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Home My WebLink AboutCRUZ, MIGUEL TORRES (3)City of Santa Ana Clerk of the Council AGREEMENT TERMINATION FORM Please complete this form in its entirety when the attached agreement and all amendments (if any) are no longer in effect. Note: If your agreement is grant related, please ensure that all grant retention requirements have been satisfied prior to signing the termination form. Is the agreement(s) a permanent record? Yes _ No COTC Office Use Only fli: THE COUNCIL Return form to the Clerk of the Council Office (M-30). Call 647-1520 if you have any questions. i The agreement with 1 YUZ, M 1 N-2019-254-02 No. was completed on and final payment has been made. (List all amendments. Use space below N needed.) Department: Phone/Ext.: Signature: bft A" �C Date: ilagreements6ormsNorm-agreement termination form _goldenrod.doc ON FILE N-2019-254-02 PROCEED URANCE EXPIRES MAY 0 5 2021 12-31- a-1 COUNCIL SECOND AMENDMENT TO ARTS AND CULTURE p:C46UP) (T✓) 5r- ARTIST GRANT PROGRAM AGREEMENT L-C THIS SECOND AMENDMENT TO ARTS AND CULTURE ARTIST GRANT PROGRAM AGREEMENT is made and entered into this 10th day of February, 2021, by and between 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"), and Miguel Torres Cruz ("Grantee"). RECITALS A. City and Grantee entered into Arts and Culture Artist Grant Program Agreement number N-2019-254, dated August 20, 2019, for the purpose of providing grant funding pursuant to the Investing in the Artist Grant Program ("said Agreement'). B. City and Grantee entered into a First Amendment to said Agreement dated July 6, 2020, for the purpose of extending the Term of said Agreement until June 30, 2021, and adjusting the amount of the grant. C. In accordance with the terms and conditions of said Agreement, the parties now desire to amend Section 1 — Term, to extend said Agreement until June 30, 2022, and Section 2 — Funding, to correct and decrease the maximum amount of funding for said Agreement. NOW THEREFORE, in consideration of the mutual and respective promises, and subject to the terms and conditions of said Agreement, except as herein modified, the parties agree as follows: Section 1, Term, shall be amended to read as follows: "This Agreement shall commence on the date first written above and terminate on June 30, 2022, unless terminated earlier in accordance with this Agreement. The term of this Agreement may be extended upon a writing executed by the City Manager and the City Attorney." 2. Except as hereinabove modified, all terms and conditions of said Agreement shall remain in full force and effect. Page 1 of 2 N-2019-254-02 IN WITNESS WHEREOF, the Parties have executed this Second Amendment to Arts and Culture Artist Grant Program Agreement the date and year first above written. ATTEST: DAISY GOMEZ' Jerk of the Council APPROVED AS TO FORM: SONIA R. CARVALHO City Attorney � Q By. , Ryan O. Hodge Assistant City Attorney RECOMMENDED FOR APPROVAL: STEV N A. MENDOZA Executive Director Community Development Agency CITY OF SANTA ANA sdr KR19TINF RIDG City Manager Page 2 of 2 DocuSign Envelope ID: FFEC154C-2F47-4B70-B605-3832F524E588 rranLlDe n. vmdredl v,narem Date:2021.04.21 172214-07'OP ACORO® CERTIFICATE OF LIABILITY INSURANCE `..�+'' DATE(MM/DD YVYY) 04/16/2021 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 CONTACT Christopher Escueta NAME:Escueta Insurance Services 1712 W Magnolia Blvd 9 PHONE (818)840-8010 nAic Not 1 (818) 840-7066 EMAIL ADDRESS: chris@escueta-ins.com INSURERS AFFORDING COVERAGE NAIC If INSURERA; United States Liability Insurance Company 25895 Burbank CA 91506 INSURED INSURER B: INSURERC : Craig Tyrl - The Wayward Artist INSURERD: 125 N Broadway #E INSURER E: 1 INSURER F: Santa Ana CA 92701 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR I TYPE OF INSURANCE ADDLSUBR J= Byll POLICY NUMBER POLICYEFF MMIDDIYYVY1 POLICYEXP (MMIDDIYYYY1 LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE �X OCCUR PREMISES Ea.cc PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 A Y NPP1599302 12/31/2020 12/31/2021 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY � PRO- ❑ LOC ECT PRODUCTS - COMPIOP ADS $ Included Abuse Aggregate $ 300,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ HIRED NON -OWNED AUTOSONLY AUTOS ONLY PROPERTY DAMAGE Per accident $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 A EXCESS LIAB CLAIMS -MADE XL1609945 12/31/2020 12/31/2021 DED I I RETENTION$ Products/Comp Ops $ Included WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN I PER OTH- STATUTE I I ER E.L. EACH ACCIDENT $ ANYPROPRIETOWPARTNERIEXECUTIVE ❑ OFFICERIMEMBEREXCLUDED9 NIA E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) If as, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached it more space Is required) Miguel Torres Cruz and the City of Santa Ana, officers, agents, employees, and volunteers are named as additionally insured on this policy pursuant to written contract, agreement, or memorandum of understanding. Such insurance as is afforded by this policy shall be primary, and any insurance carried by City shall be excess and noncontributory. 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 REPRESENTATIVE —DocuSigned by; 4/16/2021 �CBB2CRSBD09Q1196B-2015 ACORD ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD M"NU negement ulmm tJ REVIEWED&APPR,ovEn By., �rp Risk Management Analyst UNITED STATES LIABILITY INSURANCE GROUP WAYNE, PENNSYLVANIA This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM BLANKET ADDITIONAL INSURED ENDORSEMENT Section II — Who Is An Insured is amended to include as an insured any person, entity or organization that is: 1. A franchisor under a franchise agreement with the Named Insured as franchisee relating to "your work"; or 2. A licensor under a license agreement with the Named Insured as licensee relating to "your work"; or 3. A co-owner with the Named Insured in premises used for "your work"; or 4. A majority owner with a controlling interest in the Named Insured but only with respect to liability arising out of such owner's (i) financial or operational control of the Named Insured; or (ii) ownership, maintenance or use of premises leased or occupied by the Named Insured for purposes of "your work'; or 5. A mortgagee, assignee or receiver of the Named Insured relating to "your work"; or 6. A lessor, or an agent of a lessor, under a lease agreement with the Named Insured as lessee relating to "your work"; or 7. A grantor of a permit to the Named Insured as permitee relating to "your work". However, if the grantor of a permit is a federal, state or local government or political subdivision, there is coverage under this endorsement only for liability arising from: a. The existence, maintenance, repair, construction, erection or removal of advertising signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoist away openings, sidewalk vaults, street banners or decorations and similar exposures; or b. The construction, erection or removal of elevators; or c. The ownership, maintenance or use of any elevators covered by this insurance; or 8. A lessor of equipment leased to the Named Insured relating to "your work"; or 9. A contributor, benefactor, or supporter who provides financial assistance to the Named Insured in connection with "your work"; but only to the extent the Named Insured is required to add such person, entity or organization as an additional insured to this policy under a written contract, written permit or written agreement relating to "your work". Such person, entity or organization is an insured only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" that is caused, in whole or in part by your acts or omissions or the acts or omissions of those acting on your behalf in connection with "your work" while such written contract, written permit or written agreement is in effect. L 744 NPP (06-10) L � iE,*m & A`PRntDivis� Y. GRtvieviEo & APPR6Vm Br: s 3 I9Nf•CiMd �. U:4Efne%f �"-�—� Risk Management Analyst I IXGLIUMI(1UR] There is no coverage under this endorsement for loss or expense, including but not limited to the cost of defense for "bodily injury", "property damage" or "personal and advertising injury": 1. That occurs after all of "your work", including materials, parts or equipment furnished in connection with "your work" and performed under a written contract, written permit or written agreement has ended; or When that portion of "your work" out of which the "bodily injury", "property damage" or "personal and advertising injury" arises and performed under a written contract, written permit or written agreement has been put to its intended use by any person(s) or organization(s); whichever occurs first. 2. Arising directly or indirectly from construction or demolition operations of any kind performed by you. 3. Caused or alleged to be caused by the sole negligence of an additional insured under this endorsement. 4. Arising out of "your work" performed for a federal, state or local government or political subdivision under a written permit. 5. Included within the "products -completed operations hazard". CONDITIONS Coverage provided by this endorsement will be excess over any insurance available to any additional insured under this endorsement unless a written contract, written permit or written agreement specifically requires that coverage under this endorsement is primary. All other terms and conditions of this policy remain unchanged. This endorsement is a part of your policy and takes effect on the effective date of your policy unless another effective date is shown. L 744 NPP (06-10) e Zak MenagementDhisinn REAEwED&APPR�OVEDBy. 8 I �-� ��R9YNke �, Vatt{Jd¢RG Risk Management Analyst Certificate Of Completion Envelope ld: FFEC154C2F474B70B6053832F524E688 Subject: Please DocuSign: Wayward Artist 04162021 ACORD 0025.pdf Source Envelope: Document Pages: 1 Signatures: 1 Certificate Pages: 1 Initials: 0 AutoNav: Enabled Envelopeld Stamping: Enabled Time Zone: (UTC-08:00) Pacific Time (US & Canada) Record Tracking Status: Original 4/16/2021 1:14:26 PM Signer Events Christopher Escueta chris@escueta-ins.com Commercial Lines Manager Escueta Insurance Services Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign In Person Signer Events Editor Delivery Events Agent Delivery Events Intermediary Delivery Events Certified Delivery Events Carbon Copy Events Witness Events Notary Events Envelope Summary Events Envelope Sent Certified Delivered Signing Complete Completed Payment Events Holder: Christopher Escueta chrls@escueta-[ns.com Signature CCBDocuSigned by BXIIIWME1 . Signature Adoption: Uploaded Signature Image Using IP Address: 47.37.178.196 Signature Status Status Status Status Status Signature Signature Status Hashed/Encrypted Security Checked Security Checked Security Checked Status Docu: 0 sli 4Rm9 Status: Completed Envelope Originator: Christopher Escueta ch ris @escueta-ins, corn IP Address: 47.37.178.196 Location: DocuSign Timestamp Sent: 4/16/2021 1:14:41 PM Viewed: 4/16/2021 1:14:45 PM Signed: 4/16/2021 1:15:20 PM Freeform Signing Timestamp Timestamp Timestamp Timestamp Timestamp Timestamp Timestamp Timestamp Timestamps 4/16/2021 1:14:41 PM 4/16/2021 1:14:45 PM 4/16/2021 1:15:20 PM 4/16/2021 1:15:20 PM Timestamps �IY,GREVIEWED &�AjPPR OtVDiD By. WI.IFr. d r ythtY.�AC h, �+�dKP4f� �-WgRi Risk Management Analyst March 5, 2021 To whom it may concern, My name is Miguel Torres Cruz and I am one of the recipients of the Arts and Culture Artist Grant. I am writing to inform you that I will not be using a vehicle (any auto or owned, hired autos, non -owned autos) for activates related to my artist grant project. The term of my agreement is from August 20, 2019 to June 30, 2022. Thank you so much, C Migu ones Cruz REVIEWED& APPROVED BY. Risk Management Analyst CITY OF SANTA ANA RISK MANAGEMENT a d4*zoa 4 HUMAN RESOURCES Managing Risk #wia, Posl&e Change WORKERS' COMPENSATION DECLARATION Miguel Torres Cruz (Name/Title) following declaration: I certify on behalf of of my contract for hereby affirm under penalty of perjury, the that during the term (Consultant/Company Nome) The artist Grant 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. Michael -Miguel Productions Date: 3/5/21 Print Name: Miguel Torres Cruz Print Title: Producer Signature: Telephone: 714-914_5877 �J 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 ADDITIONAL TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. l:I Risk MgmtlInsurance Requirements �WC Declaration 08152019 Rkk Management Analyst