HomeMy WebLinkAboutSkidmore, Cheryl 2City of Santa Ana
Clerk of the Council
AGREEMENT TERMINATION
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Please complete this form when the attached agreement is no longer in a ect. "
Return form to the Clerk of the Council Office (M-30).
Call 647-2520 if you have any questions. ~ ~ ; ~~ "~• F''
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The agreement with Cheryl Skidmore Kids Can Do Gymnastics dba Fun With Horses
No. N-2004-058; N-2004-058-01; N-2004-058-02; N-2004-058-03;
N-2004-058-04
and final payment has been made.
was completed on 12-31-08
Department: PRCSA
Phone/Ext.: 4203
Signature: e ~~~~1~~~
Date: 7-21-09
Revised 05-04-08
INSURANCE NO} ON FILE
WORK MAY NOT PROCEED
CLERK OF COUNCIL
DATE: (;-;)...-{)'1
2:1P~
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N-2004-058
CONSUL T ANT AGREEMENT
THIS AGREEMENT made and entered into this \ day of 1/\ ~tV\"+, 2004 by
and between Cheryl Skidmore, an individual (hereinafter "Consultant"), 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 (hereinafter "City").
RECITALS
A. The City desires to retain a consultant having special skill and knowledge in the field of
horsemanship, to instruct various camps and classes.
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 $5,000.00 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
December 31, 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 perfornls 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
anlount of $1 ,000,000 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. Reserved
c. 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.
d. The following requirements apply to the insurance to be provided by Consultant
pursuant to this section:
(i) Consultant shall maintain all insurance required above in full force and
effect for the entire period covered by this Agreement.
2
(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 of termination. Consultant waives the right to
rcceive 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 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. The Consultant 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 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.
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 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 ofthe other
party is covered by this Agreement.
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.
3
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 copy 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
To Consultant:
Cheryl Skidmore
1370 Sanderson Avenue
Anaheim, California 92806
Telefacsimile (949) 645-8773
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
4
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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.
13. DISCRIMINATION
Consultant shall not discriminate because ofrace, 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 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 governmental agencies. Consultant 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.
5
16. MISCELLANEOUS PROVISIONS
a. All Exhibits referenced herein and attached hereto shall be incorporated as if fully set
forth in the body of this Agreement.
IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year
first above written.
ATTEST:
CITY OF SANTA ANA
~~
City Manager
(/-~ ~ i1J~..~c::;
,---;;t ~.-/
PA TRICIA E. HEALY
Clerk of the Council
APPROVED AS TO FORM:
JOSEPH W. FLETCHER
City Attorney
By; {..{
L ra Sheedy
Assistant City Attorney
~
CONSULTANT .
O!5t'r-:. ~.L}il ~(+l1. He,,-s.e.s . .
'\ '\; <) l iVv. .)-0 (,zV;yl/V'V'v"'0HC S
~L '_' ~ .:j
CH~~"~;D~:;~L "'%~)
Tax 10# .-) .7., L' 2,c 71/ $c{
RECOMMENDED FOR APPROVAL:
JON "RIP" RIBBLE
Executive Director of Parks,
Recreation and Community Services
6
EXHIBIT A
SCOPE OF SERVICES
CAMP BUCKAROO
. Consultant shall provide interaction with horses classes aimed at children ages 6 to 12
years.
. The camp shall be conducted during five separate one-week sessions meeting 2 y, hours
twice during the week as follows:
o Thursday/Friday - June 17 & 18 from 12:00 - 2:30 pm
o Thursday/Friday - June 24 & 25 from 12:00 - 2:30 pm
o Thursday/Friday - July 29 & 30 from 12:00 - 2:30 pm
o Monday/Tuesday - August 16 & 17 from 9:00 - 1 1 :30 am
o Monday/Tuesday - August 23 & 24 from 9:00 - 1 1 :30 am
· Registration fee is $65.00 per participant per session plus a $10.00 materials fee paid to
Consultant at the first class.
HORSE FUN FOR KIDS
. Consultant shall provide basic horsemanship classes for children ages 3 to 12 years.
. The class shall be taught during two separate three-week sessions meeting once each
week for 45 minutes as follows:
o Session 1 - July 18, 25 & August I
o Session 2 - August 8,15 & 22
o Children ages 3 - 6 y, will meet from 12:00 to 12:45 pm
o Children ages 7 - 12 will meet from I :00 to l:45 pm
· Registration fee is $50.00 per participant (3 to 6 y,) per session, and $55.00 per
participant (7 to 12) per session. All participants shall pay Consultant a $10.00 materials
fee at the first class.
INTRODUCTION TO HORSES
· Consultant shall provide an introduction to horses class for youth ages 13 and older.
. The class shall be taught during two separate three-week sessions meeting once each
week for one hour as follows:
o Session 1 - July 18,25 & August 1 from 4:00 - 5:00 pm
o Session 2 - August 8,15 & 22 from 4:00 - 5:00 pm
Registration fee is $55.00 per participant per session plus a $10.00 materials fee paid to
Consultant at the first class.
DOWN ON THE FARM
· Consultant shall conduct farm experience classes for children ages 2 to 6 Y, years.
. The class shall be taught during three separate three-week sessions meeting one hour
each week as follows:
7
,
'.
, _ _ ',: -")-7
o Session 1 -~i,-~~ ~n.~1.~;:~ r~:~~~Jl'I:O~ amT:'. .~ l~('-iv
o Session 2 - July 30, August 6 & 13 from 10:00 - 1 1:00 am. 1
Registration fee is $50.00 per participant per session, plus a $10.00 materials fee paid
to Consultant.
o All classes will be held at the Anaheim Equestrian Center
CLASS REGISTRATION AND FEES
o Each class must have a minimum of five registered and paid participants and a maximum of
15. If the minimum registration has not been met by the first class, the class may be
cancelled by mutual agreement of Consultant and City without any compensation owed
Consultant.
o No refunds will be made after the first week of classes unless the class is cancelled by the
City.
o City shall collect all registration fees - Consultant shall refer interested participants to City
for registration.
o City shall pay Consultant seventy percent (70%) of the total fees collected for her classes
within fifteen (15) working days after completion of the session. City shall retain thirty
percent (30%) of the fees.
o Only registered participants, listed on a roster prepared by City, may participate in class.
o City shall be entitled to audit Consultant's records and classes to ensure compliance with this
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:
1. The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701; 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 ofthe
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 ifnot 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 9270 I.
(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
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,jun29 2004 315PM
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CHEVAL [NSURANCE
No 5235
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NEW Rl;STNFSS . SL-llC'3177.00
~Mtrican Bankers . 12:01 Alii AT IIIISUREOs ADDRESS
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222 S. 15th Street, SullH OOJS. Omell., NE 68102
POLICY "UMBE~ J>:'IlICV :;;f'I:"lD POLICY TYPE AGENCY p
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Sr. 1103177 HI!200J l~m:2004 Cl~MMTlRClAf LJ.\I:HUn COVblLo\W:. 3432001.002!S I
YOU AS NAMED INSUltED AND ADDRESS AGENT
CHERYL 3KIDMOJU: tJ - ;1.004-- 055' THe OARN (iR01'P, ['Ie
DBAfUl\ \\lTIIIlORS.'lS 21~L.J)SI ~nu:FT
1~7 E. WILSON ST.
COHA MESA. CA 92627 t-"'EW VORK. r-. Y 10('16-
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Tho Insured Is: .1lI An Individual 0 A Joint Venlure
:J J\ PlrtnClr&:hip 0 ^n Or"anlz~tr~n (otr.arth.:an a panncrahip -11J;nt vontur.,.)
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All know" e~posures orlh. beginning of the ~ollcy p.,jocl ho". b~~" I~p."ti~ed below.
L.aC8tjan of 2111 pr.mis8s owP'1ed, fBntad oocupied or controlled by th. insured;
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AN"HF.l?vl U 92805
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CONTlIIIUED 0". IIIElCT PAGE
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I.J Au,*g,11, 2004211 36AM THCHEVAL INSURANCE
I TO: CHEVAL INSURANCE
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: ..-11Lerican Bankers
"'Insurance Company nl Flcrrida
NO.No~ 7470 P. E' 2
222 South 15'. SIr..t. Ste. (iOOS
Orru2ha, NE 6& 102
ENDORSEMENT
Agent; THE GARN GROUP INC.
219 E. 31 ST STREET
NEW YORK. NY 10016
This endorsement, effective 6/23/04, forms a part of Policy No. SLll03177
Issued to Cheryl Skidmore DBA Fun With Horses
Policy Period - From: 8/31/03 To: 8/31/04
The above described policy is amended as follows:
It is agreed:
Additional insured added ~ follows:
City of Santa Ana Parks Beach and Recreation
PO Box 1988 M2.3
Santa Ana, CA 92702
7j1 ~/
Endorsement No.1
PremiUIll Chll1lge: $25
C01Illtersign~e Date
~~4~
gent \.
Rovis"d Annual Premium: $ Prepared: 8fl0/04 By: M.A.
All other terms and conditions of this policy remain unchanged.
Received Time Aug, 11, 10:58AM
Jun 292004 ,215PM
CHEVAL INSURANCE
No 5235
P
Cheval Insurance Services
P. O. 801 2933
Fullt<ton, CA 92837
Phon.: 714.447-9191 Fa" 714.525.9191
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Page 1
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08/3112003 08/3112004
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ACORD. CERTIFICATE OF LIABILITY INSURANCE OP 10 551 DATE (MMfODNYY'i)
SKIDM-l 06/23/04
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Cheval Insurance Services ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Lie. OC94257 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P. O. Box 2933 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Fullerton CA 92837
Phone' 714-447-9191 Fax,714-525-9191 .'-NSURERS AFFORDING COVERAG~_ ___ _ NAIC#
iNSUREO--._u -.---,.-"'-.---- -,,- --_.--
INSURER ^ AmeriCaIl Bankers
- - ____ __o_____n_. --.-'- .--- --,--'-
INSURER B ___1-----
Cher*l Skidmore .---.--.'- --- ---
Fun i th Horses INSURER C -
_.-- ----- ----- -- - __.___n_"__
187 E. W11son St. " INSURER D -----.-
Costa Mesa CA 92627 1--:- -. ------ -- ----,--
INSURER E
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR Tt-lE POlley PERIOO INDiCATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO Wf~ICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFfORDE.U BY THE POLICIES OESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
I~: =!-"'-~YPE O;.INSURA~;__--..----._.POL.ICY NUMBER ~---
A
_~NER"lllABll1TY
X X COMMERCIAL GENERAL. LIA8IL1lY
::::.:=- '] CLAIMS MADE ~ OCCUR
- -_.-- .-.-
- _.- ----
G~'L AGGRE~E,LlMIT APP~~ES PER
X I POLICY I I ~~8-r f =~l- LaC
AUTOMOBILE LIABILITY
-
___ ANY AUTO
._ ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
SLll03177
"'POL1CV""E"e~T~ P01.1CYEXJJlRi\fl~-------- -- - .--.. -~
DATE IMMIDDfYYl DATE (MMIOOIVV'j" LIMITS
~~gi~.g:~- ~!.' 000 -,.Q.Q.~--
08/31/04 PREMISES(E8ocGUrel'l~L.! 50,090
I_MED EX~ (An~ o""'_~~~)_ .! 5 , 0 ~ O~
~~NAL&ADVI~.JURY . _ ~~.' 000./ 009._
GENERALAGGRE~ATE -----L!. 2 I 09.0, OQ_~
~~ODUCTS_-COMPIOPAC.~ 2_t..2..2.9, 002..-
COMBINED SINGLE LIMIT fl ,
(l=aar.c1d8nt)
-~- --
BOOII Y INJURY $
(Per person)
m__ __ ---
BOD\L Y INJURY
(Peraccidel'lt)
--
08/31/03
NONE
I-
f--.
.
NON-OWNED ....UTOS
--
PROPERTY DAMAGE
(Pllrlleel(lllnl)
.
_O_l"AOE L1ABIUTY
_I ANY AUTO
NONE
~~OONLY-EA~CCIDEN~f-S ~
OTHER THAN !:A_A~~ $~_.~____
AUTO ONI y. AGG $
EACH OCCURRENCE $
ExceSSlUM8RELLA LIABILITY
~ OCCUR [] CLAIMS MADE
-,
_----I DEDUCTIBLE
I RETENTION $
WORKERS COMPENSATION AND
EMPLOYER5~UABIUTY
ANY PROPRIETOR/PARTNERlEXECUTlVE
OFFICERlMEf.ABER EXCLUDED?
~~~I~tS~"Ov~~16~s below
OTHER
NONE
~G~EGA~,=-- _n_. ~___ __
--- -- r!------
1--- - -- !. .------
NOtfE
.IT~Wy1!~W~L_ UR- ____ _ ___ --
_~LEAC~ACCIDENT . _5__.__
E.l. DISEASE - EA EMPLOYEE S
E.L. UISEASE . POLICY LIMIT S
NONE
DESCRIPTION OF OJ>ERATIONS I LOCATIONS /VEHICLES IEXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
Certificate holder is an additional insurQd as sponsor of recreation program
but only for insureds operation5 under this contraot.
CERTIFICATE HOLDER
CANCELLATION / '\
CITY SA
SHOULD ANY OF THE A OVE ESCRlBEO PDUCIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE I UING NSURER WILL ENIJE.AVOK TO MAIL 10 DAYS WRITTEN
NOTICE TO THE CE.,.f1 CATE OL.OER NAMED TO THE LEFT, aUT fAILURE TO DO 80 SHALL.
~
Y OF ANY KINO UPON THE INSURf:R, ITS AGENTS OR
~
City of Santa Ana
Parks~ Beach and Recreation
M 23 Attn: Rosa or Carol
PO Box 1988
Santa Ana CA 92702
IMPOSE NO OBlIG n
REPRE.SENTATlvd~ //,
AUTHORIZED REPJ ~ ~TI E
Cheval ~;rce
/ f./-/
servi~~
V
@ACORD CORPORATION 1988
ACORD 25 (2001/08)
No.96Q5
PAGE ell
p. 1
a3{f?1.1~~5 l3:el4
M~r 0 21, 2005
7145714209
9:15AM CHEvAL INSURANCE
PARKS AND RECREATION
,... "
ACORD.. CERtiFICATE OF LIABILITY INSURANCE eM RI) \ p.<\TE I"'~~
,,- SKIOM-l 03/21/05
....ODUCER THtfI CIiRTIIIICAn; IS ISSUED AI A MATTIR OF '''fQ~JI~TION
ChQvai 1nauranc. ServlQ.. ONLY AND CONFER' NO IlIl!lHT~ VPQM TH' ClERnFICATE
Lie. OCi42,S7 HOLDeR. THIS CERllFlCATE DOES NOT ....E~D. ~ND ~.
P. O. Box 2i33 14- TER Tlie CQVIAAGE AFFOR,DEO BY THE POLICIES BI<J.OW,
FUJ.1f!!!rton CA 92837
Phon8i714-447-9191 Fax:?14-S25-91S1 INSURERS AFFORDINQ CDYERAQIi MAle #
iNtU"I!D INfURER ^, Amer~gan Banko.3
INSU~R g.
Cherw-i- SkidmorQ I N31JR&R C:
Fun ]. t:h llo:r588
197 ~. W~~$Qn I~' IN06UR~ [1;
c;;:osta Mesa. CA 2627
I~$UAE~ I:
COVI5RAGES
TloII; POLIClliiS o~ IN5Ul\ANCf Ll5TfO Il~LOW IfAIIE BEEN IssueD TO THE INSURED foWwleo "'lKWE FOR THE; Po~ICY jjE~Ot;lINl)'~TJ:D, N,irWIMT"lI:lr~
/Vf'f ~Q\JlFIIiMliiHT. T6RM OR CONl;lITIOM or N<< corm......~T ~ OTHeR (;IOe.VMl:NT 'f'n'7i N!SI'EC1' TO WWICH T"'I& el~l'lI'ICA,", w.y tlI!. ISsueo OR
bIJo.'o( ~-'iINo THE INSURANCE ...!!~ORQl;D llV 1'14r: POllC11!Q DESCRIBED HEREIN 19 SOQJECT TO ALl THE TaR"!, !XCLU!!IONS AND coNtllT10NS OF SUCll
POLICIIlS. AGG~Tl: L.IMI1'S SHOWN /MY /l.VI! DfISN RIiiOUcel BY "'''10 o.Jl11;l5.
Ii:ii\ ~ T"r"~ 0'" irt$\IrW4~ POuc:Y NUIII8ER IJATe lIIIMlDNY o,;;n~ L.WITl!
uI!MMAL. UAIlIUTY EAo;H ocCUMINC~ 51,000 000
-
A X ~ 3~RGIAL GEtlErw. ~lAlIIUTY SL11.0:n ?7 09/31/04 08/3:1./05 ~R~Es Tes o=urence) 530,000
: CLAM M,t,~ [[] QeCt,l" 1.100 EXP {Ally "'" ~l I IS. 000
--...J
- PERSOl'lAL r. Af1tIlNJURY 52.000,000
....... GINeRALAGQREGATE s2,000,OOO
IilL "'I3O.,ee'l~ LIMIT IIPn I'm: PR.ODUCTS ' COI&lJOP AGG S 2 , 000 .000
X flOLICV n ~m LOC
~TD~1i lJABIUTT COM8INED &lNI3l& ULIT f
f'I('( AIJfQ NO~ (I!i ~4enl'
~ --
ALL OWNIiD -'lJTOS ~DILV IIoLIUIW
- "
$Cl4itlUlEO AUTOS (PI' poqan)
-
~ HII'I!:O AUT1J5 80DIL Y INJunV
,
~N;;O MITes (!'*-''''G'Ilo!rd'
-
I>ROl'l!MV OAMA.GE I
[!"or Illl:Illenl)
Q~1llE L"'lllll'fJ' AUTO ONL V _1iA ACC1DEI\IT S
~. ANY AUTO NONE APPROV f D A.S TO FORM ~~ 'TJiAN EA I\QQ I
AUTI) ONLY: "'GO Ii
~1I~ALIAIl"'!TY ....~O ~ .. . E.'oCH OCCUl:lRG/oICIO. S
OOCUP. D CUiIoAS r.oAOE NONE ..h-'"" -.;;. JJJ>d.l/ 2- AGGREGATe $
- 7' Ll!.U a Stit,~~6d'
$
=1 DEOUCT1l1L~ AI. ssiStll ot City Attot ey $
~IIN"ION S I
WORKERI tOMIleNSATlOtl AMD ITO~ LiMiTs I I"~~
liMl'\,OY....'. UA6I\.11"f NONE ~oJ., ~eH AeODENT $
.lilt( Pf\OPftlETORf!i'A~!:fiIEXECUTI\IE
6FFlCERIMEMlll!JI{ !llClUllW'l E.L. D1SEAS& - &.-. iMPLOYIii~ I
~I, _~O. UPllIlI' E.L DlSEA8i - POLIcY LIMIT
ww. pclOVl!lOf.I!!l boola.. $
OTHER
NONE I
(
DlO~ON OF op~tlg"ll LOCA1101K1 YlH\C\,1I , IIl(CLU~N$ AIlII'!ll .., "'DOASEIlENT I !!PEe....\. PRO\ll8lONll
o8rtific.ta Holde:r iB an addit~on.~ in.~ed ~. :.cility Q~~~.
City of Bant:a Ana
~.rks & R&cr..tion
K 25 Attlu Deborah
PO BO:ll: BI8B
Santa Ana CA 92702
eANCIS~TtON
ClrY SA lIHOlILD IIHY Of Tl1E NW'I1i peKIlIIII:D POJ.ICll:e $! e"'~I!!LLEl) IIUQRE Tilt mclI1ltA.l'l/lN
D"TE THEREO~o 1'HI! I9!lUING IN!lUREIl WILL IlNDiAVOR TO IIIAlL ~ OAYS Wltln.",
NOTice TO Tl1f oamflCAll: HOLDER l't...,.lIIl TO T1iE.LEFr, BUT FM"'''. 'to cO!;() $.......L
IMP0611 1'10 08LIGATION (IR L Of! /UN KlWrl U~jO 'I'6llllN.U"'~, mJ M1E"''l'!1 CIIl
Rl!JlIl.lHMl A'f1V111.
^,,""~l) I'lI!II
Ch.val :rnl;ll.1ran
@ACORD COftPOMTlON 199
CE~TlfICAl'E HOLDER
ACORD 15 l20a1/G8l
63/~(J2~e5 13:04 7145714209
Ma r. 21. 2005 9: 1SAM CHEVAL INSuRANCE
PARKS AND RECREATION PAGE 02
No,9605 p. 2
;~
I~
..
~, 11. ~OO4 lZ. S:FM THE: tiffiN GROlP
TO;C~ IN~
NO . c184 P. 1
. .AIl-rlcan Bonk.r!
IIII'R: ~_ ClIIllIllIIlY of Florida
21j 50urA I SA Strtllt, St& 600$
OI'lD1Ja, NH 61101
ENDORSEMENT
AgaO\: THE GARN GR.OuP INC.
219;e, 31ST STREEt
~W YORK. NY 10016
This CIldorseDlm.t effective 6/23J04. forms a.,~ olPolicy No. SLlI03177
Issu~ tQ Cftl!tYt Skidmore !leA Fun With Honea
policy Period - From.: 8131/03 To: i/31/04
The l!Ibave dc.a~ribt4 policy is a.D:u~.o.ded All tollows:
It i!! agreed:
Addidon~l iuSllred added /18 I'olklw.:
Clty m Saata Alla P,m Beac:b U<l Rlll:f'udOD
PO Ba "'!lIUI M2]
Sllllta Ana. CA 9%101
APPRO V 1:.1) AS 'j' () For;'~vi
~ ;? /~
/,r~..____...-,- ....___._
Laura '.1. . ,"', ....J
AssistanL '-'~:J "..Hurney
Hndoneme.nt No.1
l"ielni\HP aw'Se: $2S
Countersign~e Date
c1::6~
gent ~
Revised Annual Pr~~: $ ~lU:cd; 8110/04 By: M.A.
All othertenna and conditioN ofthi$ policyremun unchiUlJed.
ReceivQd Time Aug.il, lO:58AM
ACORD~ CERTIFICATE OF LIABILITY INSURANCE OP ID RD I DATE (UMlDDIYYYY)
SKJ:DM 1 03/03/08
PRODUCER THIS CERTIFICATE IS ISSUED AS A MAlTER OF INFORMATION
Cheval Insurance Services ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Lie. OC94257 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P. O. Box 2933 ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW.
Fullerton CA 92837
Phone: 714-447-9191 Fax: 714-525-9191 INSURERS AFFORDING COVERAGE NAlC..
INSURED Cheryl Skidmore A1- rRCO<I-o~f/- INSURER A: American Bankers
INSURER B:
Kids Can Do ~astics 03 INSURER c:
dba Fun With orses
187 E. Wilson St. ----.- -.------
Costa Mesa CA 92627 INSURER D:
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 CONDmoNS OF SUCH
POLICIES AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE U/NDDIYY1 D'k%TIMMlDONV)" LIMITS
GENERAL LIABILITY EACH OCCURRENCE 11.000.000
L-
A X ~ 3MMERCIAL GENERAL LIABILITY SL1103177 08/31/07 08/31/08 I PREMiSES lea occunnc:e) $ 50 .000
f--- ClAIMS MADE ~ OCCUR MED EXP (Any one person) I 5,000
PERSONAL & AI:N INJURY $1.000.000
GENERAL AGGREGATE $2,000.000
GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS.CDM~PAGG $ 2,000.000
Xl POLICY n ~8T n LOC
AUTOMOBILE LIABILITY COMBINED SINGLE UI'IIT
- .
ANY AUTO NONE (b accident)
-
ALL OWNED AUTOS BDOIL Y INJURY
- .
SCHEDULED AUTOS (Per""......,)
-
- HIRED AUTOS BODILY INJURY
.
NON-OWNED AUTOS (Per accident)
--
- PROPERTY DAMAGE .
(Per Kcldlnt'
GARAGE LIABILITY AUTO ONlY. EA ACCIDENT .
R ANY AUTO NONE OTHER THAN EA ACC $
AUTO ONLY: AGG .
EXCESSlUMBRELLA LIABILITY EACH OCCURRENCE $
tJ OCCUR D CLAlIiIS MADE .
NONE AGGREGATE $
$
R DEDUCTIBLE I
.-
RETENTION $ $
WORKERS COMPENSATION AND I TORY" uMiT's I IO~.
EMPLOYERS LIABILITY NONE
M1Y PROPRIETORIPARTNER/EXECUTIVE E.L EACH ACCIDENT $
OFFICERlMEMBER EXCLUDED? EL. DISEASE . I!A EMPLOYEE $
It yes., describe under
SPECIAL PROVISIONS below E.L DISEASE. POUCY UMIT .
OTHER
NONE
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
Certificate holder is additional insured as sponsor of recreational program
but only insofar as insured operations in connection with said insured.
CERTIFICATE HOLDER
CANCELLATION
CITY SA SMOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City of Santa Ana DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN
Community Development Agency NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
M 25 Attn: Deborah
;po Box 1988 IMPOSE NO OBliGATION DR .1} ILfTY OF ANY KIND UPON THE INSURER. ITS AGENTS OR
Santa Ana CA 92702 REPRESENTATIVES.
AUTHORIZED REPRESENT} I~ ~ces
Cheval Insur
ACORD 25 (2001108) 4 ;/2... @ACORD CORPORATION 1988
// /~/--Ci.- \
./'
y
AAIS
This endorsement changes the Commercial
liability Coverages provided by this policy
-- PLEASE READ THIS CAREFULLY -
GL.B41
Ed. 1.0
ADDITIONAL INSURED
DESIGNATED PARTY
Iemental Declarations.
Designated party: CITY OF SANTA ANA PARKS & REC
Designated Activity: SPONSOR REC PROGRAM
Designated Interests: KIDS CAN DO GYMNASTICS INe
The Commercial Uability Coverage is amended as follows:
I DEFINITIONS
_.~
activities designated in the Schedule rating to:
The definition of Insured is amended to Include the
following:
a. your operations;
b. premises owned by or rented to you, or
c. other designated interests shown in the Schedule.
Insured also includes the party designated In the
Schedule but only with respect to liability arising oul of
GL-B41 Ed 1.0
Copyright MCMXCI, American Association of Insurance Servlces
AAIS