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HomeMy WebLinkAboutCONANT, SARA ELLIS - COACHING & CONSULTINGGL- 9`3-J9 ALL C UR R E ltjr Auto? N-2018-191 NSURANCENOT ON FILE WC PQM &' an Fie ( WORK MAY N PROCEED OCT - 3 2010 CLERK OF COUNCIL AGREEMENT TO PROVIDE TEAM BUILDING AND DATE. ` 111ala STRATEGIC PLANNING SERVICES -111a la AGREEMENT is made and entered into on this I" day of October, 2018, by and between Sara, Ellis Conant — Coaching &c Consulting; ("Consultant'), 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 consultant having special skill and knowledge in the field of Team Building and Strategic Planning Services: B. Consultant represents that Consultant is able and willing to provide such services to the City. C. In undertaking the performance of this Agreement, Consultant represents that it is knowledgeable in its field and that any services performed by Consultant under this Agreement will be performed in compliance with such standards as may reasonably be expected from a professional consulting firm in the field. 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 Consultant shall perform during the term of this Agreement, the tasks and obligations including all labor, materials, tools, equipment, and incidental customary work required to fully and adequately complete the services described and set forth in'Exhibit 'A, attached hereto and incorporated by reference. 2. COMPENSATION it. City agrees to pay, and Consultant agrees to accept as total payment for its services for City, the rates and charges identified in Compensation - Exhibit B. The total amount to be expended during the term of this Agreement shall not `exceed $20,000, This amount includes the base amount of $10,500 specified in Exhibit B, and $9;500 in contingency funds to. cover, additional set -vices performed at the sole discretion of the City b. Payment by City shall be made within 45 days (forty-five) days following receipt of proper invoice evidencing work performed, subject to City accounting procedures, Payment need not be made for work which fails to meet the standards of performance set forth in the Recitals which may reasonably be expected by City, Page 1 of 8 3. TERM This Agreement shall commence on the date first written above and continue for a one (1) year period until September 30, `2019, unless terminated earlier in accordance with Section 15, below. 4. INDEPENDENT CONTRACTOR Consultant shall, during the entire tern 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 Consultant performs the services which are the subject matter of this Agreement; however, the services to be provided by Consultant shall be provided in a manner consistent with all applicable standards and regulations governing such services. Consultant 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. 5. OWNERSHIP OF MATERIALS This Agreement creates a non-exclusive and perpetual license for City to copy, use, modify, reuse, or sublicense any and all copyrights, designs, and other intellectual property embodied in plans, specifications, studies, drawings, estimates, and other documents or works of authorship fixed in any tangible medium of expression, including but not limited to, physical drawings or data magnetically or otherwise recorded on computer diskettes, which are prepared or caused to be prepared by Consultant under this Agreement ("Documents & Data"). Consultant shall require all subcontractors to agree in writing that City is granted a non-exclusive and perpetual license for any Documents & Data the subcontractor prepares under this Agreement. Consultant represents and warrants that Consultant has the legal right to license any and all Documents & Data. Consultant makes no such representation and warranty in regard to Documents & Data which were provided to Consultant by the City. City shall not be limited in any way in its use of the Documents and Data at any time, provided that any such use not within the purposes intended by this Agreement shall be at City's sole risk. G. INSURANCE Prior to undertaking performance of work under this Agreement, Consultant shall maintain and shall require its subcontractors, if any, to obtain and maintain insurance as described below: a. Commercial General Liability Insurance. Consultant shall maintain commercial general liability insurance naming the City, its officers, employees, agents, volunteers and representatives as additional insured(s) and shrill 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 Consultant'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 Page 2 of 8 bodily and personal injury, including death resulting therefrom, and properly damage, in the total amount of $1,000,000 per occurrence, with $2,000,000 in the aggregate. Such insurance shall (a) name the City, its officers, employees, agents, 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. Business -automobile liability insurance, or equivalent form, with a combined single limit of not less than $1,000,000 per occurrence. Such insurance shall include coverage for owned, hired and non -owned automobiles. c. Worker's Compensation.insurance. In accordance with the provisions of Section 3700 of the Labor Code, Consultant, if Consultant has any employees, is required to be insured against liability for worker's compensation or to undertake self- insurance. elfinsurance. Prior to coimnencing the performance of the work under this Agreement, Consultant agrees to obtain and maintain any employer's liability insurance with limits not less than $1,000,000 per accident. d. The following requirements apply to the insurance to be provided by Consultant 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. ii, 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 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, 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 of insurance shall be incorporated by reference into the Agreement. V. Consultant shall supply City with a fully executed additional insured endorsement. e. If Consultant 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 forthwith tenninate this Agreement. Such termination shall not affect Consultant's right to be paid for its time and materials expended prior to notification of termination. Consultant waives the right to receive compensation and agrees to indemnify the City for any work performed prior to approval of insurance by the City. 7. INDEMNIFICATION Consultant agrees to defend, and shall indemnify and hold harmless the City, its officers, agents, employees, contractors, special counsel, and representatives from liability: (1) for personal injury, damages, just compensation, restitution, judicial or equitable relief arising out of claims for Page 3 of 8 personal injury, including death, and claims for property damage, which may arise from the negligent operations of the Consultant, its subcontractors, agents, employees, or other persons acting on its 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 clue by reason of the terms of or effects arising from this Agreement. 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. The Consultant 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 property rights arises by reason of the terns of, or effects arising from this Agreement. City may make all reasonable decisions with respect to its representation in any legal proceeding. Notwithstanding the foregoing, to the extent Consultant's services are subject to Civil Code Section 2782.8, the above indennity shall be limited, to the extent required by Civil Code Section 2782.8, to claims that arise out of, pertain to, or relate to the negligence, recklessness, or willful misconduct of the Consultant. 8. INTELLECTUAL PROPERTY INDEMNIFICATION Consultant shall defend and indemnify the City, its officers, agents, representatives, and employees against any and all liability, including costs, for infringement of any United States' letters patent, trademark, or copyright infringement, including costs, contained in the work product or documents provided by Consultant to the City pursuant to this Agreement. 9. RECORDS Consultant shall keep records and invoices in connection with the work to be performed under this Agreement. Consultant shall maintain complete and accurate records with respect to the costs incurred under this Agreement and any services, expenditures, and disbursements charged to the City for a minimum period of three (3) years, or for any longer period required by law, from the date of final payment to Consultant under this Agreement. All such records and invoices shall be clearly identifiable. Consultant shall allow a representative of the City to examine, audit, and make transcripts or copies of such records and any other documents created pursuant to this Agreement during regular business hours, Consultant shall allow inspection of all work, data, documents, proceedings, and activities related to this Agreement for a period of three (3) years from the date of final payment to Consultant under this Agreement. 1.0. CONFIDENTIALITY If Consultant receives from the City information which due to the nature of such information is reasonably understood to be confidential and/or proprietary, Consultant 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 less than reasonable care. "Confidential Information" shall include all nonpublic information. Confidential information includes not only written information, but also Page 4 of 8 information transferred orally, visually, electronically, or by other means. Confidential information disclosed to either party by any 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 Consultant disclosed in a publicly available source; (c) is in rightful possession of the Consultant without an obligation of confidentiality; (d) is required to be disclosed by operation of law; or (e) is independently developed by the Consultant without reference to information disclosed by the City. 11. CONFLICT OF INTEREST CLAUSE Consultant 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. 12. DISCRIMINATION Consultant 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, training, utilization, promotion, termination or other employment related activities. Consultant affirms that it is an equal opportunity employer and shall comply with all applicable federal, state and local laws and regulations. 13. EXCLUSIVITY AND AMENDMENT This Agreement represents the complete and exclusive statement between the City and Consultant, and supersedes any and all other agreements, oral or written, between the parties. In the event of a conflict between the terns 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 Consultant. 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 Consultant 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. 14. ASSIGNMENT Inasmuch as this Agreement is intended to secure the specialized services of Consultant, Consultant 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 to have any of the services which are the subject to this Agreement performed by City personnel or by other consultants retained by City. Page 5 of 8 15. TERMINATION This Agreement may be terminated by the City upon thirty (30) days written notice of termination. In such event, Consultant shall be entitled to receive and the City shall pay Consultant compensation for all services performed by Consultant prior to receipt of such notice of termination, subject to the following conditions: a. As a condition of such payment, the Executive Director may require Consultant to deliver to the City all work product(s) completed as of such date, and in such case such work product shall be the property of the City unless prohibited by law, and Consultant consents to the City's 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. 16. WAIVER No waiver of breach, failure of any condition, or any right or remedy contained in or granted by the provisions of this Agreement shall be effective unless it is in writing and signed by the party waiving the breach, failure, right or remedy. No waiver of any breach, failure or right, or remedy shall be deemed a waiver of any other breach, failure, right or remedy, whether or not similar, nor shall any waiver constitute a continuing waiver unless the writing so specifies. 17. 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. 18. PROFESSIONAL LICENSES Consultant shall, throughout the tern 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. Consultant 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. 19. MISCELLANEOUS PROVISIONS a. Each undersigned represents and warrants that its signature herein below has the power, authority and right to bind their respective parties to each of the terms of this Agreement, and shall indemnify City fully, including reasonable costs and attorney's fees, for any injuries or damages to City in the event that such authority or power is not, in fact, held by the signatory or is withdrawn. Page 6 of 8 b. All Exhibits referenced herein and attached hereto shall be incorporated as if fully set forth in the body of this Agreement, 20. 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 City 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 courtesy copies to: Executive Director, Public Works Agency City of Santa Ana 20 Civic Center Plaza (M-21) P.O. Box 1988 Santa Ana, California 92702 Fax: 714-647-5635 To Consultant: Sara Ellis Conant, Owner Sara Ellis Conant — Coaching & Consulting 1002 O'Reilly Avenue San Francisco, CA 94129 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 atter 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 sliall be excluded. Page 7 of 8 N-2018-191 IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first above written. ATTEST: Maria D. Huizar Clerk of the Council APPROVED AS TO FORM: SONIA R. CARVALHO City Attorney By: John 61,Funk Assistant City Attorney FOR APPROVAL: Fuadas, PE, PLS Executiv Director Public irks Agency CITY OF SANTA ANA Raul Oodinez 11 -4�— City Manager CONSULTANT: Sara Ellis Conant Owner Page 8 of 8 EXHIBIT A SCOPE OF SERVICES SCOPE OF SERVICES Team Building/Strategic Planning Sara Ellis Conant Scope Analysis of Strengths, Weaknesses, Opportunities, and Threats (SWOT): • Conduct 5 hours of interviews to assess the team's strengths, weaknesses, opportunities, and threats including goals, values, and alignment as a team • Contribute to questions for an on-line survey for all team building exercise attendees • Summarize themes and recommendations in a written report Design and co -facilitation of a one -day team exercise (9 a.m. - 5 p.m.), as well as electronic, typed up copies of all flipcharts and other outputs. Schedule for Delivery of Services Team Building Workshop on October 12, 2018 to include Consultant. Recommendations will be delivered by October 31, 2018. Exhibit A COMPENSATION Fee Proposal including hourly rates July 20, 2018 Sara Ellis Conant Coaching 8t Consulting Lorrie Ortiz Executive Secretary City of Santa Ana Public Works Agency Re: Proposal for Team Building a Strategic Planning Meeting Background On July 12, Lorrie Ortiz and Sara Ellis Conant spoke via phone about Fuad Sweiss' request for a SWOT analysis and 1 -day team building and strategic planning meeting. The proposal below is for such an analysis and meeting, designed to assist the leaders of the City of Santa Ana's Public Works Agency to develop a strategic plan which addresses their challenges and threats while building upon their strengths and opportunities. Deliverables Sara will provide the following services: 1. Analysis of Strengths, Weaknesses, Opportunities, and Threats (SWOT): • Conduct 5 hours of anonymous interviews with 10 individuals to assess the team's strengths, weaknesses, opportunities, and threats including goals, values, and alignment as a team • Contribute to questions for an on-line survey for all meeting attendees • Summarize themes and recommendations in a written report Sara Ellis Conant - Coaching a Consulting 1002 O'Reilly Ave., San Francisco, CA 94129 415.378.4417 - sara@saraellisconant.com 2. Design and facilitation of a one -day meeting (9 a,m,- 5 p.m.), as well as electronic, typed up copies of all meeting flipcharts and other outputs City of Santa Ana Public Works to provide: 1. Names and email addresses of SWOT interviewees 2. Introduction of Sara and the meeting objectives and interview approach (anonymity) via an email or at team meeting 3. Two 60 -minute touch -points with Fuad: a. Development and review of meeting objectives and agenda b. Review of final meeting agenda and SWOT findings 4. All logistical arrangements, meeting space, and refreshments Fees SWOT Analysis $ 5,000 1 -day Meeting Design, Facilitation, and Outputs 5,000 Travel expenses—flight and ground transportation, not to exceed 500 Total Qualifications $10,500 Sara Ellis Conant brings over 18 years of experience as a facilitator, trainer, consultant, and leadership coach. She assists individuals and teams to make lasting improvements in the areas of leadership, strategic planning, productivity, communication, and time management. Sara has worked with clients across sectors including public (City of San Francisco Departments of Public Works and Recreation Ft Parks, Denver Public Schools, UC Berkeley), non-profit (Biomimicry Institute, Help A Mother Out, Net Impact, Opportunity Collaboration, RSF Social Finance, Young Women Social Entrepreneurs), and corporate (Applied Materials, Autodesk, Capital One, Chevron, Clorox, Deloitte, Gap Inc., Google, Pfizer), Previously, Sara was a Manager at Deloitte Consulting specializing in training, facilitation, change management, communication, and organization design. She managed the launch of Deloitte's sustainability and corporate responsibility practice. Sara is co-founder and board member of Young Women Social Entrepreneurs and also serves on the board of RSF Social Finance. Sara has an MBA and a BA in Sociology from Stanford University. Sara Ellis Conant - Coaching a Consulting 1002 O'Reilly Ave., San Francisco, CA 94129 415.378.4417 - sara@saraellisconant.com ACOR®® CERTIFICATE OF LIABILITY INSl1RANCE (►..-/ DATEIMMIDDIYYYY) 07/24/2018 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(les) 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). PRODUCER CONTACT NAME: Hiscox Inc. d/b/a/ Hiscox Insurance Agency in CA 520 Madison Avenue 32nd Floor PNONE (888) 202-3007 ac No: ADDRESS: ADDRESS: INSURERS AFFORDING COVERAGE NAIC p New York, NY 10022 INSURER A: Hlscox Insurance Company Inc 10200 PREMISES Ea occurrence) $ 100,000 INSURED INSURER B: Sara Ellis Conant Coaching and Consulting 1002 O'Reilly Ave San Francisco, CA 94129 INSURER C: INSURER D: INSURER E: $ INSURER F: AUTOMOBILE 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 LTR TYPE OF INSURANCE D- POUCYNUMBER POLICYEFF D Y POLICY EXP MMIDDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE N OCCUR Y UDC -1488979 -CGL -18 09/03/201809/03/2019 ""'"-` EACH OCCURRENCE $ 2,000,000 PREMISES Ea occurrence) $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL a ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY [�]JECT PRO- FLOC OTHER: GENERALAGGREGATE $ 2,000,000 PRODUCTS - COMPIOP AGO SSR Gen. Agg $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIREDAUTOS AUOTOSWNED COMBI EDSNGLELIMIT $ Ea accident BODILY INJURY (Par person) g BODILY INJURY Per accident $ ( ) � pPe�acdde AMA E S $ UMBRELLA LIAR EXCESS ILIA e OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN ANYPROPRIETOMPARTNERIEXECUTIVE ❑ OFFICERIMEMBER EXC W DED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA PER OTH- STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ EL.DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 901, Additional Remarks Schedule, may be attached if mar* epsco is required) City of Santa Ana Its officers, employees, agents and representatives are named as additional Insured subject to policy terms and conditions ttEVILWCD BY; � �EL€NICE HFRFDtA (PO ,�OF,�. ). City of Santa Ana 20 Civic Center Plaza Santa Ana, CA 92701 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 All rights rasarvsd. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD ner RISCO X Policy Number: UDC -1488979 -CGL -18 Named Insured: Sara Ellis Conant Coaching and Consulting Endorsement Number: 34 Endorsement Effective: October 02, 2018 Hiscox Insurance Company Inc. 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 Persons Or Organization(s) City of Santa Ana, its officers, employees, agents and representatives 20 Civic Center Plaza Santa Ana,CA 92701 Information re uired to complete this Schedule, if not shown above, will be shown in the Declarations. Section 11 — Who Is An Insured is amended to in- clude as an additional Insured the person(s) or organk zation(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 omis- sions of those acting on your behalf: A. In the performance of your ongoing operations; or B. In connection with your premises owned by or rented to you. CG 20 26 07 04 © ISO Properties, Inc 2004Page 1 of 1 REVIEVVFLI BY. -'' % F.UY!!'F i ERE:DIA tnvi of WORKERS' COMPENSATION DECLARATION I Sara Ellis Conant hereby affirm under penalty of perjury, the (NamGTitle) following declaration: I certify on behalf of Conant Coaching & Consulting LLC that during the term of my (Consultant/Company Name) contract for consulting 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: 9/25/18 ff, By: )44 Name: Sara Ellis Conant Title: Telephone: 415-378-4417 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, Ifliy-9EWCti EiW': E'.t1N4C€ FkEF2E;iY9A (pCv ` € ) --##