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HomeMy WebLinkAboutCAZALES, ANAHICity of Santa Ana ---- ------ ---e- 1 Clerk of the Council coic 6 ce u-s ---------- - -- — ---- 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TERMINATION FORM Please complete this form in its entirety when the attached agreement and all amendments (if any) are no longer in effect.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. Is the agreement(s) a permanent record? Yes No IL t s tVX Ur C Return form to the Clerk of the Council Office (M-30). Call 647-1520 if you have any questions. The agreement with P-hr VAO( —\ \ Ca 2-o-X� No. 111,o29019-d4Z was completed on 12131121010 and final payment has been made. (List aH amendments. Use space below if needed.) Department: 1?W15h Phone/Ext.: -0,211 Signature: IL Date: J0IIES1202% Revised: 10-18-16 1/ INSURANCE NOT ON FILE WORK MAY NOT PROCEED CLERK OF COUNCIL N-2019-261 DATE: O: PRCS ( ) DEC 2 3 20E,CREATION SERVICES AGREEMENT Silvia Cuevas THIS AGREEMENT is made and entered into this 17`h day of December, 2019 by and between Anahi s•("Provider") and the City of Santa Ana, a charter city and municipal corporattbTi-organized" and existing under the Constitution and laws of the State of California ("City"). RECITALS A. The City desires to retain a recreation service provider having special skills, resources and knowledge to provide BrighrPuture Learning classes on cognitive and social development, motor skills, art, and STEM to prepare children for kindergarten in its recreation class program. B. Provider represents that she is able and willing to provide such services to the City C. In undertaking the performance of this Agreement, Provider represents that she is knowledgeable in their field and that any services performed by Provider under this Agreement will be performed in compliance with such standards as may reasonably be expected. 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: SCOPE OF SERVICES Provider shall perform those services as set forth in Exhibit A to this Agreement. 2. COMPENSATION In consideration for the provision of the programs set forth in Exhibit A, City agrees to pay the Provider seventy percent (70%) of all gross revenue received from program participants. Total revenue to Provider shall not exceed $25,000.00 annually. Payment to Provider shall be made monthly within thirty (30) days following completion of the last class taught by Provider the prior month. City shall be responsible for collecting all fees from program participants. Provider shall not collect fees but will refer all interested participants to City for registration information. Provider agrees that City shall retain thirty percent (301/o) of all gross revenue received from program participants as an administrative fee. 3. TERM This Agreement shall commence on January 1, 2020 and end on December31, 2020 unless terminated earlier in accordance with Section 12 below. The term of this Agreement may be extended by a writing executed by the City Manager and the City Attorney. #19187vi 4. INDEPENDENT CONTRACTOR Provider 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 manner in which Provider performs the services which are the subject matter of this Agreement; however, the services to be provided by Provider shall be provided in a manner consistent with all applicable standards and regulations governing such services. Provider 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. Provider is not an agent, representative or employee of City and Provider shall have no authority to act on behalf of the City. 5. INSURANCE Prior to undertaking performance of work under this Agreement, Provider shall maintain and shall require its subcontractors, if any, to obtain and maintain insurance as described below: a. Ctiiial General Liability Insurance. Provider shall maintain commercial general liability insurance which 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 Provider'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. Worker's Compensation Insurance. In accordance with California State law, Provider, if Provider+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, Provider agrees to obtain and maintain any employer's liability insurance with limits not less than $1,000,000 per accident. c. The following requirements apply to the insurance to be provided by Provider pursuant to this section: i. Consultant 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 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 #19187v1 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. d. If Provider 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 Provider's right to be paid for its time and materials expended prior to notification of termination. Provider 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 Provider agrees to and shall indemnify, defend 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 negligent operations of the Provider 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, to the extent that the injury, damages, just compensation, restitution, judicial or equitable relief is caused by the negligence of the Provider. 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. City may make all reasonable decisions with respect to its representation in any legal proceeding. In no case will Provider be required to indemnify or hold harmless the City from injury, damages, just compensation, restitution, judicial or equitable relief caused by the negligence of the City. 7. CONFLICT OF INTEREST Provider 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. 8. LIVE SCAN BACKGROUND CHECK Provider, and any employees, subcontractors or substitutes, shall arrange for and submit their fingerprints for a criminal background check through the Department of Justice through the City's Human Resources Department process. Consultant shall be responsible for all charges associated with fingerprinting. Consultant shall not perform any services pursuant to this Agreement until clearance is received and Consultant is notified by the City's Parks, Recreation and Community Services Department. #19187v1 9. NOTICE 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 copy to: Executive Director of Parks, Recreation and Community Services City of Santa Ana 20 Civic Center Plaza (M-23) P.O. Box 1988 Santa Ana, California 92702 Fax (714) 571-4211 To Provider: Anahi Cazales 701 E. 201h Street Santa Ana, CA 92706 Phone: 714 315-5136 Email: anahicazalesna vahoo.com A party may change its address by giving notice in writing to the other party. Thereafter, any communication shall be addressed and transmitted to the new address. 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 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 as set 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 Provider regarding the subject matter herein, 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 Provider. 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 Provider or the City. Each party to this Agreement acknowledges that no representations, #19187v1 inducements, promises or agreements, orally or otherwise, have been made by any party, or anyone acting on behalf of any party, which is not embodied herein. 11. ASSIGNMENT/SUBSTITUTES a. Assignment. The experience, knowledge, capability and reputation of Provider were a substantial inducement for City to enter into this Agreement. Therefore, Provider 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. b. Substitutes. In the event Provider is not able to teach a class due to illness or some other cause beyond Provider's reasonable control, Provider must procure, at its sole expense, a qualified substitute instructor to teach the class at its regular time and place. Provider shall ensure that substitute instructors are at least twenty-one (21) years of age and comply with the City's insurance and live scan requirements contained herein. Evidence of compliance with City's insurance and live scan requirements shall be provided upon request. Provider must immediately notify the City of the substitute instructor's name, qualifications, address and phone number. If Provider cannot procure a qualified substitute and the City is unable to assist in this regard, then the class shall be canceled and a make-up class must be added to the session. Provider must notify participants as soon as possible of any class cancellation and make-up class. Provider must personally teach at least seventy-five percent (75%) of its offered classes. 12. TERMINATION a. This Agreement may be terminated by the City upon thirty (30) days written notice of termination. In such event, Provider shall be entitled to receive, and City shall pay Provider, compensation for all services rendered prior to the effective date of termination. b. Termination or cancellation of classes by the Provider outside of Section 1 Lb. must be given to the City at least thirty (30) days prior to termination/cancellation. Failure to provide adequate cancellation notice to the City may put future contracting of business with the City at risk and will result in the City's retention of ten (10%) percent of the final payment to Provider. 13. RECORDS Provider shall use attendance sheets generated and supplied by the City to record attendance in each class. Provider shall keep these and any other records in connection with the work to be performed under this Agreement and shall permit City, upon request, to review such records for a period of three (3) years from the date of final payment to Provider under this Agreement. 14. NON-DISCRIMINATION Provider shall not discriminate because of race, color, creed, religion, sex, marital status, sexual orientation, gender identity, gender expression, gender, medical conditions, genetic information, or military and veteran status, age, national origin, ancestry, or disability, as defined #19187vl and prohibited by applicable law, in the recruitment, selection, teaching, training, utilization, promotion, termination or other employment related activities or any services provided under this Agreement. Provider affirms that it is an equal opportunity employer and shall comply with all applicable federal, state and local laws and regulations. 15. 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 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. 16. LICENSES Provider 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. 17. SEVERABILITY In the event that one or more of the phrases, sentences, clauses, paragraphs or sections contained in this Agreement shal I be declared invalid or unenforceable by valid judgment or decree of a court of competent jurisdiction, such invalidity or unenforceability shall not affect any of the remaining phrases, sentences, clauses, paragraphs or sections of this Agreement, which shall be interpreted to carry out the intent of the parties hereunder. 18. EXHIBITS All Exhibits referenced herein and attached hereto shall be incorporated as if fully set forth in the body of this Agreement. 19. AUTHORITY The person(s) executing this Agreement on behalf of the parties hereto warrant that they are duly authorized to execute this Agreement on behalf of said parties and that by so executing this Agreement, the parties hereto are formally bound to the provisions of this Agreement. [Signatures on next page] #19187vl N-2019-261 IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first above written. ATTEST: `''a� _ D. A��c, APPROVED AS TO FORM: SONIA R. CARVALHO City Attorney Laura A. Rossini Senior Assistant City Attorney Director of Parks, i and Community Services Agency #19187vl CITY OF SANTA ANA Kristine Ridge City Manager Exhibit A SCOPE OF SERVICES A. Provider shall conduct Bright Future Learning classes for ages 3 - 5 years old. B. Provider shall teach such or similar classes (1) at the times below at facilities to be designated by the City or (2) on a schedule agreed upon by the parties for each class session or term, including the location, specific days and hours when classes will be held, and holidays to be observed, in accordance with City's needs. Bright Future Learning students will have the opportunity to learn in a safe and structured environment as they prepare at an early age for school. Program will focus on cognitive and social development, motor skills, art, and STEM. Students will gain the fundamental skills to prepare them for kindergarten. The program is also designed to promote learning through play and activities. There will be a parent and child interaction activity day once a month. Parents are welcome! Participants must be potty trained INSTRUCTOR: Miss Anahi LOCATION: 1825 W Civic Center Dr., Santa Ana, (714) 647-6558 • Classes will consist of monthly sessions, held 4 days per week, 3 hours per day. C. Provider shall provide all materials, supplies, equipment, records and personnel. Provider shall be responsible for clean-up of the facilities and materials and shall ensure the safety and effectiveness of instruction. D. Provider shall be certified in First Aid, and in Infant and Child CPR. Provider shall furnish proof of certification. E. Background check may be required to volunteer. F. Provider is not allowed to transport children. CLASS SIZE A. Provider will only accept of 10 paid students and no more than 24 students. B. No registration will be accepted after the second meeting of classes. C. If the minimum registration has not been reached by the second class, the class shall be canceled. Provider will be under no obligation to provide services for the cancelled classes, and the City will have no further obligations to pay Provider compensation for the remaining classes that were cancelled in that session. CLASS FEES A. Each participant shall pay class registration fees as established by City. B. Provider may not waive class participation/registration fees. C. Only registered participants may participate in class. D. Any refunds to participants will be made in accordance with City policy. E. Any materials fee shall be established by mutual agreement of City and Provider and shall be payable directly to Provider. #19187vl 1 American A1530990 MNRhOry A,. fMy Adult, Child, Infant CPR & AED Training (BLS) AnahiCAn es This card certifies that The above individual has successhdly completed the regm ements in accordance tv'slh Alnerican Health Care Academy's curriculum. 12111/2019_.. __ - 12/11C2021 ....... Instnlctor Signature i Holder's Signature Call 9t1 in case of a medica. cmergoacy Cali 1.800-222-12n in a poison. cmergcncy For CPRlAED or First Aid training information call 1-888-277-7865 or visit cinaedcoutse.eom American Health Care Academy t Renewal Rceommcnded overy 2 years A� b® CERTIFICATE OF LIABILITY INSURANCE °ivi6M s 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: N the certWcate 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 pollc)es may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(a). Pf00110E1 Sanah Devereaux-Barnentos, Agent 1202 W 1St St Arleftm Santa Ana, CA 92703 CONTN T NAM : IAH DEVEREAUX PHONE 280 FAX EA000Re : sanah.devereaum.181statefarm.com INSUREgS] AFFORDINGCOVERASE NNC , INSURER A: Slate Fenn Fire and Casualty INSURED CAZALES, ANAHI DBA: BRIGHT FUTURE LEARNING CENTER 2320 N GRAND AVE SANTA ANA, CA 92705 INSURER e: INSUREac: INSURER D INWR ! 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. am ME OF INSURANCE L9U -, P NUMBER PO EFF POLICY EXPAM namotIrrinryl Lam A I oENEML tABe.IrY X COMMERCIAL GENERAL LIABILITY CWMS-MADE ❑X OCCUR Y 11 92-0IU/977i 03104W2 0310112020 EACH OCCURRENCE 5 1,000,000 WISES (Fat 5 3W.000 MEDEXa(Arone ) s 5,000 PERSONALSADV WJtRV 5 1,000,000 GENERAL AGGREGATE t 2,000,000 DIDIL AGGREGATE MIT APPLIES PER POLICY 7, WT Loc PRODUCTS-COMPI(WAGG s 2,000.000 Business Properly s S,DOU AYTOYOeII! LAearry ANY AUTO GAINEAUTSCHEDULE OS D AUTOSO HIREIOWNED DAUFOG AUTOS I I a LE OMIT 5 aOO1LYINJURY(Perptnon) 5 BODILY INJURY(FW a.uCaX) S 5 f UMBRELU LMa EXCESS UAB OCCUR CLA)M"ADE —JHS EACH OCCURRENCE s AGGREGATE s DIED I I RFTEATIONS WORKERS CDMPENSATIOM ANDEMPLOYERS'UAINUTV ANY PROPRIETOR/PARTHOUEXECUTVE Yln OFRCEAAEIABBR EXCUJOED+ (Mr„ eamry In NN) M YW, aesrntR �n0ar MIA YID STATU- Ono EL. EACH ACCIDENT i5 EL DISEASE - EA EMPL 5 E.L. DISFASE- POLICY 01dr s DESCRIPTION of OPERATIONS I LOCATIONS'VEHICLES IAtesh ACORD "I. AMiSerul RNnIft iih�lw N mom*,n, M n,ui l RE: Recreation Class Instructor The Certificate holder is added as an additional insured, but only for liability caused, in whole or in pan. by the acts a omissions of the mired insured. City will be mailed 30 days miters notice of policy cancellation and the references "Endeavor To' failure to mail such notice shall Impose no Obligation or liability of any kind upon the Company, its agents or representatives" shall be removed or Crossed out. CITY OF SANTA ANA RISK MANAGEMENT DIVISION 19 20 20 CIVIC CENTER PLAZA SANTA AN SAMA HA M. U1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. — 0-1988-2010 ACORD CORP All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of A 001486 132849.8 01-23-2013 Policy No. 92 GHM977 9 CMP-4786.1 Page 1 of 2 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CMP-4786.1 ADDITIONAL INSURED — OWNERS, LESSEES, OR CONTRACTORS (Scheduled) This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number: 92 GHM977 9 Named Insured: CAZALES, ANAHI DBA BRIGHT FUTURE LEARNING CENTER 2320 N GRAND AVE SANTA ANA CA 92705-8700 Name And Address Of Additional Insured Person Or Organization: CITY OF SANTA ANA RISK MANAGEMENT DIVISION 20 CIVIC CENTER PLAZA SANTA ANA CA 92702 SECTION II — WHO IS AN INSURED of SECTION 11 — LIABILITY is amended to in- clude, as an additional insured, any person or organization shown in the Schedule, but only with respect to liability for "bodily injury , "property damage", or "personal and advertis- ing injury" caused, in whole or in part, by. a. Ongoing Operations (1) Your acts or omissions; or (2) The acts or omissions of those acting on your behalf; in the performance of your ongoing opera- tions for that additional insured; or b. Products— Completed Operations "Your work" performed for that additional insured and included in the "products - completed operations hazard". However, Paragraph 1, above is subject to the following: a. The insurance afforded to the additional insured only applies to the extent permit- ted by law; ®. Includes 19 1019 b. If coverage provided to the additional in- sured is required by a contract or agree- ment, the insurance provided to the additional insured will not be broader than that which you are required by the contract or agreement to provide for such addition- al insured; and c. If the contract or agreement between you and the additional insured is governed by California Civil Code Section 2782 or 2782.05, the insurance provided to the additional insured is the lesser of that which: (1) Is allowed for the satisfaction of a de- fense or indemnity obligation by Cali- fornia Civil Code Section 2782 or 2782.05 for your sole liability; or (2) You are required by contract or agreement to provide for such addi- tional insured. We have no duty to defend or indemnify the additional insured under this endorsement un- til a claim or "suit" is tendered to us. M. LAMBERT * company. 2018 Inc., with its permission- 2. Any insurance provided to the additional in- sured shall only apply with respect to a claim made or a "suit" brought for damages for which you are provided coverage. 3. With respect to the insurance afforded to the additional insured, the following is added to SECTION 11— LIMITS OF INSURANCE: If coverage provided to the additional insured is required by contract or agreement, the most we will pay on behalf of the additional insured will be the lesser of the amount of insurance: a. Required by the contract or agreement; or b. Available under the applicable Limits Of Insurance shown in the Declarations. This endorsement shall not increase the ap- plicable Limits Of Insurance shown in the Declarations. 4. With respect to the insurance afforded to the additional insured, the following is added to Paragraph 3. Duties In The Event Of Occur- rence, Offense, Claim Or Suit of SECTION 11— GENERAL CONDITIONS: The additional insured must: a. See to it that we are notified as soon as practicable of an "occurrence" or an of- fense which may result in a claim. To the extent possible, notice should include: (1) How, when and where the "occur- rence" or offense took place; CMP-4786.1 Page 2 of 2 (3) The nature and location of any injury or damage arising out of the "occur- rence" or offense; b. Tender the defense and indemnity of any claim or "suit" to us and to all other insur- ers who may have insurance potentially available to the additional insured; and c. Agree to make available any other insur- ance the additional insured has for de- fense or damages for which we would provide coverage under SECTION II — LIABILITY. 5. With respect to the insurance afforded the ad- ditional insured, the following replaces SEC- TION II —LIABILITY of Paragraph 7. Other Insurance of SECTION I AND SECTION 11 — COMMON POLICY CONDITIONS: a. This insurance is primary to and will not seek contribution from any other insurance available to the additional insured, provided that the additional insured is a named in- sured under such other insurance. b. Regardless of any agreement between you and the additional insured, this insur- ance is excess over any other insurance whether primary, excess, contingent or on any other basis for which the additional in- sured has been added as an additional in- sured on other policies. There will be no refund of premium in the event this endorsement is cancelled. (2) The names and addresses of any in- jured persons and witnesses; and All other policy provisions apply. CMP-4786.1 1007033 148011 08-21-2014 9, Copyright, State Farm Mutual Automobile Insurance Company, 2013 Includes copyrighted material of Insurance Services Office, Inc., with Its permission, REVI WED & APPROVED y RI MANAGEMENT DIVISION 19 2019 tAMA THA M. LAMBERT Anahi Cazales 701 E 20'h St. Santa Ana, CA. 92705 12/11/2019 City of Santa Ana Risk Management Division 20 Civic Center Plaza. Santa Ana, CA 92702 Rc: Auto Insurance Requirement Release of Liability. Dear City of Santa Ana Risk Management Division: 1, Anahi Cazales, Bright Furure Learning, hereby release the City of Automobile Liability. I do not use/drive any vehicle during the course and scope of my course/instruction class. Daring the term Jan 1, 2020 through Dec 31, 2020, 1 will be teaching Bright Future Leaming at El Salvador center, located at: 1825 W Civic Center Dr., Santa Ana. Sincerely Anahi Cazales Recreation Class instructor & APPROVED krxMFNT DiVWON 19 2019 M. LAMBERT CITY OFSANTA ANA RISK MANAGEMENT a d&a4o%* 4 HUMAN RESOURCES hlarTayhg Risk nvmpn Posldve Cl nige - WORKERS' COMPENSATION DECLARATION I, #AW ramU5. hereby affirm under penalty of perjury, the (Name/rifle) following declaration: ` I certify on behalf of ay, �A?L+% that during the term (Consul ton t/Company Name) of my contract for (M1QI Ix, services with the City of Santa Ana, (Type o/ service provided) 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 the provisions and provide proof of workers' compensation coverage immediately. Date: " i N I I q Print Name: Print Title: ►1 (� !L Signature: Telephone: I LI . gel Wls� 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. & APPROVED \CEMENT DIVISION 19 2019 SAMAINTHA M. LAMBERT 1:IRisk Mgmtl,nsurance RequirementslWC Declaration 08152019 A`� CERTIFICATE OF LIABILITY INSURANCE °02/25/20 0 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 Sariah Devereaux-Barrientos, Agent 1417 S Broadway StateFarm Santa Ana, CA 92707 NAME: CT SARIAH DEVEREAUX-BARRIENTOS PHONE No Sam 714-541-7280 1 VC No), 714-384-3892 E-MAIL A°DREss: sariah.devemaux.tBlb statefarm.com INSURERISI AFFORDING COVERAGE NAIC# INSURERA: State Farm Fire and Casualty Company 25143 INSURED CAZALES, ANAHI DBA BRIGHT FUTURE LEARNING CENTER 2320 N GRAND AVE SANTAANACA 92705-8700 INSURER B: INSURER C: 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. INSR LTR TYPE OF INSURANCE ADDLSUBR POLICY NUMBER POLICY EFF MM/DUEFF POLICY EXP ,,IODIYYYYI LIMITS A GENERAL LIABILITY ❑ 92-GH-M977-9 02/01/2020 03104/2021 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE I —XI OCCUR DAMA ETO RE PREMISES Ea occunence $ 300,000 MED EXP (Any one person) $ 5,000 PERSONAL S ADV INJURY $ 1,000,000 GENERALAGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMPIOP AGG $ 2,000,000 X1 POLICY JECOT LOC Business Property $ 5,100 AUTOMOBILE LIABILITY ❑ ❑ COMBINED SINGLE LIMIT Ea amid nt $ BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY Per accitlent ( ) $ NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE IPer accident S UMBRELLA LIAB OCCUR ❑ ❑ EACHOCCURRENCE $ AGGREGATE Is EXCESS LIAB CLAIMS -MADE DELI I I RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABWTY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICE/MEMBER EXCLUDED'! N / A ❑ TORY LIMI ER E.L. EACH ACCIDENT $ E.L DISEASE - FA EMPLOYE $ (Mandatory in NH) If under DES RIPTIdescrON E.L. DISEASE -POLICY LIMIT $ ❑ ❑ DEDUCTIBLE S500.00 DESCRIPTION OF OPERATIONS/ LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) City if Santa Ana, officers, agents, employees, and volunteers are named as additional insureds on this policy pursuant to written contract, agreement, or memorandum of understanding. Such insurance as is afforded by this policy shall be primary, and any insurance carried by City shall be excess and noncontributory. Certificate of Insurance shall provide thirty (30) day prior written notice of cancellation By Risk CITY OF SANTA ANA RISK MANAGEMENT DIVISION 20 CIVIC CENTER PLAZA /SQL SANTA ANA, CA 92702 �Y .41li L9ga1 �G�$PICI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. �lLKLCSQ, © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD 1001486 132849.8 01-23-2013 CA Policy No. 92-GH-M977-9 CMP-4786.1 Page 1 of 2 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CMP-4786.1 ADDITIONAL INSURED — OWNERS, LESSEES, OR CONTRACTORS (Scheduled) This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number:92-GH-M977-9 Named Insured: CAZALES, ANAHI DBA BRIGHT FUTURE LEARNING CENTER 2320 N GRAND AVE SANTA ANA CA 92705 8700 Name And Address Of Additional Insured Person Or Organization: CITY OF SANTA ANA RISK MANAGEMENT DIVISION 20 CIVIC CENTER PLZ SANTA ANA CA 92701 4058 SECTION II — WHO IS AN INSURED of SECTION II — LIABILITY is amended to in- clude, as an additional insured, any person or organization shown in the Schedule, but only with respect to liability for "bodily injury", "property damage", or "personal and advertis- ing injury' caused, in whole or in part, by: a. Ongoing Operations (1) Your acts or omissions; or (2) The acts or omissions of those acting on your behalf; in the performance of your ongoing opera- tions for that additional insured; or b. Products - Completed Operations "Your work" performed for that additional insured and included in the "products - completed operations hazard". However, Paragraph 1, above is subject to the following: a. The insurance afforded to the additional insured only applies to the extent permit- ted by law; b. If coverage provided to the additional in- sured is required by a contract or agree- ment, the insurance provided to the additional insured will not be broader than that which you are required by the contract or agreement to provide for such addition- al insured; and c. If the contract or agreement between you and the additional insured is governed by California Civil Code Section 2782 or 2782.05, the insurance provided to the additional insured is the lesser of that which: (1) Is allowed for the satisfaction of a de- fense or indemnity obligation by Cali- fornia Civil Code Section 2782 or 2782.05 for your sole liability; or (2) You are required by contract or agreement to provide for such addi- tional insured. We have no duty to defend or indemnify the additional insured under this endorsement un- til a claim or "suit' is tendered to us. ©, Copyright, State Farm Mutual Automobile Insurance Company, 2013 Includes copyrighted material of Insurance Services Office, Inc., with its permission. CONTINUED 2. Any insurance provided to the additional in- sured shall only apply with respect to a claim made or a "suit' brought for damages for which you are provided coverage. 3. With respect to the insurance afforded to the additional insured, the following is added to SECTION 11— LIMITS OF INSURANCE: If coverage provided to the additional insured is required by contract or agreement, the most we will pay on behalf of the additional insured will be the lesser of the amount of insurance: a. Required by the contract or agreement; or b. Available under the applicable Limits Of Insurance shown in the Declarations. This endorsement shall not increase the ap- plicable Limits Of Insurance shown in the Declarations. 4. With respect to the insurance afforded to the additional insured, the following is added to Paragraph 3. Duties In The Event Of Occur- rence, Offense, Claim Or Suit of SECTION 11— GENERAL CONDITIONS: The additional insured must: a. See to it that we are notified as soon as practicable of an "occurrence" or an of- fense which may result in a claim. To the extent possible, notice should include: CMP-4786.1 Page 2 of 2 (3) The nature and location of any injury or damage arising out of the "occur- rence" or offense; b. Tender the defense and indemnity of any claim or "suit' to us and to all other insur- ers who may have insurance potentially available to the additional insured; and c. Agree to make available any other insur- ance the additional insured has for de- fense or damages for which we would provide coverage under SECTION II — LIABILITY. 5. With respect to the insurance afforded the ad- ditional insured, the following replaces SEC- TION II —LIABILITY of Paragraph 7. Other Insurance of SECTION I AND SECTION II — COMMON POLICY CONDITIONS: a. This insurance is primary to and will not seek contribution from any other insurance available to the additional insured, provided that the additional insured is a named in- sured under such other insurance. b. Regardless of any agreement between you and the additional insured, this insur- ance is excess over any other insurance whether primary, excess, contingent or on any other basis for which the additional in- sured has been added as an additional in- sured on other policies. (1) How, when and where the 'occur- There will be no refund of premium in the event rence" or offense took place; this endorsement is cancelled. (2) The names and addresses of any in- jured persons and witnesses; and All other policy provisions apply. CMP-4786.1 1007033 148011 08-21-2014 0, Copyright, State Farm Mutual Automobile Insurance Company, 2013 Includes copyrighted material of Insurance Services Office, Inc., with its permission. M Anahi Cazales 701 E 20" St. Santa Ana, CA. 92705 12/11/2019 City of Santa Ana Risk Management Division 20 Civic Center Plaza. Santa Ana, CA 92702 Re: Auto Insurance Requirement Release of Liability. Dear City of Santa Ana Risk Management Division: 1, Anahi Cazales, Bright Future Learning, hereby release die City of Automobile Liability. f do not use/drive any vehicle during the course and scope of my course/instruction class. During the term Jan 1, 2020 through Dec 31, 2020, 1 will be teaching Bright Future Learning at El Salvador center, located at: 1825 W Civic Center Dr., Santa Ana. Sind Anahi Cazales Recreation Class instructor & APPROVED mrMENT DIVISION 19 2019 M, LAMBERT CITY OFSANTA ANA RISR MANAGEMENT. d/<wu' 4HUMAN RESOURCES _ Managln,I Risk a wth Posldve Change WORKERS' COMPENSATION DECLARATION I, f►�I� f (lYAk5, hereby affirm under penalty of perjury, the (Nome/Title) following declaration: I certify on behalf of AMM tyAlLro that during the term (Consultant/Company Name) of my contract for (M1C(I I ngyKdrr-, services with the City of Santa Ana, (Type of service provided) 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 the provisions and provide proof of workers' compensation coverage immediately. Date: it 1N I&1 Print Name: OVI C1+,� 115 Print Title: t1 Signature: Telephone: �' LI . 3q,.1 � t5 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. & APPROVED \DEMENT DIvI5i0N 19 2019 MRisk Mgmtjlnsumnce Requirements) WC Declaration 08152019