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HomeMy WebLinkAboutWEST COAST COMMUNITY DEVELOPMENT, LLC 3 -2014City of Santa Ana -.--._. --- . Clerk of the Council COTC Office Use Only AGREEMENT TERMINATION FORM ,19 Al7 Please complete this form when the attached agreement and all amendments (if any) are no longer in effect. CITY OF SA TA ANA CLERK OF COUNCIL Return form to the Clerk of the Council Office (M-30). j Call 647-1520 if you have any questions. The agreement with No. N-2014-146 was completed on t 2 and final payment has been made. (List all amendments. Use space below N needed.) Department: PR G Phone/Ext.: 4lq Signature: AA4z Date: Q I I g I Q Revised 10-31-12 1� . wCINCE ON FILE 1. ,,AW PROCEED SURANCE EXPIRES g-- 02^f-/.5" ULthr� OF, COUNCIL DAM), . 42014 o; p�0SC80� RECREATION SERVICES AGREEMENT N-2014-146 THIS AGREEMENT made and entered into this Ist day of. October 2014, by and between West Coast Community Development, LLC (hereinafter "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 (hereinafter "City"). RECITALS A. The City desires to retain a recreation service provider having special skills, resources and knowledge to conduct cross training classes in its leisure class program. B. Provider represents that Provider 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 its field and that any services performed by Provider under this Agreement will be performed in compliance with such standards as may reasonably be expected. 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 Provider shall perform those services as set forth in Exhibit A to this Agreement. 2. COMPENSATION In consideration for the right to provide the programs set forth in Exhibit A, City agrees to allow the Provider to retain all gross revenue received from program participants, if any. Anticipated revenue from this class shall not exceed $25,000 annually. 3. TERM This Agreement shall commence on the date set forth above and terminate on September 30, 2016, unless terminated earlier in accordance with Section 12, below. The tern of this Agreement may be extended upon 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 applicable withholding taxes. 5. INSURANCE Prior to undertaking performance of work under this Agreement, Provider shall maintain and shall require its subcontractors, if any, to obtain and maintain insurance as described below: a. Commercial General Liability hisurance. Provider shall maintain commercial general liability insurance which shall include, but not be limited to protection against claims arising from bodily and personal injury, including death resulting therefrom and damage to property, resulting from any act or occurrence arising out of Provider's operations in the performance of this Agreement, including, without limitation, acts involving vehicles. The amounts of insurance shall be not less than the following: single limit coverage applying to bodily and personal injury, including death resulting therefrom, and property damage, in the total amount of $1,000,000 per occurrence. Such insurance shall (a) name the City, its officers, employees, agents, volunteers and representatives as additional insured(s); (b) be primary and not contributory with respect to insurance or self-insurance programs maintained by the City; and (c) contain standard separation ofinsured's provisions. b. Worker's Compensation Insurance. In accordance with the provisions of Section 3300 of the Labor Code, Provider, if Provider has any employees, is required to be insured against liability for worker's compensation or to undertake self-insurance. Prior to commencing the performance of the work under this Agreement, Provider agrees to obtain and maintain any employer's liability insurance with limits not less than $1,000,000 per accident. c. The following requirements apply to the insurance to be provided by Provider pursuant to this section: (i) Provider shall maintain all insurance required above in full force and effect for the entire period covered by this Agreement. Certificates of insurance shall be furnished to the City upon execution of this Agreement and shall be approved in form by the City Attorney. (ii) Certificates and policies shall state that the policies shall not be canceled or reduced in coverage or changed in any other material aspect without thirty (30) days prior written notice to the City. d. If Provider fails or refuses to produce or maintain the insurance required by this section or fails or refuses to fiirnish the City with required proof that insurance has been procured and is in force and paid for, the City shall have the right, at the City's election, to forthwith terminate this Agreement. Such termination shall not affect Provider's right to be paid for its time and materials expended prior to notification of termination. Provider waives the right to receive compensation and agrees to indemnify the City for any work performed prior to approval of insurance by the City. 2 6. INDEMNIFICATION Provider agrees to and shall indemnify and hold harmless the City, its officers, agents, employees, Providers, special counsel, and representatives from liability for personal injury, damages, just compensation, restitution, judicial or equitable relief arising out of claims for personal injury, including health, and claims for property damage, which may arise from the direct or indirect 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. The Provider further agrees to indemnify, hold harmless, and pay all costs for the defense of the City, including fees and costs for special counsel to be selected by the City, regarding any action by a third party asserting that personal injury, damages, just compensation, restitution, judicial or equitable relief due to personal or property rights arises by reason of the terms of, or effects arising from this Agreement. City may make all reasonable decisions with respect to its representation in any legal proceeding. 7. CONFLICT OF INTEREST Provider 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. 8. LIVE SCAN BACKGROUND CIIECK Providers, and any employees or substitutes, in contact with minors under eighteen (18) years of age shall arrange for and submit to a Live Scan electronic background check for criminal history available through the California Department of Justice as a condition of this Agreement and provide proof of compliance prior to performing services hereunder. 9. 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 facsimile or other telegraphic communication in the manner provided in this Section, to the following persons: To City: Clerk of the Council City of Santa Ana 20 Civic Center Plaza (M-30) P.O. Box 1988 Santa Ana, CA 92702-1988 Facsimile (714) 647-6956 With copy to: Executive Director of Parks, Recreation and Community Services City of Santa Ana 26 Civic Center Plaza (M-75) P.O. Box 1988 Santa Ana, California 92702 Facsimile (714) 571-4211 I To Provider: West Coast Community Development, LLC 59 Long Meadow Irvine, CA 92620 (714)661-3762 A party may change its address by giving notice in writing to the other party. Thereafter, any communication shall be addressed and transmitted to the new address. If sent by mail, communication shall be effective or deemed to have been given three (3) days after it has been deposited in the United States mail, duly registered or certified, with postage prepaid, and addressed as set forth above. If sent by facsimile, communication shall be effective or deemed to have been given twenty-four (24) howl 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. 10. EXCLUSIVITY AND AMENDMENT This Agreement represents the complete and exclusive statement between the City and Provider, 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. 11. ASSIGNMENT Inasmuch as this Agreement is intended to secure the specialized services of Provider, 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. 12. TERMINATION This Agreement may be terminated by the City upon thirty (30) days written notice of termination. Termination or cancellation of classes by the Provider must be given to the City at least thirty (30) days prior to termination/cancellation. Failure to provide adequate cancellation notice to the City may put future contracting of business with the City at risk. 13. DISCRIMINATION Provider shall not discriminate because of race, color, creed, religion, sex, marital status, sexual orientation, age, national origin, ancestry, or disability, as defined and prohibited by applicable law, in the recruitment, selection, training, utilization, promotion, termination or other employment related activities. Provider affirms that it is an equal opportunity employer and shall comply with all applicable federal, state and local laws and regulations. 14. 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. 15. 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. 16. EXI3IBITS All Exhibits referenced herein and attached hereto shall be incorporated as if fully set forth in the body of this Agreement. 7 IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first above written. ATTEST: Maria D: Huizar Clerk of the Council APPROVED AS TO FORM: SONIA R. CARVALHO City Attorney By:�. Lisa Storck Assistant City Attorney RECOMMENDED FOR APPROVAL GERARDO MOUET Executive Director of Parks, Recreation and Community Services CITY OF SANTA ANA < � Y David Cavazos City Manager PROVIDERy� West Coast Community Development LLC By: Exhibit A SCOPE OF SERVICES— West Coast Community Development (Cross Training) A. Provider shall conduct Cross Training classes for persons age 18-99 years old B. Cross Train is held on Monday, Wednesday and Friday - 45 minutes per day C. Classes shall be 3 days a week, September, three-week sessions) (Fall), January through and June through August (Summer) October, (November and December shall have March (Winter), April through June (Spring), D. Provider shall work with City staff in setting a schedule for classes, including the location, specific days and hours when class will be held and holidays to be observed. Provider shall provide materials, supplies, equipment, records and personnel. Provider shall be responsible for cleanup of the facilities and materials and shall ensure the safety and effectiveness of instruction. If Provider allows others to teach his/her class, those teachers must be over 21, have obtained and maintain an instructor rating, and be covered by Provider's insurance. Provider shall provide City with documentation to verify instructor and insurance requirements. G. This class will not require registration through the City nor will any fees be collected by the City. PRODUCER Maguire Insurance Agency, Inc. 2]101 Puerta Real Suite 200 Misslpn Viejo, CA92691 (BTT).43 87459 Marc Payan,dba, W estCOastComm unity. Develpment, LLC 59 Long MI Irvine, CA 92620 - COVERAGES CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATION 15 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMMEND, EXTEND OR ALTERTHE COVERAGE AFFORDED BYTHE POLICIES BELOW. 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERIFICATION 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. HER ABUT POLICY EFFECTIVE POLICY EXPI RATION LTR INSRD TYPE OF INSURANCE POLICY N UMBER DATE MM/DD/YYYY DATE MM/DD/YYYY LIMITS A X GENERAL LWBIUTY PHPK1024916 05/24/2014 05/24/2015 EACH OCCURENCE $1,000,000 PREMISES Ea occurrence $100,000 X COMMERCALGENEML LIABILITY CLAIMS MADE OCCUR 000 MED EXP(Anyone person) $2,500 PERSONAL&ADV INJURY $1,000,000 % PROFESSIONAL LIABILITY GENERAL AGGREGATE $3,000,000 PRODUCTS — COMP/OP AGG $3,0001000 GEN'LAGGREGATE LIMITAPPLIES PER: % POLICY PROTECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO IEA accident) BODILYIWURY ALL OWNED AUTOS SCHEDULEDAUTOS (Per person) BODILY INJURY HIRED AUTOS NONOWNED AUTOS (Per amldent) PROPERTY DAMAGE (Per accident) GARAGE LIABILITY AUTO ONLY — CA ACCIDENT 07HERTHAN EA ACC ANY AUTO AUTO ON LY: AGG EXCESS / UMBRELLA LIABILITY EACH OCC U FENCE OCCUR F-1 CLAIMS MADE AGGREGATE DEDUCTIBLE RETENTION s1.11c.tauP,.erPP EMPLOYERS' LIABILITY V/N WL TO RY LIMITS PR ANY PROPRIETOR/PARTNER EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED E.L. EACH ACCIDENT E.L. DISEASE—EA A MPLOYEE (Mandatary in NH) f Yes cribe under SPECIALdesPROVISIONS below E.L. DISEASE—POLICY LIMIT OTHER DESCRIPTION OF OPERATIONS / LOCATIONS/ VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT / SPECML PROVISIONS If s understood and agreed than he following entity is added as an addiHowl insured but only with respamd) to the operations oft he named insured cereal hat Ilabllky resulting from the additional Insured's sole negligence. CERTIFICATE HOLDER CANCELLATION City of Santa Ana, its officers, agents andemployees 20 Civic Center PI, Santo Ana, CA 92701- SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBUGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25 (2009/01) © 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ADDITIONAL INSURED ENDORSEMENT Insurance Company Philadelphia Indemnity Insurance Company This endorsement modifies such insurance as is afforded by the provisions of Policy # PHPKI024916-000 relating to the following: The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701; it officers, employees, agents and representative are named as additional insureds ("additional insureds") with regard to liability and defense of suits arising from the operations and uses performed by or on behalf of the named insured. 2. With respect to claims arising out of the operations and uses performed by or on behalf of the named insured, such insurance as is afforded by this policy is primary and is not additional to or contributing with any other insurance carried by or for the benefit of the additional insureds. 3. This insurance applies separately to each insured against whom claim is made or suit is brought except with respect to the company's limits of liability. The inclusion of any person or organization as an insured shall not affect any right which such person or organization would have as a claimant if not so included. 4. With respect the additional insureds, this insurance shall not be cancelled, or materially reduced in coverage or limits except after thirty (30) days written notice has been given to the City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701. (Completion of the following, including countersignature, is required to make this endorsement effective.) effective 09/29/2014 Policy # Issued to Marc Payan, dt a Valet Coest Community neveloMent, LLC. this endorsement form as part of Name Insured �'Q�g Countersigned by Insurance Agent Signature eV1 fib, c5--5 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights tothe certificate holder in lieu of such endorsement(s). 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). DISCLAIMER This Certificate of Insurance does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25(2009/01) Commercial General Liability CG 00 01 12 07 Bankruptcy or insolvency of the insured or of the insured's estate will not relieve us of our obligations under this Coverage Part. 2. Duties In The Event Of Occurrence, Offense, Claim Or Suit a. You must see to it that we are notified as soon as practicable of an "occurrence" or an offense which may result in a claim. To the extent possible, notice should include: (1) How, when and where the "occurrence" or offense took place; (2) The names and addresses of any injured persons and witnesses; and (3) The nature and location of any injury or damage arising out of the "occurrence" or offense. b. If a claim is made or "suit" is brought against any insured, you must: (1) Immediately record the specifics of the claim or "suit" and the date received; and (2) Notify us as soon as practicable. You must see to it that we receive written notice of the claim or "suit" as soon as practicable. c. You and any other involved insured must: (1) Immediately send us copies of any demands, notices, summonses or legal papers received in connection with the claim or "suit"; (2) Authorize us to obtain records and other information; (3) Cooperate with us in the investigation or settlement of the claim or defense against the "suit'; and (4) Assist us, upon our request, in the enforcement of any right against any person or organization which may be liable to the insured because of injury or damage to which this insurance may also apply. d. No insured will, except at that insured's own cost, voluntarily make a payment, assume any obligation, or incur any expense, other than for first aid, without our consent. 3. Legal Action Against Us No person or organization has a right under this Coverage Part: a. To join us as a party or otherwise bring us into a "suit" asking for damages from an insured; or b. To sue us on this Coverage Part unless all of its terms have been fully complied with. A person or organization may sue us to recover on an agreed settlement or on a final judgment against an insured; but we will not be liable for damages that are not payable under the terms of this Coverage Part or that are in excess of the applicable limit of insurance. An agreed settlement means a settlement and release of liability signed by us, the insured and the claimant or the claimant's legal representative. 4. Other Insurance If other valid and collectible insurance is available to the insured for a loss we cover under Coverages A or B of this Coverage Part, our obligations are limited as follows: a. Primary Insurance This insurance is primary except when Paragraph b. below applies. If this insurance is primary, our obligations are not affected unless any of the other insurance is also primary. Then, we will share with all that other insurance by the method described in Paragraph c. below. b. Excess Insurance (1) This insurance is excess over: (a) Any of the other insurance, whether primary, excess, contingent or on any other basis: (i) That is Fire, Extended Coverage, Builder's Risk, Installation Risk or similar coverage for "your work"; (ii) That is Fire insurance for premises rented to you or temporarily occupied by you with permission of the owner; (iii) That is insurance purchased by you to cover your liability as a tenant for "property damage" to premises rented to you or temporarily occupied by you with permission of the owner; or (iv) If the loss arises out of the maintenance or use of aircraft, "autos" or watercraft to the extent not subject to Exclusion g. of Section I — Coverage A — Bodily Injury And Property Damage Liability. CG 00 01 12 07 © ISO Properties, Inc. , 2000 Page 11 of 16 4-5 POLICY NO: PH P K1024916-000 POLICY CHANGE DOCUMENT CHANGE # 1 CHANGE EFFECTIVE: 09/29/2014 Philadelphia Indemnity Insurance Company ! PRODUCER: Maguire Insurance Agency, Inc. NAMED INSURED: Marc Payan, dba, West Coast Community Development, LLC. MAILING ADDRESS 59 Long Mdw Irvine, CA 92620 - POLICY PERIOD: FROM 05/24/2014 TO 05/24/2015 at 12:01 A.M. Standard Time at your mailing address shown above. DESCRIPTION: In consideration of the premium reflected, the policy is amended as indicated below: Added 1 Additional Insured. Total Annual Total Prorate Additional/Return Premium $0.00 Additional/Return Premium $0.00 Total Annual Additional/Return Tax/Surcharge/Fee Total Prorate Additional/Return $0.00 Tax/Surcharge/Fee Page 1 of 1 $0.00 , ---N a. DATE (MM/DD/YyYYI CERTIFICATE OF LIABILITY` INSURANCEoq llanl�, PRODUCER Mag I:.. h9,5i➢rb Agot'e['+f. Irt( sIM 11-0a `-I ,.,sly, ytl,ilp Nt i Mn 6fa1-J / Y ,11;'Il 37 7 413- 74'59 INSURED NWPa"-P,a N(LlA.LLC. "i9 L g Md,, Irw;ne. „Ai2r,24. COVERAGES THIS CERTIFICATION IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AMMEND, EXTEND OR. ALTER THE COVERAGE AFFORDEDBY THE POLICIES BELOW. I`1 sURER ,t- Pf iladeln�,r� ind rerty Inzu ranee I'V 5LIRf Ii B: IN'§uRER c. 13Pi9 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 CERIFICATION 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, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD`L POLICY EFFECTIVE POLICY EXPIRATION LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE (MM/DD/YYYY) DATE (MM/DD/YYYYI LIMITS .1 X GENERAL LIABILITY PHPK1342208,- QSr 2R iR'{*; DW29/2U113 FACUOCCURENCE $I,ODdoco M a: (!tofMERCVAI, rAN( RAI, I IABILI TY 6110 MAG »��`� PREISAISES La r' TT 1170,000 1X1 IA.y -e Petsud)l >asr7u.. 1:Isarei:'s Naoaar: Q-1111MED PERSONAL 1 AUV I,NAj RY $1,000,D60 A Fr ,UFF,SSrt2NA99. AIBj,,[TY SENERA{ A£C,REGiAIE SJ„ Oouvloo PRODUCFS COMPtiPAGG 5I'M0,000 GEN' 1. AGGRE GATE LI DUT APPI..IES PER: X. P II I'ti 11-.1117 1.01 AUTOMOBILE LIABILITY COMBINED "SIN(3LE u1`01 ANY AUTO IEA ae'Clder,U BDOILYINIIURY.. �. Au 1MIIIII ;ua.wlf)5 SSC HUDIJLEIa .AUTO (f" , Pe,,un) APED Au'LS7S LI -OILY INJURY NONOWNEU 4uT0S fP-, rcn'fderat'N PROPFRI'f DAMAGE IPRt'nmdentd GARAGE LIABILITY AUTO DNl d - F. Atl:— D NT ANY AVID UTHER MAN F. +'S 4tlC ,AUTO ONLY: i AGG EXCESS/ UMBRELLA LIABILITY C.,ACTIML,L fCNCE. AGGREGATE �CC(:llR F %L,V4k,s MADE 0LDu( I181..E T1ETINFION -TI SAL. .r.,..- - EMPLOYERS' LIABILITY TORY LIMI t5 EA ANY rRUPRI$TCJRPPAR7NERfTXEC.{)TIUL EL EAC/d ACCI-ENT DFFIC FRINIFMBER „XC,d U MD" E.A. DISEASE - EA ANIPLOYEE (Mandatory in NH) al E -L .�.I'SL EASE -POLICY LICvtlT SPECIAL PR -VISIONS dednuw OTHER DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEH CLE5I EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS IF .d—t--d Y d a,g,q Ad p11'a.t Tu;Y)dlp ahR -ETC, ,g, Aded 3, zn dd t -W rnSAl d IJnt "N N,V, 1r:.5� q{ l to Il-. —atm- Af th% nd—d S—p, tlh,t 'Idbdllty 1,S3uIIl1Ie ,POnS 011 "'04—A nk'—d'S S.I,. Y4f:Bld'RYRna;e. } CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE ('Ay of Santa Ana, 'I, office", tR:n4 —d ^,+npalnYrdes THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN ND114CE TO THE 20 cmc ('-,we, PI" CERTIFICATE HOLDER NAMED TO THE LEST, BUT FAILURE TO DO 50 SHALL IMPOSE NO OBLIGATION OR Santa Ana,. CA 427+)1- LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25 (2009/01) CQ 1988-2009 ACORI) CORPORATION All rights reserved. The ACORD name and logo are registered marks of ACORD ADDITIONAL INSURED ENDORSEMENT Insurance Company Philadelphia Indemnity Insurance Company This endorsement modifies such insurance as is afforded by the provisions of Policy PHPK1 342298-000 relating to the following: The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701; it officers, employees, agents and representative are named as additional insureds ("additional insureds") with regard to liability and defense of suits arising from the operations and uses performed by or on behalf of the named insured. 2, With respect to claims arising out of the operations and uses performed by or on behalf of the named insured, such insurance as is afforded by this policy is primary and is not additional to or contributing with any other insurance carried by or for the benefit of the additional insureds, This, insurance applies separately to each insured against whom claim is made or suit is brought except with respect to the company's limits of liability. The inclusion of any person or organization as an insured shall not affect any right which such person or organization would have as a claimant if not so included. 4. With respect the adclifiona9 insureds, this insurance shall not be cancelled, or materially reduced in coverage or limits except after thirty (30) days written notice has been given to the City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701. (Completion of the following, including countersignature, Is required to make this endorsement effective.) Effective 5/26/2015 Issued to M.1 1.1- Ob. Y0.11 ism r --.4y U—kl�-W LLC Name Insured Countersigned by this endorsement form as part of Insurance Agent tiignafklre IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement{s). 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). DISCLAIMER This Certificate of Insurance dries not constitute a contract between the issuing insurer{s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2OQ9/01) Commercial General Liability CO 000'11207 Bankruptcy or insolvency of the insured or of the insured's estate will not relieve us of our obligations under this Coverage Part, 2. Duties In The Event Of Occurrence, Offense, Claim Or Suit a. You must see to it that we are notified as soon as practicable of an "occurrence" or an offense which may result in a claim. To the extent possible, notice should include: (1) How, when and where the "occurrence" or offense took place; (2) The names and addresses of any injured persons and witnesses; and (3) The nature and location of any injury or damage arising out of the "occurrence" or offense. b. If a claim is made or "suit" is brought against any insured, you must: (1) Immediately record the specifics of the claim or "suit" and the date received; and (2) Notify us as soon as practicable. You must see to it that we receive written notice of the claim or "suit" as soon as practicable. c. You and any other involved insured must: (1) Immediately send us copies of any demands, notices, summonses or legal papers received in connection with the claim or "suit"; (2) Authorize us to obtain records and other information; (3) Cooperate with us in the investigation or settlement of the claim or defense against the "suit"; and (4) Assist us, upon our request, in the enforcement of any right against any person or organization which may be liable to the insured because of injury or damage to which this insurance may also apply. d. No insured will, except at that insured's own cost, voluntarily make a payment, assume any obligation, or incur any expense, other than for first aid, without our consent. 3. Legal Action Against Us No person or organization has a right under this Coverage Part; a. To join us as a party or otherwise bring us into a "suit" asking for damages from an insured; or b. To sue us on this Coverage Part unless all of its terms have been fully complied with. A person or organization may sue us to recover on an agreed settlement or on a final judgment against an insured; but we will not be liable for damages that are not payable under the terms of this Coverage Part or that are in excess of the applicable limit of insurance. An agreed settlement means a settlement and release of liability signed by us, the insured and the claimant or the claimant's legal representative. 4. Other Insurance If other valid and collectible insurance is available to the insured for a loss we cover under Coverages A or B of this Coverage Part, our obligations are limited as follows: a. Primary Insurance This insurance is primary except when Paragraph b, below applies. If this insurance is primary, our obligations are not affected unless any of the other insurance is also primary. Then, we will share with all that other insurance by the method described in Paragraph c, below. b. Excess Insurance (1) This insurance is excess over: (a) Any of the other insurance, whether primary, excess, contingent or on any other basis: (i) That is Fire, Extended Coverage, Builder's Risk, Installation Disk or similar coverage for "your work"; (ii) That is Fire insurance for premises rented to you or temporarily occupied by you with permission of the owner; (iii) That is insurance purchased by you to cover your liability as a tenant for "property damage" to premises rented to you or temporarily occupied by you with permission of the owner; or (iv) If the loss arises out of the maintenance or use of aircraft, "autos" or watercraft to the extent not subject to Exclusion g. of Section I -- Coverage A •- Bodily Injury And Property Ramage Liability. FR— CS CG 00 01 12 07 0 180 Properties, lnc. , 2000 Page 11 of 16 Philadelphia indemnity Insurance Company One Bala Pilaza, Suite, I Do, Bala Cynwyd, Pennsylvania 19004 COMMON POLICY DECLARATIONS Policy Number: PHPK1342298-000 Named Insured and Mailing Address: Producer: 6039 Marc Payan, dba WCCD, LLC. Maguire Insurance Agency, Inc. 59 Long Mdw 27101 Puerta Real Suite 200 Irvine, CA 92520- Mission Viejo, CA 926'91- Policy Period From: 05f28/2015 To: 05/28/2015 at 12:01 AM. Standard Time at your rnaiting address shown above Business Description: Fitness Trainer Style/Art: Coach IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECTTO ALL THE TERMS OF THIS POLICY, WE AGREE WITH YOU TO PROVIDE THE INSURANCE AS STATED IN THIS POLICY. THIS POLICY CONSISTS OF THE FOLLOWING COVERAGE PARTS FOR WHICH A PREMIUM IS INDICATED. THIS PREMIUM' MAY BE SUBJECT TO ADJUSTMENT. PREMIUM Commercial' Property Coverage Part Commercial General Liability Coverage Part $182.00 Commercial Crime- Coverage Part Cornmercial Inland Marine Coverage Part Commercial Auto Coverage Part Commercial Stop Gap Part Businessowners Workers Compensation Taxes/Fees/Surcharges $50.00 Total $232.00 FORM (S) AND ENDORSEMENT (S) MADE A PART OF THIS POLICY AT THE TIME OF ISSUE Refer To Farms Schedule *Omits applicable Forms and Endorsements if shown in specific Coverage Part/Coverage Form Declarations Countersignature Date Authorized Representative