HomeMy WebLinkAboutSWIM BRAYV FOUNDATION (2) INWRANCL ON .,Lt N-2025-950
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}A� JUN 10 2025 AGREEMENT WITH SWIM BRAYV FOUNDATION TO PROVIDE
DROWNING PREVENTION PROGRAMMING FOR CITY EVENTS
THIS AGREEMENT is made and entered into this 29th day of May 2025, by and between Swim
Brayv Foundation, a California nonprofit corporation("Contractor"), and the City of Santa Ana, a
charter city and municipal corporation organized and existing under the Constitution and laws of
the State of California("City"), each a "Party"or collectively "Parties."
RECITALS
A. The City desires to retain a contractor to provide special programming for various
City events, including the City's Summer Splash Day Camp, Kids Night Out,
Afterschool Programs, and other events ("Events") as directed by the City.
B. Contractor represents that it is able and willing to provide such services to the City.
C. In undertaking the performance of this Agreement, Contractor represents that it is
knowledgeable in its field and that any services performed by Contractor under this
Agreement will be performed in compliance with such standards as may reasonably
be expected from a professional contracting firm in the field.
NOW THEREFORE, in consideration of the mutual and respective promises, and subject to the
terms and conditions hereinafter set forth, the parties agree as follows:
1. SCOPE OF SERVICES
a. As needed, Contractor shall, during the term of this Agreement, provide the
equipment and personnel to provide the services as further described and set forth
in Exhibit A,attached hereto and incorporated in full, at dates,times,and locations
as mutually agreed upon by the Parties in a signed writing.
b. City grants Contractor the right to enter its property for the purpose of delivery, set-
up, operation, and pick-up on the days of the scheduled Events.
C. The equipment shall be disassembled and removed by Contractor at the conclusion
of each Event.
d. City shall have the sole discretion as to engagement of Contractor for
services/events not detailed in Exhibit A. The City reserves the right to
administratively change event locations, dates, or services for any mutually agreed
upon services/events.
2. COMPENSATION
a. City neither warrants nor guarantees any minimum compensation to Contractor
under this Agreement. Contractor shall be paid only for actual services performed
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under this Agreement at the rates and charges identified in Exhibit A. The total
amount to be expended under this Agreement shall not exceed Five Thousand
Dollars and 00/100 ($5,000.00).
b. Payment by City shall be made within forty-five (45) days of Event following
receipt of proper invoice evidencing work performed, subject to City accounting
procedures. City and Contractor agree that all payments due and owing under this
Agreement shall be made through Automated Clearing House (ACH) transfers.
Contractor agrees to execute the City's standard AC.H Vendor Payment
Authorization and provide required documentation. Upon verification of the data
provided,the City will be authorized to deposit payments directly into Contractor's
account(s) with financial institutions.
C. Payment need not be made for work that fails to meet the standards of performance
set forth in the Recitals and Scope of Work,which may reasonably be expected by
City.
3. TERM
This Agreement shall commence on June 1, 2025 and terminate on May 31, 2026, unless
terminated earlier in accordance with Section 16, below.
4. INDEPENDENT CONTRACTOR
Contractor shall, during the entire term of this Agreement, be construed to be an
independent contractor and not an employee of the City. This Agreement is not intended nor shall
it be construed to create an employer-employee relationship, a joint venture relationship, or to
allow the City to exercise discretion or control over the professional manner in which Contractor
performs the services which are the subject matter of this Agreement; however, the services to be
provided by Contractor shall be provided in a manner consistent with all applicable standards and
regulations governing such services. Contractor shall pay all salaries and wages,employer's social
security taxes, unemployment insurance and similar taxes relating to employees and shall be
responsible for all applicable withholding taxes.
5. OWNERSHIP OF MATERIALS
This Agreement creates a non-exclusive and perpetual license for City to copy, use,
modify, reuse, or sublicense any and all copyrights, designs, and other intellectual property
embodied in plans, specifications, studies, drawings, estimates, and other documents or works of
authorship fixed in any tangible medium of expression, including but not limited to, physical
drawings or data magnetically or otherwise recorded on computer diskettes,which are prepared or
caused to be prepared by Contractor under this Agreement ("Documents & Data"). Contractor
shall require all subcontractors to agree in writing that City is granted a non-exclusive and
perpetual license for any Documents & Data the subcontractor prepares under this Agreement.
Contractor represents and warrants that Contractor has the legal right to license any and all
Documents & Data. Contractor makes no such representation and warranty in regard to
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Documents &Data that were provided to Contractor by the City. City shall not be limited in any
way in its use of the Documents & Data at any time, provided that any such use not within the
purposes intended by this Agreement shall be at City's sole risk.
6. INSURANCE
Contractor shall procure and maintain for the duration of the agreement, the following
insurance coverages:
Minimum Scope and Limit of Insurance. Contractor shall maintain limits of insurance
coverage in the following minimum amounts and shall be at least as broad as:
• Commercial General Liability (CGL): Insurance Services Office 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.
• Sexual Abuse or Molestation Liability(SAML): If the CGL policy referenced above
is not endorsed to include affirmative coverage for sexual abuse or molestation,
Contractor shall obtain and maintain a policy covering Sexual Abuse and Molestation
with a limit of no less than $1,000,000 per occurrence or claim.
• Automobile Liability(AL): Insurance Services Office Form CA 00 01 covering Code
1 (any auto), with combined single limits of$1,000,000. In the event Contractor does
not maintain commercial automobile liability insurance, City will accept evidence of
personal automobile insurance with existing limits, which can be lower than
$1,000,000.
• Workers' Compensation (WIC): as required by the State of California,with statutory
limits, and Employer's Liability Insurance with limit of no less than $1,000,000 per
accident, per employee, per policy for bodily injury or disease. This requirement can
be waived if Vendor has no employees.
• If Contractor maintains broader coverage and/or higher limits than the minimums
shown above, City requires and shall be entitled to the broader coverage and/or the
higher limits maintained by Contractor, Any available insurance proceeds in excess of
the specified minimum limits of insurance and coverage shall be available to City.
Other Insurance Provisions. The insurance policies are to contain, or be endorsed to
contain, the following provisions:
• CGL, SAML and AL policies: City of Santa Ana, its City Council, its officers,
officials, employees, agents, and volunteers are to be covered as additional insureds
with respect to liability arising out of work or operations performed by or on behalf of
the Contractor including materials, parts, equipment, and personnel furnished in
connection with such work or operations.
• All required insurance policies: Insurance company(ies) agrees 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 Contractor for City.
• All required insurance policies: For any claims related to this contract, Contractor's
insurance coverage shall be primary and any insurance maintained by City, its City
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Council, its officers, officials, employees, agents, or volunteers shall not contribute
with it.
• All required insurance policies: A severability of interest provision must apply for all
the additional insureds, ensuring that Contractor's insurance shall apply separately to
each insured against whom a claim is made or suit is brought, except with respect to
the insurer's limits of liability.
• Each insurance policy required 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.
• Certificate Holder on each Evidence of Insurance certificate shall be: City of Santa
Ana, Attention: Parks, Recreation, & Community Services Agency, 20 Civic Center
Plaza,M-23, Santa Ana,CA 92701.The name and location of event should be included
in the Description of Operations section of each certificate.
Self-Insured Retentions. Self-insured retentions must be declared to and approved by the
City. City may require Contractor to purchase coverage with a lower retention or provide proof of
ability to pay losses and related investigations, claim administration, and defense expenses within
the retention.
Acceptability of Insurers. Insurance is to be placed with insurers authorized to conduct
business in the state of California with a current A.M. Best rating of no less than ANII, unless
otherwise acceptable to City.
Verification of Coverage. Contractor shall furnish City with original Certificates of
Insurance including all required amendatory endorsements (or copies of the applicable policy
language effecting coverage required by this clause) and a copy of the Declarations and
Endorsement Page of the CGL policy listing all policy endorsements to Entity before work begins.
However, failure to obtain the required documents prior to the work beginning shall not waive
Contractor's obligation to provide them. City reserves the right to require complete, certified
copies of all required insurance policies, including endorsements required by these specifications,
at any time.
Claims Made Policies. If any of the required policies provide coverage on a claims-made
basis:
• The retroactive date must be shown and must be before the date of the contract or the
beginning of work.
• Insurance must be maintained and evidence of insurance must be provided for at least
three (3) years after completion of work.
• If coverage is canceled or non-renewed, and not replaced with another claims-made
policy form with a retroactive date prior to the contract effective date, Company must
purchase "extended reporting" coverage for a minimum of three (3) years after
completion of work.
Subcontractors. Contractor shall require and verify that all sub-contractors maintain
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insurance meeting all the requirements stated herein, and Contractor shall ensure that City is an
additional insured on insurance required from sub-contractors.
Special Risks or Circumstances. City reserves the right to modify these requirements,
including limits,based on the nature of the risk,prior experience, insurer,coverage,or other special
circumstances.
7. INDEMNIFICATION
Contractor agrees to defend, and shall indemnify and hold harmless the City, its officers,
agents,employees, contractors,special counsel,and representatives from liability: (1)for personal
injury, damages,just compensation,restitution,judicial or equitable relief arising out of claims for
personal injury, including death, and claims for property damage, which may arise from the
negligent operations of the Contractor or its subcontractors, agents, employees, or other persons
acting on their behalf which relates to the services described in section 1 of this Agreement; and
(2) from any claim that personal injury, damages, just compensation, restitution, judicial or
equitable relief is due by reason of the terms of or effects arising from this Agreement. This
indemnity and hold harmless agreement applies to all claims for damages, just compensation,
restitution,judicial or equitable relief suffered, or alleged to have been suffered, by reason of the
events referred to in this Section or by reason of the terms of, or effects, arising from this
Agreement. The Contractor further agrees to indemnify, hold harmless, and pay all costs for the
defense of the City, including fees and costs for special counsel to be selected by the City,
regarding any action by a third party challenging the validity of this Agreement, or asserting that
personal injury,damages,just compensation,restitution,judicial or equitable relief due to personal
or property rights arises by reason of the terms of, or effects arising from this Agreement. City
may make all reasonable decisions with respect to its representation in any legal proceeding.
Notwithstanding the foregoing, to the extent Contractor's services are subject to Civil Code
Section 2782.8,the above indemnity shall be limited, to the extent required by Civil Code Section
2782.8, to claims that arise of, pertain to, or relate to the negligence, recklessness, or willful
misconduct of the Contractor.
8. INTELLECTUAL PROPERTY INDEMNIFICATION
Contractor represents and warrants that it has obtained the requisite licenses to show the
films contemplated by this Agreement. Contractor further agrees to defend, indemnify and hold
harmless the City, its officers,agents,representatives, and employees against any and all liability,
including costs, and attorney's fees, for infringement of any United States' letters patent,
trademark, or copyright contained in the work product or documents provided by Contractor to the
City pursuant to this Agreement.
9. RECORDS
Contractor shall keep records and invoices in connection with the work to be performed
under this Agreement. Contractor shall maintain complete and accurate records with respect to
the costs incurred under this Agreement and any services, expenditures, and disbursements
charged to the City for a minimum period of three (3) years, or for any longer period required by
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law, from the date of final payment to Contractor under this Agreement. All such records and
invoices shall be clearly identifiable. Contractor shall allow a representative of the City to
examine, audit, and make transcripts or copies of such records and any other documents created
pursuant to this Agreement during regular business hours. Contractor shall allow inspection of all
work, data, documents, proceedings, and activities related to this Agreement for a period of three
(3) years from the date of final payment to Contractor under this Agreement.
10. CONFIDENTIALII`Y
If Contractor receives from the City information which due to the nature of such
information is reasonably understood to be confidential and/or proprietary, Contractor agrees that
it shall not use or disclose such information except in the performance of this Agreement, and
further agrees to exercise the same degree of care it uses to protect its own information of like
importance, but in no event less than reasonable care. "Confidential Information" shall include all
nonpublic information. Confidential information includes not only written information, but also
information transferred orally, visually, electronically, or by other means. Confidential
information disclosed to either party by any subsidiary and/or agent of the other party is covered
by this Agreement. The foregoing obligations of non-use and nondisclosure shall not apply to any
information that(a)has been disclosed in publicly available sources; (b) is,through no fault of the
Contractor disclosed in a publicly available source; (c) is in rightful possession of the Contractor
without an obligation of confidentiality; (d) is required to be disclosed by operation of law; or(e)
is independently developed by the Contractor without reference to information disclosed by the
City.
11. CONFLICT OF INTEREST CLAUSE
a. 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.
b. No immediate family members of either the Mayor, City Council Member, or any
appointed City Official, including appointed board and commission members, as
defined under the City's Municipal Code, whose position with the City shall award or
influence the award of this Agreement, or any competing contract or amendment
thereof, shall be employed in any capacity by the Consultant or have any other direct
or indirect financial benefit or interest in this Agreement.
c. The section also prohibits the awarding of any agreement, contract, grant, or any
amendment to those awards, to any former full-time employee for one-year from date
of employee separation except for any CalPERS retiree as authorized by City Council
resolution
d. The Consultant must comply with all conflict of interest laws, ordinances, and
regulations now in effect or hereafter to be enacted during the term of this Agreement.
The Consultant warrants that it is not now aware of any facts which conflict with the
prohibitions defined above. If the Consultant hereafter becomes aware of any facts that
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might reasonably be expected to create a conflict of interest, it must immediately make
full written disclosure of such facts to the City. Full written disclosure must include,
but is not limited to, identification of all persons implicated and a complete description
of all relevant circumstances. Failure to comply with the provisions of this paragraph
will be a material breach of this Agreement.
e. Consultant covenants that none of its directors, officers, employees, or agents shall
participate in selecting or administrating any subcontract supported(in whole or in part)
by City fiends stemming from the Agreement where the awarding of the subcontract
has any direct or indirect financial benefit or interest to any individual, as defined in
subsections (b) and (c) above.
12. NOTICE
Any notice, tender, demand, delivery, or other communication pursuant to this Agreement
shall be in writing and shall be deemed to be properly given if delivered in person or mailed by
first class or certified mail, postage prepaid, or sent by fax or other telegraphic communication in
the manner provided in this Section, to the following persons:
To City: City Clerk
City of Santa Ana
20 Civic Center Plaza(M-30)
P.O. Box 1988
Santa Ana, CA 92702-1988
Fax 714- 647-6956
Executive Director
Parks, Recreation, and Community Services Agency
City of Santa Ana
20 Civic Center Plaza(M-23)
P.O. Box 1988
Santa Ana, CA 92702
To Contractor: Swim Brayv Foundation
Attn: Candace Theme, Founder
5701 Santa Catalina Ave.
Garden Grove, CA 92845
candace.thomeaswimbravv.org
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
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timeframes, weekends, federal, state, County or City holidays shall be excluded.
13. EXCLUSIVITY AND AMENDMENT
This Agreement represents the complete and exclusive statement between the City and
Contractor regarding the subject matter herein, and supersedes any and all other agreements, oral
or written, between the parties. In the event of a conflict between the terms of this Agreement and
any attachments hereto, the terms of this Agreement shall prevail. This Agreement may not be
modified except by written instrument signed by the City and by an authorized representative of
Contractor. The parties agree that any terms or conditions of any purchase order or other
instrument that are inconsistent with, or in addition to, the terms and conditions hereof, shall not
bind or obligate Contractor 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 are not embodied herein.
14. ASSIGNMENT
Inasmuch as this Agreement is intended to secure the specialized services of Contractor,
Contractor may not assign, transfer, delegate, or subcontract any interest herein without the prior
written consent of the City and any such assignment, transfer, delegation or subcontract without
the City's prior written consent shall be considered null and void. Nothing in this Agreement shall
be construed to limit the City's ability to have any of the services that are the subject to this
Agreement performed by City personnel or by other contractors retained by City.
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. TERMINATION
This Agreement may be terminated by the City upon thirty(30) days written notice of
termination. In such event, Contractor shall be entitled to receive and the City shall pay Contractor
compensation for all services performed by Contractor prior to receipt of such notice of
termination, subject to the following conditions:
a. As a condition of such payment, the Executive Director may require Contractor to
deliver to the City all work product completed as of such date, and in such case,
such work product shall be the property of the City unless prohibited by law, and
Contractor consents to the City's use thereof for such purposes as the City deems
appropriate.
b. Payment need not be made for work that fails to meet the standard of performance
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specified in the Recitals of this Agreement.
17. NON-DISCRIMINATION
Contractor shall not discriminate because of race, color, creed, religion, sex, marital
status, sexual orientation, gender identity, gender expression, gender, medical conditions, genetic
information, or military and veteran status, age, national origin, ancestry, or disability, as defined
and prohibited by applicable law, in the recruitment, selection, teaching, training, utilization,
promotion, termination or other employment related activities or any services provided under
this Agreement. Contractor affirms that it is an equal opportunity employer and shall comply
with all applicable federal, state and local laws and regulations.
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. PROFESSIONAL LICENSES
Contractor shall,throughout the term of this Agreement,maintain all necessary licenses,
permits, approvals, waivers, and exemptions necessary for the provision of the services hereunder
and required by the laws and regulations of the United States, the State of California, the City of
Santa Ana and all other governmental agencies. Contractor shall notify the City immediately and
in writing of its inability to obtain or maintain such permits, licenses, approvals, waivers, and
exemptions. Said inability shall be cause for termination of this Agreement.
20. MISCELLANEOUS PROVISIONS
a. Each undersigned represents and warrants that its signature herein below has the
power, authority and right to bind their respective parties to each of the terms of
this Agreement, and shall indemnify City fully, including reasonable costs and
attorney's fees, for any injuries or damages to City in the event that such authority
or power is not, in fact, held by the signatory or is withdrawn.
b. All exhibits referenced herein and attached hereto shall be incorporated as if fully
set forth in the body of this Agreement.
[signature page follows]
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SIGNATURE PAGE FOR
AGREEMENT WITH SWIM BRAYV FOUNDATION TO PROVIDE
DROWNING PREVENTION PROGRAMMING FOR CITY EVENTS
IN WITNESS WHEREOF,the parties hereto have executed this Agreement the date and year first
above written.
ATTEST: �` '' CITY OF SANTA
��t• �
+r n•
ennifer Alvaro Nunez
C* City Manager
APPROVED AS TO FORM CONTRACTOR
SONIA R. CARVALHO
City Attorney
By:
Candace Theme{Jun 3,2025 10:30 PDT)
Jonathan T. Marti ez Candace Thome
Assistant City Attorney Founder
RECOMMENDED FOR APPROVAL
4 - _--- -
4ar
Scott
tive • ector
, Recreation, a nity Services Agency
Page 10 of 10
Exhibit A
SCOPE OF SERVICES
VENDOR INFORMATION: Swim Brayv
EVENT: Summer Splash Day Camp, Kid's Night Out, Pool Events, &Afterschool Programs
SERVICE DATE(S): Swim Brayv is a drowning prevention nonprofit that will provide one-hour special
programming during dates, times, and locations that will be mutually agreed upon in writing by each
party.
COMPENSATION DUE TO THE VENDOR: Vendor not to exceed $25,000 for the year.
Compensation with be agreed upon in written agreement between the parties.
DESCRIPTION:
Swim Brayv is a drowning prevention nonprofit that will provide one-hour special programming at
Summer Splash Day Camp, Kid's Night Out, and Afterschool Programs at the following centers.
Our 1 hour presentation reviews the Swim BRAYV Pledge -which consists of easy to-do,proactive water
safety tips &knowledge. We then have the attendees interact with the mermaid through engaging
conversations and a learning game -where fun prizes are available to each attendee. The presentation can
be tailored for ages 3 to 18+. We bring a 2ft wide banner, 4ft table &cloth,a chair for the mermaid,
educational handouts, an interactive standing game and prizes!
El Salvador Community Center/Pool
Jerome Community Center/Pool
Salgado Community Center/Pool
Garfield Community Center
Roosevelt Walker Community Center
Special entertainment will be held at each site with vendor and city seasonal staff for a period of I hour
with 30 minutes to I hour for set-up and take-down.
Program Needs: Private changing area for the mermaid,ADA accessible pathway from changing area to
site location (to move the mermaid around), Appx 1Ox1O site location space (Canopy/Shade needed if
outside)
The Vendor will be paid the full amount of compensation, within 45 days of each event.
Established and confirmed events:
3 sessions on Friday 7/25 - 11:OOam-12pm Salgado Center(60 campers)
1:OOpm-2:00pm Jerome Center(50 campers)
3:00pm-4:OOpm El Salvador Center(40 campers)
Total per session: $125
Total for 3 events: $375
ACC>R" CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDNYYY)
1111 4/25/2025
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
The J. More Company, Inc. NAME: Matt Sakurao
Y PHONE FAX
10833 Valley View Street, Suite 550 N ,714-562-5910 vc No:714-562 8747
Cypress CA 90630 ADDRESS: msakurau@imoreyins.com
INSURERS)AFFORDING COVERAGE NAIC#
License#:0655907 INSURER A:HIsCOX Insurance Comeany 10200
INSURED SW MSRA-01
Swim Brayv INSURER B
5701 Santa Catalina Ave INSURER C
Garden Grove CA 92845 INSURERD:
INSURER E
INSURER F
COVERAGES CERTIFICATE NUMBER:975469206 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 REOJiREMENT, 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 ADDL SUBR POLICY EFF POLICY EXP
TYPE OF INSURANCE
LTR 4
POLICY NUMBER MMIDDIYYYY MMIDDIYYYY LIMITS
A X COMMERCIAL GENERAL LIABILITY Y Y P102.732.064.4 511012025 5/10/2026 EACH OCCURRENCE $1,000,000
MAGE TO
CLAIMS-MADE X DA
OCCUR PREMISES Ea
RENTED occurrence $100,000
MED EXP(Any one person) $5,000
PERSONAL 8 AUV INJURY $1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER; GENERAL AGGREGATE $2,000,000
X POLICY[:] PRO- ❑
JECT LOC PRODUCTS-COMP/OP AGG $
OTHER' S
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
Ea accident
ANY AUTO BODILY INJURY(Per person) $
OWNED SCHEDULED Peracesdent
AUTOS ONLY AUTOS BODILY INJURY( ) $
HIRED NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY AUTOS ONLY Par accident
$
UMBRELLA LIAB OCCUR EACHOCCURRENCE $
EXCESS L1AB HCLAIMS-MADE AGGREGATE $
DED I I RETENTION$ $.
WORKERS COMPENSATION PER OTH-
AND EMPLOYERS'LIABILITY YIN STATUTE ER
ANYPROPRIETORIPARTN ER/EXECUTIVE
OFF ICERIMEMBEREXCLUDED7 El NIA E.L.EACH ACCIDENT $
)Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
City of Santa Ana,its Clty Council,officers,officials,employees,agents,and volunteers are considered additional insured and a waiver of subrogation applies
in respects to general liability
Tu Tran Tu Tran
signed by APPROVED
Tu Trann Nguyen
DaW2025.05.14 By Tu Tran Nguyen at 9:46 am,May 14,2025
Nguyen 09:45:3,-07'00'
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
The City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS.
Attn: Parks, Recreation, and
Community Services Agency AUTHORIZED REPRESENTATIVE
20 Civic Center Plaza
Santa Ana CA 92701
t
1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD
40
HI SCVX Hiscox Insurance Company Inc.
Policy Number: P102.732.064.4
Named Insured: Swim Brayv
Endorsement Number: 1s
Endorsement Effective: 05110I2025
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 Persons Or Or anization s
City of Santa Ana, its City Council, officers, officials, employees, agents, and volunteers
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-
zations) 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 c0 ISO Properties, Inc., 2004 Page 'I of 1
40
Hf JCOX Hiscox Insurance Company Inc.
Policy Number: P102.732.064.4
Named Insured: Swim Brayv
Endorsement Number: 16
Endorsement Effective: 05/10/2025
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
MODIFIED WAIVER OF TRANSFER OF RIGHTS OF
RECOVERY AGAINST OTHERS TO US
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
The following is added to Paragraph 8. Transfer Of
Rights Of Recovery Against Others To Us of
Section IV—Conditions:
You may waive your rights against another party so
long as you do so in writing prior to: (i) an offense
arising out of your business that caused a "personal
and advertising injury"; or (ii) an "occurrence" that
caused "bodily injury" or"property damage".
CGL E5402 CW(03110) Page 1 of 1
Includes copyrighted material of Insurance Services Office, Inc.,with its permission.
CITY OF SANTA ARIA
Risk Management a division of Human Resources
Managing Risk through Awareness and Action
AFFIDAVIT OF EXEMPTION FOR AUTOMOBILE LIABILITY INSURANCE
1, Candace Thome, Board Chair ("Representative"),attest that I am an authorized
(Name and Title of Vendor Representative)
representative of Swim BrayV
p ("Company"), and
(Consul tantlCompany Name)
possess the authority to legally bind Company.
In my capacity as Representative of Company, I represent and confirm the following, as relates to the
agreement between Company and City of Santa Ana, agreement number
("Agreement")to provide edu-tainment outreach
("Services"):
(Services to be provided under agreement/contract)
During the course and scope of Company's agreement with the City of Santa Ana,
Company employees,consultants, representatives, and agents will not use and/or drive
any Company owned/rented/leased/borrowed vehicles to perform Services to, for,or on
behalf of City of Santa Ana.
If at any time it is found that Company is not adhering to any and/or all of the statements in this
document and does not maintain the minimum automobile liability insurance coverage as
required in the Agreement, it will be considered a breach of Agreement rendering the Agreement
null and void and Company will be fully liable for any and all damages.
05/01/25
Signature DaLe
CAndace THome
Print Name
Board Chair
Title
candace.thome@swimbrayv.org
Contact Information,i.e.,Telephone Number and/or Email Address
Affidavit of Exemption far Automobife Liability Insurance 11.12.2C24
CITYOFSANTAANA
RISK MANAGEMENT a division of HUMAN RESOURCES
Managing Risk through Awareness and Action
Agreement to Indemnify, Hold Harmless and Defend
Title of Event/Activity: aquatics summer camps
Event Date. July 25th 2025
Description of Event/Activity: Edutainment outreach
Business or Organization Name: Swim Brayv
Full Name of Authorized Representative of Candace Thome
Bus iness/Organization:
Title of Authorized Representative: Board Chair
On behalf of the above named Business or Organization, the undersigned
represents that he/she/they has full authority to bind said Business or Organization.
The undersigned further agrees, on behalf of the above named Business or
Organization, to indemnify, defend and hold harmless the City of Santa Ana, its
City Council, officers, officials, agents, volunteers and employees from and against
all suits or actions and from any claims, loss, damage, liability, cost or expense,
including reasonable attorney's fees, for personal injury, death, and property
damage which may arise from the direct or indirect operations of the Business or
Organization named above or it contractors, sub-contractors, agents, employees,
volunteers, or other persons acting on their behalf while participating in the above
titled Event/Activity.
60i5��
Candace Thome` 05/01/25
Authorized Representative Signature of Authorized Representative Date
of Business or Organization(Print Name) of Business or Organization
CITY OF SANTA ANA
Risk Management a division of Human Resources ;E
Managing Risk through Awareness and Action
AFFIDAVIT OF EXEMPTION FOR WORKERS' COMPENSATION INSURANCE
1 Candace Thorne' Board Chair
("Representative"), attest that I am an authorized.
(Name and Title of Vendor Representative)
representative of Swim Brayv ("Company"), and
(Consultant/Company Name)
possess the authority to legally bind Company.
In my capacity as Representative of Company, I represent and confirm the following, as relates to the
agreement between Company and City of Santa Ana, agreement number
("Agreement")to provide edu-tainment outreach ("Services"):
(Services to be provided under agreement/contract)
During the course and scope of Company's agreement with the City of Santa Ana,Company will
not employ any person in any manner so as to become subject to the workers' compensation laws
of California, and agree that if Company should become subject to the workers' compensation
provisions of Section 3700 of the Labor Code, Company shall forthwith comply with the
provisions and provide proof of workers' compensation coverage immediately.
If at any time it is found that Company is not adhering to any and/or all of the statements in this
document and does not maintain the minimum professional liability insurance coverage as
required in the Agreement, it will be considered a breach of Agreement rendering the Agreement
null and void and Company will be fully liable for any and all damages.
C4;�W� 05/01/25
Signature Date
CAndace THome
Print Name
Board Chair
Title
candace.thome@swimbrayv.org
Contact hiformation,i.e.,Telephone Number and/or Email Address
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSANT DOLLARS($100,000).IN ADDITION TO THE COST OF
COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,
INTEREST,AND ATTORNEY'S FEES.
Affidavit of Exemption for Workers'Compensation Insurance 11.12.2024