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HomeMy WebLinkAboutSHERMAN, BRUCE, AN INDIVIDUAL, DBA: A-PLUS PROMOTIONSM City of Santa Ana *- Clerk of the Council AGREEMENT TERMINATION FORM Please complete this form in its entirety when the attached agreement and all amendments (if any) are no longer in effect. Note: If your agreement is grant related, please ensure that all grant retention requirements have been satisfied prior to signing the termination farm. Is the agreement(s) a permanent record? Yes No r Return form to the Clerk of the Council Office (M-30). Coil 647-1520 if you have any questions. The agreement with COTC Office Use Only C Zo 19 HE C OUN01 No. N-2019-069 was completed on 'r� fljq and final payment has been made. (fist all amendments. Use space below if needed.) Revised: 10-18-16 Department: Phone/Ext.: �[ Signature: J�-- Date: iNSl R :,NOE NOT ON FILE WORK MAY NO PROCEED CLERK OF COUNCIL DATE: APR 3 0 2019 INDEPENDENT CONTRACTOR AGREEMENT N-2019-069 5 t\v tw ( a luK THIS AGREEMENT is made and entered into this I st day of April, 2019, by and ?etween Bruce Sherman, an individual, doing business as A -Plus Promotions. ("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 provider to supply electrical animals and a trackless train for the City's Children's Day/Book Day (Dia de los Ninos) event to be held on April 20,201 ("Event"). B. Provider represents that Provider 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 its 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: SCOPE OF SERVICES Provider shall furnish (7) electric animal rides and a trackless train for a three hour time frame, as more fully described in Exhibit A attached hereto and incorporated by reference. City grants Provider the right to enter its property for the purpose of delivery, set-up, and piok-up. The equipment shall be set-up and ready for operation by 10:30 a.m. on April 20"' at locations to be specified by City and shall be disassembled and removed by Provider at the conclusion of the Event. 2. COMPENSATION a. City agrees to pay, and Provider agrees to accept as total payment for its services the amount of One Thousand Seven Hundred and Seventy -Five Dollars ($1,775.00). The cost is identified in Exhibit A, attached hereto and incorporated by reference. b. Payment by City shall be made within thirty (30) days following receipt of proper invoice evidencing work performed, subject to the (::ity's 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 the City. TERM This term of this Agreement shall commence on the first date written above and terminate on April 21, 2019,.unless terminated earlier in accordance with Section 1.1 below. Page I of 8 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, including coverage of sexual misconduct. 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 (e) contain standard separation of insured's 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 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. d. The following requirements apply to the insurance to be provided by Provider pursuant to this section: Page 2 of 8 (i) Provider shall maintain all insurance required above in full force and effect for the entire period covered by this Agreement, Certificates of insurance shall be furnished to the City upon execution of this Agreement and shall be approved in form by the City. (ii) 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, e, 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 forthwith 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 defend, indemnify and hold harmless the City, its officers, agents, employees, contractors, special counsel, and representatives from liability 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 direct or indirect 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, The Provider farther 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 asserting personal injury, damages, just compensation, restitution, judicial or equitable relief due to personal or property rights arising 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. This indemnification provision No, 6 shall survive any expiration or termination of this Agreement. 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. FINGERPRINTS AND BACKGROUND CHECK Provider, and any employees, subcontractors or substitutes, shall arrange for and submit their fingerprints for a criminal background check through the Department of Justice through the City's Human Resources Department process. Consultant shall be responsible for all charges associated with fingerprinting, Consultant shall not perform any services pursuant to this Agreement until clearance is received and Consultant is notified by the City's Parks, Recreation and Community Services Department, Page 3 of 8 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: 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: A PLUS Promotions 17120 Ermanita Ave. Torrance, CA 90504 Phone: (310) 532-6223 Email: info Itrainsoil theinove.com 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 put -poses 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 terns of this Agreement and any attachments hereto, the terns of this Agreement shall prevail. This Agreement may not be modified except by written instrument signed by the City and by an authorized representative of Provider. The parties agree that any terns 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 Page 4 of 8 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. It. 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. 12. TERMINATION This Agreement may be terminated by the City upon seven (7) 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. 13. RECORDS Provider shall keep records and invoices in connection with the work to be performed under this Agreement. Provider 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 City under this Agreement. Provider 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 City 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 in connection with any activities under this Agreement. 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 Page 5 of 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 hi 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 imenforceability 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 be so executing this Agreement, the parties hereto are formally bound to the provisions of this Agreement. IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first above written. ATTEST: NORMA MITRE Acting Clerk of the Council APPROVED AS TO FORM: SONIA R. CARVALHO City Attorney By: &M— ."his LAURA A. ROSSINI Senior Assistant City Attorney CITY OF SANTA ANA STEVEN MENDOZA Acting City Manager Page 6 of 8 RECOMMENDED FOR APPROVAL: LI A R LOFF Exehifive Director of Parks, Recreation and Community Services Agency PROVIDER: A PLUS Promotions lv� Name: Bruce Shenaan Title: Owner Page 7 of 8 EXHIBIT A SCOPE OF SERVICES/FEES Page 8 of 8 F�- A PLUS PROMOTIONS 17120 Ermanita Avenue Torrance CA, 90504 Bruce Sherman www.ti*ainsotithemove.com Email; info@trainsonthemove.com Phone (310) 532-6223 Cell (310) 686-2379 TO: Santa Ana Public Llbrary 26 Civic Center Plaza Santa Ana, Ca 92701 Attn: Elvia Hernandez Office: 714-836-0880 / Alt: 714.647-5397 Cell: 714-647-5261 Email: ehernandez50iisanta-ana.org INVOICE #831A t Santa Ana Public Library 26 Civic Center Plaza Santa Ana, Ca 92701 04/20/2019 - Saturday I DESCRIPTION I AMOUNT 7 ELECTRIC ANIMALS RIDE: 3hrs (10:30am - 1:30pm) TRACKLESS TRAIN RIDE: 3hrs (10:30am - 1:30pm) Travel/Setup Insurance Endorsement $750.00 $750.00 $200.00 $275.00 SUBTOTAL $1975.00 Travel/Setup DISCOUNT ( 200.00) ++Customer will provide narking for our Van & 'railer++ RAIN: WE WILL OPERATE THE TRAJk N IN LIGHT RAIN DRIX2L A-RAY9P„g-�,,QyT.SURFACE. If RAIN IS EXPECTED we will contact you the morning of the event to see If you still want the Train Ride. 1) If you decide you Do NOT Want the Train Ride at that time NO payment e required 2) If you decide you DO want the Train Ride we will provide the train ride and full payment is required ELECTRIC ANIMALS (Max WeieLht is 2003iss) We will need minimum space of 20ft X 40ft to operate the additional animals. RAIN: WE CAN NOT OPERATE THE ANIMAL RIDE IN RAIN (INDOORS ONLY . If RAIN IS EXPECTED we will contact you the morning of the event to see if you still want the Animal Ride, 1) If you decide you DO NOT want the Animal Ride at that Cime NO payment iCra_q_uired. 2) If you decide you DO want the Animal Ride we will provide the Animal Ride and full payment is required. You will have to make indoor arrangements for the Animal Ride Activity. HILLS: WE CANNOT OPERATE ON HILLS FOR SAFETY TOTAL I $1775.00 Please Make Check Payable to: A PLUS PROMOTION Total amount due on o before day of Thank you . • your business! Join us for the 11`h Annual library event to celebrate children, families, literature, and cultures Acompknenos a celebrar el 11°Evento Anual de la biblioteca dedicado a los ninos, las familias, la literatura, y la cultura Entertahnnent • Book Sale • Authors • Resouree Pau• Entretenh.- iento • Nenta de libros • .ltrtores • [Feria deReetosos AJO "r u I i tidbs& l IS 20d,eab - 20 10:30 ain — 2:00 pm Main Library Biblioteca Central 26 Civic Center Plaza Santa Ana, CA 92701 (714) 647-5258 BRUGSHE-01 LCASTELLANO DAT1YVI .4� a CERTIFICATE OF LIABILITY INSURANCE 312 25512010199 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 have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject t0 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 endomement(s). PRODUCER CONTACT Lauren Castellanos NAME: Arroyo Insurance Services - A2 PHONE FAX IAIC, No, E.tl_(626) 243.9619 �(AIC, Npp(626) 623.6135 225E Santa Clara Street Suite 130 _ Arcadia, CA 91006 AE- I-ss:laurenc@arroyoins.com _ INSURERISI AFFORDING COVERAGE _ NAICp _ INSURER A: Western World Ins Co. 13196 INSURED _ INSURER B: Bruce Sherman dba. Trains on the Move, INSURER C: A Plus Promotions & CollectiblesI- 17120 Ermanita Avenue INsuRER p: ___ INSURER E : Torrance, CA 90504 [INSURER F: COVERAGES CERTIFICATE NUMBER: R1=VICI0NI NI Imi 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 ADOLISUBR LTR TYPE OF INSURANCE II SD, MD POLICY NUMBER POLICY EFF POLICY E%P MMIDDIVYW DIY1'YY LIMITS A X COMMERCIAL GENERAL LIABILITYi EACH OCCURRENCE $ 2,000,000 CLAIMS-MADE OCCUR NPP8488687 6/10/2018 6/1012019 DAMAGE TO RENTED P EMI8E5 fEapccurrenceL-Y$.. __ 100,000 ME O EXP (AnV one person)I $ 5,000 PERSONAL&ADV INJURY- $ 2,000,000 -. __ GENERAL AGGREGATE $ 2,000,000 '. GEN'L AGGREGATE LIMIT APPLIES PER: PRO- POLICY. JECT LOC . PRODUCTS-COMP/OPAGG $ Included - _ $ — _ OTHER'. AUTOMOBILE LIABILITY COMBINED LIMIT $ ANY AUTO OWNED SCHEDULED BODILY INJURY (Per person) $ BOOOILY INJUORY (Per eccitle�--. $ AUTOS ONLY AUUTOOSWN _ $ - - AUTOS ONLY AUTOS 'NED (PeOF R�n[7AMAGE $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ _ EXCESS LIAB CLAIMS -MAD AGGREGATE $ . DED RETENTION$ $ WORKERS COMPENSATION I PER 1 1 OTH- AND EMPLOYERS' LIABILITY YIN ail STATUTE ER $ ANY PROPRIETOR/PARTNER/EXECUTIVE -'�. QQFFICE�,/9EMRRFR EXCLUDED? J NIA E.L.EACH ACCIDENT — $ (Mantla or m N - If yes, describe under E.L. DISEASE, EA EMPLOYEE - _-- - $ DESCRIPTIONOFOPERATIONSbelpw E.L. DISEASE -POLICY LIMIT e DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule may be attached if mores ace u requimtl THE CITY OF SANTA ANA, IT'S OFFICERS, EMPLOYEES, AGENTS, AND REPRESENTATIVE ARENA NIED AS ADDITIQAL RED I REGARDS TO GENERAL LIABILITY PER ATTAHCED CG20120509 ADDITIONAL �NSJ INSURED FORM. �A F�wwJJ.. y�® G CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF SANTA ANA THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 CIVIC CENTER PLAZA ACCORDANCE WITH THE POLICY PROVISIONS. Santa Ana, CA 92701 AUTHORIZED REPRESENTATIVE � �T^-&.-15-" ACORD 25 (2016103) ©1988.2016 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD :roc: t:x g CERTIFICATE OF LIABILITY INSURANCE Da 04ri1/2019 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 IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the pollcy(les) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, sub Bat to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rl hts to the certificate holder In lieu of such endorsement s - PRODUCER CONTACT NA E PHONE FAX AIC Na E: 24D2 12 Automobile Club Of Southern Calliomla 2601 S. Rguede Blvd A H302 Las Angeles, CA EfdAIL ADDRESS! INSUREN(S) AFFORDING COVERAGE NAIL # INSURER A : Inllnlly Select Insurance Company 20250 INSURED INSURED B : INSURED C Sherman, Brace 17120 Ermanila Ave INSURED D INSURED E Tcrmnca, CA @0504 INSURED F COVERAGES CERTIFICATE NUMBER: REVISION MUMRPP- THIS IS TOCERTIFY THATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUEDTOTHE INSURED NAMED ABOVE FORTHE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECTTO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALLTHETERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL INSC 9UBR VIVID POLICY NUMBER POLICY EFF POLICY EXP LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS -MADE ❑OCCUR DAMAGETO RENTED PREMISES $ MED EXP(Any one parson) $ PERSONAL &ADV INJURY $ GEN'LAGGREGATE LIMITAPPLIES PER: GENERALAGGREGATE $ POLICY ❑ PRO- ❑ LOC CT PRODUCTS COMPOPAGG $ $ OTHER: AUTOMOBILE LIABILITY COMBNED SINGLE LIMIT (Ea accident) $1,000,000 ANYAUTO BODILY INJURY (Per person) $ A OWNED f SCHEDULED AUTOS ONLY AUTOS X 5D4610033573001 D410112D19 D410112020 (Par BODILY INJURY Pe $ PROPERTY DAMAGE (Per accidan) $ HIRED NON OWNED AUTOS ONLY AUTOS ONLY UA%FELLAUAS OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESSLIAB ()III DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN PER STATUTE OTH- ER ANYPROPRIETORNARTNEPIEXECUTIVE OFFICEWMEM3ER EXGLUOFp? (Mandatory in NH) NIA ET, EACH ACCIDENT $ ELDISEASE EAEMPLOYEE $ IESSRIPTIONeU,rIbb El-DISEASE-POLICYLI IT Is OFFunder DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (ACOnD 1IS, Additional Remarks Schedule, may be atmched It more space is req�uIrred! •qy-' CERTIFICATE HOLDER CANCELLATION ' " SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED Santa Ana Public Library BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 26 Civic Center Plaza Santa Ana,CA 92701 AUTHORIZED REPRESENTATIVES 301988-2015 ACORD CORPORATION- All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD Bruce Sherman DBA Trains on the Move, A Plus Promotions & Collectibles POLICY NUMBER: NPP8488687 COMMERCIAL GENERAL LIABILITY CG 20 12 05 09 THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - STATE OR GOVERNMENTAL AGENCY OR SUBDIVISION OR POLITICAL SUBDIVISION - PERMITS OR AUTHORIZATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE State Or Governmental Agency Or Subdivision Or Political Subdivision: CITY OF SANTA ANA, ITS OFFICERS, AGENTS AND EMPLOYEES, 20 CIVIC CENTER PLAZA, SANTA ANA, CA 92701 Information required to complete this Schedule, if not shown above, will be shown in the Declarations Section 11 - Who Is An Insured Is amended to include as an insured any state or governmental agency or subdivision or political subdivision shown in the Sched- ule, subject to the following provisions: 1. This insurance applies only with respect to opera- tions performed by you or on your behalf for which the state or governmental agency or subdivision or political subdivision has issued a permit or author- ization. 2. This insurance does not apply to a. 'Bodily injury", "property damage" or 'personal and advertising injury" arising out of operations performed for the federal government, state or municipality; or b. 'Bodily injury' or 'property damage" included within the 'products -completed operations haz- ard". CG 20 12 05 09 Copyright, Insurance Services Office, Inc., 2008 Page 1 of 1 Bruce Sherman DBA Trains on the Move, A Plus Promotions & Collectibles Policy #NPP8488687 This Endorsement Modifies Your Policy (Effective At Inception Unless Another Data Shown Below) PRIMARY INSURANCE - ADDITIONAL INSURED(S) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART The insurance afforded by this policy for "bodily Injury," "property damage" and/or "personal and advertising injury" shall also apply to the "additional insured" listed below for claims, suits, and/or damages made against the "additional insured," but only to the extent the "additional insured" is being held responsible for the acts, omissions and/or negligence of the "named insured." This insurance afforded shall not apply to claims, suits and/or damages arising out of the acts, omissions and/or negligence of the "additional insured(s)." This Insurance afforded will be considered Primary Insurance and Noncontributing, but only If such claims, suits and/or damages arise out of the sole negligence of the Named Insured. The inclusion of the "additional insured(s)" shall not operate to increase the Limits of Insurance, To the extent, if any, that this policy affords coverage to an "additional insured," the "additional insured" is subject to all of the terms of the policy. Our obligation to provide coverage to an "additional insured" Is further limited by the interest of the "additional insured" as defined below. Interest of the Additional Insured(s) Defined: Owner or customer as required by written contract, for work performed for the Additional Insured by our Named Insured _ For the purpose of this endorsement, the "named insured' Is the person(s) and/or party(ies) designated on the Declarations Page of the policy or on any endorsement. The "additional insured' is the person(s) and/or party(ies) identified below. Identity of Additional Insured(s): Owner or customer as required by written contract, (Complete this section If endorsement is added after policy is Issue Polity Number Endorsement Number Endorsement Signature of Authorized Representative Producer Number INSURED VVW 419 (03110) WORKERS' COMPENSATION DECLARATION I Bruce T. Sherman / Owner hereby affirm under penalty of perjury, the (Nama/Title) Following declaration: I certify on behalf of A PLUS Promotions that during the term of my (Consulwt/Company Name) contract for 04/20/19 — SaturdM 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: 03/26/19 By: 4 Name: Bruce T. Sherman Title: Owner Telephone: 310-532-6223 Office / 310-686-2379 Cell 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.