the Project who is brought onto or
involved in the project by Contractor, provide the same minimum insurance
coverage and endorsements required of Contractor. Contractor agrees to monitor
and review all such coverage and assumes all responsibility for ensuring that such
coverage is provided in conformity with the requirements of this section . Contractor
agrees that upon request , all agreements with consultants , subcontractors , and
others engaged in the Project will be submitted to City for review .
15. City 's Right to Revise Requirements . The City or its Risk Manager reserves the
right at any time during the term of the contract to change the amounts and types
of insurance required by giving the Contractor ninety (90) Days advance written
notice of such change. If such change results in substantial add itional cost to the
Contractor, the City and Contractor may renegotiate Contractor's compensation .
If the City reduces the insurance requirements , the change shall go into effect
immediately and require no advanced written notice.
16 . Self-Insured Retentions . Any self-insured retentions must be declared to and
approved by City. City reserves the right to require that self-insured retentions be
eliminated , lowered , or replaced by a deductible . Self-insurance will not be
considered to comply with these specifications unless approved by City.
17. Timely Notice of Claims . Contractor shall give City prompt and timely notice of
claims made or suits instituted that arise out of or result from Contractor's
performance under this Contract, and that involve or may involve coverage under
any of the required liability policies .
18. Additional Insurance. Contractor shall also procure and mainta in, at its own cost
and expense , any additional kinds of insurance , which in its own j udgment may be
necessary for its proper protection and prosecution of the Work.
19 . Safety. Contractor shall execute and maintain its work so as to avoid injury or
damage to any person or property. In carrying out its Services , the Contractor
shall at all times be in compliance with all applicable local , state and federal laws ,
rules and regulations , and shall exercise all necessary precautions for the safety
of employees appropriate to the nature of the work and the conditions under which
the work is to be performed . Safety precautions , where applicable , shall include ,
but shall not be limited to : (A) adequate life protection and lifesaving equipment
and procedures ; (B) instructions in accident prevention for all employees and
subcontractors , such as safe walkways , scaffolds, fall protection ladders , bridges ,
gang pla nks , confined space procedures , trenching and shoring , equipment and
other safety dev ices , equipment and wearing apparel as are necessary or lawfully
required to prevent accidents or injuries ; and (C) adequate facil ities for the proper
inspection and maintenance of all safety measures .
Contract No. C47160
ARTICLE 8. PREVAILING WAGES.
Contractor shall be required to pay the prevailing rate of wages in accordance with the Labor
Code which such rates shall be made available at the City's Office or may be obtained
online at http://www.dir.ca.gov and which must be posted at the job site.
ARTICLE 9. FALSE CLAIMS.
Contractor acknowledges that if a false claim is submitted to the City, it may be considered fraud
and Contractor may be subject to criminal prosecution . Contractor acknowledges that
the False Claims Act, California Government Code sections 12650, et seq., provides
for civil penalties where a person knowingly submits a false claim to a public entity.
These provisions include within their scope false claims made with deliberate
ignorance of the false information or in reckless disregard of the truth or falsity of the
information . In the event the City seeks to recover penalties pursuant to the False
Claims Act, it is entitled to recover its litigation costs , including attorneys' fees.
Contractor hereby acknowledges that the filing of a false claim may the Contractor to
an administrative debarment proceeding wherein Contractor may be prevented from
further bidding on public contracts for a period of up to five (5) years.
[REMAINDER OF PAGE LEFT INTENTIONALLY BLANK]
Contract No. C47160
IN WITNESS WHEREOF , th is Contract has been duly executed by the above-named part ies , on
the day and year above written.
CITY OF PALM DESERT
ATTEST :
By :
By :
sr ah
Best Best & Krieger LLP
City Attorney
AMERICAN ASPHALT SOUTH, INC.
By ~ • FFPEm PRESIDENT
By ~ ~ KENDER,SEcRETARY
A
Contractor's License Number and
Classification
DIR Registration Number
(CONTRACTOR'S SIGNATURE MUST BE
NOTARIZED AND CORPORATE
SEAL AFFIXED , IF APPLICABLE)
END OF CONTRACT QC: MN
Insurance:
a;::review
Bonds
Contract No. C47160
Notary Acknowledgment
A notary public or other officer completing this certificate verifies only the identity of the individual who signed the
document to which this certificate is attached , and not the truthfulness , accuracy, or validity of that document.
STATE OF CALIFORNIA 1 COUNTY OF R ,,, ;:_,qi. A~
On \y\ aJ d, 0 , 20Jj_, before me, <"Ro lg tv\ a,-<~'1 A-ri:Za 8 c, , Notary Public, personally
appeared ,J: t & f f ,:rs 9 1.f ~ \ ~\, y S K,wk"" , who proved to me on the basis of satisfactory
evidence to be the person(s) whose name(s) ys/are subscribed to the within instrument and acknowledged to
me that t:lelshe/they executed the same in ~r/their authorized capacity(ies), and that by RtStAer/their
signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted , executed
the instrument.
I certify under PENAL TY OF PERJURY under the laws of the State of California that the foregoing paragraph
is true and correct.
WITNESS my hand and official seal.
Signature of Notary Public
OPTIONAL
Though the information below is not required by law, it may prove valuable to persons relying on the document
and could prevent fraudulent removal and reattachment of this form to another document.
CAPACITY CLAIMED BY SIGNER
o Individual
o Corporate Officer
o Partner(s)
o Attorney-In-Fact
o Trustee(s)
o Guardian/Conservator
D Other:
Signer is representing :
Title(s)
D
D
Name Of Person(s) Or Entity(ies)
Limited
General
DESCRIPTION OF ATTACHED DOCUMENT
Title or Type of Document
Number of Pages
Date of Document
Signer(s) Other Than Named Above
CERTIFICATES OF INSURANCE REVIEW
THIS SECTION TO BE COMPLETED BY CITY CLERK STAFF
Project No.:
Approval Date:
Contract No.:
Contractor:
Project Manager:
Approver:
GENERAL LIABILITY POLICY POLICY DATES/COMMENTS
Occurence Limit Met _____________________________________
Aggregate Limit Met _____________________________________
Primary Non-Contributing End. _____________________________________
Additional Insured End. _____________________________________
AUTOMOBILE LIABILITY POLICY
Limits Met _____________________________________
Additional Insured End. _____________________________________
WORKERS COMPENSATION POLICY
Coverage Indicated (per Statute) _____________________________________
Waiver of Subrogation End. _____________________________________
Employer Liability Limits _____________________________________
Declaration Form (if uninsured) _____________________________________
A.M. BEST RATING MET
General Liability Policy _____________________________________
Auto Liability Policy _____________________________________
Workers Compensation Policy _____________________________________
Other: _____________________________________
CERTIFICATE OF INSURANCE (COI)
Certificate Holder Correct _____________________________________
Insured Correct _____________________________________
Date Current _____________________________________
Signed COI _____________________________________
OTHER INSURANCE (AS REQUIRED)
Professional Liability (E&O) _____________________________________
Pollution/Environmental _____________________________________
Builder’s Risk _____________________________________
Comments:_____________________________________________________________________________________
1
Gloria Sanchez
From:Tim Varon <TVaron@carlwarren.com>
Sent:Friday, November 22, 2024 9:16 AM
To:Gloria Sanchez; Damian Olivares
Cc:Janice Baluyut; Andrea Staehle; Amber Molina
Subject:FW: CJP-3052858 - City of Palm Desert - 946 - Randy Morales
Attachments:2024-11-21 Morales, Randy - 946.pdf; 20241122 Morales Palm Desert NOTIFICATION
LETTER CJP-3052858.pdf
Hi Gloria,
Please find attached a copy of our Notification Letter for your records.
Have a great weekend!
Tim
Tim Varon
Claims Supervisor
TVaron@carlwarren.com
Tel: (657) 622-4287 | Fax: (866) 254-4423
Carl Warren & Company, LLC
CA Entity License No: 2607296
www.carlwarren.com
PO Box 2411, Tustin, CA, 92781
Because Quality and Integrity Matter... please EMAIL my Supervisor about the service you received.
Important Notice: This email (including any attachments) is intended solely for the use of the
individual or entity to which it is addressed, and may contain information that is confidential,
proprietary, non-public and/or privileged. If you are not the in tended recipient, you are hereby notified
that any use, dissemination, distribution, or copying of this communication is strictly prohibited. If you
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PO Box 2411, Tustin, CA 92781
T: 657-622-4200 | F: 866-254-4423 | www.carlwarren.com
CA License #2607296
November 22, 2024
Randy Morales
35751 Gateway Dr., Unit L1211
Palm Desert, CA 92211
RE: Claimant : Randy Morales
Date of Loss : 11/21/24
Claim Filing Date : 11/21/24
Our File Number : CJP-3052858 JBV
Carl Warren & Company is the claims management company for the City of Palm Desert. The
above-captioned claim has been assigned to Janice Baluyut for handling. Ms. Baluyut may be
reached at 657-622-4326.
When our investigation is complete, we will advise you as to whether or not we can recommend
settlement.
Very Truly Yours,
CARL WARREN & CO.
Timothy M. Varon
Timothy M. Varon
Claims Supervisor
cc: Member Agency: City of Palm Desert, attn:Gloria Sanchez
1
Gloria Sanchez
From:Gloria Sanchez
Sent:Friday, November 22, 2024 8:42 AM
To:Todd Hileman; Isra Shah; Carl Warren cjpia@carlwarren.com
Cc:Chris Escobedo; Anthony Mejia; Andrea Staehle; Tim Varon; Damian Olivares
Subject:RE: Claim Against the City of Palm Desert - 946 - Randy Morales
Attachments:2024-11-21 Morales, Randy - 946.pdf
Good morning,
Attached is the claim for Randy Morales.
Have a nice weekend.
From: Gloria Sanchez
Sent: Thursday, November 21, 2024 3:28 PM
To: Todd Hileman <thileman@palmdesert.gov>; Isra Shah <isra.shah@bbklaw.com>; Carl Warren cjpia@carlwarren.com
<cjpia@carlwarren.com>
Cc: Chris Escobedo <cescobedo@palmdesert.gov>; Anthony Mejia <amejia@palmdesert.gov>; Andrea Staehle
<astaehle@palmdesert.gov>; Tim Varon <TVaron@carlwarren.com>; Damian Olivares <dolivares@palmdesert.gov>
Subject: Claim Against the City of Palm Desert - 946 - Randy Morales
Good afternoon,
Attached for your review and appropriate action is Claim No. 946 submitted by Randy Morales.
If you have questions or need additional information, please do not hesitate to contact us.
Kind regards,
City of Palm Desert Clerk’s OƯice
P i. y DESERT. 4
Claim Against the City of Palm DesertIEOY 21PM 3; ;
For Damage(s)to Person(s) or Personal Property
Instructions: Please fill out this form completely. Failure to provide sufficient information may result in
delays in claim processing. If you need an accommodation to complete or submit this form, please contact
the City Clerk's Office Claims Coordinator at cityclerkApalmdesert.gov or(760) 346-0611.
Important Information:
1. Claims for death, injury to person or to personal property must be filed no later than six (6)
months after the occurrence.
2. Claims for damages to real property must be filed no later than one (1) :year' after the
occurrence. See Government Code §911.2.
3. Be sure claim is against the City of Palm Desert, not another public entity.
4. Claimant is advised to consul a rivate attorney if legal advice is desired. No employee of the
City may give legal advice to any claimant relating to private claims. •
Instrucciones: Complete este formulario en su totalidad. Si no brinda informacion suficiente, pueden
demorar el procesamiento del reclamo. Si necesita alguna acomodacion para completar o enviar este
formulario, comuniquese con el Coordinador de Reclamos a la direccion de correo electronico
cityclerkApalmdesert.gov o al telefono (760) 346-0611.
Informacion importante:
1. Los reclamos por muerte, lesiones personales o oleos a la propiedad deben presentarse a mas
tardar seis (6) meses despues de haberse producido el hecho.
2. Los reclamos por danos a bienes inmuebles deben presentarse a mas tardar un (1) ano despues
de haberse producido el hecho. Consulte al codigo § 911.2 del gobierno de California.
3. Asegurese su reclamo es hacia la ciudad de Palm Desert y no otra entidad publica.
4. Se aconseja al demandante consultar con un abogado privado si asi to desean. Ningun empleado
de la ciudad puede brindar asesoramiento legal al demandante en relacion con reclamos privados.
Received by: in.e•Sony 2_ U.S. Mail.
Assigned Claim No. 9" ' >� Interoffice
Claimant Name/Nombre de Demandante: • • ✓ Over-the-Counter
out ,
First Name(Nomb e) M.L(Inicial de Segundo YAM&S •
Last Name(Apellido) Suffix(Sufijo)
Home Address/Domicilio:
5515 1 Cmr 1,v --)
Street Number and Name(Numero y Nombr Cale)
L. 1_ 211
Unit Number(Numero de Apartamento/Unidad)
& Iwo D cso i (-A
City(Ciudad) State/Province/Region(Estado)
61211 (
Zip Code(Codigo Postal)
Preferred Phone Number/Numero de telefono preferido:
L 1(00 TN- 0 -L
Email/Correo Electronico:
If represented by an attorney, provide name and address — Si cuenta con la representacion
de un abogado indique su nombre y domicilio:
First Name(Nombre) Last Name(Apellido) Suffix(Sufijo)
Address/Domicilio:
Street Number and Name(Numero y Nombre de Ca//e)
Unit Number(Numero de Apartamento/Unidad)
City(Ciudad) State/Province/Region(Estado)
Zip Code(Codigo Postal)
Date and time of damage/injury/loss Fecha y la hora del dano, la lesion, o la perdida:
1112112 $:?)LGn
Date(Fecha) Time(Nora)
Location of damage/injury/loss (if:known, include specific address) - L'ugar donde ocurrio el
dano, la lesion, o la perdida (si conoce el domicilio, indiquelo):
Plaxv1 K bt tei_Ok+r A. . 4 `I—otivv i Sk
Provide a general description of the indebtedness/obligation/damage/injury/loss so far as it may
be known at the time of presentation of this claim. If there were no injuries, state "no injuries"
— De una descripcion general del endeudamiento, obligacion, dano, lesion, o perdida al
momento de este reclamo. Si no hubo lesiones, indique "no lesiones":
S � ► (���� r e-oklt\-c w J yr si 9+a9c.,
N;ic e-o) brhki S;9 vl DJ to .uktd oval Lo4-5 of- )oak,
v+n kV Yt..akrt tsf i t In 64v0- Q v aunt Sckrut&h.2s 0,1/14 dke v.
1 f
Specify how the damage/injury/loss occurred — Especifique.como se produjo el dano, la lesion,
o la perdida:
Tvrvve_d kvv T-tOtvy.jS S4\t‘e,4va %c tt,wua vases
opt d too ct vo,,v.e (av cc cc coeyvv ),
What particular action/omission by the City, or its employee(s), caused the damage/injury/loss?
- LQue acciOn u omision especifica de Ia ciudad o su(s) empleado(s) ocasionaron el dano, Ia
lesion, o la perdida?:
IW S 5"9k- LA ti j wt-ci- is
Vtuc,k , In ovty 5 roAfil
Provide the name(s) of the City employee(s) involved in the damage/injury/loss, if.known -Si to
conoce, indique el nombre(s) de el/los empleado(s) de Ia ciudad involucrado(s) en el dano, la
lesion, o la perdida.
Name(s) and address(es) of any other person(s) injured - Nombre(s) y domicilio de otra(s)
persona(s) que sufrio lesiones:
AJ On_e
i`
Name(s) and address(es) of witness(es), if any - Nombre(s) y domicilio(s) de el/los testigos, si
los hubiera:
Name(s) and address(es) of all physician(s) or hospital(s) where claimant was treated, if any -
Nombre(s) y domicilio(s) del medico(s) u hospital(es) donde el demandante recibio tratamiento
si to hubiera:
Was a police report filed?— iSe hizo denuncia a la policia? YES NO
If yes, provide the police report number — Si se hizo una denuncia, indique el numero de la
denuncia:
Any additional Information that might be helpful in considering claim — Incluya cualquier otra
informacion que pueda resultar util para procesar el reclamo:
DAMAGES CLAIMED / DANOS RECLAMADOS:
If the amount claimed exceeds$10,000, it is not required that a dollar amount be provided. However, your claim
must indicate whether it would be a Limited Civil Case. A Limited Civil Case is one where the recovery sought,
exclusive of attorney fees, interest, and court co tsbes not exceed $25,000. An Unlimited Civil Case is one
in which the recovery sought is more than $25,000.
Si el monto reclamado supera los $10,000, no es necesario indicar la cantidad en dolares. Sin embargo, el
reclamo debe indicar si se tratase de una Accion Civil Limitada. Una Accion Civil Limitada es una acciOn en la
que el resarcimiento pretendido no super los$25,000, sin incluir honorarios de abogados, intereses y costos del
tribunal. En una Accion Civil sin Limite, el resarcimiento pretendido supera los $25,000.
Damages Claimed/Davos reclamados:
❑ Limited Civil Case (damages between $10,000 - $25,000) -Accion Civil Limitada (los danos ascienden
a $10,000-$25,000)
❑ Unlimited Civil Case(damages exceed$25,000)—Accion Civil sin Limite(los danos superan los$25,000)
If the amount claimed is under$10,000,state amount claimed—Si el monto reclamado es menos
rde $10,000, indiquelo:
I
Basis for computation of amount claimed (include estimate/bills as an attachment, if possible)
— Base por to que calculo el monto reclamado (si es possible proporcione con este reclamo
presupuestos/facturas):
WARNING: IT IS A CRIMINAL OFFENSE TO FILE A FALSE CLAIM. (CALIFORNIA PENAL CODE 72 AND
CALIFORNIA INSURANCE CODE)
I certify under penalty of perjury that the facts herein above set forth are true and correct to the best of my
knowledge.
ADVERTENCIA: ES UN DELITO PENAL PRESENTAR UN RECLAMO FALSO. (CODIGO PENAL DE
CALIFORNIA 72 Y CODIGO DE SEGUROS DE CALIFORNIA) Por la presente certifico bajo pena de
perjurio que los hechos establecidos anteriormente son verdaderos y correctos a mi leal saber y enteder.
Signed this Af0 V, day of 2 1 , 20 24 , at 2 %, prvi .
Signature of Claimant/ Irma de emandante Signature of Claimant/Firma de Demandante