HomeMy WebLinkAboutOLSEN, KRIS 1 -2004
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N-2004-067
INSURANCE NOl ON FILE
WORK MAY NOl PROCEED
CLERK OF COUNCIL
DATE: l£J ~/'3 -04
CONSULTANT AGREEMENT
THIS AGREEMENT made and entered into this ~ 5-r1' day of M tL~ ' 2004 by
and between Kris Olsen, 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").
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RECITALS
A. The City desires to retain a consultant having special skill and knowledge in the field of
golf instruction.
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 conduct golf classes and camps at Riverview Golf Course, 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 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 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 $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 ofthe 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
(iii)
Certificates of insurance shall be furnished to the City upon execution of
this Agreement and shall be approved in form by the City Attorney.
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.
(ii)
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
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 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 1 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 of the 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:
Kris Olsen
1023 W. Orange Road
Santa Ana, California 92706
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
4
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 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 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 ofthe 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.
16.
MISCELLANEOUS PROVISIONS
5
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
) ~
~--/c1~~.. . . _?'I
PATRICIA E. HEALY -Y
Clerk of the Council
APPROVED AS TO FORM:
JOSEPH W. FLETCHER
City Attorney
~ 5i '
By:. ' '-' 1.G-? . 'Va: ry
Laura Sheedy
Assistant City Attorney
RECOMMENDED FOR APPROVAL:
CONSUL T ANT
~
JON "RIP" RIBBLE
Executive Director of Parks,
Recreation and Community Services
~ (JL~
KRIS OLS
Tax ID# 5(o039/O?O'/
6
Instructor: Kris Olsen
Class: Jr. Golf Class, Jr. Golf Camp, Beginning Golf, Intra to Golf
EXHIBIT A
Scope of Services
Junior Golf Class
. Consultant shall provide Jr. Golf Classes. These classes are targeted at youth 7 to 14 years of age.
. Consultant shall conduct the one hour class, once a week for five weeks.
. Consultant will provide each participant with balls, golf clubs (if needed) and a $25 range card which
will allow each student to practice hitting balls on the golf range.
. Consultant will confer with city to determine a class, day, and time.
Junior Golf Camp
. Consultant shall provide Jr. Golf Camp. This camp is targeted at youth 7 to 14 years of age.
. Consultant shall conduct a two hours class, five times in a one week period.
. Consultant will provide each participant with balls, golf clubs (if needed) and a $25 range card which
will allow each student to practice hitting balls on the golf range.
. Consultant will confer with city to determine a class, day, and time.
Beginning Golf Class
. Consultant shall provide Beginning Golf Classes. These classes are targeted at Teens and Adults, ages
15 years and older.
. Consultant shall conduct the one-hour class, once a week for four weeks.
. Consultant will provide each participant with balls, golf clubs (if needed) and a $25 range card which
will allow each student to practice hitting balls on the golf range.
. Consultant will confer with City to determine a class, day, and time.
Intro to Golf Class
. Consultant shall provide Intro to Golf Class. This class is targeted at families and individuals.
. Consultant shall conduct five one-hour class sessions
. Consultant will provide each participant with balls, golf clubs (if needed) and a $50 family range card or
a $25 individual range card, which will allow each family or each individual to practice hitting balls on
the golf range.
. Consultant will confer with City to determine a class, day, and time.
Class Size
. Jr. Golf Class must have a minimum of four registered and paid participants and a maximum of ten.
. Jr. Golf camp must have a minimum of eight registered participants and a maximum of twelve.
. Beginning Golf Class must have a minimum of four registered participants and a maximum of ten.
. Intro to Golf Class must have a minimum of three registered families.
. If the minimum registration has not been reach by the first class, the class may be cancelled by mutual
agreement of Consultant and City, with out any compensation owed of Consultant.
Classes Fees
. The class registration fee for Jr. Golf Class is $69 per participant per five week session.
. The class registration for Jr. Golf Camp is $129 per participant per one week session.
. The class registration fee for Adult Beginning Golf Class is $99 per participants per four week session.
. The class registration fee for Intro to Golf is $25 per family and $15 per individual for one session.
. No refunds shall be made to participants after the first week of classes unless the class is cancelled by the
Parks, Recreation and Community Services Agency.
. The City shall collect class registration fees from each participant during the registration period.
. Consultant shall not collect registration fees but shall refer interested participants to City for registration.
. City agrees to pay Consultant seventy percent (70%) of the total fees within fifteen (15) working days
after completion of the class session.
. City and Consultant agree that City shall retain thirty (30%) of the fees collected.
. Consultant agrees that City representative shall be entitled to audit Consultant's records and classes to
ensure that only registered participants are in class.
. Consultant may not waive fees.
. Only registered participants listed on roster may participate in class.
. City will agree to prepare class rosters from receipts and provide copy to consultant.
Class Location & Dates
Riverview Golf Course
Jr. Golf Class Schedule (Thursdays)
Thursdays: Session I
1. June 24
2. July I
3. July 8
4. July 15
5. July 22
Thursdays: Session II
I. July 29
2. August 5
3. August 12
4. August 19
5. August 26
Thursdays: Session III
I. September 2
2. September 9
3. September 16
4. September 23
5. September 30
Thursdays: Session IV
I. October 7
2. October 14
3. October 21
4. October 28
5. November 4
Thursdays: Session V
l. November 11
2. November 18
3. December 2
4. December 9
5. December 16
1 Class per site
1 Site
10 Max. per site
Conducted 1 time a week (5 sessions from June - December)
1 Hour per class
Class Time For the 5 Sessions
4:00pm-5 :OOpm
.
.
.
.
.
Jr. Golf Class Schedule (Sundays)
Sundays: Session I
I. June 27
2. July II
3. July 18
4. July 25
5. August 1
Sundays: Session II
1. August 8
2. August 15
3. August 22
4. August 29
5. September 5
Sundays: Session III
l. September 12
2. September 19
3. September 26
4. October 3
5. October 10
Sundays: Session IV
1. October 17
2. October 24
3. October 3 1
4. November 14
5. November 21
Class Time For thefSessions
4:00pm-5:00pm
1 Class per site
1 Site
10 Max. per site
Conducted 1 time a week (4 sessions from June - November)
1 Hour per class
.
.
.
.
.
Beginning Golf Class Schedule (Sundays)
Sundays: Session I
I. June 20
2. June 27
3. July II
4. July 18
Sundays: Session II
I. July 25
2. August I
3. August 8
4. August 15
Sundays: Session III
I. August 22
2. August 29
3. September 5
4. September 12
Sundays: Session IV
I. September 19
2. September 26
3. October 3
4. October 10
Sundays: Session V
I. October 17
2. October 24
3. October 31
4. November 7
Sundays: Sessions VI
l. November 14
2. November 21
3. November 28
4. December 5
Class Time For the 6 Sessions
1 :00pm-2:00pm
,
Beginning Golf Class Schedule (Thursdays)
Thursdays: Session I
l. June 24
2. July I
3. July 8
4. July 15
Thursdays: Session II
I. July 22
2. July 29
3. August 5
4. August 12
Thursdays: Session III
I. August 19
2. August 26
3. September 2
4. September 9
Thursdays: Session IV
l. September 16
2. September 23
3. September 30
4. October 7
Thursdays: Session V
l. October 14
2. October 21
3. October 28
4. November 4
Sundays: Sessions VI
I. November 11
2. November 18
3. November 25
4. December 2
Class Time For the 6 Sessions
1:00pm-2:00pm
1 Class per site
1 Site
10 Max. per site
Conducted once a week (4 sessions from June - December)
1 Hour per class
.
.
.
.
.
Jr. Golf Camp Schedule
Mon-Fri: Session I
l. June 28
2. June 29
3. June 30
4. July I
5. July 2
Mon-Fri: Session II
l. July 12
2. July 13
3. July 14
4. July 15
5. July 16
Mon-Fri: Session III
1. October 2
2. October 3
3. October 4
4. October 5
5. October 6
Mon-Fri: Session IV
l. October 16
2. October 17
3. October 18
4. October 19
5. October 20
1 Class per site
1 Site
12 Maximum per site
Conducted 5 times per week per session (4 sessions from June - October)
2 Hours per class
Class Time For the 4 Sessions
9:00am-II :OOam
.
.
.
.
.
Intro to Golf Class
Saturday: Session 1
June 12
Saturday: Session II
June 26
Saturday: Session III
July 17
Saturday: Session IV
August 7
Saturday: Session V
August 21
1 Class per site
1 Site
No Maximum per site
Conducted for 5 different sessions (June - August)
1 Hour class
.
Class Time For the 5 Sessions
9:00am
.
.
.
.
. .
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 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.)
, this endorsement form as a part of
Effective
Policy #
Issued to
Named Insured
Countersigned by
Authorized Representative
7
CERTIFICATE OF INSURANCE
1063165
0
9 23 04
K & K Insurance Group, Inc.
1712 Magnavox Way
P.O. Box 2338
Fort Wayne, In 46801
THIS CERTIFICATE 15 ISSUED M. Á tNn'ER OF INFORMÁ1l0N
ONLY AND CONFEFIS NO RlGHlS UPON THE CERTIFICATE
HOLDER. THIS CERTIFIOOE DOES NC1r AMEND. EXTEND OR
ÁIIER THE COVERAGE AFFORDED 81' THE POLICIES BELOW
F'RODYCS"I
COMPANIES AFFORDING COVERAGE
INSUREC
LADIES FROFESSIONAL GOLF ASSOCIATION
AND ITS MEMBERS
100 INTERNATIONAL GOLF DRIVE
DAYTONA BEACH, FL 321241092
COMPANY A
LETTER VIRGINIA
CCMPAI-IY B
LETTER
COMPÞ.NY C
LEtTER
SURETY COMPANY
INC.
COVE!RAGI!:S
THIS IS 11) CE""FV TH.<r THE PCUCI"" OF INSURANCE LlST'!D aB.OW HAVE sEEN ISSUED 10 THI! INSURED NAMED ABOVE FCI\ THE POLla.' _100 IN-
DlCATEP. NOTWITHS11.NDING ANY REQUIREUEI(T, TERM OR DONDITlON OF ANY CON1RACT OR OTHER COOUMEttTWlTH ÆSPECI" 10 WHICH THIS OERTIACPJ"E
MAY BE 1I$$I)EOORtUf PEm"AIN, THE rNSURANCEAFFO~DED BVTH€ POLIC:IES DESCFŒlEO ~E N 18 SUBJEGT TO AU.. TH!; TERMS. ËXCLUSlaNBAND CONm.
TIONS OF SUOH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID ClAIIoI&
ro POlICY EFFECI1VE POUOY EXPFWICI'
LTA TYPE OF INSURANCE POLlev NUMBEA D/lTE IMMIDDIVYI DATE (MMIDDIYY)
LIMITS (in tnousands)
A
G...,II LI8bIIltJ
ŒICommiHCiral GenerBI Liability
0 CIBlm. Made ŒI Occur.
DOwn,,'. & Cenl""'" ProI.
0
T7 0001215700
12:01AM
1/01/04
12:01AM
1/01/05
G"""",I J9.¡re . $
FrallIIOIS-Co /0 S
Pe"",nBI & Adver1s In', S
Each Occ1!rrem:ø S
Rre Oa . A on.1!Ja S
Ue<lical;x Nil OM I'$on S
I'or1lçlpant Logo! LI.bll $
CtJmbif1si:l
Sif1ç!a
U""
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Injury
IITSDß $
NONE
1000
1000
1000
300
5
1000
Aut...- Llabllly
0 Any aulD
DAII CIM1'" auIDO
0 Sohocjuled auto.
0- au'"
D Non.owned IUIOB
OGara¡¡e Liability
0
Ex.... LilÞnl1y
0
0 Other than Umbrella form
$
-
~,'k;øOM) s
",",Otty
Domaaa
$
Each
Occurrel'1ðGl
AGe-
$
$
War"" Compenaatkln
.1Id
Employe..- Liability
I/J
s
S
$
AD&D
Primer Medical
E)(œS8 Medical
Week Indemni
Slatu
Eaeh ""cidenr
Diseue-PoR Lin'ii1
D__och Em I
Portlclpaot
Aoeldon!
$
$
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.,fSCRIPT1QN OFOPfRATI SILD
ONS,V 1CL.E61 SfNCT 81
LALITEMS
CERTIFICATE HOLDER IS NAMED AS AN ADDITIONAL INSURED ON THE POLICY BUT ONLY AS
RESPECTS THE OFERATIONS OF THE NAMED INSURED.
CERTIFICATE HOLDER
CANCELLATION
CITY OF SANTA ANA, ITS
EMPLOYEES, VOLUNTEERS,
REPRESENTATIVES
OFFICIALS,
AND
SHOULD At>IY OF THE ABOVE DESCRIBED POLICIES SE
CANCELlED BEFORE THE EXPIRATION DÅTE THEREOF, THE
ISSUING COMPANY WILL ENDEAIIOR TO MAIL JQ.. DAYS
WRITTEN NOnCE TOTHECERTIRCATE HOLDER NAMEDTOTHE
LEFT. BUT FAIWRE TO MAIL SUCH NOTICE SHALL IMPOSE NO
OBLIGATION OR LIABILITY Of' AJoJY KIND UPON THE COMPANY.
rrs AGENTS OR REPRESENT.Oi
2~ J;EPRJ:;.SEN"OOl
'.92
SL 39
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SEP-23-20Ø4 lØ:07
L.P.G.A.
3862741092
P. 01/01
SEP-21-2004 1'Π02;24 PtI nK SPORTS
FJ\X NO. 2604695120
P. 02
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pÕicy c:nange()o02
Number
THIi !iNDORSEMENT Çt!Þ.NGeS THE POUCY. PLEASE: READ IT CAREFULLY.
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(11-81)
1L12m n as
POUCY CHANGES
POuCV NO.
T7 0OOOOO121P70D
POLIOY ClWlGI!S
EFFECTM!
09tJ.0/04
COMPAIIIY
VJ:RGINn SURS'rY CO!G'1UO[ ¡
INC.
NAMI' ) INSURED
LADIES PROnSSXONAL GOLl" ASSOCIA'J)IOR
~~IIITA'I1\Ia
~ :mßCl!1IHCB 1IGEN~.mc.
DOVERAGE PARTS »1'è(.1 ED
PAßß 01 OF OJ.
~ aBNBRAL LIA'Bn.rrt
cttANGES
TI!E POLrCY is AMB1IPED AS FOLLOWS,
'!'!IE CIfi OF SI\!ITA ANA, ITS ()¡;' f.IaALS, æ(P'LO!US VOL~ AND
R!lpliESE!II'rA'1'IVES Al!S ADDBtI 1-9 ADDITIONAL JJilSDRRDS ON THE POLICY.
PORM VSD76GL IS BSING ¡¡DDBD 'J:O THE POLICY w:rm RBSPKC'l'S TiŒ AJ!OI/ÓO
MJ!N'l':I:01ItSD JlPPrrIONAL J:NS1JRE ).
'.Wi: nïSURED :aBRI1JSY AW<NOJIIoiiI""'"'~ iHAT ~ CANCELL!\,'!'ION OF THS PeLle1/' IQ
IMPAIRED OOE 'J:O 'l'Hl;: A'1"l'ACHED VSK876GL AND WILL B2 ¡rss1i'OJlSJ:BLK l1'CIIi .!\NY
P ttIM p~ DUB D'CRING THE !>1C'I'U'J:CATIOlil PERIOD.
~
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RE: IUVBRV1iW GO'!3 C:OtnU1il
~
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-
C~I~nœSl;lr\llCM~.lnG"J 1983
Cop¡Irighl,l90 CoInmorolol RiSI< s.r.;œ., Inc. 1983
JA
09/13/04.
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5EP-23-2004 10:09
L.P.G.A.
3862741092
P.01/Ø2
SEP-21-2004 TIlE 02:24 PM K&K SPORTS
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~INIA SURETY COMP~Y, INC.
I'OUOY N\IMEI'I: T7 ( OOÞOÐI:n6700
FAX NO. 2804595120
P. 03
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COIPV-w. GENeRAL LlØILnY
THIS ENDORSEMENT CKANGI!S THE pòucy. PLEASI!! RQg IT CARa'ULLV.
POLICY CONDITIONS
This ~ m<:>dIftÐ$ insQranc& tmdêrlhe fdIowinø;
COMMERCIAL GSNERA\.. UIIBIl.I"TV coveRAGE: PART
O'THER INSURANCE Is amønded lIS foIIow8:
aTHeR INSURANCE -If 01IEII Valid and colJøeliÞle ÏI18IJIBi\<I9. any other kIaIIrw incbdng 8ffYftmnalRII-
InsIwd reIII1Iion ~ is &l'laíIaÞIe \D"" ccMiring a - Øo ~ þY 1hII PoIioJ. ølllørllan insll1lllC81hat Is fa ex.
- oftlaln6lUancll afIorIIr¡d by 11118 "*'. 1I1e nsnnœ aIfgrt ed þyfIis Pol"", stoaI be in -- g and &hili no!CI\IIIribIØ
WIth ,"''':11 ahirlnsUf;lPCe. NoIhIng þeraIn shall 1Is..,1I8IMd 11> make 1h1a PoI~ suÞjoc:IltI1be -. ooncIiIIon8l111d 11m.
UonsolGlhar-œ.
x Cov6r/lllll afloJdeII und8r IIW PdIq'", primary ...~ran=a end OTHER INSURANCS .hal no! "'I'PY as respaG!s
.""" "'" nw as lIdditional N8II1Ød Ii1Iur8cIs-
x CANCELLATION - ThefollawiRg is aadsd 10 1ha PoUr:y: IU. a oond1\IQn oI1ha I'oII"¥ bJlhis EnåoJ1¡é ' lBll\ 1hat!he
PoIII:¥ 'l1li1 not be cancelled Withotll. " d8¥S' prio, wrtIt8n notiQa to: '-F "'"
. . anc!1Urthar.llatlhtpenon(aj
named obova aI9 not liable lor !he pa¡omenI 01111'(»' pr8IIÌUl/1S or a~ manl$ on IhIé PoIÎC!J.
'CITY OF tWlTÞ-ANA.1T8 OFI'IWI.S. eMPLOYEes. I/O!.UN1'æ!IS AND ~EPREseIT"TIVEB.
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CERTIFICATE OF INSURANCE ISSUE C1ATE tMwt:em'}
1328630 2/20/07
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY
K & K Insurance Group, Inc. AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
1712 Magnavox Way CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE
P_O_ Box 2338 COVERAGE AFFORDED BY THE POLICIES BELOW_
Fort Wayne, In 46801
COMPANIES AFFORDING COVERAGE
INSURED COMPANY A
LETTER GREAT AMERICAN ASSURANCE COMPA
LADIES PROFESSIONAL GOLF ASSOCIATION
AND ITS MEMBERS COMPANY B
100 INTERNATIONAL GOLF DRIVE LETTER
DAYTONA BEACH, FL 32124l0n COMPANY C
LETTER
COVERAGES
THJS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN lSSUeO TO THE INSURED NAMED ABOve FOR THE POLlCY
PERIOD INOlCATED, NOTVVITHSTANOlNG 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 POUCIES DESCRIBED HEREIN IS SuBJeCT TO
ALL THE TERMS, EXCLUSIONS AND CONOlTIONS OF SUCH POLIClES_ LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAlD CLAIMS_
CO_ TYPE OF INSURANCE ~ EFFECTIVE POUCY EXPIRATlON
POUCY NUMBER TE (I,MtlOIYY) DATE'1/fNOCIIYY) LIMITS (In thousands)
LTR
General liability 12,01AM 12,OlAM General Aggregate $ NONE
A f.ii] Commercial General liability GLP0568996402 1/01/07 1/0l/08 Products-ComplOps AggJegaie $ 1000
o Claims Made &]OccUL P$'r$Ol1al & Adverlising Injury $ lOOO
DOwner's 8. contraclors Pro!. Each OccUff~ $ 1000
0 Fire Damage (Any one fire) . 300
Medil,.'al Expense (Anyone pefllOn) $ ,
Participant Legal Uability 000
Aulomobile Liability Combined
o Any auto Single $
limit
BAll owned autos Bod",
SCheduled autos Injury $
roo
B Hired altos Bod'"
NOI'HMf1ed autos ~~~---""'''l\ $
o Gerage Liability Property
0 Damage .
Ex.ceS5 Liability Each Aggregaffl
0 Oceurumce
OOlhefthan Umb<el1e 10m> $ $
Workers' Compensation 21/;) , Statutory
and / ) $ Each Accid~ll
Employers' LlabUfty $ Dlsea$e-Policy Limll
,. $ ~""E~I-
AD8.D $
Participant Primary Medical $
Accident Excess Medical $
Weekly IndemnitY $ X
DESCRIPTION OF OPERATIONSn..OCATIONSNEHICLESlRESTRICTlONSlSPECIALITeMS
RE: KRIS OLSEN
EVENT: GOLF INSTRUCTION
CERTIFICATE HOLDER IS NAMED AS AN ADDITIONAL INSURED PER FORM CG20ll,
CERTIFICATE HOLDER CANCELLATIOlII
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE I
CITY OF SANTA ANA, CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE
ITS OFFICERS, AGENTS t EMPLOYEES & ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 DAYS
REPRESENTATIVES WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO !
88B W. SANTA ANA BLVD THE LEFT, BLIT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE
SANTA ANA, CA 92702 NO OBLIGATION OR L1ABILlT~~~~N.ANY KI~- UPON THE
COMPANY, ITS AGENTS OR REPR TATIV _
^UTOORIZIiD REPR.ESE"'^1 . :e--: '/1
; ~I
SL39 / U~ ) 1->
JTHRASH
.
Policy Change 00 0 1
Number
GU 269
(11-85)
THE ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
IL12011185
POLICY CHANGES
POLICY NO.
POLICY CHANGES
EFFECTIVE
GLP0000568996402
02/20/07
COMPANY
GREAT AMERICAN ASSURANCE
COMPANY
NAMED INSURED
AUTHORIZED REPRESENTATIVE
LADIES PROFESSIONAL GOLF ASSOCIATION
K&K INSURANCE AGENCY,INC.
COVERAGE PARTS AFFECTED
PAGE 01 OF 01
COMMERCIAL GENERAL LIABILITY
CHANGES
THE POLICY IS AMENDED AS FOLLOWS:
ADD ADDITIONAL INSURED: CITY OF SANTA ANA, ITS OFFICERS, AGENTS,
EMPLOYEES AND REPRESENTATIVES
FORM GAC 3580CG IS BEING ADDED TO THE POLICY WITH RESPECTS TO THE
ABOVE MENTIONED ADDITIONAL INSURED.
THE INSURED
IS IMPAIRED
ANY PREMIUM
HEREBY ACKNOWLEDGES THAT THEIR CANCELLATION OF THE POLICY
DUE TO THE ATTACHED GAC3580CG AND WILL BE RESPONSIBLE FOR
PAYMENT DUE DURING THE NOTIFICATION PERIOD.
INSURED NAME
DATE
~"_:~:;;;~~~ -:> ~
, ~
Copyright Insurance Services Office, Inc., 1983
Copyright. ISO Commercial Risk Sen1ces, Inc. 1983
JA 02/20/07
'. .
GLPOOOO568996402
GAC 35 80 CG
(Ed. 07 03)
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
POLICY CONDITIONS
This endorsement modilies insurance under Ille lollowing;
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, 4. OIher Insurance is deleted and replaced with
the following;
D If other valid and collectible insurance with any other insurer including any fonnal sell-insured retention pro-
grams is available to you covering a loss also covered by this Policy, other than insurance that is in excess of
the insurance afforded by this Policy, the insurance afforded by fhis Policy shall be in excess of and shall not
contribute with such other insurance. Nothing herein shall be construed to make this Policy subject to the
terms, conditions and limitations 01 other insurance.
D Coverage afforded under this Policy is primary insurance and OTHER INSURANCE shall not apply as respects
as edditional Named Insureds.
The CANCEUA l10N condition 01 this policy is amended by the addition of the following:
o CANCELLATION - The following is added to the Policy: It is a condrtion of the Policy by this Endorsementlhal
the Policy will not be cancelled without 30 days' prior written notice to:
'SEE BELOW and further, that the persons
named above are not liable for the payment of any premiums or assessmenls on this Policy.
. CITY OF SANTA ANA, ITS OFFiCERS, EMPLOYEES & REPnESENTATIVES
888 W. SANTA ANA BLVD.
SANTA ANA, CA 92702
'\ ?.t jJ -,'-
'~'.<) :;1'::>)
GAC 35 80 CG (Ed. 07103)
(Page 1 of 1)