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HomeMy WebLinkAboutCOSMOS EVENT RENTALS (ROBERTO ZAVALA) (2) INSURAINU ON FILE 'CORK lMAY PROCI-EC, N-2024-386-01 UN�tL!F;SUF' !,JC �i; MAYOR CITY MANAGER Valerie Amezcua CITY CI_ERF MAYOR PRO TEM DATE. ?' '�:'� Alvaro Nu�iez Nov 2 5 2025 . ' CITY ATTORNEY Benjamin Vazquez Sonia R.Carvalho COUNCILMEMBERS CITY CLERK Phil Bacerra § � fi Jennifer L.Hall Johnathan Ryan Hernandez Jessie Lopez David Penaloza Thai Viet Phan CITY OF SANTA ANA 4: ?V'JA ( a?) +hru Ike y es(u�) PUBLIC WORKS AGENCY 20 Civic Center Plaza I PO Box 1988 Santa Ana,California 92702 www.santa-ana.org October 28, 2025 Cosmos Event Rentals 1773 W. Lincoln Ave, Suite S Anaheim, CA 92801 Attn: Roberto Zavala Re: Extension of Agreement(N-2024-386) to Provide Event Equipment Rental Services Pursuant to Section 3 ("Term") of the above-referenced Agreement, entered into by Roberto Zavala DBA Cosmos Event Rental Services and the City of Santa Ana, dated November 15, 2024, the time period of the Agreement is hereby extended for an additional one-year period through November 14, 2026. Any insurance certificates are required to be extended and/or renewed to cover this extension. All other terms and conditions of the Agreement remain unchanged and in fitll force and effect. Sincerely, AIR i i mary Rudy Rosas(Nov 14,202515:03:48 PST) Rodolfo Rosas, P.E. Acting Executive Director, Public Works Agency CITY OF S TA ANA ATTEST A varo Nunez c, ennifer L. 11 City Manager Citv C APPROVED AS TO FORM ROBERTO ZAVALA DBA COSMOS EVENT RENTALS 1�y€e' Nellesen Roberto Zavala Assistant City Attorney Owner SANTA ANA CITY COUNCIL Valerie Amezcua Benjamin Vazquez Thai Vie[Phan Jessia Lap- Phil B-erra Jahnathan Ryan Hemandez David Panaloza Mayor Mayor Pro Tem-Ward 2 ward 1 ward 3 Ward 4 Ward 5 Ward 6 vamazcua(@santa-aria arp dvaznuezCuTsanta-ane ora WhanlNsanla-ana.am jessielopez sanla-aria phacerraAsanta-aria ara irvanhemandazCalsanta-ana.oiv d enaloza santa-an o Aco Q� � CERTIFICATE OF LIABILITY INSURANCE DgrE(MMroDiYYYY) 1.� 09/04/2025 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 CONTACTNAME: Automatic Data Processing Insurance Agency, Inc. Automatic Data Processing Insurance Agency, Inc. H0NN Ext: 1-800-524-7024 IF No E-MAIL ADDRESS: 1 Adp Boulevard INSURERS)AFFORDING COVERAGE NAIC# Roseland NJ 07068 INSURER A: Federal Insurance Company 20281 INSURED Cosmos Fvent Rentals LLC INSURER B INSURER C: 1773 W Lincoln Avesta S INSURER D: INSURER E Anaheim CA 92801 INSURERF: COVERAGES CERTIFICATE NUMBER: 4528246 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 TERMST 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 INSD WVD POLICY NUMBER MMdDDIYYYY) (MMIDi3fYYYYI LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE ❑ PREMOCCUR DAMAGE T R FNT PREMISES Ea occurrence $ MED EXP(Any one person) $ PERSONAL BADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY❑ PRO LOC JECT PRODUCTS-COMPIOPAGG $ OTHER: $ AUTOMOBILE LIABILITY COMHINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) 5 OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) 5 HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Peraccidenk 5 UMBRELLA LAB OCCUR EACH OCCURRENCE S EXCESS LIAR CLAIMS-MADE AGGREGATE S DIED I I RETENTIONS WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETORIPARTNEWEXECUTIVE E.L.EACH ACCIDENT S 1,000,000 A OFFICERIMEMBEREXCLUDED? NIA Y 7181-25-32 06/21/2025 00/21/2026 (Mandatory in NH) E.L.DISEASE-EA EMPLOYE 5 1,000.000 If yes,describe under 1'oOQ'ooa DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (AGORD 101,.Additional Remarks Schedule,may be attached if more space is required) Tu Tra n Digita y signe y This certificate has a blanket Waiver of Subrogation for the following state(s):GA Tu rran Ng yen Nguyen °a3gosz0oao5 APPROVED By Tu Tran Nguyen of 10:38 am,Sep 05, 2025 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Cfty of Santa Ana,Attn:City of Santa Ana-City Wide ACCORDANCE WITH THE POLICY PROVISIONS. 20 Civic Center Plaza AUTHORIZED REPRESENTATIVE Santa Ana CA 92701 O 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD Workers'Compensation and Employers'Liability Policy Named Insured Endorsement Number COSMOS EVENT RENTALS LLC 002 Policy Number 7181-25-32 Symbol: Number: 25 7181-26-32 Policy Period Effective Date of Endorsement 06/2112025 TO 06/21/2026 06/21/2025 Issued By(Name of Insurance Company) Federal Insurance Company Insert the policy number.The remainder of the information is to be completed only when this endorsement is issued subsequent to the geparation of the policy. CALIFORNIA WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement applies only to the insurance provided by the policy because California is shown in Item 3.A. of the Information Page. We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule, but this waiver applies only with respect to bodily injury arising out of the operations described in the Schedule, where you are required by a written contract to obtain this waiver from us. You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. Schedule 1. ( ) Specific Waiver Name of person or organization: X ) Blanket Waiver Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. 2. Operations: Equipment Rentals of Chairs, Table, Linens, Canopies and other accessories. 3. Premium: The premium charge for this endorsement shall be 1% percent of the California premium developed on payroll in connection with work performed for the above person(s) or organization(s) arising out of the operations described. 4. Minimum Premium: Authoriz d Representative WC 90 03 75(05/18) Insured Copy Ac R" CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 2/1112025 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 ACT NAME: Adrian J Robles A J INSURANCE PHONE 714 673 5549 7farc No: 3843 S Bristol Street,#130 AOI Ress: a'insurance live.com Santa Ana,CA 92704 INSURERS AFFORDING COVERAGE NAIL n -INSURER A: MESA UNDERWRITERS SPECIALTY INS. 36838 INSURED INSURER B COSMOS EVENT RENTALS INSURER c: ZAVALA, ROBERTO INSURER D: 1773 W LINCOLN AVE#S INSURER E: ANAHEIM CA 92801 INSURERF: 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 LTR TYPE OF INSURANCE iNsn vvvn SUER POLICY NUMBER MMIDOPOLICY EFF MMfDDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1 000000 �/ DAMAGE TO RENTED CLAIMS-MADE /� OCCUR PREMISES Fa occurrence $ 100,000 DED: 500 MED EXP(Any one person) $ 5,000 A x x MP000401410006200 111412025 1114/2026 PERSONAL a ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 2000000 POLICY PRO- JECT ❑ LOC PRODUCTS-COMPIOP AGG $ 2,000,000 OTHER: S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S Ea accident ANY AUTO BODILY INJURY(Per person) S OWNED SCHEDULED INJURY BODILY INJU Per accident AUTOS ONLY AUTOS I I $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONL fY Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ CED RETENTIONS S WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY yl N STATUTE ER ANY PROPRIETORIPARTNERIEXECUTIVE L EACH ACCIDENT S OFFICERIMEMBER EXCLUUED7 O E NIA (Mandatory in NH) EL DISEASE-EA EMPLOYEE S If yes,desenbe under DESCRIPTION OF OPERATIONS below E.L.❑PSEASE-POLICY LIMIT $ , PROPERTY A MP000401410006200 111412025 1114/2026 CONTENTS: 100,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) PARTY RENTAL STORE: City of Santa Ana,its officers,employees,agents and representatives are Additional Insureds with respect to General Liability and Auto Liability per the attached endorsements or as required by written Contract.Insurance is Primary and Non-Contributory,LIBRARY SERVICES AGENCY PROGRAMMING IN THE CIYT OF SANTA ANA. 30 Days'Notice of Cancellation with 10 Day's Notice for Non-Payment of Premium in accordance with the policy provisions. Tu Tran TuTrallysqurn y APPROVED Tu Tran Nguyen Gate:2025.0320 Nguyen I1:3,g-moo' By Tu Tran Nguyen at 11:29 am,Mar 20,2025 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. CITY OF SANTA ANA-CITY WIDE 20 Civic Center Plaza AUTHORIZED REPRESENTATIVE Santa Ana, CA,92702 O 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: MP0004014010006200 COMMERCIAL GENERAL LIABILITY CG20120413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - STATE OR GOVERNMENTAL AGENCY OR SUBDIVISION OR POLITICAL SUBDIVISION - PERMITS OR AUTHORIZATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE State Or Governmental Agency Or Subdivision Or Political Subdivision: CITY OF SANTA ANA-CITY WIDE CITY OF SANTA ANA, ITS CITY COUNCIL, OFFICERS, OFFICIALS, EMPLOYEES, AGENTS, AND VOLUNTEERS 20 Civic Center Plaza Santa Ana, CA, 92702 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II—Who Is An Insured is amended to 2. This insurance does not apply to. include as an additional insured any state or a. Bodily injury", property damage" or governmental agency or subdivision or political "personal and advertising injury" arising out subdivision shown in the Schedule, subject to the of operations performed for the federal following provisions: government, state or municipality; or 1. This insurance applies only with respect to b. "Bodily injury"or"property damage" included operations performed by you or on your behalf within the "products-completed operations for which the state or governmental agency or hazard". subdivision or political subdivision has issued a permit or authorization. B. With respect to the insurance afforded to these additional insureds, the following is added to However: Section III a Limits Of Insurance: a. The insurance afforded to such additional if coverage provided to the additional insured is insured only applies to the extent permitted required by a contract or agreement, the most we by law; and will pay on behalf of the additional insured is the b. if coverage provided to the additional insured amount of insurance: is required by a contract or agreement, the 1. Required by the contract or agreement; or insurance afforded to such additional insured will not be broader than that which you are 2. Available under the applicable Limits of required by the contract or agreement to Insurance shown in the Declarations; provide for such additional insured, whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 2012 0413 © Insurance Services Office, Inc., 2012 page 1 of 1 INSURED POLICY NUMBER:MP0004014010006200 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTSICOMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: CITY OF SANTA ANA - CITY WIDE CITY OF SANTA ANA, ITS CITY COUNCIL, OFFICERS, OFFICERS, OFFICIALS, EMPLOYEES, AGENTS AND VOLUNTEERS 20 Civic Center Plaza Santa Ana, CA, 92702 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Sec- tion IV--Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products-com- pleted operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 ©Insurance Services Office, Inc., 2008 Page 1 of 1 INSURED COMMERCIAL GENERAL LIABILITY CG 20 33 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -- OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section Il — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured any person or additional insureds, the following additional organization for whom you are performing exclusions apply: operations when you and such person or This insurance does not apply to: organization have agreed in writing in a contract or agreement that such person or organization be 1. "Bodily injury", "property damage" or "personal added as an additional insured on your policy, and advertising injury" arising out of the Such person or organization is an additional rendering of, or the failure to render, any insured only with respect to liability for "bodily professional architectural, engineering or injury", "property damage" or "personal and surveying services, including: advertising injury"caused, in whole or in part, by: a. The preparing, approving, or failing to 1. Your acts or omissions; or prepare or approve, maps, shop drawings, 2. The acts or omissions of those acting on your opinions, reports, surveys, field orders, change orders or drawings and behalf; specifications; or in the performance of your ongoing operations for b. Supervisory, inspection, architectural or the additional insured. engineering activities. However, the insurance afforded to such additional This exclusion applies even if the claims against insured: any insured allege negligence or other wrongdoing 1. Only applies to the extent permitted by law; in the supervision, hiring, employment, training or and monitoring of others by that insured, if the 2. Will not be broader than that which you are "occurrence" which caused the "bodily injury" or required by the contract or agreement to "property damage", or the offense which caused provide for such additional insured. the "personal and advertising injury", involved the rendering of or the failure to render any A person's or organization's status as an additional professional architectural, engineering or insured under this endorsement ends when your surveying services. operations for that additional insured are completed. CG 20 33 0413 ©Insurance Services Office, Inc., 2012 Page 1 of 2 INSURED 2. "Bodily injury" or "property damage" occurring C. With respect to the insurance afforded to these after: additional insureds, the following is added to a. All work, including materials, parts or Section III--Limits Of Insurance: equipment furnished in connection with The most we will pay on behalf of the additional such work, on the project (other than insured is the amount of insurance: service, maintenance or repairs) to be 1. Required by the contract or agreement you performed by or on behalf of the additional have entered into with the additional insured; or insured(s) at the location of the covered operations has been completed; or 2. Available under the applicable Limits of b. That portion of"your work"out of which the Insurance shown in the Declarations; injury or damage arises has been put to its whichever is less. intended use by any person or organization This endorsement shall not increase the applicable other than another contractor or Limits of Insurance shown in the Declarations. subcontractor engaged in performing operations for a principal as a part of the same project. CG 20 33 0413 0 Insurance Services Office, Inc., 2012 Page 2 of 2 COMMERCIAL GENERAL LIABILITY CG 20 01 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY -- OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance (2) You have agreed in writing in a contract or Condition and supersedes any provision to the agreement that this insurance would be contrary: primary and would not seek contribution Primary And Noncontributory Insurance from any other insurance available to the This insurance is primary to and will not seek additional insured. contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and CG 20 01 0413 ©Insurance Services Office, Inc.,2012 Page 1 of 1 INSUM ACOR" CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 03/18/2025 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(les) 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 ELIDA GARCIA CERVANTES NAME: StatelFarm EDDIE QUILLARES JR, PHONNE E (714)617 7150 FAX No): (714)617 7158 STATE FARM AGENCY n olEss: F LIDA.GARCI AC ERVANTES.VAF5S3@STATEFARM.COM WWI R 415 BROADWAY -INSURER($)AFFORDING COVERAGE NAIL# SANTA ANA CA 92701 INSURERA: State Farm Fire and Casualty Company 25143 INSURED INSURER B: State Farm Mutual Automobile Insurance Company 25178 INSURER C COSMOS EVENT RENTALS LLC INSURER D: 1773 W LINCOLN AVE STE S INSURERE: ANAGEIM CA 92801 INSURERF: 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 INSD WVn POLICY NUMBER MMIDDIYYYY MMIDDIYYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAWS-MADE 1A OCCUR PREMISES Ea occurrence- $ MED EXP(Any one person) $ A PERSONAL&ADV INJURY $ GEN'L AGGRFGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ X POLICY PRO JECT LOC PRODUCTS-COMPIOPAGG $ OTHER'. $ AUTOMOBILE LIABILITY Y Y 6981115-0O2-75A 03/02/2025 03/02/2026 COMB€NED SINGLE LIMIT $ 1,a00,000 Ea accident ANY AUTO 867 6798-F20-75 12/20/2024 06120/2025 BODILY INJURY(Per person) $ B OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED X NON-OWNED 195 7791-F12-75D 12/12/2024 12/12/2025 PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR_H CLAIMS-MADE AGGREGATE $ DEP RETENTION$ $. WORKERS COMPENSATION PER OTH- STATUTE ER AND EMPLOYERS`LIABILITY Y!N ANY PROPRIETOMPARTNERIEXECUTIVE OFFICERiMEMBER EXCLUDED? ElN/A E.L.EACH ACCIDENT $ (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) City of Santa Ana,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 permittee Including materials,parts,equipment,and personnel furnished in connection with such work or operations APPROVED By Tu Tran Nguyen at 11:30 am,Mar 20,2025 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Santa Ana-City Wide AUTHORIZED REPRESENTATIVE 20 Civic Center Plaza ( i% L Santa Ana CA 92701 Q 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 1001486 132849.13 04-22-2020 FE-6609 SECTION 11 ADDITIONAL INSURED ENDORSEMENT Policy No.: 195 7791-F12-75D Named Insured: SANTA ANA CHAMBER OF COMMERCE Additional Insured (include address): City of Santa Ana-City Wide 20 Civic Center Plaza Santa Ana, CA 92701 CITY OF SANTA ANA,ITS CITY COUNCIL,OFFICERS,OFFICIALS, EMPLOYEES,AGENTS,AND VOLUNTEERS WHO IS AN INSURED, under SECTION II DESIGNATION OF INSURED, is amended to include as an insured the Additional Insured shown above, but only to the extent that liability is imposed on that Additional Insured solely because of your work performed for that Additional Insured shown above. Any insurance provided to the Additional Insured shall only apply with respect to a claim made or a suit brought for damages for which you are provided coverage. Z The Primary Insurance coverage below applies only when there is an 'X' in the box. Primary Insurance. The insurance provided to the Additional Insured shown above shall be primary insurance. Any insurance carried by the Additional Insured shall be noncontributory with respect to coverage provided to you. All other policy provisions apply. FE-6609 POLICY NUMBER: 195 7791-F12-75D WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHER TO US Policy Number: 195 7791-F12-75D Named Insured: SANTA ANA CHAMBER OF COMMERCE SCHEDULE NAME OF PERSON OR ORGANIZATION: City of Santa Ana-City Wide 20 Civic Center Plaza Santa Ana, CA 92701 CITY OF SANTA ANA, ITS CITY COUNCIL,OFFICERS,OFFICIALS,EMPLOYEES,AGENTS,AND VOLUNTEERS Information required to complete this Schedule,if not show above, will be shown in the Declarations. The following is added to Paragraph 10.b. of SECTION 1 AND SECTION II—COMMON CONDITIONS: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for any injury arising out of: a. Your ongoing operations; or b. Your work done under contract with that person or organization and included in the products-completed operations hazard. This waiver applies only to the person or organization shown in the Schedule above. All other policy provisions apply. FE-6671 ©,Copyright, State Farm Mutual Automobile Insurance Company,2008 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. (E PE-6609 SECTION 11 ADDITIONAL INSURED ENDORSEMENT Policy No.: 867 6798-F20-75 Named Insured: SANTA ANA CHAMBER OF COMMERCE Additional Insured (include address): City of Santa Ana-City Wide 20 Civic Center Plaza Santa Ana, CA 92701 CITY OF SANTA ANA,ITS CITY COUNCIL,OFFICERS,OFFICIALS, EMPLOYEES,AGENTS,AND VOLUNTEERS WHO IS AN INSURED, under SECTION II DESIGNATION OF INSURED, is amended to include as an insured the Additional Insured shown above, but only to the extent that liability is imposed on that Additional Insured solely because of your work performed for that Additional Insured shown above. Any insurance provided to the Additional Insured shall only apply with respect to a claim made or a suit brought for damages for which you are provided coverage. Z The Primary Insurance coverage below applies only when there is an "X" in the box. Primary Insurance. The insurance provided to the Additional Insured shown above shall be primary insurance. Any insurance carried by the Additional Insured shall be noncontributory with respect to coverage provided to you. All other policy provisions apply. FE-6609 POLICY NUMBER: 867 6798-F20-75 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHER TO US Policy Number: 867 6798-F20-75 Named Insured: SANTA ANA CHAMBER OF COMMERCE SCHEDULE NAME OF PERSON OR ORGANIZATION: City of Santa Ana -City Wide 20 Civic Center Plaza Santa Ana, CA 92701 CITY OF SANTA ANA, ITS CITY COUNCIL,OFFICERS, OFFICIALS,EMPLOYEES,AGENTS,AND VOLUNTEERS tnformation required to complete this Schedule, if not show above, will be shown in the Dechuations. The following is added to Paragraph 10.b. of SECTION 1 AND SECTION II—COMMON CONDITIONS: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for any injury arising out of: a. Your ongoing operations; or b. Your work done under contract with that person or organization and included in the products-completed operations hazard. This waiver applies only to the person or organization shown in the Schedule above. All other policy provisions apply. FE-6671 O,Copyright,State Farm Mutual Automobile Insurance Company,2008 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. FE-6609 SECTION II ADDITIONAL INSURED ENDORSEMENT Policy No.: 698 1115-CO2-75A Named Insured: SANTA ANA CHAMBER OF COMMERCE Additional Insured (include address): City of Santa Ana-City Wide 20 Civic Center Plaza Santa Ana, CA 92701 CITY OF SANTA ANA, ITS CITY COUNCIL,OFFICERS,OFFICIALS, EMPLOYEES,AGENTS,AND VOLUNTEERS WHO IS AN INSURED, under SECTION II DESIGNATION OF INSURED, is amended to include as an insured the Additional Insured shown above, but only to the extent that liability is imposed on that Additional Insured solely because of your work performed for that Additional Insured shown above. Any insurance provided to the Additional Insured shall only apply with respect to a claim made or a suit brought for damages for which you are provided coverage. Z The Primary Insurance coverage below applies only when there is an "X" in the box. Primary Insurance. The insurance provided to the Additional Insured shown above shall be primary insurance. Any insurance carried by the Additional Insured shall be noncontributory with respect to coverage provided to you. All other policy provisions apply. IN EE-6609 POLICY NUMBER: 698 1115-0O2-75A WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHER TO US Policy Number: 698 1115-0O2-75A Named Insured: SANTA ANA CHAMBER OF COMMERCE SCHEDULE NAME OF PERSON OR ORGANIZATION: City of Santa Ana -City Wide 20 Civic Center Plaza Santa Ana, CA 92701 CITY OF SANTA ANA, ITS CITY COUNCIL,OFFICERS,OFFICIALS, EMPLOYEES,AGENTS,AND VOLUNTEERS Information required to complete this Schedule, if not show above, will be shown in the Declarations. The following is added to Paragraph 10.b. of SECTION 1 AND SECTION II —COMMON CONDITIONS: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for any injury arising out of: a. Your ongoing operations; or b.. Your work done under contract with that person or organization and included in the products-completed operations hazard. This waiver applies only to the person or organization shown in the Schedule above. All other policy provisions apply. FE-6671 OO, Copyright,State Farm Mutual Automobile Insurance Company,2008 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. '4C0�a CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDmvY) 03113/2025 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 Automatic Data Processing Insurance Agency, Inc. Automatic Data Processing Insurance Agency, Inc. PHONE 1-800-524-7024I FAx NC No Ext: AiC,No): E-MAIL ADDRESS: 1 Adp Boulevard INSURER(S)AFFORDING COVERAGE NAIC# Roseland NJ 07068 INSURER A: Federal Insurance Company 20281 INSURED Cosmos Event Rentals LLC INSURER B INSURER C: 1773 W Lincoln Aveste S INSURER D: INSURER E: Anaheim CA 92801 INSURER F: COVERAGES CERTIFICATE NUMBER: 4185456 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 TYPE OF INSURANCE ADUL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD lYY WVD POLICY NUMBER MMfDDYY MMIDDfYYYY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE _0AIV7;L TO RENTED OCCUR PREMISES Ea occurrence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY❑ JECTPRO ❑ LOG PRODUCTS-COMPlOP AGG $ OTHER: I S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S Ea accident ANY AUTO BODILY INJURY(Per person) S OWNED SCHEDULED BODILY INJURY(Per accident) S AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE S AUTOS ONLY AUTOS ONLY Per accident $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $. EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED F RETENTION$ $ WORKERS COMPENSATION PER Y!N OTH- AND EMPLOYERS'LIABILITY STATUTE ER ANY PROPRIETORIPARTNERIEXECUTIVE M EL.EACH ACCIDENT $ 1,000,000 A OFFICERIMI=MBEREXCLUDED? NIA Y 71812532 06/21/2024 06/21/2025 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ T _T DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) This certificate has a blanket Waiver of Subrogation for the following state(s):CA APPROVED ISy Tu Tran Nguyen at 11r30 am,Mar 20,2QZ5 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,Attn:City of Santa Ana-City Wide ACCORDANCE WITH THE POLICY PROVISIONS. 20 Civic Center Plaza AUTHORIZED REPRESENTATIVE Santa Ana CA 92701 O 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD Workers'Compensation and Employers'Liability Policy Named Insured Endorsement Number COSMOS EVENT RENTALS LLC Q02 Policy Number 7181-25-32 Symbol: Number: 25 7181-26-32 Policy Period Effective Date of Endorsement 06/21/2024 TO 06/21/2025 02/11/2025 Issued By(Name of Insurance Company) Federal Insurance Company Insert the policy number.The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. CALIFORNIA WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement applies only to the insurance provided by the policy because California is shown in Item 3.A. of the Information Page. We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule, but this waiver applies only with respect to bodily injury arising out of the operations described in the Schedule, where you are required by a written contract to obtain this waiver from us. You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. Schedule 1. ( ) Specific Waiver Name of person or organization: ( X ) Blanket Waiver Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. 2. Operations: Equipment Rentals of Chairs, Table, Linens, Canopies and other accessories. 3. Premium: The premium charge for this endorsement shall be 1% percent of the California premium developed on payroll in connection with work performed for the above person(s) or organization(S) arising out of the operations described. 4. Minimum Premium: Z�)ta12eL & Authoriz d Representative WC 90 03 75(05/18) Insured Copy