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HAYNES, FRANKLIN (2)
INSURANCE ON FILE WORK MAY PROCEED UNTIL INSURANCE EXPIRES CITY CLERK DATE: MAR 2 7 ZOZ4 'Co% N-2024-106 U . P 9_ s AGREEMENT WITH FRANKLIN HAYNES, TO PROVIDE MARIONETTE PUPPET (S . 6,VJ) � SHOWS FOR CITY EVENTS THIS AGREEMENT is made and entered into this 5th day of March 2024, by and between Franklin Haynes, an individual ("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"), each a "Party" or collectively "Parties." RECITALS A. The City desires to retain a contractor to provide marionette puppet shows for various City events, including the City's Summer Splash Day Camp, Kids Night Out, Afterschool Programs, and other events ("Events") as directed by the City. B. Contractor represents that it 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 its 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 contracting 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 a. Contractor shall perform the services that are described in Exhibit A, attached hereto and incorporated by reference. To schedule services, Contractor will provide a quote to City detailing services and costs for an event. City will provide a letter agreement to Contractor, to be executed by the Executive Director of Parks, Recreation and Community Services, or their designee, and Contractor to finalize services and schedule the Event. Work by Contractor may not proceed without a letter agreement, signed by the parties, for a scheduled Event. b. City grants Contractor the right to enter its property for the purpose of delivery, set- up, operation, and pick-up on the days of the scheduled Events. C. The equipment shall be disassembled and removed by Contractor at the conclusion of each Event. 2. COMPENSATION a. City does not guarantee any minimum compensation to Contractor under this Agreement. Contractor shall be paid only for actual services performed under this Agreement at the rates and charges mutually agreed upon by the Parties, in an executed side letter, as defined in Section la of this Agreement. The total amount Page 1 of 10 to be expended under this Agreement shall not exceed Twenty -Five Dollars and Zero Cents ($25,000). b. Payment by City shall be made within forty-five (45) days following receipt of proper invoice evidencing work performed, subject to City accounting procedures. City and Contractor agree that all payments due and owing under this Agreement shall be made through Automated Clearing House (ACH) transfers. Contractor agrees to execute the City's standard ACH Vendor Payment Authorization and provide required documentation. Upon verification of the data provided, the City will be authorized to deposit payments directly into Contractor's account(s) with financial institutions. C. Payment need not be made for work that fails to meet the standards of performance set forth in the Recitals and Scope of Work, which may reasonably be expected by City. 3. TERM This Agreement shall commence on the date first written above and terminate on June 30, 2025, unless terminated earlier in accordance with Section 17, below. 4. PREVAILING WAGES Contractor is aware of the requirements of California Labor Code Section 1720, et seq., and 1770, et seq., as well as California Code of Regulations, Title 8, Section 16000, et seq., ("Prevailing Wage Laws"), which require the payment of prevailing wage rates and the performance of other requirements on "public works" and "maintenance" projects. If the services being performed are part of an applicable "public works" or "maintenance" project, as defined by the Prevailing Wage Laws, and the total compensation is $1,000 or more, Contractor agrees to fully comply with such Prevailing Wage Laws. Contractor shall defend, indemnify and hold the City, its elected officials, officers, employees and agents free and harmless from any claim or liability arising out of any failure or alleged failure to comply with the Prevailing Wage Laws, 5. 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. Page 2 of 10 6. OWNERSHIP OF MATERIALS This Agreement creates a non-exclusive and perpetual license for City to copy, use, modify, reuse, or sublicense any and all copyrights, designs, and other intellectual property embodied in plans, specifications, studies, drawings, estimates, and other documents or works of authorship fixed in any tangible medium of expression, including but not limited to, physical drawings or data magnetically or otherwise recorded on computer diskettes, which are prepared or caused to be prepared by Contractor under this Agreement ("Documents & Data"). Contractor shall require all subcontractors to agree in writing that City is granted a non-exclusive and perpetual license for any Documents & Data the subcontractor prepares under this Agreement. Contractor represents and warrants that Contractor has the legal right to license any and all Documents & Data. Contractor makes no such representation and warranty in regard to Documents & Data that were provided to Contractor by the City. City shall not be limited in any way in its use of the Documents & Data at any time, provided that any such use not within the purposes intended by this Agreement shall be at City's sole risk. 7. 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, for the entire Term of this Agreement, against claims for injuries to persons or damage to property which may arise from or in connection with services, products and materials supplied to City. Total cost of such insurance shall be borne by Contractor. a. Minimum Scope and Limit of Insurance (1) Commercial General Liability (CGL). Insurance Services Office ("ISO") Form CG 00 01 covering CGL on an "occurrence" basis, including products and completed operations, property damage, bodily injury and personal & advertising injury with limits no less than $1,000,000 per occurrence and $2,000,000 aggregate. Required policy limits can be met with primary and umbrella/excess insurance policies. (2) Automobile Liability. ISO Form CA 00 01 covering Code 1 (any auto), with limits no less than $1,000,000 per accident for bodily injury and property damage. In the event Contractor does not maintain commercial automobile liability insurance, City will accept evidence of personal automobile insurance as compliance with this requirement. (3) Workers' Compensation. As required by the State of California, with Statutory Limits, and Employer's Liability Insurance with limit of no less than $1,000,000 per accident for bodily injury or disease. Coverage is not required if Contractor has no employees and signs request to waive.\ (4) Sexual Abuse or Molestation Liability (SAML). If the work will include contact with minors, and the CGL policy referenced above is not endorsed to Page 3 of 10 include affirmative coverage for sexual abuse or molestation, Contractor shall obtain and maintain a policy covering Sexual Abuse and Molestation with a limit of no less than $1,000,000 per occurrence or claim. (5) Broader Coverage. If the Contractor maintains broader coverage and/or higher limits than the minimums shown above, the City requires and shall be entitled to the broader coverage and/or the higher limits maintained by the Contractor. Any available insurance proceeds in excess of the specified minimum limits of insurance and coverage shall be available to the City. b. Other Insurance Provisions The above required insurance policies are to contain or be endorsed to contain the following provisions: (1) Additional Insured Status. The City, its officers, officials, employees, and volunteers are to be covered as additional insureds on the CGL policy, with respect to liability arising out of work or operations performed by or on behalf of the Contractor including materials, parts, or equipment furnished in connectionwith such work or operations. (2) Waiver of Subrogation. Contractor's insurance company(ies) agree(s) to waive all rights of subrogation against the City, its City Council, its officers, officials, employees, agents, and volunteers for losses paid under the terms of any policy which arise from work performed by Contractor under this Agreement. (3) Primary Coverage. For any claims related to this Agreement, Contractor's insurance coverage shall be primary and any insurance maintained by City, its City Council, its officers, officials, employees, agents, or volunteers shall not contribute with it. (4) Severability. A severability of interest provision must apply for all the additional insured, ensuring that Contractor's insurance shall apply separately to each insured against whom a claim is made or suit is brought, except with respect to the insurer's limits of liability. (5) Cancellation. Insurance policy(ies) herein shall provide that coverage shall not be canceled, suspended, voided, reduced in coverage or in limits, non -renewed by the carrier, or materially changed except after thirty (30) days prior written notice has been given to City. Ten (10) days prior written notice shall be provided to City for policy cancellation or non -renewal due to non-payment. (6) Certificate Holder. The Certificate Holder on each evidence of insurance certificate shall be: City of Santa Ana, 20 Civic Center Plaza, Santa Ana, CA 92701. Page 4 of 10 C. Acceptability of Insurers. Insurance is to be placed with insurers authorized to conduct business in the state with a current A.M. Best's rating of no less than A: VII, unless otherwise acceptable to the City. d. Verification of Coverage. Contractor shall famish the City with original Certificates of Insurance including all required amendatory endorsements (or copies of the applicable policy language effecting coverage requiredby this clause) and a copy of the Declarations and Endorsement Page of the CGL policy listing allpolicy endorsements to City before work begins. However, failure to obtain the required documents prior to the work beginning shall not waive the Contractor's obligation to provide them. The City reserves the right to require complete, certified copies of all required insurance policies,including endorsements required by these specifications, at any time. e. Special Events Coverage. Special events coverage is available and can be purchased by Contractor. Use this link to learn more: www.2sparta.com f Special Risks or Circumstances. City reserves the right to modify these requirements, including limits, based on the nature of therisk, prior experience, insurer, coverage, or other special circumstances. 8. INDEMNIFICATION Contractor agrees to defend, and shall indemnify and hold harmless the City, its officers, agents, employees, contractors, 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 Contractor or its subcontractors, agents, employees, or other persons acting on their behalf which relates to the services described in section 1 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. The 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 Page 5 of 10 2782.8, to claims that arise of, pertain to, or relate to the negligence, recklessness, or willful misconduct of the Contractor. 9. INTELLECTUAL PROPERTY INDEMNIFICATION Contractor represents and warrants that it has obtained the requisite licenses to show the films contemplated by this Agreement. Contractor further agrees to defend, indemnify and hold harmless the City, its officers, agents, representatives, and employees against any and all liability, including costs, and attorney's fees, for infringement of any United States' letters patent, trademark, or copyright contained in the work product or documents provided by Contractor to the City pursuant to this Agreement. 10. RECORDS Contractor shall keep records and invoices in connection with the work to be performed under this Agreement. Contractor shall maintain complete and accurate records with respect to the costs incurred under this Agreement and any services, expenditures, and disbursements charged to the City for a minimum period of three (3) years, or for any longer period required by law, from the date of final payment to Contractor under this Agreement. All such records and invoices shall be clearly identifiable. Contractor shall allow a representative of the City to examine, audit, and make transcripts or copies of such records and any other documents created pursuant to this Agreement during regular business hours. Contractor shall allow inspection of all work, data, documents, proceedings, and activities related to this Agreement for a period of three (3) years from the date of final payment to Contractor under this Agreement. 11. 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. "Confidential Information" shall include all nonpublic information. Confidential information includes not only written information, but also information transferred orally, visually, electronically, or by other means. Confidential information disclosed to either party by any subsidiary and/or agent of the other party is covered by this Agreement. The foregoing obligations of non-use and nondisclosure shall not apply to any information that (a) has been disclosed in publicly available sources; (b) is, through no fault of the Contractor disclosed in a publicly available source; (c) is in rightful possession of the Contractor without an obligation of confidentiality; (d) is required to be disclosed by operation of law; or (e) is independently developed by the Contractor without reference to information disclosed by the City. 12. CONFLICT OF INTEREST CLAUSE Contractor covenants that it presently has no interest and shall not have interests, direct or indirect, which would conflict in any manner with performance of services specified under this Page 6 of 10 Agreement. 13. 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: City Clerk City of Santa Ana 20 Civic Center Plaza (M-30) P.O. Box 1988 Santa Ana, CA 92702-1988 Fax 714- 647-6956 Executive Director Parks, Recreation, and Community Services Agency City of Santa Ana 20 Civic Center Plaza (M-23) P.O. Box 1988 Santa Ana, CA 92702 To Contractor: Franklin Haynes Marionettes 1234 Muirfield Road Riverside, CA 92506 franklinghaynesmaiionettes.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 timeframes, weekends, federal, state, County or City holidays shall be excluded. 14. EXCLUSIVITY AND AMENDMENT This Agreement represents the complete and exclusive statement between the City and Contractor 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 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 Page 7 of 10 bind or obligate Contractor or the City. Each parry 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. 15. 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 that are the subject to this Agreement performed by City personnel or by other contractors retained by City. 16. WAIVER No waiver of breach, failure of any condition, or any right or remedy contained in or granted by the provisions of this Agreement shall be effective unless it is in writing and signed by the party waiving the breach, failure, right or remedy. No waiver of any breach, failure or right, or remedy shall be deemed a waiver of any other breach, failure, right or remedy, whether or not similar, nor shall any waiver constitute a continuing waiver unless the writing so specifies. 17. TERMINATION This Agreement may be terminated by the City upon thirty (30) days written notice of termination. hi 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, subject to the following conditions: a. As a condition of such payment, the Executive Director may require Contractor to deliver to the City all work product completed as of such date, and in such case, such work product shall be the property of the City unless prohibited by law, and Contractor consents to the City's use thereof for such purposes as the City deems appropriate. b. Payment need not be made for work that fails to meet the standard of performance specified in the Recitals of this Agreement. 18. NON-DISCRIMINATION Contractor 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 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. Contractor affirms that it is an equal opportunity employer and shall comply with all applicable federal, state and local laws and regulations. Page 8 of 10 19. 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. 20. 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 be cause for termination of this Agreement. 21. NHSCELLANEOUS PROVISIONS a. Each undersigned represents and warrants that its signature herein below 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. [signature page follows/ Page 9 of 10 N-2024-106 SIGNATURE PAGE FOR AGREEMENT WITH FRANKLIN HAYNES, TO PROVIDE MARIONETTE PUPPET SHOWS FOR CITY EVENTS IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first above written. CITY OF SANTA ANA 71wAYR-Aw- 'Momas R. Hatch Interim City Manager APPROVED AS TO FORM SONIA R. CARVALHO City Attorney By: andon Salvatierra Deputy City Attorney RECOMMENDED FOR APPROVAL Hawk Scott (Mar 13, 202415:33 PDT) Hawk Scott Executive Director Parks, Recreation, and Community Services Agency CONTRACTOR 17 '�lir. Huy.aes Owner Page 10 of 10 EXHIBIT A Exhibit A SCOPE OF SERVICES VENDOR INFORMATION: Franklin Haynes Marionettes (FHM) EVENTS: Summer Splash Day Camp, Kid's Night Out, Afterschool Programs, As Needed City Events SERVICE DATE(S): Dates, times, and locations will be mutually agreed upon, in writing, by the parties for varied City Events, including but not limited to the events listed above. COMPENSATION DUE TO THE VENDOR: Franklin Haynes Marionettes will quote and bill per service within a price range of $400 - $600. Compensation amount will be determined by show choice, show length, event size and agreed upon, in writing, by the parties. DESCRIPTION: Franklin Haynes Marionettes will provide shows using professionally handcrafted marionettes will provide one -hour of special entertainment at Summer Splash Day Camp, Kid's Night Out, Afterschool Programs, and other special events at the following centers: El Salvador Community Center Jerome Community Center Salgado Community Center Garfield Community Center Roosevelt Walker Community Center Additional City locations, as agreed upon, in writing, by the parties ILI bi SPECIALTY IN$VAANCI AOINCT CERTIFICATE OF LIABILITY INSURANCE FOATE (MM/DD/YYYYI 02/22/2024 IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and condhions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the c IN lieu of such endorsement(S). ucpaeteI�holder sl rance Agency C ntact Name: Heather Weiss Zenzen f� ,,1 P ers of the U.S. Acevedo Phone: 715-246-8908 FAX: 715-246-8908 p �1 3432 DenmarklAve#231 Date: 2O24.03.1814. certs@specialtyinsumnceagency.com 1 RS AFFORDING COVERAGE NAIC # INSURED PERFORMERS OF THE U.S. MID ITS PAR IRVIATING M s: 0 0 INSURER A: Evanston Insurance Company 35378 Terry Conci INSURER B: dba Franklin Haynes Marionettes INSURER C: 1234 Muirfield Road Riverside, CA 92506 INSURER D: L:UVt_HAUtJ 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 CONTRACTOR 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS INSD vmo DATE(MM/DD/YY) DATE(MM/DD/YY) :X] COMMERCIAL GENERAL EACH OCCURRENCE $ 1,000,000 LIABILITY DAMAGE TO RENTED CLAIMSMADELCCUR —PREMISES (Eeoccurtence) $300,000 GENT AGGREGATE LIMIT MED IXP (Any one person) $ 5,000 A X X 2CN0177-7334 09/08/2023 09/07/2024 PERSONALBADV INJURY APPLIES PER: $1,000,000 GENERAL AGGREGATE $ 2,000,000 X POLICY ❑PROJECT PRODUCTS-COMP/OP LOG AGG $ 2,000,000 PERFORMER ASSISTANTS) EACH OCCURRENCE $ A AGGREGATE $ A BUSINESS PERSONAL PROPERTY -INLAND MARINE AGGREGATE $ SEXUALABUSEAND EACH OCCURRENCE $1,000,000 A MOLESTATION 2CN0177-7334 09/08/2023 09/07/2024 $2,000,000 X OCCUR AGGREGATE A DATA BREACH AND CYBER AGGREGATE $ LIABILITY COVERAGE A EQUIPMENT LEASED OR AGGREGATE $ RENTED DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS PERFORMER IS A NAMED INSURED AS A MEMBER OF PERFORMERS OF THE U.S.: Terry Cone! dba Franklin Haynes Marionettes Additional Insured: The City of Santa Ana, Risk Management, it's officers, employees, agents, representatives, and volunteers as additional inured. Coverage is primary and not -contributory with respect to insurance or self-insurance maintained by the City. Waiver of Subrogation applies to general liability. Thirty (30) day prior written notice of Cancellation required. Sexual abuse or molestation coverage is not excluded by endorsement. $1,000,000/$2,000,000 coverage limits apply to educational institutions only; otherwise $100,000 each occurrence/$300,000 aggregate limits apply to sexual abuse or molestation coverage. Email: jhoang@santa-ana.org Event Dates: 05/04/2024 - 07/15/2024 Insured for: Puppeteer CERTIFICATE HOLDER CANCELLATION City of Santa Ana Risk Management Division I SHUULU ANY OF IHE ABOVE DESCRIBED POLICIES BE CANCELLED ORE THE EXPIRATION DATE THEREOF, THE INSURER AFFORDING 20 Civic Center Plaza, 4th floor Santa Ana, CA 92702RAGE WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE -^��DbA -t,. TIFlCATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO $O A±% �:. RENEWED Yy APPROVED BY: LL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE 1( A,.�:.r A - _ 1 RER, ITS AGENTS OR REPRESENTATIVES. Risk Management Spedkist ORIZED REPRESENTATIVE ,inl ql I n POLICY NUMBER: 2CN0177-7334 COMMERCIAL GENERAL LIABILITY CG 20 12 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - STATE AGENCY OR SUBDIVISIO SUBDIVISION - PERMITS OR This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE N OR GOVERNMENTAL OR POLITICAL AUTHORIZATIONS State Or Governmental Agency Or Subdivision Or Political Subdivision: City of Santa Ana Risk Management Division 20 Civic Center Plaza, 4th floor Santa Ana, CA 92702 The City of Santa Ana, Risk Management, it's officers, employees, agents, representatives, and volunteers as additional inured. Coverage is primary and not -contributory with respect to insurance or self-insurance maintained by the City. Waiver of Subrogation applies to general liability. Thirty (30) day prior written notice of cancellation required. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured any state or governmental agency or subdivision or political subdivision shown in the Schedule, subject to the following provisions: 1. This insurance applies only with respect to operations performed by you or on your behalf for which the state or governmental agency or subdivision or political subdivision has issued a permit or authorization. However: a. The insurance afforded to such additional insured only applies to the extent permitted by law; and b. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 12 04 13 2. This insurance does not apply to: a. "Bodily injury", "property damage" or "personal and advertising injury" arising out of operations performed for the federal government, state or municipality; or b. "Bodily injury" or "property damage" included within the "products -completed operations hazard". B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. •"�_^`ec Rutk AlD[vlel"` Renexn:o 6 APPROVm Br. Auw.1e 1' Risk Management Specialist © Insurance Services Office, Inc., 2012 Page 1 of 1 COMMERCIAL GENERAL LIABILITY POLICY NUMBER: 2CN0177-7334 MARKEL® EVANSTON INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM SCHEDULE Name Of Person Or Organization: Any person(s) or organization(s) with whom the Named Insured agrees, in a written contract executed prior to the "occurrence", to waive rights of recovery Additional Premium: $ The following is added to Condition 8. Transfer Of Rights Of Recovery Against Others To Us under Section IV — Commercial General Liability Conditions: We waive any right of recovery we may have against any person or organization shown in the Schedule of this endorsement. This waiver applies only to the person or organization shown in the Schedule of this endorsement. All other terms and conditions remain unchanged. 4�t� RIeItAlanpgemattlTMeiPn a,` •3 REVIEWED ,APPRfT/®BY: ql MEGL 0241-01 OS 16 Includes ct A'.`n ' rvices Office, Inc., R6k Mznagement Spetlalist Page 1 of 1 POLICY NUMBER: 2CN0177-7334 COMMERCIAL GENERAL LIABILITY CG 20 01 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. Rink MotagemodDMolon REVIEWED&RPPROVaJBY.' Risk Management Spedalist CG 20 01 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 Auto Liability (Non -Use Agreement) Date 2/20/24 City of Santa Ana Risk Management Division 20 Civic Center Plaza Santa Ana, CA 92702 Re: Auto Insurance Requirement Dear City of Santa Ana Risk Management Division: Franklin Haynes Marionettes has intent to enter into an agreement with the City of Santa Ana. Throughout the course of this agreement, Franklin Haynes Marion attests to the following: I Franklin Haynes Marionettes will not use/drive any vehicle during the course and scope of the services provided in the agreement/contract. 2 Franklin Haynes Marionettes will not use any owned/rented/leased vehicles during thecourse and scope of the services provided in the agreement/contract. 3. Franklin Haynes Marionettes consultants/independent contractors/employees utilize their personal vehicles/non-company owned, borrowed, or rented/leased vehicles for transportation to and from work and if applicable carry their own automobile insurance. By signing below, I, Franklin Haynes attest that I possess the legal authority to enter into an agreement with the City of Santa Ana as well as the legal authority to attest to the statements above. If at any time it is found that Franklin Haynes is not adhering to any/all statements in this document and has not provided the minimum Auto liability insurance coverage of $1 million per occurrence, the contract will be considered null and void andthe company will be held fully liable for any and all damages. Signature:"' f Name: Franklin Haynes Job Title: puppeteer Company Name: Franklin F Contact Phone: 800-687-535 Email Address: Frank@Puppe g='-tw jj ,, Risk MaagmientEliwfmt RENAMEO&APPRQ BY. MWRisk Management SpeaAist 00, I, CITYOF.SANTAANA RISK MANAGEMENT a division of HUMAN RESOURCE5 Managing Risk urrouab Post m Change Affidavit of Exemption for Workers' Compensation Insurance Franklin Haynes (Name/Title) following declaration: hereby affirm under penalty of perjury, the I certify on behalf of Franklin Haynes Marionettes that during the term (Consultant/Company Name) of my contract for marionette puppet shows 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: 2/20/24 Print Name: Franklin Haynes Print Title: Puppeteer Signature: Telephone: 800-687-5393 �—r-- 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. iiEVIE &APP ckmo : A,,JU ®' Risk Management Spedahst I:\Risk Mgmt\Insurance Insurance 2021 Ir r DATE SPECIALTY CERTIFICATE OF LIABILITY INSURANCE (MM/DD/YYYY) INSURANCE AGENCY 08/28/2024 IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or 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 ` , Specialty Insurance Agency C Inta t e l e�I r ss�I n e Y Performers of the U.S. I PI : ne: 715 6-8908 FW. 715-246-8908 3432 Denmark Ave #231 Err ill: tyi r e Eagan, MN 55123 It 3l RtRTAFWM G tOMMIT NAIC # INSURED PERFORMERS OF THE U.S. AND ITS PARTICIPATING MEMBERS: ZRIEr. in U a 8 Terry Conci INs,'�L� • • •1. dba Franklin Haynes MarioAcevedo t 1234 Muirfield Road INSURERC30% 9!nk!l 9!nk n!71 n rh I Riverside, CA 92506 — INSURE • • COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS INSD VWD DATE (MM/DD/YY) DATE (MM/DD/YY) GENERAL EACH OCCURRENCE $ 1 000 000 COMMERCIAL LIABILITY CLAIMS MADE X�OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ 300,000 MED EXP (Any one person) $ 5,000 A GEN'L AGGREGATE LIMIT X X 2CN0180-7334 09/08/2024 09/08/2025 12:01 am PERSONAL &ADV INJURY $ 1,000,000 APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X�POLICY PROJECT 171 PRODUCTS - COMP/OP $ 2,000,000 LOC AGG PERFORMER ASSISTANT(S) EACH OCCURRENCE $ A AGGREGATE $ A BUSINESS PERSONAL AGGREGATE $ PROPERTY - INLAND MARINE SEXUAL ABUSE AND EACH OCCURRENCE $ 1,000,000 A MOLESTATION 2CN0180-7334 09/08/2024 09/08/2025 12:01 am $ 2,000,000 X� OCCUR AGGREGATE A DATA BREACH AND CYBER AGGREGATE $ LIABILITY COVERAGE A EQUIPMENT LEASED OR AGGREGATE $ RENTED DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS PERFORMER IS A NAMED INSURED AS A MEMBER OF PERFORMERS OF THE U.S.: Terry Conci dba Franklin Haynes Marionettes Additional Insured: The City of Santa Ana, Risk Management, it's officers, employees, agents, representatives, and volunteers as additional inured. Coverage is primary and not -contributory with respect to insurance or self-insurance maintained by the City. Waiver of Subrogation applies to general liability. Thirty (30) day prior written notice of cancellation required. Sexual abuse or molestation coverage is not excluded by endorsement. $1,000,000/$2,000,000 coverage limits apply to educational institutions only; otherwise $100,000 each occurrence/$300,000 aggregate limits apply to sexual abuse or molestation coverage. Email: jhoang@santa-ana.org Attn: Julie Hoang Event Dates: 08/28/2024 - 04/30/2025 Insured for: Puppeteer GtK I IFIGAI L KULULK GANGELLATIUN City Of Santa Ana Risk Management Division SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE 20 Civic Center Plaza, 4th floor Santa Ana, CA 92702 COVERAGE WILL LL EENNDEERA1 RiskMwwgemodDivision CERTIFICATE HOLDER N a "� :e SHALL IMPOSE NO OBLI( i a REVIEWED & APPROVED BY. INSURER, ITS AGENTS OI `I,A a; cJ A� A �I _ o 1. AUTHORIZED REPRESENT �', r I � �� Risk Management Specialist POLICY NUMBER: 2CN0180-7334 COMMERCIAL GENERAL LIABILITY CG20120413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - STATE AGENCY OR SUBDIVISION SUBDIVISION - PERMITS OR This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE OR GOVERNMENTAL OR POLITICAL AUTHORIZATIONS State Or Governmental Agency Or Subdivision Or Political Subdivision: City of Santa Ana Risk Management Division 20 Civic Center Plaza, 4th floor Santa Ana, CA 92702 The City of Santa Ana, Risk Management, it's officers, employees, agents, representatives, and volunteers as additional inured. Coverage is primary and not -contributory with respect to insurance or self-insurance maintained by the City. Waiver of Subrogation applies to general liability. Thirty (30) day prior written notice of cancellation required. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured any state or governmental agency or subdivision or political subdivision shown in the Schedule, subject to the following provisions: 1. This insurance applies only with respect to operations performed by you or on your behalf for which the state or governmental agency or subdivision or political subdivision has issued a permit or authorization. However: a. The insurance afforded to such additional insured only applies to the extent permitted by law; and b. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. 2. This insurance does not apply to: a. "Bodily injury", "property damage" or "personal and advertising injury" arising out of operations performed for the federal government, state or municipality; or b. "Bodily injury" or "property damage" included within the "products -completed operations hazard". B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 12 04 13 © Insurance Services Office, Inc., 2012 oR,N�F RiskMougementDMslcrn r' REVIEWED & APPROVED BY. x Risk Management Specialist Page 1 of 1 COMMERCIAL GENERAL LIABILITY POLICY NUMBER: III 2CN0180-7334 MARKEL' EVANSTON INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM SCHEDULE Name Of Person Or Organization: Any person(s) or organization(s) with whom the Named Insured agrees, in a written contract executed prior to the 'occurrence", to waive rights of recovery Additional Premium: $ The following is added to Condition 8. Transfer Of Rights Of Recovery Against Others To Us under Section IV — Commercial General Liability Conditions: We waive any right of recovery we may have against any person or organization shown in the Schedule of this endorsement. This waiver applies only to the person or organization shown in the Schedule of this endorsement. All other terms and conditions remain unchanged. oR,N�F RiskMougementDMsian REVIEWED & APPROVED BY. MEGL 0241-01 05 16 Includes copyrighted material of Insurance Services Office, ®} A"AaN44 suce ces � �1 Risk Management Specialist with its permission. POLICY NUMBER: 2CN0180-7334 COMMERCIAL GENERAL LIABILITY CG 20 01 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. CG 20 01 04 13 © Insurance Services Office, Inc., 2012 oR,N�F RiskMougementDMsian r' REVIEWED & APPROVED BY. x Risk Management Specialist Page 1 of 1 Dig itaIly sig ned Tu Tran by Tu Tran Nguyen Renewal auto policy declarations NguyenDagtZ 0zo oo3 WAllstate. Your policy effective date is January 11,2025 APPROVED By Tu Tran Nguyen at 12:13 pm,Jun 03,2025 Page 1 of 4 Information as of November 20,2024 Total Amount Due for the Policy Period Please review your insured vehicles and verify their VI Ns are correct. Summary Vehicles covered Identification Number Premium Named Insured(s) 2017 Volvo Xc90 YV4A22PK9H1150953 $870.78 Catherine Parra,Franklin Haynes 2010 Ford Van Econoline 1FTNEIEL8ADA15582 826.98 Mailing address California Fraud Assessment Fee 1.76 1234 Muirfield Ct Total* $1,699.52 Riverside CA 92506-5577 Policy number *Your bill will be mailed separately.Before making a payment,please refer to your 924 941 534 latest bill,which includes payment options and installment fee information.If you do Your policy provided by not pay in full,you will be charged an installment fee(s). Allstate Northbrook Indemnity See the Important payment and coverage information section for details about Company installment fees. Policy period Beginning January 11,2025 through July 11,2025 at 12:01 a.m.standard time DISCOUntS (included in your total premium) Your Allstate agency is Anti-theft $6.24 Good Driver(20%) $406.72 Alvarado Agency Multiple Policy $84.18 Distinguished $162.34 3579 Arngtn Ave#700 Driver Riverside CA 92506-3916 Total discounts $659.48 (951)369 0277 malvarado6@al Istate.com Discounts per vehicle Some or all of the information on your Policy Declarations is used in the rating 2017 Volvo Xc90 $409,92 of your policy or it could affect your Anti-theft $6.24 Good Driver(20%) $199.97 eligibility for certain coverages.Please Multiple Policy $41.37 Distinguished $162.34 notify us immediately if you believe that Driver any information on your Policy 2010 Ford Van Econoline $249.56 Declarations is incorrect.We will make Good Driver(20%) $206.75 Multiple Policy $42.81 corrections once you have notified us, and any resulting rate adjustments,will be made only for the current policy Listed drivers on your policy period or for future policy periods. Catherine Parra Please also notify us immediately if you Franklin Haynes believe any coverages are not listed or are inaccurately listed. Excluded drivers from your policy None 0 m 0 0 u Renewal auto policy declarations Page 2 of 4 Policy number: 1924941 534 Policy effective date: January 11,2025 Coverage detail for 2017 Volvo Xc90 Coverage Limits Deductible Premium Automobile Liability Insurance Not applicable $365.07 • Bodily Injury $100,000 each person $300,000 each occurrence • Property Damage $100,000 each occurrence Auto Collision Insurance Actual cash value $1,000 $245.45 Waiver of deductible applies Auto Comprehensive Insurance Actual cash value $500 $118.50 Rental Reimbursement Not purchased* Towing and Labor Costs $100 each disablement Not applicable $4.81 Uninsured Motorists Insurance for Bodily $100,000 each person Not applicable $136.95 Injury $300,000 each accident Automobile Medical Payments Not purchased* Coordinated Medical Protection Not purchased* Sound System Not purchased* Tape Not purchased* Total premium for 2017 Volvo Xc90 $870.78 *This coverage can provide you with valuable protection. To help you stay current with your insurance needs,contact your Allstate agent to discuss coverage options and other products and services that can help protect you. VIN YV4A22PK9H1150953 Rating information Your premium is determined based on certain information,including the following: • This vehicle is driven 3-9 miles to work/school, married person licensed 45 years. Allstate uses mileage information as one factor to help determine your premium amount. o m 0 Important Note:The annual mileage figure applicable to this vehicle for the expiring policy period was:8,000-8,499.The a annual mileage figure applicable to this vehicle for the current policy period is:9,000-9,499. The required odometer information to calculate your annual mileage for the current policy period was not provided,was illegible,could not be obtained or the most recent odometer reading we received was less than a previous reading. 0 0 If any of the information shown above is incorrect,missing or changes in the future,please contact your Allstate o representative.Please keep in mind that a change in any of the information may result in an adjustment to your premium. o m O � CO � o � o rn o o � 00 o � o ¢_ o14 � N O ¢ N N V N O V Q � U O � O N O � H N x ¢ Renewal auto policy declarations Page 3 of 4WAllstate. Policy number: 924941 534 Policy effective date: January 11,2025 g Coverage detail for 2010 Ford Van Econoline Coverage Limits Deductible Premium Automobile Liability Insurance Not applicable $476.59 ■ Bodily Injury $100,000 each person $300,000 each occurrence ■ Property Damage $100,000 each occurrence Auto Collision Insurance Actual cash value $1,000 $121.18 Waiver of deductible applies Auto Comprehensive Insurance Actual cash value $500 $58.11 Rental Reimbursement Not purchased* Towing and Labor Costs $100 each disablement Not applicable $4.81 Uninsured Motorists Insurance for Bodily $100,000 each person Not applicable $166.29 Injury $300,000 each accident Automobile Medical Payments Not purchased* Coordinated Medical Protection Not purchased* Sound System Not purchased* Tape Not purchased* Total premium for 2010 Ford Van Econoline $826.98 *This coverage can provide you with valuable protection. To help you stay current with your insurance needs,contact your Allstate agent to discuss coverage options and other products and services that can help protect you. VIN 1FTNElEL8ADA15582 Lienholder Westlake Portfolio Management Rating information Your premium is determined based on certain information,including the Interested party following: Westlake Portfolio Management ■ This vehicle is driven 3-9 miles to work/school, married person licensed 32 years. Allstate uses mileage information as one factor to help determine your premium amount. Important Note:The annual mileage figure applicable to this vehicle for the expiring policy period was:11,000-11,499.The annual mileage figure applicable to this vehicle for the current policy period is:11,000-11,499. The required odometer information to calculate your annual mileage for the current policy period was not provided,was illegible,could not be obtained or the most recent odometer reading we received was less than a previous reading. If any of the information shown above is incorrect,missing or changes in the future,please contact your Allstate representative.Please keep in mind that a change in any of the information may result in an adjustment to your premium. 0 m 0 0 u Renewal auto policy declarations Page 4 of 4 Policy number: 1924941 534 Policy effective date: January 11,2025 Additional coverages Automobile Death Indemnity Insurance Not purchased* Automobile Disability Income Protection Not purchased* Identity Theft Expenses Not purchased* *This coverage can provide you with valuable protection. To help you stay current with your insurance needs,contact your Allstate agent to discuss coverage options and other products and services that can help protect you. Your policy documents Your automobile policy consists of this Policy Declarations and the documents in the following list. Please keep these together. ■ Allstate Automobile Policy-AU104-3 ■ California Amendatory Endorsement-AU14629-3 ■ Amendment of Policy Provisions-AU14626-1 ■ California Paperless Disclosure-AU14943 Important payment and coverage information Here is some additional,helpful information related to your coverage and paying your bill: ►Your rate is lower because you are insuring multiple cars. ►Your bill will be sent to you in a separate mailing and will list any payment option(s)available to you. If you are eligible to pay your premium in installments,your first/renewal bill will reflect your available payment options, including the option to pay in full or to pay in monthly installments. If you decide to pay your premium in installments,there will be a$3.50 installment fee charge for each payment due. If you make 5 installment payments during the policy period,and do not change your payment plan method,then the total amount of installment fees during the policy period will be$17.50. If you are on the Allstate® Easy Pay Plan,there will be a$1.00 installment fee charge for each payment due. If you make 5 installment payments during the policy period,and remain on the Allstate® Easy Pay Plan,then the total amount of installment fees during the policy period will be$5.00. 0 m If you change payment plan methods or make additional payments,your installment fee charge for each payment due and the total amount of installment fees during the policy period may change or even increase. Please note that the Allstate® Easy Pay Plan allows you to have your insurance payments automatically deducted from your checking or savings account. o 0 0 0 Allstate Northbrook Indemnity Company's Secretary and President have signed this policy with legal authority at Northbrook, F� o Illinois. o m O Ln/� o V/� o N a, Oo o Phil Telgenhoff Courtney Welton o 0 President Secretary R o " 0 0 o N N � N N O � Q o O U O N O � H N X Q Renewal auto policy declarations Allstate Your policy effective date is July 11,2025 Page 1 of 5 Information as of May 20,2025 Total Amount Due for the Policy Period Please review your insured vehicles and verify their VI Ns are correct. Summary Vehicles covered Identification Number Premium Named Insured(s) 2017 Volvo Xc90 YV4A22PK9H1150953 $1,971.40 Catherine Parra,Franklin Haynes 2010 Ford Van Econoline 1FTNEIEL8ADA15582 901.24 Mailing address California Fraud Assessment Fee 1.76 1234 Muirfield Ct Riverside CA 92506-5577 Total* $2 8774,40 Policy number *Your bill will be mailed separately.Before making a payment,please refer to your 924 941 534 latest bill,which includes payment options and installment fee information.If you do Your policy provided by not pay in full,you will be charged an installment fee(s). Allstate Northbrook Indemnity See the Important payment and coverage information section for details about Company installment fees. Policy period Beginning July 11,2025 through January 11,2026 at 12:01 a.m.standard time DISCOUntS (included in your total premium) Your Allstate agency is Anti-theft $16.13 Good Driver(20%) $700.43 Alvarado Agency Multiple Policy $146.08 3579 Arngtn Ave#700 Total discounts $862.64 Riverside CA 92506-3916 (951)369-0277 ma Iva rado6@al Istate.com Discounts per vehicle Some or all of the information on your 2017 Volvo Xc90 $590,56 Policy Declarations is used in the rating Anti-theft $16.13 Good Driver(20%) $475.11 of your policy or it could affect your Multiple Policy $99.32 eligibility for certain coverages.Please 2010 Ford Van Econoline $272,08 notify us immediately if you believe that Good Driver(20%) $225.32 Multiple Policy $46.76 any information on your Policy Declarations is incorrect.We will make corrections once you have notified us, Surcharge (included in your total premium) and any resulting rate adjustments,will 2017 Volvo Xc90 be made only for the current policy period or for future policy periods. - At Fault Accident:02/27/2025 Please also notify us immediately if you believe any coverages are not listed or Listed drivers on your policy are inaccurately listed. Catherine Parra Franklin Haynes Excluded drivers from your policy None 0 m 0 0 u Renewal auto policy declarations Page 2 of 5 Policy number: 1924941 534 Policy effective date: July 11,2025 Coverage detail for 2017 Volvo Xc90 Coverage Limits Deductible Premium Automobile Liability Insurance Not applicable $732.66 • Bodily Injury $100,000 each person $300,000 each occurrence • Property Damage $100,000 each occurrence Auto Collision Insurance Actual cash value $1,000 $569.54 Waiver of deductible applies Auto Comprehensive Insurance Actual cash value $500 $306.66 Rental Reimbursement Not purchased* Towing and Labor Costs $100 each disablement Not applicable $4.28 Uninsured Motorists Insurance for Bodily $100,000 each person Not applicable $358.26 Injury $300,000 each accident Automobile Medical Payments Not purchased* Coordinated Medical Protection Not purchased* Sound System Not purchased* Tape Not purchased* Total premium for 2017 Volvo Xc90 $1,971.40 *This coverage can provide you with valuable protection. To help you stay current with your insurance needs,contact your Allstate agent to discuss coverage options and other products and services that can help protect you. VIN YV4A22PK9H1150953 Rating information Your premium is determined based on certain information,including the following: • This vehicle is driven 3-9 miles to work/school, married person licensed 46 years. Allstate uses mileage information as one factor to help determine your premium amount. o m 0 Important Note:The annual mileage figure applicable to this vehicle for the expiring policy period was:9,000-9,499.The a annual mileage figure applicable to this vehicle for the current policy period is:9,000-9,499. The required odometer information to calculate your annual mileage for the current policy period was not provided,was N illegible,could not be obtained or the most recent odometer reading we received was less than a previous reading. o M If any of the information shown above is incorrect,missing or changes in the future,please contact your Allstate o 6 representative.Please keep in mind that a change in any of the information may result in an adjustment to your premium. N o La � O � O v M N N O V O O O p¢ O N lf7 V I� V M MM Q N Ln o O O Ln Ln N N O V Q � U O � O N O � H N x Q Renewal auto policy declarations A I Istate Policy number: 924941 534 Page 3 of 5 Policy effective date: July 11,2025 Coverage detail for 2010 Ford Van Econoline Coverage Limits Deductible Premium Automobile Liability Insurance Not applicable $526.17 ■ Bodily Injury $100,000 each person $300,000 each occurrence ■ Property Damage $100,000 each occurrence Auto Collision Insurance Actual cash value $1,000 $121.18 Waiver of deductible applies Auto Comprehensive Insurance Actual cash value $500 $63.54 Rental Reimbursement Not purchased* Towing and Labor Costs $100 each disablement Not applicable $4.28 Uninsured Motorists Insurance for Bodily $100,000 each person Not applicable $186.07 Injury $300,000 each accident Automobile Medical Payments Not purchased* Coordinated Medical Protection Not purchased* Sound System Not purchased* Tape Not purchased* Total premium for 2010 Ford Van Econoline $901.24 *This coverage can provide you with valuable protection. To help you stay current with your insurance needs,contact your Allstate agent to discuss coverage options and other products and services that can help protect you. VIN 1FTNElEL8ADA15582 Lienholder Westlake Portfolio Management Rating information Your premium is determined based on certain information,including the Interested party following: Westlake Portfolio Management ■ This vehicle is driven 3-9 miles to work/school, married person licensed 32 years. Allstate uses mileage information as one factor to help determine your premium amount. Important Note:The annual mileage figure applicable to this vehicle for the expiring policy period was:11,000-11,499.The annual mileage figure applicable to this vehicle for the current policy period is:11,000-11,499. The required odometer information to calculate your annual mileage for the current policy period was not provided,was illegible,could not be obtained or the most recent odometer reading we received was less than a previous reading. If any of the information shown above is incorrect,missing or changes in the future,please contact your Allstate representative.Please keep in mind that a change in any of the information may result in an adjustment to your premium. 0 m 0 0 u Renewal auto policy declarations Page 4 of 5 Policy number: 1924941 534 Policy effective date: July 11,2025 Additional coverages Automobile Death Indemnity Insurance Not purchased* Automobile Disability Income Protection Not purchased* Identity Theft Expenses Not purchased* *This coverage can provide you with valuable protection. To help you stay current with your insurance needs,contact your Allstate agent to discuss coverage options and other products and services that can help protect you. Your policy documents Your automobile policy consists of this Policy Declarations and the documents in the following list. Please keep these together. ■ Allstate Automobile Policy-AU104-3 ■ California Amendatory Endorsement-AU14629-3 ■ Amendment of Policy Provisions-AU14626-1 ■ California Paperless Disclosure-AU14943 Important payment and coverage information Here is some additional,helpful information related to your coverage and paying your bill: ►If we cancel or non-renew your policy,a copy of the notice of cancellation will be sent to all listed drivers on the policy. ►Your rate is lower because you are insuring multiple cars. ►Your bill will be sent to you in a separate mailing and will list any payment option(s)available to you. If you are eligible to pay your premium in installments,your first/renewal bill will reflect your available payment options, including the option to pay in full or to pay in monthly installments. If you decide to pay your premium in installments,there will be a$3.50 installment fee charge for each payment due. If you make 5 installment payments during the policy period,and do not change your payment plan method,then the total amount of installment fees during the policy period will be$17.50. If you are on the Allstate® Easy Pay Plan,there will be a$1.00 installment fee charge for each payment due. If you make 6 installment payments during the policy period,and remain on the Allstate® Easy Pay Plan,then the total amount of installment o fees during the policy period will be$6.00. o 0 If you are on the Recurring Credit Card Plan,there will be a$3.50 installment fee charge for each payment due. If you make 6 U installment payments during the policy period,and do not change your payment plan method,then the total amount of installment fees during the policy period will be$21.00. ¢ N 0 O If you change payment plan methods or make additional payments,your installment fee charge for each payment due and the a total amount of installment fees during the policy period may change or even increase. o 0 N O M O Please note that the Allstate® Easy Pay Plan allows you to have your insurance payments automatically deducted from your l o checking or savings account. N N oa oo o o 0 o ¢ o Ln N lf1 � n o O M M O ¢ N N o q O N N Ln � Q o U O O N O � H N X ¢ CITY OF SANTA ANA Risk Management a division of Human Resources Managing Risk through Awareness and Action 0- AFFIDAVIT OF EXEMPTION FOR WORKERS' COMPENSATION INSURANCE I, Franklin Haynes ("Representative"), attest that I am an authorized (Name and Title of Vendor Representative) representative of Franklin Haynes Marionettes ("Company"), and (Consultant/Company Name) possess the authority to legally bind Company. In my capacity as Representative of Company, I represent and confirm the following,as relates to the agreement between Company and City of Santa Ana, agreement number ("Agreement")to provide Summer Splash Marionette Puppet Shows ("Services"): (Services to be provided under agreement/contract) During the course and scope of Company's agreement with the City of Santa Ana,Company will not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if Company should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, Company shall forthwith comply with the provisions and provide proof of workers' compensation coverage immediately. If at any time it is found that Company is not adhering to any and/or all of the statements in this document and does not maintain the minimum professional liability insurance coverage as required in the Agreement,it will be considered a breach of Agreement rendering the Agreement null and void and Company will be fully liable for any and all damages. 6/3/25 Signature Date Franklin Haynes Print Name Owner, Puppeteer Title 800-687-5193 Frank@PuppetShows.com Contact hiformation,i.e.,Telephone Number and/or Email Address WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSANT 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. Affidavit of Exemption for Workers'Compensation Insurance 11.12.2024