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HomeMy WebLinkAboutTKO YOUTH FOUNDATIONINSURANCE ON FILE WORK MAY PROCEED UNTIL INSUR� NCEEXPIRES O l !I 1 Zazz C KOFCOUNCIL A-2021-187 FACILITY USE AGREEMENT WITH TKO YOUTH FOUNDATION FOR USE OF N THE FITNESS ROOM AT JEROME COMMUNITY CENTER aq THIS FACILITY USE AGREEMENT ("Agreement") is dated September 21, 2021 and is entered into between the CITY OF SANTA ANA, a charter city and municipal corporation ("City") and TKO Youth Foundation ("TKO"), a California non-profit corporation. City and TKO also collectively referred to herein as "the Parties." O gec-�La✓x) (Su) I RECITALS 4 A. The City is the owner of Jerome Community Center located at 726 South Center Street in the City of Santa Ana; and B. TKO is a non-profit California corporation founded in 1994 whose purpose is to serve as a gang prevention and after school youth program; and C. TKO has been training local Santa Ana youth in boxing for two decades and offers educational support including scholarships. TKO's mission is to challenge the youth in their program to achieve their academic and athletic potential; and D. TKO requires participants in its program to maintain a minimum grade point average and monitors their academic performance; and E. City acknowledges the community need for programs such as those offered by TKO that encourage Santa Ana youth to engage in sports and offer supervised activities in a safe environment after school. NOW THEREFORE, in consideration of mutual covenants herein contained, the Parties do hereby promise and agree as follows: 1. The City hereby grants to TKO the limited right to use the Fitness Room in the City's Jerome Community Center to provide boxing classes, training, to hold periodic tournaments and for equipment storage pursuant to the terms of this Agreement. Attached as Exhibit A and incorporated herein by reference is a diagram of the City's Jerome Community Center identifying the location of the Fitness Room ("Fitness Room.") 2. Term. The term of this Agreement shall begin on the date set forth above and end on September 21, 2023 unless terminated pursuant to Sections 14 or 16 of this Agreement. 3. Consideration. City acknowledges the public benefit provided by TKO to the youth of the City of Santa Ana through its program and the fact that, TKO is a non-profit corporation with 501(c)(3) status. Starting September 1, 2022, TKO will pay to City a fee for use of the Fitness Room, per month, as determined by the City's Facility Use Agreement With TKO Youth Foundation Miscellaneous Fee Schedule. All payments shall be made by the 1st day of each month in the form of a cashier's check or ACH electronic transfer made payable to "City of Santa Ana." 4. Improvements to the Fitness Room. A. City will allow TKO to make certain non -permanent improvements to Fitness Room as mutually agreed upon in writing between the Parties. These improvements include installation of a boxing ring and punching bags. B. TKO shall pay for all improvements. City will not pay any costs associated with any improvements pursuant to this Agreement. C. City shall have final approval of all design, engineering, construction, specifications and improvements. D. After improvements are completed, TKO will not make any additional improvements or alterations to the Fitness Room without the prior written consent of the City Manager or her designee. The Fitness Room shall remain the property of the City. Upon expiration or termination of the Agreement or when the Fitness Room is needed for other City uses, TKO shall return Fitness Room to its original condition, unless otherwise specified by the City. 5. Operational Rules and Regulations. TKO shall comply with all operational rules and regulations promulgated by the Executive Director of Parks, Recreation and Community Services, City Manager or City Council regarding the operation of City's Jerome Community Center, including but not limited to, hours of operation and COVID-19 protocols. 6. Hours of Use. Unless the Jerome Community Center is closed, TKO shall be allowed to use the Fitness Room Monday- Friday from 2:00 p.m. to 7:00 p.m., unless other hours and days are agreed to in writing by the City's Executive Director of Parks, Recreation and Community Services Agency. City officials and employees will at all times have access to the Fitness Room. 7. Maintenance. TKO shall at all times maintain Fitness Room in good condition and repair and in a clean and safe condition reasonably satisfactory to the City's Executive Director of Parks, Recreation and Community Services Agency. 8. Damage to Facility. TKO shall be liable for any damages to the Fitness Room caused by any act of negligence of TKO, its partners, agents, servants, contractors, Facility Use Agreement With TKO Youth Foundation 2 representatives, guests, employees, invites or customers. City may at its option, repair such damage, and TKO agrees to reimburse City for the total cost of repair. 9. Compliance with Laws and Licensing. TKO shall comply with all applicable federal, state and local laws. TKO shall at all times during the term of this Agreement have and maintain in force any and all licenses, permits or approvals required by law for the conduct of TKO's activities under this Agreement. 10. Indemnification. A. TKO shall defend, indemnify, and hold harmless the City and its officers, officials, employees, and volunteers from and against any claims, liabilities, damages, losses, costs, expenses incurred or suffered by City on account of any personal injuries or property damage resulting from the use of Fitness Room pursuant to this Agreement or any activity or negligent omission of TKO or its employees, agents, volunteers or contractors. In the event that City is named as a codefendant, TKO shall notify City of such fact and shall represent City in such legal action unless City undertakes to represent itself in such legal action. TKO further agrees to indemnify, hold harmless, and pay all costs of defense of the City, including fees and cost for special counsel to be selected by the City, regarding any action 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, or effects of this Agreement. City may make all reasonable decisions with respect to its representation in any legal proceedings. B. TKO agrees to indemnify the City from and against any contamination of the Fitness Room with hazardous materials by TKO occurring after the commencement of this Agreement. TKO further agrees to defend and hold harmless the City from and against all actions, agreements, attorney's fees, causes of action, claims, contracts, costs, covenants, damages, debts, demands, expenses, judgments, lawsuits, liabilities, liens, losses, obligations, and orders which arise during or after the term of this Agreement related to the existence of hazardous materials at the Fitness Room or in the groundwater under the Fitness Room except for: (1) the cost of any remediation of Hazardous Materials deposited in the soil by City or its employees, agents or contractors; and (2) any third party personal injury actions which allege exposure to such undiscovered Hazardous Materials as a result of use of the Fitness Room. "Hazardous Materials" as used herein shall be interpreted broadly to mean any hazardous or toxic substance, material or waste that now is or hereafter becomes regulated by any local Facility Use Agreement With TKO Youth Foundation 3 government authority, the State of California, or the United States Government. 11. Insurance. TKO shall procure and maintain for the duration of the Agreement insurance against claims for injuries to persons or damage to property which may arise from or in connection with the use allowed hereunder and the results of that use by TKO, its agents, representatives, employees and subcontractors pursuant to the scope and coverage noted below: A. Commercial General Liability (CGL): Insurance Services Office Form CG 00 01 covering CGL on an "occurrence" basis, including products and completed operations, property damage, bodily injury and personal & advertising injury with limits no less than $2,000,000 per occurrence. If a general aggregate limit applies, either the general aggregate limit shall apply separately to this project/location (ISO CG 25 03 or 25 04) or the general aggregate limit shall be twice the required occurrence limit. B. Workers' Compensation: as required by the State of California, with Statutory Limits, and Employer's Liability Insurance with limit of no less than $1,000,000 per accident for bodily injury or disease. This insurance coverage is not required if TKO has no employees C. Other Provisions Applicable to Insurance Requirements: i. If the TKO maintains broader coverage and/or higher limits than the minimums shown above, the City requires and shall be entitled to the broader coverage and/or the higher limits maintained by the contractor. Any available insurance proceeds in excess of the specified minimum limits of insurance and coverage shall be available to the City. ii. The insurance policies are to contain, or be endorsed to contain, the following provisions: iii. Additional Insured Status- the City, its officers, officials, employees, and volunteers are to be covered as additional insureds on the CGL policy with respect to liability arising out of work or operations performed by or on behalf of TKO including materials, parts, or equipment furnished in connection with such work or operations. General liability coverage can be provided in the form of an endorsement to TKO's insurance (at least as broad as ISO Form CG 20 10 11 85 or if not available, through the addition of both CG 20 10, CG 20 26, CG 20 33, or CG 20 38; and CG 20 37 if a later edition is used). iv. Primary Coverage- For any claims related to this contract, TKO's insurance coverage shall be primary coverage at least as broad as Facility Use Agreement With TKO Youth Foundation 4 ISO CG 20 01 04 13 as respects the City, its officers, officials, employees, and volunteers. Any insurance or self-insurance maintained by the City, its officers, officials, employees, or volunteers shall be excess of the TKO's insurance and shall not contribute with it. v. Notice of Cancellation- Each insurance policy required above shall provide that coverage shall not be canceled, except with notice to the City. vi. Waiver of Subrogation- TKO hereby grants to City a waiver of any right to subrogation, which any insurer of TKO may acquire against the City by virtue of the payment of any loss under such insurance. TKO agrees to obtain any endorsement that may be necessary to affect this waiver of subrogation, but this provision applies regardless of whether or not the City has received a waiver of subrogation endorsement from the insurer. vii. Self -Insured Retentions- Self -insured retentions must be declared to and approved by the City. The City may require TKO to purchase coverage with a lower retention or provide proof of ability to pay losses and related investigations, claim administration, and defense expenses within the retention. The policy language shall provide, or be endorsed to provide, that the self -insured retention may be satisfied by either the named insured or City. viii. Acceptability of Insurers- Insurance is to be placed with insurers authorized to conduct business in the state with a current A.M. Best's rating of no less than A:VII, unless otherwise acceptable to the City. ix. Claims Made Policies- If any of the required policies provide claims -made coverage: 1. The Retroactive Date must be shown, and must be before the date of the contract or the beginning of contract work. 2. Insurance must be maintained and evidence of insurance must be provided for at least five (5) years after completion of the contract of work. 3. If coverage is canceled or non -renewed, and not replaced with another claims -made policy form with a Retroactive Date prior to the contract effective date, TKO must purchase "extended reporting" coverage for a minimum of five (5) years after completion of work. x. Verification of Coverage- TKO shall furnish the City with original Certificates of hisurance including all required amendatory endorsements (or copies of the applicable policy language effecting coverage required by this clause) and a copy of the Declarations and Endorsement Page of the CGL policy listing all policy endorsements Facility Use Agreement With TKO Youth Foundation 5 to City before work begins. However, failure to obtain the required documents prior to the work beginning shall not waive TKO's obligation to provide them. xi. The City reserves the right to require complete, certified copies of all required insurance policies, including endorsements required by these specifications, at any time. xii. Special Risks or Circumstances- The City reserves the right to modify these requirements, including limits, based on the nature of the risk, prior experience, insurer, coverage, or other special circumstances. 12. Assi ng ment. TKO shall not assign all or any portion of this Agreement, nor shall TKO, without the written consent of the City Council, enter into any agreement allowing the use by another person of the Fitness Room granted by this Agreement. 13. Relationship of the Parties. Nothing in this Agreement shall effect or create a partnership between the Parties. Any persons retained by TKO shall at all times be its employees or independent contractors and not employees or independent contractors of the City. TKO shall have no power to incur debt, obligation or liability on behalf of the City. The City shall not have control over the conduct of TKO, except as set forth in this Agreement. TKO shall not, at any time, or in any manner, represent that it or any of its officers, agents, employees, contractors or volunteers are in any manner employees or contractors of the City. 14. Termination for Cause. Should TKO be dissolved or if a petition in bankruptcy or insolvency be filed by or against TKO, whether voluntarily or involuntarily, or if use of Fitness Room is abandoned for a period of thirty (30) days; or if the uses conducted so as to constitute a public nuisance, or if any of the provisions of this Agreement are breached and the breach if not corrected within ten (10) days after written notice from the City to TKO, then the City may immediately terminate this Agreement by written notice to TKO and recover and resume possession of Fitness Room. 15. Remedies for Termination for Cause. In the event of TKO's breach, default, abandonment or insolvency, City may: A. Terminate the Agreement and recover from TKO any amount necessary to compensate City for all detriment proximately caused by TKO's failure to perform its obligations under this Agreement. B. Should TKO default in the performance of any of the terms, conditions, or obligations contained in this Agreement, City may, in addition to the remedies available pursuant to the law and this Agreement, re-enter and Facility Use Agreement With TKO Youth Foundation 6 regain possession of the Fitness Room in the manner provided by the laws of the State of California. 16. Termination without cause. The Parties each may terminate this Agreement with thirty (30) days' notice in writing to the other Party. t7. Fingerprinting, Background Checks and Identification Badges. TKO shall provide proof to City that all TKO officials, employees and any volunteers are fingerprinted and background checked prior to conducting any work at Jerome Community Center or in Fitness Room. TKO employees and volunteers shall prominently display badges or identification cards, in a form mutually agreed upon by the Parties, at all times while at Jerome Community Center or in Fitness Room. TKO badges or identification cards shall state that official, employee or volunteer works for or is affiliated with TKO. Badges or identification cards shall not display City name or logo. 18. Taxes. The Parties agree that if the City or Jerome Community Center are assessed any taxes or similar fees or charges due to the activities of TKO pursuant to this Agreement or TKO's permitted users, then TKO shall bear the entire cost of said taxes, assessment, fees or charges. 19. Liens. TKO will not permit any mechanics' liens or materialmen's' liens or any other type of lien to stand against the Jerome Community Center by any use, occupancy or improvement by TKO or any agent, employee, or contractor of TKO. 20. Nondiscrimination: TKO shall not discriminate in the course of its activities in or about the Fitness Room on the basis of race, color, disability, religion, sex, marital status, sexual orientation, gender identity, age, national origin, ancestry, military or veteran's status, disability, or any other basis prohibited by law. TKO affirms that it is an equal opportunity employer and shall comply with all applicable federal, state and local laws and regulations. 21. Jurisdiction and 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. 22. Surrender of Premises. Upon termination or expiration of this Agreement, TKO shall immediately surrender and deliver the premises to the City in good condition and repair, together with all improvements and alternations made by TKO, and any Facility Use Agreement With TKO Youth Foundation and all furniture, furnishings, equipment, and other personal property then located on the premises. 23. Attorney's fees and Costs. The prevailing Party shall pay all costs and reasonable attorney's fees that the other Party incurs in enforcing any of the rights or remedies provided for pursuant to this Agreement. 24. Exclusivity and Amendment. This Agreement represents the complete and exclusive statement between the City and TKO regarding the subject matter herein, and supersedes any and all other agreements, oral or written, between the Parties regarding the use of the Fitness Room. In the event of 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 an authorized representative of TKO. The Parties acknowledge that no representatives, inducements, promises or agreements, orally or otherwise, have been made by any party, or anyone acting on behalf of any party, which are not embodied herein. 25. Assig_nment. TKO 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. TKO shall not allow any other person or entity to use the Fitness Room without the prior written consent of City. 26. Force Mai care. Should the performance of an act required by this Agreement to be performed by either the City or TKO be prevented or delayed by reason of an act of God, strike, lockout, labor troubles, inability to secure materials, restrictive government laws or regulations, or any other cause except financial inability not the fault of the Party required to perform the act, the time for performance of the act will be extended for a period of time equivalent to the period of the delay, and performance of the act during the period of delay will be excused, provided, however, that nothing contained in this section shall excuse the prompt payment of compensation by TKO as required by this Agreement or the performance of any act rendered difficult solely because of the financial condition of the party, City or TKO, required to perform the act. 27. Construction. The Parties acknowledge that each Party and its counsel have reviewed and revised this Agreement and that the normal rule of construction to the effect that any ambiguities are resolved against the drafting party shall not be employed in the interpretation of this Agreement. 28. Severability. If any one or more of the provisions contained in this Agreement shall for any reason be held invalid, illegal or unenforceable in any respect such Facility Use Agreement With TKO Youth Foundation 8 invalidity, illegality or unenforceability shall not affect any other provision hereof, and this Agreement shall be construed as if such invalid, illegal, or unenforceable term or provision had never been contained herein. 29. Conflict of Interest. TKO covenants that it presently has no interests and shall have no interests direct or indirect, which would conflict in any manner with the use authorized pursuant to this Agreement. 30. Non -Recording. Unless required by law, neither Party shall record this Agreement. 31. No Waiver. Any waiver, consent or approval by either Party of any breach, default or event of default of any provision, condition or covenant of this Agreement must be in writing and shall be effective only to the extent set forth in writing. No waiver of any breach, default or event of default shall be deemed a waiver of any later breach, default or event of default of the same or any other provision of this Agreement. Any failure or delay on the part of either Party in exercising any power, right or privilege under this Agreement shall not operate as a waiver thereof, nor shall any single or partial exercise of any such power, right or privilege preclude any further exercise thereof. 32. Notice. Any notice, tender, demand, delivery, or other communication pursuant to this Agreement shall be in writing and directed to the addresses below or such addresses as either party may later specify in writing. Notice is deemed effective on the date it is given if hand -delivered or received by facsimile that day. Notice given by U.S. mail shall be deemed to have been given three (3) business days after it is deposited in the U.S. mail, postage prepaid and addressed as follows: 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 With copies to: Executive Director of Parks, Recreation and Community Services City of Santa Ana 20 Civic Center Plaza, P.O. Box 1988 Santa Ana, California 92702 To TKO: Mary Lara, Chief Financial Officer TKO Youth Foundation 1030 West Macarthur Boulevard, Suite 85 Santa Ana, California 92707 Facility Use Agreement With TKO Youth Foundation 9 33. Authority: 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. 34. Counterparts and Electronic Signature. The Parties agree that this Agreement may be signed in counter parts and compiled to make one original Agreement. The Parties further agree that this Agreement may be signed electronically by any means that reasonably ensures authenticity. IN WITNESS WHEREOF, the Parties hereto have affixed their signatures this/ day ot5qp1&,L , 2021. CITY ;;� k L ; r Kristine Ridge City Manager APPROVED AS TO FORM: Sonia R. Carvalho City Attorney By:C1cyu A. R Laura A. Rossini Chief Assistant City Attorney RECOMMENDED FOR APPROVAL: UsA!ACC udloff Executive Director of Parks, Recreation, And Community Services Agency ATTEST: Gomez of Council TKO YOUTH FOUNDATION Facility Use Agreement With TKO Youth Foundation 10 Exhibit A JEROME CENTER FLOOR PLAN 1 ELECTRICAL ROOM TEEN SPACE COMPUTER TEEN SPACE SATELLITE LAB KITCHEN, n r-. e ! 7 j*@ f a i Room Entryway (318o Square Feet) Storage Room (iqg Square Feet) w d 4:u i � W W O X IlIC: ►To- ,1 Speed Bag Mounts i IA Boxing Ring & Free Weights (yoo Square Feet & igz Square Feet) i1 Heavy Bag/Speed Bag/Speed Ball Area (636 Square Feet) Heavy Bags li I� is dw Digitally signed by Francine R. Francine R. Villareal Villareal Date: 2022.01.2416:35.57 USABOXI-01 08'00' DJONES ACORO°° CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 1 /13/2022 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 CONTACT NAME: PHONE FAX (A/C, No, Ext): (801) 937-6700 (A/C, No):(801) 937-6710 The Buckner Company 6660 S Millrock, Suite #300 Salt Lake City, UT 84121 E-MAILinfo@buckner.com INSURERS AFFORDING COVERAGE NAIC # INSURERA:State National Insurance Company, Inc. 12831 INSURED INSURER B INSURER C USA Boxing, Inc. INSURER D 1 Olympic Plaza Colorado Springs, CO 80909 INSURER E INSURER F 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 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 EACH OCCURRENCE $ 2,000,000 CLAIMS -MADE � OCCUR OVE0000013-00 1/1/2022 1/1/2023 ETORENTED PREMISES PREMISES Ea occurrence 1�QQQ�QQQ $ MED EXP (Any oneperson) $ Excluded PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 5,000,000 POLICY JECT FX LOC PRODUCTS - COMP/OP AGG $ 1,t)t)t),t)t)t) PARTICIPANT LEG $ 1,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY Perperson) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ PROPERTY DAMAGE ccident Per accident) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN PER OTH- STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) NIA E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Coverage applies as respects the operations of USA Boxing and is contingent upon adherence with all rules and guidelines set forth by USA Boxing. Coverage applies to TKO Boxing Club and TKO Youth Foundation. The City of Santa Ana, its officers, officials, employees, and volunteers are Additional Insureds with respect to General Liability per endorsement CG-GL-CW-0133 (12/20). Waiver of Subrogation applies with respect to General Liability per written contract per endorsement #CG-GL-CW-0001 (12/20). Coverage is Primary and Non -Contributory with respect to General Liability per written contract per endorsement (pending issuance). SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Santa Ana AUTHORIZED REPRESENTATIVE Risk Management Division 20 Civic Center Plaza V �CA w cF ,`REVIEWED& RAMwagmentDiVisian APPROVED BY.- Santa Ana 92702 k_/ ; ' ACORD 25 (2016/03) ©1988-2015 ACORD C , The ACORD name and logo are registered marks of ACORD �` Risk Management Analyst ENDORSEMENT NO. ATTACHED TO AND ENDORSEMENT EFFECTIVE DATE FORMING A PART OF (12:01 A.M. STANDARD TIME) NAMED INSURED AGENT NO. POLICY NUMBER n/a OVR-0000013 1/1/22 USA Boxing, Inc. dba USA Boxing THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSUREDS OWNERS AND/OR LESSORS OF PREMISES, SPONSORS OR CO -PROMOTERS This insurance modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART A. SECTION II —WHO IS AN INSURED is amended to include as an additional insured any per- son(s) or organization(s) of the types indicated by an "x" in any boxes shown below, but only with respect to liability for "bodily injury," "property damage" or "personal and advertising injury" caused, in whole, by your acts or omissions or the acts or omissions of those acting on your behalf: 1. In the performance of your ongoing operations; or 2. In connection with your premises owned by or rented to you. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is 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. With respect to an additional insured owner and/or lessor of premises, this insurance does not apply to: a. An "occurrence" or offense which takes place while you are not a tenant in possession of the subject premises. b. "Bodily injury" or "property damage" arising out of: (1) Structural alterations, new construction or demolition operations performed by or on behalf of the owner and/or lessor of premises; (2) Any design defect or structural maintenance of the premises; or (3) Any premises defect. B. 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 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. cF Risk Management Di skm J1°x REVIEWED & APPROVED BY.- CG-GL-CW-0133 (12/20) Includes material copyrighted by ISO Properties, Inc., with its per �� . ` V° --� W. janagement Analyst This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Schedule of Additional Insureds: ❑x Owners and/or Lessors of the premises leased, rented or loaned to you ❑x Sponsors ® Co -Promoters ❑x Any individual person(s) or organization(s) listed below: COACHES, OFFICIALS AND VOLUNTEERS ARE ADDITIONAL INSUREDS BUT ONLY WHILE ACTING WITHIN THE SCOPE OF THEIR DUTIES FOR THE INSURED (OTHERS BY REQUEST AND ENDORSEMENT, SUBJECT TO UNDERWRITING APPROVAL). AUTHORIZED REPRESENTATIVE DATE cF RAMmWmentDMsian J1°x REVIEWED & APPROVED BY.- CG-GL-CW-0133 (12/20) Includes material copyrighted by ISO Properties, Inc., with its per �� . ` Vk --� Risk Pjanagement Analyst POLICY NUMBER: OVE0000013-00 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COMMERCIAL GENERAL LIABILITY BROADENED COVERAGE ENDORSEMENT This endorsement modifies coverage provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM A. Subparagraph 2.g.(2) of COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY (SECTION I — COVERAGES) is deleted and replaced with the following: (2) A watercraft you do not own that is: (a) Less than 51 feet long; and (b) Not being used to carry persons or property for a charge; B. Subparagraphs 2.b. and 2.c. of COVERAGE B PERSONAL AND ADVERTISING INJURY LIABILITY (SECTION I — COVERAGES) are deleted and replaced with the following: b. "Personal and Advertising Injury" arising out of publication of material, including, but not limited to, oral, written, televised, videotaped or electronically transmitted publication of material, if done by or at the direction of the insured with knowledge of its falsity; c. "Personal and Advertising Injury" arising out of publication of material, including, but not limited to, oral, written, televised, videotaped or electronically transmitted publication of material, whose first publication took place before the beginning of the policy period; C. Subparagraphs 1.b. and 1.d. of SUPPLEMENTARY PAYMENTS — COVERAGES A AND B (SECTION I —COVERAGES) are deleted and replaced with the following: b. Up to $1,000 for the cost of bail bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverage applies. We do not have to furnish these bonds. d. All reasonable expenses incurred by the insured at our request to assist us in the investigation or defense of the claim or "suit", including actual loss of earnings up to $500 a day because of time off from work. D. Subparagraph 3.a. of SECTION II -WHO IS AN INSURED is deleted and replaced with the following: a. Coverage under this provision is afforded only until the 120th day after you acquire or form the organization or the end of the policy period, whichever is earlier; E. Subparagraphs 2.e. and 2.f are added to SECTION IV— COMMERCIAL GENERAL LIABILITY CONDITIONS: e. Knowledge of the 'occurrence", offense, claim or "suit" by the agent, servant, or "employee" of an insured shall not in itself constitute your knowledge unless one of your officers, manager or partners has received notice of the 'occurrence", offense, claim or "suit". ew cF RAMwagementDMsian Jy/ \'x REVIEWED & APPROVED BY.- CG-GL-CW-0001 (12/20) Includes material copyrighted by ISO Properties, Inc., with its per Is --� Risk janagement Analyst f. Failure by the agent, servant or "employee" of an insured (other than an officer, manager or partner) to notify us of an "occurrence" shall not constitute a failure to comply with subparagraphs 2.a. and 2.b. of this Section. F. Paragraphs 10. is added to SECTION IV— COMMERCIAL GENERAL LIABILITY CONDITIONS as follows: 10. Waiver of Right of Recovery We waive all rights of recovery when you have agreed to waive your rights of recovery when required by a written contract. However, this provision only applies if the written contract was executed prior to the date of the "occurrence". G. Paragraphs 3. and 14. of SECTION V — DEFINITIONS are deleted in their entirety and replaced with the following: 3. "Bodily Injury" mean bodily injury, sickness or disease sustained by a person. This includes mental anguish, mental injury, shock, fright, humiliation, emotional distress or death resulting from bodily injury, sickness or disease. 14. "Personal and advertising injury" means injury, including consequential "bodily injury", arising out of one or more of the following offenses: a. False arrest, detention or imprisonment; b. Malicious prosecution or abuse of process; c. The wrongful eviction from, wrongful entry into, or invasion of the right of private occupancy of a room, dwelling or premises that a person occupies, committed by on or on behalf of its owner, landlord or lessor; d. Any publication of material including, but not limited to oral, written, televised, videotaped or electronically transmitted publication of material that slanders or libels a person or organization or disparages a person's or organization's goods, products or services;; e. The use of another's advertising idea in your "advertisement"; or f. Infringing upon another's copyright, trade dress or slogan in your "advertisement". H. The word fire is replaced with the phrase fire or explosion where it appears in: a. Subparagraph 2.j. of COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY (SECTION I — COVERAGES); Paragraph 2. of COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY (SECTION I —COVERAGES); c. Paragraph 6. of SECTION III - LIMITS OF INSURANCE; d. Subparagraph 4.b.(1) of SECTION IV -COMMERCIAL GENERAL LIABILITY CONDITIONS I. I. The following is added to SECTION III — LIMITS OF INSURANCE: The Limit of Insurance applicable to Damage to Premises Rented to You is $300,000 unless a higher limit is specified on the Declarations. All other terms, conditions and exclusions remain unchanged. ew cF RAMwagementDMsian Jy/ \'x REVIEWED & APPROVED BY.- CG-GL-CW-0001 (12/20) Includes material copyrighted by ISO Properties, Inc., with its perrr Is --� Risk janagement Analyst POLICY NUMBER: OVE0000013-00 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - WHERE REQUIRED UNDER WRITTEN CONTRACT OR WRITTEN AGREEMENT (PRIMARY AND NON-CONTRIBUTORY) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS / COMPLETED OPERATIONS COVERAGE PART SECTION II — WHO IS AN INSURED is amended to include any person or organization to whom you become obligated to include as an additional insured under this policy, as a result of any written contract or written agreement you enter into which requires you to furnish insurance to that person or organization of the type provided by this policy, but only with respect to liability arising out of your operations or premises owned by or rented to you. However, the insurance provided will not exceed the lesser of: a. The coverage and/or limits of this policy; or b. The coverage and/or limits required by said contract or agreement. Coverage afforded to these additional insured parties will be primary to, and non-contributory with, any other insurance available to that person or organization. cF RAMwagementDMsiun Jy/\'x REVIEWED & APPROVED BY.- V"° CG-GL-CW-0058 (12/20) Includes material copyrighted by ISO Properties, Inc., with its per 1---1WAIR� Wsk Pjanagement Analpt ('11T OF 5ANrA ANA R�M MANAGEMENTm d��w" 4 HLOAAN RESOUACES WinaqVic), R[Sk Oww'w, h POSItIve Change )'V Affidiavit of Exemption for'Worker�'Compensatiojn Insurance John, M. Raya, FounderlPiresiderd hereby affirm, under penalty of perjury, the following declaratlon: I certify on behalf of T'KO Youth Foundation ("TKO") that during the 'terra (r-- orn pan y No ff m?) of my contract for after school youth program services Mth the City of Santa Ana, dype of.,erwc, pwvido� I wRI not employ any, person hn any manner so as to become subject to the workers' cornpensatoon Iaws of CaVornia, and agree that if I should become subject to, the workers'compensation provisions of Section 3700 of the Labor Code, I shall forthwth comply, with the proviis�ons and provide proof of workers' compensatbn coverage rnmediately., Date", . .. . . .. ....... Print Name: ........ . . ) ,, �4i . ......... . . . . 'r ... . . . .......... . .... .. .. .. Print Tulle. Signature 16%�, Telephone:,—,,, . .... . . . .. . ........... WARNING„ FAtiLIJRE TO SECURE WORKERS' COMPENSA70N COVERAGE IS UNLAWFUL, AND SHALL. SUBJECT' AN EMPLOYER TO CRIME NAL PENALTIES AND CIVL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,004 IN ADMTION TO THE COST OF COMPENSAWN, DAMAGES AS PROVIDED FOR VN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES, L\Risk Mgnij,a�nsurance RequirermLnts'n Affidavat of exemption for Workers'Compensation IUn-wrancie 2021 Rick Management Division REVIEWED & APPROVED BY: Comm I Risk Monagewnt Analyst NOTICE OF COMPLIANCE CITY STAFF: PRINT THIS PAGE AND INCLUDE WITH AGREEMENT TO THE CLERK OF THE COUNCIL Contractor USA Boxing Inc Sponsor Club TKO Boxing Club Name: Project A-2021-187-01 Number: First Amendment To Facility Use Agreement With TKO Youth Project Foundation For Use Of The Fitness Room At Jerome Name: Community Center 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: POLICY EXPIRATION TYPE OF INSURANCE COI DATE FILE NAME NUMBER DATE GENERAL LIABILITY OVE000001301 01/01/2024 12/28/2022 Certificate.pdf WORKERS COMPENSATION AND WAIVER 10/26/2023 10/27/2022 Scan_0003.pdf EMPLOYERS' LIABILITY Thank you, City of Santa Ana Risk Management Division in partnership with CTrax Plus Services Team 1/5/2023 11:12 AM