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HomeMy WebLinkAboutDREAM SHAPERS 6INSURANCE ON FILE WORK MAY PROCEED &; TIL INSURANCE EXPIRES COPWC' �-6 19'CL�F,loh ERK OF COUNCIL' DATE: J "IL j D 2ljiQ O: PRCS (/ ) Silvia Cuevas June 28, 2018 Dream Shapers ("Speaker/Performer") P.O. Box 3831 Orange, CA 92865 Re: Speaker/Performer Engagement Agreement N-2018-128 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: Variety -type performances to entertain patrons with performances selected and agreed upon by the parties per the list provided in Exhibit A. 2. Scheduling of Performances: Speaker/Performer to provide City with a proposal/invoice for the event including type of performance, date and rate(s) forty-five (45) days prior to a proposed event date. Forty-five (45) day time period is required to allow City to advertise the event. City will provide a written confirmation from the Executive Director of PRCSA of the event, location, date and time. 2. Term: July 1, 2018 through June 30, 2019. 3. Event Time(s): Each performance will be one hour in length and event start time will be scheduled per Section 2. 4. Location: Various City Locations as provided in Exhibit A and agreed upon by the parties per Section 2 ("Property") 5. Compensation: Total sum to be expended under this Agreement shall not exceed $5,000. Performance rates and description of the type of performance are listed in Exhibit A. A check for the scheduled performance willbe issued within 30 calendar days of event. Speaker/Performer must provide IRS form W-9 before payment; 6. Equipment provided by City: None, however, the City will be responsible for setting up the space for the patrons attending and advertising the program. 7. Equipment provided by Speaker/Performer: all equipment necessary for each performance 8. City Contact Person (for coordinating purposes only): Lupita Arroyo or Michelle Loera 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 Letter Agreement — Dream Shapers Page 2 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: Speakev?erformer, 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. It. 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, frilly release, waive and discharge forever any and all claims, demands, rights, and causes of action of any kind or nature against, and covenant 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. 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 webcast 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/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, Letter Agreement — Dream Shapers N-2018-128 Page 3 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 SANTA ANA r RA GODINEZ II Interim City Manager ATTEST: MARIA D. HUIZAR r Clerk of the Council T,�E}V F R APPROVAL: Ralph J. NuRez, Interim Executive Director Parks, Recreation, and Community Services Agency SHAPERS APPROVED AS TO FORM: By: �Cn ttAL?c k LAURA A. ROSSINI Senior Assistant City Attorney WM S-128 Exhibit A SCOPE OF SERVICES VENDOR INFORMATION: Dream Shapers P.O. Box 3831 Orange CA 92865 (714) 771-1981 EVENT: Variety Type Performances SERVICE DATE(S): July 1, 2018 through June 30, 2019 COMPENSATION: Not to exceed $5,000 DESCRIPTION: This vendor will provide entertainment performances from the list below for the period of July 1, 2018 through June 30, 2019. The total amount for this Agreement shall not exceed $5,000. The various performances will range in cost per the list below and is at a cost per per performance, Performances will be presented at any of the following locations: Main Library, 26 Civic Center Plaza, Santa Ana CA 92701, the Newhope Library Learning Center, 122 N. Newhope Street, Santa Ana CA 92703, Centennial Regional Park, 3000 W. Edinger Avenue, Santa Ana CA 92704 and Plaza Calle Cuatro- 325 E. 41" St., Santa Ana CA 92701. Location, Date of event and event time will be mutually agreed in writing by the parties when scheduled. Events will be scheduled forty-five (45) days in advance to allow City to advertise event. The City will be responsible for setting up the space for the patrons attending and advertising the program, Vendor will be responsible for providing all equipment, materials, supplies and personnel necessary toperformthe act. City staff will be present at all times during the performance. List of Performers — Types of Performance -- hates Georgette Baker (music, storytelling, bilingual, Spanish heritage, multicultural) $300 Brettso the Great (magic, balloons) $275 hia Buchner -Barnette (storytelling, movement games, poetry) $285 Dan Crow (children's music) $325 Ken Frawley (music, storytelling, puppets, trick roping) $295 Joe Gandelman (ventriloquism) $275 Rebecca Martin (storytelling, puppets) $275 Michael D McCarty (storytelling, multicultural) $300 Craig Newton (multi -instruments, music) $275 Chazz Ross (percussion) $325 Mark Wenzel (mime) $285 Christopher Yates (circus arts, music, environmentalism) $300 Markus Law (puppets, music) $275 Ranger Jack (music, puppets) $325 Teresa Smith (dance) $280 Arty Loon (magic, balloons, puppets) $300 Native American Tribal Dance & Culture (dance, storytelling, multicultural) $350 Auntie Kayte (children's music) $275 John McLean Allan (music, storytelling) $290 Dennis Forel (balloons) $290 Wendy Hersh (children's music) $285 Dave Kinnoin (children's music) $275 Santa Thomas (stories, and pictures) $350 Silly Science Show (science) $300 Jay Leslie (magic) $280 Zoomation (animals, puppets, songs and facts) $295 Georgia Frawley (American Sign Language) $295 AC E) CERTIFICATOF LIABILITY INSURANCE °A�'5/2018 OB/25/2078E 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. Astatement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT Dianna Mahn NAME: All -Cal Insurance Agency "ON' Ex : (916) 784.9070 /wc NPI: (918) 784-0 558 505 Vernon Street ADDRESS: dianna@all-calinsurance.com INS_URER(SIAFFORDING COVERAGE NAICM Roseville CA 96678 INSURERA: Nonpro8(einsurance Alliance of California 011845 INSURED State Compensation INSURERS: pe sation Insurance Fund 35076 The Los Angeles Dream Shapers INSURER C: P.O. Box3837 INSURER D: INSURERS: Orange CA 92865 INSURERF: CERTIFICATE NUMBER: CL 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 CONTRACTOR 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. ww LTR TYPE OF INSURANCE. INSD WVO POLICYNUMBER POUC EF lmmmoIYYYY MMIDDYYYY LIMITS ERCIALGENERAL DABILTYEACHOCCURRENCE S 1,000,000 =XCLO]AE-Ar LUMS-MADE Z OCCUR PREMISES Ea orr Reece 5 500,000 MEOEXP(My one person) S 20,000 liability $1,000,000/1,000,000 PERSONAL a AOV INJURY 5 1.000.000 A Y 2018-08609NPO 06/13/2018 06/13/2019 AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE S 2,000.000 GEN'L X POLICY PET LOC PRODUCTS-COIAPIOPAGG 3 2,000.000 S OTHER: AUTOMOBILE LIABILITY COMmNEO IN LELIMIT Ea a dtlent SI 0000,000 BODILY INJURYIPer person) S ANYAVTO A OYPIED SCHEDULEO AUTOS ONLY AUT 2018-08609NPO 06113/2018 06/ 13/2019CSIMUURY(PIl.mdent ­BODILYS ) HIRED x NON OWNED X AA E AUTOS ONLY AUTOS ONLY Per ecddent S Comp/Coll deductible 5 500 UMBRELLA DAB OGCUR EACHOCOURRENCE S AGGREGATE S EXCESS LIAR CLAIMS -MADE DED I I RETENTION 5 S WORKERS COMPENSATION H_ AND EMPLOYERS' LIABILITY YIN x STATUTE ER E.L. EACH ACCIDENT S 1,000,000 B ANY PROPRIETORRARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? ❑ N/A 9015327-18 06/06/2018 - 06/06/2019 EL DISEASE -EA EMPLOYEE S 1000,000 (Mandatory In NH) H yes, describe E.L. DISEASE -POLICY LIMIT S 11000,000 DESCRIPTION OF OF O OPERATIONS bnlav DESCRIPTION OF OPERATIONS I LOCATIONS f VEHICLES IADDR0101, Addilionel Remarks Schedule, may be aaacnedVmore space is required) `I The City of Santa Ana, its officers, agents, employees and volunteers are named additional insured under their Contract terms. Coverage is #aty and non -Contributory and Form CG 20 26 applies P SHOULD ANY OF THE ABOVBTTESCRIBE ES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTIC WILL BE DELIVERED IN City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS. 20 Civic Center Plaza AUTHORIZED REPRESENTATIVE Santa Ana CA 92701 ,I �),,,,till�. 91988-2015 ACORD CORPORATION. A711thtS reserved. AUURU Z5 (ZU15/U3) The ACORD name and logo are registered marks ofACORD POLICY NUMBER: 2018-08609NPO 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 Persou(s) Or Organization(s) Any person or organization that you are required to add as an additional insured on this policy, under a written contract or agreement currently in effect, or becoming effective during the tenn of this policy. Tire additional insured status will not be afforded with respect to liability arising out of or related to your activities as a real estate manager for that person or organization. The City of Santa Ana, its officers, agents, employees and volunteers are named additional insured under their contract terms. Coverage is primary and non-contributory and Form CG 20 26 applies 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 included 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 111— 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 endorsement shall not increase the applicable Limits of insurance shown in the Declarations. ed�U`l GgP� CG 20 26 0413 Copyright, Laurance Services Office, Inc., 2012 Page 1 of 1 NONPROFITS POLICY NUMBER:201B-08609 FORM: NIAC-E61 11 17 INSURANCE NAMED INSURED: Los Angeles Dream Shapers (The) ALLIANCE Of CALIFORNIA A Head far Insurance. AHeartfor Nonproffts. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED PRIMARY AND NON-CONTRIBUTORY ENDORSEMENT FOR PUBLIC ENTITIES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: (Information required to complete this Schedule, if not shown above, will be shown in the Declarations.) A. Section If — Who Is An Insured is amended to include any public entity as an additional insured for whom you are performing operations, who may be named in the schedule above, when you have agreed in a written contract or written agreement that such public entity be added as an additional insured(s) on your policy, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your negligent acts or omissions; or 2. The negligent acts or omissions of those acting on your behalf; in the performance of your ongoing operations: No such public entity is an additional insured for liability arising out of the "products -completed operations hazard" or for liability arising out of the sole negligence of that pubic entity. B. With respect to the insurance afforded to these additional insured(s), the following additional exclusions apply. This insurance does not apply to "bodily injury' or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. C. The following is added to SECTION III —LIMITS OF INSURANCE: The limits of insurance applicable to the additional insured(s) are those specified in th written contract between you and the additional insured(s), or the limits available under this policy, whichev(r'*6less. These limits are part of and not in addition to the limits of insurance under this policy. eJ5 eea NIAC-E61 11 17 S�\�\a P1PdPage 1 of 2 p>�Ct� NONPROFITS POLICY NUMBER: 2018-08609 FORM: NIAC-E61 11 17 INSURANCE NAMED INSURED: Los Angeles Dream Shapers (The) ALLWNCF OF CALIFOONIA A Head farInsurance. A Heart for Nonprofits. D. A. With respect to the insurance provided to the additional insured(s), Condition 4. Other Insurance of SECTION IV — COMMERCIAL GENERAL. LIABILITY CONDITIONS is replaced by the following: 4. Otherinsurance a. Primary Insurance This insurance is primary if you have agreed in a written contract or written agreement. (1) That this insurance be primary. If other insurance is also primary, we will share with all that other insurance as described in c. below; or (2) The coverage afforded by this insurance is primary and non-contributory with the additional insured(s)' own insurance. Paragraphs (1) and (2) do not apply to other insurance to which the additional insured(s) has been added as an additional insured or to other insurance described in paragraph b. below. b. Excess Insurance This insurance is excess over: 1. Any of the other insurance, whether primary, excess, contingent or on any other basis: (a) That is Fire, Extended Coverage, Builder's Risk, Installation Risk or similar coverage for "your work"; (b) That is fire, lightning, or explosion insurance for premises rented to you or temporarily ocoupied by you with permission of the owner; (c) That is insurance purchased by you to cover your liability as a tenant for "property damage" to premises temporarily occupied by you with permission of the owner; or (d) If the loss arises out of the maintenance or use of aircraft, "autos' or watercraft to the extent not subject to Exclusion g. of SECTION I -- COVERAGE A— BODILY INJURY AND PROPERTY DAMAGE. (e) Any other Insurance available to an additional insured(s) under this Endorsement covering liability for damages which are subject to this endorsement and for which the additional Insured(s) has been added as an additional insured by that other insurance. (1) When this insurance is excess, we will have no duty under Coverages A or B to defend the additional insured(s) against any "suit" if any other insurer has a duty to defend the additional insured(s) against that "suit". If no other insurer defends, we will undertake to do so, but we will be entitled to the additional insured(s)' rights against all those other insurers. (2) When this insurance is excess over other insurance, we will pay only our share of the amount of the loss, if any, that exceeds the sum of: (a) The total amount that all such other insurance WOWId pay for the loss in the absence of this insurance; and (b) The total of all deductible and self -insured amounts under all that other insurance. (3) We will share the remaining loss, if any, with any other insurance that is not described in this Excess Insurance provision and was not bought specifically to apply in excess of the Limits of Insurance shown in the Declarations of this Coverage Part. c. Methods of Sharing If all of the other insurance available to the additional insured(s) permits contribution by equal shares, we will follow this method also. Under this approach each insurer contributes equal amounts until it has paid its applicable limit of insurance or none of the loss remains, whichever cM4-first. f any other the other insurance available to the additional insureds) doe Perm mit contri on by equal shares, we will contribute by limits. Under this method, each ip{@s share is b don the ratio of its applicable limit of insurance to file total applicable limits of yam@ nc�`4f�all ins NIAC-E61 11 17 5 Page 2 of 2 e ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) `/ 05/15/2019 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 endomement(s). PRODUCER CONTACT DiAnna Martin NAME: All -Cal Insurance Agency AIc No Eat: (916)784-9070 FAX, NoJAIC1: (916J 784-0158 505 Vernon Street E-MAIL dianna@all-cafinsurance.com ADDRESS: INSURER(S) AFFORDING COVERAGE NAICN Roseville CA 95678 INSURER A: Nonprofits' Insurance Alliance of California NIAC INSURED INSURER B: INSURER C: The Los Angeles Dream Shapers N D �'p�,� P.G. BOX 3831 lV_�,O I�_f 3��' INSURER D: NSURER E : Orange CA 92865 1 INSURER F: COVERAGES CERTIFICATE NUMBER: CL1951508301 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 TYPE OF INSURANCE INSD MD POLICYNUMBER POLICY EFF MMIDDn'YYY POLICY UP MMIDDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR EACH OCCURRENCE $ 1,000,000 OAMAUL KILN LU PREMISES Ea occurrence) $ 500,000 X MED UP (Any one person) $ 20,000 Liquor Liability $1,000,000/1,000,000 PERSONALSADV INJURY $ 1,000,000 A Y 2019-OB60gNPO 06/13/2019 06/13/2020 GEN'LAGGREGATE X LIMITAPPLIES PER: POLICY DPRG ❑ JECT LOC GENERALAGGREGATE s 2.00O,000 PRODUCTS - COMPIOP AGO $ 2,000,000 Increased Aggregate s OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea acadent s 1,000,000 BODILY INJURY (Per person) $ ANVAUTO A OWNED SCHEDULED AUTOS ONLY AUTOS 2019-08609NPO 06/13/2019 06/13/2020 BODILY INJURY (Per accident) $ X HIRED H NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Peraoddenl $ Comp/Coll deductible s 500 UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE IS EXCESS LIAB CLAIMS -MADE OEO I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? NIA PER OTH- STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) It yes, describe under E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS below e DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) p�-� Cityof Santa Ana, its officers, agents, employees, representatives and volunteers are named additional insured under their cont l'�P2rITS yq/r�e�'agIs aC, primary and non-contributory, and Form CG 20 26 applies. City of Santa Ana 20 Civic Center Plaza Santa Ana CA 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 1D 1989-2016 All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACUti^ NONPROFITS POLICY NUMBER: 2019-08609NPO FORM: NIAC-E61 11 17 INSURANCE NAMED INSURED: The Los Angeles Dream Shapers �9 ALLIANCE OF CALIFOILNIA A Head for Insurance. A Heart for Honprof/ts. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED PRIMARY AND NON-CONTRIBUTORY ENDORSEMENT FOR PUBLIC ENTITIES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: City of Santa Ana, its officers, agents, employees, representatives and volunteers A. Section II — Who Is An Insured is amended to include any public entity as an additional insured for whom you are performing operations, who may be named in the schedule above, when you have agreed in a written contract or written agreement that such public entity be added as an additional insured(s) on your policy, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: Your negligent acts or omissions; or 2. The negligent acts or omissions of those acting on your behalf, in the performance of your ongoing operations: No such public entity is an additional insured for liability arising out of the "products -completed operations hazard" or for liability arising out of the sole negligence of that pubic entity. B. With respect to the insurance afforded to these additional insured(s), the following additional exclusions apply. This insurance does not apply to "bodily injury" or "property damage" occurring after: I. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing ope tions or a principal as apart of the same project. �eDv�1 C. The following is added to SECTION III —LIMITS OF INSURANCE: The limits of insurance applicable to the additional insured(s) are those specified in thi2itten co 46en you and the additional insured(s), or the limits available under this policy, whichever are less. Thy' part of and not in addition to the limits of insurance under this policy. NIAC-E61 11 17 Q� Page 1 of 2 NONPROFITS POLICY NUMBER:2019-08609NPO FORM:NIAC-E611117 INSURANCE NAMED INSURED: The Los Angeles Dream Shapers ALLIANCE OF CALIEORNIA A Head jor Insurance. A Heartfor Nonprofits. D. A. With respect to the insurance provided to the additional insured(s), Condition 4. Other Insurance of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS is replaced by the following: 3. Other Insurance a. Primary Insurance This insurance is primary if you have agreed in a written contract or written agreement: (1) That this insurance be primary. If other insurance is also primary, we will share with all that other insurance as described in c. below; or (2) The coverage afforded by this insurance is primary and non-contributory with the additional insured(s)' own insurance. Paragraphs (1) and (2) do not apply to other insurance to which the additional insured(s) has been added as an additional insured or to other insurance described in paragraph b. below. b. Excess Insurance This insurance is excess over: 1. Any of the other insurance, whether primary, excess, contingent or on any other basis: (a) That is Fire, Extended Coverage, Builder's Risk, Installation Risk or similar coverage for "your work"; (b) That is fire, lightning, or explosion insurance for premises rented to you or temporarily occupied by you with permission of the owner; (c) That is insurance purchased by you to cover your liability as a tenant for "property damage" to premises temporarily occupied by you with permission of the owner; or (d) If the loss arises out of the maintenance or use of aircraft, "autos" or watercraft to the extent not subject to Exclusion g. of SECTION I — COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE. (e) Any other insurance available to an additional insured(s) under this Endorsement covering liability for damages which are subject to this endorsement and for which the additional insured(s) has been added as an additional insured by that other insurance. (1) When this insurance is excess, we will have no duty under Coverages A or B to defend the additional insured(s) against any "suit" if any other insurer has a duty to defend the additional insured(s) against that "suit". If no other insurer defends, we will undertake to do so, but we will be entitled to the additional insured(s)' rights against all those other insurers. (2) When this insurance is excess over other insurance, we will pay only our share of the amount of the loss, if any, that exceeds the sum of: (a) The total amount that all such other insurance would pay for the loss in the absence of this insurance; and (b) The total of all deductible and self -insured amounts under all that other insurance. (3) We will share the remaining loss, if any, with any other insurance that is not described in this Excess Insurance provision and was not bought specifically to apply in excess of the Limits Insurance shown in the Declarations of this Coverage Part. c. Methods of Sharing 0�\e ` (J—/ �C If all of the other insurance available to the additional insured(s) permits contribution b� equal shay we will follow this method also. Under this approach each insurer contributes equal amounts u paid its applicable limit of insurance or none of the loss remains, whichever comes first. �J If any other the other insurance available to the additional insured(s) does not permit c Abut' y equal shares, we will contribute by limits. Under this method, each insurer's share is Sased on le ratio of its applicable limit of insurance to the total applicable limits of insurance of all insurers. NIAC-E61 11 17 Page 2 of 2 POLICY NUMBER: 2019-08609NPO 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) Any person or organization that you are required to add as an additional insured on this policy, under a written contract or agreement currently in effect, or becoming effective during the term of this policy. The additional insured status will not be afforded with respect to liability arising out of or related to your activities as a real estate manager for that person or organization. City of Santa Ana, its officers, agents, employees, representatives and volunteers 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 included 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 I I I — 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 endorsement shall not increase the applicable Limits of insurance shown in the Declarations. 6 Q� C CG 20 26 04 13 Copyright, Insurance Services Office, Inc., 2012 Page I of I WORKERS' COMPENSATION DECLARATION I T4.e iguuag'f G"hereby affirm under penalty of perjury, the (Nmndritle) following declaration I certify on behalf of �� �fiafring the term of my 3u i nUCompaM Ne ) ^ (Cauulle contract for 4:�°� ` rr�i'r °' T 1lrservices 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: v a� By - Name: Title: f >r+t Gi Q. Telephone: .I N • `1-1 N ' WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SMALL 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.