Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
THOMAS BYSTRY DBA VIDEO ENGINEERING SERVICES
A-2020-257-03 CC AGREEMENT TO PROVIDE VIDEO PRODUCTION SERVICES FOR THE CITY OF —' \ SANTA ANA �a CPA11I LGL'�rtS 1L6 THIS AGREEMENT is made and entered into on this 15s day of December, 2020 by and between Thomas Bystry doing business as Video Engineering Services ("Consultant"), 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 consultant having special skill and knowledge in the field of video production services on an as needed basis. B. Consultant represents that Consultant is able and willing to provide such services to the City. C. In undertaking the performance of this Agreement, Consultant represents that it is knowledgeable in its field and that any services performed by Consultant under this Agreement will be performed in compliance with such standards as may reasonably be expected from a professional consulting firm in the field. 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 On an on -call basis, and at the City's sole discretion, Consultant shall perform the services described in the scope of work that was included in RFP No. 20-105 for video production services, which is attached as Exhibit A, and as more specifically delineated in Consultant's scope of work, which is attached as Exhibit B and incorporated in fall. Consultant shall not be compensated for any services rendered in connection with its performance of this Agreement, unless such additional services are authorized in advance and in writing by the City. 2. COMPENSATION a. City neither warrants nor guarantees any minimum or maximum compensation to Consultant under this Agreement. Consultant shall be paid only for actual services performed under this Agreement at the rates and charges identified in Exhibit B. Consultant is one of three (3) consultants selected to provide video production services on an on -call basis under RFP 20-105. The total compensation for these services provided by all such consultants selected under RFP 20-105 shall not exceed the amount of six hundred thousand dollars ($600,000.00) during, the term of this Agreement, including any extension periods exercised under Section 3. This sum shalt be comprised of the shared aggregate amount of two hundred thousand dollars ($200,000.00) annually during the term of the Agreement, including any extension periods. Page l of l l b. Payment by City shall be made within 45 days (forty-five) days following receipt of proper invoice evidencing work performed, subject to City 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 City. 3. TERM This Agreement shall commence on January 1, 2021 and terminate on December 3I, 2022, with the option for the City to grant up to a one (1) year renewal, unless terminated earlier in accordance with Section 15, below. 4. INDEPENDENT CONTRACTOR Consultant shall, during the entire terns of this Agreement, be construed to be an independent contractor and not an employee of the City. This Agreement is not intended nor shalt 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 Consultant performs the services which are the subject matter of this Agreement; however, the services to be provided by Consultant shall be provided in a manner consistent with all applicable standards and regulations governing such services. Consultant 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. S. OWNERSHIP OF MATERIALS This Agreement creates a non-exclusive and perpetual license for City to copy, use, modify, reuse, or sublicense any and all copyrights, designs, and other intellectual property embodied in plans, specifications, studies, drawings, esthnates, and other documents or works of authorship fixed in any tangible medium of expression, including but not limited to, physical drawings or data magnetically or otherwise recorded on computer diskettes, which are prepared or caused to be prepared by Consultant under this Agreement ("Documents & Data"). Consultant shall require all subcontractors to agree in writing that City is granted a. non-exclusive and perpetual license for any Documents & Data the subcontractor prepares under this Agreement. Consultant represents and warrants that Consultant has the legal right to license any and all Documents & Data. Consultant makes no such representation and warranty in regard to Documents & Data which were provided to Consultant by the City. City shall not be limited in any way in its use of the Documents and Data at any time, provided that any such use not with -III the purposes intended by this Agreement shall be at City's sole risk. 6. INSURANCE Prior to undertaking performance of work under this Agreement, Consultant shall maintain and shall require its subcontractors, if any, to obtain and maintain insurance as described below: a. Commercial General Liability Insurance. Consultant 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 Page 2 of I 1 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 Consultant'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 (a) name the City, its officers, employees, agents, 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 insureds 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 Section 3700 of the Labor Code, Consultant, if Corrsuitant 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, Consultant agrees to obtain and maintain any employer's liability insurance with limits not less than $1,000,000 per accident. d. If Consultant is or employs a licensed professional such as an architect or engineer: Professional liability (errors and omissions) insurance, with a combinedsingle limit of not less than $1,000,000 per claim with $2,000,000 in the aggregate. e. The following requirements apply to the insurance to be provided by Consultant pursuant to this section: i. Consultant shall maintain all insurance required above in frill force and effect for the entire period covered by this Agreement. ii. 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. f. If Consultant 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 terminations shall not affect Consultant's right to be paid for its time and materials expended prior to notification of termination. Consultant waives the right to receive compensation and agrees to Page 3 of I 1 indemnify the City for any work performed prior to approval of insurance by the City. INDEMNIFICATION Consultant agrees to defend, and shall indemnify and hold harmless the City, its officers, agents, employees, contractors, 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 Consultant, its subcontractors, agents, employees, or other persons acting on its behalf which relates to the services described in section 1 of this Agreement; and (2) frorn 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. This indemnity and bold harmless agreement applies to all claims for datnages, 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. The Consultant further 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 patty challenging the validity of this Agreement, or asserting that personal injury, damages, just compensation, restitution, judicial or equitable relief due to personal or property rights arises by reason of the terms of, or effects arising from this Agreement. City may make all reasonable decisions with. respect to its representation many legal proceeding. Notwithstanding the foregoing; to the extent Consultant's services are subject to Civil Code Section 2782.8, the above indemnity shall be limited, to the extent required by Civil Code Section 2782.8, to claims that arise out of, pertain to, or relate to the negligence, recklessness, or willful misconduct of the Consultant. 8. INTELLECTUAL PROPERTY INDEMNIFICATION Consultant shall defend and indemnify the City, its officers, agents, representatives, and employees against any and all liability, including costs, for infringement of any United States' letters patent, trademark, or copyright infringement, including costs, contained in the work product or documents provided by Consultant to the City pursuant to this Agreement. 9. RECORDS Consultant shall keep records and invoices in connection with the work to be performed under this Agreement. Consultant shall maintain complete and accurate records with respect to the costs incurred under this Agreement and any set -vices, 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 Consultant under this Agreement- All such records and invoices shall be clearly identifiable. Consultant shall allow a representative of the City to examine, audit, and make transcripts or copies of such records and any other documents created pursuant to this Agreement during regular business (tours, Consultant shall allow inspection of all work, data, documents, proceedings, and activities related to this Agreement fin• a period of three (3) years from the date of final payment to Consultant under this Agreement. Page 4 of 1 I 1e. CONFIDENTIALITY If Consultant receives from the City information which due to the nature of Stich information is reasonably understood to be confidential and/or proprietary, Consultant agrees that it shall not'use or disclose such information except in the performance of this Agreement, and ftirther agrees to exercise the same degree of care it uses to protect its own information of like importance, but in no event less than reasonable care. "Confidential Information" shall include all nonpublic information. Confidential information includes not only written information, but also information transferred orally, visually, electronically, or by other means. Confidential information disclosed to either party by any subsidiary and/or agent of the other party is covered by this Agreement. The foregoing obligations of non-use and nondisclosure shall not apply to any information that (a) has been disclosed in publicly available sources; (b) is, through no fault of the Consultant disclosed in a publicly available source; (c) is in rightful possession of the Consultant without art obligation of confidentiality; (d) is required to he disclosed by operation of law; or (e) is independently developed by the Consultant without reference to information disclosed by the City. 1 L CONFLICT OF INTEREST CLAUSE Consultant 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. 12. NON-DISCR][MINATION Consultant 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. Consultant affirms that it is an equal opportunity employer and shall comply with all applicable federal, state and local laws and regulations, 13. EXCLUSIVITY AND AMENDMENT This Agreement represents the complete and exclusive statement between the City and Consultant, 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 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 Consultant. The parties agree that any tents 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 Consultant 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. Page 5 of 11 14. ASSIGNM1ENT Inasmuch as this Agreement is intended to secure the specialized services of Consultant, Consultant 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. Nothing in this Agreement shall be construed to limit the City's ability to have any of the services that are the subject to this Agreement performed by City personnel or by other consultants retained by City. 15. TERMINATION This Agreement may be terminated by the City upon. thirty (30) days written notice of termination, In such evcni, Consultant shall be entitled to receive and the City shall pay Consultant compensation far all services perforated by Consultant prior to receipt of such notice of termination, subject to the following conditions: a. As a condition of such payment, the City Manager may require Consultant to deliver to the City all work product(s) completed as of such date, and in such case such work product shall be the properly of the City unless prohibited by law, and Consultant consents to the City's use thereof for sueht purposes as the City deems appropriate. b. Payment need not be made for work that fails to meet the standard of performance specified in the Recitals of this Agreement. 16. WAIVER No waiver of breach, failure of any condition, or any right or remedy contained in or granted by the provisions of this Agreement shall be effective unless it is in writing and signed by the party waiving the breach, failure, right or remedy. No waiver of any breach, failure or right, or remedy shall be deemed a waiver of any other breach, failure, right or remedy, whether or not similar, nor shall any waiver constitute a continuing waiver unless the writing so specifies. 17. 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. 18, PROFESSIONAL LICENSES Consultant shall., throughout the term of this Agreement, maintain aft 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. Consultant shall notify the City immediately and Page 6 of I I in writing of its inability to obtain or maintain such permits, licenses, approvals, waivers, and exemptions. Said inability shall be cause for termination of this Agreement. 19. MISCELLANEOUS PROVISIONS a. Each undersigned represents and warrants that its signature herein below has the power, authority and right to bind their respective parties to each of the terms of this Agreement, and shall indemnify City fully, including reasonable costs and attorney's fees, for any injuries or damages to City in the event that such authority or power is not, in fact, field by the signatory or is withdrawn. b. All Exhibits referenced herein and attached hereto shall be incorporated as if fully set forth in the body of this Agreement. 20. 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 City 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 courtesy copies to: City Manager City of Santa Ana 20 Civic Center Plaza (M-) P.O. Box 1988 Santa Ana, California 92702 To Consultant: Video Engineering Services Attention: Thomas E. Bystry, Owner/President 915 Wycliffe Irvine, California 92602 videootbCaol com Telephone: (714) 366-4666 Page 7 of t I A-2020-257-03 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. IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first above written. ATTEST: CITY OF SANTA ANA Gomez Kristine Ridge of the Council City Manager APPROVED AS TO FORM: SONIA R. CARVALHO City Attorney By: Jose Montoya Deputy City Attomey CONSULTANT: Thomas E. Bystry Owner/President Page 8 of I l EXHIBIT A SCOPE OF SERVICES Page 9 of to REQUEST FOR PROPOSALS (RFP) NO. 20-105 FOR VIDEO PRODUCTION OF CITY COUNCIL MEETINGS, OTHER VARIOUS PRODUCTIONS, AND CABLE/VIDEO EQUIPMENT MAINTENANCE CITY OF SANTA ANA CITY MANAGER'S OFFICE Paul Eakins City Manager's Office Phone: (714) 647-5200 Email: peakins(a)santa-ana.ora KEY RFP DATES: The schedule below is tentative and subject to change at the discretion of City, with appropriate notice to prospective Proposers. Issue Date: Deadline for Questions about RFP: Proposal Due Date: Review of Proposals: Projected Award Date: Projected Start Date: July 21, 2020 July 31, 2020 August 14, 2020, by 4:00 PM August 17 — 20, 2020 September 15, 2020 October 1, 2020 CITY OF SANT ANA EXHIBIT A CITY OF SANTA ANA REQUEST FOR PROPOSALS FOR VIDEO PRODUCTION OF CITY COUNCIL MEETINGS, OTHER VARIOUS PRODUCTIONS, AND CABLE/VIDEO EQUIPMENT MAINTENANCE SCOPE OF SERVICES A. Council Meetings The City of Santa Ana provides the control room equipment, cameras and equipment located inside the Council Chambers to record and broadcast the City Council meetings, including computers and other video production equipment. Contractor will serve as Producer/Administrator for City of Santa Ana City Council meetings. Duties will include hiring and supervising video production staff. Contractor shall provide production services in live meeting coverage and playback for up to twenty-four (24) meetings, including City Council meetings held the first and third Tuesdays of the month, and various additional meetings as selected by the Clerk of the Council and/or City Manager. Production services shall include all responsibility for graphics during the presentations, video roll -ins and all audio/visual needs. Additionally, Contractor shall provide technical assistance for city production crews and staff. Services shall include: 1. Serve as Video Producer for all council meetings and cable -casting events in council chambers. 2. Maintain open communications with the Public Affairs Information Officer and Clerk of the Council office for special needs or changes pertinent to the agenda for each council meeting. 3. Communicate and confirm with the Public Affairs Information Officer regarding council meeting coverage and playback related to the city channel. Report technical playback and council meeting technical issues and remedies to the PAIO. 4. Provide, hire and supervise all video production crew and staff which will include Director, Camera Robotics Operator, Audio Operator, Graphics Designer and Playback Operator. These positions may be consolidated in one person. 5. Schedule video production staff. Pre -arrange and notify crew of video productions and changes. 6. Provide maintenance of playback equipment located in City Hall as necessary for City Council meeting. 7. Provide for office administration and payroll for video production crew and playback. 8. Provide and be responsible for all production staff training and hands-on use of equipment for video crews. 9. Direct communication with City Council members and Clerk of the Council. 10. Review any needs or concerns related to production request: includes PowerPoint, overheads, video roll -ins and presentations, review cueing system, proper use of microphones for Council. RFP No. 20-105 Video Services for Government Access Channel 3 & Related Services Page 21 of 23 r CITY OF SANT ANA 11. Arrange for and design overall look and style of productions. 12. Arrange for input of council graphics prior to the meeting. Run a spell check. Arrange for graphics to state replays during the meeting, approximately every 30 minutes during program. 13. Access to Analytical Data — Contractor will provide access to the analytical data related to the usage of the video streaming service by the public. Analytics shall include the quantity of persons viewing video streams and archived videos. 14. Video streaming services that integrate with Facebook Live, YouTube Live, or similar social media platforms. B. Annual State of the City Address Contractor shall produce the mayor's state of the city address, including: Hiring and supervising crew for camera operations, audio mixing, cable running, equipment load in and load out. 2. Directing the show for video. 3. Renting all needed video equipment and editing the finished video for playback. C. CableNideo Equipment Maintenance 1. Confer with the Public Affairs Information Officer to evaluate needs and supervise maintenance activity of all city owned audio/video facilities. Said facilities include, but are not limited to, City Hall, recreation centers, senior centers, Stadium, Soccer fields. Etc. 2. Review and make recommendation for the repair and /or replacement of said audio/video facilities. 3. Design layout of electrical circuitry for existing and /or acquired audio/video equipment. 4. Ensure compliance with local, state, and federal safety codes and regulations. 5. Establish and maintain equipment log and data base to keep inventory and records of maintenance and to track equipment performance. 6. Help establish and enforce Agency wide policies for equipment use. Provide operation instruction for staff. 7. Conduct regular security checks on the City's production equipment. 8. Prepare preventative maintenance schedules and execute said maintenance on a routine basis. 9. Supervise annual asset inventories and tagging of new assets, as needed. 10.Coordinate equipment repair with outside agencies. 11.Coordinate acquisition of new production equipment. 12. Facilitate and supervise use of facilities or equipment by outside agencies, persons, other City employees or cable franchisee staff. 13.Facilitate completion of production services requested by City staff (including making dubs, editing and shooting videos, setting up equipment, delivering equipment, setting up operating facilities as needed.) RFP No. 20-105 Video Services for Government Access Channel 3 & Related Services Page 22 of 23 (9) CITY OF SANT ANA 14. Provide updates to Public Affairs Information Officer and/or assigned staff on progress of equipment installation, maintenance, building projects and anticipated completion dates. 15.Assist City Clerk and other staff on use of Council Chambers: video, audio, lighting, PowerPoint, Elmo or other technical needs. D. Training and Support 1. Initial Training - Contractor shall provide a training program (remotely or in -person) to a group of up to eight (8) City staff members. Training shall be conducted before the video streaming and archive system is officially commissioned. Training shall describe the roles and responsibilities of the Contractor in providing the video streaming service. Training shall identify how City Staff can identify and rectify minor problems that may arise in the rollout of the video streaming services. 2. Contact — Contractor shall provide a main point of contact for City Staff. The main point of contact shall have a thorough understanding of the video streaming system and be capable of troubleshooting problems remotely with City Staff who may not be experts in video and audio technology. A. Event Video Production 1. On- and off -site video production services in Santa Ana for city -produced events including, but not limited to: 41 of July Celebration, Fiestas Patrias, Santa Ana 5k and Plaza Navidena. 2. This shall include all responsibility for graphics, video roll -ins and all audio/visual needs. B. Social Media Video Production 1. On- and off -site video production services in Santa Ana to produce videos tailored for social media, City TV channel, marketing, website, and internal use. These would be brief videos (30 seconds — 5 minutes), shall include editing for graphics, video roll -ins and all audio/visual needs. C. Additional Meeting Video Production Services 1. City Council meeting video production services beyond the 24 meetings included in the base services listed above. Video production services for other city meetings and functions at City Hall or other city facilities. D. Other Services Not Mentioned 1. In addition to the designated proposal cost categories provided below, Proposers are encouraged to provide cost proposals for services that are not described in this RFP but may be of benefit to the City with regard to video streaming services. RFP No. 20-105 Video Services for Government Access Channel 3 & Related Services Page 23 of 23 MAYOR Miguel A Pulido MAYOR PRO TEM Juan Villages COUNCILMEMBERS Phil Bacerra Nelids Mendoza David Pension Vicente Sarmiento Jose Solorio CITY OF SANTA ANA FINANCE AND MANAGEMENT SERVICES AGENCY 20 Civic Center Plaza • P.O. Box 1988 Santa Ana, Califomia 92702 714-647-6468 www.santaana om CITY MANAGER Kristine Ridge CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL Daisy Gomez VIDEO PRODUCTION OF CITY COUNCIL MEETINGS, OTHER VARIOUS PRODUCTIONS, AND CABLENIDEO EQUIPMENT MAINTENANCE RFP 20-105 ADDENDUM NO. 1 July 29, 2020 Notice is hereby given that where applicable; the City of Santa Ana Planning & Building Agency has made certain modifications, additions, and/or deletions, in the specifications to RFP No. 20-105, or reference is made in this Addendum No. 1, NEW SECTION Exhibit B - Bidders shall refer to this Standard Agreement (Sample), referenced throughout the RFP PROPOSER QUESTIONS AND CITY RESPONSES Q1. The Addendum specifies 7-10 videos and possible lengths of the two subject matters, but not how many of each. In other words, what is the anticipated breakdown of how many videos about Land Use and how many about Development Code? Al. This question is for RFP 20-103 and should be disregarded. 02. Is the Agreement Statement the same thing as Attachment B: Proposer's Statement? A2. These are two separate items. The Agreement Statement is in reference to the now included Exhibit BStandard Agreement (Sample). Q3. Does the video production of City Council Meetings (A. Council Meetings) INCLUDE the Spanish - language versions? If not, is this something you would like budgeted as an Add -On? A3. Yes, it includes the Spanish -language version. The Spanish translation is provided through a separate interpreter service contracted with the City. Q4. The RFP bid says the vendor is responsible programing playback. Is the vendor expected to do all the programing for the cable channel? The 2417 schedule? Youtube? Granicus? Please ask the Public Information Officer to clarify? A4. The bidder is only responsible for the playback on Granicus and YouTube of City Council meetings and any other City meetings for which the bidder provides video services. ALL OTHER TERMS, CONDITIONS, AND SPECIFICATIONS REMAIN UNCHANGED. END OF ADDENDUM NO. 1 Page 1 of 8 MAYOR Miguel A. Pulido MAYOR PRO TEM Juan Villegas COUNCILMEMBERS Phil Bacerra Nelida Mendoza David Penaloza Vicente Sanniento Jose Solorio CITY OF SANTA ANA FINANCE AND MANAGEMENT SERVICES AGENCY 20 Civic Center Plaza . P.O. Box 1988 Santa Ana, California 92702 714-647-5468 vmv.santa-ana crg CITY MANAGER Kristine Ridge CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL Daisy Gomez VIDEO PRODUCTION OF CITY COUNCIL MEETINGS, OTHER VARIOUS PRODUCTIONS, AND CABLE/VIDEO EQUIPMENT MAINTENANCE RFP 20-105 ADDENDUM NO. 2 August 11, 2020 Notice is hereby given that where applicable; the City of Santa Ana Planning & Building Agency has made certain modifications, additions, and/or deletions, in the specifications to RFP No. 20-105, or reference is made in this Addendum No. 2. BID DUE DATE EXTENDED The bid due date has been extended to Wednesday, August 19, 2020 at 4:00 P.M., Pacific Standard Time. PROPOSER QUESTIONS AND CITY RESPONSES Q1. Two questions: There is very little information in the bid about the control room systems, the playback systems, the council chamber system. It only talks about maintenance. Question one: A/V equipment. Is the selected vendor required to do equipment installation, integration, upgrade equipment or systems (when needed). To develop equipment purchase list? Question two: Do you require the proposer to do system troubleshooting, system repair, system alignment and calibration? system design? Al. Yes, the vendor would be required to develop purchase lists, install, integrate and upgrade systems or equipment as needed. Yes, the vendor would do system troubleshooting, system repair, system alignment, calibration and design. Q2. For the Add -On Services at the end of the bid description. Item B. It read "on and off site video production services to produce 30sec -5 min videos. Can you give us some idea of how many per month (or year) you might expect to require from the proposer? It makes it difficult to do a proper bid amount without knowing some rough quantity, how many are you thinking, just some kind of estimate? A2. Approximately 1-2 videos per month could be requested. Please provide an estimated cost per video or hourly rate. Q3. You list add on services at the end of the bid. Item A: list the events: 4th of July, Fiestas Patrias, etc, but it also says not limited to the listed events. Can you give us a general idea of how many additional events? 5-10? 10-20? It makes it hard to bid on this if we don't have an some idea of how many additional events you want produced? Page 1 of 2 A3. In addition to the 4 events listed, we anticipate possibly 4-8 other events could be requested for filming. Please provide an estimated cost per event or hourly rate. Q4. Can you provide a list of equipment the city owns and uses for these purposes — in other words, what specific equipment will we need to provide operators for? A4. Standard audio and video recording production and post -production equipment including mounted cameras operated from a control room are used. Please see page 21, Exhibit A, Section A of the RFP for additional information. Q5. Is the bidder/vendor expected to use city facilities and equipment for the entire process of producing every council meeting video? i.e. for production, and post production? A5. Yes, the vendor is expected to use city facilities and equipment for the entire process. Q6. What additional personnel, besides camera operators, does the vendor/bidder need to provide? A6. Please see page 21, Exhibit A, Section A, No. 4 of the RFP. Q7. How many crew members will the bidder/vendor have to supply at each meeting? For example, does the vendor need to supply two camera operators? Three? AT Please see page 21, Exhibit A, Section A, No. 4 of the RFP. We recommend 2-3 crew members, but it will be at the discretion of the contractor to determine best practices. Q8. Can you provide an example of a previously produced City Council meeting video, that has the same general parameters of what will be expected going forward? A8. This is our regular (in -person) meeting: https://santaana.granicus.com/MediaPlayer.php?view id=2&clip id=2643 This is our temporary current (virtual teleconference) meeting operation: https://santaana.granicus.com/MediaPlayer.php?view id=2&clip id=2857 Q9. Is the bidder/vendor responsible for any type of live broadcast of the council meetings? Either online or on television? Or is the vendor only responsible to record, and prepare the meetings for .'playback," as indicated? A9. Yes, the vendor will manage the live broadcast of the council meeting online and on television. Q10. How many cameras are used for these meetings? A10. A total of ten cameras are used for City Council meetings. Q11. What is the delivery format of the finished videos? Where does the city host them for viewing by the public (Youtube? Website? What is the delivery platform?)? Al1. The videos are shown on YouTube. Granicus and on television on the City's channel, CTV3. ALL OTHER TERMS, CONDITIONS, AND SPECIFICATIONS REMAIN UNCHANGED. END OF ADDENDUM NO. 2 Page 2 of 2 EXHIBIT B CONSULTANT'S SCOPE OF SERVICES & COMPENSATION Page 10 of 10 RIP 20-105 Scope of Service From Date 11/23/2020 Video Engineering Services Thomas E Bystry 915 Wycliffe Irvine, CA. 92602 videotb(&,aol.com 714-366-4666 Tax ID 93-1099297 To The City of Santa Ana Attention: Paul Eakins Scope of Services RFP-20-105 PRICING STRUCTURE Annual Amounts for a one year contract with another year renewal option. Amounts are consistent with what was offered in the RFP bid. I have not had any price increases in over 6 years. All my costs have increased, insurances, crew, parts and supplies, parking. Hence, see below. Annual amounts Exhibit A- Hourly Services. All areas: Engineering, Production, Videography, Editing, Troubleshooting, Repair, Alignment, Calibration, New systems install, City Hall, Senior Centers, Rec Centers, Stadium. Training Staff, Cable channel programing, Prime Gov, etc. Per direction of consultant's manager. Only bill for hours worked or project performed. $80 per hour, Tom Bystry, senior engineer (2 hr min). $45 per hour Crew: Mark Kiss, Shawn Bohonos, Martin Bystry, Josh Hernandez, Joaquin Torres. All crew member assignments will be discussed with Manager and Tom Bystry. IBM- State of The City Address: $5,500 Flat: includes all pre -production meetings with staff. Crew members, event, supplies, pants, post editing, putting it on our channel. Copies and Distribution Exhibit C-Council meetings- Flat Rate Uv to 26 meetings = $39,000 S 1500 Includes crew and possible remote meetings S 100 Extra if it goes past midnight Justification: City Council meeting technical video production services up to 26 meetings (I only bill for meetings that I (crew) attend). Detailed description of services provided listed in the RFP. Exhibit D —Contingency: $15,000 recommended amount I hope this gives you an idea of an annual amount to budget for. Please contact me for any additional questions. Tom ri-ancine Fla ncine R.VilIareaI late: 2 R. Villareal 09:07,02-08'00'3 Phone:(714)647.5420 Fax:(714)647.6944 CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED REPRESENTATIVE OR PRODUCER. AND THE CERTIFICATE HOLDER :ertiiCate holder Is an AUDITIONAL INSURED, U* P WAIVED, subject to the terms and conditions of the PRIMUCEr` Triton of Calif Insurance Services, Inc. 5000 San Juan Avenue Fair Oaks, CA 95628 License #: OF41767 TOM BYSTRY 1 DBA: VIDEO ENGINEERING SERVICES 14 APPOMATTOX IRVINE, CA 92620 must have ADDITIONAL INSURED provisions Dr be endorse attain policies may require an andomemenL A statementon Chris .___ INSURF_H(S)AFFOROWO COVEMGE COVERAGES CERTIFICATE NUMBER: 00003262.93AR RFUIRInM MIIMRPR• " THIS ISTO 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 OWED 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. Oak IN6R TYPE OF INSUPMICEsil N#Fmt1CYwmm A X COMMERCOLLDBIERALUAeRRY cuwsJAaDE ❑X occuR Y MP0004009006721 � 02/01/2020 OV0112021 EACH=MRENCE s 1,001000 Ea ooa s 100 000 MEDEWWWu s 5000 CENL PERSOHALaAWIWURY 6 1000000 AGdF1EOATE UTATAPPLIEB PER PGICY ❑ J ❑Lac OTHER: GENERALACCFEGLTE PRODU(;M-COMPA Aoo 6 2000000 s 2,000,000 6 AUTOMOBILE LABILITY ANY AUTO OWNED ALTOS MY �O6 EOULED HIRED 1404-0L AVTO6 ONLY AUT09ONLY r COMB 6 BO1)ILY1NIURY(PupuxP,l 1 BODILY IWURY (PeI ACGdRq 6 --. S. i UMBREWI WLB EXCESS LAS OCCUR CLAIM L j I EACH OCCURRENCE 6 AGGREGATE $ DELI I I RETENn)N6 6 iNORKBRS CONPENMTRNI ANOF,MPLOTERYLIASILRY YIN FFl BER ARTNEWEXOY ECIRIVE tLYynwle MNHl CESCRIPrgN OF OPERATIONS Wbw NIA PEA ELEAGHACGDENT 6 EL DISEASE -EA EMI Y 6 EL MSEASE-POLICY UVR 6 I DESCMPnM dF OPEMTIONS I LOCAnO l VEIOCIFA (ACORO f01, AdSIwu1 Rwwhv BswEUM, nuYOr JwcME it,Ao,R rpu W RWw� The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701; Its officers, employees, agents and representatives are named as additional Insureds per CG2010 attached to this policy. The insurance is primary and noncontributory. Certificate of Insurance shall provide thirty (30) day prior written notice of cancellation REVIEWED 81 APPROVED FE Q ZO2O SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City Of Santa Ana THE M(FIRATION DATE THEREOF, NOTICE WILL SE DELIVERED IN Risk Management Division ACCORDANCE WITH THE POLICY PROVISIONS. 20 Civic Center Plaza, 4 SANTA ANA, CA 92702 ANGiP ACEvEdo "TMOR�D 'AE CPR ®1988-2015 ACORD CORPO ACORD 26 (2016103) The ACORD name and logo are registered marka of ACORD Rhk MRnagenLRdDtvieton Pdnted by CPR onJ -"a `.i ccREVIEWED&ppAP,P`RI�C�IV'/ED BY.' '� rAhK�-h6 Yam. I<+L!lHEJLL v Risk Management Analyst POLICY NUMBER: MP0004009006721 COMMERCIAL GENERAL LIABILITY CG 2010 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organ ization s Locations Of Covered Operations THE CITY OF SANTA ANA RISK MANAGEMENT; ITS OFFICERS, VARIOUS EMPLOYEES, AGENTS AND REPRESENTATIVES PO BOX 1988 M-16 SANTA ANA, CA 92702 A. Section If — Who Is An Insured is amended to Include as an additional Insured the person(s) or orgenization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "properly damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or in B. With respect to the insurance afforded to these additional insureds. the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. 2. The acts or omissions of those acting on your behalf; In the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 2. 1. The insurance afforded to such additional Insured only applies to the extent permitted by law; and 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 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 rform' pe ng operations for a 2. If coverage provided to the additional insured is principal as a part of the same project. required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which YQU%WED & APPROVED required by the contract or agrearnoptRr1A tilnnact nrENr Division provide for such additional insured. FE3g D 2020 ANGLE AcEVEdO CG 20 10 0413 Op Insurance Services Office, Inc., 2012 RIAMEWarugemadDiWalan f' REVIED & APPROVED BY. �9111i:lJ F4"e n.t P1. VIL" 1 �� Risk Management Analyst j POLICY NUMBER: MP00D4009006721 COMMERCIAL GENERAL LIABILITY CG 20 01 0413 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 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 CG 20 01 0413 (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. REVIEWED & APPROVED By Risk MANAfrEMENT DivisioN F 1 2o20 ANGiE ACF.vEdo © Insurance Services Office, Inc., 2012 Rlmk Management Dtviatmi t, RenEwED 6 APPROVED BY: ® Risk 6danagemen[ Analyst CITYOFSANTAANA RISK MANAGEMENT &cede" 4HUMAN RESOURCES Managing Risk vAwo PosNve Change WORKERS' COMPENSATION DECLARATION v Wnelr I, / riaM 4S 1� y S �cy hereby affirm under penalty of perjury, the (Name/Title) following declaration: /l I certify on behalf of V ea Lc 11 11jeffir%q SerVfCto&that during the term '/� (Co nsb ant/Company ome) of my contract for V ► 400 fiPc A S ryi c,e 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: f - 7- 2 b;� % Print Name:,/-A,,,,,, ame: !h6M9S Print Title: OLon er Signature: �w Telephone: `914 _ 36o %� 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. I:11fisk Mgmt1insuronce RequirementsJWC Declaration 08152019 K MRwganvltlimslan ,s REVIEWED & �APPROVM BY. �AAMU9ee Imo. YKCIv1PAC 61B{L4¢7 Risk Management Analyst ttionalGeneralAutn, Hone & Health Imuana ox 3199 • Winston Salem, NC 27102-3199 THOMAS E BYSTRY 915 WYCLIFFE IRVINE CA 92602 Policy Number: Named Insured: ` Thomas E Bystry Policy Period: 5/21/2020 - 5121/2021 Date of Notice: 03AM2020 2:34 AM Policy Underwritten By: Integon National Insurance Company 24 Hour Claim 1,1111liporting: 1-800-468-3466 For Policy Ifftmation: 1-877.468-3466 www.MyNatGenPolicy.com Your Agent: Fiesta Auto Insutllftce Center Store #Ca078 1714 E McFadden Ave Ste P Santa Ana CA 92705 (714) 884-4284 CA COMMERCIAL VEHICLE DECLARATIONS PAGE Renewal Effective 05121/2020 12:01 AM Drivers, Employees and Household Residents #1 Thomas E Bystry -- Driver Status License # LIc State Date of Birth Gender Marital Status Driver Pts Yrs. Licensed Owner Driver XXX9358 CA 10126/1957 Male Married 0 46 #2 Jennifer L Bystry Driver Status License # LIc StIlte Date of Birth Gender Marital Status Driver Pts Yrs. Licensed Relative 2/6/1978 FemAts Married 0 26 Excluded Insured Vehicle(s) and Schedule of Coverages #1 2011 HOND ELEMENT LX VIN: Usage: Personal Use Radius: 0 5J6YH1H32BLp03266- Only BD3335 Garaging Location: 92602 Policy Coverage Level ScheduledAuto Coverages Provided Bodily Injury / Property Damage - Combined Single Limit Medical Payments Uninsured / Underinsured Mottt►W Combined Single Limit Discounts A Policy Level Limits/Deductibles $1,000,000 Combined Single Limit $10,000 Each Person / Each Accident $100,000 Combined Single Limit Premium $798.00 $63.00 $112.00 Total for this Vehicle $973 00 Combined Vehicle Premium $973.00 Aogt*ibon Expense $20.00 CA Vehicle Assessment and Fraud Fee $1.76 Total 12 Month Policy Premium $994.76 10039CA (06012014) Business Experience ,.. u%�rT ua vrvawn �.+{ (REVIEWED & APPROVED BY. � 111�' r't!•6J.�-ht R. �+W✓iPNt. ® Risk Management Analyst Paperless Discount Paid in Full Discount Package Discount Surcharges Applied Policy Level Excluded Operator Surcharge Important Notice Our Company offers multiple programs in California to eligible insureds. A lower rate or better coverage may be available to you. If you are a member of an association and would like your policy reviewed to assure you are receiving the best possible rate, please contact your agent or our call center at 1-877-4683466. Additional Policy Information Insured email: videotb@aol.com Tier 10 Disclosure of Possible Additional Charges The amounts below are authorized for use in this state. However, they are only charged if they apply to your policy. Acquisition Expense $20.00 Additional Insured Charge $25.00 Additional Insured Charge - Blanket $1,000.00 CA Vehicle Assessment and Fraud $1.76 Fee Cancellation Charge $10.00 Convenience Fee $5.00 -Federal F!Fng Fee $75.00 FR Filing Charge $25.00 Late Charge $10.00 Nonsufficient Funds Charge $25.00 Reinstatement Charge - Federal Filing $75.00 Reinstatement Charge - No Federal $25.00 Filing UIIA Fee $75.00 Waiver of Subrogation $25.00 Waiver of Subrogation - Blanket $1,000.00 Forms and Endorsements Form Edition Form Name 10150 01012014 NUCLEAR ENERGY LIABILITY EXCLUSION 07594 12012018 EXCLUSION OF NAMED DRIVER 11332 03012018 COMMERCIAL AUTO POLICY Authorized Signature R1,1 Management DMslan &�yAPPRovm BY; rrREmEWED 10039CA(06012014) M' Risk Management Analyst o19111ty191ed by Fancne R. Francine R. Villareal Villareal Date :2021.012] 17 0059-08'00' Phone:(714)647-5420 Fax:(714)647-6944 ACORa CERTIFICATE OF LIABILITY INSURANCE DATE(MWDDIYYYY) 01/27/2021 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 Triton of Calif Insurance Services, Inc. CONTACT NAME: Chris Rudolph PHONE AIC No Ext: (916)485-1705 FAX No: (916)485-0198 5000 San Juan Avenue NDDRESS: chris@tritoninsurance.com Fair Oaks, CA 95628 INSURER(S)AFFORDING COVERAGE NAICIt License #: OF41767 INSURER A: Mesa UnderWdtersSpeciality Insurance Co. INSURED TOM BYSTRY INSURER B: INSURER C: DBA: VIDEO ENGINEERING SERVICES INSURER D: 915 WYCLIFFE INSURER E: IRVINE, CA 92602 INSURER F: COVERAGES CERTIFICATE NUMBER: 00003962-9368 REVISION NUMBER: 35 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 TOALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRPOLICY R TYPE OF INSURANCE INSD WVD SUB' POLICY NUMBER EFF MWDD YYYY POLICY EXP MMIDDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY Y MP0004009007169 02/01/2021 02/01/2022 EACHOCCURRENCE $ 1,000,000 CLAIMSMADE EXI OCCUR PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL &ADV INJURY $ 1000000 AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2000000 GEN'L X POLICY JECT LOC PRODUCTS -COMP/OPAGO $ 2,000,000 $ OTHER AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ DAMAGE Per accident $ HIRED NONOWNEDPROPERTY AUTOS ONLY AUTOS ONLY UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMSMADE DED I I RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS 'LIABILITY YIN PER OTH- STATUTE ER EL. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED' NIA EL.DISEASE -EAEMPLOYE $ (Mandatory in NH) fyas desrnbeunder DESCRIPTION OF OPERATIONS below EL.DISEASE -POLICYUMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701; its officers, employees, agents and representatives are named as additional insureds per CG2010 attached to this policy. The insurance is primary and non-contributory. Certificate of Insurance shall provide thirty (30) day prior written notice of cancellation City of Santa Ana Risk Management Division 20 Civic Center Plaza, 4th Floor SANTA ANA, CA 92702 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 ©1988-2015 ACORD CO ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Printed by CP Rime Mrenagnnent Diaisian REVIEWED&APPROVED BY: '� Risk Management Analyst POLICY NUMBER: MP 0004009007169 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Or anization s : Location(s) Of Covered Operations THE CITY OF SANTA ANA, ITS OFFICERS, EMPLOYEES, AGENTS AND REPRESENTATIVES RISK MANAGEMENT P.O. BOX 1988 M-16 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 include as an additional insured the person(s) or organizalion(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: 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(s) at the location(s) designated above. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily Injury" or "property damage" occurring after: 1. 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 However: 2. That portion of "your work" out of which the injury or damage arises has been put to its 1. The insurance afforded to such additional intended use by any person or organization insured only applies to the extent permitted by other than another contractor or subcontractor law; and engaged in performing operations for a 2. If coverage provided to the additional insured is principal as a part of the same project. 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. CG 20 10 0413 © Insurance Services Office, Inc., 2012 Insured Copy pane 1 of 2 Rime 1ituagment Diaisian REVIEWED&APPRDVEDBY: °�1„3�1 Ia•j;' faaa.o:.a.e �.. V:,@QRnzbl '� Risk Management Analyst C. 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 CG 20 10 04 13 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. © Insurance Services Office, Inc., 2012 Pane 2 of 2 Rime Management DMsian ( rREmEWED&APPRDVED By., �_4.Ilil _II.IPJ-z' rAE� P. VdRE/t¢bl. S, ® Risk Management Analyst I*orntional General >> A.W. He & Health Imumnce P Box 3199 • Winston Salem, NC 27102-3199 THOMAS E BYSTRY 915 WYCLIFFE IRVINE CA 92602 Policy Number: Named Insured: Thomas E Bystry Policy Period: 5/21/2020-5121/2021 Date of Notice: Policy Underwritten By: 2006521219 03MZU020 2:34 AM Integon National Insurance Company 24 Hour Claim 1611porting: 1-800-468-3466 For Policy Information: 1-877468-Me www.MyNatGenPolicy.com Your Agent: Fiesta Auto Insuf tce Center Store #Ca078 1714 E McFadden Ave Ste P Santa Ana CA 92705 (714) 884-4284 CA COMMERCIAL VEHICLE DECLARATIONS PAGE Renewal Effective 05/21/2020 12:01 AM Drivers, Employees and Household Residents #1 Thomas E Bystry --- Driver Status License # Lic State Date of Birth 0;ender Marital Status Driver Pts Yrs. Licensed Owner Driver XXX9358 CA 10126/1957 Male Married 0 46 #2 Jennifer L Bystry Driver Status License # Lic Stale Date of Birth Gender Marital Status Driver Pts Yrs. Licensed Relative 2/6/1978 Fent61e Married 0 26 Excluded Insured Vehicle(s) and Schedule of Coverages #1 2011 HOND ELEMENT LX VIN: Usage: Personal Use Radius: 0 5J6YH1H32BL003266- Only BD3335 Garaging Location: 92602 Policy Coverage Level ScheduledAuto Coverages Provided Bodily Injury / Property Damage - Combined Single Limit Medical Payments Uninsured / Underinsured MoURW Combined Single Limit Discounts Applied Policy Level Limits/Deductibles $1,000,000 Combined Single Limit $10,000 Each Person / Each Accident $100,000 Combined Single Limit Premium $798.00 $63.00 $112.00 Total for this Vehicle $973.00 Combined Vehicle Premium Acquisition Expense CA Vehicle Assessment and Fraud Fee 10039CA (06012014) Business Experience $973.00 $20.00 $1.76 Total 12 Month Policy Premium $994.76 Ride Management DMsinn REvIEWED & APPROVED BY: '� Risk Management Analyst Paperless Discount Paid in Full Discount Package Discount Surcharges Applied Policy Level Excluded Operator Surcharge Notice Our Company offers multiple programs in California to eligible insureds. A lower rate or better coverage may be available to you. If you are a member of an association and would like your policy reviewed to assure you are receiving the best possible rate, please contact your agent or our call center at 1-877-468.3466. Additional Policy Information Insured email: videotb@aol.com Tier 10 Disclosure of Possible Additional Charges The amounts below are authorized for use in this state. However, they are only charged if they apply to your policy. Acquisition Expense $20.00 Additional Insured Charge $25.00 Additional Insured Charge - Blanket $1,000.00 CA Vehicle Assessment and Fraud $1.76 Fee Cancellation Charge $10.00 Convenience Fee $5.00 Federal Filing Fee $75.00 FIR Filing Charge $25.00 Late Charge $10.00 Nonsufficient Funds Charge $25.00 Reinstatement Charge - Federal Filing $75.00 Reinstatement Charge - No Federal $25.00 Filing UIIA Fee $75.00 Waiver of Subrogation $25.00 Waiver of Subrogation - Blanket $1,000.00 Forms and Endorsements Form Edition Form Name 10150 01012014 NUCLEAR ENERGY LIABILITY EXCLUSION 07594 12012018 EXCLUSION OF NAMED DRIVER 11332 03012018 COMMERCIAL AUTO POLICY 10039CA (06012014) Authorized Signature Ride Management DMsion � % REVIEWED&APPROVEDBY: F4.f :.a.e i:. Mv,axl '� Risk Management Analyst CITYOFSANTAANA RISK MANAGEMENT a d& aewt 4 HUMAN RESOURCES ManagingRisk Pcsfflw Change WORKERS' COMPENSATION DECLARATION dLAM er I, /riemgs 1� y S rry hereby affirm under penalty of perjury, the (Name/Title) I�— following declaration: I certify on behalf of V e_10 FAJ I l S rV CAthat during the term p (Consbitont/Company Arne) of my contract for Ili o ev fi>°c A "�2ry('jO 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: /7— 2 �� Print Name: 6M9 S 17yS�� Print Title: ! Il 0 Lon er Signature: Ir> Telephone: 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. l: RiskMgmtVnsuranceRequirements�WCDeclaration 08152019 RiskMwagxmentDMsian REVIEWED&APPROVED BY: '� Risk Management Analyst R. Digitally signed by Francine Francine . Il R. Vil lareaI Villareal Date: 2022.01.2808:19:14 08,00, Phone: (714)647-5420 Fax: (714)647-6944 ACOR" CERTIFICATE OF LIABILITY INSURANCE ill DATE (MMIDD/YYYY) 1 01 /26/2022 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 Triton of Calif Insurance Services, Inc. 5000 San Juan Avenue CONTACT Chris Rudolph PHONE FAX A/C No Ext : (916)485-1705 A/C No : (916)485-0198 E-MAIL ADDRESS: ChrIS@trltOr11r1SUrarlCe.COm Fair Oaks, CA 95628 INSURER(S) AFFORDING COVERAGE NAIC# License #: OF41767 INSURERA: Mesa Underwriters Speciality Insurance Co. INSURED TOM BYSTRY INSURER B DBA: VIDEO ENGINEERING SERVICES INSURER C 915 WYCLIFFE INSURER D IRVINE, CA 92602 INSURER E: INSURER F : COVERAGES CERTIFICATE NUMBER: 00003962-9368 REVISION NUMBER: 38 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 CONTRACTOR 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 LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY Y Y MP0004009007964 02/01/2022 02/01/2023 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE F�vl J OCCUR DAMAGE TO PREM SES (E.0.RENTEFence) Fence)$ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY D PRO- JECT LOC �( PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLA LAB OCCUR EACH OCCURRENCE $ ECLAIMS-MADE AGGREGATE $ EXCESS LAB DED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N PER OTH- STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? N / A E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701; its officers, employees, agents and representatives are named as additional insureds per CG2010 attached to this policy. The insurance is primary and non-contributory. Certificate of Insurance shall provide thirty (30) day prior written notice of cancellation City of Santa Ana Risk Management Division 20 Civic Center Plaza, 4th Floor SANTA ANA, CA 92702 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 REP ATIVE )';lSil Mwag7MM2d DMsiun Aw F �40 \'x REVIEWED & APPROVED BY.- v N371F Ill @ 1988-2015 ACORD C h Wsk Management Analyst ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Pri POLICY NUMBER', MP 0004009007964 COMMERCIA L GEN ERAL LIABILITY CG 2010 04,113 MUL 14;4�7mm **A 4 Th is ond orsernerit mc,Wies insuraive Provided u odler the followirgi; COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Addifionall In amd Persan(s) Location(s), Of Covered Operations THE CITY OF SANTA ANA, ITS OFFICERS, EMPLOYEES, ACENTS AND REP RESENTATIVEM RISX MAN&GEhMNT P,0. Box 1988 H-16 �W'TA ANA, CA 927,02, .... ..... .... ... ... .... .... .... ...... Information rug quiredlo complete this Schedule, If not shown a b o v e Witt 11 be shown in the Dedarations A. Setfin III —'Who Is An Insured is amended to Include as an additional Insured the person(s) or, organization(s) shown in Me Schedule, but only with respect to hability for wbodily injIury", ",property darnai or, '"prrr^sruraall arradi advei Injury"' caused, In wWe or In part, by� 1. Your acts or omissions; or ,2. The acts or omissions of, those acting on your, behal1i; in the performance of your origoing operationfor the aiddItionall Insured(s) at the location(s) designated above, However. 1. The Insurance afforideld to, such additional insured only appties to the exten't pemilitted by Iaw; and 2. If coverage provided to the addillihall Insured Is required by a contract or agreerneint, the insurance aff'or ded to such additional Insured will not be broader than M, t whicih, you are required by the contract or agreement to provide f6r, such add Ifional Insure d, B. With resperiat. to, the insurance afforded to 11 iese addiltionall Insureds, the followIng additional exclusions apply�,, Tis Insarance does not, apply to "bodily Injury" or "property damagell omothi after, 1 . Ail work, Including matedails, ,parts a,r equipment furnished In connection with such work, on the pryw:t (91her than service, maintenance, or repairs) to be performed by or ori behall war the additional irisured(s) atfite location of' the covered aparations hors been complellet Or 2. That portion of 'Your work' out of volilch the, Injury or darnage arises has been put to its, Intended use by any, person or organization other, thain another contractor or, subcontractor eingaged in perforn,flng operations for a principal as, a pad, of the, saii project. CG 20 10 041 0 inSUirance Services Office, I nci., 2012 Irnauxed ii cF Risk MmVmerdDMsiun Jy? 'K�q REVIEWED & APPROVED BY.- F04c.�" P, VX*vd Rtiementftali C.VVith 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.Avolable under the applicable Limits of Insurance shown imthe Declarations; whichever isless. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. (9)Insurance Services Office, |nc,2O12 Risk MmRgmedoMsiun nswsWso&APPROVED mr F04*"�" P, VX*vd mWmanmo,mentxuwlpt�� POLICY NUMBER: MP0004009007964 COMMERCIAL GENERAL LIABILITY C6,20 0`04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE IREAD IT CAREFULLY. This endorsement modifies insurance provided under the follovAng The following is added to the Other Insurance Condition and supersedes any, provision to the contrary: Primary And Noneontributory Insurance This insurance is pemary to and will not seek contribution from any other insurance available to an additionaI insured under your policy, provided that.,. (1) The additional insured is a Named lins�ured unider such other insurance; and (2`) You have agreed in writing in a oontrad: or agreement that this iasurance would be p4mary and would not seek contribution from; any other insurance available to tha addifional ilnsurd. CG 20 04 04 13 0 Insijirance Services Office, Inc., 2012 ep ..cF RAMwagmedDMsiun Jy? N,�q REVIEWED & APPROVED BY.- VX*vd RtWjanagementftalpt POLICY NUMBER: 0004009O7964 A IL T This endorsement modifies insurance provided under the folloviiing� COMMERCIAL GENERAL LIABILITY CG 24 04 05 (19 COMMERCIAL GENERAL, LIABILITY COVERAGE PART PROD UCTVCOMPLETED OPERATIONS LIABILITY COVERAGE PART Name Of Person Or Organization: T'EE C)<TY OF S,4-YTA A',AI'I'S OFFICERS,, EMPLOYEES, AGENTS A,D REPRESENTXTIVES Information required to complete this $Qhedlule, if'not shown albove, wall be shown,, in the Deolarations. The foRowing is added to, Paragraph S. Transfer Of Rights Of Recovery Against Others To Us of Section IV — Conditions: We waive any, right of'recovery nee may have against. the person, or organization shown in the Schedule above because of payments we make for injury or damage airislng out of your ongoing operations, or "Your work" done under a contract with that person at organization and included ib the "products- cnmpleted operations hazard""- Thi-s waiiver applies only to the person or organization shown in the Schedule above. CG 2404 05 09 Q Insurance Services Office, iInc., 20,08 ep ..cF RAMwagmedDMsiun Jy? N,�q REVIEWED & APPROVED BY: F04c.�" z VX*vd RtWjanagementftalpt Reata Auto linisuranice Center Store #CaG73, 171:4 IE McFadden Ave Site P, Santa, Ania., ,CA 92705, (711Q BB4-42',94 RestaCAOT8CRestaffisu ranjoe.comi hila ke A Paym ent Request My ID Ca Report a N eww Ca%m Update Contest Info View Cialms IHlistory Need hleip? Click to Chat orgive, us a call 1 877 4168-34166, Pohty Summary Tl,-i 011112 S IBystry - '20 0 6 521219 - 03 La.g 0 ILI, -I Tho,n'ias, E Bysiry g 15 wg diffe 20065212'19 $0-00 �No Payment Due lI CA 92502, *�Olf Ad*L-ss Pdii Verm, 'T' Otal Wit mi'virri"; Remainiltig, 04laiii*L� Odeoth,oad coma EirZV2021 - 5212=12 S1,227.76 LO 00 Lasi P**0111if -IiA It, I Playivin M&6�*d I (714) 3W-4aaa, Apfi-I S1,227.76 !WTI1a'2G2,1 Dowment D604I MtOddl EFVAll- PaV Rrw Full Dract Mill '-No Alerts and PAessages are available for reAew on torus policy. I'2&,202t Renewwall Payment Letter 5121A2021 3; 1 E%f2L22 I Policy Renewal b 113KII&3'312018) C3MMIERC-11ALAUTO POLICY 5r2 1 o"202 1 )X'� kra)2LLexperie DU doc-unleris" gill j Y�� 1 Thomas Rystry California 1 2011 HOND 5JG',(H 11 HIKSLOOKW No 92,602 NO, ELEMENT LX Boddly lr�pjry �' PrI Damage - CombiI 05mgle Limit Uninsured I Underinsured, Motonst Combined Single Limit hil's-diII Payments No No l'.40 No $ t,II �Combined 3i Ingle Limit ,5 I12i0,000 Combined Single Limit $1 0,CQG Eash Person �( Ea Accident 'wp ..cF RJAN[wagmedDMsiun k4e? N,�q REVIEWED & APPROVED BY.- vk" RtI Pjanagement Analyst CITYoFSANTAANA RisK MANAGEMENT Aww4w HUMAN RESOURCES Managing Risk omq�o Poshtm Change WORKERS' COMPENSATION DECLARATION 6 LA) 6 el III. �ts^1 q S rY hereby affirm under penalty of perjury, the (NamelTitle) following declaration: I certify on behalf of -VAeo FA / ► rVI(16that during the term (Cons Vto n tlComp an y do m e) of my contract for 111Ae-,c>"-JfrA 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: / - 77- 2- 6� / Print Name: -17� E Print Title: (3 Lo A er Signature: Telephone: 19/ 4- - 3 94�; - Z/- 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 ATTORNEYS FEES. 1:Risk Mgmt\lnsurance Requirements�WC Declaration 08152019 Risk MwaganedDMsiun REVIEWED & APPROVED BY.- F04c"�" Z vk" RtWjanagementftalpt Angie Digitally signed by Angie Acevedo Thank you for insuring with us! Here are your identification cards for Droof of i,is ar�2: 2022.06.14 Aceve0 09:17:35-07'00' N,AT101NAIL GENERAL CALIFORNIA COMMERCIAL EVIDENCE OF LIABILITY INSURANCE This insurance complies with CVC § 16056 or § 16500.5 Integon National Insurance Company NAIC POLICY NUMBER PO Box 3199 Winston Salem, INC 27102-3199 29742 2006521219 Thomas E Bystry DBA VIDEO ENGINEERING SERVICES EFFECTIVE DATE EXPIRATION DATE 915 Wycliffe 5/21/2022 5/21/2023 Irvine. CA 92602 KEEP THIS CARD IN YOUR MOTOR VEHICLE AGENCY 9005056 Report all accidents immediately to: Fiesta Auto Insurance Center Store (714) 884-4284 National General Insurance 1714E McFadden Ave Ste P Santa Ana, CA 92705 Toll free at: 1 800 468 3466 MOD 04 YEAR MAKE MODEL VEHICLE IDENTIFICATION NUMBER 2011 HOND ELEMENT 5J6YH1 H32BL003266 Cut On Dotted Line — Store In Your Vehicle 10321 (01012011) Ride Mmsgmad Division E o N,`P' REVIEWED & APPROVED BY. e eev '�--'Risk Management Specialist 0 m E in C4 -6 LM E X El: 1--C C, CE 8 m � 0 t rL Z z t; v E - . 2 'S2 NOTICE OF COMPLIANCE CITY STAFF: PRINT THIS PAGE AND INCLUDE WITH AGREEMENT TO THE CLERK OF THE COUNCIL Contractor Tom Bystry Name: Project A-2020-257-03 Number: Project Agreement To Provide Video Production Services For The City Of Santa Name: Ana The Certificate of Insurance (COI) submitted indicates that the coverages are in compliance with the insurance requirements. No further action is required at this time. The compliant coverage(s) are: EXPIRATION TYPE OF INSURANCE POLICY NUMBER COI DATE FILE NAME DATE AUTOMOBILE LIABILITY 2006521219 05/21/2023 12/06/2022 Cert of Ins - City of GENERAL LIABILITY MP000400900796406 02/01/2024 01/25/2023 Santa Ana.PDF T Bystry Waive Pro PROFESSIONAL LIABILITY WAIVER 12/13/2023 12/15/2022 Ins.pdf WC Declaration_Thomas WORKERS COMPENSATION AND WAIVER 12/05/2023 12/05/2022 E Bystry dba Video EMPLOYERS' LIABILITY Engineering Services.pdf Thank you, City of Santa Ana Risk Management Division in partnership with CTrax Plus Services Team 1/31/2023 4:32 PM