HomeMy WebLinkAboutCOAST LIVE OAK SCHOOL 4 -2016City of Santa Ana
Clerk of the Council
AGREEMENT TERMINATION FORM
Please complete this form in its entirety when the attached agreement and all
amendments (if any) are no longer in effect. ?'
Note: If your agreement is grant related, please ensure that all grant retention requirements IT r
have been satisfied prior to signing the termination form. C
Is the agreement(s) a permanent record? Yes _ No
Return form to the Clerk of the Council Office (M-30).
Call 647-1520 if you have any questions.
The agreement with
COTC Office Use Only
22 P19 Lt: 06
SANTA ANA
aP COUNCIL
No. N-2016-174 was completed on W': t I o and final payment has been made.
(List all amendments. Use space below if needed.)
Department:
Phone/Ext.:
Signature: �SAQ`DlOA-2 C( �idGP
Date: C1.413G! LE
Revised: 10-18-16
INSURANCE ON FILE
WORK MAY PROGELD
TIL INSURANCEr: yEXPIRES N.2016474
CLERK OF GOUNGIL
DATE: 2 0 2DIO
0: PRCs (/ } RECREATION SERVICES AGREEMENT
Silvia Cuevas
THIS AGREEMENT is made and entered into this 23 rd day of November, 2016 by and
between Coast Live Oak School, Inc. ("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 recreation service provider having special skills, resources and
knowledge to provide cheerleading classes in its leisure class program.
B. Provider represents that he/she is able and willing to provide such services to the City.
C. In undertaking the performance of this Agreement, Provider represents that he/sho/it is
knowledgeable in her 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 patties 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 provision of the programs set forth in Exhibit A, City agrees to
pay the Provider seventy percent (70%) of all gross revenue received from program participants.
Total revenue to Provider shall not exceed $25,000,00 annually. Payment to Provider shall be
made monthly within thirty (30) days following completion of the last class taught by Provider
the prior month, City shall be responsible for collecting all fees from program participants.
Provider shall not collect fees but will refer all interested participants to City for registration
information. Provider agrees that City shall retain thirty percent (30%) of all gross revenue
received from program participants as an administrative fee.
3. TERM
This Agreement shall commence on January 1, 2017 and end on December 31, 2017,
unless tenninated earlier in accordance with Section 12 below. The term of this Agreement may
be extended by a writing executed by the City Manager and the City Attorney,
4, INDEPENDENT CONTRACTOR
Provider shall, during the entire term of this Agreement, be construed to be an
independent contractor and not an employee of the City, This Agreement is not intended nor
shall it be construed to create an employer -employee relationship, a joint venture relationship, or
to allow the City to exercise discretion or control over the manner in which Provider performs
the services which are the subject matter of this Agreement; however, the services to be provided
by Provider shall be provided in a manner consistent with all applicable standards and
regulations governing such services. Provider shall pay all salaries and wages, employers 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.
S. . 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. 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 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 full force and
effect for the entire period covered by this Agreement. Certificates
of insurance shall be fcumished to the City upon execution. of this
Agreement and shall be approved in form by the City.
(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 falls 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 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 indemnify, defend and hold harmless the City, its officers,
agents, employees, consultants, special counsel, and representatives from liability: (1) for
personal injury, damages, just compensation, restitution, judicial or equitable relief arising out of
claims for personal injury, including death, and claims for property damage, which may arise
from the negligent operations of the Provider or its contractors, subcontractors, agents,
employees, or other persons acting on their behalf which relates to the services described in
section 1 of this Agreement; and (2) from any claim that personal injury, damages, just
compensation, restitution, judicial or equitable relief is due by reason of the terms of or effects
arising from this Agreement, to the extent that the injury, damages, just compensation,
restitution, judicial or equitable relief is caused by the negligence of the Provider. This indemnity
and hold harmless agreement applies to all claims for damages, just compensation, restitution,
judicial or equitable relief suffered, or alleged to have been suffered, by reason of the events
referred to in this Section or by reason of the terms of, or effects, arising from this Agreement.
City may make all reasonable decisions with respect to its representation in any legal proceeding.
In no case will Provider be required to indemnify or hold harmless the City from injury,
damages, just compensation, restitution, judicial or equitable relief caused by the negligence of
the City.
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.
S. LIVE SCAN BACKGROUND CHECK
Provider, and any employees, subcontractors 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 fax or other telegraphic
communication in the manner provided in this Section, to the following persons:
To City: Cleric of the Council
City of Santa Ana
20 Civic Center Plaza (M-30)
P.O. Box 1988
Santa Ana, CA 92702-1988
Fax (714) 647-6956
With copy 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
Fax (714) 571-4211
To Provider: Coast Live Oak School, Inc.
P.O. Box 838
Tustin, CA 92781
Attn: Mark Hay
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.
10. EXCLUSIVITY AND AMENDMENT
This Agreement represents the complete and exclusive statement between the City and
Provider regarding the subject matter herein, and supersedes any and all other agreements, oral
or written, between the parties. In the event of a conflict between the terns of this Agreement
and any attaclnnents 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 terns or conditions of any purchase order or other
instrument that are inconsistent with, or in addition to, the terns 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/SUBSTITUTES
a. Assigmnent. 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.
b. Substitutes. In the event Provider is not able to teach a class due to illness or some
other cause beyond Provider's reasonable control, Provider must procure, at its sole expense, a
qualified substitute instructor to teach the class at its regular time and place. Provider shall
ensure that substitute instructors are at least twenty-one (21) years of age and comply with the
City's insurance and live scan requirements contained herein. Evidence of compliance with
City's insurance and live scan requirements shall be provided upon request. Provider must
immediately notify the City of the substitute instructor's name, qualifications, address and phone
number. If Provider cannot procure a qualified substitute and the City is unable to assist in this
regard, then the class shall be canceled and a make-up class must be added to the session.
Provider must notify participants as soon as possible of any class cancellation and make-up class,
Provider must personally teach at least seventy-five percent (75°%) of its offered classes,
12. TERMINATION
a. This Agreement maybe terminated 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,
b. Termination or cancellation of classes by the Provider outside of Section I l .b. 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 fixture contracting of business with the City at
risk and will result in the City's retention of ten (10%) percent of the final payment to Provider.
13. RECORDS
Provider shall use attendance sheets generated and supplied by the City to record
attendance in each class. Provider shall keep these and any other records in connection with the
work to be performed render this Agreement and shall permit City, upon request, to review such
records for a period of three (3) years from the date of final payment to Provider under this
Agreement.
14. 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 any services provided under this
Agreement. Provider affirms that it is an equal opportunity employer and shall comply with all
applicable federal, state and local laws and regulations.
15. 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.
16. 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.
17, SEVERABILITY
In the event that one or more of the phrases, sentences, clauses, paragraphs or sections
contained, in this Agreement shall be declared invalid or unenforceable by valid judgment or
decree of a court of competent jurisdiction, such invalidity or unenforceability shall not affect
any of the remaining phrases, sentences, clauses, paragraphs or sections of this Agreement,
which shall be interpreted to carry out the intent of the parties hereunder.
18. EXHIBITS
All Exhibits referenced herein and attached hereto shall be incorporated as if fully set forth
in the body of this Agreement.
19. AUTHORITY
The person(s) executing this Agreement on behalf of the parties hereto warrant that they are
duly authorized to execute this Agreement on behalf of said parties and that by so executing this
Agreement, the parties hereto are formally bound to the provisions of this Agreement.
IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and
year first above written.
ATTEST; CITY OF SANTA A
o
�u Maria D. Huizar David Cavazos
Cleric of the Council City Manager
[signatures continue on next page]
APPROVED AS TO FORM:
SONIA R. CARVALHO
City Attorney
By: 06-4 1w, 1�4
J6Kn M. Funk
Assistant City Attorney
RECOMMENDED FOR APPROVAL:
Gerardo Monet
Executive Director of Parks,
Recreation and Community Services Agency
PROVIDER:
Natrk: ffk'
Title: Verde
COO- wet
Exhibit A
SCOPE OF SERVICES — Coast Live Oak School
A. Provider shall conduct nature skills camp for children ages 7-14,
B. Provider shall teach such or similar classes (1) at the times below at facilities to be
designated by the City or (2) on a schedule agreed upon by the parties for each class
session or term, including the location, specific days and hours when classes will be held,
and holidays to be observed, in accordance with City's needs.
• Nature skills classes will consist of 3-day sessions, 6 hours per day or as
otherwise scheduled by mutual agreement of the parties
C. Provider shall provide all materials, supplies, equipment, records and personnel.
Provider shall be responsible for clean-up of the facilities and materials and shall ensure
the safety and effectiveness of instruction.
CLASS SIZE
A. Each class must have a minimum of 5 paid students and a maximum of 11.
B. No registration will be accepted after the second meeting of classes.
C. If the minimum registration has not been reached by the second class, the class shall be
cancelled, Provider will be under no obligation to provide services for the cancelled
classes, and the City will have no further obligations to pay Provider compensation for
the remaining classes that were cancelled in that session.
CLASS FEES
A. Each participant shall pay class registration fees as established by City.
B. Provider may not waive class participation/registration fees.
C. Only registered participants may participate in class.
D. Any refunds to participants will be made in accordance with City policy.
E. Any materials fee shall be established by mutual agreement of City and Provider and
shall be payable directly to Provider,
ace�ea® CERTIFICATE OF LIABILITY INSURANCE
DATEIMMIDDIYYYY)
�...+�
10/3/2016
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must 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 endorsements .
PRODUCER
CONTACT
vy SoI1Gr-Flynn
Wood Gutmann & Bogart
License#0679263
PHONE FAX
(AIC,No. ENo 714-505-7000 (m,Ns),714-573-1770 --
15901 Red Hill Ave., Suite 100
ADOREE-MAILS vy@wgbib.com
Tustin CA 92780
_.INSURERIt S AFFORDING COVERAGE NAIC#
_—
__......_.__
INSURER A:PhiladelphialndemnitylnsCo.
INSURED CGAST66
INSURERS:
Coast Live Oak School
INSURER z
Mark Hay
.—.�
316 Edgewood Road Q - 1-1201 {�
INSURERD
Santa Ana CA 92706
INSURERE.
INSURER F :
COVERAGES CERTIFICATF KIHMRFR• 249180180 REtneTnu NUMBER
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR _- —. _—__ DDLISUBft.__
LTR TYPE OFIN5URANCE INSDIWVO. POLICY NUMBER POLICY EFF POLICYEXP
MMIOCIYYYYI i (MMIDDIWWI LIMITS
A iX COMMERCIAL GENERAL LIABILITY
PHPK1S31933 9/22/2016 19/22/2017 EACH OCCURRENCE $1,000000
CLAIMS -MADE X OCCUR
TE
DAMAGETORENPREMISES (Ea occurrD nce) $100 000
o
_
- kMED EXP(Arlyoneperaan) $$00
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PERSONAL &ADV INJURY $1.000,000
GEN'LAGGREGATE LIMIT APPLIES PER
: ! GENERAL AGGREGATE $2,000,000
_
'-
X POLICY PRO- Lee
_.i JECT
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" PRODUCTS - COMP/OP AGO I $2,000,000
OTHER.
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AUTOMOBILE LIABILITY
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ANY AUTO
• BODILY INJURY person) I$
ALL OWNED SCHEDULED
NON OWNED
ed�LJ,q BODILY INJURY (Per accident) $
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HIRED AUTOS ' AUTOS
•� �`I IPRDPERTY DAMAGE $
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$
UMBRELLA LIAR OCCUR
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EXCESS LIAR 'CLAIMS -MADE!
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AGGREGATE $
DEAD RETENTION$
ni k$
WORKERS COMPENSATION
PER O H
AND EMPLOYERS' LIABILITY YINII(D
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ANY PROPRIET➢RIPARTNEMEXECUTIVE
- OFPICERIMEMSER EXCLUDED?
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IMendetory in
_, El DISEASE - EA EMPLOYEE, S
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describe
-
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OF
' OE5CRIPTION OF OPERATIONS below
E.L. DISEASE -POLICY LIMIT ': $-
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 1U1, Additional RemarNa Suhetlu(e, mey ba aaached iE more apace Is requlmMl
City of Santa Ana, its officers, agents and employees are named as additional insured on the General
Liability per attached PI OLD VS 01 08. Cancellation verbiage as per IL0017 11 98 attached. Primary
and Nan -Contributory applies on the General Liability per attached PI OLD VS 01 08,
THIS CERTIFICATE SUPERCEDES ANY PREVIOUSLY ISSUED,
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Oily of Santa Ana; Parks, Recreation and Community THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Services Agency ACCORDANCE WITH THE POLICY PROVISIONS.
Attn: Carmen Acosta
1825 W. Civic Center Drive
Santa Ana CA 92701 AUTHORIZED REPRESENTATIVE
01988.2014 ACORD
ACORD 26 (2014101) The ACORD name and logo are registered marks of ACORD
Policy No, PHPKIS31933
Pi-GLD-vs (01/08)
GENERAL LIABILITY DELUXE ENDORSEMENT
SCHOOLS
This endorsement modifies insurance provided under the following:
It is understood and agreed that the following extensions only apply in the event that no other speciflo
coverage for the indicated loss exposure is provided under this policy. If such specific coverage applies,
the terms, conditions and limits of that coverage are the sole and exclusive coverage applicable under
this policy, unless otherwise noted on this endorsement. The following Is a summary of the Limits of
Insurance and additional coverages provided by this endorsement. For complete details on specific
coverages, consult the policy contract wording.
Coverage Applicable
Limit of Insurance
Page #
Damage to Premises Rented to You
$300,000
2
Extended Property Damage
included
2
Non -Owned Watercraft
Less than 58 feet
2
Supplementary Payments — Bail Bonds
$2,500
2
Supplementary Payment — Loss of Earnings
$600 per day
2
Medical Payments
$15,000
3
Medical Payments -Extended Reporting Period
3 years
3
Employee Indemnification Defense Coverage for Employee
$25,000
3
Additional Insured -- Medical Directors and Administrators
Included
3
Additional Insured— Managers and Supervisors
Included
3
Additional Insured— Broadened Named Insured
Included
3
Additional Insured — Funding Source
Included
3
Additional Insured — Managers or Lessors of Premises
Included
4
Additional Insured -- By Contract, Agreement or Permit
Included
4
Additional Insured -- Broad Form Vendors
Included
4
General Aggregate — PerCampu
Included
5
Duties in the Event of Occurrence, Claim or Suit
Included
6
Other Insurance — Primary Additional Insured
Included
e
Other Insurance - You Are An Additional Insured On
Another Person's Or O anization's Policy.
I hided
7
Unintentional Failure to Disclose
Hazards
Included
a
Liberalization f
,,� Included
8
Bodily injury — includes Mental Aatguish
Included
8
Personal and Advertising Injury —includes Abuse of
Process Discrimination
r included
4
8
Transfer of Rights of Recovery Against Others, Us �ll
Clarification
8
Science Laboratory "Occurrence"
$50,000
9
Medical Incident Liability -Nurse and Athletic Trainer
included
Page 1 of 9
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
PI-GLD-VS (01108)
A. Damage to Premises Rented to You
1. If damage by fire to premises rented to you is not otherwise excluded from this Coverage Part, the
word "fire" is changed to "fire, lightning, explosion, smoke, or leakage from automatic fire protective
systems" where it appears in:
a. The last paragraph of SECTION I —COVERAGES. COVERAGE A BODILY INJURY AND
PROPERTY DAMAGE LIABILITY, Subsection 2. Exclusions;
b. SECTION III - LIMITS OF INSURANCE, Paragraph 6.;
c. SECTION V — DEFINITIONS, Paragraph 9.a.
2. If damage by fire to premises rented to you is not otherwise excluded from this Coverage Part, the
words "Fire Insurance" are changed to "insurance for fire, lightning, explosion, smoke, or leakage
from automatic fire protective systems" where It appears in:
a. SECTION IV -COMMERCIAL GENERAL LIABILITY CONDITIONS, Subsection 4.Other
Insurance, Paragraph b. Excess Insurance
3. The Damage To Premises Rented To You Limit section of the Declarations is amended to the
greater of:
a. $300,000; or
b. The amount shown in the Declarations as the Damage to Premises Rented to You Limit.
This is the most we will pay for all damage proximately caused by the same event, whether such
damage results from fire, lightning, explosion, smoke, or leaks from automatic fire protective
systems or any combination thereof.
B. Extended "Property Damage"
SECTION I - COVERAGES. COVERAGE A, COVERAGE A BODILY INJURY AND PROPERTY
DAMAGE LIABILITY, Subsection 2. Exclusions, Paragraph a. is deleted and replaced by the
following;
a. Expected or Intended Injury
"Bodily injury" or "Property Damage" expected or intended from the standpoint of the insured.
This exclusion does not apply to "bodily injury" or "properly damage" resulting from the use of
reasonable force to protect persons or property.
C. Non -Owned Watercraft
SECTION I — COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY
LIABILITY, Subsection 2. Exclusions, Paragraph g. (2) is amended to read as fo
(2) A watercraft you do not own that is:
(a) Less than 58 feet long; and
(b) Not being used to carry persons or property for a charge;
This provision applies to any person, who with your consent, either uses or is ree onsiblA
use of a watercraft. This Insurance is excess over any other valid and collectible insurance
available to the insured whether primary, excess or contingent,
2-Supplementary Payments
Under the SUPPLEMENTARY PAYMENTS • COVERAGE A AND B provision, Items 1.b. and 1.d.
Page 2 of 9
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
PI-GLD-VS (01108)
are amended as follows:
1. The limit for the cost of bail bonds is changed from $250 to $2,500; and
2. The limit for loss of earnings is changed from $250 a day to $500 a day.
E. Medical Payments - Limit Increased to $15,000, Extended Reoortinc Period
If COVERAGE C MEDICAL PAYMENTS is not otherwise excluded from this Coverage Pail:
1. The Medical Expense Limit is changed subject to all of the terms of SECTION III -LIMITS OF
INSURANCE to the greater of:
a. $15,000; or
b. The Medical Expense Limit shown in the Declarations of this Coverage Part.
2. SECTION I --COVERAGE, COVERAGE C MEDICAL PAYMENTS, Subsection 1. Insuring
Agreement, the second part of Paragraph a. is amended to read:
provided that:
(2) The expenses are incurred and reported to us within three years of the date of the accident;
F. Emolovee Indemnification Defense Coverage
Under the SUPPLEMENTARY PAYMENTS -COVERAGES A AND S provision, the following is
added:
3. We will pay, on your behalf, defense costs incurred by an "employee" in a criminal proceeding.
The most we will pay for any "employee" who is alleged to be directly involved in a criminal
proceeding is $25,000 regardless of the numbers of "employees", claims or "suits" brought or
persons or organizations making claims or bringing "suits".
G. SECTION II -WHO IS AN INSURED is amended as follows:
1. If coverage for newly acquired or formed organizations Is not otherwise excluded from tt•L'�F'a tklas�"
Coverage Part, Paragraph 3.a, is changed to read: J �%
a. Coverage underthis provision is afforded until the end of the policy period.
2. Each of the following is also an insured:��`
a. Medical Directors and Administrators -Your medical directors and administrators, b8o y1
while acting within the scope of and during the course of their duties as such.
b. Managers and Supervisors - If you are an organization other than a partnership orjoint
venture, your managers and supervisors are also insureds, but only with respect to their duties
as your managers and supervisors.
c. Broadened Named Insured - Any organization and subsidiary thereof which you control and
actively manage on the effective date of this Coverage Part. However, coverage does not
apply to any organization or subsidiary not named In the Declarations as Named Insured, if they
are also insured under another similar policy, but for its termination or the exhaustion of its limits
of insurance.
d. Funding Source -Any person or organization with respect to their liability arising out of:
(1) Their financial control of you; or
Page 3 of 9
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
PI-GLD-VS (01l08)
(2) Premises they own, maintain or control while you lease or occupy these premises.
This insurance does not apply to structural alterations, new construction and demolition
operations performed by or for that person or organization.
e. Managers or Lessors of Premises - Any person or organization with respect to their liability
arising out of the ownership, maintenance or use of that part of the premises leased to you
subject to the following additional exclusions:
This insurance does not apply to:
(1) Any "occurrence" which takes place after you cease to be a tenant in that premises.
(2) Structural alterations, new construction or demolition operations performed by or on
behalf of that person or organization.
f. By Contract, Agreement or Permit -Any person or organization with whom you agreed,
because of a written contract or agreement or permit, to provide Insurance such as is afforded
under this policy, but only with respect to your operations, "yourwork" or facilities owned or
used by you.
(1) This provision does not apply:
(a) Unless the written contract or agreement has been executed or permit has been issued
prior to the "bodily injury," "property damage," "personal and advertising injury":
(b) To any person or organization Included as an insured under g. Broad Form Vendors
below; or
(c) To any person or organization included as an insured by an endorsement issued by us
and made a part of this Coverage Part.
(2) When an engineer, architect or surveyor becomes an insured underthis Coverage Part, the
following additional exclusion applies:
(a) "Bodily injury", "property damage", "personal and advertising injury" arising out of the
rendering of or the failure to render any professional services by or for you, including:
(i) The preparing, approving, or failing to approve maps, drawings, opinions, reports,
surveys, change orders, designs or specifications; and
(ii) Supervisory, inspection, or engineering services.
(3) When a lessor of leased equipment becomes an insured under this Coverage Part, the
following additional exclusions apply:
(a) To any "occurrence" which takes place after the equipment lease expires; or
(b) To "bodily injury" or "property damage" arising out of the sole negligence of the lessor.
(4) When owners or other interests from whom land has been leased become an insured under
this Coverage Part, the following additional exclusions apply:
(a) Any "occurrence" which takes place after you cease to lease that land; or
(b) Structural alterations, new construction or demolition operations performed by or on
behalf of the owners or other interests from whom land has been leased.
g. Broad Form Vendors - Any person or organization with whom you agreed, because of a
written contract or agreement to provide insurance, but only with respect to "bodily injury" or
"property damage" arising out of "your products" which are distributed or sold in the regular
course of the vendor's business, subject to the following additional exclusions. X ��A.
(1) The insurance afforded the vendor does not apply to:
(a) "Bodily injury" or "property damage" for which the vendor is obligated to pay
by reason of the assumption of liability in a contract or agreement. This ex ien
not apply to liability for damages that the vendor wouId have in the absence of the
contract or agreement;
(b) Any express warranty unauthorized by you; ,
(c) Any physical or chemical change in the product made intentionally by the v ar;
(d) Repackaging, unless unpacked solely for the purpose of Inspection, dem strati,
testing or substitution of parts under instructions from the manufacturer, and then
repackaged in the original container;
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(e) Any failure to make such inspections, adjustments, tests or servicing as the vendor has
agreed to make or normally undertakes to make in the usual course of business, in
connection with the distribution or sale of the products;
(f) Demonstration, installation, servicing or repair operations, except such operations
performed at the vendor's premises in connection with sale of the product;
(g) Products which, after distribution or sale by you, have been labeled or relabeled or used
as a container, part or ingredient of any other thing or substance by or for the vendor.
(2) This provision does not apply to any insured person or organization, from whom you have
acquired soon products, or any ingredient, part or container, entering into, accompanying or
containing such products.
(3) This provision does not apply to any vendor included as an Insured by an endorsement
Issued by us and made a part of this Coverage Part.
(4) This provision does not apply If "bodily injury" or "properly damage" included within the
"products•Completed operations hazard" Is excluded either by the provisions of the
Coverage Part or by endorsement.
1. SECTION III — LIMITS OF INSURANCE, Paragraph 2., is amended to the following:
The General Aggregate limit is the most we will pay:
a. For all sums which the insured becomes legally obligated to pay as damages caused by
"occurrences" Linder SECTION I — COVERAGE, COVERAGE A BODILY INJURY AND
PROPERTY DAMAGE LIABILITY, and for all medical expenses caused by accidents under
SECTION I — COVERAGE, COVERAGE C MEDICAL PAYMENTS which can be attributed only
to operations at a single designated "campus" shown in the Declarations.
(1)A separate General Aggregate Limit is applicable to each single designated "campus" shown
in the Declarations and that limit is equal to the amount of the General Aggregate Limit
shown In the Declarations.
(2) The General Aggregate Limit is the most we will pay for the sum of all damages under
COVERAGE A, except damages because of °bodily injury" or "property damage" included in
the "products -completed operations hazard", and for medical expenses under COVERAGE C
regardless of the number of:
(a)Insureds;
(b) Claims made or "suits" brought; or
(c) Persons or organizations making claims or bringing "suits".
(3) Any payments made under COVERAGE A for damages or under COVERAGE C for medical
expenses shalt reduce the General Aggregate Limit for that designated "campus". Such
payments shall not reduce the General Aggregate Limit shown in the Declarations nor shall
they reduce any other General Aggregate Limit for any other designated "campus" shown in
the Declarations.
(4) The limits shown in the Declarations for Each Occurrence, Fire Damage and Medical
Expense continue to apply, However, instead of being subject to the General Aggregate
Limit shown In the Declarations, such limits will be subject to the applicable single �C'?
designated "campus" General Aggregate Limit,
2. SECTION V — DEFINITIONS is amended by adding the following:'eIly 3J���.
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"Campus" is defined as premises involving the same or connecting lots, or premises whose
connection is interrupted only by a street, roadway, waterway or right-of-way of a railroad.
I. Duties in the Event of Occurrence. Claim or Suit
1. The requirement in Paragraph 2.a, of SECTION IV -COMMERCIAL GENERAL LIABILITY
CONDITIONS that you must see to it that we are notified as soon as practicable of an "occurrence"
or an offense, applies only when the "occurrence" or offense is known to;
a. You, if you are an individual;
b. A partner, if you are a partnership; or
c. An executive officer or insurance manager, If you are a corporation.
2. The requirement in Paragraph 2.b. of SECTION IV — COMMERCIAL GENERAL LIABILITY
CONDITIONS that you must see to it that we receive notice of a claim or "suit" as soon as
practicable will not be considered breached unless the breach occurs after such claim or "suit" is
known to:
a. You, if you are an Individual;
b. A partner, if you are a partnership; or
c. An executive officer or insurance manager, if you are a corporation.
J. Other insurance — Primary Additional Insured
1. If the written contract or agreement or permit requires this insurance to be primary for any person
or organization with whom you agree to include in SECTION 11- WHO IS AN INSURED, then
SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS, Subsection 4.Other
Insurance is replaced by the following:
If other valid and collectible insurance is available for a loss we cover under COVERAGE A of this
Coverage Part, our obligations are limited as follows:
a. Primary Insurance - This Insurance Is primary. We will not seek contributions from other
insurance available to the person or organization with whom you agree to Include in SECTION
11- WHO IS AN INSURED, except when 2. below applies.
b. Excess Insurance -This insurance is excess over any of the other insurance whether primary,
excess, contingent or any other basis:
(1) That is Fire, Extended Coverage, Builder's Risk, Installation Risk or similar coverage for
"your work";
(2) That is Fire, lightning or explosion insurance for premises rented to you; or temporarily
Occupied by you with permission of the owner; or
(3) If the loss arises out of the maintenance or use of aircraft, "autos" or watercraft to the extent
not subject to SECTION I — COVERAGE, COVERAGE A BODILY INJURY AND
PROPERTY DAMAGE LIABILITY, Subsection 2. Exclusions, Paragraph g.
When this insurance is excess, we will have no duty under Coverages A or B to defend any
claim or "suit" that any other insurer has a duty to defend. If no other Insurer defends, we will
undertake to do so, but we will be entitled to the Insured's rights against all those other
Insurers.
When this insurance is excess over other Insurance, we will pay only our share of the amount ���
of the loss, if any, that exceeds the sum of: .9
Z mil`
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PI-GLD-VS (01108)
(1) The total amount that all such other insurance would pay for the loss in the absence of this
insurance; and
(2) The total of all deductible and self -insured amounts under all other insurance.
We will share the remaining loss, if any, with any other insurance that is not described in this
excess insurance provision and was not bought specifically to apply in excess of the Limits of
insurance shown in the Declarations of this Coverage Part.
c. Method of Sharing - if all the other insurance permits contribution by equal shares, we will
follow this method also. Under this approach each insurer contributes equal amounts until it
has paid Its applicable limit of insu rance or none of the loss remains, whichever corns first.
If any or the other insurance does not permit contribution by equal shares, we will contribute
by limits. Under this method, each insurer's contribution is based on the ratio of Its
applicable limits of insurance of all insurers.
2. This provision only applies with respect to your operations, "your work" or facilities owned or
used by you.
K. Other Insurance — You Are An Additional Insured On Another Persons Or Orttanixation's
If you are an insured under SECTION It - WHO IS AN INSURED, then SECTION IV — COMMERCIAL
GENERAL LIABILITY CONDITIONS, Subsection 4.OTHER INSURANCE, Paragraph b. Excess
Insurance is replaced by the following:
This insurance is excess over any other insurance, whether primary, excess, contingent or on any
other basis:
1. That is Fire, Extended Coverage, Builders Risk, Installation Risk or similar coverage for "your
work';
2. That is Fire, lightning or explosion insurance for premises rented to you or temporarily occupied by
you with permission of the owner;
1 It the loss arises out of the maintenance or use of aircraft, "autos" orwatercraft to the extent not
subject to SECTION I — COVERAGE, COVERAGE A BODILY INJURY AND PROPERTY
DAMAGE LIABILITY, Subsection 2. Exclusions, Paragraph 9,; or
4. When any of the Named Insureds, under this Coverage Part, are additional insureds under a
commercial general liability policy or similar insurance of another party.
When this insurance is excess, we will have no duty under Coverages A or B to defend any claim or
"suit" that any other insurer has a duty to defend. If no other insurer defends, we will undertake to do
so, but we will be entitled to the Insured's rights against all those other Insureds.
When this insurance is excess or other insurance, we will pay only our share of the amount of the loss,
If any, that exceeds the sum of:
1. The total amount that all suoh other insurance would pay for the loss in the absence of this
insurance; and
2. The total of all deductible and self -Insured amounts under all that other insurance.
We will share the remaining loss, If any, with any other insurance that is not described In this Excess
Insurance provision and was not bought specifically to apply in excess of the Limits of Insurance
shown in the Declarations of this Coverage Part. \��u
e14 U1 ��
r
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L. Unintentional Failure To Disclose Hazards
It is agreed that, based on our reliance on your representations as to existing hazards, if you should
unintentionally fail to disclose all such hazards prior to the beginning of the policy period of this
Coverage Part, we shell not deny coverage under this Coverage Part because of such failure.
M. Liberalization
If we revise this endorsement to provide more coverage without additional premium charge, we will
automatically provide the additional coverage to all endorsement holders as of the day the revision is
effective in your state.
N. Bodily Iniury - M2_rAal Anguish
SECTION V — DEFINITIONS, Paragraph 9. is changed to read:
"Bodily Injury":
a. Means bodily injury, sickness or disease sustained by a person, and Includes mental anguish
resulting from any of these; and
b. Except for mental anguish, Includes death resulting from the foregoing (item a. above) at any
time.
O. Personal and Advertising Iniury — Abuse of Process. Discrimination
If COVERAGE B PERSONAL AND ADVERTISING INJURY LIABILITY COVERAGE is not otherwise
excluded from this Coverage Part, the definition of "personal and advertising injury" is amended as
follows:
1. SECTION V — DEFINITIONS, Paragraph 14. b. is revised to read:
b. Malicious prosecution or abuse of process:
2. SECTION V — DEFINITIONS, Paragraph 14. is amended to include the following:
"Personal Injury" also means discrimination based on race, color, religion, sex, age or national
origin, except when:
a. Done intentionally by or at the direction of, or with the knowledge or consent of:
(1) Any insured; or
(2) Any executive officer, director, stockholder, partner or member of the insured; or
b. Directly or indirectly related to the employment, former or prospective employment,
termination of employment, or application for employment of any person or persons by an
insured; or
c. Directly or Indirectly related to the sale, rental, lease or sublease or prospective sales, rental,
lease or sub -lease of any room, dwelling or premises by or at the direction of any insured, or
d. Insurance for such discrimination is prohibited by or held in violation of law, public policy,
legislation, court decision or administrative ruling.
The above does not apply to fines or penalties imposed because of discrimination.
P. Transfer of Rights of Recovery Against Others To Us
b6.
As a cladfication, the following is added to SECTION IV — COMMERCIAL GENERAL LIABILITY 0�
CONDITIONS, Subsection 8. Transfer of Rights of Recovery Against Others To Us: \e� A 00
12
dQ..
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Therefore, the insured can waive the insurer's Rights of Recovery prior to the occurrence of a loss,
provided the waiver is made in a written contract.
g. Science Laboratory "Occurrence"
SECTION I — COVERAGE, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE
LIABILITY, Subsection 2. Exclusions, Paragraph f. does not apply to any "bodily injury" or "physical
damage" arising cut of a fire or "occurrence" in any of your science laboratories while teaching is being
conducted in that laboratory, subject to a $50,000 per policy limit.
R. Medical Incident Liability -Nurse and Athletic Trainer
1. SECTION II — WHO IS AN INSURED, Subparagraph 2.a. (t) (d) is deleted and replaced by the
following:
(d) Arising out of his or her providing or falling to provide professional medical services. This
paragraph does not apply to a registered or practical nurse or athletic trainer, while acting within
the scope of his or her duties for the Named Insured and arising out of a "medical Incident".
2. SECTION V — DEFINITIONS,13. is deleted and replaced bythe following:
"Occurrence" means an accident, including continuous or repeated exposure to substantially the
same general harmful conditions, and "medical incident".
3. The following definition is added to SECTION V — DEFINITIONS:
"Medical Incident" means any act oromission in the furnishing or failure to furnish professional
medical services by the insured or any person acting under the personal direction, control, or
supervision of the insured. Any such act or omission together with all related acts or omissions in
the furnishing of such services to any one person shalt be considered one "medical incident".
"Medical incident" does not include any actual, alleged or threatened emotional, physical, or sexual
abuse of any patient or professional medical services recipient.
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WORKERS' COMPENSATION DECLARATION
I a "' Si`� Vl�hereby affirm under penalty of perjury, the
(Name/Title
following declaration
I certif on behalf of Y iy l)G �r I that during the ternz of my
Consultant/Company Name)
contract for 1R �(services with the City of Santa Ana, I will
not employ any person in any manner so as to become subject to the workers'
compensation laws of California, and agree that if I should become subject to the
workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with those provisions and provide proof of workers' compensation coverage.
DATE: l�
By:
Nam
Title
Tele
S
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN
ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR
IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
e,.04 ��'
EVANSTON INSURANCE COMPANY
CERTIFICATE NO.: 2017-19
CERTIFICATE OF INSURANCE
SPECIAL EVENT LIABILITY PROGRAM
1PRODUCER
PUBLIC ENTITY (ADDITIONAL INSURED)
Alliant Insurance Services, Inc. in conjunction with
City of Santa Ana
Apex Insurance Services
20 Civic Center Plaza
P. O. Box 6450
Santa Ana, CA 92701
Newport Beach, CA 92658
License No: OC 36861
NAMED INSURED (EVENT HOLDER):
EVENT INFORMATION:
Vessica Campos
TYPE: Dance
7082 Senway Drive, Apt. 5
DATE(S): 01/04/17 — 12/31/17
Westminster, CA 92683
LOCATION: Memorial Center
*Liquor Liability YesE] NoZ
**Lisuor Liability after 12 am ends before 2 am ❑
'Phis is to certify that the insurance policy listed below has been issued to the above insured named (event holder) for the policy
period indicated. The insurance described herein is subject to all the terms, exclusions and conditions of such policy(ies) unless
amended as described in Special Conditions.
INSURANCE CARRIER: Evanston Insurance Company
MASTER POLICY NUMBER: SEP41023
MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2017 EXPIRATION: JANUARY 1, 2018
COMMERCIAL GENERAL LIABILITY
OCCURRENCEFORM
DEDUCTIBLE: NONE
General Aggregate Limit �S 2,000,000
Products & Completed Operations 1,000,000
SPECIAL CONDITIONS:
Personal & Advertising Injury 1,000,000
The following endorsements attached to
Each Occurrence Limit 1,000,000
the Master Policy do not apply to, this
Damage'] o Premises Rented To You (Any One Premises) 100,000
Certificate OfInsurance:
Medical Payments (Any One Person) 5,000
Liquor Liability (if purchased) 1,000,000
Optional Limits Purchased
F-1 $ 1,000,000/S3,000,000
F-1 $2,000,000/S2,000,000
Damage To Property (if purchased)
,Net
The limits Of insurance apply separately to each event insured by this policy as ifa
separate policy ofjEAy�aAheq4g
orAjjevent.
OTHER ADDITIONAL IN9ffkDS CS
CANCELLATION: Should the above described policy be cancelled before the expiration date thereof, notice will be delivered in accordance with the policy
provisions.
AUTHORIZED REPRESENTATIVE:
DATE ISSUED: January 4, 2017 by Stella Faiardo