HomeMy WebLinkAboutGUTIERREZ, ROBERTO dba LIGHTER SHADE OF BROWNCity of Santa Ana
Clerk of the Council
AGREEMENT TERMINATION FORM
Please complete this form in its entirety when the attached agreement and all
amendments (if any) are no longer in effect.
Note: If your agreement is grant related, please ensure that all gran retention requirements
have been satisfied prior to signing the termination form.
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
COTC Office Use Only
.1T_;3 u a n.-..:.
SEP 1 2 2 .--' ---
N-2022-232
No. was completed on cX 2q I Z Z and final payment has been made.
(List all amendments. Use space below if needed.)
Department:C�
Phone/Ext.:��
Signature:
Date:
ilagreements\forms\farm -agreement termination form_goldenrod.doc
INSURANCE ON FILE
WORK MAY PROCEED
UNTIL INSURANCE EXPIRES
2.223
CLERK OF COUNCIL
DATE:
N-2022-232
AGREEMENT WITH ROBERT GUTIERREZ DBA LIGHTER SHADE OF BROWN TO
0 �RsA PROVIDE A LIVE PERFORMANCE AT CITY'S CHICANO HERITAGE FESTIVAL
THIS AGREEMENT is made and entered into this 9�7 day of August, 2022, by and between
N Robert Gutierrez, an individual dba Lighter Shade of Brown ("Artist"), and the City of Santa Ana,
o a charter city and municipal corporation organized and existing under the Constitution and laws of
U-) the State of California ("City").
N
RECITALS
A. The City desires to retain artists to provide live performances at the City's Chicano
Heritage Festival.
B. Artist represents that Artist is able and willing to provide such a performance to the
City.
C. In undertaking the performance of this Agreement, Artist represents that it is
knowledgeable in its field and that any services performed by Artist under this
Agreement will be performed in compliance with such standards as may reasonably
be expected.
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. Artist shall perform, during the term of this Agreement, the tasks and obligations
including all labor, materials, tools, equipment, and customary work required to
provide a live performance as Lighter Shade of Brown ("Artist"), as further
described in Exhibit A, for the City's Chicano Heritage Festival on August 28,
2022 at El Salvador Park,1825 West Civic Center Dr., Santa Ana, CA 92701.
b. Artist shall provide a . minute live performance, beginning at 1�
Artist's Initials:
C. Artist must provide song list of family friendly, clean edit songs with lyrics to be
approved by the City of Santa Ana prior to performance.
2. COMPENSATION
a. City agrees to pay, and Artist agrees to accept as total payment for its services for
City, including all travel expenses and performance by Artist, the rates and charges
identified in Exhibit A. The total amount to be expended under this Agreement
shall not exceed Three Thousand, Five Hundred Dollars and Zero Cents
($3,500.00). This sum is comprised of (1) a base amount of $3,000 and (2) a
Page 1 of 10
contingency in the amount of $500 to be used at the City's sole discretion.
b. Union fees, manager and/or agent commissions, and insurance obligations are part
of the cost of production and City shall not be liable or responsible for any such
payments under this Agreement.
C. Payment of deposit of half of invoiced amount for Artist's performance, One
Thousand Five Hundred Dollars and Zero Cents ($1,500), shall be processed upon
execution of Agreement and receipt of an invoice by the City..
d. Remaining balance for Artist's performance of One Thousand Five Hundred
Dollars and Zero Cents ($1,500) shall be paid on the day of the event, subject to
City accounting procedures.
e. Payment need not be made for work that fails to meet the standards of performance
set forth in the Recitals and Scope of Work, which may reasonably be expected by
City.
"10004WITMA
This Agreement shall commence on August 28, 2022 and terminate on December 31, 2022,
unless terminated earlier in accordance with Section 17, below.
4. ROYALTY -FREE LICENSE
The City shall have the right and royalty -free license to simulcast or produce and show a
tape -delayed broadcast of the Artist's performance to the City community or general public,
through the internet or any other means. This license shall be non-exclusive and the copyright
shall remain with the Artist. Copies of Artist's performance may be maintained by the City, and
Artist consents to use of such recordings.
5. INDEPENDENT CONTRACTOR
Artist 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 Artist performs the
services which are the subject matter of this Agreement; however, the services to be provided by
Artist shall be provided in a manner consistent with all applicable standards and regulations
governing such services. Artist 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.
6. INSURANCE
Artist shall procure and maintain for the duration of the contract insurance against claims
Page 2 of 10
for injuries to persons or damages to property which may arise from or in connection with the
performance of the work hereunder and the results of that work by the Artist, his agents,
representatives, employees or subcontractors.
a. Minimum Scope and Limit of Insurance:
1. Commercial General Liability Insurance. Artist shall maintain commercial
general liability insurance, which shall include, but not be limited to, protection
against claims arising from bodily and personal injury, including death resulting
therefrom and damage to property, resulting from any act or occurrence arising out
of Artist's operations in the performance of this Agreement. 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 $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. Worker's Compensation Insurance. In accordance with California State law,
Artist, if Artist has any employees, is required to be insured against liability for
worker's compensation or to undertake self-insurance. Prior to commencing the
performance of the work under this Agreement, Artist agrees to obtain and maintain
any employer's liability insurance with limits not less than $1,000,000 per accident.
3. Broader Coverage. If the Artist 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 Artist. 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
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 Artist
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 Artist'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 Artist's insurance
coverage shall be primary coverage at least as broad as 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 Artist's insurance and shall not contribute with it.
Page 3 of 10
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. Artist hereby grants to City a waiver of any right to
subrogation that any insurer of said Artist may acquire against the City by virtue of
the payment of any loss under such insurance. Artist 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 Artist 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.
7. Claims Made Policies. If any of the required policies provide claims -made
coverage:
a. The retroactive date must be shown, and must be before the date of the
contract or the beginning of contract work.
b. Insurance must be maintained and evidence of insurance must be provided
for at least five (5) years after completion of the contract of work.
c. If coverage is canceled or non -renewed, and not placed with another
claims -made policy form with a retroactive date prior to the contract
effective date, the Artist must purchase "extended reporting" coverage for
a minimum of five (5) years after completion of work.
8. Verification of Coverage. Artist 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 Artist'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.
Page 4 of 10
9. Subcontractors. Artist shall require and verify that all subcontractors maintain
insurance meeting all the requirements stated herein, and Artist shall ensure that
City is an additional insured on insurance required from subcontractors.
10. 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.
RELEASE
Artist, on behalf of Artist, accepts any City -provided equipment used in connection with
the performance in their "as -is" condition, with all faults. Artist, on behalf of Artist, 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 City -provided equipment or Artist's use thereof.
S. INDEMNIFICATION
Artist agrees to defend, and shall indemnify 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 Artist or its subcontractors, agents, employees, or other persons acting
on their behalf which relates to the services described in section 1 of this 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. 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. The Artist further
agrees to indemnify, hold harmless, and pay all costs for the defense of the City, including fees
and costs for special counsel to be selected by the City, regarding any action by a third party
challenging the validity of this Agreement, or asserting that personal injury, damages, just
compensation, restitution, judicial or equitable relief due to personal or property rights arises by
reason of the terms of, or effects arising from this Agreement. City may make all reasonable
decisions with respect to its representation in any legal proceeding. Notwithstanding the foregoing,
to the extent Artist's services are subject to Civil Code Section 2782.8, the above indemnity shall
be limited, to the extent required by Civil Code Section 2782.8, to claims that arise of, pertain to,
or relate to the negligence, recklessness, or willful misconduct of the Artist.
9. INTELLECTUAL PROPERTY INDEMNIFICATION
Artist shall defend, indemnify and hold harmless the City, its officers, agents,
representatives, and employees against any and all liability, including costs, and attorney's fees,
Page 5 of 10
for infringement of any United States' letters patent, trademark, or copyright contained in the work
product or documents provided by Artist to the City pursuant to this Agreement.
10. RECORDS
Artist shall keep records and invoices in connection with the work to be performed
under this Agreement. Artist shall maintain complete and accurate records with respect to the
costs incurred under this Agreement and any services, expenditures, and disbursements charged to
the City for a minimum period of three (3) years, or for any longer period required by law, from
the date of final payment to Artist under this Agreement. All such records and invoices shall be
clearly identifiable. Artist shall allow a representative of the City to examine, audit, and make
transcripts or copies of such records and any other documents created pursuant to this Agreement
during regular business hours. Artist shall allow inspection of all work, data, documents,
proceedings, and activities related to this Agreement for a period of three (3) years from the date
of final payment to Artist under this Agreement.
11. CONFIDENTIALITY
If Artist receives from the City information which due to the nature of such information is
reasonably understood to be confidential and/or proprietary, Artist 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. 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 Artist disclosed in a
publicly available source; (c) is in rightful possession of the Artist without an obligation of
confidentiality; (d) is required to be disclosed by operation of law; or (e) is independently
developed by the Artist without reference to information disclosed by the City.
12. CONFLICT OF INTEREST CLAUSE
Artist covenants that it presently has no interest and shall not have interests, direct or
indirect, which would conflict in any manner with performance of services specified under this
Agreement.
13. 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:
Page 6 of 10
To City: Clerk of the City Council
City of Santa Ana
20 Civic Center Plaza (M-30)
P.O. Box 1988
Santa Ana, CA 92702-1988
Fax: 714- 647-6956
With copy to: Executive Director
Parks, Recreation, and Community Services Agency
City of Santa Ana
20 Civic Center Plaza (M-23)
P.O. Box 1988
Santa Ana, California 92702
To Artist: Robert Gutierrez dba Lighter Shade of Brown
1941 California Ave., Unit 78633
Corona, CA 92877
951-206-9837
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
timeframes, weekends, federal, state, County or City holidays shall be excluded.
14. EXCLUSIVITY AND AMENDMENT
This Agreement represents the complete and exclusive statement between the City and
Artist 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
Artist. 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 Artist or the City. Each party to this Agreement acknowledges that no representations,
inducements, promises or agreements, orally or otherwise, have been made by anyparty, or anyone
acting on behalf of any party, which are not embodied herein.
15. ASSIGNMENT
Inasmuch as this Agreement is intended to secure the specialized services of Artist, Artist
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
Page 7 of 10
prior written consent shall be considered null and void. Nothing in this Agreement shall be
construed to limit the City's ability to have any of the services that are the subject to this Agreement
performed by City personnel or by other consultants retained by City.
16. WAIVER
No waiver of breach, failure of any condition, or any right or remedy contained in or
granted by the provisions of this Agreement shall be effective unless it is in writing and signed by
the party waiving the breach, failure, right or remedy. No waiver of any breach, failure or right, or
remedy shall be deemed a waiver of any other breach, failure, right or remedy, whether or not
similar, nor shall any waiver constitute a continuing waiver unless the writing so specifies.
17. TERMINATION
This Agreement may be terminated by the City upon thirty (30) days written notice of
termination. In such event, Artist shall be entitled to receive and the City shall pay Artist
compensation for all services performed by Artist prior to receipt of such notice of termination,
except that payment need not be made for work that fails to meet the standard of performance
specified in the Recitals of this Agreement.
18. NON-DISCRIMINATION
Artist 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. Artist affirms that it is an equal opportunity employer and shall comply with all
applicable federal, state and local laws and regulations.
19. 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.
20. PROFESSIONAL LICENSES
Artist 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. Artist shall notify the City immediately and in
writing of its inability to obtain or maintain such permits, licenses, approvals, waivers, and
exemptions. Said inability shall be cause for termination of this Agreement.
Page 8of10
N-2022-232
21. MISCELLANEOUS PROVISIONS
a. Each undersigned represents and warrants that its signature herein below has the
power, authority and right to bind their respective parties to each of the terms of
this Agreement, and shall indemnify City fully, including reasonable costs and
attorney's fees, for any injuries or damages to City in the event that such authority
or power is not, in fact, held by the signatory or is withdrawn.
Artist represents and warrants that it is in compliance and will maintain
compliance with all applicable laws including, but not limited to, the California
Talent Agency Act.
C. All exhibits referenced herein and attached hereto shall be incorporated as if fully
set forth in the body of this Agreement.
In the event of any conflict or inconsistency between the terms and conditions in
this Agreement and any terms or conditions set forth in any Exhibit, purchase
order, or other document relating to the transactions contemplated by this
Agreement, the terms and conditions set forth in this Agreement shall prevail.
e. This Agreement is the final and complete agreement and any prior or
contemporaneous agreement(s) for similar services between the parties is
superseded by this Agreement.
IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first
above written.
ATTEST:
D
DAISY GOMEZ
4,-Clerk of the Council
APPROVED AS TO FORM
SONIA R. CARVALHO
City Attorney
By:
randon Salvatierra
Deputy City Attorney
CITY OF SANTA ANA
STINE RIDGE
City Manager
ARTIST
4� �--
rt ti ez dba Lighter Shade of
Brown
[signatures continued on next page]
Page 9 of 10
I
Hawk Scott
Executive Directo
Parks, Recreation, d Co::xl<ty Services Agency
Page 10 of 10
EXHIBIT A
Exhibit A
SCOPE OF SERVICES
VENDOR INFORMATION:
Robert Gutierrez (Lighter Shade of Brown)
1941 California Ave., Unit 78633
Corona, CA. 92877
(951)206-9837
EVENT: Chicano Heritage Festival
SERVICE DATE(S): August 28, 2022 (Set time: TBD)
COMPENSATION DUE TO THE VENDOR: $3,000 as follows: Deposit of $1,500 upon fully
executed agreement and $1,500 due the day of the event.
DESCRIPTION:
Lighter Shade of Brown will be providing entertainment services for the city of Santa Ana's 2022
CHICANO HERITAGE FESTIVAL EVENT taking place August 28, 2022. The event will take
place at El Salvador Park, 1825 West Civic Center Dr. Santa Ana, CA 92701.
TracyDigitally signed by
Traglambs
Jacobs Dale:zgz2.DA14
121136-2.0
A� CERTIFICATE OF LIABILITY INSURANCE °"08122J"w`z0" z"
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 pollcy(les) must be endorsed. If SUBROGATION IS WANED, subject to the
terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer fights to the
certificate holder In lieu of such endorsement(s).
PaooucER
coveter
r L- Insurance Canopy Program Support
Insurance Canopy
Pg oxB .844520.6993 F .801-763-1374
PO Box 34833
inro(o3insurancecenopy.com
North Chesterfield VA 23234
INSUMISAPFOMMOCDVEMGE
Mee
—..
NSUMA: Great American E&S Insurance Company
26832
—..
IRWM
WaIraEN a:
Robed Gutierrez, DBA Lighter Shade of Brown
WSURER e:
1227 Aspenwood Ave
NBURER o:
Corona CA 92881
MSDRERE:
WSMFR F:
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 POUCHES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
pjp
TYPEOFMSUMM
onmisnal
Poll MMBM
1 Wp
aPo04➢
UNIS
OM MLWBIll1Y
EACH OCCURRENCE
s 1,090.000
A COMMERCLLLGENEROLLIFBnIiT
CRAIMSM^DE OCCUR
r
♦
PREM19E8 axu,mm
S 300,000
NgMEYPINryme Peon]
5,000
A
PLE676887-CDJA76000
02/02M2022
02/02Y2023---
PERSONA- SAW INJURY
_s
5 1,000,000
GENETALAGGREMTE
5 2,000,000
GENL AGGREWTEGMRMRJES PFA:
PROOLCTS-OOMaoFAGG
5 2.000.000
5 POMCT PF0. LOC
ANIMAL BNLEE
S
AUTOMOBILE
UPOUTY
rr
ECUae sINGLEUMff
5
BODILYINJURYIPxpemn)
S
ANY MTO
AU -Mal
FR
LY IPnblat)
OIIvIrrO
FNED
HREDAUTOS UT
ar9LED
F
5
S
VMBREU —
OCCUR
F—Ir
EACHCCCURRENCE
b
gGGREGAIE
5
ExcESS wV
CIAIMSMADE
DED REIEMION5
S
WORXFNSGOMPE mmm
WC STAl4 Oii4
AHO ('MPLDYFRS'WBIRPY YIN
ANYPROPRETOWPARNEWECECIrm£
OFFILEAIEMaFF FXCU-DEDY ❑
NIA
EL EACH ACCIDENT
s
EL DISEASE -FA EMR
S
IM"Meary In an
Irneemmeeunre
ELDI6E45E- PCLICYIWn
S
rr
DESCRcate OFOPEMTO p1tlMAeOM tar ing 6NMUIgN
Certificate had been aftacatl
oona degas additionalthe bone
as regarding the above men8onetl policy per aHached
Orga insured policyaa per
Insureheld.
ted P
Person
n or (CG 2 13)
Additional Insured-utory&
bOrganization(CG20er Notice
Waiver
Primary, Nonwnldbubry & Waiver of SubragaUon applies. Earlier Notice of Cancella8an Provided by Us applies
a
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Santa Ana
ACCORDANCE WITH THE POLICY PROVISIONS.
nter Plaza Santa Ana, CA 92701
Es
CA 92701
AIMMONED REPRESENTATIVE 77
l c
01988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014/01) The ACORD name and logo are registered marks Of ACORD
INS02519vail
y� X1i[MawgmleiDallimL
j`9_.Ies� �T& REVIEWED6A°PROVEO BY:
® Risk Manager ent Analyst
PLE676887-CDJA76000
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):
The City of Santa Ana
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
CG 20 26 (Ed. 04 13)
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.
Copyright, ISO Properties, Inc., 2012
CG 20 26 (Ed. 04113) PRO (Page 1 of 1)
o ; REVIE &APPROVEDBY:
T4&1 Jeu+(r,
RURMar.gemen[Analysr
Gte> nrq yr
INSURANCE GROUP
Policy Number: PLE676887-CDJA76000
Effective Date of Change: 08/22/2022
BUSINESSPRO POLICY CHANGES
NAMED INSURED AND ADDRESS:
POLICY PERIOD:
Robert Gutierrez
12:01 A.M. STANDARD TIME AT THE ADDRESS OF
DBA: Lighter Shade of Brown
THE NAMED INSURED SHOWN AT LEFT.
1227 Aspenwood Ave
Corona, CA 92881
FROM: 02/02/2022 TO: 02/02/2023
THIS ENDORSEMENT CHANGES
BROKER NAME AND ADDRESS:
THE POLICY.
Insurance Canopy
PO Box 34833
PLEASE READ IT CAREFULLY.
North Chesterfield, VA 23234
INSURANCE IS AFFORDED BY THE COMPANY INDICATED BELOW:
(EACH A CAPITAL STOCK CORPORATION)
( ) GREAT AMERICAN INSURANCE COMPANY ( ) GREAT AMERICAN ASSURANCE CO.
( ) GREAT AMERICAN ALLIANCE INS. CO. ( ) GREAT AMERICAN INSURANCE CO. OF NY
(X) GREAT AMERICAN E & S INSURANCE COMPANY
In consideration of the additional premium of $20.00 plus a BHTA Fee of $20.00, for a total of
$40.00, it is hereby understood and agreed that the following form has been added to the policy
mentioned above:
❑ Additional Insured —Vendors CG2015 (Ed. 04 13) with primary and noncontributory wording
O Additional Insured — Designated Person or Organization CG 20 26 (Ed. 04/13) with primary and
noncontributory wording
0 Primary and Noncontributory— Other Insurance Condition CG 20 01 (Ed. 04 13)
PI Waiver of Transfer of Rights of Recovery Against Others to Us CG 24 04 (Ed. 05 09)
❑ Trailer Endorsement — Amendment to Exclusion -Aircraft, Auto or Watercraft CG 88 02 (Ed. 11 85)
❑ Increase Inland Marine Limits to $ (maximum payout for any one article) / $ (annual aggregate)
❑ Increase Aggregate Limits to $2M
❑ General Endorsement — Professional Coverage Extension CG 88 02 (Ed. 11 85)
❑ Loss Payable Provisions — CM 78 70 (Ed. 06 92)
All other terms and conditions remain the same.
RiJeMvvgaw,dDb,:m.
RenEw &APPR Br.
® Rnk Management Malyst
CG 20 01 (Ed. 04 13)
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
The following is added to the Other Insurance
Condition and supersedes any provision to the
contrary:
Primary and Noncontributory Insurance
(1) the Additional Insured is a Named Insured
under such other insurance; and
(2) you have agreed in writing in a contract or
This insurance is primary to and will not agreement that this insurance would be
seek contribution from any other insurance primary and would not seek contribution from
avail- able to an additional insured under any other insurance available to the
your policy provided that: Additional Insured.
Copyright, ISO Properties, Inc., 2012
CG 20 01 (Ed. 04/13)
CG 24 04
(Ed. 05 09)
^^,.s xakMa.B�eaomra�
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. '�=;_� ee"Ewmi/NrR°vmBv:
8 - i l"w y 44"4
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US ' '' Ruk Manaae nt MaMk
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
Name of Person or Organization:
The City of Santa Ana
20 Civic Center Plaza Santa Ana, CA 92701
Santa Ana, CA 92701
Information required to complete this Schedule, if not shown above, will be shown in the
Declarations.
The following is added to paragraph8. 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 (Ed. 05/09) Copyright, ISO Properties, Inc., 2008
PRO (Page 1 of 1)
s MwWwaDWAa
®: 74" J"
® Ruk Management MalFst
CITY OFSANTA ANA
RISK MANAGEMENT* (*dates 4HuMAN REsouRCEs
Managing Risk owuoh PoMv Change
WORKERS' COMPENSATION DECLARATION
I, EQlreNL,4 -P�e hereby affirm under penalty of perjury, the
(Name/Title)
following declaration:
I certify on behalf of i 511 P'� 56/L n4gOtIO that during the term
(ConsultanVCompany Name)
of my contract for JJVM rv)( e services with the City of Santa Ana,
(Type of semice provided)
I will not employ any person in any manner so as to become subject to the workers'
compensation laws of California, and agree that if I should become subject to the
workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with the provisions and provide proof of workers' compensation coverage
immediately.
Date: ': N 1707 7_
Print Name:
Print Title:
Signature:
Telephone: Q
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.
I.Mlsk MgmAinsurance RequimmentslM Dedararion 09152019
_p., REv �� fi�ol% .
T.y Jrwo�a
94�� Risk tAanagement Analyst