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Home My WebLink AboutMCINTOSH, DEBORAH F..,, City of Santa Ana Clerk of the Council AGREEMENT TERMINATION FORM Please complete this form in its entirety when the attached e ment and all amendments (if any) are no longer in effect. M -6 Fhi 4: 22 Note: If your agreement is grant related, please ensure that all grant retention,t7qutrQSF; ts have been satisfied prior to signing the termination form. tt II YY UU ) J TA A N A Is the agreement(s) a permanent record? Yes No CLERIK OF COUNCIL Return form to the Clerk of the Council Office (M-30). Call 647-1520 if you have any questions. COTC Office Use Only The agreement with m, No. N-2017-128 was completed on -71LA and final payment has been made. (List all amendments. Use space below if needed.) Department: Nc22;A Phone/Ext.: Signature:4�4< Date: 'IIIc Lq Revised: 10-18-16 INSURANCE ON FILE WORK MAY PROCEED (10ANDL INSURANCE EXPIRES ?-G—•/7 CLERK OF COUNCIL DATE.J 1 �1Ci 0: PRCS U 1 Silvia Cuevas June 21, 2017 Deborah F. McIntosh ("Speaker/Performeo 23454 Darcy Lane Newhall, California 91321-3924 Re: Speaker/Performer Engagement Agreement N-2017-128 This letter represents your agreement with the City of Santa Ana ("City") as entered into on the above date for the engagement described below: 1. Event Description: Historical Re-enactment Services, Character: Betsy Ross 2. Date(s): Tuesday, July 4, 2017 3. Event Time(s): 5:30 p.m. to 9:30 p.m. 4. Location: Show will be presented at the Centennial Park, Santa Ana CA ("Property") 5. Compensation: $225 (payable by check within 30 calendar days of event) provided agreement is fully executed; Speaker/Performer must provide IRS form W-9 before payment can be made. 6. Equipment provided by City: 2 tables. Equipment provided by Speaker/Performer: all supplies, costumes, and equipment, required for the performance S. City Contact Person (for coordinating purposes only): Sonia Batres 9. Independent Contractor: Speaker/Performer shall, during the entire term of this Agreement, be construed to be an independent contractor and not an employee of the City. 'Phis 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 professional manner in which Speaker/Performer performs the services that are the subject matter of this Agreement; however, the services to be provided by Speaker/Performer shall be provided in a manner consistent with all applicable standards and regulations. Speaker/Performer 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. 10. Indemnification: Speaker/Performer, his or her agents, or employees (if applicable) agrees to and shall indemnify, defend, and hold harmless the City, its officers, agents, employees, consultants, special counsel, and representatives from and against all loss, expenses, or liability (including costs and attorney's fees) arising from the negligence or willful misconduct of Speaker/Performer, his or her agents, or employees. 11. Release: Speaker/Performer accepts the Property and any City -provided equipment used in connection with the performance in their "as -is" condition, with all faults. Speaker/Performer fully releases, waives and discharges forever any and all claims, demands, rights, and causes of action of any kind or nature against, and covenants not to sue, City, its elected officials, officers, employees, agents and volunteers, and all persons acting on behalf of, by, through or under each of them, under any present or future laws, statutes, or regulations for any claim or event relating to the condition of the Property or City -provided equipment or Speaker/Performer's use thereof. Letter Agreement — Deborah F. McIntosh Page 2 12. Commercial General Liability Insurance. Speaker/Performer shall maintain commercial general liability insurance naming the City, its officers, employees, agents, volunteers and representatives as additional insured(s) and 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 Speaker/Performer'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, with S2,000,000 in the aggregate. Such insurance shall: (1),name the City; its officers, employees, agents, volunteers, and representatives as additional insureds: (2) be`primary and not contributory with respect to insurance or self-insurance programs maintained by the City; and (3) contain standard separation of insured provisions. 13. Worker's Compensation Insurance. In accordance with the California Labor Code, Speaker/Performer, if Speaker/Performer has any employees, is required to be insured against liability for worker's compensation or to undertake self-insurance. 14. The City shall have the right and royalty -lice license to simulcast or produce and show a tape -delayed broadcast of Speaker/Performer's presentation to the City community or general public, through wcbcast or any other means. This license shall be non-exclusive and the copyright shall retrain with the Speaker/Performer. Copies of Speaker/Performer's presentation may be maintained by the City, and Speaker/Performer consents to use of such recordings. 15. Speaker/Performer shall not discriminate because of race, color, creed, religion, sex, marital status, sexual orientation, age, national origin, ancestry, disability, or any other basis protected by applicable law in connection with any activities related to this Agreement. 16. This Agreement shall in all respects shall be interpreted, enforced, and governed exclusively by and under the laws of the state of California. Both parties 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. 17. This Agreement represents the complete and exclusive statement between the City and Speaker/Performer regarding the subject matter herein and supersedes any and all other agreements, oral or written, between the parties. This Agreement may not be modified except by written instrument signed by the City and by an authorized representative of SpeaUr/Performer. Please execute this letter to reflect your agreement to the terms and conditions set forth herein. CITY OF SANTA AN C IIA TZ —lam Interim City M ATTEST: � -� MARIA D. FIUIZAR Clerk of the Council RECOMMENDED FOR APPROVAL. SPEAKER/PERFO%MER AX6 A G By: DEBORAH F. MCINTOSH APPROVED AS TO FOILM: By: L, JOH .FUNK Assistant City Attorney GERARDO MOUET, Executive Director, Parks, Recreation, and Community Services Agency Yfistory of Women EXHIBIT A Invoice #001:7-4-2017 To: Sonia Batres, Community Events Supervisor City of Santa Ana, Parks, Recreation & Community Services Agency 20 Civic Center Plaza, P.O.Box 1988 Santa Ana, CA 92702 Program: Independence Day Program as Betsy Ross Performance Date: Tuesday, July 4, 2017 Performance Time: Approximately 5:30 p.m. — 9:30 p.m. Arrival Time: Approximately 5:30 p.m. (could be earlier, traffic allowing) Address: Centennial Park — 3000 W. Edinger Avenue, Santa Ana • Portrayal of Betsy Ross, telling how she came to sew the "Stars and Stripes." • Platform stage presentation and booth presentation including showing how Betsy cut a perfect 5-pointed star with a snip of a scissors. • Display booth will include a sign and flags used during our history, • An appliqued star, and a 42-ft red stripe to illustrate how big the "Star-Spangled Banner" was. Fee: $225 payable to: Deborah F. McIntosh (History Through the Eyes of Women) 23454 Darcy Lane Newhall, CA 91321-3924 Thank you for your patronage A� �P CERTIFICATE OF LIABILITY INSURANCE DIG DA6/29/201.7 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must 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). PRODUCER Anthony Insurance Services, Inc. P.O. Box 927 Edwards, CO 81632 www.AnthonylnsuranceServices.com CONTACT NAME: PHOAICNNo EXt: NC, No: ADDRESS: lCaitlyn@anthonyinsuranceservices.com INSURER(S) AFFORDING COVERAGE NAICN INSURERA: U.S. Fire Insurance Company 21113 INSURED SPORTS AND RECREATION PROVIDERS ASSOCIATION(PURCHASING GROUP) AND ITS PARTICIPATING MEMBERS: INSURER B: INSURERC: HISTORY THROUGH THE EYES OF WOMEN INSURERD: DEBORAH MCINTOSH 23454 DARCY LANE INSURERE: INSURERF: NEWHALL, CA 91321 COVERAGES CERTIFICATE NUMBER: USS350089 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR rypEOFINSURANCE ADDL INSR SUER WVD pOLICYNUMeER POLICY EFF MMIDDIYYYY POUCYEXP MMIDDIYYYY LIMITS GENERALLIABILITY GENERALAGGREGATE $ 1.000,000 PRODUCTS-COMPIOP AGO $ 1,000,000 X COMMERCIALGENERA.UAyUTY PERSONAL &ADV INJURY $ 1,000,000 A Cl-NMS-MADE rX1 OCCUR SRPG-101-0717 12:01 01 A AM 12:01:0117 AM EACH OCCURRENCE 3 1,000,000 FIRE DAMAGE (Any one fire) S 300,000 MED EXP(Any One person) $ 5,000 GENL AGGREGATE LIMITAPPLIEe PER: -XI POLICY JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea acddem IS BODILY INJURY (Per person) $ ANY AUTO H\e ALL OWNED SCHEDULED AUTOS AUTOS 1(� BODILY INJURY (Per accident) $ HIREDAUTO NON-GMED AUTOS YJ� PROPERTY DAMAGE Peraccitlent $ S UMBRELLA LIAB OCCUR EACH OCCURRENCE IS EXCESS LIAB CUk MS -MADE S AGGREGATE $ BED RETENTION $ `ate r `yeA V •0 $ WORKERS COMPENSATION AND EMPLOYERS' UASIDTY YIN ANY PROPRIETORIPARTNER,EXEC1frIVE OFFICER/MEMBER EXCLUDED? ❑N/A \CA_ �j� �/ 1 GW J WCSTATU- To UMITS OTH Eft $ E.L. EACH $ (Mandatory in NH) E. L. DISEEASEASE-EA EMPLOYEE g DESCRIPTION OF OPERATIONS below E.L DISEASE - POLICY LIMIT AD&D MAXIMUM MEDICAL DEDUCTIBLE TERMS OF PAYMENT DESCRIPTION OF OPERATIONS I LOCATIONS i VEHICLES (Attach ACORD 101, AEEItIonal Remarks Schedule, it more space Is required) Covered Performer Type: Historical Portrayal. Certificate Holder is named as additional insured with respect to the operations of the Named Insured. CITY OF SANTA ANA, ITS OFFICERS, EMPLOYEES, AGENTS, VOLUNTEERS AND REPRESENTATIVES 20 CIVIC CENTER PLAZA SANTA ANA, CA 92701 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE API.��LPPI.rJ rPl�.l%'1-A-�L.C�,sF.l-V� @ 1988.2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD A� D® CERTIFICATE OF LIABILITY INSURANCE DA6/29/2017�) 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 INSURERS), AUTHORIZED REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the pollcy(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 Anthony Insurance Services, Inc. P.O. Box 927 Edwards, C081632 www.AnthonylnsuranceSarvices.com CONTACT NAME: NO PA/C NNE o Eat: AAIC No: ADDRESS: Caitlyn@anthonyinsuranceservices.com INSURERIS) AFFORDING COVERAGE NAIC0 INSURERA: U.S. Fire Insurance Company 21113 INSURED SPORTS AND RECREATION PROVIDERS ASSOCIATION(PURCHASING GROUP) AND ITS PARTICIPATING MEMBERS: INSURERS: INSURERC: HISTORY THROUGH THE EYES OF WOMEN DEBORAH MCINTOSH INSURERD: INSURERE: 23454 DARCY LANE INSURERE: NEWHALL, CA 91321 UUVEHAGES CERTIFICATE NUMBER: USS350OR9 OMIMIAM MITUMeo• 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 LTR I TYPE OF INSURANCE AODL INSR SUER LNID POLICYNUMEER POLICY EFF IMMIDWYYYI POUCYEXP flauuormYmLIMITS GENERALLIABILITY GENERALAGGREGATE E 1.000,000 X wMMERCIPI GENERAL DPBMTY PRODUCTS - COMP/OP AGG s 1,000,000 PERSONAL S ADV INJURY 5 LOMP00 cWMs MADE �acclw p SRPG-101-0717 7/:01 17 EACNOCCURRENCE 12:01 AM A 2:01 12:01 AM s 1,000,000 FIRE DAMAGE (Any one fve) $ 3DO,000 CEN'LAGOREGATE LIMIT APPLIES PER MED EXP(Any one person) $ 5,000 X POLICY JECT 7 Loa AUTOMOBILE LIABILITY OMBINEEDD SINGLE LIMITffs-cul $ ANYAUTO BODILY INJURY (Per person) $ AUOWNED OCKOULED BODILY INJURY (Per evident) s AUTOS AUTOS WREDAUTO NG300GWNED ` 41�•° PROP.dd.nq MACE V Per ectleem $ $ e LJUMBRELLA LIAB LJ OCCUR ^ e T� EACH OCCURRENCE $ EXCESS LIAR I CtAIMSMAOE q�j V AGGREGATE IS OEO I RETENTION a $ • �Y , `• WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN a, C\�\ yVC STATLL ToRY IIMITS orry $ ANY PROPRIETOmPARTNERADtECUfIVE cr v Eft E.L. E.L. EACH ACCIDENT $ OFRCERKAEMBER EXCLUDE))) NI ^GJ (Mandatory In NH) C E.L. DISEASE - EA EMPLOYEE IS ntt•.ae•vme unaer El- DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS csw AO&D MAXIMUM MEDICAL DEDUCTIBLE TERMS OF PAYMENT DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACOR0101, Additional Remarks Schedule, if mom space Is required) Covered Performer Type: Historical Portrayal, Proof of Insurance, HISTORY THROUGH THE EYES OF WOMEN DEBORAH MCINTOSH 23454 DARCY LANE NEWHALL, CA 91321 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE AvL>ji-" In,c Lra*Lu, Service V 15Stl-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY CG 20 26 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED — DESIGNATED PERSON OR ORGANIZATION Policy Number: SRPG-101-0717/USS350089 Insured: History Through The Eyes of Women This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE City of Santa Ana, its officers, employees, agents, volunteers, and representatives 20 Civic Center Plaza Santa Ana, CA 92701 to 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 B. In connection with your premises owned by or rented to you. eday. s ue�a. 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