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HomeMy WebLinkAboutBERNAL, YENNY (2)INSURANCE ON FILE WORK MAY PROCEED WC Declaration on file. UNTIL INS R, - EXPIRES N-2018-102,-01 r- _ 5%G C} : `(2 As (6) CLERK Of COUNCIL ZAW LQ DAF€ C C�'�"' FIRST AMENDMENT TO ART WORKSHOPS AGREEMENT WITH YENNY BERNAL THIS FIRST AMENDMENT to the above -referenced agreement is entered into on September 19, 2018, by and between Yenny Herrral ("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 parties entered into Agreement #N-2018-102, dated June 12, 2018 ("Agreement"), by which Provider agreed to organize and facilitate ten (10) "Uplifting Soul Art Event" workshops at the Downtown Santa Ana Farmer's Market. B. The original term of the Agreement was from June 12, 2018.through December 31, 2018, and is currently in effect. The Agreement, in its Scope of Services, provides a series of workshops at the Farmer's Market, with the current list including a final workshop scheduled for October 21, 2018. C. The parties wish to amend the Agreement to change the location and scheduling of the remaining events provided in the Scope of Services due to the closing of the Farmer's Market location on September 16, 2018. There are no other revisions to the terms of the Agreement. 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. Section 1, Scope of Services, is amended as to the following: a. Location — Downtown Artwalk, Second Street Promenade b. Event Dates and Time: Friendship Celebration (October 6, 2018) — 7:00p.m. to 9:00 p.m. ii. Autumn Celebration (November 3, 2018) — 7:00p.m. to 9:00 p.m. iii. Understanding of Life and Death in Cultural Traditions (December 1, 2018) — 7:OOp.m. to 9:00 p.m. 2. Except as modified by this First Amendment, all terms and conditions of the Agreement shall remain in full force and effect. [signatures continued on next page] Page 1 of 2 N-2019-102-01 IN WITNESS WHEREOF, the parties hereto have executed this First Amendment to the Agreement on the date and year first written above. ATTEST r. MARIA D. MZARdm 1 Ni Clerk of the Council APPROVED AS TO FORM SONIA R. CARVALHO City Attgrogy , r,. am City Steven Mendoza Executive Director, Community Development Agency CITY OF SANTA ANA RAUL GODINEVII City Manager 141OW&VIWFEW." Name: Yenny Bernal Title: Sole Proprietor Page 2 of 2 N-2018-102-01 A� �' CERTIFICATE OF LIABILITY INSURANCE D09/24/2018Y) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER Eddie Quillares Jr. State Farm Agency IN N. Broadway San Santa Ana, CA 92701 I'UNT: D Eddle QUlllares P80NC FAX c No Ext: 714.617.7150. Alc NO: 14.617.7150 AooalEss eddie eddie insurance.com WSURERSAFFORDING COVERAGE NAIL INSURER A: State Farm General Insurance Com an 25151 INSURED Yenny Bernal DBA Uplifting Soul Art Events 1052 W Pine St Santa Ana, CA, 92703 INSURER B: INSURER C: INSURER D: INSURER E, INSURER F: COVERAGES CERTIFICATE NUMBER: 75-0450 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, LTR TYPE OF INSURANCE INSR VAID POLICYNUMBER POLICY EFF MMIDONYYY LIMITS A GENERAL LIABILITY Y 92 -EX -K512-8 05/06/2016 05/06/2019 EACHOCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY CLAIMS-MADEOCCUR AI\A ETO RENTE PREMISES Ea occurrence$ 300,000 MED EXP(Anygnepercon) $ 5,000 PERSONAL &ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATELIMIT APPLIES PER'. PRODUCTS - COMPIOP AGO $ 2,000,000 POLICY JRCOT LOC $ AUTOMOBILE LIABILITY ❑❑ COMBINEU SINULL UMHT BODILY INJURY ((Per person) $ ANY AUTO ALL OWN ED SCHEDULED AUTOS AUTOS BODILY INJURY(Peraccideul) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE Par accitlanl 5 UMBRELLA LIAB OCCUR ❑ EACH OCCURRENCE $ EXCESSUAS CLAIMS -MADE AGGREGATE 5 DED RETENTION$ 10,000 $ WORKERS COMPENSATIONWC STATU- OTH- AND EMPLOYERS' LIABILITY YIN ANY PROPMETORIPARTNEWEXECUTIVEE.L. OFFICEIMEMBER EXCLUDED? ❑ NIA❑ TO V R EACH ACCIDENT $ E.L. DISEASE -EA EMPLOYE $ (Mandatory In NH) It yoa, d.'re under E.L. DISEASE -POLICY LIMIT $ $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Adach ACORDi01,Additlonal Remarks Schedulo,Ifmarospoce le required) THE CITY OF SANTA ANA, ITS OFFICERS, EMPLOYEES, AGENTS, AND REPRESENTATIVE ARE NAMED AS ADDITIONAL INSURED IN REGARDS TO GENERAL LIABILITY PER ATTACHED EXHIBIT B ADDITIONAL INSURED FORM. CERTIFICATE HOLDER CANCELLATION CITY OF SANTA ANA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 CIVIC CENTER PLAZA ACCORDANCE WITH THE POLICY PROVISIONS. SANTA ANA, CA 92701 AUTHORIZED REPRESENTATIVE Au ill SONIABATRES ©1988-2010 ACDRD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD 1001486 132849.7 03-01-2012 Sioey%'W'« Ove YIe`ict Page-" N-2018-102-01 Exhibit B ADDITIONAL INSURED ENDORSEMENT FOR COMMERCIAL GENERAL LIABILITY POLICY Insurance Company: State Farm Insurance This endorsement modifies such insurance as is afforded by the provisions of Policy Number: 92 -EZ -K512-8 relating to the following: 1) The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701; its officers, employees, agents and representative are named as additional insured ("additional insured") 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 names insured, such insurance as is afforded by this policy is primary and is not additional to or to contributing with any other insurance carried by or for the benefit of the additional insured. 3) This insurance applies separately to each insured against whom claim is or suit is brought except with respect to the company's limit of liability. This inclusion of any person or organization as an insured shall not affect any right which is such person or organization would have as claimant if not so included. 4) With respect to the additional insured, this insurance shall not be cancelled, or materially reduced in coverage or limits except after thirty (30) written notice has been given to the City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701. Effective April 18, 2017 this endorsement form as a part of Policy Number: 92 -EZ -K512-8 Issued Yenny Bernal DBA Uplifting Soul Art Events. Countersigned by 7 41 06Z�&aAz,4 Authorized Representative P2..2 ,.�eA \0`) N-2018-102-01 WORKERS' COMPENSATION DECLARATION I �4,(yNn`A SQXni % hereby affirm under penalty of perjury, the (NanelTttle) following declaration: 1 certify on behalf of �A 6,m I R P --(n7 (SAO that during the term of my (organization Name) contract with the Community Development Agencx 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. DATE: --- �"-� -- ------ un4'nl moo\ kk CVcv, By: ��>^r�� � -rr�----- Name: `i y» ��1— ° Ynk -_ Title: Telephone: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECTAN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UPTO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGESAS PROVIDED FOR IN SECTION 3706OFTHE LABOR CODE, INTEREST,AND ATTORNEY'S FEES.