HomeMy WebLinkAboutCAL JUMP SOUTH ORANGE COUNTY LCC INSURANCE ON FILE
Wt7RK MAY PROCEEC
UN-111 INSU t',f`t'E EXPIH' N-2025-206
CITY CLERK
SATE. JUL 3 1 �AflZJ GREEMENT BETWEEN CAL JUMP SOUTH ORANGE COUNTY LLC AND
CITY OF SANTA ANA FOR INFLATABLE EQUIPMENT
TI ITS ACIt1:EMENT is made and entered into on this 81 day of May,2025 by and between Cal
G, fro "" ��'1 Jump South grange County LI,C, (-Comsuhant-), and the City of Santa Ana,'a charter city and
municipal eorpontlion organized and existing under the Constitution and laws of the State of
California("City").
RECITAW
K llte Cite desires to retain a Consultant to provide irttlatnble equipment rental for use by the
Banta Ana Police 1)cparttnent.
B. Consultant represents that Consultant is able and willing to provide such services to the
CO.
C. In undertaking the performance of this Agreement, Consultant represents that it is
kmowk�lgeable 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
e.%pected 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:
1. SCOPE OF SERVICES
Consultant shall deliver inflatable recreational equipment to City as described in Invoice
No.39625919-Exhibit A,attached hereto and incorporated herein,on July 24,2025.Consultant
will set up and will dismantle the equipment at the end of the same day.
2. COMPENSATION
a. City agrees to pay,and Consultant agrees to accept as total payment for its senices for
City, the rates and charges identified in Invoice No. 39625919-Exhibit A,attached
hereto and incorporated herein The totall amount to be expended during the term of this
Agreement shall not exceed S1,477.00.
b. Payment by City shall be made prior to July 24, 2025, subject to City accounting
procedures. City and Consultant agree that all payments due and owing under this
Agreement shall be made through Automated Clearing House (ACH) transfers.
Consultant agrees to execute the City's standard ACH Vendor Payment Authorization
and provide required documentation. Upon verification of the data provided,the City
will be authorized to deposit payments directly into Consultant's account(s) with
financial institutions.
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'111is Atlivei scut iv for one(1)day and shall cunnttcrtcu on July 24,2025,and terminate at
the and(it the same day.
4. INI KPC,NDENT CONTRACTOR
Consultant shall, thtriug Ilre entire term of Illis Agreement, be construed to be an
independent Consultant and not an employee of the City, 'Phis Agreenrcnt is not irnendcd ncrr sbitll
it lie construed to create an employer-employee relationship, a joint vcnlurc relationship,or to
allow the City to exorcise discretion or control over the:professlorial manner in whioh Consultant
performs the services which arc the subject matter or116 Agreement;however,the services to be
provided by Consultant shall be provided iit a manner consistent wilh all opplicablo standards and
regulations governing such services.Consultant shall pay all salaries and wagers,employer's social
security taxes, Unemployment insurance and similar tuxes 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 Consultant under this Agreement("Documents&Data"). Consultant
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.
Consultant represents and warrants that Consultant bus the legal right to license any and all
Documents & Data, Consultant makes no such representation and warranty in regard to
Documents&Data which were provided to Consultant by the City City shall not be limited it
any way in its use of the Documents and Data at any time,provided that any such use not within
the purposes intended by this Agreement shall be at City's sole risk,
G. INSURANCE
Consultant shall procure and maintain for the duration of the contract insurance against
claims for injuries to persons or damages to property which may arise from or in connection with
the performance of the work hereunder and the results of that work by the Consultant,his agents,
representatives,employees or subcontractors,
MINIMUM SCOPE OF INSURANCE
Coverage shall be at least as broad as:
Commercial General Liability (CGL): Insurance Services Office Form CG 00 01
covering COI, 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.
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• Autotnablle Unbility(AL): Insurance SCrVIBea Office 1701111 CA 00 01 covering Code I
(any auto),with combined single limits of$1,000,000. In the event Consultant does not
maintain commetnial automobile liability insurance,City will accept evidence of personal
automobile insurance with existing limits,which coin bpi lower than 51,000,000.
• Workers' Compensation (W/C): as required by [Ile 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 Consultant has no employees.
if Consultant maintains broader coverage and/or higher limits than[lie minimums shown above,
City acquires and shall be entitled to the broader coverage and/or the higher limits maintained by
Consultant. Any available insurance proceeds In execss of the specified winimunt 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:
I. CGi, 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 oroperatious performed by or on behalf of the Consultant
including materials,parts,equipment,and personnel furnished in connection with such
work or operations.
2. 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 Consultant for City.
3. All required insurance policies:For any claims related to this contract, Consultant's
insurance coverage shall be primary and any insurance maintained by City,its City
Council, its officers,officials,employees, agents,or volunteers shall not contribute
with it.
4. All required insurance policies:A severability of interest provision must apply for all
the additional insureds,ensuring that Consultant'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.
S. 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«xitten notice shall be provided to City for policy cancellation
or non-renewal due to non-payment.
6, Certificate Holder on each Evidence of Insurance certificate shall be: City of Santa
Ana,Attention:Dario Gaitan,20 Civic Center Plaza, M-96,Sonia.Ana, CA.92701.
The name and location of the event should be included in the Description of Operations
section of each certificate.
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Self-insured rowntions must bo declared to and approved by the City.City may require Consultant
to purobase coverage with a lower retention or provido Proof of ability to pay lasses and related
investigations,claim administmion,and defense expenses within the retention.
Aecoptahility of insurers
lltsul'tttica is to be placed with insurers authorized to conduct business in the slato of California
►vith a current A,M,nest rating ONO less than ANN,unless otherwise acceptable to City.
Verification of Coverage
Consultant shall famish City with original Certificates of Insurance fooluding all required
amendatory endorsements(or collies of the applicable policy language affecting coverage required
by►leis clatttic)and a copy of the Declarations and Endorsement Page of the COI,policy listing all
policy cndolvaianls to fruity before work begin% However, failure to obtain the required
documents prior to the work beginning shall not waive Consultant's obligation to provide them.
City reserves the tight 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:
I. The retroactive date must be shorn and must be before the date of the contract or the
beginning of work.
2. Insurance must be maintained and evidence of insurance must be provided for at least three
(3)years after completion of work.
3. If coverage is canceled or non-rmevwed,and not repi iced with another claims-made policy
form with a retroactive date prior to tic contract effective date,Company must purchase
"extended reporting"coverage for a minimum of three(3)years after completion of work.
Subcontractors
Consultant shall require and verify that all sub-contractors maintain insurance meeting all the
requimments stated herein, and Consultant 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
Consultant agrees to defend,and shall indemnify and]told 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, its subcontractors, agents, employees, or other persons
acting on its behalf which relates to the services described in section I of this Agreement;and(2)
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from any claim that personal injury,damages,just cotltpensation,restitution,judicial or equitable
relief is due by reason of the toms of or effect,;arising fatal this Agreement,`t'his indcnulily and
hold harmless agreorment applies to ail claims for damages,just compensation,restitution,judicial
or equitable relief suffer d,or alleged to have been suffered,by reason of line events reform,()to in
this Section or by Mason of the towns or,or effects,arishsg fixim this Agivonlenl. Tito Consultant
further agrees to indemnify,hold harmless,and pay all costs fur the defense of the City,including
fees and costs for special counsel to be selected by the City,r;gording any action by a third party
challenging the validity or this Agreillent, or nsscrling that personal injury, dmnages, just
compensation,restitution,judicial or equitable rolicl'duo to personal or property rights arises by
reason of file scans of, or effects arising tYoln this Agreement. City may make all reasonable
dLeNions with respect to its reprose»Iation ill ally legal proceeding.Notwithslanding the foregoing,
to the extent Contnnctor's services are subject to Civil Code Section 2792.8,Ilse above indemnity
shall be limited,to the extent required by Civil Code Sections 2782,8,to olaints that ariso out of,
pertain to,or relate to tho negligence,recklessness,or willful misconduot or the Conlraotor.
S. INTELLECTUAL PROPERTY INDEMNIFICATION
Consultant shall defiKnd and indemnify the City, its officers, agents,representatives,and
employees against any and all liability,including costs, for infringement of any United States'
letters patent,trademark,or copyright infringement,including costs,contained in the work product
or documents provided by Consultant to the City pursuant to this Agreement.
). RECORDS
Consultant shall keep records and invoices in connection with the work to be performed
under this Agreement. Consultant shall maintain complete and accurate records with respect to
the costs incurred under this Agreement and any services, expenditures, and disbursements
charged to the City for a minimum period of three(3)years,or for any longer period required by
law,f3rom the date of final payment to Consultant under this Agreement. All such records and
invoices shall be clearly identifiable. Consultant 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. Consultant 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 Consultant under this Agreement.
10. 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 perforrnance 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 Inforniation"shall include all
nonpublic iatfor4ation. Confidential infon nation includes not only written information,but also
information transf4rocl orally, visually, cleetronioally, or by other means. Confidential
infornlat.ion disclosed to either party by any subsidiary and/or agent of(lie other party is covered
by this Agreement. The foregoing obligations of non-use and nondisclosure shall not apply to any
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information that(a)has been disclosed in publicly available sources;(b)is,through no fault of the
Consultant disclosed in a publicly available sourco;(a)is in rightful possession of die Consultant
without an obligation of confidentiality;(d)is required to be disclosed by operation of late;or(a)
is independently developed by (lie Consultant 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 ilia 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 fonner full-time employee for one-year from date
of employee separation except for any CaIPERS 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(Contract,
Agreement,or Grant).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 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.
c. Consultant covenants that none of its directors, officers; employees,or agents shall
participate in selecting or administrating any subcontract supported(in whole orin part)
by City funds 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. NON DISCRIMINATION
Consultant 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 late, in the recruitment, selection, teaching, training, utilization,
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promotion,wt7tlinalion or other e111ploynlcnl related Aolivillcs or ally sctvicess provided haler this
Agreement, Consultant of litlus that it i:1 all equal Opixlt full lty colployal.and shall comply with all
applicable,federal,state and local laws and regulaliolts.
13. EXCLUSIVITY AND AMENDMENT
This A1trvamenl repivients the carinpidte and exclusive sla(emeut between file City and
C,'outrnotor,alld supersedes any and all other agreanwm,oral or wriltcn,between the parties. In
the event of a conflict betwoon the terns of this Agreement and any attachments hereto,the terms
of IIIi t Agrt errant shall prdvai(. This Agreement may not be modified oxcept by written instrument
signed by the City and by an authorized representnlive(If Contractor, The parties agree Ihat any
terinsr or conditions of any purchase order or other insftusnent (fiat are inconsistent with, or in.
addition to,the terms and conditions hereof,shall not bind or obligate Consultant ortho City.Bach
party to this Agreement acknowledges that no represcruations, inducements, promises or
agreements,orally or olhcrwise,have bean made by any party,or anyona acting on bellalf of any
panty,which is not embodied herein.
14. ASSIGNMENT
Inasmuch as this Agreement is intended to secure the specialized services of Contractor,
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. 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 Contractors retained by City.
IS. TERMINATION
This Agreement may be terminated by the City prior to July 24,2025 with written notice
of termination, In such event,Consultant shall refund City for any payment made.
16. WAIVER
No waiver of breach, failure of any condition, or any right or remedy contained in or
granted by the provisions of this Agreement shall be effective unless it is in writing and signed by
the party waiving the breach,failure,right or remedy.No waiver of any breach,failure or right,or
remedy shall be deemed a waiver of any other breach,failure,right or remedy,whether or not
similar,nor shall any waiver constitute a continuing waiver unless the writing so specifies.
17. 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 Stale 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,
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18. 1Pal OVIESSIONAL LICENSES
Cbusuitant shall,thmugbout lite term of this Agiventonl,maintain all necessary licenses,
pennils,approvals,rvaivcs A'and dXmitpliouR nt ccssuty'for the provision of tlio services heraunder
and t:quired by the lulus and nttuiatlons of the Uhtflcd States,the State dff California,late City of
Santa Ann and all other governmental attencies. Consultant shall tiotily IN City immedialoly and
in ivritiu8 of its inability to obtain or niainluin such pernits, licenses, approvals,waivers, and
exemptions. Saltl itutbility sfudl ba cause iitr tcxtnihiation ttl'this Agreement.
19. NOTICE
Any notice,tender,demand,delivery,or other communication pursuant to this Agreamcnt
shall be in\miring and sliall be deemed to be ltittperly given if delivered in person or mailed by
fih,tt class or ecrtifiecl mail,postage prepaid,or sent by fnx or other telegraphic communication in
the inAnner provided in this Section,to Qie following petlons:
`1"o City;
Cily clerk.
City of Santa Ana
20 Civic Conley Plata(M-30)
RO.Box 1988
Santa Ana,CA 92702.1988
Fax:714-647.6956
With courtesy copies to;
Chief of Police
City of Santa Ana
20 Civic Center Plaza(M-96)
P.O.Box 1988
Santa Ann,California 92702
To Contractor:
Dwayne Anderson
Cal rump South Orange County LLC
2717 South Orange Ave.
Santa Ana,CA 92702
A pasty may change its address by giving notice in writing to the other party. Thereafter,
any communication shall be addressed and transmitted to the now address, If seal by mail,
communications 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 scat 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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time frames,u eckends,federal,state,County or City holidays shall he eotcluded.
20. MISCELLANEOUS PROVISIONS
a. Each undersigned rcprtwcnts and warrants that its signature herein below has the
po%%CT,authority and right to hind tloctr respective Mastics it)each of the terms of
this Agreement, and shall indemniR. City fully, including reasonable costs and
atto ney's fees,for any injuries or damages to City in the event that such authority
or you cr is not,in fact,held by the signatory or is a ithdravvm
b. All Exhibits referenced herein and attached hereto shall he 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 tear first
above written.
A`I'I"EST: -., CITY OF SA: A ANA
2
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Cite Clerk City N ana�-cr
APPROVED AS TO FORM:
SONIA R.CARVALHO CALJ **IP SOLTII ORANGE
Cite Atlorney C'O1 tiT�'LLC:
f
I AMARA 110 0SIAN 1)',1,1 fi*,i .1`.?o; ittit►ti
Senior Assl%Ianl Cite Atturne%
RECOMMENDED FOR APPROVAL-
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Chief o P,11:cc
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A��I P
ATE(MMIDDIYYYY)
�� CERTIFICATE OF LIABILITY INSURANCE 0511912025
THIS CERTIFICATE 1S 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 1NSURER(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 CONTANAME:CT Tony Cannizzaro
First Commercial Insurance Agency PHONEo. (386)775-1781 FAc No
P.O. Box 295 E-MAIL nsurance u com
ADDRESS: i g y@cfl.rr.
INSURERS AFFORDING COVERAGE NAIC N
Cassadaga FL 32706 INSURER A: BEAZLEY 1 CERTAIN UNDERWRITERS AT LLOYC 37540
INSURED INSURER 6;
Cal Jump South Orange County LLC INSURER C
2717 S Orange Ave Unit DIE INSURER D
INSURER E
Santa Ana CA 92707 INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE INSD WVQSUBR POLICY NUMBER MMIDDffYYYY MMIDDNYYYY LIMITS
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
DAMAGE TO RENTED
X CLAIMS-MADE aceuR PREMISES Ea occurrence $ 300,000
X 3 year extended reporting period MED ExP(Any one parson) $ 25,000
A X Retroactive Date: 05/12/2023 X X ZISMB2420 02 05/12/2025 05/12/2026 PERSONAL&ADV INJURY $ 1,000,000
X
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 21000,000 POLICY PRO- 7 I LOC PRODUCTS-COMP/OP AGG $ 2,000,000
JECT u
OTHER: $
AUTOMOBILE LIABILITY COBINED SINGLE LIMIT
Fa M accident $
ANY AUTO "C'DILY INJURY(Per person) $
OWNED SCHEDULED RODILY INJURY(Per accident) $
AUTOS ONLY AUTOS
HIRED NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY AUTOS ONLY Per accident
$
UMBRELLA LIAR OCCUR EACH OCCURRENCE $
EXCESS LIAR CLAIMS-MADE AGGREGATE $
DIED RETENTION$ $
WORKERS COMPENSATION PER OTH-
AND EMPLOYERS'LIABILITY YIN STATUTE ER
ANY PROPRIETORfPARTNERIEXECUTIVE ❑ F.L.EACH ACCIDENT $
OFFICERIMEMBFR EXCLUDED? N I A
(Mandatory in NH) E.L.DISEASE-FA EMPLOYE $
If yes,describe under
DESCRIPTION OF OPERATIONS below RL,DISEASE-POLICY LIMIT $
[APPROVED
By Tu Tran Nguyen of 2:39 pm,Jun 11,2025
DESCRIPTION OF OPERATIONS lLOCATIONS f VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required)
City of Santa Ana,.its City Council,officers,officials,employees,agents,and volunteers are named as Additional Insured with Waiver of Subrogation as regard
the General Liability policy when required by written contract subject to the terms, conditions,and exclusions of the policy,
igTitally signed
Tu Tran byDu Traa
Event Date:07/24125 Nguyen
Nguyen Date:2025.06.11U
Project Manager Name: Dario Gaitan,Police Department,2627 W McFadden Ave,Santa Ana,CA 92704 N g y 14:45:06-07'00'
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City Of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS,
Attn:Dario Gaitan,Police Department AUTHORIZED REPRESENTATIVE
60 Civic Center Plaza,M-23 62 �
Santa Ana CA 92701 L
c01988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD
UMR: UMR B1284 UB 24 A969A
Effective date of this Endorsement: 519125
This Endorsement is attached to and forms a part of Policy Number: ZISMB2420 02
Zodiac Insurance,A World Company Referred to In this endorsement as either the"Insurer"or
the"Underwriters"
ADDITIONAL INSURED ENDORSEMENT
This endorsement modifies insurance provided under the following:
ENTERTAINMENT EQUIPMENT OPERATOR GENERAL LIABILITY CLAIMS MADE AND
REPORTED INSURANCE
in consideration of the premium charged for this policy, it is understood and agreed that:
1. Section Ill. PERSONS INSURED is amended to include as an Insured the person or
organization shown in the Schedule at paragraph 2. below, but only with respect to liability
arising out of the Named Insured's operations or premises owned by or rented to the Named
Insured.
2. SCHEDULE
Name of Person or Organization:
City of Santa Ana,its City Council, officers,officials,
employees,agents,and volunteers
Attn:Dario Gaitan,Police Department 60 Civic Center
Plaza,M-23
Santa Ana,CA 92701
Event Date:07/24/25
Any person or organization for whom the Named Insured has agreed by written "insured
contract"to designate as an additional insured subject to all provisions and limitations of this
policy.
(If no entry appears above, information required to complete this endorsement will be shown in
the Declarations as applicable to this endorsement).
All other terms and conditions of the Policy remain unchanged.
UMR: B1284 UB 24 A969A
Effective date of this Endorsement: 5f9125
This Endorsement is attached to and forms a part of Policy Number: zismB2420 02
Zodiac Insurance,A World Company Referred to in this endorsement as either the"Insurer" or
the"Underwriters"
ADDITIONAL INSURED PRIMARY AND NON CONTRIBUTORY AND WOS ENDORSEMENT
This endorsement modifies insurance provided under the following:
ENTERTAINMENT EQUIPMENT OPERATOR GENERAL LIABILITY CLAIMS MADE AND
REPORTED INSURANCE
In consideration of the premium charged for this policy,it is understood and agreed that:
1. Section III. PERSONS INSURED is amended to include as an Insured the person or
organization shown in the Schedule at paragraph 2. below, but only with respect to liability
caused, in whole or in part, by the Named Insured's performance of ongoing operations for that
Insured. However:
a) The insurance afforded to such additional insured only applies to the extent permitted by
law; and
b) If coverage provided to the additional insured is required by written"insured contract",the
insurance afforded to such additional insured will not be broader than that which you are
required by the written"insured contract"to provide for such additional insured.
c) This coverage is provided on a primary and non-contributory basis.
2. SCHEDULE
Name of Person or Organization:
City of Santa Ana, its City Council, officers, officials, employees, agents, and
volunteers
Attn: Dario Galtan, Police Department
60 Civic Center Plaza, M-23
Santa Ana, CA 92701
Event Date: 07/24/25
Any person or organization for whom the Named Insured has agreed by written"insured
contract"to designate as an additional insured subject to all provisions and limitations of this
policy.
(If no entry appears above, information required to complete this endorsement will be shown in
the Declarations as applicable to this endorsement)
All other terms and conditions of the Policy remain unchanged.
For Roadside Assistance: 800-531 -8555
Report a claim, get coverage and deductible information, request a tow from the accident
scene, schedule an appraisal or reserve a rental car using:
usaa.com,
USAA's Mobile App, or
By calling 210-531-USAA (8722), our mobile phone shortcut number #8722 or
800-531 -USAA.
California Evidence of Financial Responsibility
This ID card is evidence of liability insurance for your vehicle. The card is valid only as long as liability
insurance remains in force. Keep a copy of the ID card in your vehicle at all times.
You may be required to produce your identification card at vehicle registration or inspection, when
applying for a driver's license, following an accident, or upon a law enforcement officer's request.
FCA1 Rem. 6-13 50781 -0513 02
--------------------------------------------------------------------------- --------------------------- -b - - -- - - -------------------------
CALIFORNIA EVIDENCE OF FINANCIAL RESPONSIBILITY
Name and Address of Insured NAIC 21253
California Evidence of Financial Responsibility
DWAYNE ANDERSON Keep this card.
4162 W 156TH ST
LAWNDALE CA 90260-2230 IMPORTANT: The California Financial Responsibility
Act (Section 16020) of the Vehicle Code requires every
owner or operator of a vehicle subject to the
requirements of the Financial Responsibility Act to carry
evidence of financial responsibility in the vehicle at all
times. Under vehicle code (Section 16028) every driver
f involved in an accident must provide evidence of
o financial responsibility at the scene. Failure to comply is
I an infraction and shall be punishable by fines,
DWAYNE ANDERSON d impoundment or license suspension.
Insurance Company
GARRISON PROP AND CAS INS CO
Policy Number I Effective Date Expiration Date Additional copies available at usaa.com
03412 03 33R 7101 9 02/14/25 08/14/25
Vehicle Make/Vehicle Identification Number Year
FORD 1 FTEWICP3PKE19252 2023
CONTACT U5:270-531-USAA(8722)
This policy provides at least the minimum amounts of liability insurance OR 800-531-USAA
required by the CA VEH CODE SECTION 16056 for the specified vehicle and
named insureds and may provide coverage for other persons and other 9800 Fredericksburg Road, San Antonio, Texas 78288
vehicles as provided by the insurance policy. g
6/5/25,5:37 PM 13mail-Auto Insurance Confirmation
Gmail Dwayne Anderson <dwaynea995@gmaii.com>
...........- -.......... ..........
Auto Insurance Confirmation
USAA<USAA.Customer Service@ m ai Icenter.usaa.co m> Thu, Jun 5, 2025 at 535 PM
Reply-To: USAA<USAA.Customer.Service@mailcenter.usaa.com>
To: dwaynea995@gmaii.com
To ensure delivery to your inbox,please add USAA.Customer.Service@mallcenter.usaa,com to your address book.
I ig
Auto Insurance Confirmation
Please use this as confirmation of auto insurance; however,this doesn't take the place of an insurance
identification card.
Registered owner: DWAYNEANDERSON
Address: 4162 W 156TH ST
LAWNDALE CA 90260
Policy number: GAR 034120333 7101
Policy effective date: February 14, 2025
Policy expiration date: August 14, 2025
Vehicle: 2023 FORD F-150
VIN: 1FTEW1CP3PKE19252
h[tps:1/rnail.googlc.com/rn ail/u/0/?ik=ef4510941 fi&v i ew=pt&search=al1&perrnrnsgid—msg-f:1834137802271676954&simpl=msg-f:183413780227 1676954 113
615125,5:37 PM Gmail-Auto Insurance Confirmation
Bodily injury liability limit: $30,000
each person 1
$60,000 each accident
Property damage liability limit: $25.000 each accident
Comprehensive deductible: $1,000
Collision deductible: $1,000
Lienholder. FORD MOTOR CREDIT COMPANY
PO BOX 390910
MINNEAPOLIS
MN 55439 0910
Meets California minimum statutory liability requirements
This confirmation of coverage neither affirmatively nor negatively amends, extends or alters the coverage given
by the policy issued by Garrison Property and Casualty Insurance Company.
How to Contact Us
Thank you for choosing us for your auto insurance needs. If you have any questions, please contact us using
one of the following options:
Phone: 210-531-USAA(8722), our mobile shortcut#8722 or 800-531-8722
Fax: 800-531-8877
Thank you,
https:llmail.google.com/mail/u/0/?ik=ef45109416&view=pt&search=all&permmsgid=msg-f:18341378Q2271676954&simpl=msg-f:1934137902271676954 213
615125,5:37 PM Gmail-Auto Insurance Confirmation
Garrison Property and Casualty Insurance Company
Garrison Property and Casualty Insurance Company,a subsidiary of USAA Casualty Insurance Company,is authorized to
use the USAA logo,a registered trademark of United Services Automobile Association.
40 Go Digital
Review and edit your online document preferences at usaa.com.
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Garrison Property and Casualty Insurance Company,9800 Fredericksburg Road,San Antonia,Texas 78288 U S �
93127-0111
https:/imait.google,comimailiu/0/?ik-ef45109416&view-pt&search-all&pennmsgid-msg-f:183413780'2271676954&simpl=msg-f:1834137802271676954 313
MY OF SANTA.ANA
Risk Management a dlvlslon of Human ltesourres
Managing Risk Ihrough Awareness and Action
AI 1DAVIT O FXFMry110N FOR WORKERS' c OMPI-:NSATION INSURANCE
I VAJ__._ )l C— G �'StlYI [ 'lteprl.eohillvu, {,atre;t that l Fltn au aalhorared
w__..._ . __._...�._.
f�,t;�� ul,itlr t lfrft,3.x rir{�r�rwaq,c, / /�
i' h l`�'.1�I 171r f`„IIYr-Lfl) ai.kllit'.I
lxtsuetiti the authorat} to Iegalh.hind Contl-Kim
In m% capak;tty as hepra�c:utatne n1'C urnlaArlt�, I tel�re;ettt and aoitlinn tilt;finksv inf;,trw relates,of the
attrcetuent IVIvxcV1l Cotttpain rtrtaf('it} of 5attita Aail.,;iViacineii((number
("Allteeutr;nt")to pr°vicle _ ( ,�� C�Lt_S - {,� - —('Services'}
tticn f:cs C.t he Iv:n tiled�uf�t,•,;tFtf cr.tfkcnl'c�gfCracr i
During the course rutd scope of compauy's agreement tt itlt the Cit} ol'Sonta Aria,Conipariv will
trot eratltlo} apt} person in uaay ananncr so as to hecoaue subject-to the vt�orkcrs' coanlxaasation Intt s
ol'Califontia,ratd agrea that it'('onapanr Should becolile Subject to tl{e ttorkcrs' corultcrisation
provisions of`Section 3700 of tits!.,tenor•Code,C'oauptnty sltall forthwith comply witch the
pmviniorta tend provide proof of ttarkerx'coaupellstatioat covetoge inttnediatel}
If at any time it is found that Company is not adh4riug to any andAw all of(he statements in this
doc:t►niant.and does not tuainlain the tninimurn"otkers'conipensaition insurance coverage as
required in the.Agreement,it tt ifl be ccttasidered a breach orAgreemeri(rendering the Agreement
null and void and C;ontlmny tt ili be fully liable For an} arid all d4unage.s.
ti
Sf�r!'�IU1't rya[d
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F.'nfua.F h,ErnfnF�fefn.,Le, fed lfc\uu,lrk•r aeut fE3 Ld&,.r
WARNING: FiXII.t'It.F.'l[)SECURE.4C'ORKL•'ItS'COMPt:NSATION CO1 f:'ft_ GE IS UNLAWFUL,
,AND SHAI..I.St~`BJ1-,CT AN I NIPLOYI:'R TO CRIXIINAL PEN ll,1' E S AND CIVIL FIN VS UP TO
fN.tI)DITION. t'()THj C0M,()F
COMPE'NS TION,DAXIA[IES AS PROVIDED FOR IN SECTION 370(1 OI:4111.'LABOR C( DF.
1N`II:ItI S't',.1�I).1'I1'QIttiI }"S FEES.
AEfdavltofExempWn for Workers fompecsaanInsurance tt.12 202.3