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HomeMy WebLinkAboutKIM, BONGWON INSURANCE NOT ON FILE WOPK 11AY NOT PROCEED A-2026-085-01 CITY CLERK DATE: JUN 2 5 20215 n (bk) FACILITY USE AGREEMENT WITH BONGWON KIM FOR USE OF c•Linz (�Z] RIVER VIEW GOLF COURSE THIS FACILITY USE AGREEMENT is made and entered into on June 16`s, 2026, by and between Bongwon Kim ("User"), 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 User may be collectively referred to as the"Parties" or individually as a"Party". RECITALS A. The User has a need for a venue to conduct golf instruction and/or lessons. B. The City acknowledges the community need for programs such as those offered by User that expand competitive, and non-competitive athletic opportunities within the City of Santa Ana. C. The Parties have entered into this Agreement for the purpose of setting forth the terms and conditions for the User to use designated areas at the River View Golf Course for the administration of golf instruction and/or lessons. The parties agree as follows: I. GRANT OF PERMISSION AND FACILITIES TO BE USED City hereby grants User the limited,non-exclusive right to utilize designated areas of River View Golf Course ("Facilities") to provide golf instruction and/or lessons pursuant to the Scope of Use set forth in Exhibit A, attached hereto and incorporated herein by reference. 2. COMPENSATION For the use of the Facilities described in Section 1 of this Agreement, User shall pay City fees as described in Exhibit A. 3. TERM The term of this Agreement shall begin on July 1, 2026 and terminate on June 30, 2027, unless terminated pursuant to the terms of this Agreement. 4. COMPLIANCE WITH RULES AND REGULATIONS User shall use and occupy the Facilities in a safe and careful manner and shall comply with all applicable local, state, and federal laws in its use of and activities in the Facilities, including as to the conduct of its employees, agents, clients, customers, guests, and others using the Facilities by reason of this Agreement. User shall also comply with all rules and regulations of City in effect during its use of the Facilities. Failure to abide by such Iaws,rules, or regulations, or any condition Page 1 of 5 of this Agreement,may result.in the,immediate termination of this Agreement in the sole discretion of the City. 5. BACKGROUND CHECKS User shall ensure that all,employees, subcontractors, and any volunteers are fingerprinted and background'checked prior to conducting any work pursuant to this Agreement. User shall not assign any employee, agent, subcontractor, volunteer or the User personally to provide services pursuant to. this Agreement, if that employee, agent, subcontractor, volunteer, or the User personally are required.-to register a�-a sex offender under California Penal Code Section 290 ct seq,have.a conviction for.any crime of moral turpitude,have a conviction for a sexual based crime, -have a conviction.for a violezit-felony as defined in California Penal Code Section 667,5(c), or has a conviction for. a serious felohy 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 Sdction 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, 286,289,288a,288.2, 288.3,288.4,'288.5,288.7,289,29.0, 3,b 1.1,311.2,311.3,311.4,311.10,311.11,314,347(a),368, .417(b), 451(a),518 with f86.22,,647.6;-653f(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.' 6. INDEM[NIFICATION User agrees to and shall indemnify, protect, defend, and hold harmless City, its officers, agents, employees,consultants, special counsel, and representatives from and against any and all claims, damages; judgments, attorney's fees, costs and expenses arising out of, involving, or in connection with the use of-the-Facilities or the acts or omissions of User, its officers, agents, employees; volunteers, guests, or. invitees, whether or not such acts or omissions constitute permitted uses of the Facilities. 7. INSURANCE Insurance requirements are attached,hereto and incorporated herein as Exhibit B. 8. CONFLICT OF INTEREST CLAUSE User covenants that-it presently has no interests and shall not have interests, direct or Indirect, which would conflict in any manner with performance of services specified under this Agreement. 9. FORCE MAXERE In the event that the Facilities are rendered unavailable due to destruction,partial or total, acts of nature, work stoppages or other labor disturbances, civil commotion, war, or any other Page 2 of 5 action by governmental agencies, or for any reason beyond the control of City, City shall have the right to terminate this Agreement without penalty. 10. LICENSES AND PERMITS User represents and warrants that it, and any agents, independent contractors, subcontractors,vendors,or others acting on its behalf under or with respect to this Agreement,will at all times during the term of this Agreement have and maintain in force any and all licenses, permits, or approvals required by law for the conduct of User's activities under this Agreement. 11. DAMAGE TO FACILITIES User shall be liable for any damage to the Facilities caused by'any act of negligence of ' User, its partners, agents, servants, contractors, representatives, guests, employees, invitees, of customers. City may, at its option, repair such damage, and User agrees to reimburse City for the total cost of repair. 12. PROPERTY BELONGING TO USER City shall not be responsible for lost, stolen, or damages property belonging to User, its partners, agents, servants, contractors,representatives, guests, employees,invitees, or customers. 13. NOTICE Any notice,tender, demand,delivery, or other communication pursuant to this Agreement shall be in writing and directed to the addresses below or such addresses as either party may later specify in writing.Notice is deemed effective on the date it is given if hand-delivered or received by facsimile that day. Notice given by U.S. mail shall be deemed to have been given three (3) ' business days after it is deposited in the U.S.mail, postage prepaid and addressed as follows: To City: City Clerk City of Santa Arta 20 Civic Center Plaza(M-30) P.O. Box 1988 Santa Ana, CA 92702-1988 With copies to: Executive Director of Parks,Recreation and Community Services City of Santa Ana 20 Civic Center Plaza(M-23) P.O.Box 1988 Santa Ana, California 92702 Page 3 of 5 To User: Bongwon Kim 122 Spiral Irvine, CA 92618 kimbonpwonI031O(c wnail.corn 14. EXCL,USIVITY AND AMENDMENT This Agreement represents the complete and exclusive statement between the City and User regarding the subject matter herein, and supersedes any and all other agreements, oral or written, between the parties regarding the use of the Facilities. 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 User. 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 User or the City. Each party to this Agreement acknowledges that no representations, inducements, promises or agreements, orally or otherwise, have been made by any party, or anyone acting on behalf of any party, which are not embodied herein. 15. ASSIGNMENT User 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. User shall not allow any other person or entity to use the Facilities without the prior written consent of City. 16. TERMINATION This Agreement may be terminated by the City upon thirty(30) days written notice. 17. NONDISCRIMINATION User shall not discriminate because of race,color,creed,religion,sex,marital status,sexual orientation, gender identity, gender expression, gender, medical conditions, genetic information, or military and veteran status,age,national origin, ancestry,or disability, as defined and prohibited by applicable law, in the recruitment, selection, teaching, training, utilization, promotion, termination or other employment related activities or any services provided under this Agreement. User affirms that it is an equal opportunity employer and shall comply with all applicable federal, state and local laws and regulations, 18. JURISDICTION - VENUE This Agreement has been executed and delivered in the State of California and the validity, interpretation, performance, and enforcement of any of the clauses of this Agreement shall be determined and governed by the laws of the State of California. Both parties further agree that Page 4 of 5 Orange County, California, shall be the venue for any action or proceeding that may be brought or arise out of, in connection with or by reason of this Agreement. 19. AUTHORITY I 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. AT ST: CITY OF SANTA A ennie L Half ` , Alvaro Nunez City CIerl ? / City Manager APPROVED AS TO FORM: SONIA R. CARVALHO USER: i City Attorney _ �o�tq�yo� ICi�r i Bangor Kim(May 26 2026 16 21 Aa Pn 7) Jonathan T. Martine By: Bongwon Kim Assistant City Attorney Title:Bongwon Kim RECOMMENDED FOR APPROVAL: Z ' nan Scott i tive ector of Parks, y Services Agency I Page 5 of 5 EXHIBIT A SCOPE OF SERVICES f� f t Scope of Services 1. DESCRIPTION OF USE Bongwon Kin("User", "Bongwon Kim") is an individual focused on developing and providing advanced golf performance training. Bongwon Kim may conduct the following activities at designated areas within permitted City i of Santa Ana Facilities: - a. Small Group Golf Lessons, Camps and Programs r A structured golf program offering participants the opportunity to develop and refine golf skills through structured practices.Participants will receive coaching focused on technique,physical conditioning,and sportsmanship,while fostering personal growth,discipline,and goal-setting. b. Private Golf Lessons This program will provide private,performance-focused instruction forup,intended to support golfers in achieving higher levels of technical proficiency and competitive readiness through customized coaching. 2. FACILITIES User is permitted to operate the programming outlined in this Agreement at the following City of Santa Ana Facilities ("Facilities")- a. River View Golf Course 1800 W. Santa Clara Ave. Santa Ana,CA 92706 + User shall use the Facilities solely for the purposes outlined in this Agreement and for no other purpose without the City's prior written consent.User shall not access or use the Facilities unless a City-authorized representative or designee is present.Assigned days,times,and designated areas are subject to modification during the period of this Agreement if required for City programs, maintenance, special events, or other operational needs, as determined by the City or assigned designee in its sole discretion. User shall comply with all applicable federal, state, and local laws, regulations, codes, and ordinances.User shall further comply with all directives issued by City of Santa Ana personnel or assigned designee, and applicable golf rules as may be promulgated from time to time by the City or assigned designee. User hereby acknowledges receipt of and agrees to comply with all current golf rules. The City reserves the right to relocate,reschedule, or suspend User's use if the scheduled Facility becomes inoperable, unsafe, or otherwise unavailable due to maintenance, emergency conditions, or operational necessity, as determined by the City or assigned designee. 1 r 3. TERMS OF USE For a period of one (1) year, commencing July 1, 2026 and terminating,tune 30, 2027 ("'Perm"), Bongwon Kim may conduct golf programming during dates,times,and locations assigned weekly by City's assigned designee managing day-to-day golf course operations. Beginning July 1.,2026,User shall be provided with City-designated driving Mange stations at River View Golf Course during operating hours as assigned by City's assigned designee. Requests for space allocations shall be made to City's assigned designee prior to use. User shall be responsible for managing participant attendance and submit attendance reports to City's assigned designee monthly. The City and 'its' assigned designee reserve the right to require adjustments to the schedule, staffing, or facility use based on the anticipated attendance. User shall provide City's assigned designee with written notice 30 days in advance of all group lessons and golf camps, All participants,shall execute the City of Santa Ana class waiver prior to facility entry.Participants under the age of eighteen (18) must have the waiver executed by a parent or legal guardian. Executed waivers shall be collected by User, submitted to City's assigned designee, and remain J valid and on file for the duration of the Term. User shall be responsible for managing participant and spectator conduct. Spectators, including parents and guardians, shall remain in designated viewing areas and shall not be permitted unless authorized by City's assigned designee. User shall not sell, distribute, or otherwise provide for compensation any food, beverages, concessions, merchandise, or promotional items at the Facilities without prior written approval from the City's assigned designee. This prohibition shall include,but not be limited to, sales conducted by User's employees, agents, representatives, volunteers, participants,parents, or affiliated organizations. User shall not permit any third party to conduct sales, fundraising,or commercial activity at the Facilities in connection with User's programming without prior written approval from the City's assigned designee. 4. PERSONNEL User shall provide qualified, certified golf coaches for all golf activities conducted at City of Santa Ana facilities. User shall be solely responsible for the supervision, conduct, and control of its employees, agents,representatives,volunteers, and participants at all times. User shall not permit any third party, independent contractor,parent,or participant to provide golf instruction or conduct golf programming at the Facilities without prior written approval from the City.User shall not sublicense, assign,or otherwise permit third parties to utilize the Facilities for aquatic programming under this Agreement without prior written approval by the City. i User shall ensure that all employees,agents,and representatives who work with or are in proximity to minors have successfully completed background screening and any other required certifications in compliance with applicable federal, state, and local requirements.User represents and warrants i that such personnel are legally eligible and suitable to work with minors. User shall ensure that no User personnel engage in ono-on-one supervision of a minor in locker rooms, restrooms, or other private areas at the Facilities. User shall maintain appropriate supervision of participants at all times in all areas of the,Facility,including locker rooms,spectator areas, and pool deck spaces. User shall be responsible for any injuries, losses, or damages arising out of or related to golf programming activities except to the extent caused by sole negligence or willful misconduct of the City. City's assigned designee shall conduct facility opening and closing procedures, and maintain required maintenance levels and ensure compliance with applicable health and safety regulations. The City reserves the right to immediately suspend golf activities due to weather conditions, air quality concerns,mechanical failure, contamination events, or any other condition deemed unsafe for continued use, as determined by the City in its sole discretion. 5. EQUIPMENT User shall be solely responsible for providing and maintaining all golf lesson related equipment, including. Storage of User equipment at the Facilities may be requested in writing and shall be subject to prior written approval by the City's assigned designee. Approval, if granted, may be revoked at the City's discretion. Any equipment stored at City Facilities must be well-maintained and kept orderly. User may display program-related signage at the Facilities only with the City's assigned designee prior written approval. All proposed banners shall be either jointly produced in coordination with the City in accordance with the City's style guide standards or submitted by User for review and approval prior to installation. User shall be solely responsible for all costs associated with the design,production, and installation of approved banners or signage. Approved banners shall be limited to designated display areas as determined by the City's assigned designee and shall comply with all size, content, placement, and installation requirements established by the City's assigned designee.All banners and signage shall be installed and removed in a manner that does not damage City property.User shall be responsible for any damage resulting from the installation,display, or removal of such materials:.The City's assigned designee reserves the right to require the removal of any banner or signage at any time,in its sole discretion. User shall promptly notify the City's assigned designee, of any building or facility issues, including damage,vandalism,or theft. 6. PAYMENT The User shall pay a base fee of Five Hundred Dollars ($500.00) per month for the use of the Facility, for a total annual base fee of Six'Thousand Dollars($6,000) during the Term. i The City shall issue invoices for all assessed fees on a monthlybasis(or other agreed billing cycle). Late payments may be subject to penalties or interest as permitted by law. 7. NO EXCLUSIVE RIGHTS Nothing in this Agreement shall be construed to grant User any exclusive rights to use the Facilities or any portion thereof. The City's assigned designee reserves the right to schedule, operate, and permit the use of the Facilities by other individuals, organizations, or programs at any time, including during the Term of this Agreement. User acknowledges that its use of the Facilities is non-exclusive and subordinate to City programs, maintenance activities, special events, or other operational needs, as determined by the City in its sole discretion. Nothing in this Agreement shall be interpreted to create any priority scheduling rights, continued use rights, or expectation of renewal beyond the Term stated herein, i i I 1 i i EXMIT B INSURANCE REQUIREMENTS I i Insurance Requirements User shall procure and maintain for the duration of the agreement, the following insurance coverages: MINIIWI[.IM SCOPE AND LIMIT OF INSURANCE User shall maintain limits of insurance coverage in the following minimum amounts and shall be at least as broad as: • Commercial General Liability (CGL): Insurance Services Office Form CG 00 01 covering CGL on an "occurrence" basis, including products and completed operations, property damage,bodily injury and personal & advertising injury with limits no less than $1,000,000 per occurrence and$2,000,000 aggregate. • Sexual Abuse or Molestation Liability (SAML): If the CGL policy referenced above is not endorsed to include affirmative coverage for sexual abuse or molestation, User shall ` obtain and maintain a policy covering Sexual Abuse and Molestation with a limit of no less than$1,000,000 per occurrence or claim. • Automobile Liability(AL): Insurance Services Office Forrn CA 00 01 covering Code 1 (any auto),with combined single limits of$1,000,000. In the event User 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. ' • Workers' Compensation (WC): as required by the State of California, with statutory limits, and Employer's Liability Insurance with limit of no less than $1,000,000 per accident, per employee, per policy for bodily injury or disease. This requirement can be waived if User has no employees. User attests that its workers' compensation coverage extends to all persons who will be working with the City under the agreed scope of services. If User maintains broader coverage and/or higher limits than the minimums shown above, City requires and shall be entitled to the broader coverage and/or the higher limits maintained by User, Any available insurance proceeds in excess of the spccified minimum limits of insurance and coverage shall be available to City. Other Insurance Provisions The insurance policies are to contain, or be endorsed to contain, the following provisions: 1. CGL, SAML and AL policies: City of Santa Ana, its City Council,its officers, officials, employees, agents, and volunteers are to be covered as additional insureds with respect to liability arising out of work or operations performed by or on behalf of the User including'materials, parts,equipment, and personnel furnished in connection with such work or operations. 2. COL,AL, and WC policies: Insurance company(ies) agrees to waive all rights of subrogation against City, its City Council, its officers, officials, employees, agents, and volunteers for losses paid under the terms of any policy which arise from work performed by User for City. 3. All required insurance policies:For any claims related to this contract,User's insurance coverage shall be primary and any insurance maintained by City, its City i Council, its officers, officials, employees, agents, or volunteers shall not contribute with it. 4. All required insurance policies: A severability of interest provision must apply for all the additional insureds, ensuring that User'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. Each insurance policy required herein shall provide that coverage shall not be canceled, suspended, voided,reduced in coverage or in limits,non-renewed by the carrier, or materially changed except after thirty(30)days prior written notice has been given to City.Ten(10) days prior written notice shall be provided to City for policy cancellation or non-renewal due to non-payment. b. Certificate Holder on each Evidence of Insurance certificate shall be: City of Santa Ana,Attention: Parks,Recreations, and Community Services Agency,20 Civic Center Plaza M-23, Santa Accra, CA 92701.The name and the location of event should be included in the Description of Operations section of each certificate. Self-Insured Retentions i Self-insured retentions must be declared to and approved by the City.City may require User to purchase coverage with a lower retention or provide proof of ability to pay losses and related investigations, claim administration,and defense expenses within the retention. f 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 A:VII,unless otherwise acceptable to City. Verification of Coverage User 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 Endotsement Page of the COI. policy listing all policy endorsements to Entity before work begins.However, failure to obtain the required documents prior to the work beginning shall not waive User's obligation to provide them. City reserves the right to require complete, certified copies of all required insurance policies, including endorsements required by these specifications, at any time. Claims Made Policies If any of the required policies provide coverage on a claims-made basis: 1.The retroactive.date must be shown and must be before the date of the contract or the beginning of work. 2. Insurance must be maintained and evidence of insurance must be provided for at least three (3)years after completion of work. 3. If coverage is canceled or non-renewed, and not replaced with another claims-made policy form with a retroactive date prior to the contract effective date,User must purchase "extended reporting"coverage for a minimum of three(3) years after completion of work. Subcontractors User shall require and verify that all sub-contractors maintain insurance meeting all the requirements stated herein, and User shall ensure that City is an additional insured on insurance required from sub-contractors. Special Risks or Circumstances City reserves the right to modify these requirements, including limits, based on the nature of the risk,prior experience, insurer, coverage, or other special circumstances. i I P A�'�� DATE(MMrDDIt'1'YYI CC CERTIFICATE OF LIABILITY INSURANCE ATE(MM(Dfi 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 pollcy(los) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and condltlons of the pollcy,Certain policies may require an endorsement. A statement on this Cerilflcate does not confer rights to the certificate holder In Ileu of such endorsement s). PRODUCER CONTACT NAME' _ Next First Insurance Agency.Inc. PHONE (65512225919 - `. F _...- PO Box 60787 _ _ [M'C,f{4�E6t1: �jAlc.Not: Palo Alto,CA 94306 E MA4 supportripnextlnsurance cum 1LD.QERSS INSURERM AFFORDING COVERAGE MAIC INSURER A: Next Insurance US Company 16285 INSURED Bongwon Kim INSURER a+ Banggwwcn Kim INSURERC: 1801)W Santa Clara Ave Santa Ana,CA 92706 INSURER D: INSURER E INSURER F- COVERAGES CERTIFICATE NUMBER:865574329 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, EXCLUSICN$AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. lNSR SUOR POLICY EFF POLICY E.7CP LTA TYPE OF INSURANCE l LffiaPOLICY NUMBER MMlDOrM I(MMZONYYYI L1MrTs X COMMERCULL GENERAL LIABILITY --� EACH OCCURRENCE s2,000,000-00 GW4tS-141.GE X OCCUR" PREMISES IEO aamirmaw) S100,000.00 MED EXP(Any one person) $15,000.00 A X X NXT3LYQQQ3-04-GL 04/24/2026 04/24/2027 PERSONAL 6 ADV INJURY $2.000.000 00 GENT.AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE s4,000.000,00 X POLICY J)r'0. LOC PRODUCTS•COhSPrOPAGG S4,000,000.00 4 drHER ABUSE 6 MOLESTATION s I00,000.00 E AUTOMOBILE LIA1BILn'Y COMBINED S{NGLE UNIT s ANY AUTO Ea ecradent OWNED SC>"EDVL ED BODILY INJURY(Per person) S AUTOS ONLY � AUTOS BODILY INJURY(Per aocW"t) S MREO NON-OWNED A PROPER TY DAALtGE ALIT 04'LY I-7 AUTOS ONLY Per occtdenll S �j UMBRELLA LAB OCCUR S EACH OCCURRENCE S EXCESS LIA18 I CLAIMS-MADE AGGREGATE $ CED RE eNTONS s i WORKERS COMPENSATION AN R O H AND EMPLOYERS'LLALB11 ITY YIN STATUTE ER YPROME`DR PART-ER,EXECUTIVE IOFFicr;R7AEMBEgEXCLVDED1 NfA E-L.EACH ACCIDENT I$ IimaSRndatory M NH) E.L DISEASE- 'OESC'AtIPTlO OF,.,RATIONS aeto+�r EA EMPLOYEEI S E L DISEASE•POLICY LIMIT I 5 Each Occurrence s2,o0D,o00.0o A Professional Llab Lry I NXT3LYQQQ3.04-GL 04/2412026 04/2412027 Aggregate: $4,000,000.00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES IACORD 101,Additional Remarks Schedula,may be anachad If mom apace is requited) The Certificate Holder Is City cf Santa Ana.Atin,Parks,Recreation,and Community.Wer of Subrogation applies on General{_lability in favor of the Certificate Holder and as required by written contract usual to the Insured's Operations.City or Santa Ana, Is citycounsels,officers,officials,employees,agents,and volunteers are an Additional In5Lred on the General Liability policy per the Additional Insured Automatic Status Endorsement.All Additional Insured privileges apply only If required by written aeemen netvreen the Cemflcate Haider and t e Irsured,and are subject to policy terms and conditions, gr t APPROVED CERTIFICATE HOLDER CANCELLATION By Tu Tran Nguyen at 10:40 am,Apr 21,2026 City of Santa Ana,Attn:Parks,Recreation,and Community Services Agency SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 20 to ccenter 27 r1 M-23 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Santa Ana,CA 9270i ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988.2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD American Family Connect Property and RENEWAL DECLARATION Casualty Insurance Company 6000 American Parkway APPROVED Madison,WI 53783-0001 By Tu Tran Nguyen at 10.:40 am,Apr 21,2026 CALIFORNIA POLICY NUMBER: AI02598221 POLICY PERIOD: 12/13/2025-06/13/2026 12:01 AM Standard Time LAPSE IN COVERAGE: NONE Bongwon Kim Susan Kim FOR CLAIMS SERVICE CALL: 122 SPIRAL 1-888404-5365 FOR CLIENT SERVICE CALL: IRVINE, CA 92618-1367 1-888-404-5365 COVERAGE/LIMIT 6 2024 T'ESLA MODEL V EV BODILY INJURY LIABILITY $244.00 $30,000 EACH PERSON $60,000 EACH ACCIDENT n PROPERTY DAMAGE LIABILITY INCL $25,000 EACH ACCIDENT MEDICAL EXPENSE-EXCESS COVERAGE INCL $5,000 EACH PERSON UNINSURED MOTORIST BODILY INJURY $60.00 $30,000 EACH PERSON $60,000 EACH ACCIDENT UNINSURED MOTORIST PROPERTY DAMAGE $1.00 CAR 6-WAIVER OF COLLISION DEDUCTIBLE COLLISION $313.00 DEDUCTIBLES CAR 6-$500 COMPREHENSIVE $127.00 DEDUCTIBLES CAR 6-$250 TOWING AND LABOR COSTS $5.00 $75 PER DISABLEMENT RENTAL EXPENSE NONELECT CONSOLIDATED VEHICLE ASSESSMENT FEE $0.87 TOTAL SEMIANNUAL PREMIUM PER VEHICLE $750.87 CONVENIENCE FEE*- $10.00 TOTAL SEMIANNUAL PREMIUM ALL VEHICLES- $760.87 Coverage is provided only when both a premium and limit are shown. #Convenience Fee is$5 per monthly installment if payment is made by credit/debit card or$2 per monthly installment for a preauthorized withdrawal method. adca0la(001) 11/14/2025 DRIVER INFORMATION 1.Bongwon ICim 4___ 2. 5. 3. 6. CAR INFORMATION CARS KEPT AT LOCATION OTHER THAN RESIDENCE 2024 TESLA 7SAYODEDORF197786 YOUR POLICY HAS THE FOLLOWING DISCOUNTS: PREMIER SAFETY,TENURE,COSTCO 2024 TESLA-GOOD DRIVER,ANTI-THEFT DEVICE,DUAL AND SIDE AIRBAGS YOUR POLICY HAS THE FOLLOWING ENDORSEMENTS: AMENDATORY ENDORSEMENT SPECIAL EQUIPMENT/CUSTOMIZATION:NONE LIENHOLDER INFORMATION LI> NHOLDER-2024 TESLA MODEL Y EV 4D 2WD Chase Bank,P.O.Box 901076,Fort Worth,TX 76101-2039 c(1=09-CA California Auto I»surance Identification Card CONNECT ID Cards Issued by American Family Connect Property and �/� 7SAYGDEDORF197786 2024 TESLA MODEL Y EV You can get ID cards a n d Casualty Insurance Company Declaration pages online — any NAIC 29068 Policy Number 6000American Parkway A1O2598221 time you need them! Madison,WI 53783-0001 Effective 12/13/2025-06/13/2026 Just visit: connectbyamfam.com/costco Named Kim d(s) Drivers Click on: Access M Policy Bongwon Kim Bongwon Kim y Y Susan Kim Client Service hours (Central time): Monday- Friday: 7 a.m. - 10 p.m. Saturday: 8:30 a.m. - 7 p.m. California Auto Insurance Identification Card CONNECT , Issued by American Family Connect Property and 2024 TESLA MODEL Y EV Casualty Insurance Company ) 7SAYGDEDORF197786 NAIC 29068 Policy Number 6000American Parkway A102598221 Madison,WI 53783-0001 Effective 12/13/2025-06/13/2026 Named Insured(s) Drivers Bongwon Kim Bongwon Kim Susan Kim Directions: State law requires each driver to keep an insurance ID card in his or her vehicle at all times. Carefully separate the cards along the perforations and place one in your vehicle's glove box. If you insure more than one vehicle with us, a set of ID cards has been issued for each vehicle. idca01 (003) Claims 1-888-404-5365 Client Service 1-888-404-5365 Roadside Assistance 1-888.742.4572 connectbyamfarn.com/costao The policy complies with Section 16056 of the California Vehicle Code. THIS CARD MUST BE CARRIED IN THE INSURED MOTOR VEHICLE FOR PRODUCTION UPON DEMAND Claims 1-888-404-5365 Client Service 1-888-404.5365 Roadside Assistance 1 888-742-4572 con nectbyamfam.com/costco The policy complies with Section 16056 of the California Vehicle Code. THIS CARD MUST BE CARRIED IN THE INSURED MOTOR VEHICLE FOR PRODUCTION UPON DEMAND idca0l(003) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, POLICY CHANGES Policy Change _Number 01 POLICY NUMBER �.,.., POLICY CHANGES COMPANY EFFECTIVE NXT3LYQQQ3.04-GL 04/24/2026 Next Insurance US Company NAMED INSUREC? AUTHORIZED REPRESENTATIVE I3on won Kim 180 W Santa Clara Ave Santa Ana,CA 92706 Ann Ryan COVERAGE PARTS AFFECTED Commercial General Liability Coverage Part CHANGES SEE ATTACHED SCHEDULE Additional Total $3.00 Authorized Representative Signature IL 12 01 1186 Copyright, Insurance Services Office, Inc,, 1983 Pago 1 of 2 p Copyright, ISO Commercial Risk Services, Inc., 1983 SCHEDULE OF POLICY CHANCES It Is understood and agreed that; The following forms are added. CG 24 041 21 9-Walver of Transfer of Rights of Recovery Against Others to Us(Waiver of Subrogation) All other terms and condttlons remaln unchanged, i i IL 12 01 1185 Copyright, Insurance Services office, Inc., 1983 Page 2 of 2 Copyright, ISO Commercial Risk Services, Im. 1983 POLICY I`UM8r--R:NXT3LYQQQ3.04-GL COMMERCIAL GENERAL LIABILITY CG 24 0412 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modlfies Insurance provided under the following; COMMERCIAL GENERAL LIABILITY COVERAGE PART ELECTRONIC DATA LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART DESIGNATED SITES POLLUTION LIABILITY LIMITED COVERAGE PART DESIGNATED SITES PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE~LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICY DESIGNATED TANKS SCHEDULE Name Of Person(s)Or Organization(s)- Any person or organization against whom you have agreed to waive such right of recovery In a written contract or agreement 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 Section IV—Conditions: We waive any right of recovery against the person(s) or organization(s) shown in the Schedule above because of payments we make under this Coverage Part, Such waiver by us applies only to the extent that the insured has waived Its right of recovery against such person(s) or organization(s) prior to loss. This endorsement applies only to the person(s) or organization(s)shown In the Schedule above. Co 24 04 1219 0 Insurance Services Office, Inc., 2018 Page 1 of 1 F.1 THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. POLICY CHANGES Policy Change Number 02 POLICY NUMBER POLICY CHANGES COMPANY EFFECTIVE NXT3LYQQQ3-03-GL 04/15/2026 State National Insurance company,Inc. NAMED INSURED AUTHORIZED REPRESENTATIVE 11 0 1' won Kim 1800 W Santa Clara Ave Santa Ana,CA 92706 Ann Ryan COVERAGE PARTS AFFECTED Commercial General Liability Coverage Part CHANGES SEE ATTACHED SCHEDULE Return Total $0,00 Authorized Representative Signature IL 12 011185 Copyright, Insurance Services Office, Inc., 1983 Page 1 of 2 ❑ Copyright, ISO Commerolal Risk Services, Inc., 1983 It I5 understood and agreed that: SCHEDULE OF POLICY CHANGES The rollowfng farms are added: CG 20 10 0413-Additional Insured-Owners,Lessees or Contractors-Scheduled Person or Organization All other terms and conditions remain unchanged. i i i i I I I 1L 12 01 11 85 Copyright, Insurance Services Office, Inc„ 19$3 Page 2 of 2 13 Copyright, ISO Commercial Risk Services, Inc., 1983 POLICY NUMBER: NX1XYQQQ3-03-GI. COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Porson(s) Or Organizatian(s) Locations Of Covered Operations City of Santa Ana,its city counsels,officers,officials, CA employees,agents,and volunteers 2 Civic Center Piz#M-23 Santa Ana,CA 9270 i t { information required to complete this Schedule, if not shown above,will be shown in the Declarations, A. Section It -� Who Is An Insured Is amended to 8. With respect to the Insurance afforded to these include as an additional Insured the person(s) or additional Insureds, the following additional $ organization(s) shown in the Schedule, but only exclusions apply: with respect to liability for"bodily injury" "property This insurance does not apply to "bodily injury" or damage" or "personal and advertising Injury" "property damage"occurring after: caused,in whole or In part, by: 1. Your acts or omissions;or 1. All work, including materials, parts or equipment furnished In connection with such 2. The acts or omissions of those acting on your work, on the project (other than service, behalf; maintenance or repairs) to be performed by or In the performance of your ongoing operations for on behalf of the additional Insured(s) at the the additional Insured(s) at the location(s) location of the covered operations has been designated above. completed;or However: 2. That portion of "your work" out of which the Injury or damage arises has been put to its 1. The insurance afforded to such additional Intended use by any person or organization insured only applies to the extent permitted by other than another contractor or subcontractor law; and engaged In performing operations for a 2. If coverage provided to the additional Insured Is principal as a part of the same project. 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 2010 0413 O Insurance Services office, Inc„2012 Page 1 of 2 I CITY OF SANTA ANA Risk Management a division of Human Resources Managing Risk through Awareness and Action AFFIDAVIT OF EXEMPTION FOR WORKERS' COMPENSATION INSURANCE 1, D_ dN&yj o w P T F ("Representative"),attest that I am an authorized t'Nante and Title of Vender Representati lvc) representative of U N6 W®'Iv K t ro ("Company"),and (ConsultanVCompany Name) possess the authority to legally bind Company. In my capacity as representative of Company, I represent and confirm the Following,as relates to the agreement between Company and City of Santa Ana,agreement number {.'Agreement")to provide CIO NSA UL`s1 ON ("Services"): (Services to be provided under agreemeniticuntrtct) During the course and scope of Company's agreement with the City of Santa Ana,Company will I not employ any person in any manner so as to become subject to the workers'compensation laws j of California,and agree that if Company should become subject to the workers'compensation I provisions of Section 3700 of the Labor Code,Company shall forthwith comply with the provisions and provide proof of workers' compensation coverage immediately. If at any time it is found that Company is not adhering to any and/or all of the statements in this 1 document and does not maintain the minimum professional liability insurance coverage as required in the Agreement,it will be considered a breach of Agreement rendering the Agreement null and void and Company will be fully liable for any and all damages. �!a_n:,lafC nS14 Prntt Name uV�R Tide _ kimbOA0w.0n 10,3919 & t I b Contact Information,i.e.,Telephone Number and/or Email Address A WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSANT DOLLARS(S 100,000).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, IN TEREST,AND ATTORNEY'S FEES. Affidavit of Exemption for Workers'Compensation Insurance 11.12.2034 .ram . American Family Connect Property and RENEWAL DECLARATION Casualty Insurance Company 6000 American Parkway Madison,WI 53783-0001 CALIFORNIA POLICY NUMBER: A102598221 POLICY PERIOD: 06/13/2026-12/13/2026 12:01 AM Standard Time LAPSE IN COVERAGE: NONE Bongwon Kim Susan Kim FAPPRIOVED FOR CLAIMS SERVICE CALL: 122 SPIRAL u Tran Nguyen at 9:29 am,Jul 01,2026 1-888-404-5365 FOR CLIENT SERVICE CALL: IRVINE, CA 92618-1367 1-888-404-5365 COVERAGE/LIMIT 6 2024 TESLA MODEL Y EV BODILY INJURY LIABILITY $242.00 $30,000 EACH PERSON $60,000 EACH ACCIDENT PROPERTY DAMAGE LIABILITY INCL $25,000 EACH ACCIDENT MEDICAL EXPENSE-EXCESS COVERAGE INCL $5,000 EACH PERSON UNINSURED MOTORIST BODILY INJURY $59.00 $30,000 EACH PERSON $60,000 EACH ACCIDENT UNINSURED MOTORIST PROPERTY DAMAGE $1.00 CAR 6-WAIVER OF COLLISION DEDUCTIBLE COLLISION $312.00 DEDUCTIBLES CAR 6-$500 COMPREHENSIVE $126.00 DEDUCTIBLES CAR 6-$250 TOWING AND LABOR COSTS $5.00 $75 PER DISABLEMENT RENTAL EXPENSE NONELECT CONSOLIDATED VEHICLE ASSESSMENT FEE $0.87 TOTAL SEMIANNUAL PREMIUM PER VEHICLE $745.87 CONVENIENCE FEE*- $10.00 TOTAL SEMIANNUAL PREMIUM ALL VEHICLES- $755.87 Coverage is provided only when both a premium and limit are shown. *Convenience Fee is$5 per monthly installment if payment is made by credit/debit card or$2 per monthly installment for a preauthorized withdrawal method. adca0Ia(001) 05/15/2026 DRIVER INFORMATION 1.Bongwon Kim 4. 2. 5. 3. 6. CAR INFORMATION CARS KEPT AT LOCATION OTHER THAN RESIDENCE 2024 TESLA 7SAYGDEDORF197786 YOUR POLICY HAS THE FOLLOWING DISCOUNTS: PREMIER SAFETY,TENURE,COSTCO 2024 TESLA-GOOD DRIVER,ANTI-THEFT DEVICE,DUAL AND SIDE AIRBAGS YOUR POLICY HAS THE FOLLOWING ENDORSEMENTS: AMENDATORY ENDORSEMENT SPECIAL EQUIPMENT/CUSTOMIZATION:NONE LIENHOLDER INFORMATION LIENHOLDER-2024 TESLA MODEL Y EV 4D 2WD Chase Bank,P.O.Box 901076,Fort Worth,TX 76101-2039 cdec09-CA