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HomeMy WebLinkAboutHURLEY, PATRICKINSURANCE ON FILE N-2024-149 WORK MAY PROCEED UNTIL INSURANCE EXPIRES ql III CITY CLEAIWY DATE: 0 3 1024 p ,` o-C-5; aCiL) CITY OF SANTA ANA LS gA; J) RECREATION SERVICES AGREEMENT WITH PATRICK HURLEY FOR GUITAR LESSONS THIS AGREEMENT is made and entered into on this 3rd day of April 2024 by and between Patrick Hurley, an individual ("Provider"), 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"). City and Provider are also referred to as "the Parties." RECITALS A. The City desires to retain a recreation service provider having special skills, resources and knowledge to provide guitar lesson programming in its recreation class program. B. Provider represents that it is able and willing to provide such services to the City. C. In undertaking the performance of this Agreement, Provider represents that he is knowledgeable in his field and that any services performed by Provider under this Agreement will be performed in compliance with such standards as may reasonably be expected. D. The Parties acknowledge that the City intends to provide recreational activities to the public but must balance the need to comply with all COVID-19 guidance and restrictions. 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. Provider shall perform those services as set forth in Exhibit A to this Agreement. b. All classes operated pursuant to this Agreement for conducting recreation classes at City facilities, including parks, will comply with all applicable guidance and public health orders, including those from the Centers for Disease Control ("CDC"), California Department of Public Health ("CDPH"), the Orange County Health Care Agency ("OCHCA") and the City itself for as long as those orders and guidance remain in place. Provider will remind participants of these guidelines. To the extent that Provider needs assistance with enforcing any rules or requirements, Provider will contact a City Parks' employee or City security for assistance. c. Provider shall not attend a class or teach any class if Provider is sick or has any symptom(s) associated with COVID-19 including but not limited to, fever above 100.4, chills, cough, shortness of breath loss of taste or smell, nausea, muscle or body aches, vomiting, headache, sore throat or diarrhea. d. Provider will not attend class or teach a class if Provider or any member of Provider's household has been asked to quarantine or self -isolate due to symptoms of COVID-19 or a positive test result for COVID-19. Page 1 of 10 e. Provider acknowledges that, to the extent that City is able to and chooses to conduct classes indoors, this Agreement will also cover classes conducted at one of City's recreational centers during the term of this Agreement. City reserves the right to change the location(s) at which the services contemplated by this Agreement are provided. g. Provider shall comply with the City's recreation classes policy manual and any other City rules and regulations regarding the operation of recreation classes. 2. COMPENSATION a. In consideration for the provision of the programs set forth in Exhibit A, City agrees to pay, and Provider agrees to accept as total payment for their services for the City, seventy percent (70%) of all gross revenue received from program participants. Total annual revenue to Provider shall not exceed Twenty -Five Thousand Dollars and Zero cents ($25,000). b. 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. e. Provider agrees that City shall retain thirty percent (30%) of all gross revenue received from program participants as an administrative fee. d. City and Consultant agree that all payments due and owing under this Agreement shall be made through Automated Clearing House (ACH) transfers. Consultant 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 Consultant's account(s) with financial institutions. e. Payment need not be made for work that fails to meet the standards of performance set forth in the Recitals which may reasonably be expected by City. 3. TERM This Agreement shall commence on July 1, 2024 and end on June 30, 2025 unless terminated earlier in accordance with Section 14 below. The term of this Agreement may be extended for up to one (1) one-year period upon a writing executed by the City Manager and City Attorney. 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 Page 2 of 10 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 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. Total cost of such insurance shall be borne by Provider. 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. (2) Automobile Liability (AL). Insurance Services Office (ISO) Form CA 00 01 covering Code 1 (any auto), with limits of no less than $1,000,000 per accident for bodily injury and property damage. In the event Provider 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 hrsurance with limit of no less than $1,000,000 per accident for bodily injury or disease. (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 include affirmative coverage for sexual abuse or molestation, Provider 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 Provider 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 Provider. Any available insurance proceeds in excess of the specified minimum limits of insurance and coverage shall be available to the City. Page 3 of 10 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, AL, and SAML policies required above, with respect to liability arising out of work or operations performed by or on behalf of the Provider including materials, parts, or equipment furnished in connectionwith such work or operations. (2) Waiver of Subrogation. Provider's insurance company(ies) agree(s) to waive all rights of subrogation against 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 Provider under this Agreement. (3) Primary Coverage. For any claims related to this Agreement, Provider'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 to it. (4) Severability. A severability of interest provision must apply for all the additional insureds, ensuring that Provider's insurance shall apply separately to each insured against whom a claim is made or suit is brought, except with respect to the Provider'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. 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. Provider shall furnish 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 Page 4 of 10 documents prior to the work beginning shall not waive the Provider'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 Provider. Use this link to learn more: www.2sparta.com. 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. 6. INDEMNIFICATION Provider agrees to defend, and shall indemnify and hold harmless the City, its officers, agents, employees, Providers, 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 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, 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. CONFIDENTIALITY If Provider receives from the City information which due to the nature of such information is reasonably understood to be confidential and/or proprietary, Provider 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, including but not limited to student records. 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 Page 5 of 10 sources; (b) is, through no fault of the Provider disclosed in a publicly available source; (c) is in rightful possession of the Provider without an obligation of confidentiality; (d) is required to be disclosed by operation of law; or (e) is independently developed by the Provider without reference to information disclosed by the City. 8. COVID-19 ASSUMPTION OF RISK AND WAIVER Provider acknowledges that Provider could be exposed to persons that may have COVID- 19 providing services pursuant to this Agreement. Provider understands that interacting with any person currently comes with the inherent risk of exposure to COVID-19 and that COVID-19 is highly contagious. Provider assumes the risks associated with providing services pursuant to this Agreement, namely potential exposure to COVID-19. Provider acknowledges that while some people have no symptoms or mild symptoms from COVID-19, some people have become seriously ill requiring hospitalization and that some people have died from COVID-19. Provider acknowledges that persons over the age of 65 and persons with underlying health conditions are at greater risk of contracting COVID-19 and are potentially risking serious injury or death. Provider is agreeing to provide classes pursuant to this Agreement and does so of Provider's own free will. Provider intends to be legally bound by this assumption of risk, release and waiver and to bind Provider's heirs, personal representatives, next of kin and anyone who may make a claim on Provider's behalf. Provider knowingly releases and waives any and all claims that Provider may have or could have in the future and includes any claims resulting from potential exposure or actual exposure to COVID-19, this includes claims for personal injury, transmittal of COVID-19 to others, and/or wrongful death. Provider agrees to hold harmless, defend and indemnify the City, its public officials, officers, employees, volunteers, and agents from any and all claims for liability or damages, including those for exposure to or diagnosis with COVID-19 as a result of providing services pursuant to this Agreement. 9. 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. 10. BACKGROUND CHECK Provider shall ensure that all employees, subcontractors, and any volunteers are fingerprinted and background checked prior to conducting any work pursuant to this Agreement. Provider shall not assign any employee, agent, subcontractor, volunteer or the Provider personally to provide services pursuant to this Agreement, if that employee, agent, subcontractor, volunteer, or the Provider personally are required to register as a sex offender under California Penal Code Section 290 et seq, have a conviction for any crime of moral turpitude, have a conviction for a sexual based crime, have a conviction for a violent felony as defined in California Penal Code Section 667.5(c), or has a conviction for a serious felony as defined in California Penal Code Section 1192.7(c). Disqualifying convictions include but are not limited to, violations of California Penal Code Sections 37, 128, 136.1 with Section 186.22, 187, 190-190.4 and 192(a), 205, 206, Page 6 of 10 207-209.5, 211, 212, 212.5, 213, 214, 215, 218-219, 220, 236.1(b) or 236.1(c), 243.4, 261, 261.5, 273.5, 262, 264.1, 266, 266c, 266h, 266i, 266y 267, 269, 272, 273a, 273ab, 273d, 285, 286, 288, 288a, 288.2, 288.3, 288.4, 288.5, 288.7, 289, 290, 311.1, 311.2, 311.3, 311.4, 311.10, 311.11, 314, 347(a), 368, 417(b), 451(a),518 with 186.22, 647.6, 653f(c), 664 and 187, 667.5(c), 18745, 18750, or 18755, 12022.53, 11418(b)(1) or (b)(2); Business and Professions Code Section 729. 11. 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 With copy to: Executive Director 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: Patrick Hurley 14920 Minneola Ct, Tustin, CA 92780 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. 12. 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 Page 7 of 10 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, 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. 13. 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. 14. TERMINATION a. This Agreement may be terminated by the City immediately pursuant to any federal, state, county or local health order related to or regarding COVID-19 making it impossible to hold classes. For any other reason, this Agreement may be terminated by 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. 15. 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. 16. 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. Page 8 of 10 17. 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 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. 18. 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. 19. 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. 20. SEVERABILITY In the event that one or more of the phrases, sentences, clauses, paragraphs or sections contained in this Agreement shall 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. 21. EXHIBITS All Exhibits referenced herein and attached hereto shall be incorporated as if fully set forth in the body of this Agreement. 22. 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. [Signature Page Follows] Page 9 of 10 SIGNATURE PAGE FOR RECREATION SERVICES AGREEMENT WITH PATRICK HURLEY FOR GUITAR LESSONS IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first above written. ATTEST: APPROVED AS TO FORM: SONIA R. CARVALHO City Attorney By: B on Salvatierra Deputy City Attorney 25-4bll� Hawk Scott (Apr 5, 202412:57 CDT Hawk Scott Executive Director of Parks, Recreation and Community Services Agency C=&4*- Alvaro Nunez Acting City Manager PROVIDER: �6{t�l6if tf[2 e Patrick Hurley (Apr 5, 202410:5 DT) Patrick Hurley Instructor Page 10 of 10 EXHIBIT A Exhibit A SCOPE OF SERVICES A. Provider will teach Basic and Intermediate Guitar classes for students ages 9 and up. B. Provider shall teach such or similar classes (1) at the times below at a facility to be designated by the City or (2) on a schedule otherwise 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. C. The classes will be held throughout the year at the dates, times and locations as agreed between Provider and City. D. Provider will provide and be responsible for equipment, records, and personnel and cleanup of facilities and materials necessary to ensure the safety and effectiveness of said instruction. E. If Provider allows others to teach class, those teachers must be over 21, have obtained and maintained an instructor rating, and be covered by Providers' insurance. Provider shall provide City with documentation to verify instructor and insurance requirements. INSTRUCTOR: Pat Hurley LOCATION: El Salvador Park, 1825 W Civic Center Dr. SA.,CA. (714) 647- 6558 Basic Guitar Class is designed for the beginner student as well as the student who can play some songs. Basic chords, strumming patterns, finer picking, reading tablature, sight reading, and playing a variety of current songs will be taught. Students must provide their own guitar. • Basic Guitar classes will consist of 4 week sessions, held 1 day per week, 1 hour per day. Tuesdays 6:00pm-7:00pm, $45/month CLASS SIZE 1) Each class must have a minimum of 3 paid students and no more than a maximum of 10. 2) No registration will be accepted after the second meeting of class. 3) hi the event the minimum number of enrollees is not realized by the second meeting of the class, the class shall be canceled. Provider will be under no obligation to provide services and the City will have no obligations to pay Provider compensation CLASS FEES 1) Each participant shall pay class registration fee as established by City. 2) Provider may not waive class participation/ registration fees. 3) Only registered participants may participate in class. 4) Any refunds to participants will be made in accordance with City policy. 5) Any material fee shall be established by mutual agreement of City and Provider and shall be payable directly to provider. MISCELLANEOUS PROFESSIONAL LIABILITY MPL 00 24 11 15 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED ENDORSEMENT This endorsement modifies Insurance provided under the following: Miscellaneous Professional Liability Insurance Policy SECTION V — DEFINITIONS, Section M. `Insured" of the policy is amended to add the following: The Additional Insured stated below, but only for liability arising solely out of Wrongful Acts in the performance of Insured Services by the Named Insured or the Individual Insureds: City of Santa Ana Risk Management Division It is also agreed the policy does not apply to any Claim which includes allegations or facts indicating actual or alleged independent or direct liability on the part of an Additional Insured. All other terms and conditions of this policy remain unchanged. Digitally Angiesigned by Angie AceV1 `Acevedo Date: 2024.04.11 e d O 13:49:18 -071001 MPL 00 2411 15 Page 1 of t �AW CERTIFICATE OF LIABILITY INSURANCE DATE(YYYY) 08/15/20232023 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 pollcy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terns 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 endorsements). PRODUCER BIBERK P.O. Box 113247 Stamford, CT 06911 CAMT VT E PHo a ,844-472.0967 PAX 203-654-3613 NC No SNAIL customerservice@biBERK.com INSURER ($) AFFORDING COVERAGE NAI00 INSURER A: Berkshire Hathaway Direct Insurance Company 10391 INSUREC Pat Hurley INSURER M: INSURER C: INSURER D: 14920 Minnoola Ct Tustin, CA 92780 INSURER E: INSUR P: COVERAGES CERTIFICATE NUMBER: REVISION NDMRERz THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN 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. [NOR TYPEOFINSURANCE DADL SUER POLIOYNUMBER 9— POLICYPF POLICY EXP LIMITS COMMERCIALGENERAL LIABILITY CLAIMSMAOE ❑OCCUR EACH OCCURRENCE PREMISES Ea pour a as $ MED EXP(Arry one person) $ PERSONAL &ADV INJURY $ GENU AGGREGATE LIMIT APPLIES PER: POLICY ❑ j LOC GENERAL AGGREGATE $ PRODUCTS-COMP/OP AGO $ $ OTHER: AUTOMOOILELIABILITY COMUINEDSINGLELIMrr Fa amlden _ $ ANY AUTO BODILY INJURY(Par Person) $ OWNED SCHk-nULEU AUTOS ONLY AUTOS HIRED NON -OWNED AUTOB ONLY AUTOS ONLY BODILY INJURY(Paraorldra) $ PRCPERWDAMAOE er eccldenD $ UMSRELLALIAS OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR CLAIMS-MADe D R TON $ $ WCRRERSOOMPENSATIONTTUTE EMPLOYERS'LIABILITY YIN ANWROPRIET05WARTNEPIEXECU11VE CPPICERIMEMBER EXCLUGEIYf (Mandatory In NH) If you dsealbe under DCMIPTION OF OPERATIONS below NIA - 'ER' E.LEACHACCIDENT $ RL. DISEASE. EA EMPLOYEE $ EL DISEASE. POLICY LIMIT — $ A Profe5slonal Liability (Errors & Omissions): Claims -Made rxt X N9PL761342 09/01/2,023 09/01/2024 Per Occurrence/ Aggregate $1,000,0001 $1,000,000 Clty oflSanta Ana i$Rllsted as additional IInnlsured as It pertains to professio„al liability (seattached endorsement attachetdd))a) A Waiver of Subrogation is Included on the Professional Liability (E&O) pollcyinfavorof Cityof Santa Ana (see endorsement attached) This policy is primary as to losses It covers, and the Insurer will not seek contribution If there is a written agreement between the insured and the certificate 6 I Sexual Molestation Is Included On the professional Ilabllity limits at $250,000 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City Of Santa Ana. THE EXPIRATION DATE THEREOF, NOTICE ACCORDANCE WITH THE POLICY PROVISIONS. WILL BE DELIVERED IN Risk Management division 20 Civic Center Plaza AUTHORIZED REPRESENTATIVE In Santa Ana, CA 92702 ;" _.� .60,, 0 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks ofACORD (4) Wrongful Acts are committed. This sub -limit shall be part of, and not in addition to, the Total Limit of Insurance stated In Item 5.b. of the Declarations. Payment for Claim Expense or Dam- ages to which a sub -limit applies will reduce the Total Limit of Insurance available to pay Claims covered under this policy. All other terms and conditions of this policy remain unchanged, MPL 99 02 0318 Page 2 of 2 MISCELLANEOUS PROFESSIONAL LIABILITY MPL 99 02 0318 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NON -CLINICAL SOCIAL WORKER CHANGE ENDORSEMENT This endorsement modifies insurance provided under the following: Miscellaneous Professional Liability Insurance Policy SECTION III — EXCLUSIONS, Section A.1 of the policy is deleted in its entirety and replaced by the following: The Company Is not obligated to pay Damages or Claim Expense or defend Claims for or arising directly or indirectly out of: 1. Bodily Injury or Property Damage, except this exclusion does not apply to Damages or Claim Expense for Bodily Injury or Property Dam- age arising out of the Insured's performance of Insured Services, SECTION III — EXCLUSIONS, Section A of the policy Is amended to add the following: A. The Company is not obligated to pay Dam- ages or Claim Expense or defend Claims for or arising directly or indirectly out of: Administration or monitoring of detoxification programs. Diagnosing, failing to diagnose or prevent, preventing or treating any mental illnesses Prescription, sale or dispensing of over-the- counter or prescription drugs. SECTION III — EXCLUSIONS, Section A.5 of the policy is deleted in its entirety and replaced by the following: The Company is not obligated to pay Damages or Claim Expense or defend Claims for or arising directly or indirectly out of: S. Harassment, misconduct or discrimination because of or relating to: a. Race, creed, color or age; b. Sex, sexual preference, national origin or religion; or c. Handicap, disability or marital status, but only if the harassment, misconduct or discrimination was knowingly committed, as evidenced by any judgment, final adjudica- tion, alternate dispute resolution proceeding or written admission by the Insured. Pursu- ant to SECTION 11— LIMITS OF INSURANCE, RETENTION AND REIMBURSEMENT, Section C. of this poli- cy, the Company shall have a right to reim- bursement of any Damages or Claim Ex- pense paid by the Company as a result of a Claim to which this exclusion applies. This exclusion shall not apply to any actual or al- leged sexual misconduct, sexual abuse, and/or child abuse. SECTION 11 — LIMITS OF INSURANCE, RETENTION AND REIMBURSEMENT, Section A.3., Sub -Limits, of the policy is amended to add the following: Sexual Harassment The most the Company will pay for all Damages and Claim Expense for Claims alleging sexual misconduct, sexual abuse, and/or child abuse others shall be $ 250,000 , no matter how many: (1) Insureds this policy covers; (2) Claims are made; (3) Persons or organizations make Claims; or MPL 99 02 0318 Page 1 of 2 MISCELLANEOUS PROFESSIONAL LIABILITY MPL 99 22 05 20 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY INSURANCE NONCONTRIBUTORY OTHER Thra endorsement modifies insurance provided under the following: Miscellaneous Professional Liability Insurance Policy The following is added to the Other Insurance Con- dition 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 In- sured other 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 contribu- tion from any other insurance available to the additional insured. All other terms and conditions of this policy remain unchanged. MPL 99 22 05 20 Page 1 of 1 MISCELLANEOUS PROFESSIONAL LIABILITY MPL 00 80 11 15 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET WAIVER OF SUBROGATION AS REQUIRED BY CONTRACT CHANGE ENDORSEMENT This endorsement modifies insurance provided under the following: Miscellaneous Professional Liability Insurance Policy SECTION VI — GENERAL CONDITIONS, Section F Subrogation and Recovery of the policy is amend- ed to add the following additional paragraph after F.2: The Company hereby waives any of its rights to pursue recovery in a subrogation action against all clients of any Insured hereunder, where such waiver of subrogation by the Company is a con- tractual requirement for services performed un- der a written agreement between an Insured and any client of the Insured. This waiver of subrogation rights by the Company shall apply only with respect to clients of any Insured, and not to others, associated with any Claim brought against any Insured for services performed un- der a written agreement between the client and an Insured. All other terms and conditions of this policy remain unchanged. MPL 00 80 11 15 Page 1 of 1 MISCELLANEOUS PROFESSIONAL LIABILITY MPL 00 79 1115 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF SUBROGATION CHANGE ENDORSEMENT - CLIENT SPECIFIC This endorsement modifies insurance provided under the following: Miscellaneous Professional Liability Insurance Policy SECTION VI — GENERAL CONDITIONS, Section F Subrogation and Recovery, of the policy is amended to add the following additional paragraph after F.2: The Company hereby waives Its rights to pursue recovery in a subrogation action against City of Santa Ana Risk Management Division in connection with any Claim brought against any Insured for the performance of Insured Services. All other terms and conditions of this policy remain unchanged. MPL 00 7911 16 Page 1 of 1 MISCELLANEOUS PROFESSIONAL LIABILITY MPL 00 24 11 15 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED ENDORSEMENT This endorsement modifies insurance provided under the following: Miscellaneous Professional Liability insurance Policy SECTION V — DEFINITIONS, Section M. 'Insured" of the policy Is amended to add the following: The Additional Insured stated below, but only for liability arising solely out of Wrongful Acts in the performance of Insured Services by the Named Insured or the Individual Insureds: City of Santa Ana Risk Management Division It is also agreed the policy does not apply to any Claim which includes allegations or facts indicating actual or alleged Independent or direct liability on the part of an Additional Insured. All other terms and conditions of this policy remain unchanged. MPL 00 2411 15 Page 1 of 1 Auto Liability (Non -Use Agreement) Date 10/30/23 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: Pat Hurley has intent to enter into an agreement with the City of Santa Ana. Throughout the course of this agreement, Pat Hurley attests to the following: I Pat Hurley will not use/drive any vehicle during the course and scope of the services provided in the agreement/contract. 2 Pat Hurley will not use any owned/rented/leased vehicles during thecourse and scope of the services provided in the agreement/contract. 3, Pat Hurley 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,1, Pat Hurley 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 Pat Hurley 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: `' Name: Pat Hurley Job Title: Guitar Instructor Company Name: City of Santa Ana Contact Phone: 714 904-9310 Email Address: Lespau]971@aol.com CITY OF SANTA ANA RISK MANAGEMENT a division of HUMAN RESOURCES Managing Risk naarxjh Pos*m Change Affidavit of Exemption for Workers' Compensation Insurance Pat Hurley (NomeI771tle) following declaration: hereby affirm under penalty of perjury, the I certify on behalf of City of Santa Ana (Consultant/Company Name) that during the term of my contract for Guitar Instruction 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: 10/30/2023 Print Name: pat Hurley Print Title: Guitar Instructor Signature: Telephone: 714 904-9310 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, I:\Risk Mgmt\Insurance Requirements\ Affidavit of Exemption for Workers' Compensation Insurance 2021 CERTIFICATE OF LIABILITY INSURANCE DATE (MYYYY) 07/17/2022024 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 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 CONTACT NAME: Bene-Marc Athletic Insurance Agency #OE67789 F ILNE 'IC, No 1r800) $4 -173 Ex • FAX 6301 So est Bo levard Suite 1U1 I M/aIL nt b o � �C RE ' INSURER(S)AFF RDINGCOVERAGE NAIC# FortW h, ex IN URE 7 I al pec ty INSURED I' Sk R B I I C I I pang Southern California MuniciMlOhletic Federation (SCMAF) PO Box 3605 usu� Rc: South EI te, CA 91733 INSI—NSURE • I • • • SCMAFLe er� a e - si ar INSURER F : COV G C I 90F.s-54470 1 • • EVI 02/02/24 REVISED THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTS' BE'.JW HAVE BEEN ISSLAR TME417113FTM NAKXf ABOVIJWTHE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OF. r'_jNDITION 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 ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MMIDD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 � 18LB6293 01/01/2024 01/01/2025 DAMAGE TO RENTED 100,000.00 CLAIMS -MADE OCCUR PREMISES Ea occurrence $ MED EXP (Any one person) $ 5,000.00 PERSONAL & ADV INJURY $ 1,000,000.00 A X X Abuse & Molestation GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 5,000,000.00 X POLICY ❑ JECT PRO ❑ LOC 1,000,000 OCC./2,000,000 Agg. PRODUCTS - COMP/OP AGG $ 1,000,000.00 Participant Liability $ 1,000,000.00 OTHER: AUTOMOBILE LIABILITY CEa OMBINEDSINGLELIMITid accent $ BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS PROPERTY DAMAGE $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY Per accident UMBRELLA LAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LAB CLAIMS -MADE DED RETENTION $ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY YIN STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ NIA E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ B Participant Accident Medical SRPO-50256-243 01/01/2024 01/01/2025 Deductible: $0.00 Limit: $5,000.00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) This policy includes a blanket additional insured endorsement that provides additional insured status to the certificate holder perform CG 20 26 07 04. The General Liability policy contains Primary and Non Contributory wording per endorsement E1602AJ-1112. The General Liability policy contains an endorsement for Waiver of Transfer of Rights of Recovery Against Others to Us per attached form CG 24 04 05 09.City of Santa Ana entity, its officers, officials, agents and it's volunteers are additional insured. Coverage for SCMAF member approved activities for which a premium is paid and reported to the Company. SCMAF Member: Pat Hurley - Basic Guitar Coverage is limited to the following activity dates: 08/01/24-12/31/24 CERTIFICATE HOLDER CANCELLATION City of Santa Ana Risk Management SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PRC 20 Civic Center Plaza % orz„�F RiskManagmumtDMsian AUTHORIZED REPRESENTATIVE z REVIEWED & APPROVED BY: Santa Ana, CA 92701 �� Aceva4 Alisa Lynn Hall i®, ~1 Risk Management Specialist ©1988-2015 ACORD ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 18LB6293 COMMERCIAL GENERAL LIABILITY CG 20 26 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) City of Santa Ana Risk Management 20 Civic Center Plaza Santa Ana, CA 92701 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II — Who Is An Insured is amended to in- clude as an additional insured the person(s) or organi- zation(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omis- sions of those acting on your behalf: A. In the performance of your ongoing operations; or B. In connection with your premises owned by or rented to you. CG 20 26 07 04 © ISO Properties, Inc., 2004 % Risk ManagementD'Mslcrn REVIEWED& APPROVED BY. ® C / aN TI3�ti/ Risk Management Specialist Page 1 of 1 0 This Endorsement changes the Policy. Please read it carefully. COMMERCIAL GENERAL LIABILITY ENDORSEMENT PRIMARY AND NON-CONTRIBUTORY AMENDATORY — E1602AJ-1112 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name of Person Or Organization City of Santa Ana Risk Management 20 Civic Center Plaza Santa Ana, CA 92701 Policy Number- 18LB6293 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS, paragraph 4. Other Insurance is hereby deleted and replaced with the following: 4. Other Insurance If other valid and collectible insurance is available to the insured for a loss we cover under Coverages A or B of this Coverage Part, our obligations are limited as follows: a. Primary Insurance This insurance is primary except when Paragraph b. below applies. If this insurance is primary, our obligations are not affected unless any of the other insurance is also primary. Then, we will share with all that other insurance by the method described in Paragraph c. below. However, with respect to any other valid and collectible insurance available to a person or organization as scheduled above, this insurance shall be primary to other available sources, except where the liability of such person or organization is caused by his, her, or its own negligence. Nothing herein shall be construed to make this Policy subject to the terms, definitions, conditions and limitation of any other insurance. b. Excess Insurance (1) This insurance is excess over: (a) any of the other insurance, whether primary, excess, contingent or on any other basis: (i) that is Fire, Extended Coverage, Builder's Risk, Installation Risk or similar coverage for "your work"; (ii) that is Fire insurance for premises rented to you or temporarily occupied by you with permission of the owner; F Risk MougamentDMsian % x REVIEWED & APPROVED BY. — Risk Management Specialist All other terms and conditions of the Policv remain unchanged El602AJ-1112 Page 1 of 2 (iii) that is insurance purchased by you to cover your liability as a tenant for "property damage" to premises rented to you or temporarily occupied by you with permission of the owner; or (iv) if the loss arises out of the maintenance or use of aircraft, "autos" or watercraft to the extent not subject to Exclusion g. of Section I — Coverage A — Bodily Injury And Property Damage Liability. (b) any other primary insurance available to you covering liability for damages arising out of the premises or operations, or the products and completed operations, for which you have been added as an additional insured by attachment of an endorsement. (2) When this insurance is excess, we will have no duty under Coverages A or B to defend the insured against any "suit" if any other insurer has a duty to defend the insured against that "suit". If no other insurer defends, we will undertake to do so, but we will be entitled to the insured's rights against all those other insurers. c. Method Of Sharing In the instance where we are primary, we will be non-contributory. In any other instance, we will contribute as follows: If all of the other insurance permits contribution by equal shares, we will follow this method also. Under this approach each insurer contributes equal amounts until it has paid its applicable limit of insurance or none of the loss remains, whichever comes first. If any of the other insurance does not permit contribution by equal shares, we will contribute by limits. Under this method, each insurer's share is based on the ratio of its applicable limit of insurance to the total applicable limits of insurance of all insurers. (1) When this insurance is excess over other insurance, we will pay only our share of the amount of the loss, if any, that exceeds the sum of: (a) The total amount that all such other insurance would pay for the loss in the absence of this insurance; and (b) The total of all deductible and self -insured amounts under all that other insurance. (2) We will share the remaining loss, if any, with any other insurance that is not described in this Excess Insurance provision and was not bought specifically to apply in excess of the Limits of Insurance shown in the Declarations of this Coverage Part. F Risk MougamentDMsian % x REVIEWED & APPROVED BY. — Risk Management Specialist All other terms and conditions of the Policy remain unchanged E1602AJ-1112 Page 2 of 2 POLICY NUMBER: 18LB6293 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: City of Santa Ana Risk Management 20 Civic Center Plaza Santa Ana, CA 92701 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV — Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products -completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 © Insurance Services Office, Inc., 2008 Risk ManagementDMaian % REVIEWED & APPROVED BY. Risk Management Specialist Page 1 of 1 11 A DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 1 02/05/2025 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 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 CONTACT NAME: Bene-Marc Athletic Insurance Agency#OE67789 HONE /C No, o E:t: (800)247-1734 FAX No): 6301 Southwest Boulevard,Suite 101 E-MAIL contact@bene-marc.com ADDRESS: Fort Worth,Texas 76132 INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: HDI Global Specialty SE AA-1120822 INSURED INSURERB: AXIS Global Accident&Health Insurance Company 37273 Southern California Municipal Athletic Federation(SCMAF) PO Box 3605 INSURER C South El Monte,CA 91733 INSURER D SCMAF Member: Pat Hurley-Basic Guitar INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: 9066-55782 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR I POLICY NUMBER MM/DD/YYYY MM/DDIYYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 18LB7323 01/01/2025 01/01/2026 DAMAGE To RENTED 100,000.00 CLAIMS-MADE � OCCUR PREMISES RENTED. $ MED EXP(Any one person) $ 5,000.00 A X X Abuse& Molestation PERSONAL&ADV INJURY $ 1,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 5,000,000.00 X POLICY JECT PRO LOC 1,000,000 OCC./2,000,000 Agg. PRODUCTS-COMP/OPAGG $ 1,000,000.00 OTHER: Participant Liability $ 1,000,000.00 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ ❑ OFFICER/MEMBER EXCLUDED? N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ B Participant Accident Medical SRPO-50256-243 01/01/2025 01/01/2026 Deductible: $0.00 Limit: $5,000.00 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) This policy includes a blanket additional insured endorsement that provides additional insured status to the certificate holder per form CG 20 26 07 04. The General Liability policy contains Primary and Non Contributory wording per endorsement El602AJ-1112.The General Liability policy contains an endorsement for Waiver of Transfer of Rights of Recovery Against Others to Us per attached form CG 24 04 05 09.City of Santa Ana entity,it's officers,officials,agents and it's volunteers are additional insured. Coverage for SCMAF member approved activities for which a premium is paid and reported to the Company. APPROVE SCMAF Member: Tu Tran bynTngoed Pat Hurley- Guitar By Tu Tran Nguyen at 9:23 am,Feb 11,2025 Nguyen Coverage is limited to the following activity dates: 02/05/25-04/16/25 Nguyen 0-:2U208001 CERTIFICATE HOLDER CANCELLATION City Of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Santa Ana, Parks, Recreation and Community Services THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 20 Civic Center Plaza AUTHORIZED Lynn n HallSENTATIVE 1 Santa Ana,CA 92701 �1hi�rf�t^AIX1)(nN)' Alisa Lynn Hall @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 18LB7323 COMMERCIAL GENERAL LIABILITY CG 20 26 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) City of Santa Ana, its City Council, officers, officials, employees, agents, and volunteers 20 Civic Center Plaza Santa Ana, CA 92701 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II — Who Is An Insured is amended to in- clude as an additional insured the person(s) or organi- zation(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omis- sions of those acting on your behalf: A. In the performance of your ongoing operations; or B. In connection with your premises owned by or rented to you. CG 20 26 07 04 ©ISO Properties, Inc., 2004 Page 1 of 1 ❑ POLICY NUMBER: 18LB7323 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: City of Santa Ana,its City Council,officers,officials,employees,agents,and volunteers 20 Civic Center Plaza Santa Ana,CA 92701 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV— Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products-completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 1 ❑ This Endorsement changes the Policy. Please read it carefully. COMMERCIAL GENERAL LIABILITY ENDORSEMENT PRIMARY AND NON-CONTRIBUTORY AMENDATORY- E1602AJ-1112 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name of Person Or Organization City of Santa Ana, its City Council,officers,officials,employees,agents,and volunteers 20 Civic Center Plaza Santa Ana,CA 92701 Policy Number : 18LB7323 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. SECTION IV— COMMERCIAL GENERAL LIABILITY CONDITIONS, paragraph 4. Other Insurance is hereby deleted and replaced with the following: 4. Other Insurance If other valid and collectible insurance is available to the insured for a loss we cover under Coverages A or B of this Coverage Part, our obligations are limited as follows: a. Primary Insurance This insurance is primary except when Paragraph b. below applies. If this insurance is primary, our obligations are not affected unless any of the other insurance is also primary. Then, we will share with all that other insurance by the method described in Paragraph c. below. However, with respect to any other valid and collectible insurance available to a person or organization as scheduled above, this insurance shall be primary to other available sources, except where the liability of such person or organization is caused by his, her, or its own negligence. Nothing herein shall be construed to make this Policy subject to the terms, definitions, conditions and limitation of any other insurance. b. Excess Insurance (1) This insurance is excess over: (a) any of the other insurance, whether primary, excess, contingent or on any other basis: (i) that is Fire, Extended Coverage, Builder's Risk, Installation Risk or similar coverage for"your work"; (ii) that is Fire insurance for premises rented to you or temporarily occupied by you with permission of the owner; All other terms and conditions of the Policy remain unchanged E1602AJ-1112 Page 1 of 2 (iii) that is insurance purchased by you to cover your liability as a tenant for"property damage" to premises rented to you or temporarily occupied by you with permission of the owner; or (iv) if the loss arises out of the maintenance or use of aircraft, "autos" or watercraft to the extent not subject to Exclusion g. of Section I — Coverage A — Bodily Injury And Property Damage Liability. (b) any other primary insurance available to you covering liability for damages arising out of the premises or operations, or the products and completed operations, for which you have been added as an additional insured by attachment of an endorsement. (2) When this insurance is excess, we will have no duty under Coverages A or B to defend the insured against any "suit" if any other insurer has a duty to defend the insured against that "suit". If no other insurer defends, we will undertake to do so, but we will be entitled to the insured's rights against all those other insurers. c. Method Of Sharing In the instance where we are primary, we will be non-contributory. In any other instance, we will contribute as follows: If all of the other insurance permits contribution by equal shares, we will follow this method also. Under this approach each insurer contributes equal amounts until it has paid its applicable limit of insurance or none of the loss remains, whichever comes first. If any of the other insurance does not permit contribution by equal shares, we will contribute by limits. Under this method, each insurer's share is based on the ratio of its applicable limit of insurance to the total applicable limits of insurance of all insurers. (1) When this insurance is excess over other insurance, we will pay only our share of the amount of the loss, if any, that exceeds the sum of: (a) The total amount that all such other insurance would pay for the loss in the absence of this insurance; and (b) The total of all deductible and self-insured amounts under all that other insurance. (2) We will share the remaining loss, if any, with any other insurance that is not described in this Excess Insurance provision and was not bought specifically to apply in excess of the Limits of Insurance shown in the Declarations of this Coverage Part. All other terms and conditions of the Policy remain unchanged E1602AJ-1112 Page 2 of 2