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HomeMy WebLinkAboutGALAXY PARTY RENTALS 4 - 2018City of Santa Ana - Clerk of the Council AGREEMENT TERMINATION FORM Please complete this form in its entirety when the attached agreement and all 2P JUL 19 I'M �: no amendments (if any) are no longer in effect. Note: If your agreement is grant related, please ensure that all grant retention requirements CITY OF S ANTA ANA have been satisfied prior to signing the termination form. CLERK OF COUNCIL 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 No. N-2018-082 was completed on and final payment has been made. (list all amendments. Use space below if needed.) Department: Phone/Ext.: j Signature: (1 �+f�c\eG \uC-,,VCk n Date: yA 1 { 115 Revised: 10-18-16 INSURANCE ON FILE WORK MAY PROCEED UNTIL INSURANCE EXPIRES _ l 9- 6-/p ° /�-/fK-7 N-2018-082 CLERK OF C UNCIL °h DATE: MpY y Z 201% O: PRCS (/ ) AGREEMENT WITH GALAXY PARTY RENTALS Silvia Cuevas THIS AGREEMENT is made and entered into this 10`h day of May, 2018 by and between Galaxy Party Rentals ("Contractor"), 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 Contractor having special skill and knowledge in the field of providing and removing. rental.equipment for special events such as the Santa Ana.. - Public Library 2018 Summer Programs Kick-off Event on May 19, 2018 ("Event' B. Contractor represents that Contractor is able and willing to provide such services to the City. C. In undertaking the performance of this Agreement, Contractor represents that it is knowledgeable in this field and that any services performed by Contractor under this Agreement will be performed in compliance with such standards as may reasonably be expected from a professional consulting firm in the field, NOW THEREFORE, in consideration of the mutual and respective promises, and subject to the terms and conditions hereinafter set forth, the parties agree as follows: I. SCOPE OF SERVICES Contractor shall provide, install, set-up, maintain and remove rental equipment at the Santa Ana Public Library located at 26 Civic Center Plaza, Santa Ana, CA 92701 for the Event. Equipment to be provided by Contractor includes, but is not limited to tables, chairs, canopies and generators as set forth in Exhibit A to this Agreement (the "Equipment"). 2. COMPENSATION a. City agrees to pay, and Contractor agrees to accept as total payment for its services, the rates and charges identified in Exhibit B. The total sum to be expended under this Agreement shall not exceed One Thousand Five Hundred Dollars, $1,500. b. Payment shall be made within thirty (30) days following receipt of proper invoice evidencing work performed, subject to City accounting procedures. Payment need not be made for work which fails to meet the standards of performance set forth in the Recitals which may reasonably be expected by City. 3. TERM This Agreement shall commence on the date first written above and terminate on May 31, 2018, unless terminated earlier in accordance with Section 12, below. 4. INDEPENDENT CONTRACTOR Contractor 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 professional manner in which Contractor performs the services which are the subject matter of this Agreement; however, the services to be provided by Contractor shall be provided in a manner consistent with all applicable standards and regulations governing such services. Contractor shall pay all salaries and wages, employer's social security taxes, unemployment insurance and similar taxes relating to employees and shall be responsible for all applicable withholding taxes. 5. INSURANCE Prior to undertaking performance of work under this Agreement, Contractor shall maintain and shall require its subcontractors, if any, to obtain and maintain insurance as described below: a.. Commercial General Liability Insurance. Contractor shall maintain commercial general liability insurance naming the City, its officers, agents, volunteers, and employees 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 Contractor'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. Contractor shall supply City with a fully executed additional insured endorsement upon execution of this Agreement and shall be approved in form by the City of Santa Ana. 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. Business automobile liability insurance, or equivalent form, with a combined single Iimit of not less than $1,000,000 per occurrence. Such insurance shall include coverage for owned, hired and non -owned automobiles. c. Worker's Compensation Insurance. In accordance with the California State law, Contractor, if Contractor 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, Contractor agrees to obtain and maintain any employer's liability insurance with limits not less than $1,000,000 per accident. d. The following requirements apply to the insurance to be provided by Contractor pursuant to this section: (i) Contractor shall maintain all insurance required above in full force and effect for the entire period covered by this Agreement. (ii) Certificates of insurance shall be furnished to the City upon execution of this Agreement and shall be approved in form by the City. (iii) Certificates and policies shall state that the policies shall not be cancelled or reduced in coverage or changed in any other material aspect without thirty (30) days prior written notice to the City. e. If Contractor 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 terminate this Agreement. Such termination shall not affect Contractor's right to be paid for its time and materials expended prior to notification of termination. Contractor 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 Contractor agrees to and shall defend, indemnify and hold harmless the City, its officers, agents, employees, Contractors, 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 direct or indirect operations of the Contractor or its 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. 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. The Contractor 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 challenging the validity of this Agreement, or asserting that personal injury, damages, just compensation, restitution, judicial or equitable relief due to personal or property rights arises by reason of the terms of, or effects arising from this Agreement. City may make all reasonable decisions with respect to its representation in any legal proceeding. 7. CONFIDENTIALITY If Contractor receives from the City information which due to the nature of such information is reasonably understood to be confidential and/or proprietary, Contractor agrees that it shall not use or disclose such information except in the performance of this Agreement, and further agrees to exercise the same degree of care it uses to protect its own information of like importance, but in no event less than reasonable care. 8, CONFLICT OF INTEREST CLAUSE Contractor covenants that it presently has no interests and shall not have interests, direct or indirect, which would conflict in any manner with performance of services specified under this Agreement. 9. 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: Clerk 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 copies to: Parks, Recreation and Community Services Agency City of Santa Ana 20 Civic Center Plaza (M-23) P.O. Box 1988 Santa Ana, California 92702 Fax: (714) 571-4221 and City Attorney City of Santa Ana 20 Civic Center Plaza (M-29) P.O. Box 1988 Santa Ana, California 92702 Fax: (714) 647-6515 To Contractor: Galaxy Party Rental 11787 Cardinal Circle Garden Grove, California 92843 Phone: (714) 569-1638 A party may change its address by giving notice in writing to the other party. 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 Contractor regarding the subject matter therein, 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 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 Contractor. 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 Contractor nor the City. Each party to this Agreement acknowledges that no representations, inducements, promises or agreements, orally or otherwise, have been made by any party, or anyone acting on behalf of any party, which are not embodied herein. 11. ASSIGNMENT Inasmuch as this Agreement is intended to secure the specialized services of Contractor, Contractor 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. Nothing in this Agreement shall be construed to limit the City's ability to have any of the services which are the subject to this Agreement performed by City personnel or by other Contractors retained by City. 12. TERMINATION This Agreement may be terminated by the City upon three (3) days written notice of termination. In such event, Contractor shall be entitled to receive and the City shall pay Contractor compensation for all services performed by Contractor prior to receipt of such notice of termination, 13. NONDISCRIMINATION Contractor shall not discriminate because of race, color, creed; religion, sex, marital status, sexual orientation, age, national origin, ancestry, or disability, as defined and prohibited by applicable law, in the recruitment, selection, training, utilization, promotion, termination or other employment related activities or in connection with any services performed under this Agreement. Contractor affirms that it is an equal opportunity employer and shall comply with all applicable federal, state and local laws and regulations, 14, JURISDICTION - VENUE This Agreement has been executed and delivered in the State of California and the validity, interpretation, performance, and enforcement of any of the clauses of this Agreement shall be determined and governed by the laws of the State of California. Both parties further agree that Orange County, California, shall be the venue for any action or proceeding that may be brought or arise out of, in connection with or by reason of this Agreement. 15. PROFESSIONAL LICENSES Contractor 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. Contractor shall notify the City immediately and in writing of its inability to obtain or maintain such permits, licenses, approvals, waivers, and exemptions. Said inability shall be cause for termination of this Agreement. 16. MISCELLANEOUS PROVISIONS a. Each undersigned represents and warrants that its signature hereinbelow has the power, authority and right to bind their respective parties to each of the terms of this Agreement, and shall indemnify City fully, including reasonable costs and attorney's fees, for any injuries or damages to City in the event that such authority or power is not, in fact, held by the signatory or is withdrawn. b. All Exhibits referenced herein and attached hereto shall be incorporated as if fully set forth in the body of this Agreement. Signahire Page to Follow N-2018-082 IN WITNESS WHEREOF, the parties hereto have executed dus Agreement on the date and year first abo% e written. ATTEST: /Maria D. fluizar /.) Clerk Of the COUnCil APPROVED AS TO FORM: SONIA R. CAR �r ALHO CITY ATTORNEY Laura Rossini Senior Assistant City Attornep RECOMMENDED FOR APPROVAL: CITY OF SANTA ANA Raul -6c, —(f, 1-1 e z City Manager CONTRACTOR: Galaxy Party Rentals Name: e -�o C,g 0 4iwla Title: Tax ID# Z 2,9 Z 6' Gerardo Co u et, Executive Direcor Parks, Recreation & Community Services Agency Exhibit A SCOPE OF SERVICES VENDOR INFORMATION: Galaxy Party Rentals 11787 Cardinal Circle Garden Grove, CA 92843 (714)569-1638 EVENT: Santa Ana Public Library 2018 Summer Programs Kick-off Event TERM: Saturday, May 19, 20I8 COMPENSATION: Not to exceed $1,500.00 for the duration of this term. DESCRIPTION: Galaxy Party Rentals is a party equipment rental service. This vendor is to provide their service on Saturday, May 19, 2018 for the Summer Programs kick-off event. The event will take place at the Main Library located at: 26 Civic Center Plaza, Santa Ana, CA 92701. The City will be responsible for obtaining the proper approvals for use of City space and for advertising the even to patrons. Vendor will be responsible for proving equipment, materials, supplies and personnel necessary for the setup of the space the morning of the vent and break down of the space after the event is done. The services include but are not limited to tables, chairs and canopies. EXHIBIT A All renti The cus Additia long dis Additioi during < Cancelk charge. charge. Items al Linens c 11787 Cardinal Circle Garden Grove, CA 92843 714-569-1638 714-719-9498 www.galaxyparty rents.com Invoice For: Santa Ana Public Library Patricia Lopez 26 Civic Center Plaza Santa Ana, CA 92701 714-647-5325 plopez@santa-ana.org Comments or Special Instructions: Quality Out of This Worldl Farrm Ranrails DATE 5/11/2018 Time Invoice # 18016 Customer ID --- CUSTOMER COPY Delivery: Saturday 06/1912018 Pick -Up: Same Day 05119/2018 RESERVATION SALESPERSON EVENT DATE DATE OUT RETURN BY TERMS DATE Roberto Zavala Sr. 5/11/2018 5/19/18 05/19/2018 05/19/2018 1 24 Hours Rental QUANTITY DESCRIPTION UNIT PRICE TAXABLE? AMOUNT 14 30 15 10' x 10' Canopy Standard Folding Chair Rectangular Table 6' $ $ $ 75.00 0.85 6.50 1,050.00 25.50 97.50 Please Read The Following it items, execept linens, must be returned clean and dry. :omer is responsible for damaged or broken items upon return. ml service fees will be applied to difficut access deliveries such as, up stairs or Lances. ial service fees will be made for repeat trips if the customer is not present lelivery or pick-up, unless prior arrangements have been made. tions done at least 48hrs before delivery date will result in a 35%cancellation done within 48hrs of delivery date will result in a 50% restocking e charged while out on rental, whether used or not. re to be returned dry and free of all food and debris. SUBTOTAL TAX DELIVERY/PICK-UP SET UP/TAKE DOWN DONATIONEs TOTALCancellations DOWN PAYMENT BALANCE $ 1,173.00 35.00 THANK YOU FOR CHOOSING GALAXY PARTY RENTALS Exhibit B Party Rentals Price List Standard Folding Chair..... .85 Rectangular Table (61)....... 6.50 10' x 10' Canopy........... 75.00 15' x 20' Canopy........... 180.00 S' x 10' Canopy Wall....... 15.00 Canopy Weight (90 LBS)... 5.00 1 Dozen Balloons ............... 10.00 SANTAANA PUBLIC LIBRARY Saturday, May 19, 2018 10am-12pm Activities! Prizes! Library Resources! Learn about the Summer Reading Program! ��'FI r �J(�rr�l (`(Cf `r,Ff [PlIrrM, RF,VFr�.�,�r rF sabado, 19 de mayo del 2018 10am-12pm iActividades! iPremios! iRecursos de la Bibliotecal iAprenda sobre el programa de lectura! LA`Rnnchera 9 7 FM Main Library Newhope Library 26 Civic Center Plaza 122 N. Newhope Santa Ana, CA 92701 Santa Ana, CA 92703 (714) 647-5250 II,.�k„� (714) 647-6992 CERTIFICATE OF LIABILITY INSURANCE MIDDIYYYY' S/21/2021/2018 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 AN A J INSURCE 1000 Macarthur Blvd #66 Santa Ana, CA 92707 N-2018-082 OF,57419 NAME NTACT — PmA"�Es (714) 673-5549 lac Jo DD Ess:aiinsu.rainCe ive.com INSURERS AFFORDING COVERAGE NAICq INSURERA,.NESA UNDERWRITERS SPECIALTY INS. 36838 INSURED GALAXY PARTY RENTALS ZAVALA, ROBERTO AND EUGENIO PEREZ 11707 CARDINAL CIR GARDEN GROVE, CA 92843----- INSURER B: INSURER _ INBURERD: SURER F' ChVr GAr]rC IIE1ICIn ATC nC a.eom. ­........ ......—._._ 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 REOUIREMENT. 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 SY PAID CIEMMS. INSIR LTR TYPE OF NSDRANCE R o POLICY NB OD F MMIDDY/VYY LIMITS GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 R COMMERCIAL GENERAL LIABILITY CLAIMS MADE `t OCCUR _ MAUL IU R N `U $ 100,000 S 5,000 MED EXP An ane erson A R DED: $500 MP0004014000837 09/26/1709/26/1Q. PERSONAL AADVINJURY s 1,000,000. GENERAL AGGREGATE s 2,000,000 GENT AGGREGATE 1R POLICY LIMITAPPLIEB PRO PER: LDC PRODUCTS, COMPIOP AGO s 2,000,000 $ AUTOMOBILE LIABILITY COMBINED tDLELIMIT ..I BODILY INJURY (Per person) $ ANYAUTO ALLOWNED SCHEDULED AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS H I BODILY INJURY (PeracdtlenU $ PROPERTY DAMAGE Per BCCI,.0 S S UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE S EXCESS LIAB 11M5-MADE WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PRO PRIETORIPARTNE RI EXECUTIVE OFFICERIMEMBER EXCLUDED? (Mgnd.0r, In NH) r IPS desa'Iba under DESCRIPTION Of OPEIi Tb Sbelow NIA WC STATU- }[ pTH E. L. FJ�CH ACCIDENT S E.L. DISEASE -EA EMPLOYEE S IS E, POLICY LIMIT S CONTENTS: A PROPERTY MP0004014000837 09/26/17 09/26/18 $250,0000 DED: $1,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES IAnach ACORD iD1,Addlllonal Remerke SCM1edule,It mare space is required) PARTY RENTAL STORE: City of Santa Ana, its officers, agents and employees are named as additional ins�r`��. \Q SHOULD ANY OF THE ABOVE DESCRIBED LI AE IiVI LLED BEFORE City Of Santa Ana Public Library THE EXPIRATION DATE THEREOF OTICEL DELIVERED IN 26 Civic Center Plaza ACCORDANCE WITHTHE POLICY PAI VISIONS, Santa Ana, CA 92701 / AUTHORIZED REEBE / ©1 I All rights reserved. ACORD25 (2010/05) The ACORD name and logo are registered marks of ACORD ADDITIONAL INSURED ENDORSEMENT Insurance Company MESA UNDERWRITERS SPECIALTY INS. MPO� O04OITT83flQ�iifies such insurance as is offered by the provisions of Policy Number: relating to the following: 1. The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701; it officers, employees, agents and representative are named as additional insureds ("additional insureds") with regard to liability and defense of suits arising from the operations and uses performed by or on behalf of the named insured. 2. With respect to claims arising out of the operations and uses performed by or on behalf of the named insured, such insurance as is afforded by this policy is primary and is not additional to or contributing with any other insurance carried by or for the benefit of the additional insureds. 3. This insurance applies separately to each insured against whom claim is made or suit is brought except with respect to the company's limits of liability. The inclusion of any person or organization as an insured shall not affect any right which such person or organization would have as a claimant if not so included. 4. With respect the additional insureds, this insurance shall not be cancelled, or materially reduced in coverage or limits except after thirty (30) days written notice has been given to the City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701. (Completion of the Viewing, including countersignature, is required to make this endorsement effective.) Effective 03 / 0 8 / 18 , this endorsement form part of Policy # MP0004014000837 Issued to (Name Insured) GALAXY PARTY RENTAL Countersigned by / N-2018-082 WORKERS' COMPENSATION DECLARATION I Roberto Zavala hereby affirm under penalty of perjury, the (Kamen isle) following declaration I certify on behalf of _Galaxy Party Rentals that during the term of my (,ConsWtant/CtImpany Name) contract for Santa Ana Public Library 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: 03/21/2018 By: Name: Roberto Zavala Title: Co -Owner Telephone: 714-569-1638 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. ACOKO� VEHICLE OR EQUIPMENT CERTIFICATE OF INSURANCE DADomvYr 051111201 20188 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. This form is used to report coverages provided to a single specific vehicle or equipment. Do not use this form to report liability coverage provided to multiple vehicles under a single policy. Use ACORD 25 for that purpose. PRODUCER CONTACT NAME: Sedan Devereaux $tdiBF3/I/I Sadah Devereaux-Barrientoa 00NNa: 714541-7280 FAX Net! 714-3843892 owState Farm Agent E-mAIL a sariah 7145497280.com 1202 W 1st St PR0%mEERR ID . OF33249 Santa Ana CA 92703 INSURERIS AFFORDING COVERAGE NAIC0 INSURED INSURERA: State Farm Mutual Automobile Insurance Company 25178 Roberto Zavala Cardenas INSURER 8: 14132 Kerry St. INSURER c - NSURER D: Garden Grove CA 92844 INsuR E DON OF VEHICLE OR EOt YEAR MAKE/MANUFACTURER MODEL BODY TYPE VEHICLE IDENTIFICATION NUMBER 1994 GMC 3500 Box Truck 1GDKC34N9RJ519011 DESCRIPTION VEHICLEIEQUIPMENT VALUE SERIAL NUMBER COVERAGES CERTIFICATE NUMRFR' ocvl¢rAM MnMnco. THIS IS TO CERTIFY THATTHE POLICY(IES)OF INSURANCE LISTED BELOW HASIHAVE BEEN ISSUED TO THE INSURED NAMEDABOVE FOR THE POLICY PERIODS) INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICY(IES) DESCRIBED HEREIN ISIARE SUBJECTTO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICY(IES). INSR LTR ADIYL we. TYPEOFINSURANCE POLICY NUMBER POLICYEFFECTIVE DATE(MMIDp IYYYY) POUCYEXPIRATION PATE (MM1VDPIYYYY) LIMITS X VEHICLE UABILRY COMBINED SINGLE LIMIT $ A 1957791 F-12-758 12/12/2017 12/12/2078 BODILY INJURY (Par person) $ 1,000,00D BODILY INJURY (PerawitlaM) $ 1,000,000 PROPERTY DAMAGE S 11000,000 GENERAL LIABILITY EACH OCCURENCE S OCCURRENCE GENERALAGGREGATE S CLAIMS MADE $ INSR LTR Lase PAYEE TYPEOPINSURANCE POUCYNUMBER POLICY EFFECTIVE DATE(MM)DUIYYYYI POLICY EXPIRATION DATE(MMIDDIYYYY) LIMITS I DEDUCTIBLE VEH COLLISION LOSS ❑' ACV ❑AGREED AMT $ LIMIT ❑ ❑ STATED AMT It DIED VEH COMP VEH OTC o QACV El AGREED AMT $ LIMIT ❑ El STATED AMT $ DED EQUIPMENT BASIC R BROAD SPECIAL n n��G ❑ ACV ❑ AGREED AMT ❑ RC ❑ STATED AMT ❑ f LIMIT $ DED REMARKS (INCLUDING SPECIAL CONDITIONS I OTHER COVERAGES)(ANach RD 101911 Remarks Schedule, if spae. is referred) Comprehensive deductible: 100: collision deductible: 500; Uninsured MotBdst protection 250,0001500,000 AUUI I ZONAL IN I EKES I CANCELLATION Select one ofthe following: The addhronel interest described below he. been added to the policy(ies) listed herein by parity number(.). SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE A reaa�ast has been submitted to add the additional interest described bebw to the policy(ins) Ilatetl herel b o m ra. DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. VEHICLE I EOUIPMENT INTEREST: LEASED FINANCE° DESCRIPTION OF THE ADDITIONAL INTEREST X ADDITIONAL INSURED LOSS PAYEE NAME AND ADDRESS OF ADDITIONAL INTEREST CITY OF SANTA ANA LENDER'S LOES PAYEE 20 CIVIC CENTER PLAZA LOAN I LEASE NUMBER SANTA ANA, CA 92701 AUTHORIZEDR RESENTA 7 COR I rig is reserved. ACORD 23 (2016103) The ACORD name and logo are registered marks of ACORD 10C1361 1425487.3 01-26.2016 A ?!?El VEHICLE OR EQUIPMENT CERTIFICATE OF INSURANCE DATE IMMIDDNYYY' �1r..� 05111@018 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. This form is used to report coverages provided to a single specific vehicle or equipment. Do not use this form to report liability coverage provided to multiple vehicles under a single policy. Use ACORD 25 for that purpose. PRODUCER NAME: Sarah Devereaux StateFarm Sarah Devereaux -ea Boron a°N4 ,t. 714-541-7280 PaAxc N714-384.3892 State Farm Agent A. E MAI ADDRESS:. sarah@7145417280.00m 1202 W 1st St PR oCERCL1m OF33249 Santa Ana CA 92703 INSURER E AFFORDING COVERAGE NAIL r INSURED INSURER A; Stale Farm Mutual ADiGmoblle Insurance Company 25178 EUGENIO PEREZ MARTINEZ INSURER B: 1427 S DOUGLAS ST INSURER C NSURER D; SANTA ANA CA 92704 INSURER E: YEAR MORE I MANUFACTURER MODEL BUOY TYPE VEHICLE IDENTIFICATION NUMBER - 2003 HIND FE2620 Box Truck JHBFE2JG331S10052 DESCRIPTION VENICLEMCUIPMENT VALUE SERIAL NUMBER S THIS IS TO CERTIFY THAT THE POLICY(IES) OF INSURANCE LISTED BELOW HAS/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 POLICY(IES) DESCRIBED HEREIN IS/ARE SUBJECT TO . ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICY(IES). INSR LTR AODI MrpD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE(MMIDD/YYYYI POLICY EXPIRATION DAM(MMIDUIYYYY) LIMITS X I VEHICLE LIABILITY COMBINED SINGLE LIMIT $ A 5065359E1175D 02/22/2018 02/2212019 BODILY INJURY (Pet trench) 5 1,000,000 BODILY INJURY (Perecddent) 5 1,000,p00 PROPERTY DAMAGE 5 11000,000 ' GENERAL LIABILITY EACH OCCURENCE S OCCUR0.ENCE GENERAL AGGREGATE S CLAIMS MADE S INSR LTR Loss PAYE TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTNB DAM(MMNORYYY) POLICY EXPIRATION DATE(101"DIYYYY) LIMITS I DEDUCTIBLE VEH COLLISION LOSS []i ACV ❑AGREED AMT S LIMIT ❑ ❑ STATED AMT ItDED VEH COMP VEH OTC V ACV ❑ AGREED AMT E LIMIT ❑ ❑ STATEOAMT S DED EQUIPMENT BASIC BROAD SPECIAL � y� ^/ :A �� ❑ ACV [IAGREEDAMT 0 RC ❑ STATED AMT LIMIT S CEO GNa REMARKS (INCLUDING SPECIAL CONDITIONS I OTHER COVERAGES) (Ahach ACORD I Mid on.IR chnftlo. Il more 1P.00 is ropulred) - Comprehensive deductible: 100; collision deductible: 500; Uninsured Motorist protection 250,000/500,000 Select one of the following: SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED no eddlllonelinteresl dogviued blow Iran been added to the policy(ies) listed herein by policy number(s). BE FORE TH E EXPIRATION DATE TH EREOF, NOTICE WILL BE Are� tedurns hos been rubrWhihi to Bold the edtitlonol interest dsaaibed hlcw inthe ehicl(ies) DELIVERED INACCORDANCE WITH THE POLICY PROVISIONS. lisNareM by Aeiic numbertel. VEHICLE I EQUIPMENT INTEREST I ILEASEO I (FINANCED NAME AND ADDRESS OF ADDITIONAL INTEREST CITY OF SANTA ANA 20 CIVIC CENTER PLAZA SANTA ANA, CA 92701 X ADDITIONAL INSURED LOSS PAYEE LENDER'S LOSB PAYEE LOAN (LEASE NUMBER ACORD 23 (2016/03) The ACORO name and logo are registered marks of ACOIrD v 1004361 142987.3 0145-2016