HomeMy WebLinkAboutRamirez, Daniel 2M
AGREEMENT TERMINATION
Please complete this form when the attached agreement is no longer in efftt a M €
Return form to the Deputy Clerk of the Council (M -30). Call 647 -6520 if j� i; have ally
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was completed on ( ll and final payment has been made.
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Department:
Signature:J���
Date: �.
City of Santa Ana
Revised 4 -16 -87 Clerk of the Council
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INSURANCE ON FilE
WORK MAY PROCEED
UNTil INSURANCE EXPIRES
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CLERK 01 COUNCIL
DATE, 9-.#;-0.3
N-2003-096
CONSULTANT AGREEMENT
THIS AGREEMENT, made and entered into this day of ,2003 by
and betwee~ a sole proprietor (hereinafter "Consultant"), and the City of Santa
Ana, a chart~'ffiY~fifurtlcipal corporation organized and existing under the Constitution and
laws of the State of California (hereinafter "City").
RECITALS
A. The City desires to retain a consultant having special skill and knowledge in the field of
dance instruction to teach a class of FolkIorico-Mexican Traditional dance.
B. Consultant represents that Consultant is able and willing to provide such services to the
City.
C. In undertaking the performance of this Agreement, Consultant represents that it is
knowledgeable in its field and that any services performed by Consultant under this
Agreement will be performed in compliance with such standards as may reasonably be
expected from a professional consulting 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
Consultant shall perform those services as set forth in Exhibit A to this Agreement.
2. COMPENSATION
a. City agrees to pay, and Consultant agrees to accept as total payment for its services,
the rates and charges identified in Exhibit A. The total sum to be expended under this
Agreement, shall not exceed $10,000.00.00 during the term of this Agreement.
b. Payment by City shall be made within thirty (30) days following receipt of proper
invoice evidencing work performed, subject to City accounting procedures. Payment need not
be made for work which fails to meet the standards of performance set forth in the Recitals
which may reasonably be expected by City.
3. TERM
This Agreement shall commence on the date first written above and terminate on June 30,
2004, unless terminated earlier in accordance with Section 12, below. The term of this
Agreement may be extended upon a writing executed by the Executive Director of Parks,
Recreation and Community Services and the City Attorney.
4. INDEPENDENT CONTRACTOR
Consultant 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
Consultant performs the services which are the subject matter of this Agreement; however, the
services to be provided by Consultant shall be provided in a manner consistent with all
applicable standards and regulations governing such services. Consultant 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.
5. INSURANCE
Prior to undertaking performance of work under this Agreement, Consultant shall
maintain and shall require its subcontractors, if any, to obtain and maintain insurance as
described below:
a. Commercial General Liability Insurance. Consultant shall maintain commercial
general liability insurance naming the City, its officers, employees, agents, volunteers and
representatives as additional insured(s) and shall include, but not be limited to 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 Consultant's operations in the
performance of this Agreement, including, without limitation, acts involving vehicles. The
amounts of insurance shall be not less than the following: single limit coverage applying to
bodily and personal injury, including death resulting therefrom, and property damage, in the total
amount of$I,OOO,OOO per occurrence. Consultant shall supply City with a fully executed
additional insured endorsement in substantially the form attached hereto as Exhibit B upon
execution of this Agreement and shall be approved in form by the City Attorney.
b. Worker's Compensation Insurance. In accordance with the provisions of Section
3300 of the Labor Code, Consultant, if Consultant 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, Consultant agrees to obtain and maintain any
employer's liability insurance with limits not less than $1,000,000 per accident.
c. Reserved.
d. The following requirements apply to the insurance to be provided by Consultant
pursuant to this section:
2
(i) Consultant shall maintain all insurance required above in full force and
effect for the entire period covered by this Agreement.
(ii) Certificates of insurance shall be furnished to the City upon execution of
this Agreement and shall be approved in form by the City Attorney.
(iii) Certificates and policies shall state that the policies shall not be canceled
or reduced in coverage or changed in any other material aspect without
thirty (30) days prior written notice to the City.
e. If Consultant fails or refuses to produce or maintain the insurance required by this
section or fails or refuses to furnish the City with required proof that insurance has been procured
and is in force and paid for, the City shall have the right, at the City's election, to forthwith
terminate this Agreement. Such termination shall not effect Consultant's right to be paid for its
time and materials expended prior to notification oftermination. Consultant waives the right to
receive compensation and agrees to indemnify the City for any work performed prior to approval
of insurance by the City.
6. INDEMNIFICATION
Consultant agrees to and shall indemnify and hold harmless the City, its officers, agents,
employees, consultants, special counsel, and representatives from liability: (I) for personal
injury, damages, just compensation, restitution, judicial or equitable relief arising out of claims
for personal injury, including health, and claims for property damage, which may arise from the
direct or indirect operations of the Consultant or its contractors, 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 Consultant further agrees to indemnify, hold
harmless, and pay all costs for the defense ofthe 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 ofthe terms of, or
effects arising from this Agreement. City may make all reasonable decisions with respect to its
representation in any legal proceeding.
7. CONFIDENTIALITY
If Consultant receives from the City information which due to the nature of such
information is reasonably understood to be confidential and/or proprietary, Consultant 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 nonpubIic information. Confidential information includes not only written
information, but also information transferred orally, visually, electronically, or by other means.
3
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 Consultant disclosed in a publicly available source; (c) is in rightful
possession of the Consultant without an obligation of confidentiality; (d) is required to be
disclosed by operation of law; or (e) is independently developed by the Consultant without
reference to information disclosed by the City.
8. CONFLICT OF INTEREST CLAUSE
Consultant 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.
9. 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 telefacsimile or other
telegraphic communication in the manner provided in this Section, to the following persons:
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
telefacsimile (714) 647-6956
With courtesy copies to:
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
telefacsimile (714) 571-4235
and,
City Attorney
City of Santa Ana
20 Civic Center Plaza (M-29)
P.O. Box 1988
Santa Ana, California 92702
telefacsimile (714) 647-6515
4
To Consultant:
Daniel Ramirez
13901 Fernwood Drive
Garden Grove, California 92843
Telefacsimile (714) 636-3308
A party may change its address by giving notice in writing to the other party. Thereafter,
any notice, tender, demand, delivery, or other communication shall be addressed and transmitted
to the new address. If sent by mail, any notice, tender, demand, delivery, or other
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 telefacsimile, any notice, tender, demand, delivery, or
other 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.
10. EXCLUSIVITY AND AMENDMENT
This Agreement represents the complete and exclusive statement between the City and
Consultant, 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 Consultant. 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 Consultant nor
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.
11. ASSIGNMENT
Inasmuch as this Agreement is intended to secure the specialized services of Consultant,
Consultant 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 which are the subject to
this Agreement performed by City personnel or by other consultants retained by City.
12. TERMINATION
This Agreement may be terminated by the City upon thirty (30) days written notice of
termination. In such event, Consultant shall be entitled to receive and the City shall pay Consultant
compensation for all services performed by Consultant prior to receipt of such notice of termination,
subject to the following conditions:
5
a. As a condition of such payment, the Executive Director may require Consultant 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 Consultant consents to the City's use thereof
for such purposes as the City deems appropriate.
b. Payment need not be made for work which fails to meet the standard of performance
specified in the Recitals of this Agreement.
13. DISCRIMINATION
Consultant shall not discriminate because of race, color, creed, religion, sex, marital
status, sexual orientation, age, national origin, ancestry, or disability, as defined and prohibited
by applicable law, in the recruitment, selection, training, utilization, promotion, termination or
other employment related activities. Consultant affirms that it is an equal opportunity employer
and shall comply with all applicable federal, state and local laws and regulations.
14. JURISDICTION - VENUE
This Agreement and all questions relating to its validity, interpretation, performance, and
enforcement shall be governed and construed in accordance with the laws of the State of
California. 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.
15. PROFESSIONAL LICENSES
Consultant 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 govemmental agencies. Consultant shall notify the City
immediately and in writing of his inability to obtain or maintain such permits, licenses,
approvals, waivers, and exemptions. Said inability shall be cause for termination of this
Agreement.
16. MISCELLANEOUS PROVISIONS
a. Each undersigned represents and warrants that its signature hereinbelow 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.
6
IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year
first above written.
ATTEST:
CITY OF SANTA ANA
~~:"~...L~
A TRICIA E. HEALY
Clerk of the Council
.::z::..
DAVIDN. REA
City Manager
APPROVED AS TO FORM:
JOSEPH W. FLETCHER
City Attorney
By ~n:z
Laur Sheedy
Assistant City Att rney
RECOMMENDED FOR APPROVAL:
CONSULTANT
~
JON "RIP" RIBBLE
Executive Director of the Parks,
Recreation and Community
Services Agency
_:D~'~{l",~
DANIEL RAMI Z 0 -
Tax ID# 606-16-3218
7
EXHIBIT A
SCOPE OF SERVICES
L CLASS OBJECTIVE
A. Consultant shall conduct children's after-school dance class, training children in Danza
Folklorico/ Mexican Traditional dance in Floral costumes.
B. Consultant will confer with City staff to set class time and location, including the days
and hours class will be taught, the location of said classes and the holidays which will be
observed.
C. Consultant will provide and be responsible for equipment, records, personnel and clean
up of the facilities and materials necessary to ensure the effectiveness of said instruction.
II. CLASS SIZE - REGISTRATION
A. The minimum number of participants is 20 per class. The maximum number is 50 per
class session.
B. No registration will be accepted after the second week of classes.
C. In the event the minimum number of enrollees is not realized by the second week of
classes, the class shall be canceled. Consultant will be under no obligation to provide
services and City will have no obligation to compensate Consultant.
III. FEES
A. The fee to participants shall be no more than $20.00 per month per participant. No
refunds shall be made to participants unless class is canceled, as set forth in Section II,
C., above.
B. City shall register and collect fees from each participant in the class during the
registration period. City agrees to pay Consultant seventy percent (70%) of the total fees
collected each month. City and Consultant agree that City shall retain thirty percent
(30%) ofthe fees collected.
C. Consultant agrees that City shall be entitled to audit Consultant's records to ensure
compliance with the Agreement
8
" . . .
EXHIBIT B
ADDITIONAL INSURED ENDORSEMENT
FOR COMMERCIAL GENERAL LIABILITY POLICY
Insurance Company
This endorsement modifies such insurance as is afforded by the provisions of Policy
# relating to the following:
I. The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 9270 I; its
officers, employees, agents, volunteers and representatives are named as additional insureds
("additional insureds") with regard to liability and defense of suits arising from the operations
and uses performed by or on behalf of the named insured.
2. With respect to claims arising out of the operations and uses performed by or on
behalf of the named insured, such insurance as is afforded by this policy is primary and is not
additional to or contributing with any other insurance carried by or for the benefit of the
additional insureds.
3. This insurance applies separately to each insured against whom claim is made or
suit is brought except with respect to the company's limits of liability. The inclusion of any
person or organization as an insured shall not affect any right which such person or organization
would have as a claimant if not so included.
4. With respect to the additional insureds, this insurance shall not be cancelled, or
materially reduced in coverage or limits except after thirty (30) days written notice has been
given to the City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701.
(Completion of the following, including countersignature, is required to make this endorsement
effective. )
Effective
Policy #
Issued to
, this endorsement form as a part of
Named Insured
Countersigned by
Authorized Representative
9
i}dministrative Office
1400 American Lane
Schaumburg, Illinois 60196
N - d, OD3 -0910
STEADFAST INSURANCE COMPANY
A ZURICH COMPANY
CERTIFICATE OF LIABILITY INSURANCE
Policy Number: EOL5281394-00
Fitness and Wellness Purchasing Group Certificate Number: 0393366
NAMED 0393366 Daniel Ramirez AGENT Fitness and Wellness Insurance Agency
INSURED NAME AND 380 Stevens Avenue, #115
AND 13901 Fernwood MAILING Solana Beach, CA 92075
MAILING ADDRESS
ADDRESS Garden Grove, CA 92843 800-395-8075 - L1C#OD28716
POLICY PERIOD: From: 11/10/03 To: 11/10/04
THIS CERTIFICATE OF LIABILITY INSURANCE FORMS A PART OF THE POLICY REFERENCED ABOVE.
INSURANCE AS IDENTIFIED BELOW HAS BEEN ISSUED, IS IN FORCE, AND CONVEYS ALL THE RIGHTS AND
PRIVILEGES AFFORDED UNDER THE POLICY. THE INSURANCE COVERAGE PROVIDED UNDER THIS
CERTIFICATE IS SUBJECT TO ALL THE TERMS, CONDITIONS, AND EXCLUSIONS OF THE POLICY
IDENTIFIED ABOVE.
COVERAGES LIMITS OF INSURANCE
Bodily Injury, Property Damage or $1,000,000 Each Occurrence Lim it
Professional Incident
Personal and Advertising Injury Limit $1,000,000 Anyone Person or Organization
-
General Aggregate Limit (Other than $3,000,000
Products/Completed Operations)
Products/Comnleted ODerations $3,000,000 Aaareaate Limit
Coverage D Medical Expenses $ 2,500 Any One Person
Coverage E Sexual andlor Physical Abuse Liability $ 100,000 Each Claim Limit!
$ 300,000 Annual Aggregate Limit
Coverage F Employer's Liability (Only available in Only in State(s) where this Insurance applies:
the following States: ND, OH, WVA, WA and WY) $ 100,000 Bodily Injury by Accident - Each Accident
$ 100,000 Bodily Injury by Disease - Each Employee
$ 500,000 Aggregate Limit - Employer's Liability
Damage to Premises Rented to You $ 100,000 Any One Premise
The most we will pay for any occurrence, or related occurrence that triggers Bodily Injury, Property Damage or
Professional Incident or any combination thereof is the each occurrence limit. Payments made under Sexual and/or
Physical Abuse, Medical Expenses, Employers Liability (where applicable), and Damages to Premises Rented to You
deplete the general aggregate limit of liability.
Location of all premises you own, rent or occupy:
1) Various
Premium:
RPG FEE:
Taxes/Filing Fees:
234.00
Included
Included
IF YOU HAVE ANY QUESTIONS CONCERNING THIS CERTIFICATE CONTACT:
FITNESS AND WELLNESS INSURANCE AGENCY - 800-395-8075
Jeffrev E. Frick
Authorized Representative
Form #: Certl
NOVEMBER 17.2003
Date
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ADDITIONAL INSURP.D BNDORSEMID:IT
FOR COMr.mRCIAL GENERAl, LIABILQ."Y POLICY
. :ftW>>- W 1AkRb1JAt~/lt1J, (Jfy J'I{ /.r
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Wurance C()JIlJlllDY ~.r~ 1fJr:,7!:i
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n is endorsement modifies suc.D ioJDr.mee lIS is affurded by the proVISions of Policy
1/' :DUS?el.~4- Dt> relating to the foIfowina:
1~c.,e..rc4PC>~?fMV
1. The City of Santa Ana, 20 Civic CeJ:rterflaza. Santa ADa, caurOmia 92701; its
of ieers, empIo~ aprts, yo.\Qnteera 1II1\tt"P(.;.sej,t",,"iv~s' a.."e 1lllIn=d 118 sddicitl4:lll..insureds . . __"
Coo .dditiOll8l insureds") with regard to liability and dr!ense of suits IlrisiDg from the operations.
at 1 uses peaormed by or on behalf of the XI8Ill.ed insured:
2. With respect to claims arism,g QOt of the operations and uses perlDrmed by or on
hi balt' of the 1WI1~ Wlnd, such bw.I4Ce S$ is affiJrded by thi. policy is prim8ry and is nut
a< :litioca1 to 'or conlr1Outnlg with any ofhtr insUl1lllCe carried by or fur the benefit of the
a< ditiOWll ~s
.......
3. This.~ applies seplf'Btely to each Wtm:d against whom claim i$lUI1de or
51 it is brouaht except with l'e$pec:t to the company's limit! of liability. The Ulc1'JSiol1 of an}'
p non or 0l"g1UIizali0ll1lS m insured sllallllot affect 8111 right which su.ch person or org,wzation
" ,uld havll! lIS a cl.abnant if noUo included. '. .,/ ,
4. With IespeCt to the additiolllll itlMi:ds, 1his insurancll! sballllOt be cancelled, or
II atm:ial.Iy reduced in cuverageor limitll elO:ept lifter thirty (30) days' written lloticS bll'l be~l'.
g ven to the City of SlUlUADa, 20 Civic Center Plaza, Santa ADa. c.lifomla 92701.
(' :OmpletioIl of the following, Including rountersi.gnattml. is required to make this Clldooement
e fet;:tive.)
f ffectjve TI J 1C11~ - 1\ /ID/C>4- . thi:5eMorSement forrnas a part of
I Jlicy ~ ~~~4-0o caz:nt"l~ f:4. ~~!'{P'"
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ACORD CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDNYYY)
TM 10/04/2004
PRODUCER THIS CERTIFICATE IS ISSUED AS A MA ITER OF INFORMA liON
FITNESS AND WELLNESS INSURANCE AGENCY ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
380 STEVENS AVENUE, SUITE 206 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
SOLANA BEACH CA 9207S ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE -I NAIC#
Agency LiC#, 0028716 " . -~- Steadfast Insura':1E~ Company -----
INSURED N- ;)Ot>,j - o9b IINSURE'R A:. +- -
DANIEL RAMIREZ INSURER B:
13901 FERNWOOD tJ- ~3 -- 0%-01 -..--- --..
INSURER C: -
GARDEN GROVE CA 92843 - T ------
INSURER D:
_._0-
INSURER E:
COVERAGES
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR I ADD'L TYPE OF INSURANCE
LTR INSRO
GENERAL LIABILITY
~,M.,M, ERCIAl GENERAlllABllI"
~ CLAIMS MADElX' OCCUR
POLICY NUMBER
~OLICY EFFeCTIVE
DATE MMIODNY
11/10/03
I P~.i~EY'~~~~'" i LIMITS - ----
11/10/04 I EACH OCCURRENCE 4== 1,000,000
!OAMAGETORENTED- $ 10000'0
,.PFFUI~F~ IF. t\tV""....n~"l) _. ____ .m . .~_ ____
, MED. EXP (Any Dne person) $ 2,500
PERSONAL & ADV INJURY $ _ 1,000,000
~~NERAL AGGREGATE $ 3,<!.~O,OO~
PRODUCTS.COM~!~ AGG. $ __"_ 3,000,000_
EOLS281394-Q0
A
GEN'L AGGREGATE LIMIT APPLIES PER:
----xl POLICY iUl PROJECT n LOCi
,I AUTOMOBILE LIABILITY
III ANY AUTO
, ALL OWNED AUTOS
:~.. SCHEDULED AUTOS
HIRED AUTOS
NON-OWNED AUTOS
-~
COMBINED SINGLE LIMIT I
~:~:~:~~RY 1$ --
(Per person) 1$
BODILY INJURY t-
(Peracddent)
PROPERTY DAM~GE--- : '
(Per accident)
GARAGE LIABILITY
I~' ANY AUTO
I' EXCESS I UMBRELLA LIABILITY
J OCCUR D CLAIMS MADE
~ DEDUCTIBLE
II I RETENTION $
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICERlMEMBER EXCLUDED?
lfyell,dncrlbeund.r
i SPECIAL PROVISIONS below
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!dV',1 1.' ,
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AUTO ONLY. EA ACCIDENT $
OTHER THAN __10 ACC $
AUTO ONLY: ..-..-. .$
EACH OCCURRENCE $
$
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! I:^,CSTATU- i I OTHER I
f--,
E.L. EACH ACCIDENT 1$
I AGGREGATE_ _ _.:.
E.L. DISEASE-EA EMPLOYEE
" E.L. DISEASE-POLICY LIMIT
s,____
$
OTHER:
I
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS
CERTIFICATE HOLDER ADDED AS ADDITIONAL INSURED ONLY AS THEIR INTERESTS MAY APPEAR.
CERTIFICATE HOLDER
The City of Santa Ana
20 Civic Center Plaza
Santa Ana CA 92701
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL10
DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT
FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE
INSURER, Irs AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
~~~
Jeffrey E. Frick, CEO
0028716 @ACORDCORPORATION1988
Attention:
ACORD 25 (2001/08)
Certificate #
9293
POLICY NUMBER: EOL5281394-00
COMMERCIAL GENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED-OWNERS, LESSEES OR
CONTRACTORS (Form B)
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY
SCHEDULE
Name of Person or Organization;
The City of Santa Ana
20 Civic Center Piaza
Santa Ana CA 92701
(If no entry appears above. information required to complete this endorsement will be shown in the
Declarations as applicable to this endorsement.)
WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization
shown in the Schedule, but only with respect to liability arising out of "your work' for that insured by
or for you
~?~/~
CG 20 10 11 85
Copyright. Insurance Services Office, Inc., 1984
Certificate # 9293
02/02/2005
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.!~:.!9 .7145714209 PARKS AND RECREATION
CeRllF'CATE OF UABILlTY INSURANI;t.
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notice ha. brco ~:v~r, tn ~'1" romm'",;!)' Rcu.,','eloon:<nt .A.g<;noy ..fIb;; Cil~ ul Sal,1a
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4PPR.ovsn AS 1'0 l:'v,...".
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Laura SljU .S:l':c:.U,r
Auistant City }'.l.(.,H \1';"
.
lrpOM FIT',F3S Ar~D WE~LJ\lfSS ir"S~)R,\tJCE
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9 2 '1 (16 1 -'l : r:: 8 S T I,,"' IJ, IJ., f:i ~:,> fJ 4 2 Cl >3 B ,;:
ACORD CERTIFICATE OF LIABILITY INSURANCE ) DATE (MMfDDlYYVY)
TM 031051/2006
PRODUCER Phone: (BOO) 3ll5-8075 Fax: (858j519..()822 THIS CERTIFICATE IS ISSUEO AS A MAnER OF INFORMATION
FITNESS AND WELLNESS INSURANCE AGENCY ONLY AND CONFERS NO RIGHTS UPON THE CERTIfiCATE
380 STEVENS AVENUE, SUITE 206 ~~~:R. THIS CERTIFICATE DOE~ :';>~:J:MEND. EX~~~ nO:
SOLANA BEACH CA 82075
INSURERS AFFORDING COVERAGE NAIC'
., lief 0026716 i------
-------- --- ----~-_._.
INSURED N- d-VO?;-rfi(p-O;;L INSURER ~: Zu!iCh American Insurance Company t--- --
DANIEL RAMIREZ N -;).(;o3-v9~-O' INSURER B:
13901 FERNWOOD ._..~
I~NSURER C
GARDEN GROVE CA 92843 IV -;).003-090 'NSURER-D~ - --[----
u_ --
INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LtSTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMeD ABOVE FOR THE F'OLICYP[RIQD INDICATED, NOtWITHSTANDING
ANV REQUIREMENT, TERM OR CON DillON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTlf"ICATE !MY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDI~IONS OF SUCH
POL!CIES_ AGGREGATE LIMITS SHOWN MAV fil\VE BEEN REDUCED lJV PAlO CLA!MS.
H;;R ~~ .. -----.-
LTR INSR[] TVPi OF INSURANCE I POLICY NUMBER
~NERAL LIABILITY I
! X CO".,.,ERCIAl GENERALLIABIUTYI'
I CLNMS MADE [E OCCUR
~i"~~~
~;~t:Y,=~N
LIMITS
EOL9012327-D1
01/10/06
01/10/07
EACH OCCURRENCE
DAMAGE!o.RENi!D
PREMISE"StF.OGGu~"")
MED. [J(p (Anyone F"rson:
.
.
1,0~
.~~
2,~_~_
1,000,000
. ___ 3,~0~
3,000,000
A
f--
f---~------
GENl AGGREGATE LIMIT APPLIES PER:
f-c-, .~PRO ~
X I POLlCY ! I JEer . 'LOC
PERSCNAl &ADV INJURY _ _~_
GENERAL AGGREGATE $
I
~~oou CT~_~COMP~'~~ ~~~.
.
AUTOMOBILE LlAEUl..rrY
8 . :::Y:~~DAUTOS
SCHEDULED AUTOS
HIREO AUTOS
I NON-OWNED AUTOS
-
-
COMBINED SINGLE LIMIT
(Eaaccide-nt) $
J
BODILY INJUHV
'IIP!lfpar$Onl
BODILY INJURY
(P9l"oocid9tit)
s
.
GARAGE LIABiliTY
=] ANY AUTO
~e:SS I UMBRfL.U\ L.lA8tuTY
~. OCCUR 0 CLAIMS MADE
HI--, DEDUCTIBLE
RETENllON S
I
I
Pp:~~~I~AMAGE
.
AUTO ONl.. Y : EA ACCIDENT
.
OTHER THAN
AUTO ONLY
EA ACC S
AGG $
.
.
~---
.
'-
; EACH OCCURRENCE
,
~(;ATE
WORKERS COIIPENSATlON AND
EMPLOYERS' LIABIL(TY
I ""Wi PItOPRlETORIPAJlTNe~eUTIVE
OFl'lCl!l'lmEMIlEIt.EXCLUDEO?
,~,",duc:I'lIlIIUIIdW
ISPEClAlPROVISlOta_
LjJ:(j / j I /-,
fVL '.7'+'.
.
~!iT"'T\J-~L~
TOPl_VLlMIT1; O~R - --
E.L. EACH ACCIDENT .
E.L DISEASE-EA EMPLOYEE . --
E_L DISEASE-POUCv. IM/T .
I OTHER:
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. DESCRIPTION OF OPERATIONS/LOCATIONSNEJiICLESJEXCLUSIONS ADDED BY ENDORSEMENTI SPECIAl PROVISIONS
It is understood and agreed that thQ following eoUty Is added as an additional Insured but onty as respects the operations of the ~med insured
except that Uability resulUng from the additional insureds sole negligence.
CERTIFICATE HOLDER
CANCELLA TlON
Tho Cjty of Santa Ana
20 C'vlc Centeor PIau!.
santa Ana CA 92702
SHOULD PJfV OF THE ABOVE DESCRIBED POL,CII:.S BE CANCELLE"Q BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURfR WILL MAIL 10 DAYS WRI-:-TEN
NOTlCF TO THE CERTWtCATF HOLDER NAMED TO THF LEFT
AUTHORIZED REPRESENTATIVE
~~~
Jeffrey E. Frick, CEO
@ACORDCORPORATION19Ba
Attention: FX: CARLA THOMPKINS 714-571~209
ACORD 25 (2001108) Certificate #
37082
I'::""', Y
.
. ~~~v F!T~ESS AND WELLN~SS INSURANCE
\ T H 'J) MA '" 9 2 C Li G 1 -l C, B /'; I 1 4 I~ -;' /I'J '-' F f< '2 (4::' n" 8 ':' p
POLICY NUMBER EOL9012327-01
COMMERCIAL GENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED-OWNERS, LESSEES OR
CONTRACTORS (Form B)
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY
SCHEDULE
Name of Person or Organization; The City of Santa Ana
20 Civic Center Plaza
Santa Ana CA 92702
(If no entry appears above. information required to complete this endorsement will be shown in the
Declarations as applicable to this endorsement.)
WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization
shown in the Schedule, but only with respect to liability arising out of "your work' for that insured by
or for you
Primary and noncontributory
~~
CG20 10 1185
Copyright. Insurance Services Office, Inc, 1984
Certificate # 37082