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HomeMy WebLinkAboutPYROSPECTACULARSCity of Santa A -a - - Clerk of the Cours, rl COTC Office ~ AGREEMENT TERMINATION FORM C Please complete this form in its entirety when the attached agreement and all amendments (if any) are no longer in effect. City of Santa Ana Note: If your agreement is grant related, please ensure that all grant retention requirements have been satisfied prior to signing the termination form. i Ali j 0 2 2021 Is the agreement(s) a permanent record? Yes No Clerk of the Council Return form to the Clerk of the Council Office (M-30). Call 647-1520 if you have any questions. 66'� n-^ The agreement with f YwiG r% . No. )Pr-'Ro �-j -P� was completed on 1,3j 311 VC and final payment has been made. (List all amendments. Use space below if needed.) ,PC—ac \`1- [ r�Y -(} Department: �� Si J i�iti Y�CVL. p'--aof-1- Phone/Ext.:" Revised: 10-19-16 Signature: S A) LL , Cj-k /(�10 Date: ��� IQ \ WORK MAY M PROCEED MAYOR A. Pullen CLERK OF COUNCIL MAYOR PRO TEM Juan Vlllegn DA7.L, ,. - J -- °r�-i-Q��-- - -- COUNCILMEMSERS Caellle Iplaalaa , bi Penaloze Remain Rayne Vlcante Sarmlonto �} QQ°U5k-Vo Jne.Snlndn . CITY OF SANTA ANA PARKS, RECREATION AND COMMUNITY SERVICES AGENCY 20 Civk Center Plaza M-23 + P.O. Box 1090 Santa Ana, Callkmis 92702 wWwsanta-ana orn December 13, 2018 Pyro Spectaculars, Inc. 251 E. Front Street Covina, CA 91723 CITY MANAGER Raul Godlnaz II CITY ATTORNEY Sonla R. Carvalho CLERK OF THE COUNCIL Maria D. Holzer Re: Second Extension of Production Agreement No. A-2017-054 to provide fireworks productions Dear Mr, Souza: Pursuant to Section 3.2 and Exhibit B ("Term") of Agreement No. A-2017-054 entered into by Pyro Spectaculars, Inc. and the City of Santa Ana, dated March 29, 2017, the parties now opt to extend the time period of said Agreement for an additional one (1) year period from January 1, 2019 to December 31, 2019, for the fireworks production on July 4, 2019. The insurance certificates are required to be extended and/or renewed to cover this extension. All other terms and conditions of said Agreement remain unchanged and in full force and effect — Sine rely, PYRO SPECTACULARS, INC. Llsoididloff it4 r t r Executive Director Ile - Planning and Building Agency 14 CITY OF SANTA NA Raul Godinez II City Manager APPROVED AS TO FORM al. A.tk.� k-7 -, Jj, .Y1t Laura A. Rossini - Senior Assistant City Attorney ATTEST Mane H zar Cler-4 of Council SANTA ANA CITY COUNCIL Miguel PUTT Juon Wilegae VitemesomwnW David Peneli Jose SCNfrm Roman Re"--esellia lglial" - Mayor Mayor Pro Tom. Ward 5 Ward We'd2 Word Word wow IDRWi4U 1dDILL:aAR.VID via, ay+a�uia.anSS'a %pptpllWlFP 39LUtl:8ppgry ilcwnmurdlt�gpWyg":•••.: iyulor5AWMdaWA2e =f22"0lA1M= DRAYTON INSURANCE BROKERS, INC. 2500 CENTER POINT ROAD, SUITE 301 POST OFFICE BOX 94067 BIRMINGHAM, ALABAMA 35215 BIRMINGHAM, ALABAMA 35220 TELEPHONE: (20S) 854.5806 FAX: (205) 854-5899 CERTIFICATE OF INSURANCE No. 813003 We certify that insurance is afforded as stated below. This Certificate does not affirmatively or negatively amend, extend or alter the coverage afforded by the insurance policy and the insurance afforded is subject to all the terms, exclusions and conditions of the policy. INSURER Admiral Insurance Company POLICY NO, CA000002771-32 NAMED INSURED Pym Spectaculars, hm. Pyre Spectaculars by Sonia Pyro Events, Inc. Pyro Spectacular Industries, Inc. Pym Spectaculars Productions, Inc. North American Fireworks Co., Inc. (NAFCO) P.O. Box 2329 San Diego Fireworks Rialto, California 92377 Both POLICY TERM January 13, 2018 to January 13, 2019; Days 12:01 A.M. Standard Time COVERAGE Commercial General Liability ® Occurrence Basis ❑ Claims Made Basis LIMIT OF LIABILITY $5,000,000 each occurrence, $10,000,000 general aggregate, $5,000,000 produchilcompleted operations aggregate The limit of liability shall not be increased by the inclusion of more than one insured or additional insured. INSURED OPERATIONS Public fireworks display and special effects contractor It Is certified that, if named below, this policy includes as Additional Insureds 1) the sponsor(s), promoter(s), organizer(s) (including other entities having similar interests), of insured pyrotechnic events and/or 2) the owner(s) of real property (or barges) at which insured pyrotechnic events are held and/or 3) the owner(s), manager(s), tenant(s), mortgagee(s) (including other entities having similar interests), of buildings, stadiums, aronas and similar facilities at which insured pyrotechnic events ate held and/or 4) the licensing or permitting authority, or other authority having jurisdiction, issuing licenseslpermits for insured pyrotechnic events and/or 5) any other entity for which the insurance is required to be afforded under written contract. Coverage applies only as respects the legal liability of such Additional Insured(s) for bodily injury and property damage caused by the operations of the Named Insured. The insurance afforded any Additional Insured does not include coverage for any bodily injury or property damage arising from the failure of such Additional Insured to fulfill its obligations specified in its contract with the Named Insured. NAME & ADDRESS OF INSURED SPONSORS, PROPERTY OWNERS, LICENSORS City of Santa Ana, its Officers, Employees, Agents, Volunteers and Representatives 20 Civic Center Plaza Santa Ana, CA 92701 ADDITIONAL INSURED(S) City of Santa Ana, County of Orange, Orange County Fire Authority and their officers, agents, employees and volunteers when acting in their official capacity as such. X10N The coverage afforded the additional insureds as set forth in this certificate shall be primary and non- y�(N contributory with respect to any insurance carried by such additional insurds. aV� DISPLAY LOCATION DISPLAY DATE(S) Aq Centennial Regional Park Soccer Field July 4, 2018 �e j Santa Ana, CA It is certified that this policy requires a 30 day mutual notice of cancellation between the Insurer and the Nam sured,"-' J 'd'vem of such cancellation we will endeavor to mail 10 days written notice to the Additional Insured(s), whose name and ress is sh hereon, but failure to mail such notice shall impose no obligation or liability of any kind upon the insurer and/or the undersigned. DRAYTON INSURANCE BROKERS, INC. J@guarv,15. 2018 _ -r— DATE OF ISSUE AXNTRINGER, PRESIDE ' CALIFORNIA LICENSE N AIS664 CERTIFICATE OF LIABILITY INSURANCE DATEIMMMI)OYYYY) 1/i S/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 ba endorsed. If SUBROGATION IS WAIVED, sub(ect to the terms and conditions of the policy, certain policies may require an endorsement. A statement an this certificate does not confer rights to the certificate holder In lieu of such endorsements . PRODUCER GUNTACF N ME' _ Britton Gallagher PHONE FAX r One Cleveland Center, Floor 30-W%-��5-7�-- llExal216.6,r8-7101 1375 East 9th Street Cleveland OH44114 INSUREWaIAFFGRDINGDaVERAaE i Neoa INSURED Pyro Spectaculars Inc. San Diego Fireworks P. 0. Box 2329 Rialto CA 92377 COVERAGES CERTIFICATE NUMBER: ter;RRnaaay R9VI.CIr1N NIIMRFR• THIS IS TO CERTIFY THAT THE POLIOIES 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 OCCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES OESCRI85D HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _ INTR TYPEDF INSVRANCE r-y AGtlL'erTR� ®y lao YEFF �PQ—LJ6YEXP A�I n POLICYNUMSER MM/DONYYY MlbnlyyyY�,M LIMITS GENERAL LIABILITY ,� EACH OCCURRENCE $ COMM1IERCIAL GF-NER((AL��LIABILITY BTFAASETi5'AE73fiEri PREM BF.S (Es xwrza ems,_„ .. 9 CLAIMS MADE `J OCCUR MEO E%P (-Any o�m Penonl $ PERSONAL B ADV INJURY $ GENERAL AGGREGATE � GEN'L AGGREGATE LIMIT APPUE9 PER: pRgDUCTS,COMP/OP AGGdier $ POLICY PRO. LOC 'LE LIABILITY SIBCACO031d51 1113/2018 1113/2019 _LE accheml 1ODDy000 UTO BODILY INJURY(Per Pamon)NED SCHEDULEDBODILY AUTOSAUTOSAUTOS INJURY (Por gppitlenp PeLLA JAUTOS LIAS �XJ OCCUR EXCa017986 U13120W 11113/2019 EACH OCCURRENCE $4.000.000 S LAS i ICIAIMS-MADE IAGGRr:GATE _-�� .�—m�}$4000.000 ICOMPENSATION 4YC STA U- I OTH, AND EMPLOYERS'LIABILIW YIN .TOSYLIY �$ w ANY PROPRIETORIPARTNERIEXECUTIVE EL EACH ACCIDENT OFFICERIMEMBER -EXCLUDED? (MonNatary,n NH) N/A I ELOISEAB PA EMPLOYE I$ Lv.a,....W... Iryyea aesadnounaer I ----- DEBdRIPTIONOrOPERATIONS br.nt EL.OISFISE.POLICYUMIT $�- i � DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Alteab ACORD 101, Additional Remarks Schedule, It mote space is oagahad) Certificate Holder Is Named as an additional insured. j\ 51 V ry C I'fY OF SANTA ANA SHOULD ANY OF THE ABOVE DESCRIBE OLICIES a�ANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 CIVIC CENTER PLAZA ACCORDANCE WITH THE POLICY PROVISIONS. SANTA ANA CA 92701 AUTHORIZED REPRESENTATNE AGURD 25 (201U/051 The ACORD name and logo are registered marks of ACORD Policy Number: CA000002771-32 CC 20 26 07 04 8ndorsement No.102 Effective Date: January IS, 2018 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 Narne City of Santa Ana, its officers, agents, employees and volunteers as additional insured. the Seedou 11— Who Ts An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or die acts or omissions 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. Q CG 21) 26 07 04 0 ISO Properties, Inc., 2004 Page 1 of 1 13 Polmv Number: CA000002771-32 Al 08 76 02 03 Effective Date: 01 / 13 / 2 018 THIS ENDORUIVIENT CHANGES THE POLICY, PLEASE RUAD 5T CARFFULLY. BLANKI,,T ADDITIONAL INSURED This endorsement modifies insurance: provided under the following: CON MBRCIA-L GENERAL LIABILITY COVERAGE FORM COMMERCIAL PROPERTY COWRAGfi FORM PROFESSIONAL LIABILITY COVEkAUE FORM It is hereby declared and agreed that the following entities are included as Additional lnsured(s) hereunder: 1) Sponsm(s), Iuonmter(a), organizer(s) (including ing other entities having sitridar interests), of maned pyrotechnic events, 2) Owner(s) of real property (or barges) at which insured pyrotechnic events are held, 3) Owner (9),manager(s),Mantis), mongogoals) (including other amid as having similar in terrors), of buildings, stadiums, arenas and similar facilidas at which insured pyrotechnic events are hold. 4) The licensing or permitting authority, or other authority having jurisdiction, issuingli censes/peanitg for insured pyrotechnic events. 5) Any ocher entity for which the Named(nsured is oonlraotiadly obligate dtofirm idehaar- ance such as is afforded by the terms of this polioy. but only ifsnch entities are listed as additional insured(s) in a certificate of irise ranee issued under the torms of this endocseruentRod always subject to the limitations or conditions net out in such certi(irate of insurance. 'Cho covernge afforded such Additionallnsured(s) does not apply to injury or danuge arising from the failure of any such Additional Insured to fulfill its obligations specified in its contract with the Named lnsurad, AI 08 76 02 03 Page i of 1 0 Policy Nwnber:CA0 0 0 0 0 2 7 71 — 3 2 At 08 76 02 03 Effective Date; 01. / 13 / 2 018 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, COVERAGE AMENDMENT -PRIMARY This endorsement modifies insurance provided under the following: COMWERCIAL GENERAL LIABILITY COVFRAGEFORM COMMERCIAL PROPERTY COVERAGE FORM PROFESSIONAL LIAY3ILITY COVERAGE FORM It is hereby declared and agreed that, if so stated in a certificate of insurance, the coverage afforded any entity included as an Additional Insured under the terms of ttus policy shall 1) Be primary and non-contributory with any policy of insurance (or self-insurance) issued directly to the Additional lusured. 2) Provide a waiver of subragadon in favor of such Additional Insured, N Al 09 70 02 03 page I of 1 0 POLICYHOLDER COPY P.O. BOX 8192, PLEASANTON, CA 94588 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 01-16-2018 CITY OF SANTA ANA so 20 CIVIC CENTER PL2 SANTA ANA CA 92701-4058 OROCP POLICY NUMBER: 0809749-2017 CERTIFICATE IC: 1848 CERTIFICATE EXPIRES: 10-14-2018 10-14-2017/10-14-2018 This Is to cartify that we have issued a valid Workers' Compensation insurance policy in a farm approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer, We will also give you 30 days advance notice should this policy he cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this Certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms. exclusions, and conditions, of such policy. Authorized Representative President and CEO EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE, ENDORSEMENT N2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 10-14-2002 IS ATTACHED TO AND FORMS A PART OF THIS POLICY, EMPLOYER PYRO SPECTACULARS, INC. SP PO BOX 2329 RIALTO CA 92377 InEVJ-2314! [P1Y,S0] PRINTED : 01-15-2018 M DRAYTON INSURANCE BROKERS, INC. 2500 CENTER POINT ROAD, SUITE 301 POST OFFICE BOX 94067 BIRMINGHAM, ALABAMA 35215 BIRMINGHAM, ALABAMA 35220 TELEPHONE: (205) 854-5806 FAX: (205) 854-5899 CERTIFICATE OF INSURANCE NO. 902028 We certify that insurance is afforded as slated below. This Certificate does not affirmatively or negatively amend, extend or alter the coverage afforded by the insurance policy and the insurance afforded is subject to all the reins, exclusions and conditions of the policy. INSURER Admiral Insurance Company POLICY NO. CA000002771-33 NAMED INSURED Pyro Spectaculars, Inc. Pym Spectaculars by Souza Pyw Events, Inc. Pyro Spectacular lndusu'ies, Inc. Pyro SPeCiaculmS Pmductiorrs, Inc, North American Fireworks Co., Inc. (NAFCO) P.O. Box 2329 San Diego Fireworks Rialto, California 92377 POLICY TERM January 13, 2019 to January 13, 2020; Both Days 12:01 A.M. Standard Time COVERAGE Commercial General Liability: ® Occurrence Basis ❑ Claims Made Basis LIMIT OF LIABILITY $5,000,000 each occurrence, $10,000,000 general aggregate, $5,000,000 products/co npleted operations aggregate The limit of liability shall not be increased by the inclusion of more than one insured or additional insured. INSURED OPERATIONS Public fireworks display and special effects contractor It is certified that, if named below, this policy includes as Additional Insureds 1) the sponsor(s), promoter(s), organizer(s) (including other entities having similar interests), of insured pyrotechnic events and/or 2) the owner(s) of real property (or barges) at which insured pyrotechnic events are held and/or 3) the owner(s), manager(s), tcnant(s), mortgagee(s) (including other entities having similar interests), of buildings, stadiums, arenas and similar facilities at which insured pyrotechnic events are held and/or 4) the licensing or permitting authority, or other authority having jtn indiction, issuing licenses/permits For insured pyrotechnic events and/or 5) any other entity for which the insurance is required to be afforded underwritten contract. Coverage applies only as respects the legal liability of such .Additional Insured(s) for bodily injury and property damage caused by the operations ofthe Named Insured. The insurance afforded any Additional Insured does not include coverage for any bodily injury or property damage arising from the failure of such Additional Insured to fulfill its obligations specified in its contract with the Named Insured. NAME & ADDRESS OF INSURED SPONSORS, PROPERTY OWNERS, LICENSORS City of Santa Ana, its Officers, Employees, Agents, Volunteers and Representatives 20 Civic Center Plaza Santa Ana, CA 92701 ADDITIONAL INSURED(S) City of Santa Ana, County of Orange, Orange County Fire Authority and their officers, agents, employees and volunteers when acting in their official capacity as such. The coverage afforded the additional insureds as set forth in this certificate shall be primary and non- QSt{�1 contributory with respect to any insurance carried by such additional insurds. kapl�" ,1e6 by' Orypil-�5 DISPLAY LOCATION DISPLAY DATE(S) . \I Centennial Regional Park Soccer Field July 4, 2019 C� Santa Ana, CA Gue�asr 5M�a P�Pd It is certified that this policy requires a 30 day mutual notice of cancellation between the Insurer and the N e Insuredvent of such cancellation we will endeavor to mail 10 days written notice to the Additional Insured(s), whose name and address is sit hereon, but failure to snail such notice shall impose no obligation or liability of any kind upon the insurer and/or the undersigned. DRAYTON INSURANCE: BROKERS, INC. _Eanuary 2�t�2019. _ _ __ DATE OF ISSUF....STRPRE:SIDF" — CALIFORNIA LIC'F.NSF N(. :\I8664 %. O CERTIFICATE OF LIABILITY INSURANCE OATS019 V ) 1nanDls 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 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 ICONTACT One Cleveland Center, Floor 30 tus:nR.E%D:2ib-658J100 1375 East 91h Street EMAIL ADOR€ss;_ Cleveland OH 44114 _ INSURERS) AFFORDING COVERAGE i NAICN INSURED INSURERA:Maxum Indemnity Company_ .._ 26743 _.. _. INSURER_B:EVerest NatlOnal IDsurance. Company -....... ._ 10120 Pyro Spectaculars Inc INSURER C: San Diego Fireworks --- P. O. Box 2329 - NS-URERD __—. Rialto CA 92377 _INSURER E o INSURER F' COVERAGES CERTIFICATE NUMBER: RQi sRszl9 RFVIRUDIU MIIMRFR- 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, TFRM 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 _— AODLlilen, - "- POLICY EFF POLICY E%P _ LT. TYPE OF INSURANCERISE POLICY NUMBER MMIOOM'W MMIDDIYTYY t LIMITS GENERAL LIABILITY EACH OCCURRENCE S COMMERCIAL GENERAL LIABILITYTORENT€D I DAMAG PFiEMI$E$ l�q 9ESu 14 cgj _ S _j CLAIMS -MADE OCCUR I MED EXP(A yonev a n) 5 _. _. PERSONAL B ADV INJURY s AGGIR fE IGENERAL GEN'L AGGREGATE LIMI' APPLIES PER: PRODUCTS - COMP OP AGo POLICY i PRO-JECT i LUC I j S B AUTOMOBILE LIABILITY SIBCA00031-181 1/13l2019 ' 1/1312020 O t (E codgml i 81.000.00C X�ANY AUTO BODILY INJURY IP person) ALL OWNED IEDHFOULED AUTOS ; ._1 AUTOS 0001LY INJURY (P tlen0 I S X HIRED AUTOS 'X ! NON -OWNED nuTos r ! PNOPUaY DAMAuE owdoell _ Ij e A UMBRELLA LIAR 1IX IOCCUR EXC6017995 11113/2020 EACH OCCURRENCE s4,D00000 �X EXCESS LIAR {_ GLUMSMADE (1/13/2019 _ W .gGGREGATE. S4,0000 I I DEO R[TENTIONS S WORKERS COMPENSATION I! WC STATE. LOIN AND EMPLOYERS' LIABILITY YIN ! �TORY_LIMITS l I ER _- ANYPROPRIETORIPARTNERIFXEGUTIVE EL EACH ACCIDENTIA! S OFFICFRIMFeWt R E%CLUOED7 ❑ N _ f (Magdalory In NH) I EL. DISEASE-FAFMPLOYEE:S If yes geicr0 ndar DFSCRIPTON OF OPERATIONS below I EI DISEASE -POLICY LIMITI$ I I I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Allac4 ACORD 101, Additional Remarks Schedule, if more space is required) Certificate Holder is Named as an additional insured. •� � �e�`e�ed`cy �s City of Santa Ana 20 Civic Center Plaza Santa Ana CA 92701 SHOULD ANY OF THE ABO%FwBI THE EXPIRATION DATE- THER ACCORDANCE WITH THE POLICY AUTHORIZED REPRESENTATIVE C'_''Jl:�� % V © 1988-2010 ACOF ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD CANCELLED BEFORE BE DELIVERED IN All rinhfc r<con.md Policy Number: CA000002771-33 CG 20 26 07 04 Endorsement No.107 Effective Date: January 24, 2019 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) City of Santa Ana, its officers, agents, employees and volunteers as additional insured. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section Il —Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or (lie acts or omissions 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 C, ISO Properties, Inc., 2004 Page 1 of 1 0 Policy Number.CA000002771-33 Al 08 76 02 03 Effective Date:0111312019 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 COMMERCIAL, PROPERTY COVERAGE FORM PROFESSIONAL LIABILITY COVERAGE FORM It is hereby declared and agreed that the following entities are included as Additional Insured(s) hereunder: 1) Sponsor(s),promoter(s),organizer(s)(including other entities having similar interests). of insured pyrotechnic events. 2) Owner(s) of real property (or barges) at which insured pyrotechnic events are held. 3) Owner(s), manager(s), tenant(s),mortgagee(s)(including Other entities having similar in terests), of buildings, stadiums, arenas and similar facilities at which insured pyrotechnic events are held. 4) The licensing or permitting authority, or other authority havingjurisdiction, issuing li censeslpermits for insured pyrotechnic events. 5) Any other entity for which the Named Insured is contractually obligated to provide insur- ance such as is afforded by the terms of this policy. but only if such entities are listed as additional insureds) in a certificate of insurance issued underthe terms of this endorsementand always subject to the limitations or conditions set out in such certificate of insurance. The coverage afforded such Additional Insured(s) does not apply to injury or damage arising from the failure of any such Additional Insured to fulfill its obligations specified in its contract with the Named Insured. �e\e�ed�Y, J��lQ �s S��`�\a GuP�m�� �GS� P Al 08 76 02 03 Page oft 0 Policy Number.CA000002771-33 All 08 76 02 03 Effective Date:01113/2019 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CARLYULLY. COVERAGE AMENDMENT -PRIMARY This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM COMMERCIAL PROPERTY COVERAGE FORM PROFESSIONAL LIABILITY COVERAGE FORM It is hereby declared and agreed that, if so stated in a certificate of insurance, the coverage afforded any entity included as an Additional Insured under the terms of this policy shall I) Be primary and non-contributory with any policy of insurance (or self-insurance) issued directly to the Additional Insured. 2) Provide a waiver of subrogation in favor of such Additional Insured. PEGS AI 08 76 02 03 Page 1 of 1 0 POLICYHOLDER COPY P.O. BOX 8192, PLEASANTON, CA 94588 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 01-24-2019 GROUP; POLICY NUMBER: 0803749-2018 CERTIFICATE 10: 1833 CERTIFICATE EXPIRES: 10-14-2019 10-14-2018/10-14-2019 CITY OF SANTA ANA SIP 20 CIVIC CENTER PLZ SANTA ANA CA 92701-4058 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer. We will also give you 30days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded bbythe pp/yollii���c///y described herein is subject to all the terms, /exclusions,, and conditions, of such policy. Authorized Representative President and CEO EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT N0015 ENTITLED ADDITIONAL INSURED EMPLOYER EFFECTIVE 2019-01-24 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. NAME OF ADDITIONAL INSURED: CITY OF SANTA ANA ^— ENDORSEMENT N2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 10-14-2002 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. I EMPLOYER PYRO SPECTACULARS, INC. PO BOX 2329 RIALTO CA 92377 QRG SP TP13,SD1 IREV.7-2014) PRINTED : 01-24-2019 SIP