The URL can be used to link to this page

Home My WebLink AboutBARALT, ELIZABETHCity of Santa Ana Clerk of the Council AGREEMENT TERMINATION FORM Please complete this form in its entirety when the attached agreement anciQ�Jl amendments (if any) are no longer in effect. Note: If your agreement is grant related, please ensure that all grant retention requirements CITY have been satisfied prior to signing the termination form. CL Ei 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 No. N-2018-183 (List all amendments. I _g PM 4' 21 'r NTA A OF COUNCIL was completed on 111Z 1200 and final payment has been made. Use space below if needed.) Department: 'PPC�SA Phone/Ext.: 6icZ�a Signature: Date:Z� �'aola Revised: 10-1 &-16 INSURANCE ON FILE WORK MAY PROCEED (� UNTIL INSURANCE EXPI t e• WC Declaration on a ; '�. CLERK OF COUNCIL DATE: OCT - 9 2018 September 19, 2018 Elizabeth Barak ("Speaker/Performer") 6500 Green Valley Circle, Apt. 131 Culver City, CA 90230 Re: Speaker/Performer Engagernerit reement Dear Ms. Saralt: N-2018-183 This letter represents your agreement with the. City of Santa Ana ("City") as entered into on the above date for the engagement described below: I. Event Description: Ms. E3araltwill read her, book "Amax Mas Alla de la Vida", conduct a question and answer session with audience members, and sign copies of her book. 2. Date(s): Saturday, November 3, 2018 3, Event Time(s): 1:00PM to 2:3OPM 4. Location: Santa Ana Public Library, 26 Civic Center Plaza, Santa Ana ("Property") 5. Compensation: $404.06 (payable by check within 30 calendar days of event); Speaker/Performer must provide IRS form GV -9 before payment cant be made 6. Equipment provided by City. None Equipment provided by Speaker/Performer: Reading Material 8. City Contact Person (for coordinating purposes only): Patty Lopez (714) 647-5325 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 Speaker/Performer performs the services that are the subject 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/Perfonuer, 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 Letter A ;reemeat ._ Elizabeth Baralt Page 2 fees) arising from thenegligence or willful misconduct of Speaker/Performer, his or her agents, or employees. 11. 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. 12. 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. If Speaker 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 Speaker's right to be paid for its time and materials expended prior to notification shall not affect Speaker's right to be paid for its time and materials expended prior to notification of termination. Speaker waives the right to receive compensation and agrees to indemnify the City for any work performed prior to approval of insurance by the City.. 13, 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 webeast or any other means. This license shall be non-exclusive and the copyright shall remain with the Speaker/Performer, Copies of Speakor/Perforraer's presentation may be maintained by the City, and Speaker/Performer consents to use of such recordings. l4. 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. 15. Speaker/Perfotmer 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, 16. 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. 17. This Agreement can be terminatedby the City with forty-eight (48) hours written notice, Notice shall be provided. at the address listed on page 1 of this Agreement for Speaker. 18. Speaker covenants that it presently has no interest and shall not have interest, direct or indirect, which would conflict in any manner with performance of services specified under this Agreement. 19. This Agreement is not assignable without the City's written permission. Letter Agreement — Elizabeth Baralt Page 3 N -2018-J 83 20. 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/Perforrner. 21, This Agreement maybe signed in sub -parts and via fax or electronic e -signature. Such signature will have the same force and affect as an original signature. CITY OF NTA ANA RAUL GODLX � City Manager ATTEST; MARIA D. �UIZAR �Clerk of the Council SPEAKS PERFORMER f Name: Elizabeth Baralt APPROVED AS TO FORM: SOMA R. CARVALHO City Attorney By: ti t� int LAURA ROSSINI Senior Assistant City Attorney N-2018-183 WORKERS' COMPENSATION DECLARATION C -� AL U 5 CW—IW(l hereby affirm under penalty of perjury, the (Name/Title) following declaration I certify on behalf of Name) that during the term of my 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: 91-19-4 By: Name: f l R -,7y 13+i0ilti9 Title: ft� ru Telephone: '? 5y- -2 .7 6 - 2 -3 5- � 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. EVANSTON INSURANCE COMPANY CERTIFICATE NO.: CERTIFICATE OF INSURANCE SPECIAL EVENT LIABILITY PROGRAM PRODUCER PUBLIC ENTITY (ADDITIONAL INSURED) Alliant Insurance Services, Inc. in conjunction with Apex Insurance Services P. O. Box 6450 Newport Beach, CA 92658 License No: OC 36861 NAMED INSURED (EVENT HOLDER): EVENT INFORMATION: City of Santa Ana TYPE: Elizabeth Baralt and Leadership P O Box 1988 Training Workshop Santa Ana, CA 92702 DATE(S): November 3, 12, 2018 LOCATION: 2 Civic nt r Plaza. Santa Ana CA *Liquor Liability Yes No "Liquor Liability after 12 am ends before 2 amEl This is to certify that the insurance policy listed below has been issued to the above insured named (event holder) for the policy period indicated. The insurance described herein is subject to all the terms, exclusions and conditions of such policy(ies) unless amended as described in Special Conditions. INSURANCE CARRIER: Evanston Insurance Company MASTER POLICY NUMBER: SEP41026 MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2018 EXPIRATION: JANUARY 1, 2019 COMMERCIAL GENERAL LIABILITY OCCURRENCE FORM DEDUCTIBLE: NONE General Aggregate Limit $ 2,000,000 Products & Completed Operations 1,000,000 SPECIAL CONDITIONS: Personal & Advertising Injury 1,000,000 The following endorsements attached to Each Occurrence Limit 1,000,000 the Master Policy do not apply to this Damage To Premises Rented To You (Any One Premises) 100,000 Certificate Of Insurance: Medical Payments (Any One Person) 5,000 MEGL643 Liquor Liability (If purchased) 1,000,000 C! � Optional Limits Purchased D ❑ $1,000,000/$3,000,000 11 $2,000,00052,000,000 wed Damage To Property (If purchased) � /'�``. The limits of insurance apply separately to each event insured by this policy as if a separate policy of in su e6onJSu event. OTHER ADDITIONAL I D Melody Gonzalez Heart Centered VePership, Monica Robles CANCELLATION: Should the above described policy be cancelled before the expiration date thereof, notice will be delivered in accordance with the policy provisions. AUTHORIZED REPRESENTATIVE: DATE ISSUED: