HomeMy WebLinkAboutCOLE, JEFF DBA JEFF COLE PRODUCTIONS 1
1i~~u'l\"NCE 00 FILE N-2002-145
WORK MAY PRomo
UNTil INSURANCE EXP!B.ES
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g~~~~c~ CONSULTANT AGREEMENT 03
c'. iUll'i>}~ THIS AGREEMENT, made and entered into thiS~ay of~ 2002 by and
f" \N between, Jeff Cole, dba Jeff Cole Productions (hereinafter "Consultant"), 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 (hereinafter "City")
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RECITALS
A. The City desires to retain a consultant having special skill and knowledge in the field of
video production.
B. Consultant represents that Consultant is able and willing to provide such services to the
City.
C. In undertaking the perfonnance of this Agreement, Consultant represents that it is
knowledgeable in its field and that any services perfonned by Consultant under this
Agreement will be perfonned in compliance with such standards as may reasonably be
expected from a professional consulting finn in the field.
NOW THEREFORE, in consideration of the mutual and respective promises, and subject to the
tenns and conditions hereinafter set forth, the parties agree as follows:
1. 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 $ 10,000.00 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 the date first written above and terminate on June 30,
2003 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 ofthe
Community Development Agency 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, agents, volunteers, and employees 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. Business automobile liability insurance, or equivalent form, with a combined single
limit of not less than $1,000,000 per occurrence. Such insurance shall include coverage for
owned, hired and non-owned automobiles.
c. 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.
d. If Consultant is or employs a licensed professional such as an architect or engineer:
Professional liability (errors and omissions) insurance, with a combined single limit of not less
than $1,000,000 per claim.
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e. 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.
f. 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: (1) 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; and (2) from any claim that personal injury, damages, just
compensation, restitution, judicial or equitable relief is due by reason of the terms of or effects
arising from this Agreement. This indemnity and hold harmless agreement applies to all claims
for damages, just compensation, restitution, judicial or equitable relief suffered, or alleged to
have been suffered, by reason of the events referred to in this Section or by reason of the terms
of, or effects, arising from this Agreement. The 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 challenging the validity
of this Agreement, or asserting that personal injury, damages, just compensation, restitution,
judicial or equitable relief due to personal or property rights arises by reason of the terms of, or
effects arising from this Agreement. City may make all reasonable decisions with respect to its
representation in any legal proceeding.
7. 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
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like importance, but in no event less than reasonable care. "Confidential Information" shall
include all nonpublic information. Confidential information includes not only written
information, but also information transferred orally, visually, electronically, or by other means.
Confidential information disclosed to either party by any subsidiary and/or agent of the other
party is covered by this Agreement. The foregoing obligations of non-use and nondisclosure
shall not apply to any information that (a) has been disclosed in publicly available sources; (b) is,
through no fault of the Consultant disclosed in a publicly available source; (c) is in rightful
possession of the Consultant without an obligation of confidentiality; (d) is required to be
disclosed by operation of law; or (e) is independently developed by the Consultant without
reference to information disclosed by the City.
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 ofthe 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 copies to:
Executive Director of the Community Development Agency
City of Santa Ana
20 Civic Center Plaza (M-25)
Santa Ana, California 92702-1988
Telefacsimile (714) 647-6549
and,
City Attorney
City of Santa Ana
20 Civic Center Plaza (M-29)
4
P.O. Box 1988
Santa Ana, California 92702
telefacsimile (714) 647-6515
To Consultant:
Jeff Cole Productions
5104 A East Henley
Orange, California 92867
Telefacsimile (714) 283-3907
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, that 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 assigmnent, transfer, delegation or subcontract without
the City's prior written consent shall be considered null and void. Nothing in this Agreement
shall be construed to limit the City's ability to have any of the services which are the subject to
this Agreement performed by City personnel or by other consultants retained by City.
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12. WORK PRODUCT
All work product prepared by Consultant pursuant to this Agreement shall be the
property of the City and Consultant consents to the City's use thereof for such purposes as the
City deems appropriate.
13. 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,
subject to the following conditions:
a. As a condition of such payment, the Executive Director may require Consultant to deliver
to the City all work product completed as of such date, and in such case such work product shall be
the property of the City unless prohibited by law, and Consultant consents to the City's use thereof
for such purposes as the City deems appropriate.
b. Payment need not be made for work which fails to meet the standard of performance
specified in the Recitals of this Agreement.
14. 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.
15. JURISDICTION - VENUE
This Agreement and all questions relating to its validity, interpretation, performance, and
enforcement shall be governed and construed in accordance with the laws of the State of
California. This Agreement has been executed and delivered in the State of California and the
validity, interpretation, performance, and enforcement of any of the clauses of this Agreement
shall be determined and governed by the laws of the State of California. Both parties further
agree that Orange County, California, shall be the venue for any action or proceeding that may
be brought or arise out of, in connection with or by reason of this Agreement.
16. PROFESSIONAL LICENSES
Consultant shall, throughout the term of this Agreement, maintain all necessary licenses,
permits, approvals, waivers, and exemptions necessary for the provision ofthe 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. Consultant shall notify the City
immediately and in writing of her inability to obtain or maintain such permits, licenses,
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approvals, waivers, and exemptions. Said inability shall be cause for termination of this
Agreement.
17. MISCELLANEOUS PROVISIONS
a. Each undersigned represents and warrants that its signature hereinbelow has the power,
City and right to bind their respective parties to each of the terms of this Agreement, and shall
indemnify City fully, including reasonable costs and attorney's fees, for any injuries or damages to
City in the event that such City or power is not, in fact, held by the signatory or is withdrawn.
b. All Exhibits referenced herein and attached hereto shall be incorporated as if fully set
forth in the body of this Agreement.
IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year
first above written.
PATRICIA E. HEALY
Clerk of the Council
CITYlZ4L
DAVIDN. REAM
City Manager
APPROVED AS TO FORM:
JOSEPH W. FLETCHER
City Attorney
By: i~'--ir //1. ~j 0 001.,:/
Laura Sheedy .
Assistant City Attorney
RECOMMENDED FOR APPROVAL
CONSULTANT
10 P. REEKS TIN
Exe tive Director ofthe
Community Development Agency
K:\ WPDOCS\D004\POO I \00005855.DOC
7
To: Rebecca Leifkes
From: Jeff Cole
Date: 9/19/02
Re: Cornerstone Village Videos
Dear Rebecca,
Thank you for the opportunity to submit this estimate for the Cornerstone Village Revitalization Project
videos. The following outlines the production package:
Production 1
. Shoot coverage of final landscaping activities between September 23 and September 26.
. Shoot approximately 6 interviews with city officials and residents/tenants. Some interviews may
be in Spanish, so together we'll find someone to assist with translations.
. Assist the city in preparing a script to guide viewers through the process
. Edit a final production 5 minutes in length that includes photos and/or existing footage that the
city will provide in addition to the footage and interviews we shoot.
. Deliver the 5-minute production on one DV master and two VHS viewing copies no later than
October 15.
Production 2 (in addition to the above)
. Shoot the ribbon-cutting dedication on October 26
. Assist the city in adding to the script to create a video 10-15 minutes in length, through
additional use of footage, photos, and interviews.
. Deliver the 10-15 minute production on one DV master and one viewing copy.
Given the information above, the estimated budget for the production package is $16,500. Payment of
50% ($8250) is due upon signature of the contract and prior to production. And additional 25% payment
($4125) is due upon delivery of the 5 minute production. The 25% balance ($4125) is due upon delivery
of the 10-15 minute production.
Thank you again, and we look forward to bringing these projects to life.
Best Regards,
Jeff Cole
Director, Jeff Cole Productions
5104 A East Henley Place
Orange, CA 92867
Tel 714.283.3607
Fax 714.283.3907
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:
I. The City of Santa Ana, 20 Civic Center Plaza, P.O. Box 1988, Santa Ana,
California 92702; 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 ifnot 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 (M-30), P.O. Box 1988, Santa Ana,
California 92702.
(Completion of the following, including countersignature, is required to make this endorsement
effective.)
, this endorsement form as a part of
Effective
Policy #
Issued to
Named Insured
Countersigned by
Authorized Representative
8
-ACO~Q~-'CERTIF-ICATE'-6F i(Ai~Ii.JTyiNSURANCE T D,6."-E (MMlDOfY'l)
10/09/2002
PRODUCER (714)939-0800 FAX nlls CERTIFICATE IS ISSUED /'oS A MATTER OF INFORMATION
Cal-Surance Associates, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLOER. THIS CERTIFICATE DOES NOT AMEND, EXTENO OR
PO Box 7048 ALTER THE COVERAGE AFFORDEO BY THE POLICIES BELOW.
333 City Blvd., West, Ste. 900
I Orange I CA 92863-7048 INSURERS AFFORDING COVERAGE
! INSUREO Jetf Co1 e Productions INSU~RA: COM - Gulf Insurance Company
I 5104 A East Henley Place INSURER et
I
I Orange, CA 92867 INSURER c:
INSURER 0:
I INSURER E:
COVERAGES
THe pOLICies Of' INSURANCE LISTED BELOW HAve BeEN IssueD TO THe INSURED NAMeD ABOVE FOR THE POUCY PERIOD INDICATED, NOrwlTHSTANDING
ANY ReaUIR.MENT. TERM OR CONDITION OF ANY CONTRACT OR OTHeR DOCUMeNT WITH RESP.CTTO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY peRTAIN. THE INSURANCE AFFORCED BY THe POLICIES OESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS ANO CONDITIONS OF SUCI-l.
POL1CIES. AGGREGATE L1Mrf"S SHOWN M.A.Y HAV;:: BEEN REOuCeO BY PAlO CLAIMS.
l~;: TYPlO O~ INSURAtolCE POLICY NUMBER ~~+~~~M~g~~
. ~e"L L1A"L1TY .LP7749789 04/08/2002
X COMMI,;j::.lCI~L GE.NEF\J.l. LI^61UTY
I C1Jl.1M$ MADE [!] OCCUR
6&T~'M~~~N
04/08/2003
L.IMITS
EACH OCCURRENce
,
1.000,000
50,000
10,000
1 000,000
Z.OOO.OOO
1,000.000
~'L "CGRE~ ~~ AP~S PER:
I POI..ICV 1 i JE"CT I I LOC
~OMOBll.e 1.14BIL1TY
_ .'.Ny AUTO
_ A.I..L QWNEO AI) ros
~ SCHEOUWEUAUTOS
X HlREnAUTOS
-=-
X NOfll.(J""NEO A!JTOS
f--
f--
~1"E DAMAGe (My 0"8 rll'~)
MED exp (My one person) $
PERSONAL to AOV IN,JUR'l' $
GENERALAGGA~TE $
PRODUCTS . COM~OP AGG ~
.
f!o
-
COM61NEOSINGLE LIMIT .
(E.Sae<:k:I8f1l) 1,000,000
aoOlL Y INJUR"'l' .
(Per pe~n)
SOCIL y INJU!=tV I
(PtfSGeldsl'Il)
PROPERTY OAMAGE .
(Per::lt;Cldent1
GARAGE UASII.ITY
~ A"HUIO
EJCCE:SS l..\AB1\.1 tV
P CCCUH [J CLAIMS M^DE
I DF_Ol'CiI~LE
n REn;NT10N $
WORK~RS CCMPENSATlON AIIID
IiMPI.OYERS'llAQILITY
OTHE~ 'f""AN
AUroONLY;
AUf 0 Ot.ll.. y.!;A AccrDI';,NT $
fA Poec s
AGG .
$
.
EACH OCCURRENCE
AGGRl::GATe
$
.
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IT~~~lml4s I lVE~.
E.l". EACH ACCIDENT $
e,L DISEASE .EA EMPLOYEE $
E.L, OlSEllSe . I"OLICY LIMIT .$
OTHE~
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DESCRIpTION OF OPE~.A:nONSlL.OCATIONSNeHICLESlEXCI.USIONS ACDIED BV EHDORSEMENTISPECIAL PROVlSlONS~ La... ft~ 1 V .t" I
ee attached endorsement.
~'1-U'L4-
ura Sheedy ,
Deputy City Attorney
CANCELLATION
SHOULD A~ OF THE ABOVE DESCRl8~O POLICIES BE CANCE1.t.ED BeFORE THr;
EXP1RATIOtrI DATETHEREOr=, THEISSOlNG-COM~ANVWlL.1. MAIL.
30 DAYS WRlnEN NOTICE TO THE CERTIFICATE HQL-OER NAMED TO THE LEFT,
CERTIFICA. TE HOLOER I I ADOITIONAl..INSURED;INStJREA L.EnER.:
City of Santa Ana
20 Civic Center Plaza
Santa Ana. CA 92702
ACORO 25-S 17/97)
FAX: (714)667-2225
AUTHCRIZfQJl:EPBESErroITATlVE A ..7_
,
ill>ACORD CORPORATION 1908
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'11'\J.IU\InC" 'Uf'\ IIU C'T, I r"1 J,'f"1n "''''1'''1'' f... 1 r f'lf'\
.......-., -"'-'--~":-'-.- -_...._.._----._--_._.~.._..._---_.._-_._._--_._._._._----------._----~._--_.-------_._._,----._.-
IMPORTANT
If tile certificate hOlder is an ADDITIONA~ INSURED, the pOllcy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
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).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurerls), authorized representative or producer, and the certificate holder, nor does It
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon,
ACORD 25-5 (7/97)
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+,r::n!Q('Q-hT 1'm! VUJ
'JI"\HU\Jnc "lW'\ IIU Q T I I f'l \11"'\11 '71"11"'1'7_'"'1_ r ""
Exhibit 8
ADDITIONAL INSURED ENDORSEMENT
Insurance Company
Gulf Insurance canpany
This endorsement modIfies such insurance as is afforded by the provisions of Policy
# CLP77497B9 relating to the following:
1. The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, Califomia
92702; its officers, employees, agents and volunteers 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 it;
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 additiot'lal insureds, this insurance shall not be
canceled, 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 92702.
(Completion of the following, including countersignature, is required to make this
endorsement effective.)
Effective
10/10/02
, this endorsement form as a part of
Policy# np77A'l7R'l
Issued to Jeff COle Productions
Namedl~~ured \.....-:-
Countersigned by ~.., r - A e::::::::::-
Authorized Representative
APPROVED AS TO FORM
Jif~ P2CiM
ura Shel'dy
Deputy City Attorney
In 'A
b~QIR>Rbl) 'nfJ YH-i
:j~NH).fnc:: lH~ I.IH R T , I n- Nnl.l ;>nn;>-h T ~-I '1n
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Hf?Uil et:f:" P.,~ckrll-'d
103
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. . L
WORKERS' COMPENSATION DECLARATION
I :f~Coc:.f', P.t<r-JC(f'f\"l.- hereby affinn under penalty of perjury, the
(Nametr,Ue)
following declaration:
I certify on behalf of 1C'fPU>1.E: f(UAX-l\?-)$ that during the tenn of my
(Organizalion Name)
contract with the ,::."""" ........~,~ \)L...... AjI!M-'-t 1-' City of Santa Ana and the
Community Redevelopment Agency, 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!
should become subject to the workers' compensation provisions of Section 3700 of the
r.b<>' COd'. I "-II """'wiili ,=ply wi'" "'000 pro'i'iO~
DATE: \0/1\10"2..
By: ~U?L-6
N arne: 'T&"C;C: c.o tE- ~(Z.o P\1t.l1 o1J c;
Title: -p.e., tJc.-lf'A'\..
Telephone: b I 'i ') S1 '-/- )010
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 A nORNEY'S FEES.
APPROVED AS TO FORM
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..... ~^.fl () r:h I
Uiurn n.Y /
OopU\)' tit)' A\lllflley