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HomeMy WebLinkAboutHAYNES, FRANKLIN, DBA: FRANKLIN HAYNES MARIONETTESCity of Santa Ana Clerk of the Council COTC Office 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TERMINATION FORM Please complete this form in its entirety when the attached agreement and all amendments (if any) are no longer in effect. C;tV 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�3 0 2 ZU 21 Is the agreement(s) a permanent record? Yes No Clerk of the COLInCil Return form to the Clerk of the Council Office (M-30). Call 647-1520 if you have any questions. The agreement with -�Ycu) -A\ yA \ALk.A, &V\ )Ck V�CUYW-� vlI,, � �i�WO "k4 No. N-2019-106 was completed on -j1jcj'R0jq and final payment has been made. (List all amendments. Use space below N needed.) Department: MC5A Phone/Ext.: q aP Signature: hs I' - Date: 90 yo� Revised: 100.18-16 N-2019-106 INSURANCE NOT ON FILE WORK MAY aT PROCEED CLERKRfNC UNCILI9 DALE; � 9 Z 0 May 21, 2019 Franklin Haynes dba Franklin Haynes Marionettes ("Speaker/Performer") 1234 Muirfield Road Riverside, CA 92506 Re: Sneaker/Performer EmzmQement Ameement This letter represents your agreement with the City of Santa Ana ("City") as entered into on the above date for the engagements described below: Event Description: Marionettes show: Las Marionetas en Desfile public event. Date(s): July 15, 2019 3. Event Time(s): 4:00 PM 4. Location: Newhope Learning Center located at 122 N. Newhope Street, Santa Ana ("Property") 5. Compensation: $350.00 (payable by check within 30 calendar days of event); Speaker/Perforner must provide IRS form W-9 before payment can be made. 6. Equipment provided by City: None T Equipment provided by Speaker/Performer: all equipment necessary for presentation City Contact Person (for coordinating purposes only): Lupita Arroyo or Michelle Loera Independent Contractor: Speaker/Performer shall, during the entire term of this Agreement, be construed to be an independent contractor and not an employee of the City. This Agreement is not intended nor shall it be construed to create an employer -employee relationship, a joint venture relationship, or to allow the City to exercise discretion or control over the professional manner in which Speaker/Performer performs the services that are the subject matter of this Agreement; however, the services to be provided by Speaker/Performer shall be provided in a manner consistent with all applicable standards and regulations. Speaker/Perfinlner shall pay all salaries and wages, employer's social security taxes, unemployment insurance and similar taxes relating to employees and shall be responsible for all applicable withholding taxes. 10, Indemnification: Speaker/Performer, its agents, or its employees (if applicable) agrees to and shall indemnity, defend, and hold harmless the City, its officers, agents, employees, consultants, special counsel, and representatives from and against all loss, expenses, or liability (including costs and attorney's fees) arising from the negligence or willful misconduct of Speaker/Performer, its agents, or its employees. Letter Agreement — Franklin Haynes Marionettes Page 2 11. Release: Speaker/Performer, its agents, and employees accept the Property and any City -provided equipment used in connection with the performance in "as -is" condition, with all faults. Speaker/Performer, its agents, and employees, fully release, waive and discharge forever any and all claims, demands, rights, and causes of action of any kind or nature against, and covenant not to sue, City, its elected officials, officers, employees, agents and volunteers, and all persons acting on behalf of, by, through or under each of them, under any present or future laws, statutes, or regulations for any claim or event relating to the condition of the Property or City -provided equipment. 12. Speaker/Performer shall maintain commercial general liability insurance naming the City, its officers, employees, agents, volunteers and representatives as additional insured(s) and shall include, but not be limited to protection against claims arising from bodily and personal injury, including death resulting therefrom and damage to property, resulting from any act or occurrence arising out of Speaker/Performer's operations in the performance of this Agreement, including, without limitation, acts involving vehicles. The amounts of insurance shall be not less than the following: single limit coverage applying to bodily and personal injury, including death resulting therefrom, and property damage, in the total amount of $1,000,000 per occurrence, with $2,000,000 in the aggregate, Such insurance shall: (1) name the City, its officers, employees, agents, volunteers, and representatives as additional insureds; (2) be primary and not contributory with respect to insurance or self-insurance programs maintained by the City; and (3) contain standard separation of insured provisions. 13. Worker's Compensation Insurance. In accordance with the California Labor Code, Speaker/Performer, if Speaker/Performer has any employees, is required to be insured against liability for worker's compensation or to undertake self-insurance. 14. 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, its employees and subcontractors, shall not perform stay services pursuant to this Agreement until clearance is received and Consultant is notified by the City's Parks, Recreation and Community Services Department, 15. The City shall have the right and royalty -free license to simulcast or produce and show a tape -delayed broadcast of Speaker/Performer's presentation to the City community or general public, through webcast or any other means. This license shall be non-exclusive and the copyright shall remain with the Speaker/Performer. Copies of Speaker/Performer's presentation may be maintained by the City, and Speaker/Performer consents to use of such recordings. 16. Speaker/Performer shall not discriminate because of race, color, creed, religion, sex, marital status, sexual orientation, age, national origin, ancestry, disability, or any other basis protected by applicable law in connection with any activities related to this Agreement. IT This Agreement shall in all respects shall be interpreted, enforced, and governed exclusively by and under the laws of the state of California. Both parties agree that Orange County, California, shall be the venue for any action or proceeding that may be brought or arise out of, in connection with or by reason of this Agreement. 18. This Agreement represents the complete and exclusive statement between the City and Speaker/Performer regarding the subject matter herein and supersedes any and all other agreements, oral or written, between the Letter Agreement— Franklin Haynes Marionettes Page 3 parties. This Agreement may not be modified except by written instrument signed by the City and by an authorized representative of Speaker/Performer. CITY OF SANTA ANA KRISTINE RIDGE City Manager d SPEAKER/PERFORMER By: FRANKLIN HAYNES DBA FRANKLIN HAYNES MARIONETTES APPROVED AS TO FORM: By: 73LhA51.GL h- LAURA ROSSINI Senior Assistant City Attorney RE CO vIMENDED FOR A RIkOVAL: ISA DLOFF Exe ive Director of Parks, Recreation, an ommunity Services Agency Administrative Office Franklin Haynes BookingslShow Info: 800-687.6193 1234 Mulrfield Road * tte3 Studios 909-319.2860 Riverside, CA 92606 Fax- 877-967.2830 www.Puppetshows.com FULLING NEARTSTRINGS SINCE 1985 Frank@Puppet8hows.com INVOICE #50017 'Checks Payable to: Franklin Haynes Marionettes `�' Michelle Loera Santa Ana Public Library 26 Civic Center Plaza F_ Santa Ana CA 92701 11 Invoice Date: Wednesday, March 27, 2019 11 P SERVICES TO BE DELIVERED P Event Information Event: Santa Ana Main Library's Summer Reading Program Event Date: 7/15/19 • Time(s): 4:00 p.m. Location: Newhope Library 0 City: Santa Ana CA 92701 Address: 122 N Newhope • Phone: 714-647-5397 Puppet Show Information Puppeteer: Franklin Number of Shows: One Show Name: Las Marionetas en Desfile • Show Length: Forty -Five Minutes Financial Information Discounts: $0.00 • Price for each show: $350.00 Total Show Price: $350.00 Gratuity: $0.00 • Insurance: $0.00 • Travel: $0.00 Payment received: $0.00 • Total Balance Due: $350.00 Tips/Gratuity: At Your Discretion On Day of Performance �$25.00 CHARGE ON ALL RETURNED CHECKS! $THERE IS NO CANCELATION POLICY acoRO® ifI CERTIFICATE OF LIABILITY INSURANCE DAT5/16/2 11'VYYI 5I16I2019 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 to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Stephanie Weiss Specialty Insurance Agency NAME,PHONE Extp__715-246-8908 FAX 715-246-4257 _ Performers of the U.S. _LA& No _ _ (A/C 1 RO. Box 24 E'MAIL l s eciat Incs nc ADDRESS: certs @ p Y _suranee.com _ 9_ Y New Richmond, WI 54017 -- ___ INSURER1S)AFFOROING COVERAGE NAIC # _. INSURER A: Evanston Insurance Company 35378 INSURED Franklin Delano Haynes dba Franklin Haynes Marionettes 1234 Muirfeld Road Riverside, CA 92506 C COVERAGES CERTIFICATE NUMBER- RFvISIn N1 w Ifirli 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 - - 'AC )L.8UBR POLICY EFF LTR TYPE OF INSURANCE p yy p POLICYNUMBER MMIDDnIYYY POLICY EXP MWDDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY - EACH OCCURRENCE $ 1,000,000 ._ CLAIMS -MADE X OCCUR DAMAGE TO REN ED—300,000 PREMISES (Ea occurrence) '$ —� VIED EXP(Any one person) '$ 51000 A X X 2CN0165-7335 '.. 04/18/2019 04/17/2020 PERSONAL S ADV INJURY '.$ 1,000,000 . GEN'L AGGREGATE LIMIT APPLIES PER: ' '. GENERAL AGGREGATE '. $ 2,000,000 'X POLICY'_ JEC '',J LOC PRODUCTS COMP/OP AGG $ 21000,000 OTHER' $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO '', BODILY INJURY (Per person) $ OWNED '. SCHEDULED _ AUTOS ONLY AUTOS Per accltlent BODILY INJURY ( ) 5 HIRED NON -OWNED ',� PROPERTY DAMAGE _ --' "— $ _ _AUTOS ONLY AUTOS ONLY per accident) S UMBRELLA LIAR OCCUR EACH OCCURRENCE 5 EXCESS LIAR.. CLAIMS MADE AGGREGATE - S _ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY YIN STATUTE "� ,DER__ ANYPROPRIETOR/PARTNER/EXECUTIVE - E.L. EACH ACCIDENTOFFICE EXCLUDED? NIA' ❑ —--EMPLOYEE— — (MandaR/MEMBER (Mandatory In NH ( I E.L. DISEASE - EA S if yyee describe -- — — - OFunder O -0ESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT A BUSINESS PERSONAL PROPERTY- INLAND MARINE AGGREGATE $ DESCRIPTION OF OPERATIONS 1 LOCATION SI VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) PERFORMER IS A NAMED INSURED AS A MEMBER OF PERFORMERS OF THE U,S.: Franklin Delano Haynes dba Franklin Haynes Marionettes rad� Additional Insured: The City of Santa Ana, its officers, agents and employees as additional insured Email: mloera@santa-ana.org Attn: Michelle Loera p� Event Date: July 15, 2019 G. �\�Grt,�(y:�' �\ City of Santa Ana 26 Civic Center Plaza Santa Ana, CA 92701 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE @ 1988-2015 ACORD ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY III POLICY NUMBER: 2CN0165-7335 MARKEL® EVANSTON INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, BLANKET ADDITIONAL INSURED This endorsement modifies insurance provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE FORM PRODUCTS/COMPLETED OPERATIONS COVERAGE FORM LIQUOR LIABILITY COVERAGE FORM PROFESSIONAL LIABILITY COVERAGE FORM Please refer to each coverage form to determine which terms are defined. Words shown in quotations on this endorse- ment may or may not be defined in all coverage forms. SCHEDULE Person or Entity: Any person or organization to whom you are obligated by valid written contract to provide such coverage, Additional Premium: $ (Check box if fully earned.®) Included WHO IS AN INSURED is amended to include the person or entity shown in the Schedule above as an Additional Insured under this insurance, but only as respects negligent acts or omissions of the Named Insured and only as respects any coverage not otherwise excluded in the policy. Our agreement to accept an Additional Insured provision in a contract is not an acceptance of any other provisions of the contract or the contract in total. When coverage does not apply for the Named Insured, no coverage or defense shall be afforded to the Additional In- sured. No coverage shall be afforded to the Additional Insured for injury or damage of any type to any "employee" of the Named Insured or to any obligation of the Additional Insured to indemnify another because of damages arising out of such injury or damage. All other terms and conditions remain unchanged, MEGL 0009.01 04 11 Includes copyrighted material of Insurance Services Office, Inc. Page 1 of 1 with its permission. COMMERCIAL GENERAL LIABILITY III POLICY NUMBER: 2CN0165-7335 MARKEV EVANSTON INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET WAIVER OF SUBROGATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM SCHEDULE Additional Premium: $ 0 Name of Person or Organization: Any person(s) or organization(s) to whom the Named Insured agrees to waive rights of recovery in a written contract. The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition (Section IV — COMMERCIAL GENERAL LIABILITY CONDITIONS) is amended by the addition of the following: We waive any right of recovery we may have against the person or organization shown in the Schedule above as respects written contracts that exist between you and such person or entity, provided you have agreed in writing to furnish this waiver. This waiver applies only to the person or organization shown in the Schedule above. All other terms and conditions remain unchanged. MEGL 0241-01 0411 Includes copyrighted material of Insurance 31-vices Office, Inc. with its Page 1 of 1 permission. POLICY NUMBER: 2CN0165-7335 COMMERCIAL GENERAL LIABILITY CG 20 01 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. ,Z'N1 GO 10 01 0413 © Insurance Services Office, Inc., 2012 Page 1 of 1 WORKERS' COMPENSATION DECLARATION I Franklin Haynes hereby affirm under penalty of perjury, the (Name/Title) following declaration I certify on behalf of Franklin Haynes Marionettes that during the term of my (ConsultanUCompany Name) contract for marionette puppet show 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: 5/15/19 By:���(. / Name: Franklin Haynes Title: Owner/Puppeteer Telephone: 800-687-5193 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. y CZ;�\�` QgG DATE (MMIDDIYYYY) �cQ�o CERTIFICATE OF LIABILITY INSURANCE 5/16/2019 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 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 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 Specialty Insurance Agency Performers of the U.S. P.O. Box 24 CONTACT Stephanie Weiss N&Mt, PHONE 715-246-8908 FAX 715-246-4257 IALG. N9..F.xt): ADDRESS ceft@specialtylnsuranceagerlcy.com INSURERS AFFORDING COVERAGE NAIC# New Richmond, WI 54017 INSURER A: Evanston Insurance Company 35378 _ INSURED Franklin Delano Haynes INSURERS: INSURER C dba Franklin Haynes Marionettes 1234 Muirfield Road Riverside, CA 92506 itusuRERn: INSURERE: INSURER COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TRam TYPE OF INSURANCE ADDL SUBIR 3mn POLICYHu BER POLTCYEFF POLICY EXP LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE ix� OCCUR TO FfffffffD_ PREASES(Ea o [el e $ 300,000 MED EXP (Any oneperson) $ 5,000 PERSONAL& ADV INJURY $ 1,000,000 A X X 2CN0165-7335 04/18/2019 04/17/2020 t3Etl'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS -COMP/OPAGG $ 2,000,000 X POLICY PRO ❑ LOC JECT $ OTHER: AUTOMOBILE LIABILITY (Ea pc4 en ll SINGLE LIMIT $ BODILY INJURY (Per person) $ ANY AUTO BODILY INJURY (Per accident) $ OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE $ • E UMBRELLA LIAR OCCUR EACH OCCURRENCE $ $ EXCESS LIAB CLAIMS -MADE AGGREGATE _ DIED I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETORIPARTNERIEXECUTIVE Y� STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ OFFICERIMEMBEREXCLUDED? (Mandatory In NH) N / A E.L. DISEASE -POLICY LIMIT $ If yes, describe under DESCRIPTION OF OPERATIONS below A BUSINESS PERSONAL PROPERTY - INLAND MARINE I AGGREGATE $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) PERFORMER IS A NAMED INSURED AS A MEMBER OF PERFORMERS OF THE U.S.: Franklin Delano Haynes dba Franklin Haynes Marionettes Additional Insured: The City of Santa Ana, its officers, agents and employees as additional insured Email: mloera@santa-ana.org Attn: Michelle Loera Event Date: July 15, 2019 REVIEWED & APPROVED CLItIIFIC;AII: HULUtR i \ I.HIVI.CLLPIIIUIY City of Santa Ana J 1 9 901A 26 Civic Center Plaza 1 L 7 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Santa Ana, CA 92701 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. A FIA M. LAMBERT AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATIUIV. Ali rignts reservea. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY POLICY NUMBER: III 2CN0165-7335 AR(EL" EVANSTON INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED This endorsement modifies insurance provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE FORM PRODUCTS/COMPLETED OPERATIONS COVERAGE FORM LIQUOR LIABILITY COVERAGE FORM PROFESSIONAL LIABILITY COVERAGE FORM Please refer to each coverage form to determine which terms are defined. Words shown in quotations on this endorse- ment may or may not be defined in all coverage forms. SCHEDULE Person or Entity: Any person or organization to whom you are obligated by valid written contract to provide such coverage. Additional Premium: $ (Check box if fully earned.®) Included WHO IS AN INSURED is amended to include the person or entity shown in the Schedule above as an Additional Insured under this insurance, but only as respects negligent acts or omissions of the Named Insured and only as respects any coverage not otherwise excluded in the policy. Our agreement to accept an Additional Insured provision in a contract is not an acceptance of any other provisions of the contract or the contract in total. When coverage does not apply for the Named Insured, no coverage or defense shall be afforded to the Additional In- sured. No coverage shall be afforded to the Additional Insured for injury or damage of any type to any "employee" of the Named Insured or to any obligation of the Additional Insured to indemnify another because of damages arising out of such injury or damage. All other terms and conditions remain unchanged. (A.3fqlp MEGL 0009-01 04 11 Includes copyrighted material of Insurance Services Office, Inc. Page 1 of 1 with its permission. COMMERCIAL GENERAL LIABILITY POLICY NUMBER: III 2CN0165-7335 MAR (EL, EVANSTON INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET WAIVER OF SUBROGATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM SCHEDULE Additional Premium: $ 0 Name of Person or Organization: Any person(s) or organization(s) to whom the Named Insured agrees to waive rights of recovery in a written contract. The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition (Section IV — COMMERCIAL GENERAL LIABILITY CONDITIONS) is amended by the addition of the following: We waive any right of recovery we may have against the person or organization shown in the Schedule above as respects written contracts that exist between you and such person or entity, provided you have agreed in writing to furnish this waiver. This waiver applies only to the person or organization shown in the Schedule above. All other terms and conditions remain unchanged. 1 MEGL 0241-01 04 11 Includes copyrightsfmlteRialfInsurance Services Office, Inc. with its permission. Page 1 of 1 POLICY NUMBER: 2CN0165-7335 COMMERCIAL GENERAL LIABILITY CG 20 01 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance (2) You have agreed in writing in a contract or Condition and supersedes any provision to the agreement that this insurance would be contrary: primary and would not seek contribution Primary And Noncontributory Insurance from any other insurance available to the additional insured. This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and 7 CG 20 01 04 13 © Insurance Services dffice, Inc., 2012 Page 1 of 1 Franklin Haynes dba Franklin Haynes Marionettes 1234 Muirfield Road Riverside, CA 92506 July 15, 2019 City of Santa Ana Risk Management Division 20 Civic Center Plaza, Santa Ana, CA 92702 Re: Auto Insurance Requirement Release of Liability. Dear City of Santa Ana Risk Management Division: I, Franklin Haynes, Speaker/Performer, hereby release the City of Automobile Liability. I do not use/drive any vehicle during the course and scope of my course/instruction class/performance. During the term July 15, 2019 through June 16, 2019, Agreement N-2019-106, I will be performing a Marionettes show Acrobatic Gymnast Classes at Newhope Learning Center, located at: 122 N. Newhope Street, Santa Ana, CA. Sincerely, Franklin Haynes Speaker/Performer WORKERS' COMPENSATION DECLARATION Franklin Haynes (Name/Title) following declaration: hereby affirm under penalty of perjury, the I certify on behalf of Franklin Haynes Marionettes that during the term of my (Consultant/Company Name) contract for marionette puppet show 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: 5/15/19 By: Name: Franklin Haynes Title: Owner/Puppeteer Telephone: 800-687-5193 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.