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HomeMy WebLinkAbout2015 CON Gormsen Appliance - Appliance Service andRepairSHORT FORM SERVICES AGREEMENT BY AND BETWEEN THE CITY OF NATIONAL CITY AND GORMSEN APPLIANCE CO. THIS AGREEMENT is entered into this 1st day of July, 2015, by and between the CITY OF NATIONAL CITY, a municipal corporation (the "CITY"), and GORMSEN APPLIANCE CO. (the "CONTRACTOR"). NOW, THEREFORE, CITY agrees to engage CONTRACTOR to perform the services set forth herein in accordance with the following terms and conditions: 1. Description of Services. CONTRACTOR shall provide City -Wide on -site appliance installation, sales, service and repairs as needed for our fiscal year ending June 30, 2016, and as directed by Rick Hernandez, the City's Facilities Maintenance Supervisor 2. Length of Agreement. The duration of this agreement is through June 30, 2016. 3. Compensation. The total compensation to CONTRACTOR for providing the services set forth herein shall not exceed an annual total cost of $5,000.00. The compensation for CONTRACTOR'S work shall be based upon and not exceed the rates given in Exhibit "A" (the labor rates) without prior written authorization from CITY. 4. Payment Schedule. CITY will make payment within thirty (30) days of receiving and approving a billing statement for the satisfactorily completed services of CONTRACTOR. 5. Termination. CITY may terminate this Agreement at any time by providing a one (1) day written notice to CONTRACTOR. 6. Independent Contractor. It is agreed that CONTRACTOR is an independent Contractor, and all persons working for or under the direction of CONTRACTOR are CONTRACTOR' S agents, servants and employees, and said persons shall not be deemed agents, servants, or employees of CITY. 7. Insurance. CONTRACTOR shall obtain: A. Fi If checked, Professional Liability Insurance (errors and, omissions) with minimum limits of $1,000,000 per occurrence. B. Automobile insurance covering all bodily injury and property damage incurred during the performance of this Agreement, with a minimum coverage of $1,000,000 combined single limit per accident. Such automobile insurance shall include owned, non -owned, and hired vehicles ("any auto"). C. Commercial general liability insurance, with minimum limits of $1,000,000 per occurrence/$2,000,000 aggregate, covering all bodily injury and property damage arising out of its operations under this Agreement. D. Workers' compensation insurance in an amount sufficient to meet statutory requirements covering all of CONTRACTOR'S employees and employers' liability insurance with limits of at least $1,000,000 per accident. In addition, the policy shall be endorsed with a waiver of subrogation in favor of the City. Said endorsement shall be provided prior to commencement of work under this Agreement. E. The aforesaid policies shall constitute primary insurance as to the CITY, its officers, employees, and volunteers, so that any other policies held by the CITY shall not contribute to any loss under said insurance. Said policies shall provide for thirty (30) days prior written notice to the CITY of cancellation or material change. F. Said policies, except for the professional liability and workers' compensation policies, shall name the CITY and its officers, agents and employees as additional insureds, and separate additional insured endorsements shall be provided. G. If required insurance coverage is provided on a "claims made" rather than "occurrence" form, the CONTRACTOR shall maintain such insurance coverage for three years after expiration of the term (and any extensions) of this Agreement. In addition, the "retro" date must be on or before the date of this Agreement. H. Insurance shall be written with only California admitted companies which hold a current policy holder's alphabetic and financial size category rating of not less than A VIII according to the current Best's Key Rating Guide, or a company equal financial stability that is approved by the City's Risk Manager. In the event coverage is provided by non -admitted "surplus lines" carriers, they must be included on the most recent California List of Eligible Surplus Lines Insurers (LESLI list) and otherwise meet rating requirements. 1. This Agreement shall not take effect until certificate(s) or other sufficient proof that these insurance provisions have been complied with, are filed with, and approved by the CITY's Risk Manager. If the CONTRACTOR does not keep all of such insurance policies in full force and effect at all times during the terms of this Agreement, the CITY may elect to treat the failure to maintain the requisite insurance as a breach of this Agreement and terminate the Agreement as provided herein. J. All deductibles and self -insured retentions in excess of $10,000 must be disclosed to and approved by the CITY. K. Insurance certificates must specify certificate holder as: City of National City ATTN: Risk Manager 1243 National City Blvd National City, CA 91950-4301 8. Hold Harmless. CONTRACTOR shall defend,indemnify, and hold CITY, its Officers, employees, and agents harmless from any liability for damage or claims of same, including but not limited to personal injury, property damage and death, which may arise from CONTRACTOR, or CONTRACTOR'S subcontractors, agents or employees' operations under this Agreement. CITY shall cooperate reasonably in the defense of any action, and CONTRACTOR shall employ competent counsel, reasonably acceptable to the City Attorney. 9. Acceptability of Work. The City shall, with reasonable diligence, determine the quality or acceptability of the work, the manner of performance, and/or the compensation payable to the CONTRACTOR. 10. Business License. CONTRACTOR must possess or shall obtain business license from National City Finance Department beforebeginning work. Revised August 2014 11. Miscellaneous Provisions. A. Counterparts. This Agreement may be executed in multiple counterparts, each of which shall be deemed an original, but all of which, together, shall constitute but one and the same instrument. B. Captions. Any captions to, or headings of, the sections or subsections of this Agreement are solely for the convenience of the parties hereto, are not a part of this Agreement, and shall not be used for the interpretation or determination of the validity of this Agreement or any provision hereof. C. No Obligations to Third Parties. Except as otherwise expressly provided herein, the execution and delivery of this Agreement shall not be deemed to confer any rights upon, or obligate any of the parties hereto, to any person or entity other than the parties hereto. a Exhibits and Schedules. The Exhibits and Schedules attached hereto are hereby incorporated herein by this reference for all purposes. E. Amendment to this Agreement. The terms of this Agreement may not be modified or amended except by an instrument in writing executed by each of the parties hereto. F. Waiver. The waiver or failure to enforce any provision of this Agreement shall not operate as a waiver of any future breach of any such provision or any other provision hereof. G. Applicable Law. This Agreement shall be governed by and construed in accordance with the laws of the State of California. The CONTRACTOR shall comply with all laws, including federal, state, and local, laws, whether now in force or subsequently enacted. H. Entire Agreement. This Agreement supersedes any prior agreements, negotiations and communications, oral or written, and contains the entire agreement between the parties as to the subject matter hereof. No subsequent agreement, representation, or promise made by either party hereto, or by or to an employee, officer, agent, or representative of any party hereto shall be of any effect unless it is in writing and executed by the party to be bound thereby. I. Successors and Assigns. This Agreement shall be binding upon and shall inure to the benefit of the successors and assigns of the parties hereto. J. Construction. The parties acknowledge and agree that (i) each party is of equal bargaining strength, (ii) each party has actively participated in the drafting, preparation and negotiation of this Agreement, (iii) each such party has consulted with or has had the opportunity to consult withits own, independent counsel and such other professional advisors as such party has deemed appropriate, relative to any and all matters contemplated under this Agreement, (iv) any rule or construction to the effect that ambiguities are to be resolved against the drafting party shall not apply in the interpretation of this Agreement, or any portions hereof, or any amendments hereto. IN WITNESS WHEREOF, this Agreement is executed by CITY and by CONTRACTOR on the date and year first above written. Revised August 2014 3 CITY OF NATIONAL CITY By: Leslie Deese, City Manager 'ROVED AS TO FORM: C,�., G. a Silva City Attom CONTACT INFORMATION CITY OF NATIONAL CITY 1243 National City Boulevard National City, CA 91950-4301 Phone: (619)336- 4585 Fax: (619)336-4397 Contact: Rick Hernandez Title: Facilities Supervisor Dep.: Public Works Email: rickh@nationalcityca.gov GORMSEN APPLIANCE CO. (Corporation -- signatures of two corporate officers required) (Partnership— one signature) (Sole proprietorship — one signature) viefits,z.4) (Print) , . t Qc ,tf (Title) By:ter/ (Name) APT7(. 602 S6JJ (Print) (Title) CORMSEN APPLIANCE CO. Complete Address: 1429 Garnet Ave. San Diego, CA.92109 Phone 858-274-4210 Fax 858-274-5848 Contact: Axel Gormsen Title: President Email: info@gormsenappliance.net Taxpayer I.D. No 952816563 Revised August 2014 4 GORMSEN APPLIANCE CO. 1429 GARNET AVE. SAN DIEGO, CA 92109 858-274-4210 infoiiiftloansenanpliance.net 07/08/2015 To: City Of National City Attn: Finance Dept., Purchasing Division Re: Service Rates for City of National City Service Call is $85.00. This call rate includes complete diagnosis and 15 minutes of labor. Additional labor is $25.00 for cacti 15 minutes of labor plus parts. ($100.00 per hour) We also offer new appliances for sale at competitive rates for sale and installation. Axel Gor sen Pacitic Appliance Co. dba Gormsen Appliance Co. State Lid/ A43943 Form W-9 (Rev. December 2014) Vepartment of trip. Treasury Internal Revenue Service Request for Taxpayer Identification Number and Certification Give Forrn to the requester. Do send to the not IRS. Print or type See. Specific Instructions on page 2. 1 Name (as Ghown an your income tax rattan). Name is required on this line; do not born this lino hlank. PACIFIC APPLIANCE COMPANY 2 Business namely sregarded entity name, it different from above GORMSEN APPLIANCE CO/GORMSEN MAYTAG . 3 Check appropriate box for federal tax classification, check only one of the following seven boxes: [1] indlyclual/sole proprietor or Lirl C Corporation LJ S Corporation !--] Partnership 0 Trust/estate single.-mernher LLC n t imitxi liability company. Enter the tax elassIficabon (Ceti; corporation, SS corporation, Pepartnership) e• 4 Exemptions (codes apply only to certain entitie.s, not indivirt leis: SF* instructions an page 3): Exempt payee code (it any) Note. For a single -member LLC that is disregarded, do not check LLC: check tha appropriate box in the line above for the fax classification of ire single-mamher owner. Fxemption from FATCA reporting code (if pny) DOther (sea instructions)* pap.os %. or,..etv oVelerner1 ClIck, 'IV U.V) Address (number, street, and apt, or suite no.) 1429 GARNET AVE Requester's name and address (optional) 6 City. stale, and ZIP code SAN DIEGO, CA 921 09 7 List account number(s) item (optional' Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid backup withholding. For individuals, this is generally your social security number (SSN). However, tor a resident alien, sole proprietor, or disregarded entity, see the Pad I instructions on page 3. For other entities. it is your emctover identification number (EIN). If VOL4 do not have a number, see How to get 'a LSocial security number ___ 1 FIN on page 3, Note. If the account is in more than one name, see the instructions for line 1 and the chart on page 4 for guidelines on whose number to enter. or Employer identification number 9 5 2 8 6 5 6 PtII: Certification Under penalties of perjury, I certify that: I, The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and 2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or diviciends, or (c) the IRS has notified me that I am no longer subject to backup withholding; and 3. I arn a U.S. citizen or other U.S. person (defined be)m.* and 4. The FATCA code(s) entered on this form (if any) indicating that I arn exempt Certification instructions. You must cross out item 2 above if you have been because you have failed to report all interest and dividends on your tax return. interest paid, acquisition or abandonment of secured property, cancellationof generally, payments other than interest and dividends, you are not required to instructions on page 3. Sign Here Signature of U.S. person General Instructions Section reterencof, are to the Internal Revenue Code Urli036 othervoe noted. Future developments. Information about developments affecting Form W-9 (such as legislation enacted atter we release it) Is at vinvw.irs.growfwg. Purpose of Form Ara individual or entity (Form W-9 reque.ster) who is required to file an information retain with the /RS must obtain your correct taxpayer identification number )TIN whicli may be your social security number (SON), individual taxpayer identification number ((TIN), adoption taxpayer identification number (ATIN), or employer identification number (EtN), to report on an information return the amount paid to you, or other amount reportable on an information return. examples of information returns include, but are not limited to, the following: • Form 1099-IN7 (interest earned or paid) • Form 1690-01V (dividends, including those -from stocks or mutual funds) • Form I 09941ISC (various types of income, prizes, awards, or Toss proceeds', • Form 1099-13 (stock or mutual fund sates and certain other transactions by brOkers) • Form 10-99-S (proceeds from real estate transactions) • Form 1099-k [merchant card and third party network transactions) from FATCA reporting is correct, notified oy the IF1S that you are currently subject to backup t..vithholding For real estate transactions, item 2 does not apply. For mortgage debt, contributions to en individual retirement arrangement (IRA), and sign the certification, but you must provide your correct TIN. See the Date7—'Z/-- • Form 10911 (bome mortgage interest), 1098-E (student loan interest), 1098-T (tuition) • Form 1099-C (canceled debt) • Farm 1099-A (acquisition or abandonment at secured property) Use Forrn W-9 only if you are a U.S. person (Including a resident alien), to provide your correct TIN, ifyou dom.)/ return Form W-9 to tiro tOquePtar with a TIN, you might be suhjocf to backup wthbotaing. SOB What s backup withholding? on page 2. By ,iyttiiiv tun it, you - 1. Certify that the TIN you are giving la correct (or you are waiting for a number to be issued), 2. Carlily thni you are not soh(ect to backup witlinclding, or 3. Claim exemption from backup withholding if you are a U.S. exempt payea. If applicable, you are also certifying that as a U.S. person, your allocable share of any partnership income from a U.S. trade or business is not subject to the withholding tax on foreign partners' share 01 effectively connected income, and 4. Certify that FATCA code(e) entered nn this form (if any) indicating that you are exempt from the FATCA reporting, is correct. See Wha; 8 FAIGA reP0,1Thg? on nage2 for iurther information. Cat, No. 10231X i-'(1,111 W-9 (Sey. 12-2014) ACORO� DATE (MM/DOIYYYY) 02/03/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(ies) must 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 Michael J. Machanis 1944 Kellogg Avenue Carlsbad, CA. 92008 760-438-5535 INSURED Axel Gormsen Gormsen Appliance, Inc. 1429 Garnet Avenue San Diego, CA. 92109 COVERAGES CERTIFICATE NUMBER: CERTIFICATE OF LIABILITY INSURANCE CONTACT Michael J. Machanis lac Nc &MY 760-038 5535 I FAJ1 N/A -M EAIL (A/C.. No): ADDRESS: staff.mmachanis@farmersagency.com NAME: PHONE INSURERA AFFORDING COVERAGE INSURER A : Truck Insurance exchange INSURER B : Farmers Insurance exchange INSURER C : Mid -Century Insurance Company INSURER D !POURER E : NAIC 21709 21652 21687 INSURER F : THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSUREREVISION NUER: D NAMED ABOVEB OR 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 R�_ INS._ _._..____ ADDL SUBii LTR TYPE OF INSURANCE POLICY 1NSR WVD POLICY NUMBER IMM/DOIYYYY) t1INYVYYI LIMITS GENERAL LIABILITY COMMERCIAL GENERAL. LIABILITY CLAIMS -MADE OCCUR Gall AGGREGATE LIMIT APPLIES PER: POUCY IFCT r LOC AUTOMOBILE LIABILITY X A ANY AUTO ALL OWNED AUTOS HIRED AUTOS UMBRELLA J AUTOSULED X NAUTOSON-OWNED /� 601829016 600846315 04/16/2015 03/01/2015 04/16/2016 EACH OCCURRENCE D S E'TORE'NTEI— PREMISES (Ea 9ccunpnr4L MED EXP (Any one VefEO"� PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP/OP AGG Fire Damage COMBINED SINGLE LIMIT _(Ea accident BODILY INJURYper Dervpt). 03/01/2016 BODILY INJURY (Perecxfdent) S PROF RTY DAMAGE ?Per me deru) E 2,000,000 $ 75,000 5,000 2,000,000 4,000,000 S 2,000,000 S 1,000,000 EXCESS LIAB DED RETENT ON $ OCCUR CLAIMS -MADE WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORMARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS be4,w Y/N N/A A20087662 04/01 /2015 DESCRIPTION OF OPERATIONS / LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If m City of National City named as additional insured. /01/2016 EACH OCCURRENCE AGGREGATE $ E WC STATU- OTH- IGAY11MLIS_._ 1 ER E.L. EACH ACCIDENT S 1,000,000 E.L. DISEASE - EA EMPLOYEE E 1 ,000,000 E.L. DISEASE- POLICY LIMIT $ 1,000,000 pace Is required CERTIFICATE HOLDER City of National City 1243 National City Blvd National City ACORD 25 (2010/05) CA 91950 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE © 1988-20 ACORD CORPORATION. Alt rights reserved. The ACORD name and logo are registered marks CORD FA ERS INSURANCE WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY Named . PACIFIC APPLIANCE COMPANY Irisured 'PACIFIC APPLIANCE COMPANY (A CORP) 1429 GARNET AVE SAN DIEGO CA 92109 Effective Date 07 8/15 Agen t 99-65-32P INC 9 06 20 A2008-76-62 2015 Policy Number Policy of de: Company Year WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT SPECIE! We have the right io 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 appliesonly to the extent that you perform work under a writ ten contract that requires you to obtain this agreement from us.) You roust maintain payroll t words accurately segregating the rentunerat ion of yottr employees while engaged in the work described in the Schedule_ The additional premium for this endorsement shall he 3% (K, of the WorkersCompensation prcnhium othetwisc due on such rem unerAtion, sitbject to a utin im UM charge of $250 Perm er Orgailatisa Schedule Job Description APPLIANCE R E 1243 NATIONAL CITY BLVD 91950 THE CITY OF NATIONAL CITY FINANCE DEPT PURCHASE DIVISION 1243 NATIONAL CITY BLVD NATIONAL CITY, CA 91950 This endorsement is part of your policy. It supersedes and commis anything to the corLtary. it s dterwise subject to all the terms of the policy, Countersigned r34370 1ST Authorized Representanve .16370111 Pig. Of 1 TRUCK INSMCE EX GE WORKERS' COMPENSATION GENERAL CHANGE ENDORSEMENT Named Insured and Mailing Addrcss Agency and Niaiting Address VX 99 06 09 A PACIFIC APPLIANCE COMPANY PACIFIC APPLIANCE COMPANY (A CORP) 1429 GARNET AVE SAN DIEGO CA 92109 Policy NO,: A2008-76-62 Policy Year: 20 15 Orange Effective Date: 07 /08/15 EltdOrsements Changed: 1.1',1 Insured's Name • Policy Number Li r flecrive Date 0 Expiration Date 0 insured's Mailing Address O E• xperience Modification 0 P• roducer's NAMC LJ Change in workplace of Insured LI Insured's Legal Staters ED R• einstate without intrrniption ©f coverage Description of Change CARLSBAD 1944 KELLOGG AVE CA 92008 99-65-32P MICHAEL MACHANIS 15 1)t)liCV Effective Date: 04/01/15 FEIN No.: caj FILE LJ Sens 11 Employer Liability I jut i t s Billing Plans Ei rm.-int:1)1(s) *Classiiicuion, Rate, Other El interim Adjustment of Premium 'E..] Carrier Servicing Office 0 Interstate/Intrastate Risk I.D. Number Ell Carrier Number ADD WC 990620 WAIVER OF RIGHTS TO THE CITY OF NATIONAL CITY ATTN: FINANCE DEPT . , PURCHASING DIVISION 1243 NATIONAL CITY ELVD NATIONAL CITY, CA 91950 RECOVER SPECIFIC FOR +Classification. Rate, Other Ciassdicat killS CO de No. Premium Basis Toral lisrimared Annual 1.1.eri l unerario, I Rate Per $100 of Rankin era t i();,) Estimated Annual Premium See Classification of Operations Schedule Foul Estimated Annual Premium $ IVEininitun Premium S Deposii Premium $ Consideration for Change, if any. I>ate Printed: JULY 21, 2015 Countersigned by eNcrl..... MOr 'I At 1 Make Check Or Money 0 FARMERS INSURANCE TRUCK INSURANCE EXCHANGE • PACIFIC APPLIANCE COMPANY ▪ PACIFIC APPLIANCE COMPANY (A CORP) 1429 GARNET AVE SAN DIEGO CA 92109 • • This Invoice Reflects: Fifertive Date: 0 4 / 0 1 / 15 0 New Business Reinstatement Previous Balance Owing $250.00 Premitun er ,cbk To Company Shown Bekw INVOICE LN Change Of Coverage Pro Rata Premium Due Premium For Renewing Entire Present Coverag 5250.00 Total Cliargcs JULY 21, 2 015 Daie 99-65-32P Agent's Number A2008-76-62 Policy Number Loan Number El Added Coverage To Paymems Oilier Credits 'Foul] Crn-lits $NONE BALANCE DUE UPON RECEIPT OPTIONAL AMOUNT z-1721 102 'A.MR REFUND THANK YOU FOR PLACING BOTH YOUR WORKERS COMPENSATION AND BUSINESS INSURANCE WITH FARMERS. A DISCOUNT HAS BEEN APPLIED TO YOUR POUCY, Pkase Write Your Polity Num4er On Cheep Or Money Order. RETURN THIS COPY WITH YOUR PAYMENT C7214;1 Pita 1 OF 2 CITY OF NATIONAL CITY Office of the City Clerk 1243 National City Blvd., National City, California 91950 619-336-4228 phone / 619-336-4229 fax Michael R. Dalla, CMC - City Clerk February 4, 2016 Mr. Axel Gormsen Gormsen Appliance Co. 1429 Garnet Avenue San Diego, CA 92109 Dear Mr. Gormsen, On July 1st, 2015, an Agreement was entered into between the City of National City and Gormsen Appliance Co. We are enclosing for your records a fully executed original Agreement. Sincerely, f/g Michael R. Dalla, CMC City Clerk Enclosure