Loading...
HomeMy WebLinkAboutPEREZ, BRITTANY LOUISEINSURANCE ON FILE WORK MAY PROCEED UNTIL INSURANCE EXPIRES CLERK OF COUNCIL DATE: N-2022-204 RECREATION SERVICES AGREEMENT WITH BRITTANY LOUISE PEREZ FOR DANCE FITNESS CLASS INSTRUCTION THIS AGREEMENT is made and entered into on this (5 day of July, 2022 by and cbetween Brittany Louise Perez, an individual ("Provider"), and the City of Santa Ana, a w charter city and municipal corporation organized and existing under the Constitution and r laws of the State of California ("City"). City and Provider may be collectively referred to as o the "Parties" or individually as a "Party." ¢ RECITALS A. The City desires to retain a recreation service provider having special skills, resources and knowledge to provide dance fitness classes in its recreation class program. B. Provider represents that it is able and willing to provide such services to the City. C. In undertaking the performance of this Agreement, Provider represents that it is knowledgeable in their field and that any services performed by Provider under this Agreement will be performed in compliance with such standards as may reasonably be expected. D. The Parties acknowledge that the City intends to provide recreational activities to the public but must balance the need to comply with all COVID-19 guidance and restrictions. NOW THEREFORE, in consideration of the mutual and respective promises, and subject to the terms and conditions hereinafter set forth, the Parties agree as follows: 1. SCOPE OF SERVICES A. Provider shall perform those services as set forth in Exhibit A to this Agreement. B. All classes operated pursuant to this Agreement for conducting recreation classes at City facilities, including parks, will comply with all applicable guidance and public health orders, including those from the Centers for Disease Control ("CDC"), California Department of Public Health ("CDPH"), the Orange County Health Care Agency ("OCHCA") and the City itself for as long as those orders and guidance remain in place. Provider will remind participants of these guidelines. To the extent that Provider needs assistance with enforcing any rules or requirements, Provider will contact a City Parks' employee or City security for assistance. C. Provider shall not attend a class or teach any class if Provider is sick or has any symptom(s) associated with COVID-19 including but not limited to, fever above 100.4, chills, cough, shortness of breath, loss of taste or smell, nausea, muscle or body aches, vomiting, headache, sore throat or diarrhea. D. Provider will not attend class or teach a class if Provider or any member of Provider's household has been asked to quarantine or self -isolate due to symptoms of COVID-19 or a positive test result for COVID-19. E. Provider acknowledges that, to the extent that City is able to and chooses to conduct classes indoors, this Agreement will also cover classes conducted at one of City's recreational centers during the term of this Agreement. F. City reserves the right to change the location(s) at which the services contemplated by this Agreement are provided. G. Provider shall comply with the City's recreation class policy manual and any other City rules and regulations regarding the operation of recreation classes. 2. COMPENSATION a. In consideration for the provision of the programs set forth in Exhibit A, City agrees to pay, and Provider agrees to accept as total payment for their services for the City, seventy percent (70%) of all gross revenue received from program participants. Total revenue to Provider shall not exceed twenty-five thousand dollars and zero cents ($25,000). a. Payment to Provider shall be made monthly within thirty (30) days following completion of the last class taught by Provider the prior month. City shall be responsible for collecting all fees from program participants. Provider shall not collect fees but will refer all interested participants to City for registration information. Provider agrees that City shall retain thirty percent (30%) of all gross revenue received from program participants as an administrative fee. 3. TERM This Agreement shall commence on the date first written above and end on June 30, 2023 unless terminated earlier in accordance with Section 14 below. The term of this Agreement may be extended by a writing executed by the City Manager and the City Attorney. 4. INDEPENDENT CONTRACTOR Provider shall, during the entire term of this Agreement, be construed to be an independent contractor and not an employee of the City. This Agreement is not intended nor shall it be construed to create an employer -employee relationship, a joint venture relationship, or to allow the City to exercise discretion or control over the manner in which Provider performs the services which are the subject matter of this Agreement; however, the services to be provided by Provider shall be provided in a manner consistent with all applicable standards and regulations governing such services. Provider shall pay all salaries and wages, employer's social security taxes, unemployment insurance and similar taxes relating to employees and shall be responsible for all 2 applicable withholding taxes. Provider is not an agent, representative or employee of City and Provider shall have no authority to act on behalf of the City. 5. INSURANCE Prior to undertaking performance of work under this Agreement, Provider shall maintain and shall require its subcontractors, if any, to obtain and maintain insurance as described below: a. Minimum Scope and Limit of Insurance: 1. Commercial General Liability Insurance (CGL). Provider shall procure and maintain Insurance Services Office Form CG 00 01 covering CGL on an "occurrence" basis, including property damage, bodily injury and personal & advertising injury with limits no less than $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 required occurrence limit. 2. Broader Coverage. If the Provider 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 Provider. Any available insurance proceeds in excess of the specified minimum limits of insurance and coverage shall be available to the City. b. Other Insurance Provisions 1. 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 the Provider including materials, parts, or equipment furnished in connectionwith such work or operations. General liability coverage can be provided in the form of an endorsement to the Provider'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 2037 if a later edition is used). 2. Primary Coverage. For any claims related to this contract, the Provider's insurance coverage shall be primary coverage at least as broad as ISO CG 20 0104 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 Provider's insurance and shall not contribute with it. 3. Notice of Cancellation. Each insurance policy required above shall provide that coverage shall not be canceled, except with notice to the City. 4. Waiver of Subrogation. Provider hereby grants to City a waiver of any right to subrogation that any insurer of said Provider may acquire against the City by virtue of the payment of any loss under such insurance. Provider 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. 5. Self -Insured Retentions. Self -insured retentions must be declared to and approved by the City. The City may require the Provider 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. 6. 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. Verification of Coverage. Provider shall furnish the City with original Certificates of Insurance including all required amendatory endorsements (or copies of the applicable policy language effecting coverage requiredby this clause) and a copy of the Declarations and Endorsement Page of the CGL policy listing all policy endorsements to City before work begins. However, failure to obtain the required documents prior to the work beginning shall not waive the Provider's obligation to provide them. The City reserves the right to require complete, certified copies of all required insurance policies,including endorsements required by these specifications, at any time. 8. Subcontractors. Provider shall require and verify that all subcontractors maintain insurance meeting all the requirements stated herein, and Provider shall ensure that City is an additional insured on insurance required from subcontractors. 9. Special Risks or Circumstances. 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. 6. INDEMNIFICATION Provider agrees to and shall indemnify, defend and hold harmless the City, its officers, agents, employees, consultants, special counsel, and representatives from liability: (1) for personal injury, damages, just compensation, restitution, judicial or equitable relief arising out of claims for personal injury, including death, and claims for property damage, which may arise from the negligent operations of the Provider or its contractors, subcontractors, agents, employees, or other persons acting on their behalf which relates to the services described in section 1 of this 1l Agreement; and (2) from any claim that personal injury, damages, just compensation, restitution, judicial or equitable relief is due by reason of the terms of or effects arising from this Agreement, to the extent that the injury, damages, just compensation, restitution, judicial or equitable relief is caused by the negligence of the Provider. This indemnity and hold harmless agreement applies to all claims for damages, just compensation, restitution, judicial or equitable relief suffered, or alleged to have been suffered, by reason of the events referred to in this Section or by reason of the terms of, or effects, arising from this Agreement. City may make all reasonable decisions with respect to its representation in any legal proceeding. In no case will Provider be required to indemnify or hold harmless the City from injury, damages, just compensation, restitution, judicial or equitable relief caused by the negligence of the City. CONFIDENTIALITY If Provider receives from the City information which due to the nature of such information is reasonably understood to be confidential and/or proprietary, Provider agrees that it shall not use or disclose such information except in the performance of this Agreement, and further agrees to exercise the same degree of care it uses to protect its own information of like importance, but in no event less than reasonable care. "Confidential Information" shall include all nonpublic information, including but not limited to student records. Confidential information includes not only written information, but also information transferred orally, visually, electronically, or by other means. Confidential information disclosed to either party by any subsidiary and/or agent of the other party is covered by this Agreement. The foregoing obligations of non-use and nondisclosure shall not apply to any information that (a) has been disclosed in publicly available sources; (b) is, through no fault of the Provider disclosed in a publicly available source; (c) is in rightful possession of the Provider without an obligation of confidentiality; (d) is required to be disclosed by operation of law; or (e) is independently developed by the Provider without reference to information disclosed by the City. 8. COVID-19 ASSUMPTION OF RISK AND WAIVER a. Provider acknowledges that Provider could be exposed to persons that may have COVID-19 providing services pursuant to this Agreement. Provider understands that interacting with any person currently comes with the inherent risk of exposure to COVID-19 and that COVID49 is highly contagious. Provider assumes the risks associated with providing services pursuant to this Agreement, namely potential exposure to COVID-19. Provider acknowledges that while some people have no symptoms or mild symptoms from COVID-19, some people have become seriously ill requiring hospitalization and that some people have died from COVID-19. Provider acknowledges that persons over the age of 65 and persons with underlying health conditions are at greater risk of contracting COVID-19 and are potentially risking serious injury or death. Provider is agreeing to provide classes pursuant to this Agreement and does so of Provider's own free will. b. Provider intends to be legally bound by this assumption of risk, release and waiver and to bind Provider's heirs, personal representatives, next of kin and anyone who may make a claim on Provider's behalf. Provider knowingly releases and waives any and all claims that Provider may have or could have in the future and includes any claims resulting from potential exposure or actual exposure to COVID-19, this includes claims for personal injury, transmittal of COVID-19 to others, and/or wrongful death. Provider agrees to hold harmless, defend and indemnify the City, its public officials, officers, employees, volunteers, and agents from any and all claims for liability or damages, including those for exposure to or diagnosis with COVID-19 as a result of providing services pursuant to this Agreement. 9. CONFLICT OF INTEREST Provider covenants that it presently has no interests and shall not have interests, direct or indirect, which would conflict in any manner with performance of services specified under this Agreement. 10. BACKGROUND CHECK Provider shall ensure that all employees, subcontractors, and any volunteers are fingerprinted and background checked prior to conducting any work pursuant to this Agreement. Provider shall not assign any employee, agent, subcontractor, volunteer or the Provider personally to provide services pursuant to this Agreement, if that employee, agent, subcontractor, volunteer, or the Provider personally are required to register as a sex offender under California Penal Code Section 290 or seq, have a conviction for any crime of moral turpitude, have a conviction for a sexual based crime, have a conviction for a violent felony as defined in California Penal Code Section 667.5(c), or has a conviction for a serious felony as defined in California Penal Code Section 1192.7(c). Disqualifying convictions include but are not limited to, violations of California Penal Code Sections 37, 128, 136.1 with Section 186.22, 187, 190-190.4 and 192(a), 205, 206, 207-209.5, 211, 212, 212.5, 213, 214, 215, 218-219, 220, 236.1(b) or 236.1(c), 243.4, 261, 261.5, 273.5, 262, 264.1, 266, 266c, 266h, 266i, 266j, 267, 269, 272, 273a, 273ab, 273d, 285, 286, 288, 288a, 288.2, 288.3, 288.4, 288.5, 288.7, 289, 290, 311.1, 311.2, 311.3, 311.4, 311.10, 311.11, 314, 347(a), 368, 417(b), 451(a),518 with 186.22, 647.6, 65311(c), 664 and 187, 667.5(c), 18745,18750, or 18755, 12022.53, 11418(b)(1) or (b)(2); Business and Professions Code Section 729. 11. NOTICE Any notice, tender, demand, delivery, or other communication pursuant to this Agreement shall be in writing and shall be deemed to be properly given if delivered in person or mailed by first class or certified mail, postage prepaid, or sent by fax or other telegraphic communication in the manner provided in this Section, to the following persons: To City: Clerk of the Council City of Santa Ana 20 Civic Center Plaza (M-30) P.O. Box 1988 0 With copy to: Santa Ana, CA 92702-1998 Fax (714) 647-6956 Executive Director of Parks, Recreation and Community Services City of Santa Ana 20 Civic Center Plaza (M-23) P.O. Box 1988 Santa Ana, California 92702 Fax (714) 571-4211 To Provider: Brittany Louise Perez 13641 Fairview Street, Unit 11 Garden Grove, CA 92843 714-376-9272 A party may change its address by giving notice in writing to the other party. Thereafter, any communication shall be addressed and transmitted to the new address. If sent by mail, communication shall be effective or deemed to have been given three (3) days after it has been deposited in the United States mail, duly registered or certified, with postage prepaid, and addressed as set forth above. If sent by fax, communication shall be effective or deemed to have been given twenty-four (24) hours after the time set forth on the transmission report issued by the transmitting facsimile machine, addressed as set forth above. For purposes of calculating these time frames, weekends, federal, state, County or City holidays shall be excluded. 12. EXCLUSIVITY AND AMENDMENT This Agreement represents the complete and exclusive statement between the City and Provider regarding the subject matter herein, and supersedes any and all other agreements, oral or written, between the parties. In the event of a conflict between the terms of this Agreement and any attachments hereto, the terms of this Agreement shall prevail. This Agreement may not be modified except by written instrument signed by the City and by an authorized representative of Provider. The parties agree that any terms or conditions of any purchase order or other instrument that are inconsistent with, or in addition to, the terms and conditions hereof, shall not bind or obligate Provider or the City. Each party to this Agreement acknowledges that no representations, inducements, promises or agreements, orally or otherwise, have been made by any party, or anyone acting on behalf of any party, which is not embodied herein. 13. ASSIGNMENT/SUBSTITUTES a. Assignment. The experience, knowledge, capability and reputation of Provider were a substantial inducement for City to enter into this Agreement. Therefore, Provider may not assign, transfer, delegate, or subcontract any interest herein without the prior written consent of the City and any such assignment, transfer, delegation or subcontract without the City's prior written consent shall be considered null and void. b. Substitutes. In the event Provider is not able to teach a class due to illness or some other cause beyond Provider's reasonable control, Provider must procure, at its sole expense, a qualified substitute instructor to teach the class at its regular time and place. Provider shall ensure that substitute instructors are at least twenty-one (21) years of age and comply with the City's insurance and live scan requirements contained herein. Evidence of compliance with City's insurance and live scan requirements shall be provided upon request. Provider must immediately notify the City of the substitute instructor's name, qualifications, address and phone number. If Provider cannot procure a qualified substitute and the City is unable to assist in this regard, then the class shall be canceled and a make-up class must be added to the session. Provider must notify participants as soon as possible of any class cancellation and make-up class. Provider must personally teach at least seventy-five percent (75%) of its offered classes. 14. TERMINATION a. This Agreement may be terminated by the City upon thirty (30) days written notice of termination. In such event, Provider shall be entitled to receive, and City shall pay Provider, compensation for all services rendered prior to the effective date of termination. b. Termination or cancellation of classes by the Provider outside of Section 1 Lb. must be given to the City at least thirty (30) days prior to termination/cancellation. Failure to provide adequate cancellation notice to the City may put future contracting of business with the City at risk and will result in the City's retention of ten (10%) percent of the final payment to Provider. 15. RECORDS Provider shall use attendance sheets generated and supplied by the City to record attendance in each class. Provider shall keep these and any other records in connection with the work to be performed under this Agreement and shall permit City, upon request, to review such records for a period of three (3) years from the date of final payment to Provider under this Agreement. 16. NON-DISCRIMINATION Provider shall not discriminate because of race, color, creed, religion, sex, marital status, sexual orientation, gender identity, gender expression, gender, medical conditions, genetic information, or military and veteran status, age, national origin, ancestry, or disability, as defined and prohibited by applicable law, in the recruitment, selection, teaching, training, utilization, promotion, termination or other employment related activities or any services provided under this Agreement. Provider affirms that it is an equal opportunity employer and shall comply with all applicable federal, state and local laws and regulations. 17. JURISDICTION —VENUE This Agreement has been executed and delivered in the State of California and the validity, interpretation, performance, and enforcement of any of the clauses of this Agreement shall be determined and governed by the laws of the State of California. Both parties further agree that Orange County, California, shall be the venue for any action or proceeding that may be brought or arise out of, in connection with or by reason of this Agreement. 18. LICENSES Provider shall, throughout the term of this Agreement, maintain all necessary licenses, permits, approvals, waivers, and exemptions necessary for the provision of the services hereunder and required by the laws and regulations of the United States, the State of California, the City of Santa Ana and all other governmental agencies. 19. SEVERABILITY In the event that one or more of the phrases, sentences, clauses, paragraphs or sections contained in this Agreement shall be declared invalid or unenforceable by valid judgment or decree of a court of competent jurisdiction, such invalidity or unenforceability shall not affect any of the remaining phrases, sentences, clauses, paragraphs or sections of this Agreement, which shall be interpreted to carry out the intent of the parties hereunder. 20. EXHIBITS All Exhibits referenced herein and attached hereto shall be incorporated as if fully set forth in the body of this Agreement. Itr. I : rr The person(s) executing this Agreement on behalf of the parties hereto warrant that they are duly authorized to execute this Agreement on behalf of said parties and that by so executing this Agreement, the parties hereto are formally bound to the provisions of this Agreement. IN W 1"fNESS WHEREOF, the parties hereto have executed this Agreement the date and year first above written. ATTEST: CITY OF SANTA ANA t`p Daisy Gomez Kris ne Ridge 6 ,Clerk of the Council ° City Manager [signatures continued on nest page/ 0 APPROVED AS TO FORM: SONIA R. CARVALHO City Attorney By: �. Bfarkron Salvatierra Deputy City Attorney M Recreation and Community Services Agency 10 PROVIDER: Brittany Louise Perez Proprietor Exhibit A SCOPE OF SERVICES A. Provider shall conduct Fitness classes for Adults. B. Provider shall teach such or similar classes (1) at the times below at facilities to be designated by the City or (2) on a schedule agreed upon by the parties for each class session or term, including the location, specific days and hours when classes will be held, and holidays to be observed, in accordance with City's needs. Zumba w/Brittany "An energizing dance fitness class featuring Latin, international, pop, and hip hop music. It is exercise in disguise! Very fun dance workout that will leave you wanting more" INSTRUCTOR: Brittany Perez LOCATION: El Salvador Park, 1825 W. Civic Center, Santa Ana, (714) 647-6558 • Zumba w/Brittany will consist of 4 weeks session, held 3 days per week, 50 minutes per day, for Adults C. Provider shall provide all materials, supplies, equipment, records and personnel. Provider shall be responsible for clean-up of the facilities and materials and shall ensure the safety and effectiveness of instruction. CLASS SIZE A. Each class must have a minimum of 5 paid students and no more than 25 students. No registrations accepted after the second meeting of class. C. If the minimum registration was not been reached by the second class, the class shall be cancelled. Provider will be under no obligation to provide services for the cancelled classes, and the City will have no further obligations to pay Provider compensation for the remaining classes that were cancelled in that session. CLASS FEES A. Each participant shall pay class registration fees as established by City. B. Provider may not waive class participation/registration fees. C. Only registered participants may participate in class. D. Refunds to participants will be in accordance with City policy. E. Any materials fee shall be established by mutual agreement of City and Provider and shall be payable directly to Provider. Ane Digitally signed by J Anaie Acevedo "`� u CERTIFICATE OF LIA ILITY IN l;RMQU22.m.29 DATE(MMDOYYYY) 06/30/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONL O F Rc No R O 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(les) 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 rigsto the certificate holder in lieu of such endorsements . PRODUCER CONTACT NAME: MM - Fitness Instructor/Personal Trainer K&K Insurance Group, Inc. 1712 Magnavox Way Fort Wayne IN 46804 aIc No Ezl : 1-800-506-4856 ac NJ: 1-260-459-5502 ADDRESS: info@fitnessinsurance-kk.com PRODUCER CUSTOMER to, INSURERS) AFFORDING COVERAGE NAIC® INSURED INSURER A: Markel Insurance Company 38970 Brittany Perez 13641 Fairview St., Unit 11 Garden Grove, CA 92843 INSURER B: INSURERQ INSURER D: A Member of the Sports, Leisure & Entertainment RPG INSURER E: NSURER F: COVERAGES CERTIFICATE NUMBER: W02237386 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 INSD WVD POLICY NUMBER MMB)DNYYY) (MMODNYYYI OMITS A X COMMERCIAL GENERAL LIABILITY MADES OCCUR X Ml RPGOOOOOOD016600 07/01/2022 12:01 AM EDT 07/0112023 12:01 AM EACH OCCURRENCE $1,000,000 PREMISES Ea Occurrence $1,000,000 MED EXP(Any one person) $5,000 PERSONAL& ADV INJURY $1,000,000 GENERAL AGGREGATE $5,000,000 GENT AGGREGATE UMITAPPLIES PER: POLICY PRO- LOC JECT OTHER: PRODUCTS—COMP/OP AGG $1.000,000 PROFESSIONAL LIABILITY $1,000,000 PARTICIPANTS $1,000,000 AUTOMOBILE LIABILITY ANY AUTO OWNED AUTOS SCHEDULED ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY NOT PROVIDED WHILE IN HAWAII Ea accident BODILY INJURY (Par person) BODILY INJURY (Par acadent) Per accident UMBRELLA LMB OCCUR EXCESS UABL_J CLAIMS -MADE DEO RETENTION EACH OCCURRENCE AGGREGATE WORKERS COMPENSATION AND EMPLOYERS' WIBILITY ANY PROPRIETORIPARTNERI YIN EXECUTIVE (Mandatory In ER EXCLUDED?(MandaRM In NH) N) ❑ If yes, descnbe under DESCRIPTION OF OPERATIONS below N/A PER STATUTE OTHER E.LESCHACCIOENT EL DISEASE —EA EMPLOYEE EL DISEASE —PODGY LIMB MEDICAL PAYMENTS FOR PARTICIPANTS PRIMARY MEDICAL EXCESS MEDICAL DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached R more space Is required) Certified Instructor of. Aerobics, ZUMBA The certificate holder is added as an additional insured, but only for liability caused, in whole or in part, by the acts or omissions of the named insured. CERTIFICATE HOLDER CANCELLATION City of Santa Ana Risk Management Division SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 20 Civic Center Plaza THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Santa Ana, CA 90022 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE (Owner/Lessor of Premises) Coverage is only extended to U.S. events and activities. RhIeMmPgaltodDMdon M NOTICE TO TEXAS INSUREDS: The Insurer for the purchasing group may not be subject to all the insurance laws and regulations i °`-"'°• RENEWED& APPROVED BY: a A Auvutd ACORD 26 (2076/03) 01966.2016, The ACORD name and logo are registered marks of ACORD - Risk Management Specialist POLICYNUMBER: MlRPG000000O016600 COMMERCIAL GENERAL LIABILITY CG 20 26 0413 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 Persons Or Organization(s) City of Santa Ana Risk Management Division 20 Civic Center Plaza Santa Ana, CA 90022 Named Insured: Brittany Perez 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 04 13 C Insurance Services Office, Inc., 2012 liWr Marugement DlWclan REVEWEo&A"Rav®ar. Risk Management Specialist CrrroFSAivTAAlvA RISK MANAGEMENT,. Awa... (HUMAN REsouRCEs Managing Risk rmcfrPw tive Change WORKERS COMPENSATION DECLARATION 1, Brittany/ Instructor hereby affirm under penalty of perjury, the (Name,/rafe) following declaration: I certify on behalf of myself that during the term fCanwerunr/r mPartyNarwl of my contract for Zumba Instructor services with the City of Santa Ana, (Type of aervicE provided) will not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with the provisions and provide proof of workers' compensation coverage immediately. Date: 6)1)22 Print Name: Brittany Perez Print Title: Zumba Instructor Signature: �%n (LGV%� tD�rer'V Telephone: (714) 376-9 72 WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES- L1,Rb*,Wgmr1i MnW ReyuirementrlVXVedarotim 08152019 cnwa¢ vwuion o= `�,. RenEwm6AraRovm Br. ' Risk Management Specialist u POLICYNUMBER: MIRPG000000O016600 INTERLINE IL 12 01 11 85 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY CHANGES Policy Change Number 1 POLICY NUMBER POLICY CHANGES EFFECTIVE COMPANY M1 RPG000000O016600 07/02/22 Markel Insurance Company NAMED INSURED AUTHORIZED REPRESENTATIVE Brittany Perez K&K Insurance Group, Inc. COVERAGE PARTS AFFECTED COMMERCIAL GENERAL LIABILITY COVERAGE CHANGES Form MIL 1215 has been added to the policy CP# 3796 low //Zvu Authorized Representative Signature IL 12 01 11 85 Copyright, Insurance Services Office, Inc., 1983 Copyright, ISO Commercial Risk Services, Inc., 1983 ltiekMww9mtmtDMe1mt i Rwexw &APPRW®BY: A+p Aev44 Risk Management SpedAist COMMERCIAL GENERAL LIABILITY gig POLICY NUMBER: M1 RPG000000O016600 ��EL® MARKEL INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION TO THIRD PARTY PERSONS OR ORGANIZATIONS This endorsement modifies insurance provided under the following: COMMERCIAL AUTO LIABILITY COVERAGE FORM COMMERCIAL CRIME COVERAGE FORM COMMERCIAL GENERAL LIABILITY COVERAGE FORM COMMERCIAL PROPERTY COVERAGE FORM SCHEDULE Number Of Days Advance Notice For Any For Nonpayment Of Premium Other Person(s) Or Organization(s) Reason City of Santa Ana Risk Management Division, 20 30 30 Civic Center Plaza, Santa Ana, CA 90022 Named Insured: Brittany Perez CP# 3796 Effective Date: 07/02/2022 — 07/01 /2023 A. If we cancel this policy for any reason, we will notify the Person(s) Or Organization(s) shown in the Schedule of this endorsement according to the applicable Number Of Days Advance Notice shown in the Schedule of this endorsement. However, in no event will the Number Of Days Advance Notice to such person(s) or organization(s) exceed the number of days advance notice to the first Named Insured. B. Our obligation to notify the Person(s) Or Organization(s) shown in the Schedule of this endorsement will terminate at the earlier of the current policy period expiration or when you no longer have a legal or contractual obligation to such person(s) or organization(s) to maintain insurance coverage under a policy which requires notification to the person(s) or organization(s) in the event of cancellation. C. Failure to provide such notification will not extend the policy cancellation date nor negate a cancellation of the policy. All other terms and conditions remain the unchanged. _ RiskMnugemmtDlvI o %�_ R�. Rene& 6APPRMv D MIL 1215 01 18 Includes copyrighted material of Insurance Services Office, Inc., °I ^ o ;?with its permission.I®' Risk Management Sped POLICY NUMBER: MlRPGOOO0000016600 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: City of Santa Ana Risk Management Division 20 Civic Center Plaza Santa Ana, CA 90022 Named Insured: Brittany Perez CP# 3796 Effective Date: 07/02/2022 — 07/01 /2023 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV — Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products -completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 © Insurance Services Office, Inc., 2008 RDtuwon A- ju Acwata a,, Risk Management Specialist 00 Brittany Louise Perez 13641 Fairview Street Unit 11 Garden Grove, CA. 92843 (714) 376-9272 Date: June 3, 2022 City of Santa Ana Risk Management Division 20 Civic Center Plaza, Santa Ana, CA 92702 Re: Professional Liability and Auto Insurance Requirement and Release of Liability. Dear City of Santa Ana Risk Management Division: I, Brittany Louise Perez, Zumba Instructor, hereby release the City of Automobile Liability. I do not useldrive any vehicle during the course and scope of my agreement with the City. Additionally, I am not a licensed professional and will not employ a licensed professional during the course of my contract. During the term August 1, 2022 through July 31. 2023, Fitness Instructor, El Salvador Center, 1825 W Civic Center Dr., Santa Ana, CA, Sincerely, Brittany Lo ' Perez Fitness Instructor o� R)WED & gernwttDM REVIEWED&AwRov®tBr. RBk Management Spenalist COMMERCIAL GENERAL LIABILITY gig POLICY NUMBER: MlRPG000000O016600 MARKEL® MARKEL INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE PROVISION - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM Person or Organization: SCHEDULE Management Division 20 Civic Center Plaza Santa Ana, CA 90022 Named Insured: Brittany Perez CP# 3796 Effective Date: 07/02/2022 — 07/01/2023 The following is added and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to the Person Or Organization shown in the Schedule of this endorsement, provided that: (1) Such Person Or Organization is an additional insured under your policy; (2) The additional insured is a Named Insured under such other insurance; and (3) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. All other terms and conditions remain the unchanged. g+ wekMmagana>tDMdon �, ..:_,�i RVAMED&AI ROVEDSr MGL 1574 07 21 Includes copyrighted material of Insurance Services Office, Inc., a K ` i? A Au�wto with its permission. ,; Risk Management Spedalis[ June 3, 2022 City of Santa Ana Risk Management Division 20 Civic Center Plaza Santa Ana, CA. 92702 Re: Auto Insurance Requirement Dear City of Santa Ana Risk Management Division: Brittany Louise Perez, Fitness Instructor has intent to enter into agreement with the City of Santa Ana. Throughout the course of this agreement, Brittany Louise Perez attests to the following: 1. Brittany Louise Perez will not use/drive any vehicle during the course and schope of the services provided in the agreement/contract. 2, Brittany Louise Perez will not use any owned/rented/lesed vehicles during the course and scope of the services provided in the agreement/contrast. 3. Brittany Louise Perez consultants/independent contractors/employeed utilize their personal vehide.s/non-company owned, borrowed, or rented/leased vehicles for transportation to and from work and if applicable carry their own automobile insurance. By signing below, I Brittany Louise Perez attest that I possess the legal authority to enter into an agreement with the City of Santa Ana as well as the legal authority to attest to the statements above. If at any time, it is found that Brittany Louise Perez is not adhering to any/all statements in this document an dhas not provided the minimum Auto Liability insurance voerage of $1 million per occurance, the contract will be considered null and void and the company will be held fully liable for an and all damages. Signature P Brittany! Louise Perez (714)376-9272 brabonza@gmail.com wa�M,ro Wi; 6 RE\Ae E 6ArrRw®BY. A+ ju AavAZ Risk Management Specialist i3