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HomeMy WebLinkAboutHOLISTIC YOGA AND HEALTH LLC (DBA BODY AND BRAIN)City of Santa Ana Clerk of the Council cofc 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TERMINATION FORM Please complete this form in its entirety when the attached agreement and all amendments (if any) are no longer in effect. 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 '- ;r ti ., j t iNr = P 4a Return form to the Clerk of the Council Office (M-30). Call 647-1520 if you have any questions. The agreement with �SZ\ � C D ���( (l�` No. /(%'pZQ/9-, was completed on and final payment has been made. (List all amendments. Use space below if needed.) Department: "Gish Phone/Ext.: r%?-R 17 Signature: � Date: 111011202X Revised: 10-18-16 INSURANCE NOT ON FILE WORK MAY NOT PROCEED CLERK OF COUNCIL DATE. '-DEC t f)&§ N-2019-260 a: PROS( j ) RECREATION SERVICES AGREEMENT Silvia Cuevas THIS AGREEMENT is made and entered into on this 611 day of December, 2019 by and between Holistic Yoga and Health, LLC, a California limited liability company, 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 (701/o) 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, 2020 and end onDecember31, 2020.-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, a j oint 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 GeneralLiability'Insuraff&. 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 Insurari m. 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. H. Certificates of insurance shall be furnished to the City upon execution of this Agreement and shall be approved by the City. iii. Certificates and policies shall state that the policies shall not be canceled or reduced in coverage or changed in any other material aspect without thirty (30) days prior written notice to the City. iv. Where the amounts or coverage provided by the certificates of insurance provides coverage greater than those listed by this Agreement, the amounts provided by the certificates of insurance shall be incorporated by reference into the Agreement. V. Consultant shall supply City with a fully executed additional insured endorsement. 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, 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. 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: Holistic Yoga and Health, LLC dba Body & Brain Attn: Woomyung Son 10015 Garden Grove Blvd. Garden Grove, CA 92844 Phone: (714) 537-3499 Email: gardengrovenabodybrain.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 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 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, gender identity, gender expression, gender, medical conditions, genetic information, or military and veteran status, 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. 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. SEVERADILITY 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. iF *14:1:0100 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. [Signatures on next page] N-2019-260 IN \\ I I NI SS 11'111 141 O1 , IIIt Iuullr. hcretu lurvv rsr, tilt d I1w. Alncrinrnl Ili, dab na,l vrnr Iilsl ahu�r wnllcn. AIIPs1': _ I'll Ytt1 SANIAANA -/Daisy (ionic/ Kristine Ridge ('Icrk ol'the Council City Manager APPROVED AS TO FORM: SONIA R. CARVALIIO City Attorney d By: awo- A Laura A. Rossini Senior Assistant City Attorney RECOMMENDED FOR APPROVAL: PkuVIDIfIL A Eie utive Director of Parks, Recreation and Community Services Agency Exhibit A SCOPE OF SERVICES A. Provider shall conduct Holistic Yoga and Health classes for All Ages 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. INSTRUCTOR: Roxanne Zavala LOCATION: Jerome Center, 726 S Center St. SA., CA. 714 647-6559 BODY AND BRAIN —FAMILY BRAIN WELLNESS Learn how to develop your brain power to create a healthier, happier, and more peaceful life for you and your family. Family class includes specialized Brain Education games and activities to help families increase communication, respect and appreciation for one another. Come join us for lots of fan and laughter during this special time connecting with your family We teach parents and children mindfulness training and Brain Versatilizing using hundreds of physical and mental exercises to train them how to improve their focus and strengthen their attention span. Body and 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. Each class must have a minimum of 5 paid students and no more than 100 students. B. No registration will be accepted after the second meeting of classes. C. If the minimum registration has not been reached by the second class, the class shall be canceled. Provider will be under no obligation to provide services for the canceled classes, and the City will have no further obligations to pay Provider compensation for the remaining classes that were canceled 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. ACORDM DATE (MM/DDYY YY) CERTIFICATE OF LIABILITY INSURANCE 12/17/2019 PRODUCER Pnarle 714-53>rOJ9 Fax na-E_s-rsET= 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 Agency balk Oe3g093 INSURED INSURER A. NAUTILUS INSURER B: EMPLOYERS HOLISTIC YOGA 6 HEALTH LLC 10015 GARDEN GROVE BLVD. INSURER C: GARDEN GROVE CA 928" INSURER D. NSURER E_ COVERAGES 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 rank LTR A00 Iry TYPE OF INSURANCE POLICY NUMBER POUCYEFFECTNE POLICY EXPIRATION M LIMITS GENERAL LIABILITY NC418666 mmm?AT 05/03/19 05103/20 EACH OCCURRENCE S 1,000,000 X COMMERCIAL GENERAL LIABILITY CLAIMS MADEFX-1OCCUR DAMAGE TO RENTED %tEMISEg apcu,l,rw $ 30,000 NED. EXP("0ePerson) $ 5.000 A X Primary aw Nm CmtrWwy PERSONAL S ADV INJURY S 1.000.000 X Walvar of SuOrogallm GENERAL AGGREGATE 8 2,000.000 GENL AGGREGATE LIMIT APPLIES PER X POLICY PRO- LOC PRODUCTS-COMP/OPAGG S Included $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Es awaem) S ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Pow parson) 3 HIRED AUTOS NON -OWNED AUTOS BODILY INJURY (Per aca U $ PROPERTY DAMAGE (Per accMent) S GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC § MY AUTO AUTO ONLY AGO S EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE § OCCUR CLAIMS MADE AGGREGATE $ S $ DEDUCTIBLE RETENTION § S B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOTUPMTNEIUEXEWTIVE OFFICERMEMBER EXCLUDED? EIG 2654780-01 07/02/19 07/02120 X gYTDy{g OTHER EL EACH ACCIDENT $ 1,DDD,DDD E L DISEASEEAEMPLOYEE $ 1,600,000 R yeasPM» ,SPECIAL PaovISIONlsloas Belo. EL DISEASE -POLICY LIMIT § 1,000,000 OTHER: DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS SEE SUPPLEMENTAL CERTIFICATE INFORMATION CERTIFICATE HOLDER CANCELLATION REVI By RI WED & APPROVE MANAGEMENT Divisic E CELLED BEFORE THE pRATIONYDATETTHEREHE �OFE THE ISSUING INSUR RDCRIBED POLICIESBWILL ENDEAVOR TO MAIL 30 mAys WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO 00 SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON City of Santa Ana Risk Management Division 08 2020 THE INSURER. ITS AGENTS OR REPRESENTATIVES AUTHORIZED REPRESENTATIVE 20 Civic Center Plaza, 4th floor - Santa Ana, CA 92702 _4�Jay Attention: SAWWHA M. LAMBERT Lee ACORD 25 (2001108) Certificate # 12560 0 ACORD CORPORATION 1988 DATE SUPPLEMENT TO CERTIFICATE OF LIABILITY INS #12560 DEC 172019 DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS City of Santa Ana, Risk Management, it's officers, employees, agents, representatives, and volunteers are added as additional inured on General Liability / General liability policy Primary and not -contributory with respect to insurance or self-insurance maintained by the City I Certificate of Insurance shall provide thirty (30) day prior written notice of cancellation. & APPROVED tf FMENT DIVISION 08 2020 ji] ff Nl7Zl1111&1-1:1 M Welf t-b*ij COMMERCIAL GENERAL LIABILITY CG 20 13 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, ADDITIONAL INSURED - STATE OR GOVERNMENTAL AGENCY OR SUBDIVISION OR POLITICAL SUBDIVISION - PERMITS OR AUTHORIZATIONS RELATING TO PREMISES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE State Or Govemmental Agency Or Subdivision Or Political Subdivision: City of Santa Ana, Risk Management Division Risk Management, its officers, employees, agents, representatives, and volunteers 20 Civic Center Plaza, 4th Floor, Santa Ana, CA 92702 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 However: include as an additional insured any state or 1. The insurance afforded to such additional governmental agency or subdivision or political insured only applies to the extent permitted by subdivision shown in the Schedule, subject to the law; and following additional provision: This insurance applies only with respect to the 2. If coverage provided to the additional insured following hazards for which the state or is required by a contract or agreement, the insurance afforded to such additional insured governmental agency or subdivision or political will not be broader than that which you are subdivision has issued a permit or authorization in required by the contract or agreement to connection with premises you own, rent or control provide for such additional insured. and to which this insurance applies: 1. The existence, maintenance, repair, B. With respect to the insurance afforded to these construction, erection or removal of additional insureds, the following is added to advertising signs, awnings, canopies, cellar Section III - Limits Of Insurance: entrances, coal holes, driveways, manholes, If coverage provided to the additional insured is marquees, hoist away openings, sidewalk required by a contract or agreement, the most we vaults, street banners or decorations and will pay on behalf of the additional insured is the similar exposures; or amount of insurance: 2. The construction, erection or removal of 1. Required by the contract or agreement; or elevators; or 2. Available under the applicable Limits of 3. The ownership, maintenance or use of any Insurance shown in the Declarations; elevators covered by this insurance. whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. REVIEyyED & APPROVED Uy RiSK MANAGEMENT DIVISION 08 2020 SAMANTHA M. LAMBERT CG 2013 0413 Copyright Insurance Services Office, Inc.. 2012 Page 1 of 1 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 This endorsement modifies insurance provided under the following. COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: City of Santa Ana, Risk Management Division. Risk Management, its officers, employees, agents, representatives,and volunteers 20 Civic Center Plaza, 4th Floor Santa Ana, CA 92702 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 the person or organization shown in the Schedule 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 to the person or organization shown in the Schedule. All other terms and conditions of this policy remain unchanged. REVIEWED & APPROVED Rv RiSCMANAGEMENT Divi51ON 08 2020 M. LAMBERT L605 (06107) Includes copyrighted material of Insurance Services Office, Inc., with its permission. POLICY NUMBER: NC418555 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY- AMENDMENT OF OTHER INSURANCE CONDITION - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following. COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/ COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name of Additional Insured Person(s) or Organization(s): -ity c'_ Santa Ana, Risk Maeacemen_ Risk Management, its officers, employees, agents, representatives,and volunteers 20 Civic Center Plaza, 4th Floor, Santa Ana, CA 92702 Location(s) of Covered Operations: 10015 Garden Grove Blvd Garden Grove CA 92844- 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 for the additional insured at the location(s) designated in the Schedule 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. All other terms and conditions remain unchanged. REVIEWED & APPROVED By RisqNPANACEMENT DIVISION 2020 M. LAMBERT L612 (07/ 16) Includes copyrighted material of Insurance Services Office. Inc.. with its permission Holistic Yoga & Health LLC dba Body & Brain WooMySung Son 10015 Garden Grove Blvd Garden Grove, CA. 92844 Nov 5, 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: 1, WooMySung Son, Holistic instructor, hereby release the City of Automobile Liability. I do not use/drive any vehicle during the course and scope of my course/instruction class. During the term Jan 1, 2020 through Dec 31, 2020, Nj201*".1 will be teaching at Jerome, 726 S Center St., Santa Ana, CA. Sincerely, WooMySung Son, Holistic Instructor vt7 & APPROVED tqEMENT DIVISION 08 2020 M. LAMBERT Holistic Yoga & Health LLC dba Body & Brain Roxanne Zavala 10015 Garden Grove Blvd. Garden Grove, CA. 92844 Oct 22, 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, Roxanne Zavala, Holistic instructor, hereby release the City of Automobile Liability. 1 do not use/drive any vehicle during the course and scope of my courselinstruction class. During the term Jan 1, 2020 through Dec 31, 2020, lid. I will be teaching at Jerome, 726 S Center St., Santa Ana, CA. Sincerely, Q Roxanne Zavala, Holistic Instructor REVIEWED & APPROVED By RISK4MANEIMYENt DIVISION 2020 SAAAMNA M. LAMBERT I, CITY OF SANTA ANA RisK MANAGEMENT. d&,v 4HUMAN RESOURCES nagingRisk nnwpoPosftWChange WORKERS' COMPENSATION DECLARATION Roxanne Zavala (Name/Title) following declaration: hereby affirm under penalty of perjury, the I certify on behalf of Roxanne Zavala of my contract for (Consultant/Company Name) that during the term Recreation Classes services with the City of Santa Ana, (Type of service provided) 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 the provisions and provide proof of workers' compensation coverage immediately. Date: 111.301, o 19 Print Name: 1ROXfYtJNE Z,4ilA z.4. Print Title: Recreation Class Holistic Instructor Signature: Telephone: 310 _ 901— 5�a2 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. & APPROVED IGEMENT DivisiON 2020 I:IRisk Mgmtjlnsuronce RequirementslWCDeclarotion 015m0