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HomeMy WebLinkAboutGRYPHON FITNESS STUDIO, LLC. PHOC ED N-2026-018 0 Z_ _9H- f u io _ B 0 3 ION PrzcsH C } RECREATION SERVICES AGREEMENT WITH GRYPHON FITNESS STUDIO, LLC 0P-Sump,So iCdno C p2) FOR ARCHERY CLASSES THIS AGREEMENT is made and entered into on this 181h day of December,2025 by and between Gryphon Fitness Studio, LLC, a California limited liability company ("Provider"), 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"). City and Provider may be collectively referred to as the"Parties" or individually as a"Party." RECITALS A. The City desires to retain a recreation service provider having special skills, resources and knowledge to provide archery classes in its recreation class program. B. Provider represents that it is able and willing to provide such services to the City. C. In undertaking the performance of this Agreement, Provider represents that it is knowledgeable in their field and that any services performed by Provider under this Agreement will be performed in compliance with such standards as may reasonably be expected. D. The Parties acknowledge that the City intends to provide recreational activities to the public but must balance the need to comply with all COVID-19 guidance and restrictions. NOW THEREFORE, in consideration of the mutual and respective promises, and subject to the terms and conditions hereinafter set forth, the Parties agree as follows: 1. SCOPE OF SERVICES a. Provider shall perform those services as set forth in Exhibit A to this Agreement. b. All classes operated pursuant to this Agreement for conducting recreation classes at City facilities. including parks. will comply with all applicable guidance and public health orders, including those from the Centers for Disease Control ("CDC"), California Department of Public Health ("CDPH"), the Orange County Health Care Agency("OCHCA")and the City itself for as long as those orders and guidance remain in place. Provider will remind participants of these guidelines. To the extent that Provider needs assistance with enforcing any rules or requirements, Provider will contact a City Parks' employee or City security for assistance. c. Provider shall not attend a class or teach any class if Provider is sick or has any symptom(s)associated with COVID-19 including but not limited to,fever above 100.4, chills, cough, shortness of breath, loss of taste or smell, nausea, muscle or body aches, vomiting, headache. sore throat or diarrhea. Page 1 of 8 d. Provider will not attend class or teach a class if Provider or any member of Provider's household has been asked to quarantine or self-isolate due to symptoms of COVID-19 or a positive test result for COVID-19. c. Provider acknowledges that', to the extent that City is able to and chooses to conduct classes indoors, this Agreement will also cover classes conducted at one of City's recreational centers during the term of this Agreement. f. City reserves the right to change the location(s) at which the services contemplated by this Agreement are provided. g. Provider shall comply with the City's recreation class policy manual and any other City rules and regulations regarding the operation of recreation classes. 2. COMPENSATION a. In consideration for the provision of the programs set forth in Exhibit A, City agrees to pay, and Provider agrees to accept as total payment for their services for the City, seventy percent (70%) of all gross revenue received from program participants. Total annual revenue to Provider shall not exceed Fifteen Thousand Dollars and Zero cents ($15,000). b. Payment to Provider shall be made monthly within thirty (30) days following completion of the last class taught by Provider the prior month. City shall be responsible for collecting all fees from program participants. Provider shall not collect fees but will refer all interested participants to City for registration information. Provider agrees that City shall retain thirty percent(30%) of all gross revenue received from program participants as an administrative fee. 3. TERM This Agreement shall commence on February 1, 2026 and end on January 30, 2027 unless terminated earlier in accordance with Section 14 below. The term of this Agreement may be extended by a writing executed by the City Manager and the City Attorney. 4. INDEPENDENT CONTRACTOR Provider 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 manner in which Provider performs the services which are the subject matter of this Agreement; however, the services to be provided by Provider shall be provided in a manner consistent with all applicable standards and regulations governing such services. Provider 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 Page 2 of 8 applicable withholding taxes. Provider is not an agent, representative or cinployee of City and Provider shall have no authority to act on behalf of the City. 5. INSURANCE Insurance requirements attached hereto as Exhibit B. G. INDEMNIFICATION Provider agrees to and shall indemnify, defend and hold harmless the City, its officers, agents,employees,consultants,special counsel, and representatives from liability: (1)for personal injury,damages,just compensation,restitution,judicial or equitable relief arising out of claims for personal injury, including death, and claims for property damage, which may arise from the negligent operations of the Provider or its contractors, subcontractors,agents, employees, or other persons acting on their behalf which relates to the services described in section 1 of this Agreement; and (2) from any claim that personal injury, damages,just compensation, restitution, judicial or equitable relief is due by reason of the terms of or effects arising from this Agreement, to the extent that the injury, damages,just compensation, restitution,judicial or equitable relief is caused by the negligence of the Provider. 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. City may make all reasonable decisions with respect to its representation in any legal proceeding. In no case will Provider be required to indemnify or hold harmless the City from injury, damages,just compensation,restitution,judicial or equitable relief caused by the negligence of the City. 7. CONFIDENTIALITY If Provider receives from the City information which due to the nature of such information is reasonably understood to be confidential and/or proprietary, Provider agrees that it shall not use or disclose such information except in the performance of this Agreement, and further agrees to exercise the same degree of care it uses to protect its own information. of like importance, but in no event less than reasonable care. "Confidential Information" shall include all nonpublic information, including but not limited to student records. Confidential information includes not only written information, but also information transferred orally, visually, electronically, or by other means. Confidential information disclosed to either Party by any subsidiary and/or agent of the other Party is covered by this Agreement. The foregoing obligations of non-use and nondisclosure shall not apply to any information that (a) has been disclosed in publicly available sources; (b) is, through no fault of the Provider disclosed in a publicly available source; (c) is in rightful possession of the Provider without an obligation of confidentiality; (d) is required to be disclosed by operation of law; or(e) is independently developed by the Provider without reference to information disclosed by the City. Page 3 of 8 S. COVID-19 ASSUMPTION OF RISK AND WAIVER Provider acknowledges that Provider could be exposed to persons that may have COVID- 19 providing services pursuant to this Agreement. Provider understands that interacting with any person currently comes with the inherent risk of exposure to COVID-19 and that COVID-19 is highly contagious. Provider assumes the risks associated with providing services pursuant to this Agreement, namely potential exposure to COVID-19. Provider acknowledges that while some people have no symptoms or mild symptoms from COVID-19,some people have become seriously ill requiring hospitalization and that some people have died from COVID-19, Provider acknowledges that persons over the age of 65 and persons with underlying health conditions are at greater risk of contracting COVID-19 and are potentially risking serious injury or death. Provider is agreeing to provide classes pursuant to this Agreement and does so of Provider's own free will. Provider intends to be legally bound by this assumption of risk,release and waiver and to bind Provider's heirs,personal representatives, next of kin and anyone who may make a claim on Provider's behalf. Provider knowingly releases and waives any and all claims that Provider may have or could have in the future and includes any claims resulting from potential exposure or actual exposure to COVID-19, this includes claims for personal injury, transmittal of COVID-19 to others, and/or wrongful death, Provider agrees to hold harmless, defend and indemnify the City, its public officials,officers,employees,volunteers,and agents from any and all claims for liability or damages, including those for exposure to or diagnosis with COVID-19 as a result of providing services pursuant to this Agreement. 9. CONFLICT OF INTEREST a. Provider covenants that it presently has no interests and shall not have interests, direct or indirect,which would conflict in any manner with perforrnance of services specified under this Agreement. b. No inunediate family members of either the Mayor, City Council Member, or any appointed City Official, including appointed board and commission members, as defined under the City's Municipal Code, whose position with the City shall award or influence the award of this Agreement, or any competing contract or amendment thereof, shall be employed in any capacity by the Provider or have any other direct or indirect financial benefit or interest in this Agreement. c. The section also prohibits the awarding of any agreement, contract, grant, or any amendment to those awards, to any former full-time employee for one-year from date of employee separation except for any CalPERS retiree as authorized by City Council resolution d. Provider must comply with all conflict of interest laws, ordinances, and regulations now in effect or hereafter to be enacted during the terra of this Agreement.The Provider warrants that it is not now aware of any facts which conflict with the prohibitions defined above. If Provider hereafter becomes aware of any facts that might reasonably Page 4 of 8 be expected to create a conflict of interest, it must immediately make full written disclosure of such facts to the City. Full written disclosure must include, but is not limited to, identification of all persons implicated and a complete description of all relevant circumstances. Failure to comply with the provisions of this paragraph will be a material breach of this Agreement. e. Provider covenants that none of its directors, officers, employees, or agents shall participate in selecting or administrating any subcontract supported(in whole or in part) by City 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. 10. BACKGROUND CHECK Provider shall ensure that all employees, subcontractors, and any volunteers are fingerprinted and background checked prior to conducting any work pursuant to this Agreement. Provider shall not assign any employee, agent, subcontractor,volunteer or the Provider personally to provide services pursuant to this Agreement, if that employee, agent, subcontractor, volunteer, or the Provider personally are required to register as a sex offender under California Penal Code Section 290 et seq, have a conviction for any crime of moral turpitude, have a conviction for a sexual based crime, have a conviction for a violent felony as defined in California Penal Code Section 667.5(c), or has a conviction for a serious felony as defined in California Penal Code Section 1192.7(c).Disqualifying convictions include but are not limited to,violations of California Penal Code Sections 37, 128, 136.1 with Section 186.22, 187, 190-190.4 and 192(a), 205, 206, 207-209.5, 211, 212,212.5, 213,214, 215, 218-219, 220, 236.1(b) or 236.1(c), 243.4, 261,261.5, 273.5, 262, 264,1, 266, 266c, 266h, 266i, 266j, 267, 269, 272, 273a, 273ab, 273d, 285, 286, 288, 288a, 288.2,288.3,288.4,288.5,2883,289,290,311.1,311.2,311.3,311.4,311.10, 311.11,314, 347(a), 368,417(b), 451(a),518 with 186.22, 647.6, 65311(c), 664 and 187, 667.5(c), 18745, 18750, or 18755, 12022.53, 11418(b)(1) or(b)(2); Business and Professions Code Section 729, 11. NOTICE Any notice, tender, demand,delivery, or other communication pursuant to this Agreement shall be in writing and shall be deemed to be properly given if delivered in person or mailed by first class or certified mail,postage prepaid, or sent by fax or other telegraphic communication in the manner provided in this Section, to the following persons: To City: City Clerk City of Santa Ana 20 Civic Center Plaza(M-30) P.4. Box 1988 Santa Ana, CA 92702-1988 Fax (714) 647-6956 With copy to: Executive Director of Parks, Recreation and Community Services Page 5 of 8 City of Santa Ana 20 Civic Center Plaza(M-23) P.O. Box 1988 Santa Ana, California 92702 Fax (714) 571-4211 To Provider: Gryphon Fitness Studio,LLC Attn: Eric Holmgren, President 912 Magnolia Ave. Placentia, CA 92870 A Party may change its address by giving notice in writing to the other Party. Thereafter, any communication shalt 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. 12. EXCLUSIVITY AND AMENDMENT This Agreement represents the complete and exclusive statement between the City and Provider regarding the subject matter herein, and supersedes any and,all other agreements, oral or written, between the parties. In the event of a conflict between the terms of this Agreement and any attachments hereto, the terms of this Agreement shall prevail. This Agreement may not be modified except by written instrument signed by the City and by an authorized representative of Provider. 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 Provider 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. 13. ASSIGNMENT The experience, knowledge, capability and reputation of Provider were a substantial inducement for City to enter into this Agreement. Therefore, Provider 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. 14. TERMINATION a. This Agreement may be terminated by the City upon thirty (30) days written notice of termination. Page 6 of 8 b. Termination or cancellation of classes by the Provider must be given to the City, in writing, at least thirty (30) days prior to termination/cancellation. Fail-Lire to provide adequate cancellation notice to the City may put future contracting of business with the City at risk, 15. RECORDS Provider shall use attendance sheets generated and supplied by the City to record attendance in each class. Provider shall keep these and any other records in connection with the work to be performed under this Agreement and shall permit City, upon request, to review such records for a period of three (3) years from the date of final payment to Provider under this Agreement. 16. NON-DISCRIMINATION Provider shall not discriminate because of race, color, creed, religion, sex, marital status, sexual orientation, gender identity, gender expression, gentler, 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. Provider affirms that it is an equal opportunity employer and shall comply with all applicable federal, state and local laws and regulations. 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. LICENSES Provider 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. 19. SEVERABILITY In the event that one or more of the phrases, sentences, clauses, paragraphs or sections contained in this Agreement shall be declared invalid or unenforceable by valid judgment or decree of a court of competent jurisdiction, such invalidity or unenforceability shall not affect any of the remaining phrases, sentences, clauses, paragraphs or sections of this Agreement, which shall be interpreted to carry out the intent of the Patties hereunder. Page 7 of 8 20. EXHIBITS All Exhibits referenced herein and attached hereto shall be incorporated as if fully set forth in the body of this Agreement. 21. AUTHORITY The person(s) executing this Agreement on behalf of the Parties hereto warrant that they are duly authorized to execute this Agreement on behalf of said Parties and that by so executing this Agreement,the Parties hereto are formally bound to the provisions of this Agreement. IN WITNESS WHEREOF, the Parties hereto have executed this Agreement the date and year first above written. ATTEST: CITY OF SANT A ennifer L. all e Alvaro Nunez City Clerk City Manager APPROVED AS TO FORM: SONIA R. CARVALHO PROVIDER: City Attorney Jonathan T. Martinez Eric Holmgren Assistant City Attorney President RECOMMENDED FOR APPROVAL: Hawk Scott Executive Director of Parks, Recreation and Conununity Services Agency Page 8 of 8 Exhibit A SCOPE OF SERVICES Program Overview: This Scope of Services outlines the responsibilities and expectations for engagement of Provider to provide archery classes for ages 7 - 99 years at City recreation facilities and parks, as defined below. The aim is to promote health and wellness in the community by offering affordable recreation opportunities that encourage creative activity and teamwork. A. Program and Class Offerings: i. Seasonal programs and class offerings may include, but are not limited to the following class options: i. Youth Archery ii. Teen and Adult Archery ii. Instructor shall teach such or similar classes at available City facilities to be designated by the City on a schedule agreed upon by the parties, in writing, for each class session or term, including the location, specific days and hours when classes will be held, and holidays to be observed, in accordance with City's needs. Provider and City agree that class locations and/or scheduling are subject to change due to unforeseen events or needs beneficial to the class participants. The Parties agree that changes to scheduling or location of classes shall be agreed upon, in writing, prior to the allowance of said change(s). iii. Class Size i. At the City's discretion and upon mutual agreement, the minimum and maximum number of participants required for each class will be determined to ensure the quality and safety of the class participants. ii. Class ratio of participants to instructor(s)will be set for each class to ensure effective instruction and safety based on statewide standards. iii. if the minimum registration has not been reached by the second class, it is up to the discretion of the City upon mutual agreement with Instructor, that the class shall be cancelled. Instructor will be under no obligation to provide services for the cancelled classes, and the City will have no further obligations to pay Instructor compensation for the remaining classes that were cancelled in that session. l iv. Class Fees i. Class pricing is dependent on session length per season and subject to City staff approval. Class pricing is limited to no more than a 5% increase annually. ii. Each participant shall pay class registration fees as established by City. Instructor may not waive class participation/registration fees. Only registered participants paid in full may participate in class. iii. Any refunds to participants will be made in accordance with City policy. B. Instructor Responsibilities: i. Planning and delivering engaging and age-appropriate archery classes as defined by class curriculum and description to be approved by City staff. ii. Ensuring the safety and wellbeing of all participants during class sessions. ■ Instructor will immediately report to City staff, by phone or email, any injuries as a result of class participation, damages to the facility that could cause potential injury to a class participant and/ or require facility repairs. ■ Instructor will notify parent/guardian of minors under the age of 18 and city staff regarding any injuries experienced during class. iii. Submitting seasonal program proposals to City staff for seasonal approval of class descriptions, details, and schedules. Proposals must be submitted in writing by way of the provided City form(s) to City staff for review and approval at least 60 days prior to the start of the new season, unless otherwise specified by City staff. City staff will review and approve written proposals based on community needs, facility availability, and alignment with City goals. iv. Adhering to all City policies and procedures related to the use of facilities and interaction with participants. v. Adhering to all City deadlines for required documentation. vi. The instructor's organization is responsible for fingerprinting, monitoring, and managing all staff that will be instructing. vii. Promotion of class(es) with City approved marketing materials outside of City managed platforms. Publicizing on additional channels and networks outside of City platforms is the sole responsibility of the instructor. 2 viii. Instructor shall provide all materials, supplies, equipment, records and personnel. Instructor shall be responsible for repairing and maintaining all equipment and supplies, and ensuring that it is in good working condition. Instructor shall ensure clean-up of the facilities and materials to ensure the safety and effectiveness of instruction. The City will not responsible for any damage, repairs, misplaced, or stolen supplies or equipment, and will not be responsible for storing supplies or equipment. C. City Responsibilities: i. City shall manage participant registration and class information through registration software. Instructor shall be granted access to the class roster on the City registration system and is responsible for tracking attendance. ii. City shall collect all enrollment fees through the registration software. Instructor shall not accept enrollment fees directly from a participant, and shall only collect materials fees that are pre-approved by City and published in advance as a part of the program marketing. Such material fees shall be collected by Instructor at the first scheduled class meeting. No additional fees shall be collected for materials, uniforms, awards, etc. without written approval and advanced advertising. iii. City shall provide publicity for class(es) seasonally in the City's recreation magazine (published seasonally). City shall have the sole discretion to decide what information will be included in the recreation magazine about the class and Instructor. Publicity may also include flyers created by City. Instructor created flyers are encouraged, but must be finalized by City to include use of City logos before distribution. iv. City shall provide a location for the class(es). Instructor will request dates and times for the class(es) seasonally, in writing. The City will confirm the class(es) schedule seasonally. Location selection is based on need, size of class, type of activity and availability, and is reserved at the discretion of the City. V. City shall provide refunds to participants when: ® The participant formally requests to drop the class before the second schedule class meeting. • The class is canceled by City or Instructor. 3 Insurance Requirements—Exhibit B Prior to undertaking performance of work under this Agreement, Provider shall maintain and shall require subcontractors, if any, to obtain and maintain insurance, as described below, for the entire Term of this Agreement, against claims for injuries to persons or damage to property which may arise from or in connection with services, products and materials supplied. Total cost of such insurance shall be borne by Provider. MINIMUM SCOPE AND LIMIT OF INSURANCE 1. 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. Required policy limits can be met with primary and umbrella/excess insurance policies. 2. Automobile Liability (AL): Insurance Services Office Form CA 00 01 covering Code 1 (any auto), with limits no less than $1,000,000 per accident for bodily injury and property damage. In the event Provider does not maintain commercial automobile liability insurance, City will accept evidence of personal automobile insurance,provided that such policy is endorsed for business use and provides coverage with a minimum limit of $1,000,000.Required policy limits can be met with primary and umbrella/excess insurance policies. 3, 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, policy or employee, for bodily injury or disease. Coverage is not required if Provider has no employees and signs request to waive such insurance. 4. Sexual Abuse or Molestation Liability (SAML): If the work will include contact with minors, and the CGL policy referenced above is not endorsed to include affirmative coverage for sexual abuse or molestation, Provider shall obtain and maintain a policy covering Sexual Abuse and Molestation with a limit of no less than. $1.000,000 per occurrence or claim. If Provider maintains broader coverage and/or higher limits than the minimum requirements for each line of coverage shown above, City requires and shall be entitled to the broader coverage and/or the higher limits maintained by Provider. Any available insurance proceeds in excess of the specified minimum limits of insurance and coverage shall be available to City. Other Insurance Provisions The above required insurance policies are to contain or be endorsed to contain the following provisions: 1. City of Santa Ana,its City Council,its officers,officials,employees,agents,and volunteers are to be covered as additional insureds on Provider's CGL, AL, and SAML policies with respect to liability arising out of work or operations performed by or on behalf of the Insurance Requirements—Exhibit B Provider including materials,parts, equipment,and personnel furnished in connection with such work or operations. 2. Provider's Insurance company(ics) agrees to waive all rights of subrogation against City, its City Council, its officers, officials, employees, agents, and volunteers for losses paid under the terns of Provider's CGL,AL,and WC policies which arise from work performed by Provider under this Agreement. 3. For any claims related to this contract, Provider'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. A severability of interest provision must apply for all the additional insureds, ensuring that Provider'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. 5. Insurance policy(ies) 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. b. Certificate Holder on each Evidence of Insurance certificate shall be: City of Santa Ana, Attention: Parks, Recreation, & Community Services Agency, 20 Civic Center Plaza, M- 23, Santa Ana, CA 92701. The name and location of project must be included in the Description of Operations section of each certificate. Acceptability of insurers Insurance is to be placed with insurers authorized to conduct business in the State of California with a current A.M. Best rating of no less than ANII, unless otherwise acceptable to City. Verification of Coverage Provider 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 before work begins. However, failure to obtain the required documents prior to the work beginning shall not waive Provider'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. Special Events Coverage Special events coverage is available and can be purchased by Provider. Use this link to learn more: htt s://2s arta.con-/seli application.php. 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. Ac" CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD1YYYY) 119/2026 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 RON WOOTEN NAME, CONTINENTAL BROKERS, INC. PnHrc°NE 601-707-1028 X2229 FAXAIC Ne): 601-707-1017 PO BOX 2662 E-MAIL ADDRESS: ron@continentalbrokers.biz MADISON,MS 39130 INSURER(S)AFFORDING COVERAGE NAM INSURER A: SiriusPoint America Insurance Company 38776 INSURED INSURER B Gryphon Fitness Studio LLC INSURERC: INSURER D; 912 Magnolia Ave INSURER E: Placentia CA 92870 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 SUER POLICY EFF POLICY EX? LTR TYPE OF INSURANCE IN-RD NUVD POLICY NUMBER MMfDDNYYY] mmrDDlYYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 u DAMAGE TO RENTED CLAIMS-MADE /�f OCCUR PREMISES Erenc�l _ $ 300,000 X Profess anal Liability Agg$1 m a Occur MED EXP(Any one person} $ 0 A X Participant Liability Agg$1 m Y Y PLH01GL00004162 05/08/2025 05/0812026 PERSONAL&ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER' GENERAL AGGREGATE $ 3.000,000 X POLICY PRO- JECT LOG PRODUCTS-COMPIOP AGG $ 3.060—M OTHER: Sexual Abuse Agg $ 2,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $a accident) _ ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS ONLY AUTOS I } HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE [AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANYPROPRIETORIPARTNEFZJEXECUTIVE F-1 E.L.EACH ACCIDENT $ OFFICERIMEMBEREXCLUDED? N 1 A - (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under — DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Maximum Benefit $25,000 A ACCIDENT 8 HEALTH PHSA-BAMH-12086-25 05108/2025 05/08/2026 AD&D $10,000 Deductible $250 DESCRIPTION OF OPERATIONS f LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate Holder is included as Additional Insured as respects to General Liability per Endorsement.Waiver f Subrogation is included. *Cancellation:10-days Notice for Non-Payment of premium or 30 days for all other reasons. �71!!T CERTIFICATE HOLDER CANCELLATION rgyen at 3:57pm,Jan 27,2028 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:Parks,Recreation,and Community Services Agency 20 Civic Center Plaza M-23 AUTHORIZED REPRESENTATIVE Santa Ana CA 92701 /gyZ, fi(/d9 O 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD AC" CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 01/09/2026 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 NAME: Jennifer Lamb Jennifer Lamb Insurance Agency Mae Ext (714)209-9911 arc No 949 Williams Ave E-MAIL ennifer Ins ADDRESS: 1 @i urancelamb.com INSURERS AFFORDING COVERAGE NAIC k Placentia CA 92870 INSURER A: STATE COMPENSATION INS FUND 35076 INSURED INSURER B: Gryphon Fitness Studio LLC INSURER C 912 Magnolia Ave INSURER D: INSURER E: Placentia CA 92870 INSURERF: COVERAGES CERTIFICATE NUMBER: 1 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 SUER EFF LTR TYPE OF INSURANCE �wqn WWIPOLICY NUMBER MMIDDYIYYYY MMID�Y/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES Ea occurrence S MED EXP(Any one person) 8 PERSONAL&ADV INJURY $ GENT AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ JECT POLICY a PRO LOG PRODUCTS-COMPIOP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO HODILY INJURY(Per person) 5 OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) S HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident $ S UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB Ll CLAIMS-MADE AGGREGATE $ DEn RETENTIONS �,r STATUTE $ WORKERS COMPENSATION /\ ORH AND EMPLOYERS'LIABILITY Y I N ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT $ 1,000.000 A OFFICERIMEMBER EXCLUDED? N NIA X 9294833-25 04101/2025 04101/2026 (MandatoryiaNH) E.L.DISEASE-EA EMPLOYEE S 1,000,000 It yes.describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 1,000,000 I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Waiver of Subrogation APPROVED By Tu Tran Nguyen of 3:56 pm,Jan 27, 2026 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Santa Ana Attn:Parks,Recreation and Community THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Services Agency ACCORDANCE WITH THE POLICY PROVISIONS. 20 Civic Center Plaza M-23 AUTHORIZED REPRESENTATIVE Santa Ana CA 92701 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Nguyen, Tu Tran From: Eric ITIalmgren <eholmgren@sbcglobal.net> Sent: Monday, January 26, 2026 10:39 AM To: Uribe, Juan Subject: Fw: USAA Auto Insurance Confirmation �ttentiou: This::mail ori-�inated rrom otitsiai:Lo C its orSanta Ana. Use caution when opening,attachments or finks, Hi Juan, Here is the auto insurance information. Eric ----- Forwarded Message----- From: USAA <usaa.customer.service@ mailcenter.usaa.com> To: "eholmgren@sbcglobal.net" <eholmgren@sbcglobal.net> Sent: Monday, January 26, 2026 at 10:08:45 AM PST Subject: USAA Auto Insurance Confirmation To ensure delivery to your inbox,please add USAA.Customer.Service mailcenter.usaa.eom to your address book. x Auto Insurance Confirmation Dear Mr.HoInngren, Please use this as confirmation of auto insurance, however, this doesn't take the place of an insurance identification card. Registered owner: ERIC R HOLMGREN APPROVED LAURA L HOLMGREN ByTuTranNguyenat3:66pm,Jan2-7,2026 Policy number: CIC 004418904 7101 Per Director's approval please Policy effective date: August 24, 2025 see pages 11-15 Policy expiration date: February 24, 2026 Vehicle: 2014 HONDA CR-V 4D LX VIN: 5J6RM3H33EL009366 Bodily injury liability limit: $1,000,000 each person 1 $1,000,000 each accident Property damage liability $100,000 each accident limit: Comprehensive deductible: $1,000 Collision deductible: $1,000 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 USAA 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 L"V Fax: 800-531-8877 Thank you, USAA Casualty Insurance Company Taking care of our members since 1922. Go Digital Review and edit your online document preferences at usaa.com. Please do not reply to this e-mail.To Contact USAA,visit our Secure Contact page. Privacy Promise USAA Casualty Insurance Company. 9800 Fredericksburg Road, San Antonio.Texas 78288 9 31 27-01 2 6 2 POLICY NUMBER: PLH01 GL00004162 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. GENERAL CHANGE This endorsement will not be used to decrease coverage, increase rates or deductible or alter any terms or conditions of coverage unless at the sole request of the insured, COVERAGE PART INFORMATION—Coverage parts affected by this change as indicated by ® below X General Liability ❑ Commercial Property [] Commercial Automobile ❑ Crime ❑ Inland Marine ❑ Umbrella/Excess The following item(s): ❑ Insured's Name ❑ Company ❑ Policy Number ❑ Insured's Legal Status/Business of Insured ❑ Effective/Expiration Date ❑ Premium Determination Additional Insured ❑ Coverage Forms and Endorsements ❑ Limits/Exposures ❑ Deductibles ❑ Covered Property/Location Description ❑ Classifications/Class Codes ❑ Insured's Mailing Address is (are) changed to read {See Additional Page(s)): ALL OTHER TERMS AND CONDITIONS REMAIN UNCHANGED. The above change(s) result in a change in the premium as follows: ❑ NO CHANGES XADDITIONAL: $151.93 ❑ RETURN: (This premium does not include taxes and surcharges) fr Paul NjjFhg1& President SAIC Date: 5/21/2025 Countersignature: Authorized Representative SP-IL-CW-0007 (08/22) c 2022 SiriusPoint America Insurance Company Page 1 of 2 All Rights Reservec, Nlay not be permission. POLICY CHANGES ENDORSEMENT DESCRIPTION Added form PH-GL-CW-0057 SP-IL-CW-0007 (08/22) ©2022 SiriusPoint America Insurance Company Page 2 of 2 All Rights Reserved. May not be copied avithout permission, POLICY NUMBER: PL.H01GL00004162 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - WHERE REQUIRED UNDER CONTRACT OR AGREEMENT (PRIMARY AND NON-CONTRIBUTORY WHERE REQUIRED UNDER CONTRACT) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SECTION II—WHO IS AN INSURED is amended to include any person or organization to whom you become obligated to include as an additional insured under this policy, as a result of any written contract or written agreement you enter into which requires you to furnish insurance to that person or organization of the type provided by this policy and is fully executed priorto an "occurrence", but only with respect to liability arising out of youroperations or premises owned by orrented to you. However, the insurance provided will not exceed the lesser of: a. The coverage and/or limits of this policy; or b. The coverage and/or limits required by said contract or agreement. Coverage afforded to these additional insured parties will be primary to, and non-contributory with, any other insurance available to that person or organization where required of you by written contract or written agreement. PH-GL-CW-0057 (04/22) Includes copyrighted material of Insurance Services Office, Pago 1 of 1 Inc., with its permission. O 2022 SALISPoint America Insurance Company 0 Rights Reserved. May not be copied without permission. POLICY NUMBER: PLH01GL00004162 COMMERCIAL GENERAL LIABILITY CG20260413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -- DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL_ GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s)Or Organ Lzation(s): City of Santa Ana Attention: Parks, Recreation, and Community Services Agency 20 Civic Center Plaza M-23, 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 shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following is added to organization(s) shown in the Schedule, but only Section III—Limits Of Insurance: with respect to liability for "bodily injury", "property If coverage provided to the additional insured is damage" or "personal and advertising injury° required by a contract or agreement, the most we caused, in whole or in part, by your acts or will pay on behalf of the additional insured is the omissions or the acts or omissions of those acting amount of insurance: on your behalf: 1. In the performance of your ongoing operations; 1. Required by the contract or agreement; or or 2. Available under the applicable Limits of 2. In connection with your premises owned by or Insurance shown in the Declarations; rentod to you. whichever is less. However: This endorsement shall not increase the 1. The insurance afforded to such additional applicable Limits of insurance shown in the insured only applies to the extent permitted by Declarations. law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 26 04 13O Insurance Services Office, Inc., 2012 Page 1 of 1 F. Paragraphs 10. is added to SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS as follows, 10. Waiver of Right of Recovery 1+11'e waive all rights of recovery when you have agreed to waive your rights of recovery when required by a written contract. However, this provision only ,applies if the written contract was executed prior to the date of the "occurrence". STATE Endorsement Agreement COMPrNSATION INSURANCE Waiver of Subrogation FUN61' 9294833-2025 Home Office Renewal San Francisco SC All Effective Dates are 9-90-38-09 at 12:01 AM Pacific Page 1 of 1 Standard Time or the Time Indicated at Effective January 17, 2026 at 12:01 AM Pacific Standard Time and Expiring April 1, 2026 at 12:01 AM GRYPHON FITNESS STUDIO LLC 912 MAGNOLIA AVE PLACENTIA, CA 92870 Anything in this policy to the contrary notwithstanding, it is agreed that the State Compensation Insurance Fund waives any right of subrogation against, City of Santa Ana which might arise by reason of any payment under this policy in connection with work performed by, GRYPHON FITNESS STUDIO LLC It is further agreed that the insured shall maintain payroll records accurately segregating the remuneration of employees while engaged in work for the above employer. It is further agreed that premium on the earning of such employees shall be increased by 3.00%. Nothing in this endorsement shall be held to vary, alter, waive or extend any of the terms, conditions, agreements, or limitations of this policy other than as above stated. Nothing elsewhere in this policy shall be held to vary, alter, waive or limit the terms, conditions, agreements or[imitations in this endorsement. Countersigned and Issued at San Francisco January 17, 2026 2570 Authorized Representative President and CEO SF—END Rev.2/2025 OLD DP 217 Nguyen, Tu Tran From: Scott, Hawk Sent: Tuesday, January 27, 2026 2:35 PM To: Uribe, Juan Cc: Soriano, Destinee Subject: RE: Standard COI Review: Gryphon Fitness Studio, LLC Hi Juan, And a ,pleasant good morning to you wherever you may be. Please proceed with the agreement. Thanks Hawk V. Scott E- ectitive Director of Parks, Recreation, and Community Serx-ices Santa Ana City of Santa Ana I (Z41571-4204 1 (714)720-2611 ,xkNi .santa-ana.org I liscott a Santa-ana.org S t 20 Civic Center Plaza Santa Ana.CA 9z701 ii j�na OV .. From: Uribe,Juan Sent:Tuesday,January 27, 2026 2:29 PM To: Scott, Hawk<hscott@santa-ana.org> Cc: Soriano, Destinee <dsoriano@santa-ana.org> Subject: FW:Standard COI Review: Gryphon Fitness Studio, LLC Hello Hawk, Please see the email thread below. Sincerely, Juan Magana Uribe I Management Aide City of Santa Ana, Parks, Recreation and Community Services Santa Ana 20 Civic Center Plaza, Santa Ana, CA 92701 - - (714) 571-4276 1 luribe(EDsanta-ana.org "City Nall is closed every other Friday. Click here for dates" From: RMD Sent: Tuesday,January 27, 2026 1:25 PM To: Uribe,Juan <juribe@Santa ana.or > i Cc:Soriano, Destinee <dsoriano@santa-ana.org>; Najera, Luisa <Inaiera@santa-ana.org> Subject: RE: Standard COI Review: Gryphon Fitness Studio, LLC Hi Juan, Risk is still requiring the business use endorsement per the insurance requirements in the agreement. Risk will leave the decision up to Parks, Recreation and Community Services to accept the personal auto policy as is. Please let us know what the Parks, Recreation and Community Services' decision is. Kind regards, Tu Tran Nguyen I Risk Management Technician City of Santa Ana - Human Resources Department r 20 Civic Center Plaza I Santa Ana, CA 92701 , , Office: 714-647-5141 Email: TNquyen20(cpsanta-ana.orq I Santa-ana.orglhuman-resources Linkedln Instagram City Hall hours are 8 a.m.to 5 p.m. Monday through Thursday, and 8:00 a.m. to 5:00 p.m. every other Friday. Click here for a list of observed holidays and Friday closure dates. The mySantaAna mobile app puts the power of the Santa Ana city government in the palm of your hand! The free app allows residents to quickly and easily report issues to the City, access City services, and find news and events. It is available to download from the Apple App Store and on Google Play,. Click here to report an issue directly from the City website. From: Uribe,Juan <'uribe Santa-ana.or > Sent:Tuesday,January 27, 2026 11:47 AM To: RMD <rmd@santa-ana.org>; eholmgren@sbcglobal.net Cc:Soriano, Destinee<dsoriano@santa-ana.org> Subject: RE: Standard COI Review: Gryphon Fitness Studio, LLC Good afternoon, The instructor confirmed they do not have a business endorsement for their personal automobile policy. May the auto insurance provided be accepted as is? Sincerely, Juan Magana Uribe I Management Aide City of Santa Ana, Parks, Recreation and Community Services Santa Ana 20 Civic Center Plaza, Santa Ana, CA 92701 - - - (714) 571-4276 1 lurib�santa-ana.orq "City Hall is closed every other Friday. Click here for dates" 2 From: Ron Wooten <ron@continenta[brokers.biz> Sent:Tuesday,January 27, 2026 7:08 AM To: RMD<rmd@santa-ana.org>; Uribe,Juan <juribe@santa-ana.org>; eholm ren sbc lobal.net Cc: Soriano, Destinee<dsoriano@santa-ana.org> Subject: RE: Standard COI Review: Gryphon Fitness Studio, LLC ;attention:This email originated frorn outside orcity -�zinta.ana. Use cautie>n wlten opening attachnients or linki. Updated C0I attached. RON WOOTEN New Business Underwriter and Specialty Programs Broker Sports & Fitness Insurance Corporation I Continental Brokers Office: 601,898.8464 ext. 2229 • Fax: 601.707.1017 P,O. Box 1967 Madison, MS 39130 230 Highpoint Drive, Ridgeland, MS 39157 www.continentalbrokers.biz • httl2s://sportsfitness.com/ Confidentiality Note:This email and any attachments may be confidential and protected,If you are not the intended recipient,be aware that any disclosure,copying,distribution or use of the e-mail or any attachment is prohibited.If you have received this email in error,please notify us immediately by replying to the sender and deleting this copy and the reply from your system.Thank you for your cooperation From:. RMD <rmd@santa-ana.org> Sent: Monday,January 26, 2026 5:04 PM To: Uribe,Juan <juribe@Santa-ana.oM>;eholmgren@sbcglobai.net; Ron Wooten<ron@continentalbrokers.biz> Cc: Soriano, Destinee<dsoriano@santa-ana.org> Subject: RE: Standard C01 Review: Gryphon Fitness Studio, LLC Hi Juan, In reviewing the COI, the following is missing: 1. Signature under the Authorized Signature (not printed) for CGL COI CANCELLATION SHOULD, ANY OF THE ABOVE DESCRIBE©POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, AtJTHOPIZEd REPRESENTATNE Ron Wooten Oc 1998-2015 ACORD CORPORATION. Ail rights reserved. 2. Please confirm that personal auto policy is endorsed for business use. 3 2. Automobile Liability (At.): Insurance Services Office Form CA 00 01 cover (any auto), with limits no less than $1,000,000 per accident for bodily injury a damage. In the event Provider does not maintain commercial auLoniobi insurance. City will accept evidence of personal automobile insurance, providt policy is endorsed for business use and provides coverage with a niininw $1,000,000. Required policy limits can be net with primary and umbrella/cxcc� policies. Kind regards, Tu Tran Nguyen I Risk Management Technician City of Santa Ana- Human Resources Department 20 Civic Center Plaza I Santa Ana, CA 92701 LA Office: 714-647-5141 Email: TNpuyen20(@santa-ana.orq I santa-ana.orglhuman-resources Linkedln I nstagram City Hall hours are 8 a.m.to 5 p.m. Monday through Thursday, and 8:00 a.m. to 5:00 p.m. every other Friday. Click here for a list of observed holidays and Friday closure dates. The my5antaAna mobile app puts the power of the Santa Ana city government in the palm of your hand! The free app allows residents to quickly and easily report issues to the City, access City services, and find news and events. It is available to download from the Apple App Store and on Google Play. Click here to report an issue directly from the City website. From: Uribe,Juan<iuribe@santa-ana.org> Sent: Monday,January 26, 2026 11:16 AM To: RMD <rmd@santa-ana.org> Cc:Soriano, Destinee<dsoriano@santa-ana.org> Subject:Standard COI Review: Gryphon Fitness Studio, LLC Good morning, We wish to request review of the attached insurance documents for the new agreement between the City of Santa Ana and Gryphon Fitness Studio, LLC. Request Type (check only one): X Standard COl Review—Risk Management will review and approve insurance documents submitted.This applies to PO, Event, R Permit, and Agreements. ❑ Renewal COI Review—Risk Management will review and approve renewal insurance documents submitted.This applies to PO, Reservations, Permit, and Agreements. Please attach insurance requirements and previously approved COI(s). ❑ Request Insurance Requirements- Risk Management will provide insurance requirements for agreements and RFPs. 4 ❑Review A reement RFP Language- Risk Management will review Insurance, Indemnification/Hold Harmless, Limitation of Liabil of agreements and RFPs. All fields required to advance the process—do not delete or modify. City Contact Department: PRCSA Project Manager Name: Destinee Soriano Project Manager Email: dsoriano@santa-ana.oro Contract Details: Business Name: Gryphon Fitness Studio, LLC Agreement Number and Agreement N/A Link: Vendor to provide archery classes to Santa Ana Brief description of services: residents ages 7 and up at City recreation facilities. Contractor/Insured Contact Contact Name: Eric Holmgren Contact Email Address: eholmgrren@sbcglobal.net Contact Phone: 714-519-1343 Insurance Contact(may be found at top right of the ACORD form) Ron Wooten (CGL); Contact Name: Jennifer Lamb (WC) Contact Email Address: ron@continentalbrokers.biz (CGL); jenniferc@insurancelamb.com (WC) Contact Phone; N/A Sincerely, Juan Magana Uribe I Management Aide City of Santa Ana, Parks, Recreation and Community Services Santa And 20 Civic Center Plaza, Santa Ana, CA 92701 (714) 571-4276 1 juribe(a7santa-ana.org "City Hall is closed every other Friday. Click here for dates" 5 required by the CA VEH CODE SECTION 16056 for the specified vehicle and OR named insureds and may provide coverage for other persons and other vehicles as provided by the insurance policy. California Automobile Insur& We've issued two identification cards as evidence of liability insuram as liability insurance remains in force. Keep a copy of the ID car You may be required to produce your identification card at vehicle rec license, following an accident, or upon a law enforcement officer's re 53CA1 Rev. 06-13 03/31/26 CALIFORNIA EVIDENCE OF FINANCIAL RESPONSIBILITY Name and Address of Insured NAIC 25968 ERIC R HOLMGREN 912 MAGNOLIA AVE PLACENTIA CA 92870-4421 IN (S of Fi re APPROVED (c By Tu Tran Nguyen at 3:57 pm,May 04,2026 f p I LAURA L HOLMGREN o F� ERIC R HOLMGREN I fi JAMES E HOLMGREN d FINNIGAN ORION HOLMGREN Insurance Company _ USAA CASUALTY INSURANCE COMPANY Policy Number Effective Date Expiration Date 00441 89 04C 7101 1 04/01/26 08/24/26 Vehicle Make/Vehicle Identification Number Year HONDA 5J6RS5H59TL017455 2026 This policy provides at least the minimum amounts of liability insurance C required by the CA VEH CODE SECTION 16056 for the specified vehicle and C named insureds and may provide coverage for other persons and other vehicles as provided by the insurance policy. ADDL INFO ON NEXT PAGE PAGE 6 W44 � USAA CASUALTY INSURANCE COMPANY ei„ (A Stock Insurance Company) State 1 q Vol POLICY NUMBER USAX 9800 Fredericksburg Road - San Antonio, Texas 78288 CA kl 53 XXr 00441 89 04C 7101 1 CALIFORNIA AUTO POLICY POLICY PERIOD' (12:01 A.M. standard time) AMENDED DECLARATIONS EFFECTIVE 1 2026 TO AUG24 2026 (ATTACH TO PREVIOUS POLICY) Named Insured and Address LAURA L HOLMGREN 912 MAGNOLIA AVE PLACENTIA CA 92870-4421 Descri tion of Vehicle s VEH USE' oRs H0°L VEH YEAR TRADE NAME MODEL BODY TYPE IDENTIFICATION NUMBER SYM e I ork 14 26 HONDA CR—V 4D 14000 5J6RS5H59TLO17455 P e e is e s escrl a he—re—in—i—s—pr—in—cl—p-a-ryFgaraged at the above address unless otherwise stated. 11'w =Work School B=B siness F=Farm P=P1 ure VEH 14 PLACENTIA CA 92870-4421 This policy provides ONLY those goveragqes where apremium ,is shown below. The limits hown m y ¢e rediced b poligy pro Yt t Ts aTid mar not a combined reaarde(ess of the number of ve ie es for which premium Is tste unless sp cifical authorized els where in this polic . COVERAGES LIMITS OF LIABILITY VEH VEH VEH VEH 14(°ACV" MEANS ACTUAL CASH VALUE) D DED 6 PREMIUMH D=DED I PREMIUM D=DED PREMIUM D=DED I PREMIUM AMOUN $ AMOUNTI $ AMOUNT $ ONMOUNTI $ PART A - LIABILITY BODILY INJURY EA PER $1, 000, 00 EA ACC $1, 000, 000 156 . 94 PROPERTY DAMAGE EA ACC $ 100, 000 87 . 55 PART B - MEDICAL PAYMENTS EA PER $ 100, 000 23 . 28 EXTENDED BENEFITS WAGE EARNER DISAB $2, 000 PER 0-DAYPERIO ESSENTIAL SVCS DISAB $45 WK 1 . 95 PART C - UNINSURED MOTORISTS BODILY INJURY EA PER $1, 000, 00 EA ACC $1, 000, 000 91 . 56 WAIVER OF COLL DEDUCTIBLE 1 . 35 PART D - PHYSICAL DAMAGE COVERAGE COMPREHENSIVE LOSS ACV LESS D1000 72 . 11 COLLISION LOSS ACV LESS D1000 371 . 82 RENTAL REIMBURSEMENT ECONOMY CLASS 32 . 23 TOWING AND LABOR 11 . 68 VEHICLE TOTAL PREMIUM 850 . 47 -------------------------------ADJUSTMENT REASON-------------------------------- CHANGE IN OPERATOR STATUS OP 03 ADDED VEH 14 TOTAL PREMIUM SEE FOLLOWING PAGE (S) „ 14 RMM43 0O H In WITNESS WHEREOF, we have caused this policy to be signed by our President and Secretary at San Antonio, Texas, on this date MARCH 31, 2026 5000 C05-12 Tom Eck,Secretary Randy Termeer,President L�n07 1174 4 Nguyen, Tu Tran From: Uribe,Juan Sent: Monday, May 4, 2026 3:54 PM To: RM D Cc: Soriano, Destinee Subject: RE: Request for COI Review: Gryphon Fitness Studio LLC Attachments: Gryphon Fitness -Automobile Liability_new.pdf Good afternoon, I was informed by the instructor that they bought a new vehicle in April and will be using that as their main vehicle moving forward. I have attached their new insurance certificate as well. The insurance coverage for the prior vehicle was maintained as usual per the initial documents submitted. Sincerely, Juan Magana Uribe I Management Aide City of Santa Ana, Parks, Recreation and Community Services ' 20 Civic Center Plaza, Santa Ana, CA 92701 (714) 571-4276 I iuribe(a�santa-ana.org **City Hall is closed every other Friday. Click here for dates** From: RMD Sent: Friday, May 1, 2026 8:20 AM To: Uribe,Juan <juribe@santa-ana.org> Cc: Soriano, Destinee<dsoriano@santa-ana.org> Subject: RE: Request for COI Review: Gryphon Fitness Studio LLC Good morning Juan, The initial evidence of auto reflects a different policy date and different vehicle information. Can you please confirm which vehicle they will be using to perform services? Kind regards, Tu Tran Nguyen I Risk Management Technician City of Santa Ana - Human Resources Department n 20 Civic Center Plaza I Santa Ana, CA 92701 Office: 714-647-5141 Email: TNg uy �santa-ana.or en20 santa-ana.org/human-resources Linkedln g l I nstagram i City Hall hours are 8 a.m. to 5 p.m. Monday through Thursday, and 8:00 a.m. to 5:00 p.m. every other Friday. for a list of observed holidays and Friday closure dates. The mySantaAna mobile app puts the power of the Santa Ana city government in the palm of your hand! The free app allows residents to quickly and easily report issues to the City, access City services, and find news and events. It is available to download from the Apple App Store and on Google Play. Click here to report an issue directly from the City website. From: Uribe,Juan <iuribe@santa-ana.org> Sent: Friday, May 1, 2026 8:09 AM To: RMD<rmd@santa-ana.org> Cc: Soriano, Destinee<dsoriano@santa-ana.org> Subject: RE: Request for COI Review: Gryphon Fitness Studio LLC Good morning, Please see the attached automobile liability evidencing policy limits for Gryphon Fitness Studio. Thank you, Juan Magana Uribe I Management Aide City of Santa Ana, Parks, Recreation and Community Services 20 Civic Center Plaza, Santa Ana, CA 92701 (714) 571-4276 iuribe(a�santa-ana.org "City Hall is closed every other Friday. Click here for dates" From: RMD Sent: Friday,April 3, 2026 8:34 AM To: Uribe,Juan <iuribe@santa-ana.org> Cc: Soriano, Destinee<dsoriano@santa-ana.org> Subject: RE: Request for COI Review: Gryphon Fitness Studio LLC Good morning Juan, Can you please request the personal auto evidence the policy limits? Kind regards, Tu Tran Nguyen I Risk Management Technician City of Santa Ana - Human Resources Department 20 Civic Center Plaza I Santa Ana, CA 92701 Office: 714-647-5141 Email: TNguyen20(aD-santa-ana.org I santa-ana.org/human-resources Linkedln I nstagram 2