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HomeMy WebLinkAboutVERDUZCO, NANCY PO ALCALA (DBA YELLOW TURTLE ART STUDIO) 4 _ ............. d » 0 o E 12 c a) iS / § / c''''\VI b g Q a) X E rn o : .... ..4 .. .. a M, cp / __ / / — • . g C rey \ e• - . .. E / . : / / ) o b c / a / - G f • 0 / 0 o \ gIg 2 ® 7 E • -E-5 -E (1.) ° 43 ce / � _- 22 2 C • ± . / �/ o t: C 0 _ * ° { c / / a ° $ O = « \ 2 = / g / . § .Q � k * / k �\ \ o % 0 Q 0 - o -$ / _ 0 a. 4- vi - \ o \ a) § ° / ■ -C 2 E C / = £ ƒ 0 _ © 0 b / : c C o 0 _G o 2 ® > .\a E • e / \ o o / U 0 < �- / g ® / / @ \ s �\ E , � E \ _ / 07 a © g = « \ \ ,,,,,A,,,;,,, / E - ± 9 E7 0 7 a / E k \ / ƒ = o 0 . $ ? + Eoz2 . o % 2 } 114URANOE ON FILE WORK MAY PROCEED UNTIL INSURANCE EXPIRES N-2018-112 CLERK OF COUNCIL DATE: r a 2 3 2D18 CS Silvia Cuevvasas RECREATION SERVICES AGREEMENT Si THIS AGREEMENT is made and entered into this 1 Och day of May, 2018 by and between Nancy Alcala Verduzco dba YellowTortle Art Studio ("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.. vatious:.pottery/sculpting art classes in recreation class program. B. Provider represents that it is able and willing to provide such services to the City. C. In undertaking the performance of this Agreement, Provider represents that he/she/it is knowledgeable in their 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 parties agree as follows: 1. SCOPE OF SERVICES Provider shall perform those services as set forth in Exhibit A to this Agreement. COMPENSATION In consideration for the provision of the programs set forth in Exhibit A, City agrees to pay the Provider ninety percent (90%) 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 ten percept (10%) of all gross revenue received from program participants as an administrative fee. c11111111101Y111A] This Agreement shall commence on July 1, 20i8 and end on June30, 2019 unless terminated 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, employer's social security taxes, unemployment insurance and similar taxes relating to employees and shall be responsible for all applicable withholding taxes. Provider is not an agent, representative or employee of City and Provider shall have no authority to act on behalf of the City. 5. INSURANCE Prior to undertaking performance of work under this Agreement, Provider shall maintain and shall require its subcontractors, if any, to obtain and maintain insurance as described below: a. Commercial General Liability Insurance. Provider shall maintain commercial general liability insurance which shall include, but not be limited to protection against claims arising from bodily and personal injury, including death resulting therefrom and damage to property, resulting from any act or occurrence arising out of Provider's operations in the performance of this Agreement, including, without limitation, acts involving vehicles. The amounts of insurance shall be not less than the following: single limit coverage applying to bodily and personal injury, including death resulting therefrom, and property damage, in the total amount of $1,000,000 per occurrence and $2,000,000 in the aggregate. 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 ofinsured'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 furnished 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 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 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. 8. 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: 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 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: Ms. Nancy A. Verduzco 1247 S. Hickory St. Santa Ana, CA 92707 Phone: 714429-6943 Email: yellowturtleartstudio.weebly.com 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 terms of this Agreement and any attachments hereto, the terms of this Agreement shall prevail. This Agreement may not be modified except by written instrument signed by the City and by an authorized representative of Provider. The parties agree that any terms or conditions of any purchase order or other instrument that are inconsistent with, or in addition to, the terms and conditions hereof, shall not bind or obligate. Provider or the City. Each party to this Agreement acknowledges that no representations, inducements, promises or agreements, orally or otherwise, have been made by any party, or anyone acting on behalf of any party, which is not embodied herein. 0 11. ASSIGNMENT/SUBSTITUTES a. Assignment. The experience, knowledge, capability and reputation of Provider were a substantial inducement for City to enter into this Agreement. Therefore, Provider may not assign, transfer, delegate, or subcontract any interest herein without the prior written consent of the City and any such assignment, transfer, delegation or subcontract without the City's prior written consent shall be considered null and void. 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 may be 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 Lb. 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 future 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. 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 under 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. [Signatures on next page] WM EI 1 U IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first above written. ATTEST: Maria D. Huizar '? 7 Clerk of the Council APPROVED AS TO FORM: SONIA R. CARVALHO City Attorney By A-- L" Laura Rossini Senior Assistant City Attorney RECOMMENDED FOR APPROVAL: Gerardo Mollet Executive Director of Packs, ' Recreation and,Community Services Agency CITY OF SANTA ANA Raul Godinez 11 - City Manager PROVIDER: 4"ex4ec'rk Name: NatAlcala Verduzco dba Yellow Turtle Art Studio 82-4653147 Exhibit A SCOPE OF SERVICES A. Provider shall conduct various pottery/sculpting art classes for ages 6 and up. 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. INSTRUCTOR: Nancy Alcala, AGES 6-12yrs LOCATION: El Salvador Center, 1825 W. Civic Center Dr., Santa Ana (714) 647-6558 ADVENTURES WITH CLAY Children will explore and express their creativity while they discover the world of clay. The hands-on social environment allows for creativity to flourish while children learn techniques used to create sculptures, functional pieces, personalized keepsakes and much more. They will impress you and themselves as they become ceramic artist! All tools and materials will be provided. A material fee of $15 is due to the instructor on the first class meeting. • Adventures with Clay class will consist of monthly session, held 1 day per week, 1'/z hour per day ART CLASS FOR KIDS Art class for kids offers an approach to art and a varied medium that allows children to explore, discover, and create. Students will engage with art concepts, appreciation and history while developing skills for a variety of projects. This is also a great place to have fun and make friends. Each month culminates with an in class student art show. A material fee of $10 is due to the instructor on the first class meeting. • Art Class for Kids class will consist of monthly session, held 1 day per week, 1'/2 hour per day CERAMICS STUDIO Let your hands guide your artistic expression while you learn the basics of creating ceramic art. Both hand building and throwing methods of creating with clay are offered. Instruction will guide student through the fun and relaxing art of pottery making. Fee includes potter's wheel use, tools, materials, and kiln firings. A material fee of $20 is due to the instructor on the first class meeting. • Ceramics Studio class will consist of monthly session, held 1 day per week, 2 hours per day FAMILY CLAY WORKSHOP Join us for an evening of creativity and fun for all ages and experience levels. Learn clay hand building while making unique handmade keepsakes and gifts. Workshops are thorned as followed: April: Birdhouse, May: Mosaic Tile, June: Mug. Participating children under 6 must be accompanied by an adult. A $5 material fee is due to the instructor on the first day of class. • Family Clay Workshop class will consist of 1 class per month, for 1'/2 hour, per day 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 no more than 15 students. 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. A CERTIFICATE OF LIABILITY INSURANCE DATE (M M/DD/YYYY) 04/64/261a THIS CERTIFICATE IS ISSUED ASA 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: Hector Gonzalez Insurance Agency, Inc. PHONE FAX 2670 N Main St Ste 350 N-2018-112 (A/C, NO, EXT): 714-486-6163 (A/C, NO): 866-230-1263 E-MAIL ADDRESS: Insurancebrokerl1@yahoo.com Santa Ana CA 92705-6648 INSURER(S) AFFORDING COVERAGE NAIC# INSURED INSURERA: United States Liability Insurance Company Nancy Alcala DBA: Yellow Turtle Art Studio INSURERB: NSURERC: NSURER D: 1247 S HICKORY ST NSURER E; Santa Ana CA 92707 INSURER F; COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSU RED NAME ABOVE FOR THE POLICY PERIOD IN DICATED. NOTWITHSTANDING ANY RM OR CONDITION OF ANY CONTRACT OR OTH ER DOCUMENT WITH RESPECTTO WHICH TH IS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY TH E ED HEREIN IS SU BJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPEOFINSURANCE ADDINSDL SUBR WVD POLICYNUMBER POLICY BEE (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS ERCIALGENERALLIABILITY LAIMS-MADE X OCCUR V EACH OCCURRENCE $ 1,000,000 DAMAGETO RENTED PREMISES(Ea Occurrence) $100,000 MED EXP(Anyone person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 Y N CL 1859230 03/16/2018 03/15/2019 GENT AGGREGATE LIMITAPPLIES PER: X POLICY ❑ PROJECT LOC GENERALAGGREGATE $ 2,000,000 PRODUCTS - COMP/OPAGG $ Included OTHER: Professional Liability Ea $ Included AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANYAUTO BODILY INJURY (Per person) $ OWNEDAUTOS SCHEDULED ON LV AUTOS BODILY INJURY (Per accident)$ HIREDAUTOS NON -OWNED ONLY AUTOS ONLY PROPERTY DAMAGE (Peraccident) $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DGD RETENTION$ $ WORKERS COMPENSATION LIT AND EMPLOYERS' LIABIY PER STATUTE OTHER $ ANY PROPRIETOR/PARTNER/ Y/N EXECUTIVE OFFICER/MEMBERDED? N/A L��� `' ^ / \ E.L. EACH ACCIDENT $ E. L. DISEASE -EA EMPLOYEE (Mandatory In NH) E_ IfyesEXCLudesccibe under DESCRIPTION OF OPERATIONS below \\\� n Qj\ E.L. DISEASEPOLICYLIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101, Additional Remarks Schedule ay be alt G�leV ifm%re space is required) Certificate Holder it's officers, employees, agents, and representatives �" per attached CG2026 04113 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OTTER ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION The City of Santa Ana DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE / Z E q 20 Civic Center Plaza Santa Ana C ACORD25(2016/03) 31-1769 11-15 V U C/ ©1988-2015 ACORD CORPORATION. All Rights Reserved The ACORD name and logo are registered marks of ACORD United States Liability Insurance Company 1190 Devon Park Drive Wayne, PA 19087-2191 A Member Company of United States Liability Insurance Group (888)523-5545 Date 4/3/2018 To: ROBERT MORENO INSURANCE SERVICES Attn : Bind RMIS From : Bradley Clark bclark@usli.com / (888) 523-5545 x7316 Insured : Nancy Alcala Policy #: CL 1859230 Attached please find your endorsement(s) as requested. Add Additional Insured -Designated Person or Organization (minimum premium applies) Regards, Bradley Clark Attached: Endorsement 41 ENDORSEMENT #1 This endorsement, issued by United States Liability Insurance Company to Nancy Alcala DBA: Yellow Turtle Art Studio forms a part of Policy Number CL 1859230 effective on 3/28/2018 (MO. DAY YR.) at 12:01 A.M. Add/Remove/Amend General Liability Additional Insured Endorsement In consideration of no change in premium it is hereby agreed that the following form(s) is(are) added to the Policy: CG2026 04/13 -Additional Insured -Designated Person or Organization All other terms and conditions of this Policy remain unchanged. C_; \Gc Q� ADD —REM (03-01) POLICY NUMBER: CL 1859230 COMMERCIAL GENERAL LIABILITY CG 20 26 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Additional Insured Person(s) Or Organization(s): Effective Date: 03/28/2018 12:01 AM XThe City of Santa Ana, it's officers, employees, agents, and representatives 20 Civic Center Plaza Santa Ana, CA 92701 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II -Who Is An Insured is amended to include as an additional 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 or the acts or omissions of those acting on your behalf: 1. In the performance of your ongoing operations; or 2. In connection with your premises owned by or rented to you. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III - Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorseme Limits of Insurar ble CG 20 26 0413 © Insurance Services Office, Inc., 2012 Page 1 Of 1 ADDITIONAL INSURED ENDORSEMENT Insurance Company United States Liability Insurance Company This endorsement modifies such insurance as is afforded by the provisions of Policy # CL 1859230 relating to the following: 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 suchperson 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 following, Including countersignature, is required to make this endorsement effective.) Effective 04/03/2018 Policy # CL1859230 Issued to Nancy Alcala Name Insured Countersigned by this endorsement form as part of N-2018-112 awarin .roenr�rrw+uaaaar Foacy, Park oky 9EiiP1.S?YB€5 1N5. CXT, 'Poicy Number �fi�r � �s,�,,;� A.Stock Company 91C 2tizldl m 00 ��[9Mizoia POLICY GtECLAi2ATlONS NCCf asaft r # 3 1 3 W CRIB C:ARtd 0092 . PRIOR POLICY NUMSER NEW 91 Named tnseuad and Ad _ '.A. t NANCY ALCALA NETWORKED INS AGENTS- CA ONLY 0938001 t24t47 H CKtNtR ,Akt 57UAi0 443 GRASS VALLEY, CAWN POINT �969 5 R UNIT A j �R:��• SANTA ANA CA 927074408 Telephonic 53027469W r r rtFN r Mk i@ r to tY ar to sxsei _ Additional! Locatkaw 2, the Pa#cy Period !s #ttxn05101f2014 to 06/0112019 12:01 a,m. Standard Time at the insomIT's mulling address. 3. A, Workers Compreventon Insurance: Part ONE of the policy applies to the Workers Compensation Law of the states listed hero: CA 8, Employers Liability insurance: Part TWO of the policy applies to work in each state listed In item 3A. The limits of our liability under Part TWO are: dRuddy Injury by Accident $ 1.00M000 each accident Bodily Injury by Disease $ 1.000.000 policy limit Randy Injury by Disease $ 1.000,000 each employee C. Other States f rwumcv: part THREE of the policy applies to the states, if any, listed hers; Alf states except AK, DE, HL NO, NH, OH, RI, WA, WV, WY and states listed in item 3.A. D. This policy Includes these endorsements and schedules: See attached schedule. 4, The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates, and Rating Plans. Alf Infiamistran required below is subject to verification and change by audit. SEE EXTENSION OF INFORMATION PAGE mwmum Poompan 750 Expense Constant $ 220 Premium Discount $ Assessments and Taxes $ Total Estimated Annuall remium $ 782 d This Is a Those Year Fixed Rate Policy Premium Adjustment Per'rtxf; fM Annual, 0 Semiannual: 0 Quarterly; Monthly Countersigned this Day of Ph - Issued Date. 04124/2018 Authorized Representative Issuing Office EMPLOYERS PREFfflfW INS. CO. 7110 NORTH FRESNO STREET, SUITE 250 FRESNO, CA 93720.2999 t"We Date 0412412018 INSURED COPY WC990630. 18108 £dJ Pegs 1 0f 2 ,xa F � WORKERS OWPI #RATK#tANKIPM tR/ a I INMAWCF. POUCY EMPLOYERS Mir Do POR rNumbwwfill;262aaeoeo A M** .�t w4IMUS 7110 "1"FRESNE) STRUT, SUITE 260 NwrW_ mad HARRY ACCALA MERIN, CA 63,120,2999 Agast: �NEPNoRKfti iNs CA 4ta.Y I t EXTENSION OF INFORMATION PAGE CI.ASSIFIGATION OF OPERATIONS Code Premium Basis Rate Per Estimated No. GlassifloattDn ORscriptitxs Total Est. Annual $100 of AAnnual Remuncratem m Remuneration Pmrmum Catlftxrea � ._.. Rating Period: 0510112018 through 0610112019 Site 00GO1 $968 COLL 39S 6R SCHOOLS-@RTVATE-NU'" AUTOMOBILE 2,268 I.540000 35,00 SCN4'+teS-PROFSS5,:R5, TEACHERS OR ACAUaMIC PROFESSIONAL SHPLOYx9S 9101 COLLEONS OR SCHOOLS-PRIVA76-NOT AUTOMOa ILE U 9.06e000 E LS-ALL EMPLOYERS OTHER THAN PR1?FE§SCRs, TRACHSR3. OR ACADEMIC PROFESSIONAL RVAGOYE2S-IncLUDIM CAFETERIAS, Site 00001 'total 5 35.00 Total of Silos for Rating Period $ 35.00 Rating Period Total 5 35,00 Rating Period: 0610112018 through 06101I2oi9 0900 EXPENSE CONSTANT 5.00 t79917 REDUCE Trt'r MINIMUM PREMIUM 49495.00 DS3& STATE N,C, FRAUD ASSRSSNENT 75 C.Go2SS0 2.00 0535 STATE A.C. AIRIMIMAT'IVE ASSESSNEhr 752 0937 ca INSURANCE otiA Tx 7>}. 0.1000 D.020ecD xs.cD 01138 CA UNINSURED RRAL MRS KIND 752 0.0005,13 0919 CA SUNSMOINI T INJURY YEN,ti 752 0003599 0940 (SHOP ASSESSMENT 752 0.002655 2.00 0943 LABOR IMPORCWtMT & C lRL1ANCB 752 0.002150 2.00 9741 CATASTROPHE ARBUTUS 21288 0. 040000 1100 9740 TERRORISM PREMIUM 2.2,48 U.0300Cii 1.60 Ratiol; Period Total $ 7A7.$0 '... State Total S 762«00 Policy Total 5 702.00 /`11L. VR LJ CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 03/01/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLYAND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOTAFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND ORALTERTHE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOTCONSTITUTEA CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, ANDTHE CERTIFICATE HOLDER. IMPORTANT: tithe certificate holder Is anADDITIONAL INSURED, the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subjectto theterms and conditions of the policy, certain policies may require an endorsement. Astatementon this certificatedoes notconfer rightsto thecertificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Hector Gonzalez Insurance Agency, Inc. PHONE FAX 2670 N Main St Ste 350 (A/C, NO, EXT): 714-486-6163 (A/C, No): 866-230-1263 E-MAIL ADDRESS: Insurancebrokerll@yahoo.com Santa Ana CA 92705-6648 INSURER(S)AFFORDING COVERAGE NAICA INSURED 1\� I�D�� INSURERA: United States Liability Insurance Company INSURERB: �I Nancy Alcala DBA: Yellow Turtle Art Studio NSURERC: INSURERD: 1247 S Hickory Street INSURERE: Santa Ana CA 92707 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEABOVE 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 OFSUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYpEOFINSURANCE ADDTL INSD SUBR VIVO POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICYEXP (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACHOCCURRENCE $ 1,000,00 CLAIMS -MADE OCCUR DAMAGE TO RENTED PREMISES (Ea Occurrence) $ 100,00 MED EXP(Any one person) $ 5,00 PERSONAL &ADV INJURY $ 1,000,00 A Y N CL 1859230 03/15/2019 03/15/2020 GENT AGGREGATE LI M IT APPLI ES PER: POLICY ❑ PROJECT LOC GENERALAGGREGATE $ 2,000,00 PRODUCTS-COMP/OP AGG $ Included Professional Liability Ea $ Included OTHER: AUTOMOBILE LIABILITY _ COMBINED SINGLE LIMIT (Ea accident) $ ANYAUTO BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ OWNEDAUTOS SCHEDULED ONLY AUTOS HIREDAUTOS NONOWNEDPROPERTY ONLY AUTOSONLY DAMAGE (Peraccident) $ UMBRELLALIAB OCCUR EAC (OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY PER STATUTE OTHER $ ANY PROPRIETOR/PARTNER/ Y/N EXECUTIVE OFFICER/MEMBER N/A E.L. EACH ACCIDENT $ E.L. DISEASE- EA EMPLOYEE EXCLUDED? (Mandatory in NH) I E.L. DISEASE - PO MIT $ Ifyes, describe under DESCRIPTION OF OPERATIONS below e DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached If more space is required) Certificate Holder it's officers, employees, agents, and representatives Gae�N' per attached CG202604/13 �\-� G �J CERTIFICATE HOLDER CANCELLATION ' SHOULDANY OFTHEABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION The City of Santa Ana DATE THEREOF NOTICE WILL BE DELIVERED IN ACCORDANCE WITHTHE POLICY PROVISIONS. 20 Civic Center Plaza AUTHORIZED REPRESENTATIVE Santa Ana r.A 92701 �2 B ACORD 25(2016/03) 31-1769 11-15 ©1988-2015 ACORD CORPORATION. All Rights Reserved The ACORD name and logo are registered marks of ACORD POLICY NUMBER: CL 1859230A COMMERCIAL GENERAL LIABILITY CG 20 26 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Additional Insured Person(s) Or Organization(s): Effective Date: 03/15/2019 The City of Santa Ana, its officers, employees, agents, and representatives 20 Civic Center Plaza Santa Ana, CA 92701 Information required to complete this Schedule, if not shown above, will be shown in the Declarations A. Section II - Who Is An Insured is amended to include B. With respect to the insurance afforded to these as an additional insured the person(s) or organization(s) additional insureds, the following is added to shown in the Schedule, but only with respect to liability Section III - Limits Of Insurance: for "bodily injury", "property damage" or "personal and If coverage provided to the additional insured is advertising injury" caused, in whole or in part, by your required by a contract or agreement, the most we acts or omissions or the acts or omissions of those acting will pay on behalf of the additional insured is the on your behalf: amount of insurance: 1. In the performance of your ongoing operations; or 2. In connection with your premises owned by or rented to you. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the De.*rations/ b� S sae e CG 20 26 0413 0 Insurance Services Office, Inc., 2012 Page 1 Of 1 United States Liability Insurance Company 1190 Devon Park Drive Wayne, PA 19087-2191 A Member Company of United States Liability Insurance Group (888)523-5545 To: ROBERT MORENO INSURANCE SERVICES Attn : Bind RMIS From : Danielle Rinker danielle.rinker@usli.com / (888) 523-5545 x7307 Insured: NANCY ALCALA Policy #: CL 1859230A Attached please find your endorsement(s) as requested. Add PNC. Minimum premium applies Regards, Danielle Rinker Attached: Endorsement #1 Date 5/l/2019 �� � e�� �\ey� 000, e� QF,G ENDORSEMENT #1 This endorsement, issued by United States Liability Insurance Company to NANCY ALCALA DBA: YELLOW TURTLE ART STUDIO forms a part of Policy Number CL 1859230A effective on 4/15/2019 (MO. DAY YR.) at 12:01 A.M. Add/Remove/Amend General Liability Additional Insured Endorsement In consideration of no change in premium it is hereby agreed that the following form(s) is(are) added to the Policy: L-776 04/15 - Primary And Non -Contributory - Written Contract All other terms and conditions of this Policy remain unchanged. ADD —REM (03-01) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM Primary And Non -Contributory - Written Contract Schedule: Effective Date: 04/15/2019 12:01 AM Name of Person or Organization: THE CITY OF SANTA ANA, IT'S OFFICERS, EMPLOYEES, AGENTS, AND REPRESENTATIVES, BUT ONLY WHERE REQUIRED TO BE ADDED AS AN ADDITIONAL INSURED UNDER WRITTEN CONTRACT(S), WRITTEN PERMIT(S) OR WRITTEN AGREEMENT(S). 20 CIVIC CENTER PLAZA SANTA ANA, CA 92701 (If no entry appears above, the information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement) SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, Paragraph 4. OTHER INSURANCE, a. Primary Insurance is amended with the addition of the following: The coverage afforded by this policy to the person(s) or organization(s) listed above is primary and non- contributory if: 1. This insurance is required to be primary and non-contributory under a written contract; and 2. The loss to be covered occurs on or after the effective date of the written contract; and 3. The loss to be covered resulted solely and exclusively from your ongoing acts or omissions or the ongoing acts or omissions of those acting on your behalf in performing "your work" under a written contract referred to above. 4. The person(s) or organization(s) is an additional insured under this policy. However, the coverage provided by this endorsement does not apply to any coverage provided for an "auto" on a "non -owned auto", "hired auto", uninsured motorists coverage, underinsured motorists coverage, personal injury protection, property protection or similar no-fault coverage by whatever name called and/or an "auto" coverage of any type. All other terms and conditions of this policy remain unchanged. This endorsement is a part of your policy and takes effect on the effective date of your policy unless another effective date is shown. a Q�G L 776 (04-15) Page 1 of WORKERS' COMPENSATION DECLARATION I Nancy Aleala hereby affirm under penalty of perjury, the (Name Title) following declaration I certify on behalf of Yellow Turtle Art Studio that during the term of my contract for (Consuhant,Company Name) Recreation Classes services with the City of Santa Ana, I will not employ any person in ,my 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: 3/15/2019 By: Name: Nancy Alcala Title: Recreation Instructor Telephone: 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 (SI00,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. J\e�edby J I ��GS