Loading...
HomeMy WebLinkAboutSWIM BRAYV FOUNDATIONINSURANCE ON FILE WORK MAY PROCEED UNTIL INSURANCE EXPIRES S11D,a-C CITY CLERK DATE: JUN 10 2024 a P ecs P, C 7 CITY OF SANTA ANA (s. OA%rd14s AGREEMENT WITH SWIM BRAYV FOUNDATION TO PROVIDE DROWNING PREVENTION PROGRAMMING FOR CITY EVENTS N-2024-191 THIS AGREEMENT is made and entered into this 16th day of May 2024, by and between Swim Brayv Foundation, a California nonprofit corporation ("Contractor"), and the City of Santa Ana, a charter city and municipal corporation organized and existing under the Constitution and laws of the State of California ("City"), each a "Party" or collectively "Parties." RECITALS A. The City desires to retain a contractor to provide special programming for various City events, including the City's Summer Splash Day Camp, Kids Night Out, Afterschool Programs, and other events ("Events") as directed by the City. B. Contractor represents that it is able and willing to provide such services to the City. C. In undertaking the performance of this Agreement, Contractor represents that it is knowledgeable in its field and that any services performed by Contractor under this Agreement will be performed in compliance with such standards as may reasonably be expected from a professional contracting firm in the field. 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. As needed, Contractor shall, during the term of this Agreement, provide the equipment and personnel to provide the services as further described and set forth in Exhibit A, attached hereto and incorporated in full, at dates, times, and locations as mutually agreed upon by the Parties in a signed writing. b. City grants Contractor the right to enter its property for the purpose of delivery, set- up, operation, and pick-up on the days of the scheduled Events. C. The equipment shall be disassembled and removed by Contractor at the conclusion of each Event. d. City shall have the sole discretion as to engagement of Contractor for services/events not detailed in Exhibit A. The City reserves the right to administratively change event locations, dates, or services for any mutually agreed upon services/events. 2. COMPENSATION a. City neither warrants nor guarantees any minimum compensation to Contractor Page 1 of 10 under this Agreement. Contractor shall be paid only for actual services performed under this Agreement at the rates and charges identified in Exhibit A. The total amount to be expended under this Agreement shall not exceed Five Thousand Dollars and 00/100 ($5,000) b. Payment by City shall be made within forty-five (45) days of Event following receipt of proper invoice evidencing work performed, subject to City accounting procedures. City and Contractor agree that all payments due and owing under this Agreement shall be made through Automated Clearing House (ACH) transfers. Contractor agrees to execute the City's standard ACH Vendor Payment Authorization and provide required documentation. Upon verification of the data provided, the City will be authorized to deposit payments directly into Contractor's account(s) with financial institutions. C. 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. fal10001WIiMA This Agreement shall commence on June 1, 2024, and terminate on May 31, 2025, unless terminated earlier in accordance with Section 17, below. 4. PREVAILING WAGES Contractor is aware of the requirements of California Labor Code Section 1720, et seq., and 1770, et seq., as well as California Code of Regulations, Title 8, Section 16000, et seq., ("Prevailing Wage Laws"), which require the payment of prevailing wage rates and the performance of other requirements on "public works" and "maintenance" projects. If the services being performed are part of an applicable "public works" or "maintenance" project, as defined by the Prevailing Wage Laws, and the total compensation is $1,000 or more, Contractor agrees to fully comply with such Prevailing Wage Laws. Contractor shall defend, indemnify and hold the City, its elected officials, officers, employees and agents free and harmless from any claim or liability arising out of any failure or alleged failure to comply with the Prevailing Wage Laws, 5. INDEPENDENT CONTRACTOR Contractor 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 Contractor performs the services which are the subject matter of this Agreement; however, the services to be provided by Contractor shall be provided in a manner consistent with all applicable standards and regulations governing such services. Contractor 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. Page 2 of 10 6. OWNERSHIP OF MATERIALS This Agreement creates a non-exclusive and perpetual license for City to copy, use, modify, reuse, or sublicense any and all copyrights, designs, and other intellectual property embodied in plans, specifications, studies, drawings, estimates, and other documents or works of authorship fixed in any tangible medium of expression, including but not limited to, physical drawings or data magnetically or otherwise recorded on computer diskettes, which are prepared or caused to be prepared by Contractor under this Agreement ("Documents & Data"). Contractor shall require all subcontractors to agree in writing that City is granted a non-exclusive and perpetual license for any Documents & Data the subcontractor prepares under this Agreement. Contractor represents and warrants that Contractor has the legal right to license any and all Documents & Data. Contractor makes no such representation and warranty in regard to Documents & Data that were provided to Contractor by the City. City shall not be limited in any way in its use of the Documents & Data at any time, provided that any such use not within the purposes intended by this Agreement shall be at City's sole risk. 7. INSURANCE Prior to undertaking performance of work under this Agreement, Contractor shall maintain and shall require its subcontractors, if any, to obtain and maintain insurance, as described below, for the entire Term of this Agreement, against claims for injuries to persons or damage to property which may arise from or in connection with services, products and materials supplied to City. Total cost of such insurance shall be borne by Contractor. a. Minimum Scope and Limit of Insurance (1) Commercial General Liability (CGL). Insurance Services Office ("ISO") 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 and $2,000,000 aggregate. (2) Automobile Liability. ISO Form CA 00 01 covering Code 1 (any auto), with limits no less than $1,000,000 per accident for bodily injury and property damage. (3) Workers' Compensation. As required by the State of California, with Statutory Limits, and Employer's Liability Insurance with limit of no less than $1,000,000 per accident for bodily injury or disease. Coverage is not required if Contractor has no employees and signs request to waive. (4) Sexual Abuse or Molestation Liability (SAML). If the work will include contact with minors, and the CGL policy referenced above is not endorsed to include affirmative coverage for sexual abuse or molestation, Contractor shall Page 3 of 10 obtain and maintain a policy covering Sexual Abuse and Molestation with a limit of no less than $1,000,000 per occurrence or claim. (5) Broader Coverage. If the Contractor maintains broader coverage and/or higher limits than the minimums shown above, the City requires and shall be entitled to the broader coverage and/or the higher limits maintained by the Contractor. Any available insurance proceeds in excess of the specified minimum limits of insurance and coverage shall be available to the City. b. Other Insurance Provisions The above required insurance policies are to contain or be endorsed to contain the following provisions: (1) Additional Insured Status. The City, its officers, officials, employees, and volunteers are to be covered as additional insureds on the above required policies with respect to liability arising out of work or operations performed by or on behalf of the Contractor including materials, parts, or equipment furnished in connectionwith such work or operations. (2) Waiver of Subrogation. Contractor shall require its insurance company(ies) to waive all rights of subrogation against the City, its City Council, its officers, officials, employees, agents, and volunteers for losses paid under the terms of any policy which arise from work performed by Contractor under this Agreement. (3) Primary Coverage. For any claims related to this Agreement, Contractor's insurance coverage shall be primary and any insurance maintained by City, its City Council, its officers, officials, employees, agents, or volunteers shall not contribute with it. (4) Severability. A severability of interest provision must apply for all the additional insured, ensuring that Contractor's insurance shall apply separately to each insured against whom a claim is made or suit is brought, except with respect to the insurer's limits of liability. __(5_) Cancellation._ -Insurance _policy(ics)_herein shall _provide -that -coverage shall not _ be canceled, suspended, voided, reduced in coverage or in limits, non -renewed by the carrier, or materially changed except after thirty (30) days prior written notice has been given to City. Ten (10) days prior written notice shall be provided to City for policy cancellation or non -renewal due to non-payment. (6) Certificate Holder. The Certificate Holder on each evidence of insurance certificate shall be: City of Santa Ana, Attention: (Name of Department Staff Responsible for Agreement), 20 Civic Center Plaza M-XX (Responsible Staff's Department Mail Box), Santa Ana, CA 92701. The name and location Page 4 of 10 of event should be included in the description of operations section of each certificate. C. 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. d. Verification of Coverage. Contractor 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 allpolicy endorsements to City before work begins. However, failure to obtain the required documents prior to the work beginning shall not waive the Contractor'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. e. Special Events Coverage. Special events coverage is available and can be purchased by Contractor. Use this link to learn more: www.2snarta.com Special Risks or Circumstances. City reserves the right to modify these requirements, including limits, based on the nature of therisk, prior experience, insurer, coverage, or other special circumstances. 8. INDEMNIFICATION Contractor agrees to defend, and shall indemnify and hold harmless the City, its officers, agents, employees, contractors, 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 Contractor or its subcontractors, agents, employees, or other persons acting on their behalf which relates to the services described in section I 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 Contractor 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 Contractor's services are subject to Civil Code Page 5 of 10 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 Contractor. 9. INTELLECTUAL PROPERTY INDEMNIFICATION Contractor represents and warrants that it has obtained the requisite licenses to show the films contemplated by this Agreement. Contractor further agrees to defend, indemnify and hold harmless the City, its officers, agents, representatives, and employees against any and all liability, including costs, and attorney's fees, for infringement of any United States' letters patent, trademark, or copyright contained in the work product or documents provided by Contractor to the City pursuant to this Agreement. 10. RECORDS Contractor shall keep records and invoices in connection with the work to be performed under this Agreement. Contractor 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 Contractor under this Agreement. All such records and invoices shall be clearly identifiable. Contractor 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. Contractor 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 Contractor under this Agreement. 11. CONFIDENTIALITY If Contractor receives from the City information which due to the nature of such information is reasonably understood to be confidential and/or proprietary, Contractor 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_nondiselosure_shall _not -apply _toany information that (a) has been disclosed in publicly available sources; (b) is, through no fault of the Contractor disclosed in a publicly available source; (c) is in rightful possession of the Contractor without an obligation of confidentiality; (d) is required to be disclosed by operation of law; or (e) is independently developed by the Contractor without reference to information disclosed by the City. 12. CONFLICT OF INTEREST CLAUSE Contractor covenants that it presently has no interest and shall not have interests, direct or Page 6 of 10 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: To City: City Clerk City of Santa Ana 20 Civic Center Plaza (M-30) P.O. Box 1988 Santa Ana, CA 92702-1988 Fax 714- 647-6956 Executive Director Parks, Recreation, and Community Services Agency City of Santa Ana 20 Civic Center Plaza (M-23) P.O. Box 1988 Santa Ana, CA 92702 To Contractor: Swim Brayv Foundation Attn: Candace Thome, Founder 5701 Santa Catalina Ave. Garden Grove, CA 92845 candace.thomena,swimbravv.org 702-969-9678 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, duty 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 timeftames, 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 Contractor 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 Page 7 of 10 modified except by written instrument signed by the City and by an authorized representative of Contractor. 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 Contractor 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 are not embodied herein. 15. ASSIGNMENT Inasmuch as this Agreement is intended to secure the specialized services of Contractor, Contractor 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. 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 contractors 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, Contractor shall be entitled to receive and the City shall pay Contractor compensation for all services performed by Contractor prior to receipt of such notice of termination, subject to the following conditions: a. As a condition of such payment, the Executive Director may require Contractor to deliver to the City all work product completed as of such date, and in such case, such work product shall be the property of the City unless prohibited by law, and Contractor consents to the City's use thereof for such purposes as the City deems appropriate. b. 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 Contractor 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, Page 8 of 10 promotion, termination or other employment related activities or any services provided under this Agreement. Contractor 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 Contractor 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. Contractor 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 tennination of this Agreement. 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. b. All exhibits referenced herein and attached hereto shall be incorporated as if fully set forth in the body of this Agreement. [signature page follows] Page 9 of 10 N-2024-191 SIGNATURE PAGE FOR AGREEMENT WITH SWIM BRAYV FOUNDATION TO PROVIDE DROWNING PREVENTION PROGRAMMING FOR CITY EVENTS lN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first above written. ATTEST: APPROVED AS TO FORM SONIA R. CARVALHO City Attorney By: 'Blindon Salvatierra Deputy City Attorney FOR APPROVAL )Sreho— Hawk Scott (May 17, 202412:04 P011 Hawk Scott Executive Director Parks, Recreation, and Community Services Agency CITY OF S wwTA ANA hJ Alvaro Nunez Acting City Manager CONTRACTOR Candace Thome (May 17, 202411:47 PDT) Candace Thome Founder Page 10 of 10 EXHIBIT A Exhibit A SCOPE OF SERVICES VENDOR INFORMATION: Swim Brayv EVENT: Summer Splash Day Camp, Kid's Night Out, & Afterschool Programs SERVICE DATE(S): Swim Brayv is a drowning prevention nonprofit that will provide one -hour special programming during dates, times, and locations that will be mutually agreed upon in writing by each ply. COMPENSATION DUE TO THE VENDOR: Vendor not to exceed $25,000 for the year. Compensation for events be agreed upon in a signed writing between the parties. DESCRIPTION: Swim Brayv is a drowning prevention nonprofit that will provide one -hour special programming at Summer Splash Day Camp, Kid's Night Out, and Afterschool Programs at the following centers. Our 1 hour presentation reviews the Swim BRAYV Pledge -which consists of easy to-do, proactive water safety tips & knowledge. We then have the attendees interact with the mermaid through engaging conversations and a learning game - where fun prizes are available to each attendee. The presentation can be tailored for ages 3 to 18+. We bring a 2ft wide banner, 4ft table & cloth, a chair for the mermaid, educational handouts, an interactive standing game and prizes! El Salvador Community Center Jerome Community Center Salgado Community Center Garfield Community Center Roosevelt Walker Community Center Special programming will be held at each site with vendor and city seasonal staff for a period of 1 hour with 30 minutes to 1 hour for set-up and take -down. Program Needs: Private changing area for the mermaid, ADA accessible pathway from changing area to site location (to move the mermaid around), Appx 1 Ox10 site location space (Canopy/Shade needed if outside) The Vendor will be paid the full amount of compensation, within 45 days of each event. Established and confirmed events: 3 sessions on Friday 6/07/24: 10:30am-11:30am Jerome Center (60 campers) 1:OOpm-2:OOpm Salgado Center (60 campers) 3:OOpm-4:OOpm El Salvador Center (30 campers) Total per session: $125 CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 04/30/2024 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: It 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 Hiscox Inc. d/b/a/ Hiscox Insurance Agency in CA NAME: PNONE (ggg) 202-3007 ac No 5 Concourse Parkway E-MAIL Suite 2150 AD ss: conn'tIIct@hiscox. m Atlanta GA, 30328 A Y1 �y �� D I .T RDING COVERAGE NAIC# INSURED — — — Swim Brayv 5701 Santa Catalina Gard Acevedo Garden Grove, CA 928 COVERAGES CERTIFICATE NUV317A: Inc :7 AT 169 P7 7. I I Lfi I l l A iDYDDI 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 TYPEDFINSURANCE ADDLSUBR INSD wvo POLICYNUMBER POLICY EFF MMIDD/YYYY POLICY EXP MMIDO LIMITS X COMMERCUILGENERAL LIABILITY EACH OCCURRENCE $ 1,000000 CLAIMS -MADE AIMS -MADE FIOCCUR DAMAGETO S(RENTED PREMISES Ea occurrence) $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL B ADV INJURY $ 1,000,000 A Y Y P102.732.064.3 05/10/2024 05/10/2025 BERL AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 2,000,000 X POLICY JEC �LOC PRODUCTS - COMP/OP AGG $SIT Gen. Agg. $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident)$ NON-0WNED HIRED AUTOS AUTOS PROPERTYDAMAGE Par accident $ UMBRELLA UAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR CLAIMS -MADE DIED I I RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN PER OTH- STATUTE ER E.L. EACH ACCIDENT $ ANYPROPRIETORIPARTNEWEXECUTIVE ❑NIA OFFICERIMEMBEREXCLUDED? E.L. DISEASE -EA EMPLOYE $ (Mandatary In NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT 1 $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule, may be abashed if more space is required) City of Santa Ana Risk Management Divisions be covered as additional insured on the Commercial General Liability with respect to liability arising out of work or operations performed by or on behalf of the premity including materials parts or equipment furnished in connection with such work or operation City of Santa Ana Risk Management Divisions 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 PRC @ 1988-2015 ACORD g., Risk MmugtmmtDhislan ry ge REviEWED&APPROVEDB/Y.- Risk Management Spedalist 00 ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Auto Liability (Non -Use Agreement) Date 5 / (� / ZA 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: SWtMhas intent to enter into an agreement with the City of Santa Ana. Throughout the course of this agreement CAe, dv.� attests to the following: 1. V,,) (ny�/ will not use/drive anyvehicle during the course and scope of the service 3 provided in the agreement contract 2. Sv\j j fA CAVV will not use any owned/rented/leased vehicles during thecourse aM scope of the services provided in the agreement/contract. 3. �j ft\�WAJ_q consultants/independent contractors/employees utilize their personal vehi es/noncompany owned, borrowed, or rented/leased vehicles for transportation to and from work and if applicable carry their own automobile insurance. "� imp By signing below, I, eplSytt�1G'C..��� "'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 is not adhering to any/ail statements in this document and has not provided the minimum Auto liability insurance coverage of $1 million per occurrence, the contract will be considered null and void andthe company will be held fully liable for any and all damages. Signature: k Name: Job Title: C r^�� Company Name: li _ Contact Phone: C " fV\ S(-�1 J� Email Address: ­ U 1-C && ` `�j./1 ,,,g. KIdrM�nm,�,IpR ,y '� REVIEWED6 APPROV®BY: `S gy�Aza ;n 1ll�+. Risk Mznagement Spedalisl CITYOFSANTAANA RI5K MANAGEMENT a division of HUMAN RESOURCESn Managing Rl* dvwptPosidw Change Affidavit of Exemption for Workers' Compensation Insurance Founder, Candace Thorne (Name/Title) following declaration: I certify on behalf of Swim Brayv hereby affirm under penalty of perjury, the that during the term (Consultant/Company Nome) of my contract for Edutainment Presentation services with the City of Santa Ana, (Type of service 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: 03/13/24 Print Name: Candace Thome Print Title: Exec Dir and founder Signature: Telephone: 70 2-9 69-9 678 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. I:\Risk Mgmt\Insurance Requirements\Affidavit of Exemption for Workers' Compensation Insurance 9r� Risk hknaMera:Dwislan REVIEWED &APPROVEDBY: °il,is}1I Ia 1: Aq�. Al "44 " Risk Manzgemen[SpeciBist AM HISCOX encourage courage, Declarations Page '� RiskMnnagnnmtlRvLOR REVIEWED F� APPROV®BY: A� A�w� `®' Risk Management Speddi5t HISCOX HISCOX INSURANCE COMPANY INC. (A Stock Company) encourage Courage` 104 South Michigan Avenue, Suite 600, Chicago, Illinois 60603 Commercial General Liability Declarations In return for the payment of the premium, and subject to all the terms of this Policy, we agree with you to provide the insurance as stated in this Policy. Declaration effective from: Policy No.: Named Insured: Address: Email Address: May 10, 2024 P102.732.064.3 Swim Brayv 5701 Santa Catalina Ave Garden Grove, CA 92845-1128 candace.thome@swimbrayv.org Policy period: From: I May 10, 2024 I To: I May 10, 2025 At 12:01 A.M. (Standard Time) at the address shown above Form of Business: Each Occurrence Limit: Damage to Premises Rented to You Limit: Medical Expense Limit: Personal & Advertising Injury Limit: General Aggregate Limit: Products/Completed Operations Aggregate Limit: Supplemental Business Personal Property Floater Coverage Limit: Other $1,000,000 $100,000 Any one premises $5,000 Any one person $1,000,000 Any one person or organization $2,000,000 Products -completed operations are subject to the General Aggregate Limit $0 Supplemental Business Personal Property Floater Not Applicable Coverage Deductible: All Premises You Own, Rent or Occupy Premises Number: Z Address: 5701 Santa Catalina Ave Garden Grove, CA 92845-1128 Total Premium: 381.00 Attachments: See attached Forms and Endorsements Schedule. CGL D001 10 18 Includes copyrighted material of Insurance Services Office, Inc., its permission. @ ISO Properties, Inc., 2000 .v�sv RirkMsaagmtmt DMalan REVIEWED&APPROVEDft ` Risk Management Spen Ast oyc , H ISCOX HISCOX INSURANCE COMPANY INC. (A Stock Company) encourage courage` 104 South Michigan Avenue, Suite 600, Chicago, Illinois 60603 IN WITNESS WHEREOF, the Insurer indicated above has caused this Policy to be signed by its President and Secretary, but this Policy shall not be effective unless also signed by the Insurers duly authorized representative. President Secretary Authorized Representative CGL D001 10 18 Includes copyrighted material of Insurance Services Office, Inc., v its permission. © ISO Properties, Inc., 2000 _ RiehMnwgrnt�tDiviston I?EvEwm 6 APPROVED 8Y.- A-ju A ZV44 `� ft6k Management Specialist HISCOX HISCOX INSURANCE COMPANY INC. (A Stock Company) encourage courage 104 South Michigan Avenue, Suite 600, Chicago, Illinois 60603 Forms and Endorsements Schedule Forms and Endorsements made part of this policy at time of issue: CGL D001 10 18 - Commercial General Liability Declarations INT D001 01 10 - Forms and Endorsements Schedule CGL E5410 CW (03110) - Policy Changes CG 20 26 07 04 - Additional Insured - Designated Person or Organization INT D001 01 10 n Risk MatagemodDMstan REVIE &APPRw Br. `®' Ruk Management Sped4ist 40 HISCOX encourage couragw Endorsements ,,. 11,� RAMxtueemedDMslon REVIEWED&APPRO Br �, Risk Management Specialist HISCOX Policy Number: P102.732.064.3 Named Insured: Swim Brayv Endorsement Number: 22 Endorsement Effective: 05/10/2024 Hiscox Insurance Company Inc. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY CHANGES This endorsement will not be used to decrease coverage, increase rates or deductibles or alter any terms or con- ditions of coverage unless at the sole request of the insured. The following item(s): ❑ Insured's Name ® Insured's Mailing Address ❑ Policy Number ❑ Company ❑ Effective/Expiration Date ❑ Insured's Legal Status/Business of Insured ❑ Payment Plan ❑ Premium Determination ❑ Additional Interested Parties I@ Coverage Forms and Endorsements ❑ Limits/Exposures ❑ Deductibles ❑ Covered Property/Located Description ❑ Classification/Class Codes ❑ Rates ❑ Underlying Insurance is (are) changed to read (See Additional Page(s)): The above amendments result in a change in the premium as follows: ® NO CHANGES ❑ TO BE ADJUSTED ADDITIONAL PREMIUM RETURN PREMIUM AT AUDIT CGL E5410 CW (03/10) Includes copyrighted material of Insurance Services Office, Inc. with its permission. wekMnnxgetnmtlxtietan REVIEWED & APPRDV®BY: A- fe A� `�' Risk Management SpedAut POLICY CHANGES ENDORSEMENT DESCRIPTION It is understood and agreed that effective 05/10/2024, the Policy's Mailing Address has been changed to 5701 Santa Catalina Ave, Garden Grove, CA 92845-1128. It is understood and agreed that effective 05/10/2024, Endorsement # 23 entitled Additional Insured - Designated Person or Organization is added. All other terms and conditions remain unchanged. CGL E5410 CW (03/10) Includes copyrighted material of Insurance Services Office, Inc. with its permission. Risk MawgmOd Dwislan REVIEWED&APPROVED BY: A+ "44 �� Risk Management Specialist HISCOX Policy Number: P102.732.064.3 Named Insured: Swim Brayv Endorsement Number: 23 Endorsement Effective: 05/10/2024 Hiscox Insurance Company Inc. 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 Santa Ana its officers officials emplopyees and volunteers Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II — Who Is An Insured is amended to in- clude as an additional insured the person(s) or organi- zation(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 omis- sions of those acting on your behalf: A. In the performance of your ongoing operations; or B. In connection with your premises owned by or rented to you. WekMnugmmtDiNsfon +� \c RENEWM&APPROVm BY: m' Risk Management Specialist 01 CG 20 26 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 40 H I SCOX Policy Number: P102.732.064.3 Named Insured: Swim Brayv Endorsement Number: 15 Endorsement Effective: 05/10/2024 Hiscox Insurance Company Inc. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. MODIFIED WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV — Conditions: You may waive your rights against another party so long as you do so in writing prior to: (i) an offense arising out of your business that caused a "personal and advertising injury"; or (ii) an 'occurrence' that caused "bodily injury' or "property damage'. CGL E5402 CW (03/10) Includes copyrighted material of Insurance Services Office, Inc., with its permi v ig „o^•NcR\� PJ8k J%nugarrmt DMSI0n REIAOV D&APPRovm8: A -fa &044 - Risk Management Spedalirt