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HomeMy WebLinkAboutSUSY PARTY RENTAL 7City of Santa Ana - Clerk of the Council coTc office 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TERMINATION FORM Please complete this form in its entirety when the attached agreement and all amendments (if any) are no longer in effect. Note: If your agreement is grant related, please ensure that all grant retention requirements have been satisfied prior to signing the termination form. ',-UERK I iF THE PO OWILR Is the agreement(s) a permanent record? Yes No d 13 ". ' p PMaa 3 Return form to the Clerk of the Council Office (M-30). Call 647-1520 if you have any questions. The agreement with No. N-2018-219 was completed on Ji l}21_1.G and final payment has been made. (List all amendments. Use space below if needed.) f� Department: Mu; Phone/Ext.: )� Signature: Date: q Revised: 10-18-16 tM541I2t\Nt;F ON FILE wURK MAY PROCEED WC Declaration on file. t1tVTlt t1R8U!RdtK0Ei1tPIRES-d9-lb ll�"" Ul.'6-';-t$• Ate'. ct,ERY, OF COU901L DATE: U -) it 411 AGREEMENT WITH SUSY PARTY RENTALS �� FOR PROVISION OF CANOPIES O: PRCS (/) PLAZA NAVIDENA EVENT Silvia Cuevas I1' N-2018-219 THIS AGREEMENT is made and entered into on this 14th day of November 2018, by and between Susy" "Party Rental ("Contractor"), 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 contractor to providetent canopies and related equipment far the Plaza Navidena eventthatthe City is hostingonvNovember 17, 2018,("Event7). B. Contractor represents that Contractor is able and willing to provide such services to the City. C, In undertaking the performance of this Agreement, Contractor represents that it is knowledgeable in this field and that any services performed by Contractor under this Agreement will be performed in compliance with such standards as may reasonably be expected from a professional firm in the field. 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 Contractor shall provide and remove ten (10) tent canopies, at the Event at Fourth Street and French -Street ip, Calle Quatro, as described in Exhibit A. All equipment shall be delivered and set up by 10 A.M. before the Event and removed immediately following conclusion of Event (after 9:30 PM). 2. COMPENSATION a. City agrees to pay, and Contractor agrees to accept as total payment for its services and equipment, the rates and charges identified in Exhibit A. The total amount to be expended under this Agreement shall not exceed Seven Hundred and Fifty=Three Dollars and Sixty Cents ($753.6.0), This amount includes the amount of $628.00from Exhibit A and an additional 20% of $125.60 to be used at the sole discretion of the Executive Director to compensate the Contractor for additional items or services requested on the day of the event as listed under Exhibit A. b. Payment shall be made within thirty (30) days following receipt of proper invoice evidencing work performed, subject to accounting procedures. Payment need not be made for work which fails to meet the standards of performance set forth in the Recitals which may be expected by the City. Page I of 6 3. TERM This Agreement shall commence on November 17, 2018 and terminate on November 18, 2018, unless terminated earlier in accordance with Section 12, below. 4. INDEPENDENT CONTRACTOR Contractor 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 Contractor performs the services which are the subject matter of this Agreement; however, the services to be provided by Contractor shall be provided in a manner consistent with all applicable standards and regulations governing such services. Contractor 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. 5. INSURANCE Prior to undertaking performance of work under this Agreement, Contractor shall maintain and shall require its subcontractors, if any, to obtain and maintain insurance as described below: a. Commercial General Liability =Insurance. .Contractor 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 Contractor'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, and $2,000,000 in the aggregate. Such insurance shall (a) name the City, its officers, employees, agents, volunteers 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 insured's 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 California state law, Contractor, if Contractor 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, Contractor agrees to obtain and maintain any employer's liability insurance with limits not less than $1,000,000 per accident. Page 2 of 6 d. The following requirements apply to the insurance to be provided by Contractor pursuant to this section: (i) Contractor 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 in form 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. e. If Contractor 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 terminate this Agreement. Such termination shall not affect Contractor's right to be paid for its time and materials expended prior to notification of termination. Contractor 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 Contractor agrees to and shall indemnify and hold harmless the City, its officers, agents, employees, consultants, special counsel, and representatives from liability: (1) 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 Contractor or its contractors, subcontractors, agents, employees, or other persons acting on their behalf which relates to the services described in section I of this Agreement; and (2) from any claim that personal injury, damages, just compensation, restitution, judicial or equitable relief is due by reason of the terms of or effects arising from this Agreement. This indemnity and hold harmless agreement applies to all claims for damages, just compensation, restitution, judicial or equitable relief suffered, or alleged to have been suffered, by reason of the events referred to in this Section or by reason of the terms of, or effects, arising from this Agreement. Contractor 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 challenging the validity of this Agreement, or asserting that personal injury, damages, just compensation, restitution, judicial or equitable relief due to personal or property rights arises 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. Notwithstanding the foregoing, to the extent Contractor's Services are subject to Civil Code Section 2782.8, the above indemnity shall be limited, to the extent required by Civil Code Section 2782.8, to claims that arise out of, pertain to, or relate to the negligence, Page 3 of 6 recklessness, or willful misconduct of the Contractor. This indemnification provision No. 6 shall survive any expiration or termination of this Agreement. CONFIDENTIALITY If Contractor receives from the City information which due to the nature of such information is reasonably understood to be confidential and/or proprietary, Contractor agrees that it shall not use or disclose such information except in the performance of this Agreement, and further agrees to exercise the same degree of care it uses to protect its own information of like importance, but in no event less than reasonable care, 8. CONFLICT OF INTEREST CLAUSE Contractor 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. 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 copies to: Parks, Recreation and Community Services Agency City of Santa Ana 20 Civic Center Plaza (M-23) P.O. Box 1988 Santa Ana, California 92702 Fax: (714) 571-4221 To Contractor: Susy Party Rental 1517 S. Sycamore Santa Ana, CA 92707 Phone: 714 543-9556 www.susypartyrentals.com A party may change its address by giving notice in writing to the other party. 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 Page 4 of 6 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 asset forth above, For purposes of calculating these time frames, weekends, federal, state, County or City holidays shall be excluded. 10. EXCLUSIVITY AND AMENDMENT This Agreement represents the complete and exclusive statement between the City and Contractor regarding the subject matter therein, 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 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 Contractor. 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 Contractor nor 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 are not embodied herein. 11. ASSIGNMENT Inasmuch as this Agreement is intended to secure the specialized services of Contractor, Contractor 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. Nothing in this Agreement shall be construed to limit the City's ability to have any of the services which are the subject to this Agreement performed by City personnel or by other Contractors retained by City. 12. TERMINATION This Agreement may be terminated by the City upon seven (7) days written notice of termination. In such event, Contractor shall be entitled to receive and the City shall pay Contractor compensation for all services performed by Contractor prior to receipt of such notice of termination. 13. NON-DISCRIMINATION Contractor 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, training, utilization, promotion, termination or other employment related activities or in connection with any activities related to this Agreement. Contractor affirms that it is an equal opportunity employer and shall comply with all applicable federal, state and local laws and regulations. 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 Page 5 of 6 N-2018-219 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. 15. PROFESSIONAL LICENSES Contractor 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. Contractor shall notify the City immediately and in writing of its inability to obtain or maintain such permits, licenses, approvals, waivers, and exemptions. Said inability shall because for termination of this Agreement. 16. MISCELLANEOUS PROVISIONS a. Each undersigned represents and warrants that its signature hereinbelow has the power, authority and right to bind their respective parties to each of the terms of this Agreement, and shall indemnify City fully, including reasonable costs and attorney's fees, for any injuries or damages to City in the event that such authority or power is not, in fact, held by the signatory or is withdrawn. b. All Exhibits referenced herein and attached hereto shall be incorporated as if fully set forth in the body of this Agreement. IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first above written. ATTEST: CITY OF SANTA ANA Maria D. Huizar ``_ Raul Godinez II Clerk of the Council City Manager APPROVED AS ATO FORM: Bv:C4AATtL3.j F� Laura A. Rossini Senior Assistant City Attorney iD FOR � TOVAL: \ I CONTRACTOR am itie• ryJS,v tiVv.7VYz.r`_ Recreation, and Community Services Agency Page 6 of 6 1517 S. Sycamore EXHIBIT Santa Ana, CA 92707 714-543-9556 (office) 714-329.1031 (cell) 714-543-4614 (fax) www.susypartyrentals.com & susy@susypartyrentals.com Chairs*Tables*Tents*Portable Bathrooms*Jumpers*Linens & much morel Silias*Mesas*Camas*Bafios *Pistas de Baile*Jumners*Mantelas v mucho mast INVOICE Today's Date: 1Oil 8/18 TT� Event Date: 11/17118 Client Name: Sonia Batres Delivery location: Calle 4 & French St Santa _ Company Name: City of SA Santa Ana CA Phone # :.___._. _ Dellyery date & time: 11/17/18 at-10am Phone # (cell): 714 975-4514 Pick up date & time: 11/17118 Email address: SBatrea Santa-ana.or Driver's License # & Ex date Out In Description of E. ui ment Quantity Unit Price Total Amount 1 10x10 Canopies w/4 walls & li htin 3 90 $270 10x10 Canopies w/3 walls & lighting &PC outlet 1 85 $85_ 3 1000 Cano ies _ �2�, _ _ 80_ _ — _- $160�—, 4 — —_ Power cord outlet 1 10.00 _ $10 5 _ Round 60" Round Table 5 6 $30 s Wht folding chairs 40 0.70 _—.$28 7 Red 120" linen 5 9.00 $45 _—,— 10 12 13 ._...-... __...�..._.___. _.----__—_— 15 _ -- - Notes: No delive fe. Willpayby check Sub total $628.00 Delivery fee waived Delivery Char e - Security Deposit Credit Total $628.00 Indicate: DISCOVER VISA--- 2 Down Pa meat Balance Due Please read before signing 1. Client will be responsible for ALL the rental items and anything that may occur with the rental equipment (including accidents). 2. Client is responsible for all the rental equipment at all limes including in weather conditions such as rein, wind or other extreme weather conditions. 3. Client is responsible for resuming equipment in goad & clean conditions. No staples, tape, andtor pins left on equipment. 4. Client is responsible for having the equipment restacked and ready far pickup in the same place and conditions as it was delivered. 5. Client agrees to return rented equipment within 24 hours from date ofrental unless otherwise noted and agreed to above. Additional charges will apply !foot returned with in the 24 hour. 6. Customer will be charged on credirldebit card and/or security deposit for any shortages, lost or damaged items or payments due. 7. A.mineau oiJ w"*izficc-ils-rralatretrtoie clfad 'mfttba . pailure to cancel the order in the required time will mull in the client being charged the full amount of the rentals. lfclient provides notice within the required time, the client may receive up to 50%of die deposit. 8. Delivery charge is based on delivery to ground level within reasonable carrying distance, Additional charges will apply ifmaterials are delivered at a far or elevated distance. 9. All rentals/sales are final. 10, We accept cash and credit card. please note, we do add the 7.75%tax rate fee, when we process a credit card transaction. Foror de leer antes de firmar 1. El cliente sera responsable par Is mereancia qua se le rente y per to qua pudiera suceder (incluyendo accidentes). 2. El cliente send responsable de Is rents del equipo incluyendo en candicones de Iluvia, rienm o clime extreme. 3. El clients ser6 responsible par regresar el equipo an limpias y burns candiciones sin grapas, cinta adhesive a alfileres. 4. El clients sets responsible par regresar Is mere ncia en el nature auto donde originalmente se courage. 5. El clients sets responsible de magician- la mercancia en 24 hems de la fecha, Vino habrs on costo adicional con les candiciones mencionadas. 6. Se to cobtam at clients an Is taryeta its cr6dim/debita o del depinno per aniculos quo caun daaados, perdidos a si la oreen no eats complete. 7. Sine cancels In Orden en el liempo indicado el cliente ser4 rosponsable de pager el balance de Is renta complete. Se le puede reporter 50%del dep6sito si Ileme con anticipo. 8. Cargos adicionales se eplicamn par oranges a large distancias o a niveles elevados. 9. Todas Ias ventas son finales, 10. Solo aceptamos pages en efeetivo yen nuncio its crstdim/debilo. Se cobra one from adicional de 7.75%per lransacciones de indent de ersdoo. Client Signature (Firma) (See additional terms and conditions on reverse side) A�®�`' CERTIFICATE OF LIABILITY INSURANCE DATEIMW[MNYYY) 10/17/2016 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 INSURERS), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: H the ctreifiaote holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or he en orsed. 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 comer Tf hts to the certificate holder In lieu of such endorsemen4 s . PRODUCER McLure Insurance Brokerage, Inc. 17731 Irvine Blvd. Suite 104 N-2018-219 Tustin CA 92780 ICdOA : - Ray Molure -I—F A% �� � PH0 E 714)664-8911 .,,.L1NC'Nol; (714).664.0011 -MaLA selvioe(Nmoloroin$.com INSURERS AFFORDR000VERAGE NAIC0 INSURERA: COLONY INSURANCE COMPANY $9993 INSURED BUSY PARTY RENTALS 1517 S. SYCAMORE STREET SANTA ANA CA 92707 I su RB • EMPLOYERS INSURANCE COMPANY INSURE C: sua3Ro: NSURERE r I SUA9R P ' COVERAGES CFRTIFICATF NIIMRPR• e011101^k, ..".anti n. 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, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR T TYPE OFINSURANCE DD 9 BR LIC BER LC E F IMIIWO O C VY LIMITS X. COMMERCIAL GENERAL LIABILITY EACHOGCURRENCE $ 1,000,000 CLAIMS -MADE N OCCUR -fflEIWSFS (Ea 001arencel 100.000 5000 MED EXP tine eon _ PERSONAL a ADV INJURY S 1,000 000 A Y 101 PKG 0044107.02 06/052018 06105/2019 GEN'L AGGREGATE UNIT APPLIES PER: q 4PP& M GE ERAL AGGREGATE 1 2,000 000 POLICY LOC PROWCTs.cowiOPAGG INCLUDED $ OTHER: AUTOMOBILE LIABIL17y &0,ZVED.SINGUE LIMITSW S BODILY INJURY (Per Person) ANYAILI OWNED SCHEDULED AUTOS ONLY AUT HIRED EOOILY INJURY (Pat accitlenq $ PJO D AUTOS ONLY AUTOS ONLY - PRO E DAMAGE - $ $ UMBRELLA LIAR OCCUR R6CH OCCURRENCE $ AWRE26 $ EKOESS LIAO CLAIM&MADE DED I RET NTION $ WORKERS COMPENSATION E AND EMPLOYERS' LIABILITY Y ETH• EL.ffAC AOCIOENT $ ANY PROPRIETORJPARTNEPIEXECVnVE OFFICERMIEMBER EXCLUDED? NIA Y L DISEASE • EA EMPLOYEE $ (Mandabry In NH) If deccdbe under E.L.DISEASE. FOUCY LIMIT $ D SGRI TIO OF OPERATIONS below BUILDING LIMIT: $450,000 A B.P.P. Y 101 PKG 0044107-02 06/05/2018 06/062019 LIMIT: $100,000 DESCRIPTIONOF OPERATIONS / LOCATIONS IVEHICLES (ACORD 101, Add10an4l Remarks Schedule, maybe anaehed uneae, apace Is required) " THE CITY OF SANTA ANA, 20 CIVIC CENTER PLAZA, SANTA ANA, CALIFORNIA 92701; ITS OFFICERS, EMPLOYE� ENTS AND VO EERS ARE NAMED AS ADDITIONAL INSUREDS ("ADDITIONAL INSUREDS-) WITH REGARD TO LIABILITY AND DEFE�`f�D(Z;OSU ITS ARISI ROM THE OPERATIONS AND USES PERFORMED BY OR ON BEHALF OF THE NAMED INSURED. (Cep'. CITY OF SANTA ANA 20 CIVIC CENTER PLAZA SANTA ANA CA 92701 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. MYVRY so (LYIw1vap 1ne Acurtu name anti 1090 are registered marks of ACORD s�coR[�e CERTIFICATE OF LIABILITY INSURANCE M (MMDDffTM o 11115120 8 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 DAVID I. REYES StatBFdfln 1077 W 17th ST. STE B -_ SANTA ANA, CA 92706 '`LLT*.J��� NAME: DAVID I REYES FAX I HO E ,714-285-0155 rve:714-648-1082 ,^ ep sal . DAVID.I.REYES.EBBJ@STATEFARM.COM INSURER(S)AFFORDING COVERAGE NAIOM INSURER A:5tate Farm General Insurance Company 76161 INSURED FELIPE SOSA 1606 S BIRCH ST SANTA ANA CA 92707 NSURER B: INSURER C: INSURER D I 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. ILTN TYPE OF INSURANCE POLICYNUMBER MMIDDYEPF POLICYEXP LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE IS CLAIMS -MADE Fx� OCCUR PREMISES EA occ a Ce IS MEDEXP(Anyone parson) $ S,000 PERSONAL B ACV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S POLICY PE T LOG PRODUCTS-COMPIOP AOO $ OTHER: Busn Property $ .AUTOMOBILE LIABILITY (ES EDSINGLE LIMIT Eaa tlenl $ 1,000,000 BODILY INJURY (Par potion) $ — 260,000 ANY AUTO 5385534-D19.75 10/1912019"' 074/19%2018' BODILY INJURY (Pot accident) $ 500,000 AUTOS ED X 60HEDULED HIRED AUTOS AUTOS AUTOS MED '- - Per atodenl�MAGE $ dad 1000 $ UMBRELLA LWB OCCUR EACHOCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIM64ADE OED RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORPARTNERIEXECUTIVE ❑NIA OFFICERIMEMBER EXCLUDED4 (Mandatary In NH) STATUTE ER E.L. EACH ACCIDENT $ EL. DISMS-EA EMPLOYE $ If yea, desaibe Under OE SCRIPTIONOFOPERATIONSbelow E.L. DISEASE -POLICY LIMIT 1 $ DESCRIPTION OF OPERATIONS ILOCATIONSIVEHICLESIACORD701, Addifidnal Remarks Schedule. may as attuhod if mare apace Is mqulredl ��� V.. ®sCIVN d�\� 0 a . CERTIFICATE HOLDER CANCELLATION Sonia Batres - Community events supervisor, SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANC BEFORE Parks, Recreation & Community Services Agency THE EXPIRATION DATE THEREOF, NOTICE WILL gr DELI RED IN 20 civic center plaza Santa ana ca 92701 ACCORDANCE WITH THE P OVISIONS. AUTHORIZED RESENTATIVE RPO II right reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD 1001486 132849.9 02.04.2014 J N-2018-219 WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjury, the (Namefl'It e) following declaration I certify on behalf of contract for Party Supply to that during the tern of my (Co iam/Comp ny Name) ervices 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: By (I. — Name: �q 7— Title: Lla/� Telephone: 71V )A! QZ 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. �A'.