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HomeMy WebLinkAboutHOLISTIC YOGA AND HEALTH LLC (DBA BODY AND BRAIN) 3City of Santa Ana f Clerk of the Council cOTc omce use Only 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TERMINATION FORM Please complete this form in its entirety when the attached agreement and all amendments (if any) are no longer in effect.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 ^ , 'i ;E Return form to the Clerk of the Council Office (M-30). Call 647-1520 if you have any questions. The agreement with %\611a1e S A \\MMh \1P J6 bAy 6ro� No. N-2019-016 was completed on %J181120i°1_ and final payment has been made. (List all amendments. Use space below if needed.) Department: Q(LCS� Phone/Ext.: Signature: Date: w6t l ln\ Revised: 10-18-16 wr rlcrinrntinn on file. INSURANCE ON FILE WORK MAY PROCEED UNTIL INSURANCE EXPIRES C99�c: s--s-/9 CLERK OF COUNCIL DATE:. JAN 1 5 2019 0:PRCS(/) RECREATION SERVICES AGREEMENT N-2019-016 Silvia Cuevas THIS AGREEMENT is made and entered into on this 20th day of December, 2018 by and between Holistic Yoga and Health LLC dba Body & Brain ("Provider"), 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 recreation service provider having special skills, resources and knowledge to provide Holistic Yoga and Health classes in its recreation class program. B. Provider represents that it is able and willing to provide such services to the City C. In undertaking the performance of this Agreement, Provider represents that it is knowledgeable in their field and that any services performed by Provider under this Agreement will be performed in compliance with such standards as may reasonably be expected. 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 Provider shall perform those services as set forth in Exhibit A to this Agreement. 2. COMPENSATION In consideration for the provision of the programs set forth in Exhibit A, City agrees to pay the Provider seventy percent (70%) of all gross revenue received from program participants. Total revenue to Provider shall not exceed $25,000.00 annually. Payment to Provider shall be made monthly within thirty (30) days following completion of the last class taught by Provider the prior month. City shall be responsible for collecting all fees from program participants. Provider shall not collect fees but will refer all interested participants to City for registration information. Provider agrees that City shall retain thirty percent (30%) of all gross revenue received from program participants as an administrative fee. 3. TERM This Agreement shall commence on January 1, 2019 and end on December 31 201`9 unless terminated earlier in accordance with Section 12 below. The term of this Agreement may be extended by a writing executed by the City Manager and the City Attorney. 4. INDEPENDENT CONTRACTOR Provider 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, ajoint venture relationship, or to allow the City to exercise discretion or control over the manner in which Provider performs the services which are the subject matter of this Agreement; however, the services to be provided by Provider shall be provided in a manner consistent with all applicable standards and regulations governing such services. Provider 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. Provider is not an agent, representative or employee of City and Provider shall have no authority to act on behalf of the City. 5. INSURANCE Prior to undertaking performance of work under this Agreement, Provider shall maintain and shall require its subcontractors, if any, to obtain and maintain insurance as described below: a. Commercial General Liability Insurance. Provider shall maintain commercial general liability insurance which 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 Provider'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 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 insured's provisions. b.-Worker's Compensation: Insurance. In accordance with California State law, Provider, if Provider 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, Provider 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 Provider 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 famished 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. 2 d. If Provider 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 terminate this Agreement. Such termination shall not affect Provider's right to be paid for its time and materials expended prior to notification of termination. Provider waives the right to receive compensation and agrees to indemnify the City for any work performed prior to approval of insurance by the City. 6. INDEMNIFICATION Provider agrees to and shall indemnify, defend 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 claims for personal injury, including death, and claims for property damage, which may arise from the negligent operations of the Provider or its contractors, subcontractors, agents, employees, or other persons acting on their behalf which relates to the services described in section 1 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 from this Agreement, to the extent that the injury, damages, just compensation, restitution, judicial or equitable relief is caused by the negligence of the Provider. 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. City may make all reasonable decisions with respect to its representation in any legal proceeding. In no case will Provider be required to indemnify or hold harmless the City from injury, damages, just compensation, restitution, judicial or equitable relief caused by the negligence of the City. 7. CONFLICT OF INTEREST Provider 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. 8. LIVE SCAN BACKGROUND CHECK Provider, and any employees, 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 of Justice as a condition of this Agreement and provide proof of compliance prior to performing services hereunder. 9. 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: 3 To City: Clerk of the 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 copy to: Executive Director of Parks, Recreation and Community Services City of Santa Ana 20 Civic Center Plaza (M-23) P.O. Box 1988 Santa Ana, California 92702 Fax (714) 571-4211 To Provider: Holistic Yoga and Health LLC dba Body & Brain Attn: Woomyung Son 10015 Garden Grove Blvd Garden Grove, CA 92844 Phone: (71.4) 537-3499 Email: garslengrov_e(a�7bodynbrain.conl 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 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 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 shall be excluded. 10. EXCLUSIVITY AND AMENDMENT This Agreement represents the complete and exclusive statement between the City and Provider 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 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 Provider. 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 Provider 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. 11. ASSIGNMENT/SUBSTITUTES a. Assignment. The experience, knowledge, capability and reputation of Provider were a substantial inducement for City to enter into this Agreement. Therefore, Provider 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. b. Substitutes. In the event Provider is not able to teach a class due to illness or some other cause beyond Provider's reasonable control, Provider must procure, at its sole expense, a qualified substitute instructor to teach the class at its regular time and place. Provider shall ensure that substitute instructors are at least twenty-one (21) years of age and comply with the City's insurance and live scan requirements contained herein. Evidence of compliance with City's insurance and live scan requirements shall be provided upon request. Provider must immediately notify the City of the substitute instructor's name, qualifications, address and phone number. If Provider cannot procure a qualified substitute and the City is unable to assist in this regard, then the class shall be canceled and a make-up class must be added to the session. Provider must notify participants as soon as possible of any class cancellation and make-up class. Provider must personally teach at least seventy-five percent (75%) of its offered classes. 12. TERMINATION a. This Agreement may be terminated by the City upon thirty (30) days written notice of termination. In such event, Provider shall be entitled to receive, and City shall pay Provider, compensation for all services rendered prior to the effective date of termination. b. Termination or cancellation of classes by the Provider outside of Section 1 Lb. must be given to the City at least thirty (30) days prior to termination/cancellation. Failure to provide adequate cancellation notice to the City may put future contracting of business with the City at risk and will result in the City's retention of ten (10%) percent of the final payment to Provider. 13. RECORDS Provider shall use attendance sheets generated and supplied by the City to record attendance in each class. Provider shall keep these and any other records in connection with the work to be performed under this Agreement and shall permit City, upon request, to review such records for a period of three (3) years from the date of final payment to Provider under this Agreement. 14. NON-DISCRIMINATION Provider 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, teaching, training, utilization, promotion, termination or other employment related activities or any services provided under this Agreement. Provider affirms that it is an equal opportunity employer and shall comply with all applicable federal, state and local laws and regulations. 5 15. 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. 16. LICENSES Provider shall, throughout the term 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. 17. SEVERABILITY In the event that one or more of the phrases, sentences, clauses, paragraphs or sections contained in this Agreement shall be declared invalid or unenforceable by valid judgment or decree of a court of competent jurisdiction, such invalidity or unenforceability shall not affect any of the remaining phrases, sentences, clauses, paragraphs or sections of this Agreement, which shall be interpreted to carry out the intent of the parties hereunder. 18. EXHIBITS All Exhibits referenced herein and attached hereto shall be incorporated as if fully set forth in the body of this Agreement. 19. AUTHORITY The person(s) executing this Agreement on behalf of the parties hereto warrant that they are duly authorized to execute this Agreement on behalf of said parties and that by so executing this Agreement, the parties hereto are formally bound to the provisions of this Agreement. [signature page to follow] 6 N-2019-016 IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first above written. ATTEST: Clerk of the Council APPROVED AS TO FORM: SONIA R. CARVALHO City Attorney By; Laura A. Rossini Senior Assistant City Attorney RECOMMENDED FQR APPROVAL: l Lisa kAoff Executive Director of Parks, Recreation and Community Services Agency CITY OF SANTA ANA Raul G inez 11 City Manager PROVIDER: i N-2019-016 Exhibit A SCOPE OF SERVICES A. Provider shall conduct Holistic Yoga and Health classes for ages 3 years and up. B. Provider shall teach such or similar classes (1) at the times below at facilities to be designated by the City or (2) on a schedule agreed upon by the parties for each class session or term, including the location, specific days and hours when classes will be held, and holidays to be observed, in accordance with City's needs. LOCATION: Jerome Center, 726 S Center St. Santa Ana, 714 647-6559 INSTRUCTOR: Body & Brain staff • Mind and Body/Belly Button Healing class will consist of monthly sessions, held 1 day per week, 1 hour and 30 minutes per day • Family Brain Wellness class will consist of monthly sessions, held 1 day per week, 1 hour, per day C. Provider shall provide all materials, supplies, equipment, records and personnel. Provider shall be responsible for clean-up of the facilities and materials and shall ensure the safety and effectiveness of instruction. CLASS SIZE A. No registration will be accepted after the second meeting of classes. B. Provider will be under no obligation to provide services for the cancelled classes, and the City will have no further obligations to pay Provider compensation for the remaining classes that were cancelled in that session. CLASS FEES A. Each participant shall pay class registration fees as established by City. B. Provider may not waive class participation/registration fees. C. Only registered participants may participate in class. D. Any refunds to participants will be made in accordance with City policy. E. Any materials fee shall be established by mutual agreement of City and Provider and shall be payable directly to Provider. ACORD DATE (MM DDnvvY) >., CERTIFICATE OF LIABILITY INSURANCE 05/0112018 PRDVucea Prone n+5J3-70B9 F. TIu533deD THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION EG INSURANCE AGENCY, INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 616 S. EUCLID ST. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ANAHEIM CA 92802 Al TER THE CQVERAra evenonen Rv xve D, —ie� N-2019-016 I INSURERS AFFORDING COVERAGE I NAIC # INSURED HOLISTIC YOGA & HEALTH LLC 10015 GARDEN GROVE BLVD. GARDEN GROVE CA 92844 1Q .-aC U�'-L 00 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ivsv TYPE OF INSURANCE POLICY NUMBER PpLWr EPPEcnVE GATE M/Np ra.lp ExrlaAnon PATE MAVOp LIMITS GENERALCOMMERCIAL NN930980 05/03/18 05103/19 EACH OCCURRENCE s 1,000,000 X JANAGE Ta REVFD P4 NSES£a w2i�1 S 20,096 COMMERCIPL GENERAL LIABILITY CLAIMS MADE LnJM OCCUR MEO. EXP(Anyonepnonl 5 5,690 A P/imary and Non CCntrftIoq X PERSONAL S ADV INJUR Y $ 1,000,000 X Waiver of SlArogefion GENERAL AGGREGATE s 2,000,005 GENT AGGREGATE LIMIT APPLIES PER X POLICY PRO- 71 LOG PRODUCTS-COMP,OP AGG, S Included 5 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANYAUTD (Ea atdden) S ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS iPer persory - HIRED AUTOS NON-OWNEDAUTOS BODILY INJURY (PI,r.w") 5 PROPERTY DAMAGE yPer acadenD S GARAGE AUTO ONLY - EA ACCIDENT $ ANY >U ANY AUTO M 9 OTHER THAN EA ACC 5 AUTO ONLY_ AGG S EXCESS/ UMBRELLA LIABILITY OCCUR ❑CLAIMS MADE _ L ? EACHOCCURRENCE s AGGREGATE S DEDUCTIBLE RETENTION 5WORKERS COMPENSATION ANDEMPLOYERS' UAaIUTYANY C.L. EACH ACCIDENT PROPRIETCWPARTNERIEX UTIVE r OFFICERIAIEMBER EXCLUDED+ YECIAL E L. DISEABE-EA EMPLOYEE E.L. DISEASE -POLICY LIMITOTHER: S PRO SIGNBPECIAL PROYIBIOxs mw,v Iterms DESCRIPTION OF OPERATIONS/LOCATIONSfVEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS Certificate holder, its officers, agents, and employees are named as Additional Insured in regards to General Liability per CG2 and conditions are based upon the actual policy SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO 00 SO SMALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON City of Santa Ana THE INSURER, ITS AGENTS OR REPRESENTATIVES Attn : PRCSA AJTHOR2ED REPRESENTA➢VE _ 20 Civic Center Plaza Santa Ana, CA 92701-- ._ Attention: Jay Lee ` ACORD 25 (2001108) Certificate # 11288 IS ACORD CORPORATION 1988 POLICY NUMBER. NN930980 COM ME RCIAL GENERAL LIABILITY CG 20 28 04 13 THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY, ADDITIONAL INSURED -DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): City of Santa Ana Attn:PRCSA Address: 2n Civic Center Plaza Sams Ana CA 92101 �]W ge\1 �iC Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section 11 - 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 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 less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. ec 20 26 04 13 copyright insurance services office, Inc., 2012 Page t of i POLICY NUMBER: NN930980 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US -AUTOMATIC STATUS WHEN REQUIRED IN CONTRACT OR AGREEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART The following is added to 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV . Commercial General Liability Conditions: We waive any right of recovery we may have against any person or organization because of payments we make for injury or damage caused, in whole or in part, by your acts or omissions, or the acts or omissions of those acting on your behalf in the performance of your ongoing operations or "your work" done under a written contract with that person or organization and included in the "products -completed operations hazard". This waiver applies only when you and that person or organization have agreed to such waiver in writing in a contract or agreement. All other terms and conditions of this policy remain unchanged. L609 (05/09l Includes copyrighted material of Insurance Services Office. Inc., •with its permission. POLICY NUMBER. NN930980 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -PRIMARY AND NONCONTRIBUTORY - AUTOMATIC STATUS WHEN REQUIRED IN CONTRACTOR A03REEM ENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II • Who Is An Insured is amended to include as an additional insured any person or organization when You and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy. Such person or organization is an additional insured only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured, but only for "occurrences" or coverages not otherwise excluded in the Coverage Part to which this endorsement applies. However, the insurance afforded to such additional insured: 1. Only applies to the extent permitted by law; and 2. Will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. Status as an additional insured for the person or organization to which this endorsement applies: 1. Commences during the policy period and after such written contractor agreement has been executed; and 2. Ends when: a. Your ongoing operations for that additional insured are completed; b. The contractor's contractor agreement is terminated; or c. Your policy cancels or expires; whichever occurs first. C. With respect to the insurance afforded to the additional insured, the following additional exclusions apply: This insurance does not apply to: 1. "Bodily injury", "property damage", "personal and advertising injury" or medical payments arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, including: a. The preparing, approving, or failure to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or b. Supervisory,inspection, architectural or engineering activities. c> . This exclusion applies even if the claims against any insured allege ��1 �gg,�Iyta or other wrongdoing in the supervision, hiring. employment, training or monitoring of others bttfit insured, If the 'off a" which caused the "bodily injury" or "property damage'", or the offense which caused the "person i dyertising injury", involved the rendering of or the failure to render any professional architectural,anr e a ,-0 surveying services, v t 1 L805(01117) Includes copyrighted material from Insurance Services office, Inc- with its permission, Page i of 2. "Bodily injury" or "property damage" occurring after: a. All work, including materials, palls or equipment furnished In connection with such work, on the project (other than service, maintenance, or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or b. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged In performing operations for a principal as a pail of the same project. D. With respect to the insurance afforded to the additional insured, the following is added to Section III - Limits Of Insurance; The most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement you have entered into with the additional insured; or 2. Available under the applicable Limits of Insurance shown In the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. E. The following is added to 4.a. of Other Insurance of Section IV- Commercial General Liability Conditions: if required in a written contract, the Coverage Part to which this endorsement applies is primary and noncontributory in the event of an "occurrence" caused, in whole or in part, by your acts or omissions, or the acts or omissions of those acting on your behalf that occurs while performing ongoing operations for the additional insured. All other terms and conditions remain unchanged. za4 L805 (01/ 17) Includes copyrighted material from Insurance ServiCes Office, Inc., with its permission. Page 2 of 2 W ORKERS_' COMP FNSAf ION DEC LARAT 10 N I iA/4 iT y hereby affirm under penalty of perjury, the following declaration: I certify on behalf of Hp/i t; c. YdG Ethat during the term of my (Cnnsuhawt'nwpan Nam) ' contract for _Recreation Classes 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: 1/3/2019 By: Name: Woomvunq Son Title: Owner Telephone: 714-537-3499 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. eved �v Siivia c-oe,18s PR�S6'a,i A�rnin. ACORD M DATE (WNDDrYYYYI CERTIFICATE OF LIABILITY INSURANCE 04129/2019 PRODUCER Pft E 114.533-7099 F. TI L!33AST3 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION EG INSURANCE AGENCY, INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 616 S. EUCLID ST. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ANAHEIM CA 92802 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC M INSURED INSURERA: NAUTILUS HOLISTIC YOGA & HEALTH LLC /> INSURER 8: 10015 GARDEN GROVE BLVD. Q — ao `c1`0 I INSURER C: GARDEN GROVE CA 928" NSURER D' INSURER E'. COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCYPERIOD 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 ALLTHE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATELIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 1,5R °fA TYPE OFINSURANCE POLICY NUMBER P000YEFP=TrvE MUCYEXPIRATICN LIMITS LTR INSR 01TE MMI OATS MM2 GENERAL LIABILITY NC418555 05103119 05/03/20 EACH OCCURRENCE $ X DAMAGE TO RENTED PRE413E3'Ea aarence E 30,000 COMMERCIAL GENERAL LIABILITY VIED. EXP(AnYdni,em ) $ 5,000 CLAIMS MADE&OCCUR A X Primary and Non C.Md1xXory PERSONAL& AOV INJURY $ 1,000,000 X Waiver of SMwopaion GENERALAGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS-COMPIOP AGG. $ Included X POLICY PRO- LOC 5 AUTOMOBILE LMBIUTY COMBINED SINGLE LIMIT ANYAUTO (Ea actldmp S BODILY INJURY ALL OWNED AUTOS SCHEDULED AUTOS (Pef �r ) S BODILY INJURY HIRED AUTOS NON -OWNED AUTOS (Peracdden0 $ day e(Peraccident) PROPERTY DAMAGE $ GARAGE LIABILITY ,.- 1<,` d•ti, AUTO ONLY -EA ACCIDENT $ OTHER THAN EA ACC $ ANYAUTO $ AUTO ONLY AGO EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE S AGGREGATE $ OCCUR CLAIMS MADE ❑ AA\' Wou O 5 p S PG ton DEDUCTIBLE en � l�r�C\e C. S S RETENTIONS WORKERS COMPENSATION AND WCSTAIDIOTHER, TORY LIMITS EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $ ANY PROPRIETOWPARTNEmEXECMTNE E L. DISEASE -EA EMPLOYEE $ OFFICENMEMSER EXCLUDED? X roe. deeedbe diner E L DISEASE -POLICY LIMIT Is SPECIAL PROVISIONS below OTHER: DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS City of Santa Ana, its officers, agents, and employees are named as Additional Insured in regards to General Liability per CG 20 26 04131 All terms and conditions are based upon the actual policy CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON City of Santa Ana THE INSURER, ITS AGENTS OR REPRESENTATIVES. Attn : PRCSA AUTHORIZED REPRESENTATIVE 20 Civic Center Plaza Santa Ana, CA 92701 �JayLee Attention: ACORD 25 (2001108) Certificate tf 12045 © ACORD CORPORATION 1988 POLICY NUMBER: NC418555 COMMERCIAL GENERAL LIABILITY CG 20 26 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following. COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): City __ San:a Ana, it s D`rJc__o, a7?n-s, and Address: '0 civic Center Plaza Salta A6a =A 9'7)1 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 the person(s) or organization(s) shown in the Schedule, but only with respect to liability for bodily injury", 'property damage" or 'personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: 1. In the performance of your ongoing operations, or 2. In connection with your premises owned by or rented to you. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law: and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. Wth 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 not increase the applicable Limits of Insurance shown in the � 43tions. �evlewe CG 20 26 04 13 Copyright Insurance Services Office, Inc., 2012 A1 e � Pasta (GarmeRe��eati�o� ` '��� Page 1 of I POLICY NUMBER: NC418555 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US -AUTOMATIC STATUS WHEN REQUIRED IN CONTRACT OR AGREEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART The following is added to 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV - Commercial General Liability Conditions: We waive any right of recovery we may have against any person or organization because of payments we make for injury or damage caused, in whole or in part, by your acts or omissions, or the acts or omissions of those acting on your behalf in the performance of your ongoing operations or "your work" done under a written contract with that person or organization and included in the "products -completed operations hazard". This waiver applies only when you and that person or organization have agreed to such waiver in writing in a contract or agreement. All other terms and conditions of this policy remain unchanged. gevjewed W rm �°Osta ecreakii PRCS�� L609 (05109) Includes copyrighted material of Insurance Services Office, Inc., with its pevnission. POLICY NUMBER: NC418555 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -PRIMARY AND NONCONTRIBUTORY - AUTOMATIC STATUS WHEN REQUIRED IN CONTRACTOR AGREEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II - Who Is An Insured is amended to include as an additional insured any person or organization when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy. Such person or organization is an additional insured only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured, but only for "occurrences" or coverages not otherwise excluded in the Coverage Part to which this endorsement applies. However, the insurance afforded to such additional insured: 1. Only applies to the extent permitted by law; and 2. Will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. Status as an additional insured for the person or organization to which this endorsement applies: 1. Commences during the policy period and after such written contractor agreement has been executed: and 2. Endswhen: a. Your ongoing operations for that additional insured are completed; b. The contractor's contractor agreement is terminated; or c. Your policy cancels or expires; whichever occurs first. C. Wlth respect to the insurance afforded to the additional insured, the following additional exclusions apply: This insurance does not apply to: 1. "Bodily injury", "property damage", "personal and advertising injury" or medical payments arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, including: a. The preparing, approving, or failure to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or b. Supervisory, inspection, architectural or engineering activities. �NNed'Oy This exclusion applies even if the claims against any insured alle$g8nce or other wrodoing in the supervision, hiring, employment, training or monitoring of others y that insured, if the "occdrrence" which caused the "bodily injury" or "property damage", or the offense ch cau e ' r I �d advertising injury", involved the rendering of or the failure to render any prof I " a arc I to al,Gg' in eying services. ' PGosta^ PRG �RecC�����n L805 (01117) Includes copyrighted material from Insurance Services Office. Inc., with its permission. Page 1 of 2 2. "Bodily injury" or "property damage" occurring after: a. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance, or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or b. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. D. With respect to the insurance afforded to the additional insured, the following is added to Section 111 - Limits Of Insurance: The most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contractor agreement you have entered into with the additional insured; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. E. The following is added to 4.a. of Other Insurance of Section IV - Commercial General Liability Conditions: If required in a written contract, the Coverage Part to which this endorsement applies is primary and noncontributory in the event of an "occurrence" caused, in whole or in part, by your acts or omissions, or the acts or omissions of those acting on your behalf that occurs while performing ongoing operations for the additional insured. All other terms and conditions remain unchanged. �evi�wed by PRCC SPJ?,ecreatt°n L805 (01117) Includes copyrighted material from Insurance services Office. Inc., with its permission. Page 2 of 2