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HomeMy WebLinkAboutLE, CHOC 2EAGREEMENT TERMINATION Please complete this form when the attached agreement is no longer in ef£Vn - Return form to the Sr. Deputy Clerk of the Council (M-30). Call 647-52 ii£ ou have any,t sus questions- ns E Cl - ---------------------%%--j-------------------------------- The agreement with i ` hc, No, was completed on � ! 22 �i } , and final payment has been made. Department: J f C Signature: _ �. Date: %fir _` r City of Santa Ana Revised 8-7-01 Clerk of the Council A-2004-122 INSURANCE ON FILE WORK MAY PROCEED UNTIL INSURANCE EXPIRES ' _ & _ v5 CONSULTANT AGREEMENT CLERK OF COUNCIL f. DATE: &-r1-vv THIS AGREEMENT made and entered into this 21 S day of TunE 2004 by and between Choc Le, an individual (hereinafter "Consultant'), and the City of Santa Ana, a i�f7 charter city and municipal corporation organized and existing under the Constitution and laws of Cd the State of California (hereinafter "City"). RECITALS A. The City desires to retain a consultant having special skill and knowledge in the field of Tae-Kwan-Do instruction. B. Consultant represents that Consultant is able and willing to provide such services to the City. C. In undertaking the performance of this Agreement, Consultant represents that it is knowledgeable in its field and that any services performed by Consultant under this Agreement will be performed in compliance with such standards as may reasonably be expected from a professional consulting 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: SCOPE OF SERVICES Consultant shall perform those services as set forth in Exhibit A to this Agreement. 2. COMPENSATION a. City agrees to pay, and Consultant agrees to accept as total payment for its services, the rates and charges identified in Exhibit A. The total sum to be expended under this Agreement shall not exceed $22,300.00 during the term of this Agreement. b. Payment by City shall be made within thirty (30) days following receipt of proper invoice evidencing work performed, subject to City accounting procedures. Payment need not be made for work which 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, 2004 and terminate on June 30, 2005, unless terminated earlier in accordance with Section 12, below. The term of this Agreement may be extended upon a writing executed by the Executive Director of Parks, Recreation and Community Services and the City Attorney. 4. INDEPENDENT CONTRACTOR Consultant 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 Consultant performs the services which are the subject matter of this Agreement; however, the services to be provided by Consultant shall be provided in a manner consistent with all applicable standards and regulations governing such services. Consultant shall pay all salaries and wages, employer's social security taxes, unemployment insurance and similar taxes relating to employees and shall be responsible for all applicable withholding taxes. 5. INSURANCE Prior to undertaking performance of work under this Agreement, Consultant shall maintain and shall require its subcontractors, if any, to obtain and maintain insurance as described below: a. Commercial General Liability Insurance. Consultant shall maintain commercial general liability insurance naming the City, its officers, employees, agents, volunteers and representatives as additional insured(s) and shall include, but not be limited to protection against claims arising from bodily and personal injury, including death resulting therefrom and damage to property, resulting from any act or occurrence arising out of Consultant's operations in the performance of this Agreement, including, without limitation, acts involving vehicles. The amounts of insurance shall be not less than the following: single limit coverage applying to bodily and personal injury, including death resulting therefrom, and property damage, in the total amount of $1,000,000 per occurrence. Consultant shall supply City with a fully executed additional insured endorsement in substantially the form attached hereto as Exhibit B upon execution of this Agreement and shall be approved in form by the City Attorney. b. Worker's Compensation Insurance. In accordance with the provisions of Section 3300 of the Labor Code, Consultant, if Consultant has any employees, is required to be insured against liability for worker's compensation or to undertake self-insurance. Prior to commencing the performance of the work under this Agreement, Consultant agrees to obtain and maintain any employer's liability insurance with limits not less than $1,000,000 per accident. c. The following requirements apply to the insurance to be provided by Consultant pursuant to this section: (i) Consultant shall maintain all insurance required above in full force and effect for the entire period covered by this Agreement. (ii) Certificates of insurance shall be furnished to the City upon execution of this Agreement and shall be approved in form by the City Attorney. (iii) Certificates and policies shall state that the policies shall not be canceled or reduced in coverage or changed in any other material aspect without thirty (30) days prior written notice to the City. d. If Consultant fails or refuses to produce or maintain the insurance required by this section or fails or refuses to furnish the City with required proof that insurance has been procured and is in force and paid for, the City shall have the right, at the City's election, to forthwith terminate this Agreement. Such termination shall not effect Consultant's right to be paid for its time and materials expended prior to notification of termination. Consultant waives the right to receive compensation and agrees to indemnify the City for any work performed prior to approval of insurance by the City. 6. INDEMNIFICATION Consultant agrees to and shall indemnify and hold harmless the City, its officers, agents, employees, consultants, special counsel, and representatives from liability for personal injury, damages, just compensation, restitution, judicial or equitable relief arising out of claims for personal injury, including health, and claims for property damage, which may arise from the direct or indirect operations of the Consultant 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. The Consultant 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 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. CONFIDENTIALITY If Consultant receives from the City information which due to the nature of such information is reasonably understood to be confidential and/or proprietary, Consultant 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. 8. CONFLICT OF INTEREST CLAUSE Consultant 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. 9. NOTICE Any notice, tender, demand, delivery, or other communication pursuant to this Agreement shall be in writing and shall be deemed to be properly given if delivered in person or mailed by first class or certified mail, postage prepaid, or sent by telefacsimile or other telegraphic communication in the manner provided in this Section, to the following persons: To City: Clerk of the City Council City of Santa Ana 20 Civic Center Plaza (M-30) P.O. Box 1988 Santa Ana, CA 92702-1988 telefacsimile (714) 647-6956 With courtesy copy to: Executive Director of Parks, Recreation and Community Services City of Santa Ana 20 Civic Center Plaza (M-23) P.O. Box 1988 Santa Ana, California 92702 telefacsimile (714) 571-4235 To Consultant: Choc Le 4 Fabriano Irvine, California 92620 A party may change its address by giving notice in writing to the other party. Thereafter, any notice, tender, demand, delivery, or other communication shall be addressed and transmitted to the new address. If sent by mail, any notice, tender, demand, delivery, or other 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 telefacsimile, any notice, tender, demand, delivery, or other communication shall be effective or deemed to have been given twenty-four (24) hours after the time set forth on the transmission report issued by the transmitting facsimile machine, addressed as set forth above. For purposes of calculating these time frames, weekends, federal, state, County or City holidays shall be excluded. 10. EXCLUSIVITY AND AMENDMENT This Agreement represents the complete and exclusive statement between the City and Consultant, 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 Consultant. 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 Consultant nor the City. Each party to this Agreement acknowledges that no representations, inducements, promises or agreements, orally or otherwise, have been made by any party, or anyone acting on behalf of any party, which are not embodied herein. 11. ASSIGNMENT Inasmuch as this Agreement is intended to secure the specialized services of Consultant, Consultant 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. 12. TERMINATION This Agreement may be terminated by the City upon thirty (30) days written notice of termination. In such event, Consultant shall be entitled to receive and the City shall pay Consultant compensation for all services performed by Consultant prior to receipt of such notice of termination. 13. DISCRIMINATION Consultant shall not discriminate because of race, color, creed, religion, sex, marital status, sexual orientation, age, national origin, ancestry, or disability, as defined and prohibited by applicable law, in the recruitment, selection, training, utilization, promotion, termination or other employment related activities. Consultant affirms that it is an equal opportunity employer and shall comply with all applicable federal, state and local laws and regulations. 14. JURISDICTION - VENUE This Agreement has been executed and delivered in the State of California and the validity, interpretation, performance, and enforcement of any of the clauses of this Agreement shall be determined and governed by the laws of the State of California. Both parties further agree that Orange County, California, shall be the venue for any action or proceeding that may be brought or arise out of, in connection with or by reason of this Agreement. 15. PROFESSIONAL LICENSES Consultant 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. 16. MISCELLANEOUS PROVISIONS a. All Exhibits referenced herein and attached hereto shall be incorporated as if fully set forth in the body of this Agreement. IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first above written. ATTEST: PATRICIA E. HEALY Clerk of the Council APPROVED AS TO FORM: JOSEPH W.FLETCHER City Attorney By:, Ladfa Sheedy Assistant City Attorney RECOMMENDED FOR APPROVAL: JJR1P " RIBBLE Executive Director of Parks, Recreation and Community Services CITY OF SANTA ANA AVID N. REAM City Manager CONSULTANT &q-" CHOC LE Tax ID# S$ (p —�S-0 _76SS EXHIBIT A SCOPE OF SERVICES Consultant shall provide Tae-Kwan-Do instruction for youth, teens and adults as follows: Consultant shall provide professional Tae-Kwan-Do instruction. Consultant has determined that the class will be held Saturdays from 9am - Ipm during the months of April to December and on Sundays from 9am — 1 pm in January, February and March. Consultant may adjust the schedule, based on the availability of rooms in the City's facility. Consultant shall determine which holidays will be observed. The classes will be held at the Salgado Recreation Center. The parties agree that Consultant presently has scheduled to use the gym from 9am— 12 pm and the Community Room from l2pm— 1pm. Each class shall have a minimum of 10 and a maximum of 130, registered and paid participants. If the minimum registration has not been reached by the second class, the class may be cancelled by mutual agreement of Consultant and City, with no compensation owed Consultant for any cancelled class session. Consultant shall provide and be responsible for equipment, records, personnel and clean- up of the facilities and materials necessary to ensure the safety and effectiveness of instruction. FEES • Each participant shall pay a $20.00 class registration fee per monthly session. • No refunds will be made to participants after the commencement of a session unless the class is cancelled by the Parks, Recreation and Community Services Agency. • City shall collect registration fees from each participant. Consultant shall refer interested students to City for registration. • Consultant shall receive seventy percent (70%) of total fees collected for the classes within fifteen (15) working days after completion of each class session. City shall retain thirty percent (30%) of the fees collected. • Consultant agrees that City shall be entitled to audit Consultant's records and classes to ensure compliance with this Agreement and that all participants are registered. • Consultant may not waive class participation/registration fees. • City shall prepare class rosters and provide a copy to Consultant. Only registered participants, listed on roster, may participate in class. EXHIBIT B ADDITIONAL INSURED ENDORSEMENT FOR COMMERCIAL GENERAL LIABILITY POLICY Insurance Company This endorsement modifies such insurance as is afforded by the provisions of Policy # relating to the following: 1. The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701; its officers, employees, agents, volunteers and representatives are named as additional insureds ("additional insureds") with regard to liability and defense of suits arising from the operations and uses performed by or on behalf of the named insured. 2. With respect to claims arising out of the operations and uses performed by or on behalf of the named insured, such insurance as is afforded by this policy is primary and is not additional to or contributing with any other insurance carried by or for the benefit of the additional insureds. 3. This insurance applies separately to each insured against whom claim is made or suit is brought except with respect to the company's limits of liability. The inclusion of any person or organization as an insured shall not affect any right which such person or organization would have as a claimant if not so included. 4. With respect to the additional insureds, this insurance shall not be cancelled, or materially reduced in coverage or limits except after thirty (30) days written notice has been given to the City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701. (Completion of the following, including countersignature, is required to make this endorsement effective.) Effective Policy # Issued to this endorsement form as a part of Named Insured Countersigned by Authorized Representative Administrative Office 1400 American Lane Schaumburg, Illinois 60196 STEADFAST INSURANCE COMPANY A ZURICH C0i CERTIFICATE OF LIABILITY INSURANCE Policy Number: EOL5281394-00 Fitness and Wellness Purchasing Group Certificate Number: 0375057 N NAMED 0375057 Choc V. Le AGENT Fitness and Wellness Insurance Agency AND rJAME AND 380 Stevens Avenue, #206 MAILING 4 Fabriano MAILING ADDRESS Solana Beach, CA 92075 ADDRESS Irvine, CA 92620-2576 800-395-8075 - LIC#OD28716 POLICY PERIOD: From: 01/06/04 To: 01/06/05 THIS CERTIFICATE OF LIABILITY INSURANCE FORMS A PART OF THE POLICY REFERENCED ABOVE. INSURANCE AS IDENTIFIED BELOW HAS BEEN ISSUED, IS IN FORCE, AND CONVEYS ALL THE RIGHTS AND PRIVILEGES AFFORDED UNDER THE POLICY. THE INSURANCE COVERAGE PROVIDED UNDER THIS CERTIFICATE IS SUBJECT TO ALL THE TERMS, CONDITIONS, AND EXCLUSIONS OF THE POLICY IDENTIFIED ABOVE, COVERAGES LIMITS OF INSURANCE Bodily Injury, Property Damage or Professional Incident $1 000,000 Each Occurrence Limit Personal and Advertising Injury Limit S1 000,000 Any ore Person or Drgaricaton General Aggregate Limit (Other than $3 000,000 Products/Completed Operations) Products/Completed Operations Aggre2ate Limit Coverage D Medical Expenses S 2,500 Any One aerson Coverage E Sexual and/or Physical Abuse Liability $ 100,000 Ea&,, Claim Limits Coverage F Employer's Liability (Only available in $ 300 000 Only Ann a' Aggregate Laic the following States ND, OH, WVA, N/A and PJY)$ in State(s) 100,000 where this Insurance applies: Bodily Injury by Accident — Each Acodert j $ 100,000 Bodily Injury by Disease— Each Employee � l$ 500000 Aggrega•eLlmit— EmployersLiability __ Damage tc Premises Rented to You $ 100 000 Any One Premise The most we will pay for any ocecrrerce or related occurrerce that triggers Professional Incident or Bodily Irjury, P•ocerr/ Damage or ary comb nation tl-ereo' is the each occui-rence lrn t. Payments made under Sexual and/or Physical Abuse, Medical Expenses. Employers Liability, (where applicable), and Damages to �rerrises Parted to You ceplete the general aggregate limit of liability. Location of all premises you own, rent or occuoy. 1) Various IF YOU HAVE ANY QUESTIONS CONCERNING THIS CERTIFICATE CONTACT. FITNESS AND WELLNESS INSURANCE AGENCY - 800-395-3C75 Jeffrey E. Frick JANUARY 27 2004 Authorized Representative Date Form #: Cert1 '��ol nLkill: Lill :AitUn:r� DATE: Januan 28. 2004 POLICY NUMBER: EOL5281394-00 INSURED NAME: 0375057 Choc V. Le THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY CG 20 10 1185 ADDITIONAL INSURED --OWNERS, LESSEES OR CON TRACTORS (FORM B) This endorsement modifies insurance provided under the fcllowine COM]NIERCLIL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Perscn or Organization: City of Santa Ana IobrProiect. (If no entryappears above, infermaticn req tired to complete this endorsement wil] De shown ia'lc D:clarationa as applicable to this endorsement.) WHO IS AN LNSTU .ED (Section II) is amended to :ncludc as an insured the person or org„nizati n shy wr in the Schedule, but only with respect to liability arising out of "your work" fef that insured by or fcr y„a Primary Irsuance it is agreed that such insurance ac is afforded by this policy :or the benefit of the ad,!, .anal insured shown shall be pritll insu: ante, and any other jnsuranoe maintained by :he eddition:d in.rad_ steal: be excess and r-on-contributon., 'out only as respects any claim, loss or liability arising out of the eperho: ; f the named ivured(s), or its subcontractors, anc'. only if such claim, loss or liability is c:et^,mine(: to be solo, tl : negligence or responsibility of the named insured. Notice of Cancellation cr Non -renewal it is @€reed that the company will ; rm ide the adds onal insure<: rhown bellow with 30 days notice of canoellction of this policy in the anent o' ccncel:atien sae to eci ollnc e e. )n only Hold Harmless Clause it is agreed that such insurance as is afforded by this policy .,.r the bene:,t cf he.. iditional insured shown below shall indemnif;: and hold u,irm:ess the additional in;.tred, but Drily as -esl:, l .11,;(aint, -loss or liability arairig out of the operations of named insureds) or its sub -contra( tix> Severabili:y of Interes: as is a:Torded by this ool:cy for the benefit of the additiore'. insure, she ,'n ,elow, s'111.1 appl, separately to ea:h additional insured a_ainst whom It claim is made or suit is brow_ i' ex; %Dt with i +sp its :o the limits of insurance under this policy. WAIVER OF SUBROGATION It is agreed that we waive any right of recovery we may Itate a_ains; the, er,, n o. organization shower in the schedule because of pavmr nt s, e nw.ke fcr .!nju 0- damage arising out of "your work" done under a con:rtct with tllu: person oraantzetio:t. The waiver app'.ies only to the person or eVga:iizaoon shoe r the schedule. City of Santa .Ana 20 Civic Center Plaza Santa Ana. CA 92702 ccU Assix:uit EVANSTON INSURANCE COMPANY CERTIFICATE NO.: CERTIFICATE OF INSURANCE EXCLUDES COVERAGE FOR NOMINEE EVENTS. SEE SEPARATE APPLICATIONS FOR NOMINEE EVENTS. SPECIAL EVENT LIABILITY PROGRAM PRODUCER: PUBLIC ENTITY (ADDITIONAL INSURED) Driver Alliant Insurance ServicesR-"a-�'v ��2 City o b Santa. Ana P.O.Box 26323 ,j�j•^ pC� 20 Civic Centim P.eaza, M-28 Santa Ana, CA 92799-8323 Iy al f 4- Santa Ana, CA 92701 (949) 660-8163 �^ License No: OC 36861 NAMED INSURED (EVENT HO ): p p ANT �O gMi nTST?Nuc ti.onak-Tae Kwon Do* Choa Le TYPE: 4 FabAi.an0 DATE(S): 1 /01 /05 - 12/31/05 Dtv.fne, CA 92620 LOCATION: Rafaadn Centro *Non Contact 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 requirements, terms or conditions 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. INSURANCE CARRIER: Evanston Insurance Company MASTER POLICY NUMBER: 05SEPI0000oi MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2005 EXPIRATION: JANUARY 1, 2006 COMMERCIAL GENERAL LLA131UTY OCCURRENCEFORM DEDUCTIBLE: NONE General Aggregate limit $ 2po0,000 Products & Completed Operations 11000,000 Personal & Advertising Injury 11000,000 Fach Occurrence Limit 11000,000 Fin Damage (Any One Fire) 50,000 Medical Payments (Any One Person) 5,000 The limits of insurance apply separately to each event insured by this policy as if a separate policy of insurance has been issued for that e L "Who is insured" is amended to include, as an insured, the person or organization shown in this schedule, but only with respect to liability arising out of the ownership, maintenance or use of the premises used by the named insured (event holder). This insurance doss not apply to: Any "occummm" which takes place after the event holder ceases to be a tenant in that premises. OTHER ADDITIONAL INSUREDS CANCELLATION: Should the above described policy to cancelled before the expiration date thereof, the issuing company will mail 30 days written notice to the certificate holder and additional insureds listed. AUTHORIZED REPRESENTATIVE: Z� � DATE ISSUED: /- - za1)�2-/ ACORD CERTIFICATE OF LIABILITY INSURANCE DAT;ii20/20 ' TM. 06 PRODUCER Prx,.: (800)395-8075 Fax: (858)519,0822 THIS CERTIFICATE IS ISSUED AS A MATTER OF FITNESS AND WELLNESS INSURANCE AGENCY INFORMATION 380 STEVENS AVENUE, SUITE 206 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE SOLANA BEACH CA 92075 INSURERS AFFORDING COVERAGE NAIC # AgencyLiOli OD28716 INSURED INSURER A: Zurich North America CHOC V. LE INSURER e: 4 FABRIANO IRVINE CA 92620.2576 INSURER C: NSURER D. NSURER E: 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. NSR TR ADDL NSRp TYPE OF INSURANCE POLICYNUMBER POLICY EFFEmrvE ppTE MMN vpucr EzrwprlDM DATE(MMNp LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILIT CLAIMS MADJX OCCUR ST63733.00 12/17/06 12117107 EACH OCCURRENCE $ 1,000,000 OA.AGE TO RENTED PRE. SES(E......—) $ tOO,000 MED. EXP(My one person) $ 2,500 PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PEE X POLICY PRO- LOC PRODUCTS-COMPIOP AGG. S 3,000,000 AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per Person) $ BODILY accide t) (Per accident) $ PROPERTY DAMAGE Per accitlent $ GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EAACC AUTO ONLY: AGG $ $ EXCESS I UMBRELLA LABILITY OCCUR CLAIMS MADE DEDUCTIBLE RETENTION$ EACH OCCURRENCE $ AGGREGATE $ 5 $ It WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROYRIETORIPARTNENExECUTNrE OEFICER)MEMMEN CSCLUDED? ay... x..N .. EcuL PRPRwIWlaoxe slow ToevTurrnnD E.L. EACH ACCIDENT 5 E.L. DISEASE -EA EMPLOYEE $ E.L. DISEASE -POLICY LIMIT $ OTHER: DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS SEE SUPPLEMENTAL CERTIFICATE INFORMATION CERTIFICATE HOLDER :CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 CommunityRedevelopment A PRent Agency Y DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE of the City of Santa Ana INSURER, ITS AGENTS OR REPRESENTATIVES. 20 Civic Center Plaza (M-25) Santa Ana CA 92701 AUTHORIZED REPRESENTATIVE Attention: Jeffrey E. Frick, CEO ACORD 25 (2001108) Certificate # 51125 © ACORD CORPORATION 1988 RECE; ^ 6 2006 DATE SUPPLEMENT TO CERTIFICATE OF LIABILITY INS #51125 DEC 2006 DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS The City of Santa Ana, and the City of Santa Ana, located at 20 Civic Center Plaza, Santa Ana, California 92701; and their respective off! employees, agents, volunteers and representatives are named as additional insureds ("additional insureds") with regard to liability and of suits arising from the operations and uses performed by or on behalf of the named insured. Additional Insured Endorsement is Effective: 12101106 /3 Certificate # 51125 CG 20 10 11 85 DATE: DEC 20 06 POLICY NUMBER: 5763733-00 INSURED NAME: CHOC V. LE 4 FABRIANO IRVINE CA 92620.2576 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS (FORM B) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization Job/Project: (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS AN INSURED (Section 11) is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of "your work' for that insured by or for you. Primary Insurance it is agreed that such insurance as is afforded by this policy for the benefit of the additional insured shown shall be primary insurance, and any other insurance maintained by the additional insured(s) shall be excess and noncontributory, but only as respects any claim, loss or liability arising out of the operations of the named insured(s) or its subcontractors, and only if such claim, loss or liability is determined to be solely the negligence or responsibility of the named insured. Notice of Cancellation or Non -renewal it is agreed that the company will provide the additional insured shown below with 30 days notice of cancellation of this policy in the event of cancellation due to company election only. WAIVER OF SUBROGATION It is agreed that we waive any right of recovery we may have against the person or organization shown in the schedule because of payment we make for injury or damage arising out of "your work' done under a contract with that person or organization. The waiver applies only to the person or organization shown in the schedule. SCHEDULE NAME OF PERSON OR ORGANIZATION The City of Santa Ana, its Respective Officers, Employees, Agents, Volunteers and Representatives 20 Civic Center Plaza (M-25) Santa Ana CA 92701 Y — % 610& — DATE (MWDDNYYY) ACORD TMCERTIFICATE OF LIABILITY INSURANCE 1212012006 . PRODUCER Phone. (800)395-8075 Fax (8M)519-0822 THIS CERTIFICATE IS ISSUED AS A MATTER OF FITNESS AND WELLNESS INSURANCE AGENCY INFORMATION 380 STEVENS AVENUE, SUITE 206 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE SOLANA BEACH CA 92075 INSURERS AFFORDING COVERAGE NAIC # %49 INSURER B: 2620.2576 4-Aovu-145 INSURERC: INSURERD:NCOA r-%j091-/21—613 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERI00 INDICATED, NOTWITHSTANDING OL ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TOWHICH 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. POLICY EFFELLNE VOLICY E%FIMTWN LIMITS L TYPE OF INSURANCE POOCV NUMBER DALE NMN oerE Nwop o E GENERAL LIABILITY 5763733.00 12117106 12117107 onM cEEACH o NERRNTECENCE $ X COMMERCIAL GENERAL LIABILIT nREP. lE. eccmrol CLAIMSMAD� OCCUR MED.EXP(Any onepeccon) $ PERSONAL 8 ADV INJURY $ rA 1,000,000 100,000 2,500 1,000,000 GENERAL AGGREGATE $ 3,000,000 GENT AGGREGATE LIMIT APPLIES PE PRODUCTS-COMPIOP AGG. S 3,000,000 X POLICY PRO- LOC AUTOMOBILE UABILITY COMBINED SINGLE LIMB (Ea accident) $ BODILY INJURY (Per person) $ ANY AUTO ALL OWNED AUTOS SCHEDU LED AUTOS HIRED AUTOS BODILY INJURY (Per accident) $ NON -OWNED AUTOS PROPERTY DAMAGE $ Par ac Idenl GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY: AGG $ $ EACH OCCURRENCE $ E%CESS I UMBRELLA LIABILITY OCCUR ❑ CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE RETENTION $ we sinm-OiNEP WORKERS COMPENSATION AND EMPLOYERS' LIABILITY E.L. EACH ACCIDENT E E.L. DISEASE -EA EMPLOYEE 1 $ AkY ROPRIETOMPARTNFR6%FELINE OFFICERMEUSAR E%CLUOELI T.., a..�ns...a.. BPECALP ROV.... -1— EL. DISEASE -POLICY LIMIT Is OTHER: DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS SEE SUPPLEMENTAL CERTIFICATE INFORMATION neural I ennN CERTIFICATE HOLDER' - SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVORTO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT Community Redevelopment Agency FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE of the City of Santa Ana INSURER, ITS AGENTS OR REPRESENTATIVES, 20 Civic Center Plaza (M-25) CA 92701 AUTHORIZED REPRESENTATIVE J y Santa Ana Attention: Jeffrey E. Frick, CEO ©ACORD CORPORATION 1988 ACORD 25 (2001108) Certificate # 51125 R E C E :::.: 6 2006 f SUPPLEMENT TO CERTIFICATE OF LIABILITY INS #51125 DDATE EC 2006 I DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS The City of Santa Ana, and the City of Santa Ana, located at 20 Civic Center Plaza, Santa Ana, California 92701; and their respective offh employees, agents, volunteers and representatives are named as additional insureds ("additional Insureds") with regard to liability and of suits arising from the operations and uses performed by or on behalf of the named insured. Additional Insured Endorsement is Effective: 12/01/06 Certificate 9 51125 CG 20 10 11 85 DATE: DEC 20 06 POLICY NUMBER: 5763733-00 INSURED NAME: CHOC V. LE 4 FABRIANO IRVINE CA 92620-2576 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS (FORM B) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: Job/Project: (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS AN INSURED (Section 11) is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of "your work' for that insured by or for you. Primary Insurance it is agreed that such insurance as is afforded by this policy for the benefit of the additional insured shown shall be primary insurance, and any other insurance maintained by the additional insured(s) shall be excess and noncontributory, but only as respects any claim, loss or liability arising out of the operations of the named insured(s) or its subcontractors, and only if such claim, loss or liability is determined to be solely the negligence or responsibility of the named insured. Notice of Cancellation or Non -renewal it is agreed that the company will provide the additional insured shown below with 30 days notice of cancellation of this policy in the event of cancellation due to company election only. WAIVER OF SUBROGATION It is agreed that we waive any right of recovery we may have against the person or organization shown in the schedule because of payment we make for injury or damage arising out of "yourwork" done under a contract with that person or organization. The waiver applies only to the person or organization shown in the schedule. SCHEDULE NAME OF PERSON OR ORGANIZATION The City of Santa Ana, its Respective Officers, Employees, Agents, Volunteers and Representatives 20 Civic Center Plaza (M-25) Santa Ana CA 92701 4 — o2OO -V— 122 A - A,Dv'% - /o? ;� -0 3 X _ 200#-/ Z-20 - ACORD DATE ' CERTIFICATE OF LIABILITY INSURANCE 1 0115120 8 TM. PRODUCER Phone: (800) 395.8075 Faa: (853; 519,0822 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION FITNESS AND WELLNESS ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 330 STEVENS AVENUE, SUITE 206 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR SOLANA BEACH CA 92075 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NA1C it - Actrcy.lic»_037ie45: INSURED ;_INSURER A: Philadelphia Indemnity Insurance Company j CHOC V. LE INSURER B: RVINE IANO CA 92620-2576 INSURER C: 'INSURER D:- i INSURER E: ' nnvco Ar_ee 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 AFFORCED 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. !NSF AOG'L PODGY EFFECTIVE LTR INSR,� TYPE OF INSURANCE POLICY NUMBER DwTE'NNroD I POLICY EXPIRATION DATE (NIMInOtM! LIMITS j GENERAL LIABILITY PHPK215316 12/17/07 X COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR 12/17/08 LEAqHCCCURRENCE _. _.. Ga.+acE TO RENTED .REMISES EE ocarence) MED. EXP ;Any one ptrsen) f g 1,000,000 100 000 2,500 A I 'PERSONAL S ADV INJURY rrf ! f 1,000,000 �5 3,000,000 LI 'GENERAL AGGREGATE - I GEN-L AGGREGATE LIMIT APPLIES PER:: - ; PRODUCTS-COMP/OP AGG. I: 3,000,000 -I PRO - I X i POLICY 1 I JECT IF-1 Loc i I AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea accident) S ALLOWNEDAUTOS BODILY INJURY 1 SCHEDULED AUTOS (Per ptrsan)$--'- { I S HIRED AUTOS ( NON-O'JVNED AUTOS{Pwaccidont) j BODILY INJURY f PROPERTY DAMAGE j (P.accident` GARAGE LIABILITY :. ANYAUTOTHER THAN EA ACC AAUTO f ONLY: AGG EXCESS 1 UMBRELLA LIABILITY i I ' EACH OCCURRENCE S OCCUR—, CLAIMS MADE AGGREGATE (5 �i $ _ i DEDUCTIBLE j 'f RETENTION f ':f WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORJPARTNER(E%EClIME OFFICEWMEMBER E%cwoEDY I I wC STATL i OTHER emuI %RY LIMITS 1 E.L EACH ACCIDENT f `E.L. DISEASE -FA EMPLOYEE ! 3 �IfY—.d .db.—der aPPtiAl PftovNUONs "I..'', -� /1 -r-E. E.L. DISEASE -POLICY UMIT 3 OTHER: I DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS SEE SUPPLEMENTAL CERTIFICATE INFORMATION Community Redevelopment Agency of the City of Santa Ana 20 Civic Center Plaza (M-25) Santa Ana CA 92701 Attention: SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Jeffrey E. Frick, CEO 4CORD 25 (2001108) Certificate # 67706 © ACORD CORPORATION 1988 F SUPPLEMENT TO CERTIFICATE OF LIABILITY INS #67706 'AN1508 I DESCRIPTION OF OPERATION S/LOCATIONSNEHICLES/SPECIAL ITEMS It is understood and agreed that the The City of Santa Ana, it's agents, officers, employees, volunteers and representatives are added as an additional insured but only as respects the operations of the named insured except that liability resulting from the additional insureds sole negligence. This Insurance is primary and non-contributory to any other insurance held by the insured. Additicnal Insured Endorsement Is Effective: 12/17107 Certificate # 67706 CG 20 10 11 85 DATE: JAN 15 08 POLICY NUMBER: PHPK215316 INSURED NAME: CHOC V. LIE 4 FABRIANO iRVINE CA 92620-25576 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS (FORM B) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: Job/Project: (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS AN INSURED (Section 11) is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of "your work" for that insured by or for you. Primary Insurance it is agreed that such insurance as is afforded by this policy for the benefit of the additional insured shown shall be primary insurance, and any other insurance maintained by the additional insured(s) shall be excess and non-contributory, but only as respects any claim, loss or liability arising out of the operations of the named insured(s) or its subcontractors, and only if such claim, loss or liability is determined to be solely the negligence or responsibility of the named insured. Notice of Cancellation or Non -renewal it is agreed that the company will provide the additional insured shown below with 30 days notice of cancellation of this policy in the event of cancellation due to company election only. WAIVER OF SUBROGATION It is agreed that we waive any right of recovery we may have against the person or organization shown in the schedule because of payment we make for injury or damage arising out of "your work" done under a contract with that person or organization. The waiver applies only to the person or organization shown in the schedule. SCHEDULE NAME OF PERSON OR ORGANIZATION City of Santa Ana, it's Respective Officers, Employees, Agents, Volunteers and Representatives. 20 Civic Center Plaza (M-25) Santa Ana, CA 92701