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HomeMy WebLinkAboutPYROSPECTACULARS (3)City of Santa A -a - - Clerk of the Cours, rl COTC Office ~ AGREEMENT TERMINATION FORM C Please complete this form in its entirety when the attached agreement and all amendments (if any) are no longer in effect. City of Santa Ana Note: If your agreement is grant related, please ensure that all grant retention requirements have been satisfied prior to signing the termination form. i Ali j 0 2 2021 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. 66'� n-^ The agreement with f YwiG r% . No. )Pr-'Ro �-j -P� was completed on 1,3j 311 VC and final payment has been made. (List all amendments. Use space below if needed.) ,PC—ac \`1- [ r�Y -(} Department: �� Si J i�iti Y�CVL. p'--aof-1- Phone/Ext.:" Revised: 10-19-16 Signature: S A) LL , Cj-k /(�10 Date: ��� IQ \ INSURANCE NOT ON FILE WORK MAY NI PROCEED) MAYOR CLERK OF COUNCIL Miguel A. Pulldo MAYOR PRO TEN DATE: DEC MatHrmz �� i �� COUNCILMEMBERS P. David Benavides Vicente Sarmiento Jose Solaria Sal Tlnalero Juan Vils ® tS'�5A (t ) StButi< Cv<e�'�-s November 27, 2017 Pyro Spectaculars, Inc. 251 E. Front Street Covina, CA 91723 CITY 4F SANTA ANA PARKS, RECREATION AND COMMUNITY SERVICES AGENCY 20 Civic Carder Plaza M-23 . P.O. Box 1988 Santa Ana, California 92702 wwwants-ans.ora Re: Extension of Production Agreement No. A-2017-054 to provide fireworks productions Dear Mr. Souza: A-2017-054-01 CITY MANAGER Raul Oodinez t CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL Made D. Holzer Pursuant to Section 3.2 and Exhibit H ("Tern)') of Agreement No. A-2017-054 entered into by Pyro Spectaculars, Inc, and the City of Santa Ana, dated March 29, 2017, the parties now opt to extend the time period of said Agreement for an additional one (1) year period from January 1, 2018 to December 31, 2018, for the tinworks production on July 4, 2018, The insurance certificates are required to be extended and/or renewed to cover this extension. All other terms and conditions of said Agreement remain unchanged and in full force and effect. Sincerely, Gerardo Mouer Executive Director Parks, Recreation and Community Sen ices Agency APPROVED AS'1'O FORAI: Sonia R. Carvalho City Attorney &auv.,� . v Rk Laura A. Rossinii Senior Assistant City Attorney CI O r=TA]�I'fly� Raul Godinez 11 City Mat or AT' S' t n vM ,aD.Ilui ar Clerk of the Council PYRO SPECTACULARS, INC. *-t-u Sid tI SANTA ANA CITY COUNCIL m4ud A poM W9 W0.iaMM VIGO"swmta .lasewodo P. D"d eenaNdes dim vitas Set U*M MAP, Mayor Pro Tam, Ward 2 WmdI WWd3 Wmd4 WeNS WmdO 3gi;jtyplismm� nnn.am rid ttin 3 to nn_,_, `.snrmlrcnt4 aontd ano an inalalo@eoaWA"an hganaefitama.oneara gllnpjq�fp'�Ixenln nm oro DRAYTON INSURANCE BROKERS, INC. 0 CENTER POINT ROAD, SUITE. 301 POST OFFICE BOX W067 SIRMINGIIAM, AI.ABAMA 35215 BIRMINGHAM, ALABANIA 33220 TELEPHONE: (205) 854-5806 FAX: (205) 854-5899 CERTIFICATE OF INSURANCE No. 713047 We certify that insurance is afforded as stated below. 'I'll is Certificate does not affirmatively or negatively amend, extend or alter the coverage afforded by the insurance policy and the insurance afilodrd is subject to all the terms, exclusions and conditions orthe policy. INSURER Admiral Insurance Company POLICY NO, CA000002771-31 NAMED INSURED Pyro spectaculars. Ine. Pyro Spectaculars by Souza Pyro Events, Inc. Pyro Spec acular bslustrics, Inc. Pyru Spectaculars Productions, Ine North American Fireworks Co, hte. (NAFCO) P.O. Box 2329 San Diego Fireworks Riallo,Califorian 92377 POLICY TERM January 1.1, 2017 to January 13, 2019; Roth bays 12:01 A.M. Standard "time COVERAGE Commercial General Liability: ® Occurrence Basis 0 Claims Made Basis LIMIT OF LIABILITY $5,000,000 each occurrence, $10,000,000 general aggregate, $5,000,000 products/completed operations aggregate The limit of liability shall not be increased by the inclusion of more than one insured or additional insured. INSURED OPERATIONS Public fireworks display and special effects contractor It is certified that, if named below, this policy includes as Additional Inso reds 1) the sponsor(s), promoler(s), organizer(s) (including other entities having similar interests), of insured pyrotechnic events and/or 2) the owner(s) of real property (or barges) at which insured pyrotechnic events are held and/or 3) the owner(s), ntanager(s), tenant(s), mortgagee(s) (including other entities having shmIar interests), or buildings, stadiums, arenas and similar facilities at which insured pyrotechnic events are held and/or 4) the licensing or permitting authority, or other uullimily having ,jurisdiction, issuing liecnses/pcnnits for insured pyrotechnic events and/or 5) any other entity for which the insurance is required to be afforded under written contract. Coverage applies only as respects the legal liability of such Additional Insureds) for bodily injury and property damage caused by the operations of the Named Insured. The insurance afforded any Additional Insured does not include coverage for any bodily injury or property damage arising from the failure of such Additional Insured to fulfill its obligations specified in its contract with the Named Insured. NAME & ADDRESS OF INSURED SPONSORS, PROPERTY OWNERS, IICF.NSORS City of Santa Ana, It's Officers, Employees, Agents, Volunteers and Representatives 20 Civic Center Plaza Santa Ana, CA 92701 ADDITIONAL INSURFD(5): City of Santa Ana, County of Orange, Orange County Fire Authority and their officers, agents and employees when acting in their official capacity as such. The coverage afforded the additional insureds as set forth in this certificate shall be primary and non-y15utory with respect to any insurance carried by Such additional insureds. �pd� DISPLAY LOCATION DISPLAY DATF(S) Centennial Regional Park Soccer Field July 4, 2017 Santa Ana, CA S�cCjP, It is certified that this policy requires a 30 day mutual notice ulcancellation between the Insurer and the Named Insured. In the event of such cancellation we will endeavor in mail 10 clays wi hall notice to the Additional Insured(s), whose name and address is shown hereon. but failure to mail such notice shut] inrposo no obligation or liability of any kind upon the insurer andlor the undersigned. DRAYTON INSURANCE BROKERS, INC. March 13 2017 DATE OF ISSUE , ,..STRINGER, PRESu)'— Policy Number: CA000002771-31 CG 20 26 07 04 Endorsement No,115 Effective Date: March 13, 2017 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULY. Ulm W*91 w , O i A This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART City of Santa Ana, its officers, agents, employees and volunteers as additional insured. 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 emissions or the acts or omissions of those acting on your behalf: A. In the performance ofyour ongoing operations; or B. in connection with your premises owned by or rented to you. CG 20 26 07 04 0ISO Properties, Inc., 2004 Page 1 of 1 CI Policy Nurebe r: CAO 0 0 0 027 71- 31 Al 08 76 02 03 liffective Date: 01 / 13 / 2 017 THIS ENDORSEHENT CHANGES THE POLICY. FLIVASL+ READ IT CAREFULLY. BLANKET ADDITIONAL INSURED This endorsement madifics insurance provided nader the followhtg: COMMEMCIAL GEN13RAL LIABILITY COVFRAGE FOIW COMMERCIAL PROPBRTY COVERAOF FORM PROFESSIONAL LIABILITY COVERACIE FORM It is hereby declared and agreed that the following entities are included as Additional Insured(s) hereunder: I) Sponsor(s),pr»moter(s), organizer(s) (including other entities having similar interosis), of insured pyrotechnic ovenis, 2) Owner(s) of real property (or barges) at which insured pyrotcolmic events are held. 3) Owner(s), manager(s), tcnant(a), mortgagee(s) (including other entities having sianilatr.in teeests), of buildings, stadiums, areiras and similar facilities at which in suml pyrotechnic events are held. 4) The licensing or pormiuringauthority, or other authority having jurisdiction, issuing li eenses/pemtlts for inenrnd pyroteehnfc events. S) Any other entity lot which the Named Insured iscontinent ally obllgated toprovide inaur- anoc such as is afforded by the terms of this policy. Girl. oulyifsuch entities are listed as odditional insureds) in a certificate ofinsurnneo issued under the tenses ofthis endorsement and always subjem to the Iimitations or condition sat out in such Certificate, of insurance. The coverage afforded such Additional Insured(s) does not apply to htjury or damage auising front the failure of any suolr Additional Insured to ftd:f II its obligations slrecifled h7 its Contraat with the Named Insured. Al 08 76 02 03 Page I of 1 11 Policy Naanber:CAO 0 0 002 7 73. - 31 AT 08 7602 03 EtPecMvo Date: 01 / 13 / 2 017 THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. COVERAGE GE AMENDMENT -PRIMARY This endorsement modifies insuraneeprovided under the following: COIV MERCIAI., GENERAL LIABILITY COVERAGE FORM COMMERCIAL PROPERTY COVERAGE FORNI PROFESSIONAL LIABILITY COVERAGE FORM It is hereby declared and agreed that, if so stated in a certificate of insurance, the coverage afforded any entity included as an Additional Insured under the torts of this policy shall 1) 'Be primary and non-contributory wide any policy of inswaace (or self-insurance) issued directly to the Additional Insured, 2) Provide a waiver (if subrogation in favor of such Additional Insured, Al 08 76 (12 0:1 Page 1 of 1 0 POLICYHOLDER COPY SP P.O. BOX 8192, PLEASANTON, CA 94588 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE. 03-13-20f7 CITY OF SANTA ANA SP 20 CIVIC CENTER PLZ SANTA ANA CA 92701-4058 GROUP: POLICY NUMBER: 0803748-2018 CERTIFICATE 10: Isis CERTIFICATE EXPIRES, 10-14-2017 10-14-2018/10-14-2017 This is to certify that we have issued a valid Workers' Compensation Insurance policy in a lorm approved by the California Insurance Commissioner to the employer named below for the policy period indicated, This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer, We will also give you 30days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy y described herein is subject to all the terms, exclusions, and conditions, of such policy. Authorized Representative President and CEO EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT N2055 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 10-14-2002 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. EMPLOYER PYRO SPECTACULARS, INC. SP PO BOX 2320 RIALTO CA 92377 [P13,SDj gv {q CT. (MV.7-2014) PRINTED : 03-13-2017 ACC CERTIFICATE OF LIABILITY INSURANCE 1320 7 Y Y) _ r1 r 7 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS —WAIVED, subloot to the terms and conditions of the policy, certain polloles may require an endorsement. A statement on this certificate does not confer rights to the land Center, Floor 30 9th Street OH 44114 INSURED P. O, ROM 2329 LIntlunplm P:, .,. INSURER F COVERAGES CERTIFICATE NUMBER: 1979069823 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE, BEEN ISSUED TO THE INSURED NAMED ABOVE FOR TF�A POUCH 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, GENERAL LIABILITY I !I I COMMERCIAL GENERAL LIABILITY _I OLAIMS•MADP. E. OCCUR L AGGREGATE LIMIT APPLIES PER POLPoV I 21 LOC I tRDDUCTB•COMP/OPAOG IS )MOBILE LIABILITY 1SISCA00031171 1/13/2017 111ffi2018m`igIFIEt3�Ff�LE'Ll a.Ndm91 ANYAUTO r I BODILY INJU13Y(Per person) S ALI. OWNED SCHEDULED AUTOS (. ..._ ANTOE I I BODILY INJURY (Per mccidenl) S i_ NON.OWNGD HIRED AUTOS Y` AUTOS (T"i3iS'li'%6AMA±.Ir'e..,_..� _ _ UMBRELLA LIAB� I.X I OCCUR EXC8017005 ill3/2017 1111312.018 ' EACH OCCURRENCE S' EXCESS LIAe AND EMPLOYERS' LIABILITY I I ANY PROPRIETOMPARI'NERIEXECIJTIVE YIN r OPPICER/MEMDER EXCLUDED? �INIA (Mandatory In NH) i If— Ao„ nha,e, .— r OTSCRIPTIONOFOPRRATIONS1LOfATIONSIVEHICI I .OR ale 1 LLS (Attach ACORD Addillunal Rmnaarka Schadula, It more apace Is required) �] M SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED DEPORE City Of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 Civic Center Plaza ACCORDANCE WITH THE POLICY PROVISIONS. Santa Ana CA 92703 AUTHORIZED REPRESENTATIVE 01988.2010 ACORD CORPORATION. All rights reserved. ACORD 20 (20101(15) The ACORD name and logo are registered marks of ACORD DRAYTON INSURANCE BROKERS, INC. 2500 CENTER POINT ROAD, SUITE 301 POST OFFICE BOX 94067 BIRMINGHAM, ALABAMA 35215 BIRMINGHAM, ALABAMA 35220 TELEPHONE: (205) 854-5806 FAX: (205) 854-5899 CERTIFICATE OF INSURANCE No. 813003 We certify that insurance is afforded as stated below. This Certificate does not affirmatively or negatively amend, extend or alter the coverage afforded by the insurance policy and the insurance afforded is subject to all the terms, exclusions and conditions of the policy. INSURER Admiral Insurance Company POLICY NO. CA000002771-32 NAMED INSURED Pyro Spectaculars, Inc. Pym Spectaculars by Souza Pyro Events, Inc. Pyro Spectacular Industries, Inc. Pyro Spectaculars Productions, Inc. North American Fireworks Co., Inc. (NAFCO) P.O. Box 2329 San Diego Fireworks Rialto, California 92377 POLICY TERM January 13, 2018 to January 13, 2019; Both Days 12:01 A.M. Standard Time COVERAGE Commercial General Liability: ® Occurrence Basis ❑ Claims Made Basis LIMIT OF LIABILITY $5,000,000 each occurrence, $10,000,000 general aggregate, $5,000,000 products/completed operations aggregate The limit of liability shall not be increased by the inclusion of more than one insured or additional insured. INSURED OPERATIONS Public fireworks display and special effects contractor It Is certified that, if named below, this policy includes as Additional Insureds 1) the sponsor(s), promoter(s), organizers) (including other entities having similar interests), of insured pyrotechnic events and/or 2) the owner(s) of real property (or barges) at which insured pyrotechnic events are held and/or 3) the owner(s), manager(s), tenant(s), mortgagee(s) (including other entities having similar interests), of buildings, stadiums, arenas and similar facilities at which insured pyrotechnic events are held and/or 4) the licensing or permitting authority, or other authority having jurisdiction, issuing licenses/permits for insured pyrotechnic events and/or 5) any other entity for which the insurance is required to be afforded under written contract. Coverage applies only as respects the legal liability of such Additional Insured(s) for bodily injury and property damage caused by the operations of the Named Insured. The insurance afforded any Additional Insured does not include coverage for any bodily injury or property damage arising from the failure of such Additional Insured to fulfill its obligations specified in its contract with the Named Insured. NAME & ADDRESS OF INSURED SPONSORS, PROPERTY OWNERS, LICENSORS City of Santa Ana, its Officers, Employees, Agents, Volunteers and Representatives 20 Civic Center Plaza Santa Ana, CA 92701 ADDITIONAL INSURED(S) City of Santa Ana, County of Orange, Orange County Eire Authority and their officers, agents, employees and volunteers when acting in their official capacity as such.d� The coverage afforded the additional insureds as set forth in this certificate shall be primary and non- To contributory with respect to any insurance carried by such additional insueds. (k" 2 DISPLAY LOCATION DISPLAY DATE(S) Centennial Regional Park Soccer Field July 4, 2018 Santa Ana, CA It is certified that this policy requires a 30 day mutual notice of cancellation between the Insurer and the Nam Sur vent of such cancellation we will endeavor to mail 10 days written notice to the Additional Insured(s), whose name and ress is sh bereon, but failure to mail such notice shall impose no obligation or liability of any kind upon the insurer and/or the undersigned. DRAYTON INSURANCE BROKERS, INC. January 15, 2018.r DATE OF ISSUE .. IN RESIDEc � CALIFORNIA LICENSE NOfFA18664 ACQRO CERTIFICATE OF LIABILITY INSURANCE DATE IMWDDIYYYYI 1/15/2018 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($), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: I/ 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 PRODUCER 3ritton Gallagher )ne Cleveland Center, Floor 30 375 East 9th Street ;leveland OH 44114 INSURED Pyro Spectaculars Inc. San Diego Fireworks P. O. Box 2329 Rialto CA 92377 COVERAGES CERTIFICATE NUMBER: 1dR5RnagR7 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. INTSRR TYPE OF INSURANCE AOOLYEFF D POUCYNUMBER mM D MMIUDO UMITS GENERAL LIABILITY EACH OCCURRENCE $ PREM Ea n f Cse OMMERCIAL GENERAL LABILITY MED E%P DN orw pereonl CLAIMS -MADE ❑ OCCUR PERSONAL&ADV INJURY _$___ S GENERALAOGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGG $ POLICY Pft0- LOC $ A AUTOMOBILE LIABILITY SIBCA00031-181 1/13/2018 1/13/2019 (Ea accHeNl 1 000 000 BODILY INJURY [Per pemon) Is X ANY AUTO ALLOWNED SCHEDULED AUTOS AUTOS BODILY INJURY Per accident I $ % % NONOWNED HIRED AUr05 AUTOS PROPERW OAMAGE P racciden0 $ S B UMBRELLA LIAG X OCCUR EXC6017995 1113/2018 1/13/2019 EACH OCCURRENCE S4,OD0,00D X AGGREGATE $4,000.000 EXCESS LAS CIAIMSrNADE DEO I I RETENTIONS $ WORKERS COMPENSATION CSATU- OTH- AND EMPLOYERS' I-MBILIrY YIN ANY PROPRIETORIPARTNERIE%ECUTIVE OFFICEMMEMBER EXCLUDED? NIA T E.L. EACH ACCIDENT f E.L. DISEASE -EA EMPLOYE $ (Mandatary In MI) It yes, describe under EL.DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule. If more space Is required) Certificate Holder is Named as an additional insured. �e e� 5 CITY OF SANTA ANA 20 CIVIC CENTER PLAZA SANTA ANA CA 92701 ACORD 26 (2010/05) SHOULD ANY OF THE ABOVE DESCRIBEDW'OLICIES aqANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. -V The ACORD name and logo are registered marks of ACORD rngPrTRAT1nN All rinHre --rl I Policy Number: CA000002771-32 CG 20 26 07 04 Endorsement No.102 Effective Date: January 15, 2018 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 City of Santa Ana, its officers, agents, employees and volunteers as additional insured. to Section 11— 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 wholeor in part, by your acts or omissions or the acts or omissions of those acting on your behalf: A. In the performance of your ongoing operations; or B. In connection with your premises owned by or rented to you. CG 20 26 07 04 0 ISO Properties, Inc., 2004 Page 1 of 1 13 Policy Nurnber. CA000002771-32 AI 08 76 02 03 Effective Date: 01 / 13 / 2 018 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CARLEULLY. BLANKET ADDITIONAL INSURED This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM COMMERCIAL PROPERTY COVERAGE, FORM PROFESSIONAL LIABILITY COVERAGE FORM It is bemby declared and agreed that the following entities are included as Additional Insured(s) hereunder: 1) Sponsor(s), promoter(s), organizer(s) (including other entities having similar interests), of insured pyrotechnic events. 2) Owner(s)ofreal property(or barges) at which insured pyrotechnic events we held. 3) OVnrer(S), mmnager(s), tenant(s), mortgagee(s) (including other entities having similar in terests), of buildings, stadiums, arenas and similar facilities at which insured pyrotechnic events are held. 4) The licensing or permitting authority, or other authority having jurisdiction, issuing li census/peanits for insured pyrotechnic events. 5) Any other entity for which the Named Insured is contractually obligated to provide insur- ance such as is afforded by the terms of this policy. but only if such entities are listed as additional insured(s) in a certificate of insurance issued under the terms of this endorsement and always subject to the limitations or conditions set out in such certificate of insurance. The coverage afforded such Additional Insured(s) does not apply to injury or damage arising from the failure of any such Additional Insured to fulfill its obligations specified in its contract with the Named Insured. Q�G AT 08 76 02 03 Page 1 of 1 11 Policy NombacCA0 000 02 7 71-32 At 00 76 02 03 Effectivc Date: 01 / 13 / 2 018 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COVERAGE AMENDMENT -PRIMARY This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM COMMERCIAL PROPERTY COVERAGE FORM PROFESSIONAL LIABILITY COVERAGE FORM It is hereby declared and agreed that, if so stated in a certificate of insurance, the coverage afforded any entity included as an Additional Insured under the terms of this policy shall 1) Be primary and non-contributory with any policy of insurance (or self-insurance) issued directly to the Additional Insured. 2) Provide a waiver of subrogation in favor of such Additional Insured. Q�G At 08 76 02 03 Page 1 of 1 E3 POLICYHOLDER COPY P.O. BOX 8192, PLEASANTON, CA 94588 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 01-15-2018 CITY OF SANTA ANA SIP 20 CIVIC CENTER PLZ SANTA ANA CA 92701-4058 GROUP: POLICY NUMBER: 0803749-2017 CERTIFICATE ID: 1648 CERTIFICATE EXPIRES: 10-14-2018 10-14-2017f10-14-2018 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer. We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy �described herein is subject to all the termmss,, exclusio�ns,s,��CJ�Jannd conditions, of such policy. Authorized Representative President and CEO EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT R2065 ENTITLED CERTIFICATE FOLDERS' NOTICE EFFECTIVE 10-14-2002 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. EMPLOYER PYRO SPECTACULARS, INC. SP PO BOX 2329 RIALTO CA 92377 (P1Y,SDI fnev.7-2314) PRINTED ; 01-15-2018 DRAYTON INSURANCE BROKERS, INC. 2500 CENTER POINT ROAD, SUITE 301 POST OFFICE BOX 94067 BIRMINGHAM, ALABAMA 35215 BIRMINGHAM, ALABAMA 35220 TELEPHONE: (205) 854-5806 FAX: (205) 854-5899 CERTIFICATE OF INSURANCE NO. 902028 We certify that insurance is afforded as slated below. This Certificate does not affirmatively or negatively amend, extend or alter the coverage afforded by the insurance policy and the insurance afforded is subject to all the reins, exclusions and conditions of the policy. INSURER Admiral Insurance Company POLICY NO. CA000002771-33 NAMED INSURED Pyro Spectaculars, Inc. Pym Spectaculars by Souza Pyw Events, Inc. Pyro Spectacular lndusu'ies, Inc. Pyro SPeCiaculmS Pmductiorrs, Inc, North American Fireworks Co., Inc. (NAFCO) P.O. Box 2329 San Diego Fireworks Rialto, California 92377 POLICY TERM January 13, 2019 to January 13, 2020; Both Days 12:01 A.M. Standard Time COVERAGE Commercial General Liability: ® Occurrence Basis ❑ Claims Made Basis LIMIT OF LIABILITY $5,000,000 each occurrence, $10,000,000 general aggregate, $5,000,000 products/co npleted operations aggregate The limit of liability shall not be increased by the inclusion of more than one insured or additional insured. INSURED OPERATIONS Public fireworks display and special effects contractor It is certified that, if named below, this policy includes as Additional Insureds 1) the sponsor(s), promoter(s), organizer(s) (including other entities having similar interests), of insured pyrotechnic events and/or 2) the owner(s) of real property (or barges) at which insured pyrotechnic events are held and/or 3) the owner(s), manager(s), tcnant(s), mortgagee(s) (including other entities having similar interests), of buildings, stadiums, arenas and similar facilities at which insured pyrotechnic events are held and/or 4) the licensing or permitting authority, or other authority having jtn indiction, issuing licenses/permits For insured pyrotechnic events and/or 5) any other entity for which the insurance is required to be afforded underwritten contract. Coverage applies only as respects the legal liability of such .Additional Insured(s) for bodily injury and property damage caused by the operations ofthe Named Insured. The insurance afforded any Additional Insured does not include coverage for any bodily injury or property damage arising from the failure of such Additional Insured to fulfill its obligations specified in its contract with the Named Insured. NAME & ADDRESS OF INSURED SPONSORS, PROPERTY OWNERS, LICENSORS City of Santa Ana, its Officers, Employees, Agents, Volunteers and Representatives 20 Civic Center Plaza Santa Ana, CA 92701 ADDITIONAL INSURED(S) City of Santa Ana, County of Orange, Orange County Fire Authority and their officers, agents, employees and volunteers when acting in their official capacity as such. The coverage afforded the additional insureds as set forth in this certificate shall be primary and non- QSt{�1 contributory with respect to any insurance carried by such additional insurds. kapl�" ,1e6 by' Orypil-�5 DISPLAY LOCATION DISPLAY DATE(S) . \I Centennial Regional Park Soccer Field July 4, 2019 C� Santa Ana, CA Gue�asr 5M�a P�Pd It is certified that this policy requires a 30 day mutual notice of cancellation between the Insurer and the N e Insuredvent of such cancellation we will endeavor to mail 10 days written notice to the Additional Insured(s), whose name and address is sit hereon, but failure to snail such notice shall impose no obligation or liability of any kind upon the insurer and/or the undersigned. DRAYTON INSURANCE: BROKERS, INC. _Eanuary 2�t�2019. _ _ __ DATE OF ISSUF....STRPRE:SIDF" — CALIFORNIA LIC'F.NSF N(. :\I8664 %. O CERTIFICATE OF LIABILITY INSURANCE OATS019 V ) 1nanDls 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(ies) 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 ICONTACT One Cleveland Center, Floor 30 tus:nR.E%D:2ib-658J100 1375 East 91h Street EMAIL ADOR€ss;_ Cleveland OH 44114 _ INSURERS) AFFORDING COVERAGE i NAICN INSURED INSURERA:Maxum Indemnity Company_ .._ 26743 _.. _. INSURER_B:EVerest NatlOnal IDsurance. Company -....... ._ 10120 Pyro Spectaculars Inc INSURER C: San Diego Fireworks --- P. O. Box 2329 - NS-URERD __—. Rialto CA 92377 _INSURER E o INSURER F' COVERAGES CERTIFICATE NUMBER: RQi sRszl9 RFVIRUDIU MIIMRFR- 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, TFRM 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. INSR _— AODLlilen, - "- POLICY EFF POLICY E%P _ LT. TYPE OF INSURANCERISE POLICY NUMBER MMIOOM'W MMIDDIYTYY t LIMITS GENERAL LIABILITY EACH OCCURRENCE S COMMERCIAL GENERAL LIABILITYTORENT€D I DAMAG PFiEMI$E$ l�q 9ESu 14 cgj _ S _j CLAIMS -MADE OCCUR I MED EXP(A yonev a n) 5 _. _. PERSONAL B ADV INJURY s AGGIR fE IGENERAL GEN'L AGGREGATE LIMI' APPLIES PER: PRODUCTS - COMP OP AGo POLICY i PRO-JECT i LUC I j S B AUTOMOBILE LIABILITY SIBCA00031-181 1/13l2019 ' 1/1312020 O t (E codgml i 81.000.00C X�ANY AUTO BODILY INJURY IP person) ALL OWNED IEDHFOULED AUTOS ; ._1 AUTOS 0001LY INJURY (P tlen0 I S X HIRED AUTOS 'X ! NON -OWNED nuTos r ! PNOPUaY DAMAuE owdoell _ Ij e A UMBRELLA LIAR 1IX IOCCUR EXC6017995 11113/2020 EACH OCCURRENCE s4,D00000 �X EXCESS LIAR {_ GLUMSMADE (1/13/2019 _ W .gGGREGATE. S4,0000 I I DEO R[TENTIONS S WORKERS COMPENSATION I! WC STATE. LOIN AND EMPLOYERS' LIABILITY YIN ! �TORY_LIMITS l I ER _- ANYPROPRIETORIPARTNERIFXEGUTIVE EL EACH ACCIDENTIA! S OFFICFRIMFeWt R E%CLUOED7 ❑ N _ f (Magdalory In NH) I EL. DISEASE-FAFMPLOYEE:S If yes geicr0 ndar DFSCRIPTON OF OPERATIONS below I EI DISEASE -POLICY LIMITI$ I I I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Allac4 ACORD 101, Additional Remarks Schedule, if more space is required) Certificate Holder is Named as an additional insured. •� � �e�`e�ed`cy �s City of Santa Ana 20 Civic Center Plaza Santa Ana CA 92701 SHOULD ANY OF THE ABO%FwBI THE EXPIRATION DATE- THER ACCORDANCE WITH THE POLICY AUTHORIZED REPRESENTATIVE C'_''Jl:�� % V © 1988-2010 ACOF ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD CANCELLED BEFORE BE DELIVERED IN All rinhfc r<con.md Policy Number: CA000002771-33 CG 20 26 07 04 Endorsement No.107 Effective Date: January 24, 2019 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, agents, employees and volunteers as additional insured. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section Il —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 (lie acts or omissions of those acting on your behalf, A. In the performance of your ongoing operations; or B. In connection with your premises owned by or rented to you. CG 20 26 07 04 C, ISO Properties, Inc., 2004 Page 1 of 1 0 Policy Number.CA000002771-33 Al 08 76 02 03 Effective Date:0111312019 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 COMMERCIAL, PROPERTY COVERAGE FORM PROFESSIONAL LIABILITY COVERAGE FORM It is hereby declared and agreed that the following entities are included as Additional Insured(s) hereunder: 1) Sponsor(s),promoter(s),organizer(s)(including other entities having similar interests). of insured pyrotechnic events. 2) Owner(s) of real property (or barges) at which insured pyrotechnic events are held. 3) Owner(s), manager(s), tenant(s),mortgagee(s)(including Other entities having similar in terests), of buildings, stadiums, arenas and similar facilities at which insured pyrotechnic events are held. 4) The licensing or permitting authority, or other authority havingjurisdiction, issuing li censeslpermits for insured pyrotechnic events. 5) Any other entity for which the Named Insured is contractually obligated to provide insur- ance such as is afforded by the terms of this policy. but only if such entities are listed as additional insureds) in a certificate of insurance issued underthe terms of this endorsementand always subject to the limitations or conditions set out in such certificate of insurance. The coverage afforded such Additional Insured(s) does not apply to injury or damage arising from the failure of any such Additional Insured to fulfill its obligations specified in its contract with the Named Insured. �e\e�ed�Y, J��lQ �s S��`�\a GuP�m�� �GS� P Al 08 76 02 03 Page oft 0 Policy Number.CA000002771-33 All 08 76 02 03 Effective Date:01113/2019 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CARLYULLY. COVERAGE AMENDMENT -PRIMARY This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM COMMERCIAL PROPERTY COVERAGE FORM PROFESSIONAL LIABILITY COVERAGE FORM It is hereby declared and agreed that, if so stated in a certificate of insurance, the coverage afforded any entity included as an Additional Insured under the terms of this policy shall I) Be primary and non-contributory with any policy of insurance (or self-insurance) issued directly to the Additional Insured. 2) Provide a waiver of subrogation in favor of such Additional Insured. PEGS AI 08 76 02 03 Page 1 of 1 0 POLICYHOLDER COPY P.O. BOX 8192, PLEASANTON, CA 94588 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 01-24-2019 GROUP; POLICY NUMBER: 0803749-2018 CERTIFICATE 10: 1833 CERTIFICATE EXPIRES: 10-14-2019 10-14-2018/10-14-2019 CITY OF SANTA ANA SIP 20 CIVIC CENTER PLZ SANTA ANA CA 92701-4058 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer. We will also give you 30days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded bbythe pp/yollii���c///y described herein is subject to all the terms, /exclusions,, and conditions, of such policy. Authorized Representative President and CEO EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT N0015 ENTITLED ADDITIONAL INSURED EMPLOYER EFFECTIVE 2019-01-24 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. NAME OF ADDITIONAL INSURED: CITY OF SANTA ANA ^— ENDORSEMENT N2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 10-14-2002 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. I EMPLOYER PYRO SPECTACULARS, INC. PO BOX 2329 RIALTO CA 92377 QRG SP TP13,SD1 IREV.7-2014) PRINTED : 01-24-2019 SIP