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HomeMy WebLinkAboutALL STAR JUMPER RENTALS, LLC. -2015City of Santa A, ----------- Clerk of the Council COTCOHiceUse AGREEMENT TERMINATION FORM 2020 rE8 -6 PM 14, 21 Please complete this form when the attached agreement an(tply OF SANTA ANA amendments (if any) are no longer in effect. CLERK OF COUNCIL Return form to the Clerk of the Council Office (M-30). Call 647-1520 if you have any questions. The agreement with No. N-2016-170 was completed on "J�RLAS and final payment has been made. (List all amendments. Use space below if needed.) Department: r c)jt-1 Phone/Ext.: iotl(A Signature:, Date: a bZ 42 Revised 10-31-12 N.2015A70 iNSOI iMCE ON ME WORK 104V PROCEED UNR119..lti�tU tt�E 'Cl CLERK Off ll0f [SATE:, AMUSEMENT DEN710E PROVIDER AGREEMENT PRCSICI ) Silvia Cuevas THIS .AGREEMENT is made and entered late this l91h day of October, 2015, by and between All Star Jumper Rentals, LLC ("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"). RECITALS A. The City desires to retain a provider tosupply inflatable jumpers for the City's Sunday on Main Open Street (SOMOS) event to be held on November 8, 2015, in Santa Ana 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 herainafier set forth, the parties agree as follows: 1. SCOPE OF SERVICES Provider shall furnish three (3) inflatablejunipers and (3) generators, as more fully described in Exhibit A attached hereto and incorporated by reference. City grants Provider the right to enter its property for the purpose of delivery, set-up, and pick-up. Tiie jtuapers shali be set-up and ready for operation by 9:00 a.m. on November Sth at locations to be specified by City and shall be disassembled and removed by Provider at the conclusion of the Event. 2. COMPENSATION a. City agrees to pay, and Provider agrees to accept as total payment for its services the amount of Seven Hundred and Ninety -Seven Dollars ($797.00). The cost is identified in 'Exhibit A, attached hereto and incorporated by reference. b, Payment by City shall be made within thirty (30) days following receipt of proper invoice evidencing work performed, subject to the City's accounting procedures. Payment need not be made for work which fails to meet the standards of performance set tbrth in the Recitals which may reasonably be expected by the City. 1 TERM This term of this Agreement shall commence on November 8, 2015 and end on November 9, 2015, unless terminated earlier in accordance with Section 11. below, Page 1 of 6 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. Provider is not an agent, representative or employee of City and Provider shall have no authority to act on behalf of the City. 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 Insurance. 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 and $2,000,000 in the aggregate, inch -ding coverage of sexual misconduct. 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 of insured's provisions. b. Worker's Compensation insurance. In accordance with the provisions of California state law, 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 frill 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. Page 2 of 6 (it) 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 furnish 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. 6. INDEMNIFICATION Provider agrees to and shall defend, indemnify and hold harmless the City, its officers, agents, employees, contractors, 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 death, 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 I 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 personal injury, damages, just compensation, restitution, judicial or equitable relief due to personal or property rights arising 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. 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: Clork of the Council City of Santa Ana 20 Civic Center Plaza (M-30) P.O. Box 1988 Santa Ana, CA 92702-1988 Tax (714) 647-6956 Page 3 of 6 With copy to: Executive Director of Parks, Recreation and Community Services City of Santa Ana 20 Civic Center Plaza (M-23) P.O. Sox 1988 Santa Ana, California 92702 Fax (714) 571-4211 To Provider: All Star Jumper Rentals, LLC 117 N. Standard Ave, Unit A Santa Ana, CA 92701 Phone 949-294-5341 Fax 800-288.9026 A party may change its address by giving notice in writing to the other party. Thereafter, any communication shall be addressed and transmitted to the new address. If sent by mail, communication shall be effective or deemed to have been given three (3) days after it has been deposited in the United States mail, duly registered. or certified, with postage prepaid, and addressed as set forth above. If sent by fax, communication shall be effective or deemed to have been given twenty-four (24) hours after the time set forth on the transmission report issued by the transmitting facsimile machine, addressed as set forth above. For purposes of calculating these time frames, weekends, federal, state, County or City holidays shall be excluded. 9, EXCI,USWITY 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. 10. 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. Page 4 of 6 It. TERMINATION This Agreement may be termhrated by the City upon thirty (30) days written notice of termination. In such event, Provider shall be entitled to receive, and City shall pay Provider, compensation for all services rendered prior to the effective date of termination, 12. RE' CORDS Provider shall keep records and invoices in connection with the work to be performed under this Agreement. Provider shall maintain complete and accurate records with respect to the costs incurred under this Agreement and any services, expenditures, and disbursements charged to the City for a minimum period of three (3) years, or for any longer period required by law, from the date of final payment to City under this Agreement. Provider shall allow inspection of all work, data, documents, proceedings, and activities related to this Agreement for a period of three (3) years from the date of final payment to, City under this Agreement. 13. NON-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, teaching, training, utilization, promotion, termination or other employment related activities or in connection with any activities under this Agreement, 14. J URISDICTION — 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. SEVERABILI"I X` 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 parties hereunder. Page 5 of 17. EXHIBITS All Exhibits referenced herein and attached hereto shall be incorporated as if fully act forth in the body of this Agreerncnt. 18. 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 be so mecuting this Agreement, the patties 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, F."Ifto MARIA D, HUIZAR Clerk of the Council APPROVED AS TO FORM: SONIA R. CARVALHO City Anna icy By: 004% JM-IN M. FUND Assistant City Attorney RECOMMENDED FOR APPROVAL: Gi;R�ARDO MDUET Executive Director of Parks, Recreation and Community Services Agency CITY OF SANTA ANA 5XVID CAVAZOS 4)L City Manager PROVIDER: Page 6 of 6 I 1PI -P—kt �t RENTALS, LLC EXHIBIT A All Star Jumpier Rentals 117 N Standard. Ave., Unit A, Santa Ana, CA 92701 Phone; (949) 294-534I Fax; (800) 288.9026 Webalte: www.jump2allstar.com FinaDi 1000jump2allstar.com Bill To City of Santa Arta Enrique Marban/William Sandoval Purchasing Division M-16 PO Box 1988 Santa Ana, CA 92702 Phone.(71.4)571-4254 Cell Phone: (714)631-6402 Alt. Phone: Fax: Deliver To 3O06 W. Centennial Rd Santa Ana, CA 92704 a =111s Quote Date: October 2, 2015 Written By. Chris Espino Delivery. Nov 08, 2015 Event Starts: Nov 08, 2015 09:00 am Event Ends: Nov 08, 201 02:00 pm Pick-up; Nov 08, 2015 Delivery Method: Payment Method: Check* tty Description Bllt, Days I List Price I Discount I Total 3 IGenerator (2 outlets) 1 1 $85=1 $45,001 $210,00 Order Subtotal; $797.00 Delivery Charge: $0,00 TOTAL: $797.00 Printed on 10/21201511:14 AM TE _V6� ej CERTIFICATE OF LIABILITY INSURANCE 10/7f2015 ae.THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must 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 endomement(s). l PRODUCER Contact Name: Larry Coaalo _ j Wa Cossio Insurance Agency Phone 864-688.0121 Fax 864.688-0138 PO Box 188 (NC No, Extp (A'C, No): - Simpsonville, SC 29681 E Mall tammy@ccsslolnsurance.com (864)688-0121 - ---- INSURER(S) AFFORDING COVERAGE NAIC# me At INSURER A: United States Fire Insurance Company INSURED �y SPORTS AND RECREATION PROVIDERS ASSOCIATION INSURER B: (PURCHASING GROUP) AND ITS PARTICIPATING MEMBERS: a - All Star Jumper Rentals, LLC INSURER C: 117 North Standard Avenue, Suite A Santa Ana, CA 92701 INSURER Dt INSURER E: COVERAGES CERTIFICATE NUMBER: USPT75026 REVISION NUMBER: Ve..a THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD 1 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 TERNIS. a EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NOR TYPE OF POLICY ADOL SUBW POLICY NUMBER POLICY EFF POUCYEXP LIMITS ITS INSR WVO (MM/OD/YYI (MMIDDIYY) X COMMERCIAL GENERAL LIABILITY CLAIMS MADE', OCCUR A GEN'L AGGREGATE LIMIT APPLIES PER '., X POLICY _PROJECT..'.. LOC OTHER: ._.. AUTOMOBILE LIABILITY ANYAUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS NON-0WNED AUTOS UMBRELLA LIAB OCCUR EXCESS LIAB CIAIMS-MADE DED I RETENTION$ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNEWEXECUTIVE YIN .. OFFICERIMEMBER EXCLUDED? (Mendetoryln NH) -� If yes, describe under DESCRIPTION OF OPERATIONS below SRPGP-101.0414 3/19/2015 'I. 3/19/2016 General Aggregate Limit -' $2,000,000 Products and Completed Operations $2.000,000 Personal and Advertising Injury Limit $1,000,000 Each Occurrence Limit $1,000,000 '.. Fire Damage Limit -Any One Fire $300,000 Medical Expense Limit $5,000 Deductible Limit $0 COMBINED SINGLE LIMIT $ (Ea acril BODILY INJURY (Per Person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ (Per accident) PER OTH- STATUTE FIR Accidental Death & Dismemberment $10,000 i Maximum Benefit Amount $10000 A - Accident Medical AH-GA26932.002 3/19/2015 3/19/2016 Deductible $0 Cert#US446436 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Party Equipment Rentals Operations located at 117 North Standard Avenue, Ste A Santa Ana, CA 92701. Certificate Holder As Additional Insured Amusement devices on file with the company for special event(s) dated 11/6/2015 to 11/8/2015 located at 3006 W. Centennial Road, Santa Ana, CA 02704. CERTIFICATE HOLDER: CANCELLATION City Of Santa Ana, it's Officers, SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Employees, Agents and Representative THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 Civic Plaza ACCORDANCE WITH THE POLICY PROVISIONS Santa Ana,a. CA CA 92701 AUTHORIZED REPRESENTATIVE © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD CONINIERCIAL GENERAL LIABILITY CG 20 26 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL. LIABILITY COVERAGE PART SCHEDULE Policyholder Sports and Recreation Providers Association Purchasing Group/ All Star Jumper Rentals, LLC Policy Number SRPGP-101-0414, Certificate: USP175026 Name Of Additional Insured Persons Or Or anization s City Of Santa Ana, it's Officers, Employees, Agents and Representatives 20 Civic Center Plaza Santa Ana, CA 92701 Information required to complete this Schedule, if not shown above will be shown in the Declarations. Section II - WHO IS AN INSURED is amended to include as an insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions of the acts or omissions of those acting on your behalf: A, In the performance of your ongoing operations; or i In connection with your premises owned by or rented to you. To the extent that any of the additional insureds named herein are liable for occurrences arising out of the named insured's negligent acts or omissions, the insurance afforded to the additional insureds under this endorsement is primary insurance over any other valid or collectible insurance which the additional insureds may have with respect to loss under any of the listed policies. Other insurance of any additional insured applicable to loss is non- contributory and excess over the coverage provided by this endorsement, and the amount of the company's liability under this policy shall not be reduced by the existence of such other insurance. Reitiewea n� Carmen Acosta CG 20 26 07 04 (D ISO Properties, Inc., 2004 Page 1 of 1 13 AcORO CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 10,2Ii2016 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION MEMBRILA INSURANCE SERVICES INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 23072 LAKE CENTER DRIVE SUITE 250 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR LAKE FOREST, CA.92630 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. OFFICE: 949 660-7781 LICENSE: 0052369 INSURERS AFFORDING COVERAGE NAIC N INSURED INSURER A: CALIFORNIAAUTOMOBILE INSURANCE COMPANY ALL STAR JUMPER RENTALS LLC 117 N STANDARD SUITEA INSURER B. m----- --W— SANTA ANA, CA. 92701 INSURER C T INSURER D: COVERAGES 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 CERTIFICATE MAYBE 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. rasa''Aro LTR INSR SURA _ TYPE OFINSBRANCE POLICY NUMBER tlA IOtlIY DA M I ! LIMITS GENERAL LIABILITY COMMERCIALGENERAL LIABILITY n CLAtMS MADE OCCUR EACH OCCURRENCE $ DAMAGE TO RENTED PREMISESEa oon renoe $ MED EXP (Any one peson) $ PERSONAL &AOV INJURY 5 GENERALAGGREOATE $� GEN'LAGGREGATE UMIT APPLIES PER: POLICY nPROJ80T n LOO PRODUCTS - COMPIOP AGO S A AUTOMOBILE LIABILITY .� ANY AUTO �J ALLOWNEDAUTOS ./ SCHEDULED AUTOS HIRED AUTOS NON-OWNEOAUTOS BA040000006026 V \ 4,26/15 q 4/26/16 COMBINED accietSINGLE LIMIT ( 5 300.000 80INJURY (Perr po person) $ (Peroudow) S PROPERTY DAMAGE (Per amident) S GARAGE LIABILITY ANYAUTO j ...! 35�( 1/i AUTOONLY- EAACCIDENT S OTHFRTHAN EAACC AUTO ONLY: ADD $ $ EXCESSIUMBRELLA LIABILITY OCCUR CLAMIS MADE DEDUCTIBLE"' RETENTION 5 ..f"" y Ct �y ! ( EACH OCCURRENCE $ AGGREGATE $ $ $ EMPYESOMEILYION AND ANY PROPRIETORMARTNERIEXECUTIVE- OFFICER/MEMBER EXCLUDED? It yes, tlescriba untler SPECIAL PROVISIONS balmy T)LORABIITRY LIMITS ER E.L. EACH ACCIDENT $ E.L. DISEASE - FA EMPLOYEE $ ELOISEASE-POLICYLIMIT $ OTHER The City of Santa Ana, It's officers, employees, agents, and representative are named as additional insured. Oily of Santa Ana 20 Civic Canter Plaza P0. BOX1988 M-16 Santa Ana, CA 92702 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO 00 SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR ERIC MEMBRILA 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 The Certificate of Insurance on the reverse side of this form 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. Reviewed by _. ftj'� ;S Carrnen Acosta PRC ;A/Recreation ACORD 25 (2001/08) POLICYHOLDER COPY SP P.O. BOX 8192, PLEASANTON, CA 94588 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 10-21-2015 GROUP: POLICY NUMBER: 9058588-2015 CERTIFICATE Q 25 CERTIFICATE EXPIRES: 05-29-2016 05-29-2015/05-29-2016 CITY OF SANTA ANA SP JOB:INFLATABLE BOUNCE HOUSES 3006 W. CENTENNIAL RD 20 CIVIC CENTER PLZ SANTA ANA SANTA ANA CA 92701-4058 CA 92704 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved dy the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 10 days advance written notice to the employer. We will also give you 10days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by tthheeppoolliiyycyyy described herein is subject to all the terms, exclusions, and conditions, of such policy. Authorized Representative President and CEO EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #1901 - MORENO, JUAN - EXCLUDED. Reviewed by Pa (I (; i�- 6-f� - 6 Carmen Acosta PRc Ar ecreation EMPLOYER ALL STAR JUMPER RENTALS, LLC SP 117 N STANDARD AVE STE A SANTA ANA CA 92701 [P1Q,SP) iREV.7-20141 PRINTED : 10-21-2015