Loading...
HomeMy WebLinkAboutALLEN R. OSHIRO DBA ILLUSIONS BY ALLEN 1City of Santa Ana cox office Use Only Clerk of the Council AGREEMENT TERMINATION FORM Please complete this form in its entirety when the attached agreement and all amendments (if any) are no longer in effect. Note: If your agreement is grant related, please ensure that all grant retention requirements have been satisfied prior to signing the termination form. Is the agreement(s) a permanent record? Yes No Return form to the Clerk of the Council Office (M-30). Call 647-1520 if you have any questions. The agreement with No. r� was completed on (List all amendments. Use space below if needed.) Department: Phone/Ext.: Signature: Date: Revised: 10-18-16 and final payment has been made. i INSURANCE ON FILE WC Declaration on file, WORK MAY PROCEED NTIL INSURANCE EXPIRES CLERK OF COUNCIL OATS, 0: PRCS (/) AUG 0 9 201 Silvia Cuevas July 26, 2018 Allen R. Oshiro ("Speaker/Performer") dba ;Illusions by Allen IN62, Correnti Street Pacoima, CA 91331 Re: Speaker/1erformer Engagement Agreement This letter represents your agreement with the City of Santa Ana ("City") as entered into on the above date for the engagements described below: I. Event Description: Magic Show 2, Date(s): Wednesday, August 1, 2018 and Thursday, August 2„:2018 3. Event Time(s): August P91 6-7pmand August 2* 5:30-6:30pm 4. Location: Santa Ana Senior Center 424 W. 3cd Street and Santa Ana Main Library 26 Civic Center Plaza, Santa Ana CA ("Property"). 5. Compensation: Three Hundred and 'Twenty -Five Dollars ($325) for each performance (payable by check within 30 calendar days of event); Speaker/Performer must provide IRS form W-9 before payment can be made. Total amount not to exceed Six Hundred and Fifty Dollars ($650). & Equipment provided by City: No equipment, however, the City will be responsible for room set up and advertising the program 7. Equipment provided by Speaker/Perfotmer: all equipment, materials, supplies, and personnel necessary for magic show. 8. City Contact Person (for coordinating purposes only): Patty Lopez 714 647-5325 & Michelle Loera 714 647-5231 9. Independent Contractor: Speaker/Performer shall, during the entire term of this Agreement, be construed to be an independent contractor and not an employee of the City. This Agreement is not intended nor shall it be construed to create an employer -employee relationship, a joint venture relationship, or to allow the City to exercise discretion or control over the professional manner in which Speaker/Performer performs the services that are the subject matter of this Agreement; however, the services to be provided by Speaker/Performer shall be provided in a manner consistent with all applicable standards and regulations. Speaker/Performer shall pay all salaries and wages, employer's social security taxes, unemployment insurance and similar taxes relating to employees and shall be responsible for all applicable withholding taxes. 10. Indemnification: Speaker/Performer, its agents, or its employees (if applicable) agrees to and shall indemnify, defend, and hold harmless the City, its officers, agents, employees, consultants, special counsel, and representatives from and against all loss, expenses, or liability (including costs and attorney's fees) arising from the negligence or willful misconduct of Speaker/Performer, its agents, or its employees. 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, fully release, waive and discharge forever any and all claims, demands, rights, and causes of action of any kind or N-2018-166 Letter Agreement — Allen R. Oshiro dba Illusions by Allen Page 2 nature against, and covenant not to sue, City, its elected officials, officers, employees, agents and volunteers, and all persons acting on behalf of, by, though 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, if Speaker/Performer has any employees, he 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/Perforraer shall not discriminate because of race, color, creed, religion, sex, marital status, sexual orientation, age, national origin, ancestry, disability, or any other basis protected by applicable law in connection with any activities related to this Agreement. 16. This Agreement shall in all respects shall be interpreted, enforced, and governed exclusively by and under the laws of the State of California. Both parties agree that Orange County, California, shall be the venue for any action or proceeding that may be brought or arise out of, in connection with or by reason of this Agreement. 17, This Agreement represents the complete and exclusive statement between the City and Speaker/Performer regarding the subject matter herein and supersedes any and all other agreements, oral or written, between the parties. This Agreement may not be modified except by written instrument signed by the City and by an authorized representative of Speaker/Performer. CITY OF SANTA A d RAUL GODINEZ City Manager M.T2,2 9 ,k MARIA D. HGIZAR a Clerk of the Council SP��-�[ei-RiP� RMJR By: Allen R. Oshiro dba ILLUSIONS BY ALLEN APPROVED AS TO tt FORM: LAURA ROSSM Senior Assistant City Attorney of Parks, Recreation, and Community Services Agency N-2018-156 MAGIC SHOW INVOICE: 468646 ILLUSIONS BY ALLEN.COM 12902 Correnti Street Arleta Ca. 91331 (562)397-8050 or(888)magic-45 or(888)624-4245 fax: (818)899-7559 e-mail: 1nfo@i11usionsbya11en coin Performance date: August 1, 2018 Cost: $325.00. 1 /2 hour. show live doves and Rabbit Event address: 424 W. Third St. Santa Ana. California 92701 (Santa Anna library) email Address: alooezaa-santa-ana.orc scuevas@santa-ana.org Set up time: 6:00 PM Showtime: 7:00 PM Contact phone number: 714-809-7098 and (714) 647-5254 Special instructions: all adults Contact person: Patty Buyer: Parks, Recreation and Community Services Agency Artist: Allen Oshiro N-2018-156 MAGIC SHOW INVOICE: 562547 ILLUSIONS BY ALLEN.COM 12902 Correnti Street Arleta Ca. 91331 (562)397-8050 or (888)magic-45 or (888)624-4245 fax: (818)899-7559 e-mail: info[?a illusionsbyallen com Performance date: August 2, 2018 Cost: $325 Event address: 26 Civic Center Plaza (The Santa Ana Public Library email Address: mloera@santa-ana.org Setup time: 5:30 PM Showtime: 6:30 PM Contact phone number: (714) 647-5231 Special instructions: all ages Half hour show doves and Rabbit Contact person:Michelle Loera Buyer: library Artist: Allen Oshiro ACC>RO®'II CERTIFICATE OF LIABILITY INSURANCE DATE6/8/2 DIVYYV) �� MARI(EL° /BI2018 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 pollcy(les) 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 Stephanie Weiss Specialty Insurance Agency NAME,PHONE 715-246-8908 Fax 715-246-4257 Performers of the U.S. A/c No Eater_.__._._._.._ P.O. Box 24 N-2018-156 ADDRIESS: certs@specialtyinsuranceagency.com New Richmond, WI 54017 INSURER(5)AFFOROING COVERAGE NAICN INSURERA: Evanston Insurance Company 35378 INSURED Allen R. Oshiro INSURER dba. Illusions: By Allen -- — -_---- 12902 Correnti Street INSURER C: Pacoima, CA 91331 INSURER D: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR - _ ADDLSUBR POEICY POLICY ERP LTR TYPE OF INSURANCE POLICYNUMBER MM/ODM'YV MMIDDIWVY LIMITS X COMMERCIAL GENERAL LIABILITY EACHOCCURRENCE 1,000,000 '- CLAIMS -MADE 'KI OCCUR __ DAMAGE TO RENTED PRIEMI SESEa occ.Qencel is i$ 300,000 MED E_XP(Any one person) _ �I$ 5,000 $ 1,000,000 _ A J X X 2CN0162-5668 04/25/2018 04/24/2019 PERSONAL aADV INJURY _— AGGREGATE LIMIT APPLIES PER GENT - GENERAL AGGREGATE $ 2,000,000 IX PRO- PRO- P POLICY —J LOG PRODUCTS-COMPIOPAGG _$ 21000,000 '' OTHER: $ AUTOMOBILE LIABILITY COMBINEDSINGLE LIMIT Ea accident $ — BODILY I NJURY(Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Peraccident) $ _ _ HIRED --I NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accident $ $ UMBRELLA LAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB �'I CLAIMS -MADE_ DIED RETENTION$ $ WORKERS COMPENSATION 'ANDEMPLOYERS'LIABILITY YIN ANYPROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/ME M BEREXCLUDED4 NIA PER OTH- STATUTE ER E. L. EACH ACC) DENT $ - iE.L. DISEASE LMEAS PEEDISEA LMEAS PEE OYEEI$ ------ '(MantlatoryinNH) If yes, describe under _. -- DESCRIPTIONOFOPERATIONSbelow E. L. DIS EASE - POLICY LI M IT $ BUSINESS P ERSONAL P ROPERTY- A' INLAND MARINE III AGGREGATE $ DESCRIPTION OF OPERATIONS) LOCATIONS I VEHICLES (ADDED 1e1, Additional Remarks Schedule, maybe attached If more space Is required) PERFORMER IS A NAMED INSURED AS A MEMBER OF PERFORMERS OF THE U.S.: Allen R. Oshiro dba Illusions By Allen �'a} Additional Insured: The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, CA 92701; its officers, employees, agents and represen ��yJ� s are named as additional insured's with regard to liability and defense of suits arising from the operations and uses performed by or on behalf of. li ad il7sured. Cancellation is as stated in the Policy. c2 ` ` Email: mloera@santa-ana.org Attn: Michelle Loera K� Event Date: August 2, 2018 SOm-N UCK I IFIUA It KULUCK UANUCLLA I IVN '(y The City of Santa Ana G 20 Civic Center Plaza SHOULD ANY OF THE ABOVE DESC D POLICNC LL ELLED BEFORE Santa Ana, CA 92701 THE EXPIRATION DATE THERE , NOTI FCE BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ,rr, ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD reserved. POLICY NUMBER: 2CN0162-5668 COMMERCIAL GENERAL LIABILITY CG 20 12 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - STATE OR GOVERNMENTAL AGENCY OR SUBDIVISION OR POLITICAL SUBDIVISION - PERMITS OR AUTHORIZATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE State Or Governmental Agency Or Subdivision Or Political Subdivision: City of Santa Ana and its, officers, employees, agents and representatives are named as additional insured. 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 any state or governmental agency or subdivision or political subdivision shown in the Schedule, subject to the following provisions: 1. This insurance applies only with respect to operations performed by you or on your behalf for which the state or governmental agency or subdivision or political subdivision has issued a permit or authorization. However: a. The insurance afforded to such additional insured only applies to the extent permitted by law; and b. 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. 2. This insurance does not apply to: a. 'Bodily injury", "property damage" or "personal and advertising injury" arising out of operations performed for the federal government, state or municipality; or b. 'Bodily injury" or "property damage" included within the "products -completed operations hazard". 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 endorsement shall applicable Limits of InSL Declarations. �Qdrease the shown in .144 CG 20 12 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 COMMERCIAL GENERAL LIABILITY III POLICY NUMBER: 2CN0162-5668 MARKEL® EVANSTON INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED This endorsement modifies insurance provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE FORM PRODUCTS/COMPLETED OPERATIONS COVERAGE FORM LIQUOR LIABILITY COVERAGE FORM PROFESSIONAL LIABILITY COVERAGE FORM Please refer to each coverage form to determine which terms are defined. Words shown in quotations on this endorse- ment may or may not be defined in all coverage forms. 6714 CL411144 Person or Entity: Any person or organization to whom you are obligated by valid written contract to provide such coverage. Additional Premium: $ (Check box if fully earned.®) Included WHO IS AN INSURED is amended to include the person or entity shown in the Schedule above as an Additional Insured under this insurance, but only as respects negligent acts or omissions of the Named Insured and only as respects any coverage not otherwise excluded in the policy. Our agreement to accept an Additional Insured provision in a contract is not an acceptance of any other provisions of the contract or the contract in total. When coverage does not apply for the Named Insured, no coverage or defense shall be afforded to the Additional In- sured. No coverage shall be afforded to the Additional Insured for injury or damage of any type to any "employee" of the Named Insured or to any obligation of the Additional Insured to indemnify another because of damages arising out of such injury or damage. All other terms and conditions remain unchanged. MEGL 0009-01 04 11 Includes copyrighted material of Insurance Services Office, Inc. Page 1 of 1 with its permission. COMMERCIAL GENERAL LIABILITY POLICY NUMBER: III 2CN0162-5668 MARK:r EVANSTON INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET WAIVER OF SUBROGATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM SCHEDULE Additional Premium: $ 0 Name of Person or Organization: Any person(s) or organization(s) to whom the Named Insured agrees to waive rights of recovery in a written contract. The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition (Section IV - COMMERCIAL GENERAL LIABILITY CONDITIONS) is amended by the addition of the following: We waive any right of recovery we may have against the person or organization shown in the Schedule above as respects written contracts that exist between you and such person or entity, provided you have agreed in writing to furnish this waiver. This waiver applies only to the person or organization shown in the Schedule above. All other terms and conditions remain unchanged. MEGL 0241-01 04 11 Includes copyrighted material of Insurance Services Office, Inc. with its Page 1 of 1 permission. POLICY NUMBER: 2CN0162-5668 COMMERCIAL GENERAL LIABILITY CG 20 01 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY — OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the fallowing: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance Condition and supersedes any provision to the contrary; Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. eP , CG 20 0110413 O Insurance Services Office, Inc., 2012 Page 1 of 1 N-201 BA 56 WORKERS' COMPENSATION DECLARATION I Allen O s h i ro hereby affirm under penalty of perjury, the (Name/Title) following declaration I certify on behalf of l l l u s l o n s by Allen that during the term of my Santa Ana literary°mer Name) contract for services with the City of Santa Ana, I will not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions and provide proof of workers' compensation coverage. DATE: August 2, 2018 By kuL. wo Name: Allen Oshlro Title: Owner Telephone: 562-397-8050 WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.