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HomeMy WebLinkAboutALL STAR EVENT RENTALSCity of Santa A 7 -_ Clerk of the Council AGREEMENT TERMINATION FORM Please complete this form in its entirety when the attached agrMniFFIRd4 M 4: 21 amendments (if any) are no longer in effect. Note: If your agreement is grant related, please ensure that all grant retention regLl ep(s( A. I; T A N A have been satisfied prior to signing the termination form. t h; K, OF CO: NC ( L Is the agreement(s) a permanent record? Yes _ No Return form to the Clerk of the Council Office (M-30). Call 647-1520 if you have any questions. The agreement with A-w �j}f+u� t� - � inn � �u Lg ,T4AQ r N-2©78-130 No. was completed on �j �,S�OnI� and final payment has been made. (List all amendments. Use space below N needed.) Department: rt C5A Phone/Ext.: ') n Signature: (d/r- Date: � IAIgon Revised10-I8-16 INSURANCE ON FILE WORK MAY PROCEED UNTIL INSU ANCE EXPIRES 'L : / ��/9 CLERK 0 COUNCIL DATE: I J1L 10 2018 N-2018-130 AMUSEMENT DEVICE PROVIDER AGREEMENT O: PRCS (/ ) Silvia Cuevas THIS AGREEMENT is made and entered into this 28th day of June, 2018, by and between All Star Event Rentals, INC. ("Provider") and the City of Santa Ana, a charter city and municipal corporation organized and existing under the Constitution and laws of the State of California ("City"). RECITALS A. The City desires to retain a provider to supply inflatable jumpeEs.forthe City's Fourth of July event to be held on July 4, 2018 ("Event"). B. Provider represents that Provider is able and willing to provide such services to the City. C. In undertaking the performance of this Agreement, Provider represents that it is knowledgeable in its field and that any services performed by Provider under this Agreement will be performed in compliance with such standards as may reasonably be expected. NOW THEREFORE, in consideration of the mutual and respective promises, and subject to the terms and conditions hereinafter set forth, the parties agree as follows: 1. SCOPE OF SERVICES Provider shall furnish inflatable jumpers and generator, as more fully described in Exhibit A attached hereto and incorporated by reference. City grants Provider the right to enter its property for the purpose of delivery, set-up, and pick-up. The jumpers shall be set-up and ready for operation by 4:00 p.m. on July 4`h at locations to be specified by City and shall be disassembled and removed by Provider at the conclusion of the Event. 2. COMPENSATION a. City agrees to pay, and Provider agrees to accept as total payment for its services the amount of Six Hundred Sixty Six Dollars ($666.00). The cost is identified in Exhibit A, attached hereto and incorporated by reference. b. Payment by City shall be made within thirty (30) days following receipt of proper invoice evidencing work performed, subject to the City's accounting procedures. Payment need not be made for work which fails to meet the standards of performance set forth in the Recitals which may reasonably be expected by the City. 3. TERM This term of this Agreement shall commence on July 4, 2018 and end on July 5, 2018, unless terminated earlier in accordance with Section 11 below. Page 1 of 7 4. INDEPENDENT CONTRACTOR Provider shall, during the entire term of this Agreement, be construed to be an independent contractor and not an employee of the City. This Agreement is not intended nor shall it be construed to create an employer -employee relationship, a joint venture relationship, or to allow the City to exercise discretion or control over the manner in which Provider performs the services which are the subject matter of this Agreement; however, the services to be provided by Provider shall be provided in a manner consistent with all applicable standards and regulations governing such services. Provider shall pay all salaries and wages, employer's social security taxes, unemployment insurance and similar taxes relating to employees and shall be responsible for all applicable withholding taxes. Provider is not an agent, representative or employee of City and Provider shall have no authority to act on behalf of the City. 5. INSURANCE Prior to undertaking performance of work under this Agreement, Consultant shall maintain and shall require its subcontractors, if any, to obtain and maintain insurance as described below: a. _„Commercial General,. Liability Insurance'. Consultant shall maintain commercial general liability insurance naming the City, its officers, employees, agents, volunteers and representatives as additional insured(s) and shall include, but not be limited to protection against claims arising from bodily and personal injury, including death resulting therefrom and damage to property, resulting from any act or occurrence arising out of Consultant's operations in the performance of this Agreement, including, without limitation, acts involving vehicles. The amounts of insurance shall be not less than the following: single limit coverage applying to bodily and personal injury, including death resulting therefrom, and property damage, in the total amount of $1,000,000 per occurrence, with $2,000,000 in the aggregate. Such insurance shall (a) name the City, its officers, employees, agents, and representatives as additional insured(s); (b) be primary and not contributory with respect to insurance or self-insurance programs maintained by the City; and (c) contain standard separation of insureds provisions. b. Business-automobile,=liability-insurance, or equivalent form, with a combined single limit of not less than $1,000,000 per occurrence. Such insurance shall include coverage for owned, hired and non -owned automobiles. C. Worker's Compensation Insurance. In accordance with the provisions of Section 3700 of the Labor Code, Consultant; if Consultant has any employees, is required to be insured against liability for worker's compensation or to undertake self- insurance. Prior to commencing the performance of the work under this Agreement, Consultant agrees to obtain and maintain any employer's liability insurance with limits not less than $1,000,000 per accident. Page 2 of 7 d. If Consultant is or employs a licensed professional such as an architect or engineer: Professional liability (errors and omissions) insurance, with a combined single limit of not less than $1,000,000 per claim with $2,000,000 in the aggregate. C. The following requirements apply to the insurance to be provided by Consultant pursuant to this section: i. Consultant shall maintain all insurance required above in full force and effect for the entire period covered by this Agreement. ii. Certificates of insurance shall be furnished to the City upon execution of this Agreement and shall be approved by the City. iii. Certificates and policies shall state that the policies shall not be canceled or reduced in coverage or changed in any other material aspect without thirty (30) days prior written notice to the City. iv. Where the amounts or coverage provided by the certificates of insurance provides coverage greater than those listed by this Agreement, the amounts provided by the certificates of insurance shall be incorporated by reference into the Agreement. V. Consultant shall supply City with a fully executed additional insured endorsement. , f. If Consultant fails or refuses to produce or maintain the insurance required by this section or fails or refuses to furnish the City with required proof that insurance has been procured and is in force and paid for, the City shall have the right, at the City's election, to forthwith terminate this Agreement. Such termination shall not affect Consultant's right to be paid for its time and materials expended prior to notification of termination. Consultant waives the right to receive compensation and agrees to indemnify the City for any work performed prior to approval of insurance by the City. 6. INDEMNIFICATION Provider agrees to and shall defend, indemnify and hold harmless the City, its officers, agents, employees, contractors, special counsel, and representatives from liability for personal injury, damages, just compensation, restitution, judicial or equitable relief arising out of claims for personal injury, including death, and claims for property damage, which may arise from the direct or indirect operations of the Provider or its contractors, subcontractors, agents, employees, or other persons acting on their behalf which relates to the services described in section 1 of this Agreement. The Provider further agrees to indemnify, hold harmless, and pay all costs for the defense of the City, including fees and costs for special counsel to be selected by the City, regarding any action by a third party asserting personal injury, damages, just compensation, restitution, judicial or equitable relief due to personal or property rights arising by reason of the terms of, or effects arising from this Agreement. City may make all reasonable decisions with respect to its representation in any legal proceeding. This indemnification provision No. 6 shall survive any expiration or termination of this Agreement. Page 3 of 7 CONFLICT OF INTEREST Provider covenants that it presently has no interests and shall not have interests, direct or indirect, which would conflict in any manner with performance of services specified under this Agreement. 8. NOTICE Any notice, tender, demand, delivery, or other communication pursuant to this Agreement shall be in writing and shall be deemed to be properly given if delivered in person or mailed by first class or certified mail, postage prepaid, or sent by fax or other telegraphic communication in the manner provided in this Section, to the following persons: To City: Clerk of the Council City of Santa Ana 20 Civic Center Plaza (M-30) P.O. Box 1988 Santa Ana, CA 92702-1988 Fax (714) 647-6956 With copy to: Executive Director of Parks, Recreation and Community Services City of Santa Ana 20 Civic Center Plaza (M-23) P.O. Box 1988 Santa Ana, California 92702 Fax (714) 571-4211 To Provider: All Star Event Rentals, Inc. 23988 Aliso Creek Rd., Suite Al2 4441 Laguna Niguel, CA 92677 Phone: (877) 778-8724 Email: Info@iump2allstar.com A party may change its address by giving notice in writing to the other party. Thereafter, any communication shall be addressed and transmitted to the new address. If sent by mail, communication shall be effective or deemed to have been given three (3) days after it has been deposited in the United States mail, duly registered or certified, with postage prepaid, and addressed as set forth above. If sent by fax, communication shall be effective or deemed to have been given twenty-four (24) hours after the time set forth on the transmission report issued by the transmitting facsimile machine, addressed as set forth above. For purposes of calculating these time frames, weekends, federal, state, County or City holidays shall be excluded. 9. EXCLUSIVITY AND AMENDMENT This Agreement represents the complete and exclusive statement between the City and Provider regarding the subject matter herein, and supersedes any and all other agreements, oral or written, between the parties. In the event of a conflict between the terms of this Agreement Page 4 of 7 and any attachments hereto, the terms of this Agreement shall prevail. This Agreement may not be modified except by written instrument signed by the City and by an authorized representative of Provider. The parties agree that any terms or conditions of any purchase order or other instrument that are inconsistent with, or in addition to, the terms and conditions hereof, shall not bind or obligate Provider or the City. Each party to this Agreement acknowledges that no representations, inducements, promises or agreements, orally or otherwise, have been made by any party, or anyone acting on behalf of any party, which is not embodied herein. 10. ASSIGNMENT The experience, knowledge, capability and reputation of Provider were a substantial inducement for City to enter into this Agreement. Therefore, Provider may not assign, transfer, delegate, or subcontract any interest herein without the prior written consent of the City and any such assignment, transfer, delegation or subcontract without the City's prior written consent shall be considered null and void. 11. TERMINATION This Agreement may be terminated by the City upon seven (7) days written notice of termination. In such event, Provider shall be entitled to receive, and City shall pay Provider, compensation for all services rendered prior to the effective date of termination. 12. RECORDS Provider shall keep records and invoices in connection with the work to be performed under this Agreement. Provider shall maintain complete and accurate records with respect to the costs incurred under this Agreement and any services, expenditures, and disbursements charged to the City for a minimum period of three (3) years, or for any longer period required by law, from the date of final payment to City under this Agreement. Provider shall allow inspection of all work, data, documents, proceedings, and activities related to this Agreement for a period of three (3) years from the date of final payment to City under this Agreement. 13. NON-DISCRIMINATION Provider shall not discriminate because of race, color, creed, religion, sex, marital status, sexual orientation, age, national origin, ancestry, or disability, as defined and prohibited by applicable law, in the recruitment, selection, teaching, training, utilization, promotion, termination or other employment related activities or in connection with any activities under this Agreement. 14. JURISDICTION — VENUE This Agreement has been executed and delivered in the State of California and the validity, interpretation, performance, and enforcement of any of the clauses of this Agreement shall be determined and governed by the laws of the State of California. Both parties further agree that Orange County, California, shall be the venue for any action or proceeding that may be brought or arise out of, in connection with or by reason of this Agreement. Page 5 of 7 15. LICENSES Provider shall, throughout the term of this Agreement, maintain all necessary licenses, permits, approvals, waivers, and exemptions necessary for the provision of the services hereunder and required by the laws and regulations of the United States, the State of California, the City of Santa Ana and all other governmental agencies. 16. SEVERABILITY In the event that one or more of the phrases, sentences, clauses, paragraphs or sections contained in this Agreement shall be declared invalid or unenforceable by valid judgment or decree of a court of competent jurisdiction, such invalidity or unenforceability shall not affect any of the remaining phrases, sentences, clauses, paragraphs or sections of this Agreement, which shall be interpreted to carry out the intent of the parties hereunder. 17. EXHIBITS All Exhibits referenced herein and attached hereto shall be incorporated as if fully set forth in the body of this Agreement. 18. AUTHORITY The person(s) executing this Agreement on behalf of the parties hereto warrant that they are duly authorized to execute this Agreement on behalf of said parties and that be so executing this Agreement, the parties hereto are formally bound to the provisions of this Agreement. [signatures on continued on next page] Page 6 of 7 N-2018-130 IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first above Written. ATTEST: HUIZAR �MARIA � D. ell Clerk of the Council APPROVED AS TO FORM: SONIA R. CARVALHO City Attorney sy'&�{1 w;tic LAURA A. ROSSINI Senior Assistant City Attorney RECOMMENDED FOR APPROVAL: Lg�� I,— RaIDh J. Nufjez, Interim Executive Director Parks, Recreation and Community Services Agency CITY OF SANTA ANA PROVIDER: ALL STAR �T RENTALS, INC Page 7 of 7 Scanned with CamScanner All Star Event Rentals, Inc. 23986 Aliso Creek Rd Ste Al2 #441, Laguna Niguel, CA 92677 Phone: (877)778-8724 1 Fax: (800) 288-9026 Website: www.alistareventrentals.com I Email: info@jump2allstar.com Bill To: CITY OF SANTA ANA Enrique Marban/William Sandoval 3006 W. Centennial Rd Santa Ana, CA 92704 Phone:(714)571-4254 Cell Phone: (714)631-6402 Deliver To: Centennial Park - 3000 W. Edinger Avenue Santa Ana, CA 92704 I,'! D" Invoice No: 34330 Order Date: May 04, 2018 Delivery: Jul 04, 2018 2-3pm Event Starts: Jul 04, 2018 04:00 pm Event Ends: Jul 04, 2018 09:30 pm Pick-up: Jul 04, 2018 930pm Payment Method: Check# QUANTITYJ DESCRIPTION BILL DAYS/HOURS LIST PRICE DISCOUNT TOTAL PRICE 2- Combos 1 TArurnal Kingdom Toddler Combo #238 1 1 $189.00 11 $31.001 $158.00 4- Interactive 1 40 Footer obstacle w/slide #422 1 $329.00 $100,007 $229.00 1 1 22ft Obstacle Course 430 1 $179.00 $40.001 $139.00 Miscellaneous 1 Generator(3 outlets) 1 $100.00 $20.00 $80.00 1 1 Generator (1 outlet) 1 $75.00 $15.00 $60.00 Order Subtotal: $666,00 TOTAL: $666.00 Amount Paid: $0.00 Balance Due: $666.00 HCustomer is resposible for power regnirommits O Castamer is easpuuviblefor providing adalt "vohndeenv" to supervise purees'. O Cas oneer ensures delivery pan, ftom fuck strap-oJfto set-up point by hardened and level with no steps or drop-offs. O Cuvtaner ensures set-up area iv ehy. Plens'e comilrne watering system is inoperable and set -lip area iv not wel/sogby. O Weilsogo areas will cause set-up to be cancelled at customer's full opulal prlce. RULES FOR USE - CAPACITY Sgjety fired Children's safety depends oa the presence of adult supervision while any rental equipment is in use. Keep age and size of groups compatible. 15'x15' Jumpers hold 8 children from 242 years old or 6 children from 9-15 years old. 13'xl3' Jumpers hold 8 cluldren firm 2-12 years old orb children from 9-15 years old. I rxl l' Jumpers hold 5 cluldren from 242 years old or 3 children from 9-15 years old. All Slides, Combos, Obstacle contact, hold 3 children from 5-16 years old. Took Tanks (ages 10 and up) & Velcro Walls (ages 5-and up) -I person at other. Same suds, Jousts, Boxing Rung and Head's Offers to be used by two participants only! All participants must tree the prnvided equipment Qiehnets, gloves, etc). All Pond/eoncesslon's machines must be operated by au adult only. ,SOMERSAULTS, ROUGH HOUSING AND FLIPS ARE NOT ALLOWED. NO SHOES, NO FOOD, NO GUM, NO DRINKS, NO SHARP OBJECTS AND NO SILLY STRING ALLOWED. Customer has received a troubleahootmg sheet and agrees to follow the steps listed there in case of a malfuoetiou. Adult Supervision Required At All Time,! 1. Cancellation Policy: a $50.00 fee will be clargod or collected I£eustoarer did not cancel the order with 48 hours notice. 2. Customer understands that injuries have happened using the rented game/service, injuries will happen in the fiaha'e, and there is the potential for injury during use by the Customer mid his/her guests. Customer assumes the risk ofrenting the arranged game/service, 3. Customer shall be is sole charge oFerowd control of the event at all tunes during equipment and game rental period and sball be responsible for damage and theft of equipment and game(s) during rental period 4. All Star Event Rentals, Inc., its contractors, snindims and vendors shall not be held responsible for injuries 000un'ing to customers or any using party and Customer agrees to indemnify and hold harmless the above fi'om any mid all elauns, costs, damages add liability including attorney fees, fives, penalties, etc arising from the equipment or its use. 5. Customer agrees to ensure that all participants remove shoes and/or sharp objects before using the games / service where applicable. 6. If equipment is retuned in a damaged but repairable condition, customer shall be liable for the cost of such repairs and Customer treasury responsibility for the retrmi of equipment in the same condition it was received. If equipment is retunrcal in a destroyed or irreparable condition, customer shall be liable for full replacement value of each item. 7. Customer agrees to a $50.00 cleanup fee per item if equipment or game(s) is excessively dirty upon pickup (i.e, candy, food, drinks, confetti, etc.) 8. Customer agrees to TURN OFF AFT ATIC SPRINKLERS (if applicable.) Please, DO NOT ALLOW SILLY STRING (or similar products) Failure to do so requires a $200 cleanup fee per item. 9. All Star Event Rentals, Iva. or its connectors shell at be held responsible for mrfavorable conditions (i.e. high winds, torn, electrical outages, em.) add Customer is responsible to notify All Star Event Rentals, Inc.. at least two hours before event start time in case of unforeseen eimmniumers (i.e. weather, power outages, etc.). 10. Customer cremes a hardened, level area w/ no steps for delivery and set-up 11. Refunds will be resumed by check only. DATE CERTIFICATE OF LIABILITY INSURANCE 7/3/2018 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 pollcyQes) must have ADDITIONAL INSURED provisions or 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 Contact Name: LarryCossio Cossio Insurance Agency Phone (864)688-0121 IF.. --- PO Box 5987 (AIC No, Extj__ ------- Greenville, SC 29606 �s e 130 N-G018- E MaU: tammy�cossclnsurance_com (864) 688-0121 INSURER(S) AFFORDING COVERAGE NAIC INSURED ,, INSURER A: NATIONWIDE MUTUAL INS CO 23787 All'Star Event Rentals, Inc. INSURER B. Berkley Life &Health Insurance Company 64890 23986 Aliso Creek Road Ste Al2#441 Laguna Niguel, CA 92677 _....-._._.- .... .....___________ INSURER C: - - -______..__...__._—........____ _ INSURER D INSURER E COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: ' 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 CONTRACTOR 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. INSR TYPE OF POLICY iADDL',SUBR POLICYNUMBER POLICY EFF POLICY EXP LIMITS LTR INSR j WVD (MMIDDIYY) (MMIDDIYY) X COMMERCIAL GENERAL LIABILITY ^I 1 CLAIMS MADE 'i' OCCUR F A �7] 1 X GEN'LAGGREGATE LIMITAPPLIES PER X POLICY _',PROJECT nLOO =I OTHER: AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED —' AUTOS AUTOS J ''. HIRED AUTOS NON -OWNED ❑rAUTOS _ II J UMBRELLA LIAB i^ OCCUR EXCESS LIAB '�: CLAIMS -MADE 'IJ DEO ] RETENTION$ WORKERS COMPENSATION' AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N OFFICER/MEMBER EXCLUDEB? IN/A (Mandatory in NH) If yes, describe under 1 DESCRIPTION OF OPERATIONS below . General Agg (Other than Products-C $5,000,000 Each Occurrence $1,000,000 Products and Completed Operations $1,000,000 Personal and Advertising Injury $1,000,000 FWC0000028614200 V25/2018 1/25/2019 Legal Liability to Participants $1,000,000 Professional Liability (for Event Plan $1,000,000 I Damages to Premises Rented to You $300,000 Participant Accitlent- Excess Medics $10,000 Deductible $0 COMBINED SINGLE LIMIT '', $ j (Ea accident) �I. BODILY INJURY (Per Person) BODILY INJURY (Per accident) I',I $ j PROPERTY DAMAGE (Peraccldent) I. Q1V\G V� PER ''.OF ,STATUTE '.ER Accident Medical Deductible $100 Benefit Period 52 weeks g Accident Medical PAIL012COR182502 1 1/25/2018 I 1/25/2019 Benefit Maximum $5000001 Applies During - per Levered Accident DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached Applies fDeath more spacesr Dismemberment Benefits only required)1 Party Equipment Rentals Operations located at 23986 Also Creek Rd Ste Alt#441 Laguna Niguel, CA 92677. Certificate Holder is listed as additional insured per form CG2026, The certificate holder is added as an additional insured, but only for liability caused, in whole or in part, by the acts or omissions of the named insured Amusement devices on file with the company for special events) dated 7/4/2018 to 7/4/2018 located at 3000 W. Edinger Avenue, Santa Ana, CA 92704.Coverage Is excluded for Trackless Train, Surges Trampolines, Mechanical Bulls, Mechanical Surfboards, Carnival Games, Photobooths CERTIFICATE HOLDER: City of Santa Ana Its Officers, Employees, Agents, Volunteers and Representatives 20 Civic Center Plaza Santa Ana, CA 92702 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. -\ n :AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: FWC0000028614200 COMMERCIAL GENERAL L CG 20 26 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED — DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): City of Santa Ana Its Officers, Employees, Agents, Volunteers and Representatives 20 Civic Center Plaza Santa Ana, CA 92702 Re: Special event(s) dated 7/4/2018 to 7/4/2018 located at 3000 W. Edinger Avenue, Santa Ana, CA 92704 The city, state or governmental agency or subdivision shown in the Schedule is subject to the following provision: 1. This insurance applies only with respect to operations performed by you or on your behalf for which the city, state or governmental agency or subdivision has issued a permit or authorization. Coverage does not extend to the negligence or errors & omissions of the additional insured Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", 'property damage" or 'personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: 1. In the performance of your ongoing operations; or 2. In connection with your premises owned by or rented to you. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to required by a contract or will pay on behalf of the amount of insurance: the additional insured is agreement, the most we additional insured is the 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 26 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 POLICY NUMBER: FWC0000028614200 COMMERCIAL GENERAL L' CG 20 11 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - MANAGERS OR LESSORS OF PREMISES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designation Of Premises (Part Leased To You): Name Of Person(s) Or Organization(s) (Additional Insured): City of Santa Ana Its Officers, Employees, Agents, Volunteers and Representatives 20 Civic Center Plaza Santa Ana, CA 92702 Additional Premium: $ Information re uired to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability arising out of the ownership, maintenance or use of that part of the premises leased to you and shown in the Schedule and subject to the following additional exclusions: This insurance does not apply to: 1. Any 'occurrence" which takes place after you cease to be a tenant in that premises. 2. Structural alterations, new construction or demolition operations performed by or on behalf of the person(s) or organization(s) shown in the Schedule. However: 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; 1. The insurance afforded to such additional whichever is less. insured y applies to the extent permitted This endorsement shaO, i increa the y and applicable Limits of .�Xrance sho in the Declarations.���? CG 20 110413 © Insurance Services Office, Inc., 2012 Page 1 of 1 � CERTIFICATE OF PRODUCER MEMBRILA INSURANCE SERVICES INC. 23072 LAKE CENTER DRIVE SUITE 250 LAKE FOREST, CA.92630 OFFICE: 949 860-7781 LICENSE: 0052369 INSURED ALL STAR EVENT RENTALS ]NO 3 AVON CT ALSO VIEJO, CA 92656 N,2p1-3430 COVERAGES LIABILITY INSURANCE 70231181200 YYY) 03/18/2007 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, INSURERS AFFORDING COVERAGE NAIC # CALIFORNIA AUTOMOBILE INSURANCE COMPANY THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR NSR INSRD TYPE OF INSURANCE POLICY NUMBER ��ppppEE ��yy OALTE MMIDOIYVE Egp� p� PDpTEY MM/ODIY`' N LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DRAMAG E TO RENEMISES CLAIMS MADE ❑ OCCUR 1F.',etTrEDo $ MED EXP (Any oneperson) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $ POLICY F PROJECT LOC A AUT0MOBILE LIABILITY BA040000034241 6/5/2018 6/5/2019 COMBINED SINGLE LIMIT $ 1,000,000 .7 ANY AUTO (Ea accident) .7 ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per person) $ HIRED AUTOS BODILYINJURY $ NON -OWNED AUTOS eccldent) (Parraccident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ THAN EA ACC $ ANY AUTO $ AUTO AUTO ONLY: AGG EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION S WORKERS COMPENSATION AND EMPLOYERS' LIABILITY WC ST, OTH- I TORY LIMITS Eq E.L. EACH ACCIDENT $ ANY PROPHIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? If yes, deecribe under E.L. DISEASE EAEMPLOYEE $ E.L. DISEASE -POLICY LIMIT $ SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS/ LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Listing City Santa Ana, its of officers, employees, agents, volunteers and representatives as adltional Insureds. Delivery address is : 3000 W. Edinger Avenue, Santa Ana, CA 92704 CITY OF SANTA ANA PARKS, RECREATION AND COMMUNITY SERVICES AGENCY 20 CIVIC CENTER PLAZA P.O. BOX 1988 SANTA ANA, CA 92702 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATI( DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR AUTHORIZED REPRESENTATIVE ERIC MEMBRILA ACORD 25 (2001/08) n ACnRn Cn RIPPIP InN 1QRS IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. AOOHe 25 (20M/08) =nNEM&,_ N-2018-130 WORKERS' COMPENSATION DECLARATION 1 5 ROM*AO hereby affirm under penalty of perjury, the (N. (1-) following declaration I certify on behalf of ALL 5-1a2tEuwn Gu-PLS , hat during the term of my (comultanV wPMy Name)) contract for ibmr-, Re 6A services with the City of Santa Ana, I will not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if 1 should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, 1 shall forthwith comply with those provisions and provide proof of workers' compensation coverage. DATE: 0-1 03 2J 18 By: �A { 4i A-fL o w,7 Tz� I Ste% Name: �y V� • Kq e— r\"o Title: ?tc.L⁢t- Telephone: 545. 2-'14 . T 3 41 WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. Scanned with CarnScanner