Loading...
HomeMy WebLinkAboutDREAM SHAPERS (2){ City of Santa Ana coTC O#fice Use QnF 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TERMINATION FORM Please complete this form in its entirety when the attached agreement and all amendments (if any) are no longer in effect. S - Note: If your agreement is grant related, please ensure that all grant retention requirements JQL 12 have been satisfied prior to signing the termination form, 4 P• Is the agreement(s) a permanent record? Yes No Return form to the Clerk of the Council office (M--30). Call 647-1520 if you have any questions. The agreement with r-Q lop No. N-2022-009 was completed on '� ��/� and final payment has been made. (List all amendments. Use space below if needed.) .- Department. Phone/Ext.: Signature: Date. _ " +�- i;',agreementsforrnOorm . agreement termination form_goldenrod.doc INSURANCE N01 ON FILE:. N-2022-009 WORK MAY NOT PROCEED CLERK OF COUNCIL DATE: Q� I�ee ) � 0 December 2021 / JAN 14 2022 Dream Shapers (Speaker/Performer) P.O Box 3831 Orange, CA 92865 Re: Dream Sbapers Speaker/Performer Engagement Agreement This letter represents your agreement with the City of Santa Ana ("City") as entered into on the above date for the engagement described below: 1. Event Description: Variety -type performance to entertain patrons with performances selected and agreed upon by the parties per the list provided in Exhibit A or provided on Speaker/Performer's website (wwwAreamshapers.orWall-artiste as it may be updated from time to time. 2. Scheduling of Performances: Speaker/Performer to provide City with a proposal/invoice for the event including type of performance, date and rate(s) forty-five (45) days prior to a proposed event date. The forty-five (45) day time period is required to allow City to advertise the event. City will provide a written confirmation from the Executive Director of Library Services or their representative of the event, location, date, and time. 3. Date(s): January 1, 2022 through December 31, 2022. 4. Event Time(s): Each performance will vary in length as agreed to by both parties and event start time will be scheduled per Section 2. 5. Location: Various City Locations as provided in Exhibit B and agreed upon by the Parties per Section 2 ("Property"). 6. Compensation: Total sum to be expended under this Agreement shall not exceed nine thousand five hundred dollars and zero cents ($9,500). A check for the scheduled performance will be issued within 30 calendars days of event. Speaker/Performer must provide IRS form W-9 before payment. 7. Equipment provided by City: City will be responsible for setting up the space for the patrons attending and advertising the program. 8. Equipment provided by Speaker/Performer: Speaker/Performer will be responsible for providing all equipment, materials, supplies and personnel necessary to perform the act. 9. City Contact Person (for coordinating purposes only): Maria Miranda Castro 714-647-5269. 10. Independent Contractor: Speaker/Performer shall, during the entire term of this Agreement, be construed to be an independent contractor and not an employee of the City. This Agreement is not intended nor shall it be construed to create an employer -employee relationship, a joint venture relationship, or to allow the City to exercise discretion or control over the professional manner in which Speaker/Performer performs the services that are the subject matter of this Agreement; however, the services to be provided by Speaker/Performer shall be provided in a manner consistent with all applicable standards and regulations. Speaker/Performer 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. 11. Indemnification: Speaker/Performer, his or her agents, or employees (if applicable) agrees to and shall indemnify, defend, and hold harmless the City, its officers, agents, employees, consultants, special counsel, and representatives Letter Agreement —Dream Shapers Page 2 from and against all loss, expenses, or liability (including costs and attorney's fees) arising fiom the negligence or willful misconduct of Speaker/Performer, his or her agents, or employees. 12. Release: Speaker/Performer accepts the Property and any City -provided equipment used in connection with the performance in their "as -is" condition, with all faults. Speaker/Performer fully releases, waives and discharges forever any and all claims, demands, rights, and causes of action of any kind or nature against, and covenants not to sue, City, its elected officials, officers, employees, agents and volunteers, and all persons acting on behalf of, by, through or under each of them, under any present or future laws, statutes, or regulations for any claim or event relating to the condition of the Property or City provided equipment or Speaker/Performer's use thereof. 13. Commercial General Liability Insurance. Speaker/Performer shall maintain commercial general liability insurance naming the City, its officers, employees, agents, volunteers and representatives as additional insured(s) and shall include, but not be limited to protebtion against claims arising from bodily and personal injury, including death resulting therefrom and damage to property, resulting from any act or occurrence arising out of Speaker/Performer's operations in the performance of this Agreement, including, without limitation, acts involving vehicles. The amounts of insurance shall be not less than the following: single limit coverage applying to bodily and personal injury, including death resulting therefrom, and property damage, in the total amount of $1,000,000 per occurrence. 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 original require occurrence limit. Such insurance shall: (1) name the City, its officers, employees, agents, volunteers, and representatives as additional insureds; (2) be primary and not contributory with respect to insurance or self-insurance programs maintained by the City; and (3) contain standard separation of insured provisions. 14. Automobile Liability. Speaker/Performer shall maintain automobile liability insurance with a limit no less than $1,000,000 per accident for bodily injury and property damage. 15, Worker's Compensation Insurance, In accordance with the California Labor Code, Speaker/Performer, if Speaker/Performer has any employees, is required to be insured against liability for worker's compensation with a limit of no less than $1,000,000 per accident for bodily injury and property damage or to undertake self-insurance, 16. The City shall have the right and royalty -free license to simulcast or produce and show a tape -delayed broadcast of Speaker/Performer's presentation to the City community or general public, through webcast or any other means. This license shall be non-exclusive and the copyright shall remain with the Speaker/Performer. Copies of Speaker/Performer's presentation may be maintained by the City, and Speaker/Performer consents to use of such recordings. , 17. Speaker/Performer is solely responsible for payment of royalty fees, performance fees, or similar fees that may be required by unions or similar organizations. Speaker/Performer shall indemnify the City against any liability or damages, including attorney's fees, that may arise as a result of violation by Speaker/Performer of copyright laws. 18. Speaker/Performer 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. 19. This Agreement shall in all respects shall be interpreted, enforced, and governed exclusively by and under the laws of the state of California. Both parties agree that Orange County, California, shall be the venue for any action or proceeding that may be brought or arise out of, in connection with or by reason of this Agreement. 20. This Agreement represents the complete and exclusive statement between the City and Speaker/Performer regarding the subject matter herein and supersedes any and all other agreements, oral or written, between the parties. This Agreement may not be modified except by written instrument signed by the City and by an authorized representative of Speaker/Performer. Letter Agreement —Dream Shapers Page 3 CITY OF SANTA ANA KRISTINE RIDGE City Manager ATTEST: _ DAISY GOMEZ Clerk of the Council FOR APPROVAL Brian Sternberg Library Services Library Services 11IN I , ♦Y �✓ APPROVED AS TO FORM: By: B on Salvatierra Deputy City Attorney Exhibit A — Comprehensive List of Performers Arty Loon Best Bubble Shows Brettso the Great Chazz Ross Christopher Yates Craig Newton David Skale Emmy Lamm Full Spectrum Georgia Frawley Ina Buckner — Barnette Joe Gandelman Joseph Peck Justin Rivera Ken Frawley / Cowboy Ken Luce Puppet Company Marc Griffiths Michael U. McCarty Michael Mezmer Mr. Marcus Music Party Puppets Rebecca Martin Science on the go Teresa Smith Wacky Wendee Zany Zoe Exhibit B SCOPE OF SERVICES VENDOR INFORMATION: The Los Angeles Dream Shapers P.O. Box 3831 Orange, CA 92865 Telephone: (714) 771-1981 Email: info@dreamshapers.org http://dreamshapers. ore( EVENT: Variety Type Performances LOCATIONS: Performances will be presented at the following locations: Main Library, 26 Civic Center Plaza, Santa Ana CA 92701 and the Newhope Library Learning Center, 122 N. Newhope Street, Santa Ana CA 92703. TERM: January 1, 2022 through December 31, 2022 COMPENSATION: Not to exceed $9,500 DESCRIPTION: This vendor may provide entertainment performances from but not limited to the attached Exhibit A for the period of January 1, 2022 through December 31, 2022. The total amount for this agreement shall not exceed $9,500. The City will be responsible for setting up the space for the patrons attending, and advertising the program. Vendor will be responsible for providing all equipment, materials, supplies and personnel necessary to perform the act. City staff will be present at all times during the performance. Digitally signed by Francine R. Francine R. Villareal Villareal A� " CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 02/04/2022 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 DiAnna Martin NAME: All -Cal Insurance Agency ACNE. Ext : (916) 784-9070 a/c, No): (916) 784-0158 505 Vernon Street E-MAIL dianna@all-calinsurance.com ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # Roseville CA 95678 INSURERA: Nonprofits' Insurance Alliance of California 011845 INSURED INSURER B The Los Angeles Dream Shapers INSURER C : P.O. Box 3831 INSURER D : INSURER E : Orange CA 92865 INSURER F : COVERAGES CERTIFICATE NUMBER: CL216710291 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 INSURANCEAUULbUBK INSD WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE OCCUR DAMAGE TO RENTED PREM SES Ea 0.urrrence $ 500,000 X MED EXP (Any one person) $ 20,000 Liquor Liability Coverage $ 1,000,000 / 1,000,000 PERSONAL &ADV INJURY $ 1,000,000 A Y Y 2021-08609NPO 06/02/2021 06/02/2022 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 ❑ PRO X JECT LOC PRODUCTS-COMP/OPAGG 2,000,000 $POLICY $ X1 OTHER: No Deductible AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ ANYAUTO A OWNED SCHEDULED AUTOS ONLY AUTOS Y 2021-08609NPO 06/02/2021 06/02/2022 BODI LY I NJ U RY (Pe r accide nt) $ X PROPERTY DAMAGE Per accident $ HIRED �/ NON -OWNED AUTOS ONLY X AUTOS ONLY Comp & Coll Deductible $ 500 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LAB CLAIMS -MADE DED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N PER OTH- STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE ElN OFFICER/MEMBER EXCLUDED? /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, may be attached if more space is required) The City of Santa Ana, its officers, employees, agents and representatives are additional insured with respect to General and Auto Liability per the attached endorsement as required by written contract. Insurance is Primary and Non -Contributory, 30 Days Notice of Cancellation with 10 Days Notice for Non -Payment of premium in accordance with policy provisions. Forms CG 20 26, NIAC-E61, NIAC-E26 and NIAC-Al apply. CERTIFICATE HOLDER CANCELLATION City of Santa Ana Risk Management Division 20 Civic Center Plaza 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 @ 1988-2015 ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD cF RA Management Division REVIEWED & APPROVED BY.- -� Risk Management Analyst NONPROFITS INSURANCE ALLIANCE OF CALIFORNIA A Head for Insurance. A Heart for Nonprofits. POLICY NUMBER: 2021-08609 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED PRIMARY AND NON-CONTRIBUTORY ENDORSEMENT FOR PUBLIC ENTITIES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: City of Santa Ana, its officers, employees, agents and representatives A. Section II — WHO IS AN INSURED is amended to include: 4. Any public entity as an additional insured, and the officers, officials, employees, agents and/or volunteers of that public entity, as applicable, who may be named in the Schedule above, when you have agreed in a written contract or written agreement presently in effect or becoming effective during the term of this policy, that such public entity and/or its officers, officials, employees, agents and/or volunteers be added as an additional insured(s) on your policy, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: a. Your negligent acts or omissions; or b. The negligent acts or omissions of those acting on your behalf; in the performance of your ongoing operations. No such public entity or individual is an additional insured for liability arising out of the sole negligence by that public entity or its designated individuals. The additional insured status will not be afforded with respect to liability arising out of or related to your activities as a real estate manager for that person or organization. B. Section III — LIMITS OF INSURANCE is amended to include: 8. The limits of insurance applicable to the public entity and applicable individuals identified as an additional insured(s) pursuant to Provision A.4. above, are those specified in the written contract between you and that public entity, or the limits available under this policy, whichever are less. These limits are part of and not in addition to the limits of insurance under this policy. C. With respect to the insurance provided to the additional insured(s), Condition 4. Other Insurance of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS is replaced by the following: 4. Other Insurance a. Primary Insurance This insurance is primary if you have agreed in a written contract or written agreement: (1) That this insurance be primary. If other insurance is also primary, we will share with all that other insurance as described in c. below; or NIAC-E61 02 19 cF RAManagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst NONPROFITS INSURANCE ALLIANCE OF CALIFORNIA A Head for Insurance. A Heart for Nonprofits. POLICY NUMBER: 2021-08609 (2) The coverage afforded by this insurance is primary and non-contributory with the additional insured(s)' own insurance. Paragraphs (1) and (2) do not apply to other insurance to which the additional insured(s) has been added as an additional insured or to other insurance described in paragraph b. below. b. Excess Insurance This insurance is excess over: 1. Any of the other insurance, whether primary, excess, contingent or on any other basis: (a) That is Fire, Extended Coverage, Builder's Risk, Installation Risk or similar coverage for "your work"; (b) That is fire, lightning, or explosion insurance for premises rented to you or temporarily occupied by you with permission of the owner; (c) That is insurance purchased by you to cover your liability as a tenant for "property damage" to premises temporarily occupied by you with permission of the owner; or (d) If the loss arises out of the maintenance or use of aircraft, "autos" or watercraft to the extent not subject to Exclusion g. of SECTION I — COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE. (e) Any other insurance available to an additional insured(s) under this Endorsement covering liability for damages which are subject to this endorsement and for which the additional insured(s) has been added as an additional insured by that other insurance. (1) When this insurance is excess, we will have no duty under Coverages A or B to defend the additional insured(s) against any "suit" if any other insurer has a duty to defend the additional insured(s) against that "suit". If no other insurer defends, we will undertake to do so, but we will be entitled to the additional insured(s)' rights against all those other insurers. (2) When this insurance is excess over other insurance, we will pay only our share of the amount of the loss, if any, that exceeds the sum of: (a) The total amount that all such other insurance would pay for the loss in the absence of this insurance; and (b) The total of all deductible and self -insured amounts under all that other insurance. (3) We will share the remaining loss, if any, with any other insurance that is not described in this Excess Insurance provision and was not bought specifically to apply in excess of the Limits of Insurance shown in the Declarations of this Coverage Part. c. Methods of Sharing If all of the other insurance available to the additional insured(s) permits contribution by equal shares, we will follow this method also. Under this approach each insurer contributes equal amounts until it has paid its applicable limit of insurance or none of the loss remains, whichever comes first. If any other the other insurance available to the additional insured(s) does not permit contribution by equal shares, we will contribute by limits. Under this method, each insurer's share is based on the ratio of its applicable limit of insurance to the total applicable limits of insurance of all insurers. NIAC-E61 02 19 cF RAManagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst POLICY NUMBER: 2021-08609NPO COMMERCIAL GENERAL LIABILITY CG 20 2612 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Any person or organization that you are required to add as an additional insured on this policy, under a written contract or agreement currently in effect, or becoming effective during the term of this policy. The additional insured status will not be afforded with respect to liability arising out of or related to your activities as a real estate manager for that person or organization. City of Santa Ana, its officers, employees, agents and representatives 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 included as an additional insured the person(s) or organization(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 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. CG 20 2612 19 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. This endorsement shall not increase the applicable Limits of insurance shown in the Declarations. Copyright, Insurance Services Office, Inc., 2012 Aw F Ride Management DMsian Jy/ ,'q REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst NONPROFITS INSURANCE ALLIANCE OF CALIFOI€,C 11A A Head for Insurance. A Hearr fir Nonpralim THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE ONLY In consideration of the premium charged, it is understood and agreed that the following is added as an additional insured: City of Santa Ana, its officers, employees, agents and representatives (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) But only as respects a legally enforceable contractual agreement with the Named Insured and only for liability arising out of the Named Insured's negligence and only for occurrences of coverages not otherwise excluded in the policy to which this endorsement applies. It is further understood and agreed that irrespective of the number of entities named as insureds under this policy, in no event shall the company's limits of liability exceed the occurrence or aggregate limits as applicable by policy definition or endorsement. Such insurance as is afforded by this endorsement for the additional insured shall apply as primary insurance. Any other insurance maintained by the additional insured or its officers and employees shall be excess and non- contributing with the insurance afforded by this endorsement. cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst InjNONPROFITS INSURANCE ALLIANCE OF CALIFORNIA A Head for Insurance. A Heart for Nonprofits. POLICY NUMBER: 2021-08609 FORM: NIAC-E26 11 17 NAMED INSURED: Los Angeles Dream Shapers (The) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SOCIAL SERVICE PROFESSIONAL LIABILITY COVERAGE FORM SCHEDULE Name of Person or Organization: City of Santa Ana, its officers, employees, agents and representatives Where you are so required in a written contract or agreement currently in effect or becoming effective during the term of this policy, we waive any right of recovery we may have against that person or organization, who may be named in the schedule above, because of payments we make for injury or damage. N IAC-E26 11 17 cF RAManagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst WORKERS' COMPENSATION DECLARATION I �kgoxC5' hereby affirm under penalty of perjury, the (Name/Title) following declaration: I certify on behalf of-�XtQsua, ni 7 `wring the term of my (Cpnsultant/Company Name) contract for ���,I �•1 services with the City of Santa Ana, I will not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions and provide proof of workers' compensation coverage. DATE:' ` By: Name:%. > L, Title: Telephone: " T �-7 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. RAn„atnmsb, 3 \�i REVIEWED & APPROVEDSY: 'MOW= Risk Management Analyst To r i Pierson Datea2022.06.09 12:10:33e07 00' / AC"R " CERTIFICATE OF LIABILITY INSURANCE FDAATE'MMIDD/YYYY) 06101 /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 Lauren Hand NAME: All -Cal Insurance Agency ACNE. Ext : (916) 784-9070 a/c, No): (916) 784-0158 505 Vernon Street E-MAIL lauren@all-calinsurance.com ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # Roseville CA 95678 INSURERA: Nonprofits' Insurance Alliance of California NIAC INSURED INSURER B The Los Angeles Dream Shapers INSURER C : P.O. Box 3831 INSURER D : INSURER E : Orange CA 92865 INSURER F : COVERAGES CERTIFICATE NUMBER: CL2252511447 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 INSURANCEAUULbUBK INSD WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE FX OCCUR PREM SDA AGES Ea oNcurDmnce $ 500,000 MED EXP (Any one person) $ 20,000 PERSONAL &ADV INJURY $ 1,000,000 A Y Y 2022-08609 06/02/2022 06/02/2023 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 ❑ PRO X JECT LOC PRODUCTS-COMP/OPAGG 2,000,000 $POLICY Liquor Liability $ 1,000,000 X1 OTHER: No Deductible AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ ANYAUTO A OWNED SCHEDULED AUTOS ONLY AUTOS Y 2022-08609 06/02/2022 06/02/2023 BODILY INJURY (Pe r accide nt) $ X PROPERTY DAMAGE Per accident $ HIRED �/ NON -OWNED AUTOS ONLY X AUTOS ONLY UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LAB CLAIMS -MADE DED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N PER OTH- STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE ElN OFFICER/MEMBER EXCLUDED? /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, may be attached if more space is required) The City of Santa Ana, its officers, employees, agents and representatives are additional insured with respect to General and Auto Liability per the attached endorsement as required by written contract. Insurance is Primary and Non -Contributory, 30 Days Notice of Cancellation with 10 Days Notice for Non -Payment of premium in accordance with policy provisions. Forms CG 20 26, NIAC-E61, NIAC-E26 and NIAC-Al apply. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS. Risk Management Division AUTHORIZED REPRESENTATIVE � � cxtR77�1ekCmn 20 Civic Center Plaza . ra Santa Ana CA 92702 GG !_ N p do .�'' �^ez �"�r�tcs�a�x @ 1988-2015ACORD coss<aw n gcncresaeorairsaie ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD A Head for Insurance. A Heart for Nonprofits. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AMENDED NOTICE OF CANCELLATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART BUSINESS AUTO COVERAGE FORM Cancellation: 30 Days Notice of Cancellation Person or Organization City of Santa Ana Risk Managment Division If we cancel this policy for any statutorily permitted reason other than nonpayment of premium, we will mail notice of cancellation to the person or organization shown above. We will mail such notice to the address shown at least the number of days shown for cancellation. REmEvvm & AmovED Ryr ."'."• ., Ri,kM1r9:—gcnicrtQC i-lAdie NIAC-E64 10 12 NMI[NONPROFITS INSURANCE ALLIANCE OF CALIFORNIA A Head for Insurance. A Heart for Nonprofits. NONPROFITS INSURANCE ALLIANCE OF CALIFORNIA (NIAC) www.insurancefornonprofits.org POLICY CHANGE THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COMPANY: Nonprofits Insurance Alliance of California POLICY NUMBER: 2022-08609 NAMED INSURED: Los Angeles Dream Shapers (The) POLICY CHANGE EFFECTIVE: COVERAGE PART AFFECTED: POLICY CHANGE#: 2 06/02/2022 COMMERCIAL GENERAL LIABILITY (08609) Page 1 The following additional insured(s) is/are hereby added to the policy: NIAC-E61 Locations - ALL City of Santa Ana, its officers, employees, agents and representatives $0 20 Civic Center Plaza Santa Ana, CA 92702 All other terms, limits and conditions remain the same. a'�'a (� 4, AUTHORIZED SIGNATURE 06/01 /2022 ADDITIONAL PREMIUM: RETURN PREMIUM: TOTAL PREMIUM: $0 $0 $0 lea & AmavED lr ."'"• A Girsl<M1rF.anagenxsiE CY eroral Psde A Head for Insurance. A Heart for Nonprofits. POLICY NUMBER: 2022-08609 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED PRIMARY AND NON-CONTRIBUTORY ENDORSEMENT FOR PUBLIC ENTITIES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: City of Santa Ana, its officers, employees, agents and representatives A. Section II —WHO IS AN INSURED is amended to include: 4. Any public entity as an additional insured, and the officers, officials, employees, agents and/or volunteers of that public entity, as applicable, who may be named in the Schedule above, when you have agreed in a written contract or written agreement presently in effect or becoming effective during the term of this policy, that such public entity and/or its officers, officials, employees, agents and/or volunteers be added as an additional insured(s) on your policy, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: a. Your negligent acts or omissions; or b. The negligent acts or omissions of those acting on your behalf; in the performance of your ongoing operations. No such public entity or individual is an additional insured for liability arising out of the sole negligence by that public entity or its designated individuals. The additional insured status will not be afforded with respect to liability arising out of or related to your activities as a real estate manager for that person or organization. B. Section III — LIMITS OF INSURANCE is amended to include: 8. The limits of insurance applicable to the public entity and applicable individuals identified as an additional insured(s) pursuant to Provision A.4. above, are those specified in the written contract between you and that public entity, or the limits available under this policy, whichever are less. These limits are part of and not in addition to the limits of insurance under this policy. C. With respect to the insurance provided to the additional insured(s), Condition 4. Other Insurance of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS is replaced by the following: 4. Other Insurance a. Primary Insurance This insurance is primary if you have agreed in a written contract or written agreement: (1) That this insurance be primary. If other insurance is also primary, we will share with all that other insurance as described in c. below; or --- - ------------- ra m�s r ti. � u NIAC-E61 02 19 A Head for Insurance. A Heart for Nonprofits. POLICY NUMBER: 2022-08609 (2) The coverage afforded by this insurance is primary and non-contributory with the additional insured(s)' own insurance. Paragraphs (1) and (2) do not apply to other insurance to which the additional insured(s) has been added as an additional insured or to other insurance described in paragraph b. below. b. Excess Insurance This insurance is excess over: 1. Any of the other insurance, whether primary, excess, contingent or on any other basis: (a) That is Fire, Extended Coverage, Builder's Risk, Installation Risk or similar coverage for "your work"; (b) That is fire, lightning, or explosion insurance for premises rented to you or temporarily occupied by you with permission of the owner; (c) That is insurance purchased by you to cover your liability as a tenant for "property damage" to premises temporarily occupied by you with permission of the owner; or (d) If the loss arises out of the maintenance or use of aircraft, "autos" or watercraft to the extent not subject to Exclusion g. of SECTION I — COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE. (e) Any other insurance available to an additional insured(s) under this Endorsement covering liability for damages which are subject to this endorsement and for which the additional insured(s) has been added as an additional insured by that other insurance. (1) When this insurance is excess, we will have no duty under Coverages A or B to defend the additional insured(s) against any "suit" if any other insurer has a duty to defend the additional insured(s) against that "suit". If no other insurer defends, we will undertake to do so, but we will be entitled to the additional insured(s)' rights against all those other insurers. (2) When this insurance is excess over other insurance, we will pay only our share of the amount of the loss, if any, that exceeds the sum of: (a) The total amount that all such other insurance would pay for the loss in the absence of this insurance; and (b) The total of all deductible and self -insured amounts under all that other insurance. (3) We will share the remaining loss, if any, with any other insurance that is not described in this Excess Insurance provision and was not bought specifically to apply in excess of the Limits of Insurance shown in the Declarations of this Coverage Part. c. Methods of Sharing If all of the other insurance available to the additional insured(s) permits contribution by equal shares, we will follow this method also. Under this approach each insurer contributes equal amounts until it has paid its applicable limit of insurance or none of the loss remains, whichever comes first. If any other the other insurance available to the additional insured(s) does not permit contribution by equal shares, we will contribute by limits. Under this method, each insurer's share is based on the ratio of its applicable limit of insurance to the total applicable limits of insurance of all insurers. NIAC-E61 02 19 ra m�s r a ."'."• .�'Gird<M1r9::anagcnxri4CYerira(Psdie NMI[NONPROFITS INSURANCE ALLIANCE OF CALIFORNIA A Head for Insurance. A Heart for Nonprofits. NONPROFITS INSURANCE ALLIANCE OF CALIFORNIA (NIAC) www.insurancefornonprofits.org POLICY CHANGE THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COMPANY: Nonprofits Insurance Alliance of California POLICY NUMBER: 2022-08609 NAMED INSURED: Los Angeles Dream Shapers (The) POLICY CHANGE EFFECTIVE: COVERAGE PART AFFECTED: POLICY CHANGE#: 3 06/02/2022 COMMERCIAL GENERAL LIABILITY (08609) Page 1 The following additional insured(s) is/are hereby added to the policy: NIAC-E26 Locations - ALL City of Santa Ana, its officers, employees, agents and representatives $0 20 Civic Center Plaza Santa Ana, CA 92701 All other terms, limits and conditions remain the same. a'�'a (� 4, AUTHORIZED SIGNATURE 06/01 /2022 ADDITIONAL PREMIUM: RETURN PREMIUM: TOTAL PREMIUM: $0 $0 $0 lea & AmavED lr ."'"• A Girsl<M1rF.anagenxsiE CY eroral Psde i POLICY NUMBER: 2022-08609 FORM: NIAC-E26 11 17 NAMED INSURED: Los Angeles Dream Shapers (The) A Head for Insurance. A Heart for Nonprofits. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SOCIAL SERVICE PROFESSIONAL LIABILITY COVERAGE FORM SCHEDULE Name of Person or Organization: City of Santa Ana, its officers, employees, agents and representatives Where you are so required in a written contract or agreement currently in effect or becoming effective during the term of this policy, we waive any right of recovery we may have against that person or organization, who may be named in the schedule above, because of payments we make for injury or damage. NIAC-E26 11 17 ---mQt. ra m�s r a ."'."• .0'Gird<M1r9::anagcnxri4CYerira(Psdie M011111' • NONPROFITS INSURANCE ALLIANCE OF CALIFORNIA (NIAC) www.insurancefornonprofits.org POLICY CHANGE THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COMPANY: Nonprofits Insurance Alliance of California (08609) POLICY NUMBER: 2022-08609 NAMED INSURED: Los Angeles Dream Shapers (The) POLICY CHANGE EFFECTIVE: 06/02/2022 COVERAGE PART AFFECTED: COMMERCIAL GENERAL LIABILITY POLICY CHANGE#: 4 Page 1 The following additional insured(s) is/are hereby added to the policy: NIAC-Al Locations - ALL City of Santa Ana Risk Managment Division $0 20 Civic Center Plaza Santa Ana, CA 92702 All other terms, limits and conditions remain the same. ADDITIONAL PREMIUM: RETURN PREMIUM: TOTAL PREMIUM: 06/03/2022 $0 $0 $0 ftmejim & AmavED u ."'"• A Girsl<M1rF.anagenxsiE CY eroral Psde AUTHORIZED SIGNATURE � Ii A A Head for Insurance. A Bart for Nonprofits, THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE ONLY In consideration of the premium charged, it is understood and agreed that the following is added as an additional insured: City of Santa Ana, its officers, employees, agents and representatives (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) But only as respects a legally enforceable contractual agreement with the Named Insured and only for liability arising out of the Named Insured's negligence and only for occurrences of coverages not otherwise excluded in the policy to which this endorsement applies. It is further understood and agreed that irrespective of the number of entities named as insureds under this policy, in no event shall the company's limits of liability exceed the occurrence or aggregate limits as applicable by policy definition or endorsement. Such insurance as is afforded by this endorsement for the additional insured shall apply as primary insurance. Any other insurance maintained by the additional insured or its officers and employees shall be excess and non- contributing with the insurance afforded by this endorsement. lftmejvm&AmovEDRYr ,' a ."'."• . Ri,kM1r9:­gcnicrtQC i-1Ajdie POLICY NUMBER: 2022-08609 Named Insured: Los Angeles Dream Shapers (The) COMMERCIAL GENERAL LIABILITY CG 20 26 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Any person or organization that you are required to add as an additional insured on this policy, under a written contract or agreement currently in effect, or becoming effective during the term of this policy. The additional insured status will not be afforded with respect to liability arising out of or related to your activities as a real estate manager for that person or organization. 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 organization(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 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. 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. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 26 12 19 © Insurance Services Office, Inc., 2012 ftme&Eo & AmovED Ryr 406."'."• 6'Gird<M1r9::anagcnxri4CYerira(Psdie WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjury, the (Name/Title) following declaration I certify on behalf of 1�at during the term of my tant/C mpany Name) I contract for �nservices with the City of Santa Ana, I will not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions and provide proof of workers' compensation coverage. DATE: By: Name: Title: W A-0 A (:9�R Telephone: 1-, ,--4- 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. IBM