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HomeMy WebLinkAboutADRIAN W. MERRIT DBA BILLY BONKERS MAGIC 1City of Santa Ana Clerk of the Council COTC Off ice Use Only AGREEMENT TERMINATION FORM Please complete this form in its entirety when the attached agreement and all amendments (if any) are no longer in effect. City of �anta Ana Note: If your agreement is grant related, please ensure that all grant retention requirements have been satisfied prior to signing the termination form. Is the agreement(s) a permanent record? Yes No Clerk of the Council Return form to the Clerk of the Council Office (M-30). Call 647-1520 if you have any questions. � The agreement with ��.20���^i55 No. � woscnmpletodon and final payment has been made. (List all amendments. Use space below ifneeded] Department: VRcGA Phone/Ext.: Ltalct Signature: Date: ° novisou)wm^ INSURANCE ON FILE WC Declaration on file. WORK W PROCEED NTIL INSURANCE EXPIRES t : IJ-dn"i -/Y li/ CLERK OF COUNCIL DATE: JWG � 9ZD�B O: PRCS July 10, 2018 Silvia Cuevas Adrian'W. Merrit ("Speaker/Performer") dba Billy Honkers Magic 39 North Slope Lanes Pomona, CA 91766 Re: Speaker/Perfcrmer Engagement Agreement N-2018-155 This letter represents your agreement with the City of Santa Ana ("City") as entered into on the above date for the engagement described below: 1. Event Description: Billy BonkemMagic:Show Event. 2. Date(s): Tuesday, July24, 2018 Event Time(s): 6:30pm 4. location: Santa Ana Public Library, 26 Civic Center Plaza, Santa Ana, CA 92701 ("Property") 5. Compensation: $250.00 (payable by check within 30 calendar days of event); Speaker/Performer must provide IRS form W-9 before payment can be made. 6. Equipment provided by City: No equipment provided, however, City is responsible for setting up the space for the patrons attending and advertising the program. 7. Equipment provided by Speaker/Performer: All equipment, materials, supplies and personnel necessary to provide services during event. A City employee will be present at all times during these services. 8. City Contact Person (for coordinating purposes only): Michelle Lucia (7'14) 647-5231 9. independent Contractor: Speaker/Performer 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 professional manner in which SpeakerlPerformer performs the services that are the subj ect matter of this Agreement; however, the services to be provided by Speaker/Performer shall be provided in a manner consistent with all applicable standards and regulations. Speaker/Performer 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. 10. Indemnification: Speaker/Performer, his or her agents, or employees (if applicable) agrees to and shall indemnify, defend, and hold harmless the City, its officers, agents, employees, consultants, special counsel, and representatives from and against all loss, expenses, or liability (including costs and attorney's fees) arising from the negligence or willful misconduct of Speaker/Performer, his or her agents, or employees. It. Release: Speaker/Performer accepts the Property and any City -provided equipment used in connection with the performance in their "as -is" condition, with all faults. Speaker/Performer fully releases, waives and discharges forever any and all claims, demands, rights, and causes of action of any kind or nature against, and covenants not to sue, City, its elected officials, officers, employees, agents and volunteers, and all persons acting on behalf of, by, through or under each of them, under any present or future laws, statutes, or regulations for any claim or event relating to the condition of the Property or City -provided equipment or Speaker/Performer's use thereof. N-2018-155 Letter Agreement — Adrian W. Merrit dba Billy Bookers Page 2 12. Commercial General Liability Insurance. Speaker/Performer 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 Speaker/Performer'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: (1) name the City, its officers, employees, agents, volunteers, and representatives as additional insureds; (2) be primary and not contributory with respect to insurance or self-insurance programs maintained by the City; and (3) contain standard separation of insured provisions. 13. Worker's Compensation Insurance. In accordance with the California Labor Code, Speaker/Performer, if Speaker/Performer has any employees, is required to be insured against liability for worker's compensation or to undertake self-insurance, 14. The City shall have the right and royalty -free license to simulcast or produce and show a tape -delayed broadcast of Speaker/Performer's presentation to the City community or general public, through webcast or any other means. This license shall be non-exclusive and the copyright shall remain with the Speaker/Performer. Copies of Speaker/Performer's presentation may be maintained by the City, and Speaker/Performer consents to use of such recordings, 15. Speaker/Performer is solely responsible for payment of royalty fees, performance fees, or similar fees that may be required by unions or similar organizations. Speaker/Performer shall indemnify the City against any liability or damages, including attorney's fees, that may arise as a result of violation by Speaker/Performer of copyright laws. 16. Speaker/Performer shall not discriminate because of race, color, creed, religion, sex, marital status, sexual orientation, age, national origin, ancestry, disability, or any other basis protected by applicable law in connection with any activities related to this Agreement. 17. This Agreement shall in all respects shall be interpreted, enforced, and governed exclusively by and under the laws of the state of California. Both parties 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. 18, This Agreement represents the complete and exclusive statement between the City and Speaker/Performer regarding the subject matter herein and supersedes any and all other agreements, oral or written, between the parties. This Agreement may not be modified except by written instrument signed by the City and by an authorized representative of Speaker/Performer. CITY OF SANT A RA GODINEZ f City Manager ATTES. ARIA D. HUIZAR Cierk of the Council RECOMMENDED FOR APPROVAL: SPEAKER/PERFORMER Name:jrl Title: APPROVED AS TO FORM.^ City Attorney Exhibit A SCOPE OF SERVICES VENDOR INFORMATION: Adrian W. Merrit dba Billy Bonkers 39 North Slope Lane Pomona, CA 91766 (909)217-4619 EVENT: Magic Show SERVICE DATE(S): July 24, 2018 COMPENSATION: Not to exceed $250.00 DESCRIPTION: This vendor will provide an entertainment performance on July 24, 2018. Amount shall not exceed $250.00 total per the term of the contract. Adrian W. Merrit will provide a magic show. The show will be presented at the Main Library, 26 Civic Center Plaza, Santa Ana CA 92701. The City will be responsible for setting up the space for the patrons attending and advertising the program. Vendor will be responsible for providing all equipment, materials, supplies and personnel necessary to perform the act. City staff will be present at all times during the performance. Exhibit B Billy Bunkers 39 N Slope Ln, Pomona, CA 91766 Phone 9092174619 7/2/2018 BILLTO SHIP TO Santa Ana Public Library Same as recipient 26 Civic Center, Santa Ana, CA INSTRUCTIONS . . . ... ..... . .... . ...... .......... ... Billy Brokers Magic show QUANTITY DESCRIPTION UNIT PRICE TOTAL Billy Bunkers Magic Show $250.00 $250,00 Performance date July 2V1 6.30pin SUBTOTAL $250.00 TOTAL $250.00 ACCW?a III CERTIFICATE OF LIABILITY INSURANCE DATE 71212 DIVYVY) 7/2/zD1a 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 pollcy(ies) 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 Specialty Insurance Agency Performers of the U.S. P.O. Box 24 N-2018-155 CONTACT Stephanie Weiss _ PHONE FAX (AID No,Ex6;_. 715-246-8908 IAIC No): 715-246-42.57 A MAIL certs s ecialt insurances enc .com DDRESS: p Y g Y New Richmond, WI 54017 INSURER(S) AFFORDING C_OVER_A_GE_ NAICN INSURERA: Evanston Insurance Company 35378 _ INSURED Adrian W. Merritt dba'Billy Bonkers 39 North Slope Lane INSURER B: --- "-" INSURER c:. Pomona, CA 91766 INSURER D: INSURER E : INSURER F : _ 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 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. ILTR TYPE OF INSURANCE ADDL SUER POLICYNUMBER POLIBYEFF MMIDD/YWY POLICY EXP MMIDDIYVW LIMITS X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE IXOCCUR EACH OCCURRENCE $ 1,0001000 Op G T0_FFNT Ea occurrence $ 300,000 _PREMISES MED EXP(Any one person) $ 5,000 PERSONAL aADV INJURY $ 1,000,000 A _ X X 2CN0155-17688 11113/2017- 11/12/2018 AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE _..$ 2,000,000 GEN'L X POLICY � PRO- LOCJECT PRODUCTS-COMPIOPAGG - $2,000,000 $ - OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT _(Ea acclderm__ 1$ _ '.$ ANY AUTO - BODILY INJURY (Per person) OWNED SCHEDULED AUTOS ONLY AUTOS l) citl P BODILY INJURY eracen ( -- ',$ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY _ PROPERTY DAMAGE Per accident)_ _ $ $ UMBRELLALIAS OCCUR , EACH OCCURRENCE $ AGGREGATE _ -DED EXCESS LIAB�, CLAIMS -MADE _$ $ RETENTION$ I WORKERS COMPENSATION I AND EMPLOYERS' LIABILITY YIN PER 1OTH- STATUTE ER E, L. EACH ACCIDENT _ $ ANYPROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? �I NIAI I — E_._L. DISEASE - EA EMPLOYEE - $ (Mandatory lnNH) If yes, describe Under - - - - DESCRIPTION OF OPERATIONS below E. L. DISEASE -POLICY LIMIT $ PRAL PROPERTY BUSINESS 11 PERSONAL INLAND MARINE AGGREGATE $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD fill, Additional Remarks Schedule, may be attached If more space is required) PERFORMER IS A NAMED INSURED AS A MEMBER OF PERFORMERS OF THE U.S.: Adrian W. Merritt Billy Bonkers Additional Insured:: The City of Santa Ana, 30 Day Written Notice Cancellation Required. P,� � U° Event Dates: Ongoing for policy period CERTIFICATE HOLDER CANCELLATION .00v _nl. J"' The City of Santa Ana 20 Civic Center Plaza SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Santa Ana, CA 92701 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY III POLICY NUMBER: 2CN0155-17688 MARK 1: EVANSTON INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED This endorsement modifies insurance provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE FORM PRODUCTS/COMPLETED OPERATIONS COVERAGE FORM LIQUOR LIABILITY COVERAGE FORM PROFESSIONAL LIABILITY COVERAGE FORM Please refer to each coverage form to determine which terms are defined. Words shown in quotations on this endorse- ment may or may not be defined in all coverage forms. SCHEDULE Person or Entity: Any person or organization to whom you are obligated by valid written contract to provide such coverage. Additional Premium: $ (Check box if fully earned.®) Included WHO IS AN INSURED is amended to include the person or entity shown in the Schedule above as an Additional Insured under this insurance, but only as respects negligent acts or omissions of the Named Insured and only as respects any coverage not otherwise excluded in the policy. Our agreement to accept an Additional Insured provision in a contract is not an acceptance of any other provisions of the contract or the contract in total. When coverage does not apply for the Named Insured, no coverage or defense shall be afforded to the Additional In- sured. No coverage shall be afforded to the Additional Insured for injury or damage of any type to any "employee" of the Named Insured or to any obligation of the Additional Insured to indemnify another because of damages arising out of such injury or damage. All other terms and conditions remain unchanged. MEGL 0009-01 04 11 Includes copyrighted material of Insurance Services Office, Inc. Page 1 of 1 with its permission. COMMERCIAL GENERAL LIABILITY III POLICY NUMBER: 2CN0155-17688 MARKELW EVANSTON INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET WAIVER OF SUBROGATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM SCHEDULE Additional Premium: $ 0 Name of Person or Organization: Any person(s) or organization(s) to whom the Named Insured agrees to waive rights of recovery in a written contract. The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition (Section IV — COMMERCIAL GENERAL LIABILITY CONDITIONS) is amended by the addition of the following: We waive any right of recovery we may have against the person or organization shown in the Schedule above as respects written contracts that exist between you and such person or entity, provided you have agreed in writing to furnish this waiver. This waiver applies only to the person or organization shown in the Schedule above. All other terms and conditions remain unchanged. MEGL 0241-01 04 11 Includes copyrighted material of Insurance Services Office, Inc. with its Page 1 of 1 permission. POLICY NUMBER: 2CN0155-17688 COMMERCIAL GENERAL LIABILITY CG 20 0104 13 THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance (2) You have agreed in writing in a contract or Condition and supersedes any provision to the agreement that this insurance would be contrary: primary and would not seek contribution Primary And Noncontributory Insurance from any other insurance available to the additional insured. This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and CG 20 01 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 f$ ADDITIONAL. INSURED ENDORSEMENT Insurance Company C,�P\ -;T,4 itu l E�-1 IN This endorsement mo ifies such insurance as is offered by the provisions of Policy Number: �Q t�C 1 a 1 1�,-1relating to the following: 1. The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701; it officers, employees, agents and representative are named as additional insureds ("additional insureds") with regard to liability and defense of suits arising from the operations and uses performed by or on behalf of the named insured. 2. With respect to claims arising out of the operations and uses performed by or on behalf of the named insured, such insurance as is afforded by this policy is primary and is not additional to or contributing with any other insurance carried by or for the benefit of the additional insureds. 3, This insurance applies separately to each insured against whom claim is made or suit is brought except with respect to the company's limits of liability. The inclusion of any person or organization as an insured shall not affect any right which such person or organization would have as a claimant if not so included. 4, With respect the additional insureds, this insurance shall not be cancelled, or materially reduced in coverage or limits except after thirty (30) days written notice has been given to the City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701, (Completion of the following, including countersignature, is required to make this endorsement effective.) Effective_�l �'o d t 1 Il 10 i x , this endorsement form part of Policy# ,L.�21 a ` i""1 Issued to (Name Insured} Lid t f4" - �� 1 e J\� Cesl - c'� i Countersigned by Z 72Z_ N-2018-155 WORKERS' CO PENSATION DECLARATION Z/r'r t hereby affirm under penalty of perjury, the (Nan&Fitle) following declaration: I certify on behalf of U(LE (;l?k4� /� that during the germ of my g�7 Cooax ltan Company Name) contract for / ( 6-57Mi(n)-S . _ 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 I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions and provide proof of workers' compensation coverage. DATE: f !_ 1 5 By: e` Ad +sue Title: _ Telephone: 909 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 ($I00,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.