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HomeMy WebLinkAboutTORRES, MARTIN (4)INSURANCE NOT ON FILE MAYOR WORK MAY NOT PROCEED Valerie Amezcua CITY CLERK MAYOR PRO TEM DATE: Jessie Lopez COUNCILMEMBERS Phil Bacerra Johnathan Ryan Hernandez David Penaloza Thai Viet Phan Benjamin Vazquez D PRcs A (0) (S.5Aud 11vSorndwAl)f'4- August 29, 2023 CITY OF SANTA ANA PARKS, RECREATION, & COMMUNITY Mr. Martin Tones 2421 E. Edinger Ave. PMB #1240 Santa Ana, CA 92704 SERVICES AGENCY 20 Civic Center Plaza — M25 Santa Ana, California 92702 www.santa-ana.ora N-2022-256-01 Re: Extension of Agreement #N-2022-256 for Recreation Class Services Dear Mr. Torres: CITY MANAGER Kristine Ridge CITY ATTORNEY Sonia R. Carvalho CITY CLERK Jennifer L. Hall Pursuant to Section 3 ("Term") of the Agreement between Martin Tones ("Provider") and the City of Santa Ana, dated September 1, 2022, the term of the Agreement is hereby extended through June 30, 2024. All other terms and conditions of said Agreement remain unchanged and in full force and effect. Sincerely, aw c Scott Ex utie�ve Dire tor, Parks, Recreation, & Community Services Agreement CITY OF SANTA ANA Kristine Ridge City Manager APPROVED AS TO FORM 'Orfi-don Salvatierra Deputy City Attorney ATTEST PROVIDE Y.- Title: SANTA ANA CITY COUNCIL Valerie Amezaa Jessie Lopez Thal Viet Phan Benjamin Vazquez Phil Sahara JohnaNan Ryan Hernandez Daiwa Pmaloza Mayor Mayor Pro Tam, Ward 3 Word Want Wards Want Ward ymon.srdsanlaananra essleloneArs5anlaana ara lohan(aisonla-ana am thazouotilyanla-anan pbacena(olsanla-ahem IrvantomindheA..taamsern dpenalozahlsaniaanama Trac Digitally signed Y by TracyJacobs 4U O CERTIFICATE OF LIABILITY INSURANCE Jacobs D5: 1ale B405Y1��DIZ YYY) 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 Maguire Insurance Agency, Inc. FWI 1 Bala Piz Ste 100 Bala Cynwyd, PA 19004-1401 810.817.7WO NAME: PHONE (A/C, No, Exh: FAX (A/C, Ni EMAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC# INSURER A: Philadelphia indemnity Insurance Company ifawa INSURED INSURER B: mtorresalvarez 2222 S Mahawk Avo " INSURER C: INSURER D : Santa Are, CA 92704 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR AODL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER IMMIDD/YYYY) (MMIDDIYYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY X PHPK2324258001 09/O9/2022 MM912023 EACH OCCURRENCE $1,000,000 CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES (Ea occurcence) $100,000 X MED EXP (Anyone person) $2.500 PROFESSIONAL LIABILITY PERSONAL &ADV INJURY $1,000,000 GEN'L GENERAL AGGREGATE $3,000,000 AGGREGATE LIMIT APPLIES PER: POLICY El PROJECT ❑LOC X PRODUCTS - COMP/OP AGO $3,000,000 OTHER AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per parson) $ ANY AUTO OWNED AUTOS SCHEDULED AUTOS ONLY BODILY INJURY Penal $ HIREDAUTOS PROPERTY DAMAGE HNON,DWINED ONLY AUTOSONLY (Per accident) Is UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR CLAIMS -MADE DED RETENTION$ PER OTHER AND EMPS YERSILIATION AND ILIT YIN STATUTE ROPRIEERRIPART ERV ARTNEDEXECUTIVE ANYICERIM NIA MBER OFFICERIMEMBER EXCLUDED? E. L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) f yes, describe under E,L. DISEASE ' POLICY LIMIT $ DESCRIPTION OF OPERATIONS be. A X SEXUAL ABUSEAND MOLESTATION LIABILITY PAPK2324258,001 09/09/2022 09/09/2023 EACH OCCURENCE $100,000 AGGREGATE $300000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) It is understood and agreed that the following entity's added as an additional insured but only with respects) to the operations of the named insured except that liability resulting from the addifimul Insured'. ..Is negligence. CERTIFICATE HOLDER CANCELLATION City of Santa Ana, Parks, Recreation and Community Services 20ACanter Piz SHOULDANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE SantantaAna, CA 92701-4058 EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 9 I 9E t � 6n +)4-� r REVIEWED^&APPRotVED BY: eiidi t n Risk Maa emen © 1988-2015 ACORD C( `� Analyst ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD NOTICE OF COMPLIANCE CITY STAFF: PRINT THIS PAGE AND INCLUDE WITH AGREEMENT TO THE CLERK OF THE COUNCIL Contractor Martin Torres - Karate Do Kiai Name: Project N-2022-256 & N-2022-256-01 Number: Project Recreation Services Agreement - Martin Torres Karate Do Kiai Name: The Certificate of Insurance (COI) submitted indicates that the coverages are in compliance with the insurance requirements. No further action is required at this time. The compliant coverage(s) are: POLICY EXPIRATION TYPE OF INSURANCE COI DATE FILE NAME NUMBER DATE City of Santa Ana - Martin GENERAL LIABILITY 18LB4968 01/01/2024 08/15/2023 Torres - Karate Do Kiai.pdf City of Santa Ana - Martin SEXUAL ABUSE 18LB4968 01/01/2024 09/06/2023 Torres - Karate Do Kiai.pdf WC 2023-24 WORKERS COMPENSATION AND WAIVER 09/06/2024 09/25/2023 COI EMPLOYERS' LIABILITY Renewal.pdf Thank you, City of Santa Ana Risk Management Division in partnership with CTrax Plus Services Team 9/25/2023 11:58 AM