HomeMy WebLinkAboutNATI'S HOUSE (DBA NEUTRAL GROUND)City of Santa Ana
Clerk of the Council
,t AGREEMENT TERMINATION
City of Santa Ana
Please complete this form when the attached agreement is no longer in effect. Aye? ® 2 2021
Return form to the Clerk of the Council Office (M-30). Clerk of the Council
Call 647-5237 if you have any questions.
--------------------------
The agreement with N C��1�S t�QUS'E 12 QLl`t"t Usk' 6 (bUnd
No. was completed one 1`
and final payment has been made.
Department:
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Signature: CiDt>1m Q VQV CV)
Date: % LOW W
Revised 07-23-07
INSURANCE ON FILE
WORK MAY PROCEED
UNTIL INSURANCE EXPIRES
It - t
CLERK OF COUNCIL
DATE i)V,. 17 syjkj
0: PRCS ( / ) AGREEMENT TO PROVIDE SUMMER NIGHT LIGHTS PROGRAM
N-2018-141
Silvia Cuevas
"this agreement is made and entered into this I I"' day of July, 2018 by and between Nati's House
dba Neutral Ground, a California anon -profit organization ("Contraeter") and the City ofSanta Ana, achartor
city and municipal corporation organized and existing under the Constitution and laws Of the State (if
California C'City"),
RECITAUS
.A, The City desires to retain a contractor having special skill and knowledge in the field of providing
food, games, crafts, sports and counseling and educational traiminni during the summer roonflas
to reduce violence and increase community relations.
B, Contractor represents that it is able and willing to provide such services ten the City known as the
Summer Night Lights program ("Event'),
C. In undertaking the performance of this Agreement, Contractor refirc-,ents that it is knowledgeable
in its field and that any services performed by Contractor under this Agreement will be performed
in compliance with such standards as array reasonably be expected front a professional consulting
thin in the field.
NOW T HERFFORE, it) consideration of the mutual and respective promises, and subject to the tertis and
condil ions hereinafter set linih, the parties of as follows:
I SCOPE OF SERVICES
Contractor shall provide Summer Night fights Program cervices for the City as set forth in the scope
of w"iccs attached and incorporated as Exhibit A.
2, COMPENSATION
a. Contractor agrees to pay, and City agrees to accept as total payment for its services, the rates
and charges identified in Exhibit A. 'the total sum to be expended under this Agreement shall
not exceed Line Thousand Two Hundred Ninety -Three Dollars and 30 Cents ($1,293.30) for
the term of this agreement.
b. A deposit arricaun of 'Three Thousand Dollars ($3,000,00), will be paid to the City for any
dtitna,-eqthat ninyincur, ,,isaresult f,iftlieprogram. Deposit will berefunded to Contractor
to 6 weeks after the program has ended and no heritage to the location reficrenced in Exhibit A
has beeri, confirmed by the Executive Director of the Parks, Recreation and Community
Services Agency,
31 TERM
This Agrearrient shall comiarenoe on the (late stated above and terminate on August 31, 2018, untess
teriumated earlier in accordance with Section 12, below,
4. ]INDEPENDENT CONTRACTOR
Contractor shall, during the entire term of this Agreement, be construed to be in independent
contractor mid not an employee of the City, This Agreement is not intended nor shall it he cot arued to
Page I of 8
discretion or control over the professional manner in which Contractor performs the services which are the
subject nutter of this Agreement, however, the services to be provided by Contractor shall be provided in
it manner consistent with all applicable standards and regulations governing such set -vices, Contractor shall
pay all salaries and wages, employees social security taxes, unemployment insurance and similar taxes relating
to employees and shall be responsible for all applicable withholding taxes.
5. INSURANCE
Prior to undertaking performance of work under this Agreement, Contractor shall maintain and
shall require its subcontractors, if any, to obtain and maintain insurance as described below:
a. Commercial General Liability Insurance. Contractor shall maintain commercial general
liability insurance which shall include, but not be limited to protection against claims arising frona bodily
and personal injury, including death resulting therefrom and damage to property, resulting frorn any act or
Occurrence arising out of Contractor's operations in [lie performance of this Agreement, including, without
Ifirlitarion, 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 of insureds provisions,
b, Worker's Compensation Insurance., In accordance with California State law, Contractor, if
Contractor has any employees, is required to be insured against liability for worker's compensation or to
undertake self-insurance, Prior to commencing the performance of the work under this Agreement,
Contractor agrees to obtain and maintain any employer's liability insurance with limits not less than
$ 1,000,000 per accident,
c. 'the following requirements apply to the insurance to be provided by Contractor pursuant to this
section:
i. Consultant shall maintain all insurance required above in full force and effect for the entire
period covered by this Agreement,
fi. Certificates of insurance shall be furnished to the City upon execution of this Agreement
and shall be approved by the City.
iii. Certificates and policies shot] 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.
iv, Where the amounts or coverage provided by the certificates Of insurance provides coverage
greater than those listed by this Agreement, the amounts provided by the certificates or
insurance shall be incorporated by reference into the Agreement,
V. Consultant shall supply City with a fully executed additional insured endorsement,
e. If Contractor fails or refuses to produce or maintain the insurance required by this, section or
fails Or refuses to furnish the City with required proof that insurance has been procured and is in fibroc and
paid for, the City shall have the rig ,ht, at the City's election, to forthwith terminate this Agrccmeat. Such
termination shall not effect Contractor's right to be paid for its time and materials expended prior to
notification of termination. Contractor waives the right to receive compensation and agrees to indemnify
the City for any work performed prior to approval of insurance by the City.
Page 2 of 8
6. INDEMNIFICATION
Contractor agrees to and shall defend, indemnify, 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 clauris for personal injury, including
death, and claims for property damage, which may arise from the direct or indirect operations of Contractor
or its contractors, subcontractors, agents, employees, or other persons acting an their behalf which relates
to the services described in section I 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 froth this Agreement. This indernaity and hold harmless agreement applies to all claims for daunages,
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 froni this
Agreement. Contractor further agrees to indemnify, hold harmless, and pay all costs for the defense of the
City, including fees and costs for special counsel to be selected by the City, regarding any action by a third
party challenging the validity of this Agreement, or asserting that personal injury, damages, just
compensation, restitution, judicial or equitable relief due to personal or properly rights arises by reason of
the forms of, or effects arising from this Agreement. City may make all reasonable decisions with respect
to its representation in any legal proceeding.
7. LIVE SCAN 13ACKGIIOUND CTIECK
Provider, and any cruployces, 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 (if Justice as a condition of this Agreement and provide
proof of compliance prior to performing services hereunder,
CONFIDENTIALITY
If Contractor receives from the City information which due to the nature of such information is
reasonably understood to be confidential, and/or proprietary, Contractor agrees that it shall not use or
disclose such information except in the performance of this Agreement, and further agrees to exercise the
same degree of care it uses to protect its own information of like importance, but in no event loss than
reasonable care, "Confidential Infortriation" shall include all nonpublic information. Confidential
information includes not only written infrannation, but also information transferred orally, visually,
electronically, or by other means. Confidential information disclosed to either party by tiny subsidiary
and/or agent of the other party is covered by this Agreement, The foregoing obligations of non-use and
nondisclosure shall not apply to any information that (a) has been disclosed in publicly available sources;
(b) is, through no fault of the Contractor disclosed in a publicly available source; (c) is in rightful possession
of the Contractor without an obligation of confidentiality; (d) is required to be disclosed by operation of
law; or (c) is independently developed by the Contractor without reference to information disclosed by the
City.
91 CONFLICT OF INTEREST CLAUSE
Contractor covenants that it presently has tie interests and shall not have interests, direct or indirect,
which would conflict in any manner with performance of services specified Linder this Agreement,
10. 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 irdelivered in person or mailed by first class or certified
Page 3 of 8
mail, postage prepaid, or sent by facsimile or other telegraphic communication in the manner provided in
this Section, to the following persons:
To City: Clerk of the City Council
City of Santa Ana
20 Civic Center Plaza (M-30)
P.O. Box 1988
Santa Ana, CA 92702-1988
Facsimile: 714-647-6956
Copies to: Parks, Recreation & Community Services Agency
City of Santa Ana
20 Civic Center Plaza (M-23)
Santa Ana, California 92702
Facsimile: 714-571-4221
To Contractor: Neutral Ground
Attn: Ms. Nati Alvarado
1920 E. 17"' Street
Santa Ana, CA 92705
Phone: (714) 980-0953
Email: nati a7ngservices org
A party may change its address by giving notice in writing to the other party. Thereafter, any
connntmication 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
facsimile, 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.
11. EXCLUSIVITY AND AMENDMENT
This Agreement represents the complete and exclusive statement between the City and Contractor
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
terns of this Agreement shall prevail. This Agreement may not be modified except by written instrument
signed by the City and by an authorized representative of Contractor. The parties agree that any terms or
conditions of any purchase order or other instrument that are inconsistent with, or in addition to, the terms
and conditions hereof, shall not bind or obligate Contractor nor the City. Each party to this Agreement
acknowledges that no representations, inducements, promises or agreements, orally or otherwise, have been
made by any party, or anyone acting on behalf of any party, which are not embodied herein.
12, ASSIGNMENT
Inasmuch as this Agreement is intended to secure the specialized services of Contractor, Contractor
may not assign, transfer, delegate, or subcontract any interest herein without the prior written consent of
the City and any such assignment, transfer, delegation or subcontract without the City's prior written consent
shall be considered null and void. Nothing in this Agreement shall be construed to limit the City's ability
Page 4 of 8
to have any of the services which are I lie subject to this Agreement performed by City personnel or by other
contractors retained by City.
13. TERMINATION
This Agreement may be terminated by the City upon seven (7) days written notice of termination,
In such event, Contractor shall be entitled to receive and the City shall pay Contractor compensation for all
services perforated by Contractor prior to receipt of such notice of termination, subject to the following
conditions:
a. As a condition of such payment, the fiNecutive Director may require Contractor to deliver to the
City all work product cornpletedas of such date, and in such case inch work product shall be die property of
the City unless prohibited by law, and Contractor consents to the Citys use thereof for such purposes as the
City deems appropriate.
b. Payment need not be made for work which fails to meet the standard of performance specified in
the Recitals of this Agreement,
14. NON-DISCRINIINATION
Contractor shall not discriminate because of race, color, creed, religion, sex, marnal status, sexual
orientation, age, national origin, ancestry, or disability, as defined and prohibited by applicable law, in the
recruitment, selvetam, trahung, utilization, promotion, tennination or other employment related activities
or in connection with any activities under this Agreement. Connector affirms that it is an equal opportunity
employer and shall comply with all applicable federal, state and local laws and regulations,
15. JUIUSDICTION-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 Suite of California, Both parties further agree that Orange County,
California, shall be the venue for any action orproceeding that may be brought or arise out of, in connection
with or by reason of this Agreement.
M PROFESSIONAL LICENSES
Contractor shall, throughout the terns of this Agreement, maintain all necessary licenses, permits,
approvals, waivers, and excruptions 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, including without limitation, the California Bureau of Security and Investigative
Services. Contractor shall notify the City immediately and in writing of its inability to obtain or maintain
such permits, licenses, approvals, waivers, and exemptions, Said inability shall be cause for termination of
this Agreement,
M M ISCELLANEOUS PROVISIONS
a. Each undersigned represents and warrants that its sustature herein below has the power, authority
and right to hind their respective parties to each of the tennc of this Agreement, and shall indemnify City hilly,
including reasonable costs and attorney's fees, for any injuries or damages to City in the event that inch
authority or power is not, in fact, held by the signatory or is withdrawn,
Page 5 of 8
N-2018-141
b. All Exhibits referenced herein and attached hereto shall be incorporated as if fully set forth in the
body of this Agreement.
IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first above
Written.
ATTEST:
_
MARIA D. IIWZAR
Clerk of the Council
APPROVED AS TO FORM:
SONIA R. CARVALI-IO
City Attorney
By: tv ICYUI
LAURA ROSSINI,
Senior Assistant City Attorney
Recreation & Community
CITY OF SAT•A AN
RAUL GODINEZ II
City Manager
CONTRACTOR
Page 6 of 8
N-2018-141
EXHIBIT A
SCOPE OF SERVICES
A. Contractor shall conduct Summer Night Lights activities at no charge to the Community.
Registration and participation is open for ages: 1-99 years old. Program will provide food, games,
crafts, sports and counseling and educational trainings during the summer months to reduce
violence and increase community relations
B. Contractor shall teach such or similar activities at the times provided below at facilities to be
designated by the City. Should an event require re -location, the Executive Director of Parks,
Recreation and Community Services Agency shall provide a written confirmation of the new
location(s) for these events. Scheduling is provided below for the listed activities session or term,
including the location, specific days and hours when activities will be held, and holidays to be
observed, in accordance with City's needs.
SUMMER NIGHT LIGHTS
Summer Night Lights mission: Developing a presence, forming relationships, and changing the
story with a vision to reduce violence and increase community relations during summer months.
Summer Night Lights description: Summer Night Lights is a free program for all age groups which
will provide food, games, crafts, sports and trainings during the summer months to reduce violence
and increase community relations.
Neutral Ground Non -Profit is located at: 1920 E. 17th St. Santa Ana CA 92705 number:
714.980.0953. Nati Alvarado <nati c@ngservices.org>
LOCATION: El Salvador Park, 1825 West Civic Center Dr., Santa Ana, (714) 647-6558
• Summer Night Lights will consist of weekly sessions, held 2 days per week, 3
hours per day from 7:OOpm-10:00 pm, every Thursday and Friday starting July
1.2, 2018 through August 10, 2018.
• Summer Night Lights will utilize the Basketball Court and grass area between the
handball courts and pool area at El Salvador Park.
C. Contractor shall provide all materials, supplies, equipment, music, sound equipment and personnel.
Contractor shall be responsible for clean-up of the facilities/park and materials and shall ensure the
safety and effectiveness of instruction.
D. Contractor shall be responsible for all equipment, which includes a storage bin (to be kept at El
Salvador Park, and secured by Neutral Ground) for their chairs and tables.
Page 7 of 8
E. Contractor shall be responsible for all security, and will provide adequate insurance information
(i.e., name of company, insurance, etc.) to the City of Santa Ana for verification purposes.
F. The City will not provide electricity to the provider. Contractor agrees to secure lighting other than
what is available in the park on their own.
G. Contractor will adhere to City noise ordinance.
H. Contractor will seek approval from the Orange County Health Department, if food will be served.
A copy of the approved permit will be required by the City.
If the Contractor wishes to use any portion of El Salvador Center, and or the El Salvador
Community Gardens, a separate application will be furnished to the applicant detailing costs for
rental and staff hours.
CLASS FEES
A. Contractor will not charge a fee for the program
B. Only registered participants may participate in class.
RENTAL FEES
A. Contractor shall conduct Summer Night Lights activities and agree to pay the City $1,293.30 for
usage of area(s). A deposit amount of $3,000 will be paid to the City for any damages that may
incur, as a result of the program. Deposit will be refundable 4 to 6 weeks after the program has
ended and no damage to the location has been confirmed.
Page 8 of 8
a`orzis CERTIFICATE OF LIABILITY INSURANCE
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THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED
REPRESENTATIVE OR PRODUCER. AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the polloy(1os) 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 B .
PRODUCER
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INDICATED, NOTWITHSTANDING ANY REOVIREMENT, 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,
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SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
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The City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS.
Its officers, employees, agents and volunteers _
20 Civic Center Plaza AUTHORIZED REPRESENTATIVE
Santa Ana CA 92701 c_
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ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
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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($), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the polioy(los) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in Ileu Of such endorsement(s).
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THIS 15 TD CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
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CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
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Attn: Torrl Eggers
ACCORDANCE WITH THE POLICY PROVISIONS,
20 Civic Center Plaza
AUTHORIZED REPRCSCNTATIVE
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Santa Ana, CA 92701
AO 1988.2014 ACORD CORPORATION. Ail rights reserved,
ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
POLICY NUMBER; PEPK1738104
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):
The City of Santa .Etna
its officers, employees, agents and
volunteers
Information required to complete this Schedule, if not shown above, will be shown In the Declarations,
A. Section It — Who Is An Insured is amended to
Include as an addltlonal Insured the person(s) or
organlzation(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 loss.
This endorsement shall not increase the
applicable Limits of Insurance shown In the
Doclarations,
e
e
CG 20 26 0413 0 Insurance Services Office, Inc,, 20'12 page 2 of 2
PI-GL-005 (07/12)
THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED
PRIMARY AND NON-CONTRIBUTORY INSURANCE
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Effective Date: 06/14/2017
Name of Person or Organization (Additional Insured):
The City of Santa Ana its officers, employees, agents and volunteers
SECTION 11— WHO IS AN INSURED Is amended to Include as an additional Insured the person(s) or
organlzatlon(s) shown in the endorsement Schedule, but only with respect to liability for "bodily Injury,"
"property damage" or "personal and advertising Injury' arising out of or relating to your negligence in the
performance of "your worte for such person(s) or organization(s) that occurs on or after the effective date
shown in the endorsement Schedule.
This insurance Is primary to and non-contributory with any other Insurance maintained by the person or
organization (Additional Insured), except for loss resulting from the sole negligence of that person or
organization.
This condition applies even If other valid and collectible Insurance Is available to the Additional Insured
for a loss or "occurrence" we cover for this Additional Insured.
The Additlonai Insured's limits of Insurance do not increase our limits of Insurance, as described I
SECTION III — LIMITS OF INSURANCE. ����
All other terms, conditions, and exclusions under the policy are applicable to this end trrnsr a Id
remain unchanged. � _ ,,�
\V
Page 2 of 2
Includes copyrighted material of Insurance Services Office, Inc.,
PI-CANXAICH-002 (05111)
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CANCELLATION NOTICE TO SCHEDULED ADDITIONAL INSURED OR
CERTIFICATE HOLDER
This endorsement modifies Insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PROFESSIONAL LIABILITY COVERAGE PART
COMMERCIAL CRIME COVERAGE PART
COMMERCIAL INLAND MARINE COVERAGE PART
COMMERCIAL PROPERTY COVERAGE PART
COMMERCIAL AUTOMOBILE COVERAGE PART
The following is added to A. CANCELLATION of the Common Policy Conditions of the above applicable
coverage part;
A. In the event we cancel the policy in accordance with the policy's terms and conditions, we will
endeavor to mall written notice of cancellation to Additional Insureds or Certificate Holders,
shown in the above SCHEDULE within the time frame listed below. However, failure to mail
such notice shall Impose no obligation of any kind upon us, our agents or representatives.
i. 20 days before the effective date of cancellation If we cancel for any reason other than for
non - payment of premium.
As respects Additional insureds, the above cancellation provision applies only when the
Additional Insured shown in the above SCHEDULE Is added to the policy by a separate
additional Insured endorsement as the CANCELLATION NOTICE TO ADDITIONAL INSURED
OR CERTIFICATE HOLDER does not provide additional insured coverage,
Page 1 of 1 n'��
,ono
PHILADI!rLPH.IA
T.NSURANU COMPANTT,S
A Member of tbe'rokio bla iva alroup
One Bala Plaza, Suite 100
Bala Cynwyd, Pennsylvania 19004
610.617.7900 Fax 610.617,7940
PHLY,com
Philadelphia Indemnity hlsurance Company
COMMON POLICY DECLARATIONS
Policy Number: PHPK1738184
Named Insured and Mailing Address:
Natl's House
1733 Valencia St
Santa Ana, CA 92706-2930
Policy Period From: 01/06/2018 To: 01/06/2019
Business Description: Non Profit Organization
Producer: 18025
Levitt & Touche, Inc,
1050 W Washington St Ste 233
Tempe, AZ 85281
(602)956-2250
at 12:01 A.M. Standard Time at your making
address shown above.
IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THIS
POLICY, WE AGREE WITH YOU TO PROVIDE THE INSURANCE AS STATED IN THIS POLICY,
THIS POLICY CONSISTS OF THE FOLLOWING COVERAGE PARTS FOR WHICH A PREMIUM IS
INDICATED, THIS PREMIUM MAY BE SUBJECT TO ADJUSTMENT,
PREMIUM
Commercial Property Coverage Part 203,00
Commercial General Liability Coverage Part 1,670.00
Commercial Crime Coverage Part
Commercial Inland Marine Coverage Part
Commercial Auto Coverage Part
Businessowners
Workers Compensation
Professional Liability
Sexual/Physical Abuse
Total
Total Includes Federal Terrorism Risk Insurance Act Coverage
PART OF
277,00
851.00
'&6'r)y
3,151,00
38.00
q(`
�� b
E
`Omits applicable Forrns and Endorsements it shown In SPeclflc Cove age Pad/Coverage Form Declarations
CPD- PI IC (06/14) c ✓b tr-�. . �1
Secretary President and CEO
Philadelphia Indemnity Insurance Company
Form Schedule -- Policy
Policy Number: PHPK1738184
Forms and Endorsements applying to this Coverage Part and made a part of this
policy at time of issue:
Form Edition Description
WHY MyPHLY
0000
WHY MyPHLY7
CSNotice-1
1014
Making Things Easier
BJP-190-1
1298
Commercial Lines Policy Jacket
IL N 177
0912
California Premium Refund Disclosure Notice
PP2015
0615
Privacy Policy Notice
CPD-PIIC
0614
Common Policy Declarations
Location Schedule
0100
Location Schedule
Additional Insured Schedule
0100
Additional Insured Schedule
Named Insured Schad
01.00
Named Insured Schedule
PI-BELL-1
1109
Bell Endorsement
PI-CME-1
1009
Crisis Management Enhancement Endorsement
IL0017
1198
Common Policy Conditions
IL0021
0908
Nuclear Energy Liability Exclusion Endorsement
IL0102
0505
California Changes - Actual Cash Value
IL0104
0907
California Changes
IL0270
0912
California Changes - Cancellation And Nonrenewal
IL0952
0115
Cap On Losses From Certified Acts Of Terrorism
PI-CANXAICH-002
0511
Cancellation Notice To Schad Addl Insd Or Cart Holder
PI-TER-DNL
0115
Disclosure Notice Of Terrorism Ins Coverage Rejection
Page 1 of 1
Philadelphia Indemnity Insurance Company
Locations Schedule
Policy Number: PFIPK1738184
Proms, Bldg.
No, No, Address
0001 0001 1516 N Flower St
Santa Ana, CA 92706-3721
Page 1 of 1 x D��
Philadelphia Indemnity Insurance Company
Additional Insured Schedule
Policy Number: PHPK1738184
Additional Insured
The City of Santa Ana
Its officers, employees, agents and
volunteers
20 Civic Center Piz
Santa Ana, CA 92701-4058
CG2026 - General Liability
Re: Event at local park
Additional Insured
Santa Ana Unified School District
Its governing board, officers, agents &
employees
1601 E Chestnut Ave
Santa Ana, CA 92701-6322
CG2026 - General Liability
Page 1 of 1
�1�
Philadelphia Indemnity Insurance Company
Named Insured Schedule
Policy Number: PHPK1738184
Neutral Ground dba
sy� �d 1
Page 1 of 1 ��