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HomeMy WebLinkAboutHERNANDEZ ANTUNEZ, ANDRES INSURANCE ON FILE WORK MAY PROCEED UNTtt �KUKANCE EXPIRES N-2025-231 CITY CLERK DATE:SEP 10 2025 PERFORMER AGREEMENT BETWEEN ANDRES HERNANDEZ ANTUNEZ AND &cda�Fo Ht rncsndex�Dz) THE CITY OF SANTA ANA FOR PRESENTATION OF COLORS SERVICES THIS AGREEMENT is made and entered into on this 25th day of August, 2025, by and between Andres Hernandez Antunez, an individual ("Performer"), 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"). RECITALS A. The City desires to obtain the services of a performer to provide presentation of colors services at the 2025, 2026, and 2027 Fiestas Patrias El Grito ceremonies on behalf of the City's Parks, Recreation, and Community Services Agency. B. Performer represents that it is able and willing to provide such services to the City. C. In undertaking the performance of this Agreement, Performer represents that it is knowledgeable in its field and that any services performed by Performer under this Agreement will be performed in compliance with such standards as may reasonably be expected from a professional consulting firm in the field. NOW THEREFORE, in consideration of the mutual and respective promises, and subject to the terms and conditions hereinafter set forth, the parties agree as follows: 1. SCOPE OF SERVICES Performer shall perform during the term of this Agreement, the tasks and obligations including all labor, materials, tools, equipment, and incidental Customary work required to fully and adequately complete the services described in the "Scope of Services," attached hereto and incorporated herein by reference as Exhibit A. 2. COMPENSATION a. City agrees to pay, and Performer agrees to accept as total payment for its services for City, the rates and charges identified in Exhibit A. The total amount authorized during the term of this Agreement shall not exceed $49,000.00. b. Payment by City shall be made within forty-five (45) days following receipt of proper invoice evidencing work performed, subject to City accounting procedures. City and Performer agree that all payments due and owing under this Agreement shall be made through Automated Clearing House (ACH) transfers. Performer 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 Performer's account(s) with financial institutions. 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. Pane 1 of 7 3. TERM This Agreement shall commence on the date first written above and terminate on September 30, 2027, unless terminated earlier in accordance with Section 15, below. 4. INDEPENDENT CONTRACTOR Performer 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 Performer performs the services which are the subject matter of this Agreement; however, the services to be provided by Performer shall be provided in a manner consistent with all applicable standards and regulations governing such services. Performer 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 Performer under this Agreement("Documents& Data"). Performer 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. Performer represents and warrants that Performer has the legal right to license any and all Documents& Data. Performer makes no such representation and warranty in regard to Documents& Data which were provided to Performer by the City. City shall not be limited in 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. Performer retains all ownership rights, including copyrights,to all materials and designs created tinder this Agreement.The City is granted a limited, non-transferable license for use of such materials solely for the purposes outlined in this Agreement. Any other use requires prior written consent from Performer. 6. INSURANCE Insurance requirements are set for in Exhibit B, attached hereto and incorporated herein. 7. INDEMNIFICATION Performer 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 Page 2 of 7 negligent operations of the Performer, 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) 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 Performer 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 Performer'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 out of, pertain to, or relate to the negligence, recklessness, or willful misconduct of the Performer. 8. INTELLECTUAL PROPERTY INDEMNIFICATION Performer shall defend 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 Performer to the City pursuant to this Agreement. 9. RECORDS Performer shall keep records and invoices in connection with the work to be performed under this Agreement. Performer 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, from the date of final payment to Performer under this Agreement. All such records and invoices shall be clearly identifiable. Performer 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. Performer 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 Performer Linder this Agreement. 10. CONFIDENTIALITY If Performer receives from the City information which due to the nature of such information is reasonably understood to be confidential and/or proprietary, Performer agrees that it shall not use or disclose such information except in the performance of this Agreement, and ftirther 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 Page 3 of 7 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 Performer disclosed in a publicly available source; (c) is in rightful possession of the Performer without an obligation of confidentiality; (d) is required to be disclosed by operation of law; or(e) is independently developed by the Performer without reference to information disclosed by the City. City agrees to maintain the confidentiality of any proprietary information, trade secrets, or designs disclosed by Performer, except as required by law. 11. CONFLICT OF INTEREST CLAUSE Performer 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. 12. NON-DISCRIMINATION Performer 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. Performer affirms that it is an equal opportunity employer and shall comply with all applicable federal, state and local laws and regulations. 13. EXCLUSIVITY AND AMENDMENT This Agreement represents the complete and exclusive statement between the City and Performer, 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 Performer. 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 Performer or the City. Each party to this Agreement acknowledges that no representations, inducements, promises or agreements, orally or otherwise, have been made by any party, or anyone acting on behalf of any party, which is not embodied herein. 14. ASSIGNMENT Inasmuch as this Agreement is intended to secure the specialized services of Performer, Performer 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. Page 4 of 15. TERMINATION This Agreement may be terminated by the City upon five (S) days written notice of termination. In such event, Performer shall be entitled to receive and the City shall pay Performer compensation for all services performed by Performer 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 Performer to deliver to the City all work prodLict(s) completed as of such date, and in such case such work product shall be the property of the City unless prohibited by law, and Performer 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. 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, faihire 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 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. 18. PROFESSIONAL LICENSES Performer 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. Performer 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. 19. 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 Page 5 of 7 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, California 92702-1998 Fax: 714- 647-6956 With courtesy copies to: Executive Director Parks and Recreation City of Santa Ana 20 Civic Center Plaza P.O. Box 1988 Santa Ana, California 92702 To Performer: Andres Hernandez Antunez 12041 Cole St., Apt. I Garden Grove, California 92841 A party may change its address by giving notice in writing to the other party. Thereafter, any communication shall be addressed and transmitted to the new address. If sent by mail, communication shall be effective or deemed to have been given three (3) days after it has been deposited in the United States mail, duly registered or certified, with postage prepaid, and addressed as set forth above. If sent by fax, communication shall be effective or deemed to have been given twenty-four(24) hours after the time set forth on the transmission report issued by the transmitting facsimile machine, addressed as set forth above. For purposes of calculating these time frames, weekends, federal, state, County or City holidays shall be excluded. 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. [signatures appear on following page] Page 6 of 7 SIGNATURE PAGE TO PERFORMER AGREEMENT BETWEEN ANDRES HERNANDEZ ANI'UNEZ AND THE CITY OF SANTA ANA FOR PRESENTATION OF COLORS SERVICES IN WITNESS WHEREOF, the Parties hereto have executed this Agreement the date and year first above written. ATTEST ;CITYTA AN i ennifer L. ll �Y Alvaro NLiflez City Clerk City Manager APPROVED AS TO FORM PERFORMER SONIA R, CARVALHO City Attorney By: onathan T. Martine Andres Hernandez Antunez Assistant City Attorney RECOMMENDED FOR APPROVAL: —4 Hawk Scott V Executive Director Parks, Recreation, & Community Services Agency Page 7 of 7 Exhibit A SCOPE OF SERVICES PERFORMER INFORMATION: ANDUS HERNANDEZ ANTUNEZ SERVICE DATE(S): September 13,2025 1 September 12, 2026 1 September 11, 2027 COMPENSATION DUE TO THE PERFORMER: Total not-to-exceed compensation is $49,000 for the 3-year term for the presentation of colors for the Fiestas Patrias El Grito Ceremony. The City is not obligated to spend the full annual amount or the total amount allocated for this agreement. September 2025 NTE $16,333.33 September 2026 NTE $16,333.33 September 2027 NTE $16,333.33 Included in the compensation amount under the 3-year agreement term: • 20 band members (number of band members may vary year to year) 0 Mexican flag • Bell + Dancers (availability may vary year to year) LIST OF GENERAL SERVICES: The presentation of colors for the Fiestas Patrias El Grito Ceremony. This includes a musical performance with 20 band members, rental of the official Mexican flag and bell, and Follclorico dancers (depending on availability). Any additional costs to enhance the ceremony must not exceed the annual amount or the total amount specified in the agreement. Staff has the authority to determine if extra features are feasible within the departmental budget, PAYMENT: The vendor will be paid within 30 days of the service date. j I I 7 � • S rt s lop • l EHEI t Exhibit B INSURANCE REQUIREMENTS MINIMUM SCOPE AND LIMIT OF INSURANCE. Performer 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. • Automobile Liability (AL): Insurance Services Office Form CA 00 01 covering Code 1 (any auto), with combined single limits of $1,000,00.0. In the event Performer 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 (WC): 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 Performer has no employees. If Performer 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 Performer. 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 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 Performer including materials, parts, equipment, and personnel furnished in connection with such work or operations. • CGL, AL, and WC 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 Performer for city. • All required insurance policies: For any claims related to this contract, Performer'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. • All required insurance policies: A severability of interest provision must apply for all the additional insureds, ensuring that Performer'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: (Name of Department Staff Responsible for Agreement), Address of Department Responsible for Agreement,M-XX, Santa Ana,CA 92701.The name and location of the 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 Performer 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 ANTI, unless otherwise acceptable to City. Verification of Coverage Performer 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 Performer'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: 1. The retroactive date must be shown 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-renewed, and not replaced with another claims-made policy form with a retroactive date prior to the contract effective date, Performer must purchase "extended reporting" coverage for a minimum of three (3) years after completion of work. Subcontractors .Performer shall require and verify that all sub-contractors maintain insurance meeting all the requirements stated herein,and Performer 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. ' 1 AC©R" CERTIFICATE OF LIABILITY INSURANCEE(MM7DDfYYYY) 70118T/27/2025 l� 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 havo ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Hiscox Inc.d/h/al Hiscox Insurance Agency in CA PHOJAIC,NE (888)202-3007 uc No 5 Concourse Parkway E•MAILQ Suite 2150 ADDREss: contact@hiscox.Gam Atlanta GA,30328 INSURERS AFFORDING COVERAGE NAIC# INSURERA: Hiscox Insurance Company InG 10200 INSURED INSURER B: Andres Hernandez DBA Organizacion Osos de California Banda de INSURER C Guerra 12041 Cole St INSURER D Unit 1 INSURERE: Garden Grove,CA 92841 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. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE I WV0 POLICY NUMBER MMIDDIYYYY MMIDD1YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 5 1.000,000 CLAIMS-MADE O OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ 0 X CGL is On BOP Form MED EXP(Any one person) 5 10,000 A Y Y P103,826.022,2 08128/2025 08128/2026 PERSONAL&ADVINJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 5 2,000,000 X POLICY l] PRO- JECT LOG PRODUCTS-CDMPIOPAGG s 2A04,000 OTHER: 1 5 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 5 Ea accident ANY AUTO BODILY INJURY(Per person) 5 AAll UTOS OWN Ell SCHEDULED P103.826.022.2 08/28/2025 08/2812026 BODILY INJURY(Per accident) S AUTOS A NON-OWNED PROPERFY DAMAGE X HIRED AUTOS X AUTOS Per accident 5 CGL HNOA Limit 5 1,OQp,000 er occurrence UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR , CLAIMS-MADE AGGREGATE $ DED RETENTIONS 5 WORKERS COMPENSATION PER O YIN TH- AND EMPLOYERS'LIABILITY STATUTE ER ANYPROPRIETORIPARTNERfEXECUTIVE E.L.EACH ACCIDENT $ OFFICERfMEMSEREXCLUDEDi NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE 5 If yes,desenbe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 5 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD t e1,Additional Remarks Schedule,may be attached if more space is required) To Tra-n- en Nguy Tu Trdn Event and Location: Fiestas Patrias Event 2025 Santa Ana,CA Date: Nguyen 25.09.03 Nguyen 08:25:22-07'00' APPROVED By Tu Tran Nguyen at 8:24 am,Sep 03,.2025 CERTIFICATE HOLDER CANCELLATION City of Santa Ana 20 Civic Center Plaza SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Santa Ana,CA 92701 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE I C 1988-2015 ACORD CORPORATION. Ad rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD Hiscox Insurance Company Inc. HISCQX encourage courage- Endorsement 29 NAMED INSURED:Andres Hernandez DBA Organization Osos de California Banda de Guerra Blanket Additional Insured(Lessors of Premises/Clients;Waiver of Subrogation; Primary Non- Page 1 of 2 Contributory) In consideration of the premium charged, and on the understanding this endorsement leaves all other terms, conditions, and exclusions unchanged, it is agreed the General Liability Coverage Part is amended as follows: 1. The following is added to the end of Section III.Who is an insured: AI-A, Additional insureds If you have agreed in a written contract or agreement to add them as an additional insured to a policy providing the type of coverage afforded by this Coverage Part,the following persons or organizations are insureds: 1. Any person or organization from whom you lease any premises, but only with respect to liability arising out of the ownership, maintenance, or use of that part of the premises leased to you. However,there is no coverage for such additional insureds for any structural alterations, new construction,or demolition operations performed by or on behalf of the additional insured. A person or organization's status as an additional insured under this subsection 1 ends when you cease to be a tenant in the premises. 2. Any person or organization for whom you are performing operations, but only with respect to liability arising out of: a. your acts or omissions or of those acting on your behalf; and b. the performance of your ongoing operations for the additional insured. A person or organization's status as an additional insured under this subsection 2 ends when your operations for that additional insured are completed. Il. Notwithstanding anything to the contrary in the other insurance provisions in the General Terms and Conditions or in this Coverage Part,the coverage available under this Coverage Part to any additional insured listed above will be primary with respect to and will not contribute with any other insurance available to the additional insured, provided: 1. the additional insured is a named insured under such other insurance;and 2. you have agreed in a written contract or agreement that this insurance would be primary and would not contribute with any other insurance available to the additional insured. III. Notwithstanding anything to the contrary in the subrogation provision in the General Terms and Conditions, you may waive your rights of recovery against another party in writing prior to an: 1. offense arising out of your business operations that caused a personal and advertising injury;or 2. occurrence that caused bodily injury or property damage. BOP-GL E5026 CW(11/19) Includes copyrighted material of Insurance Services Office, Inc.with its permission Hiscox Insurance Company Inc. Hiscox encourage courage- Endorsement 29 NAMED INSURED: Andres Hernandez DBA Organizacion Osos de California Banda de Guerra Blanket Additional Insured (Lessors of PremiseslCllents;Waiver of Subrogation; Primary Non- Page 2 of 2 Contributory) Endorsement Effective: August 28, 2025 Policy No.: P103.826.022.2 -ajz-�- By: Mary Boyd (Appointed Representative) BOP-Gt_ E5026 CW(11/19) Includes copyrighted material of Insurance Services Office, Inc.with its permission Hiscox Insurance Company Inc. HISCQ�C encourage courage- Endorsement 27 NAMED INSURED: Andres Hernandez DBA Organizacion Osos de California Banda de Guerra Additional Insured Endorsement(Designated Person or Organization) Page 1 of 1 In consideration of the premium charged, and on the understanding this endorsement leaves all other terms, conditions, and exclusions unchanged, it is agreed the General Liability Coverage Part is amended as follows: SCHEDULE Name of Person(s) or Organ ization(s): City of Santa Ana, Risk.Management Division 20 Civic Center Plaza, Santa Ana, CA,92702 Management Division I. The following is added to the end of Section ill.Who is an insured: DP-A. Designated person or Any person(s)or organization(s)shown in the Schedule above will be added to this organization Coverage Part as an additional insured, but only with respect to their liability for bodily injury, property damage, or personal and advertising injury arising out of: 1. your acts or omissions; 2. the acts or omissions of those acting on your behalf in the performance of your ongoing operations; or 3. in connection with premises owned by or rented to you. However,the coverage afforded to such additional insured(s): a. applies only to the extent permitted by law; and b. will not be broader than you are required by contract or agreement to provide for such additional insured(s). If coverage provided to the additional insured(s)listed in the Schedule above is required by a contract or agreement,the most we will pay on behalf of any such additional insured is the amount of insurance: i. required by such contract or agreement; or ii. available under the applicable limits stated in the Declarations,whichever is less. II. This Endorsement will not increase the applicable limits stated in the Declarations. Endorsement Effective: August 28, 2025 Policy No.: P103.826.022.2 By: Mary Boyd (Appointed Representative) BOP-GL E5003 CW(11/19) Includes copyrighted material of Insurance Services Office, Inc.with its permission CITY OF SANTA ANAL. Risk Management a division of Human Resources Managing Risk through Awareness and Action '` AFFIDAVIT OF EXEMPTION FOR WORKERS' COMPENSATION INSURANCE I Andres Hernandez Antunez ("Representative"),attest that I am an authorized (Name and Title of Vendor Representative) Banda de Guerra Osos de California representative of ("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 provide Presentation of Colors for Fiestas Patrias El Grito Ceremon(y ("Agreement")to p 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 becorne 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 workers'compensation 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. 09/02/2025 SiQr afore Date ANDRES HERNANDEZ ANTUNEZ Print Name President/Founder Title (714) 586-1460 and bdgososdecalifornia6409@gmail.com Contact Information,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, DAYIAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST,AND ATTORNEYS FEES. Affidavit of Exemption for Workers'Compensation Insurance 11.12.2024