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HomeMy WebLinkAboutNOTEWORTHY PUPPETS, INC. 4City of Santa Pna t Clerk of the Cou.—Al 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TERMINATION FORM Please complete this form in its entirety when the attached agreement and all amendments (if any) are no longer in effect.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 have been satisfied prior to signing the termination form. 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 N-2018-111 No. was completed on (List all amendments. Use space below if needed.) Revised: 1418-16 COTC Office Use Only City of Santa Ana f 04 L 2p Clerk of the Council and final payment has been made. Department: -Fy r / PAV� tdU, Phone/Ext.: Signature: lC1ti� l �J fil7C)� Date: % INSURANCE ON FILE WORK MAY PROCEED UNTIL INSURANCE EXPIRES CLERK OF COU2 IL ep5" DATE: @1W O: PRCS (j ) Silvia Cuevas June 6, 2018 Noteworthy Puppets Inc. ("Speaker/Performer") 438 S. Lincoln Place Monrovia, CA 91016 Re: Sveaker/Performer Engagement Agreement N-2018-111 This letter represents your agreement with the City of Santa Ana ("City") as entered into on the above date for the engagements described below: 1. Event Description: Up to two (2) variety -type performances including without limitation storytelling, music, puppetry, magic, mimes, juggling, as further agreed upon by the parties for each performance. 2. Date(s): As specifically scheduled by the parties by mutual agreement during the period July 1, 2018 through June 30, 2019. 3. Event Time(s): Each performance will be approximately one hour in length. 4. Location: Santa Ana Main Library or Newhope Library Learning Center ("Property"). 5. Compensation: $325 for each performance (payable by check within 30 calendar days of event); Speaker/Performer must provide IRS form W-9 before payment can be made; total sum to be expended under this Agreement shall not exceed $650. 6. Equipment provided by City: No equipment, however, the City will be responsible for room set up and advertising the program. 7. Equipment provided by Speaker/Performer: all equipment, materials, supplies, and personnel necessary for each performance 8. City Contact Person (for coordinating purposes only): Michelle Loem or Lupita Arroyo 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. 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 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, its agents, or its 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, its agents, or its employees. 11, Release: Speaker/Performer, its agents, and employees accept the Property and any City -provided equipment used in connection with the performance in "as -is" condition, with all faults. Speaker/Performer, its agents, and employees, fully release, waive and discharge forever any and all claims, demands, rights, and causes of action of any kind or N-2018-111 Letter Agreement — Noteworthy Puppets, Inc. Page 2 nature against, and covenant not to sue, City, its elected officials, officers, employees, agents and volunteer, 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. 12. 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 $2,000,000 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 -free license to simulcast or produce and show a tape -delayed broadcast of Speaker/Performer's presentation to the City community or general public, through webeast or any other means. This license shall be non-exclusive and the copyright shall remain with the Speaker/Performer. Copies of Speaker/Performer's presentation may be maintained by the City, and Speaker/Perfornier 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 Speaker/Performer. CITY OF TA ANA RAUL GODINEZ II y City Manager ATTEST„ MAR D^ D. HUIZAR { Clerk of the Council RECOMMENDED FOR APPROVAL: SPEA ERF ER By: NOTEWORTHY PUPPETS, INC. APPROVED AS TO FORM: By:� 0-wi c)" d1,t _ LAURA ROSSINI Senior Assistant City Attorney JEANNIE JUR 'DO of Parks Recreation and Co --it Services A m y gency ACTING EXECUTIVE DIRECTOR 4CO & CERTIFICATE OF LIABILITY INSURANCE DATE DIYYYV) 05/11/201 S 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 have ADDITIONAL INSURED provisions or 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 endorsement(s). PRODUCER CONTACT NAME: Mass Merchandising K&K Insurance Group, Inc. - 1712 Magnavox Way Fort Wayne IN 46804 N-? 018 111 A10, No, Ext : 1-800-328-2317 FAX No 1-260-459-5502 E-MAIL DDRESS: info@eventinsurance-kk.com APRODUCER CUSTOMER ID: INSURER(S) AFFORDING COVERAGE NAIC# INSURED 2000648858 CP# 107 INSURER A: Nationwide Mutual Insurance Company 23787 Kevin Christian NOonchesier INSURER B: DBA: NOTEWORTHY PUPPETS INC INSURER C: 438 S LINCOLN PL MONROVIA, CA 91016 A Member of the Sports, Leisure & Entertainment RPG INSURER D: INSURER E- INSURER F: COVERAGES CERTIFICATE NUMBER: 2000361159 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. INER LTR TYPE OF INSURANCE ADOL INSD SUER WVD POLICY NUMBER POLICY EFF MWDD/YYY POLICY EXP MM/DDIYYVV LIMITS A X COMMERCIAL GENERAL LIABILITY X 6BRPG0000006426200 05/15/18 05/15/19 EACH OCCURRENCE $2,000,000 CIANMSMADE E] OCCUR 12:01 AM 12:01 AM DAMAGE TO RENTED PREMISES Ea Occurrence $1,000,000 MED EXP(Any one person) $5,000 PERSONAL &ADV INJURY Excluded GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $5,000,000 POLICY PROJECT LOC PRODUCTS-COMP/OP AGO $2,000,000 PROFESSIONAL LIABILITY OTHER: LEGAL LAB TO PARTICIPANTS $2,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT a accident BODILY INJURY (Per person) AUTO IANY OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) HIRED NON -OWNED AUTOS ONLY AUTOS ONLY t {y PROPERTY DAMAGE Per accident X Not provided while In Hawaii UMBRELLA OCCUR LAB,�\ EACH OCCURRENCE EXCESS LAB CLAIMS MADE DED RETENTION J��'\,' AGGREGATE WORKERS COMPENSATION ANY PROPRIETOWPARBNER/ ILITY YIN EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) N/AAND ` ✓w\ �. rP` 7 EACHA CID OTHER E.L EACH ACCIDENT E.A. DISEASE - EA EMPLOYEE f yes, describe under DESCRIPTION OF OPERATIONS below -'+ E.L. DISEASE- POLICY LIMIT A MEDICAL PAYMENTS FOR PARTICIPANTS 6BRPG0000006426200 05/15/18 12:01 AM 05/15/19 12:01 AM PRIMARY MEDICAL $5,000 EXCESS MEDICAL DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be allached If more space Is required) Performing as Puppeteer City of Santa Ana, its officers, agents and employees are added as an additional insured, but only for liability caused, in whole or in part, by the acts or omissions of the named insured CERTIFICATE HOLDER CANCELLATION City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Attn: Purchasing Department EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH 20 Civic Center Plaza THE POLICY PROVISIONS. Santa Ana, CA 92701 AUTHORIZED REPRESENTATIVE /45-0 1 {'^r�G�-N Owner/Manager/Lessor of Premises ©1988.2015 ACORD CORPORATION. All rights reserved. Coverage is only extended to U.S. events and activities. ** NOTICE TO TEXAS INSUREDS: The Insurer for the purchasing group may not be subject to all the insurance laws and regulations of the State of Texas. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 6BRPG0000006426200 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CANCELLATION This endorsement modifies insurance under the following: COMMON POLICY CONDITIONS, A. Cancellation, 2.b. is deleted and replaced by: 10 days before the effective date of cancellation if we cancel for any other reason. This endorsement applies only to the insureds designated below: Named Insured: Kevin Christian Noonchester DBA: NOTEWORTHY PUPPETS INC Additional Insured: City of Santa Ana, its officers, agents, and employees Attn: Purchasing Department 20 Civic Center Plaza Santa Ana, CA 92701 CP #107 Effective: 05/15/18 SRPG8016 09/08 POLICY NUMBER: 6BRPG0000006426200 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY INSURANCE - ADDITIONAL INSURED This endorsement modifies insurance under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS, 4. Other Insurance, a. the following is added: Coverage afforded under this Policy is primary insurance and OTHER INSURANCE shall not apply as respects to the additional insured named below, however this insurance does not apply to the sole negligence of such additional insured. Further, we will have no duty to defend such additional insured against any suit to which this insurance does not apply. Additional Insured: The City of Santa Ana, its Officers, Employees, Agents and Representatives 20 Civic Center Plaza Santa Ana, CA 92701 Insured: Kevin Christian Noonchester DBA: Noteworthy Puppets Inc. Effective Dates: 05/15/2018 — 05/15/2019 Cert # 107 SRPG8018 09/08 POLICY NUMBER: 6BRPG0000006426200 INTERLINE IL 12 01 1185 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY CHANGES Policy Change Number 1 POLICY NUMBER POLICY CHANGES EFFECTIVE COMPANY 6BRPG0000006426200 05/15/18 Nationwide Mutual Insurance Company NAMED INSURED AUTHORIZED REPRESENTATIVE Kevin Christian Noonchester K&K Insurance Group, Inc. DBA: NOTEWORTHY PUPPETS INC COVERAGE PARTS AFFECTED COMMERCIAL GENERAL LIABILITY COVERAGE CHANGES Form SRPG8018 is added to the Policy 5� Gc,P /X'� Authorized Representative Signature IL 12 01 11 85 Copyright, Insurance Services Office, Inc., 1983 Page 1 of 1 Copyright, ISO Commercial Risk Services, Inc., 1983 POLICY NUMBER: 6BRPG0000006426200 INTERLINE IL12011185 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY CHANGES Policy Change Number 2 POLICY NUMBER POLICY CHANGES EFFECTIVE COMPANY 6BRPG0000006426200 05/15/18 Nationwide Mutual Insurance Company NAMED INSURED AUTHORIZED REPRESENTATIVE Kevin Christian Noonchester K&K Insurance Group, Inc. DBA: NOTEWORTHY PUPPETS INC COVERAGE PARTS AFFECTED Common Policy Conditions CHANGES Form Number: SRPG8016 D1Add Form Delete Form Amend Form as Follows: CP# 107 *-/A� Authorized Representative Signature IL 12 01 11 85 Copyright, Insurance Services Office, Inc., 1983 Page 1 of 1 Copyright, ISO Commercial Risk Services, Inc., 1983 N-2018-111 WORKERS' COMPENSATION DECLARATION I _Kevin Noonchester hereby affirm under penalty of perjury, the (Name/Title) following declaration I certify on behalf of Noteworthy Puppets Inc. that during the term of my (Consultant/Company Name) contract for _EjMpetShow 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: February 212018 By: Name: Kevin Noonchester Title: Owner Telephone: 323-524-SHOW 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). 1N ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.