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HomeMy WebLinkAboutCROQUIS DESIGN AGREEMENT TERMINATION Please complete this form when the attached agreement is no longer in effcct.'~ .' r 1.'1 Q: ' Return form to the~. Deputy Clerk of the council (M-30), CaI1.647-523'i iJ you have any, ,::A questions, ) "l. J' :::i L \ "". - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ~"- - ~ - - - - - - - - - - - - - - - - - - - - - - - - - - - - - The agreement with G~j//JI WP..IJ/~/.n was completed on ::::>ep\ .~O, 200 Lo . No./V-.i2006'-06P . and final payment has been made, Depmtment: CDA - FE'Z-.- tJ~~ Signature AO~ J J~ Date; ~ ~ t:;,:), 2.<:;0 (,p Revised 8-7-03 City of Santa Ana Clerk of the Council INSURANCE MQI ON FILE WOAK MAY MQI PROCEED CLERK OF COUNCIL DATE: 7-31-0' THIS AGREEMENT. made and enlered intu lhis 20th day of June. 2006 by and between Croquis Design. a sule proprietor (hereinafter "Consultan!"). and the City of Santa Ana. a chalier city and municipal corporation organized and existing under the Constitution and Imvs of the State of California (hereinafter "City"). N-2006-068 CONSlILTANT AGREF:MENT RECITALS A. The City desires to retain a consultant having special skill and knowledge in the fIeld of graphics design and painting. B. Consultant represents that Consultant is able and willing to provide such services to the City_ C. In undertaking the pertormance 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 Ilnm in the field. NOW THEREFORE. in consideratiun oUhe mutual and respective promises. and subject to the terms and conditions hereinafter set forth. the parties agree as follows: L SCOPE OF SERVICES Consultant shall design and paint variuus educatiunal schuul playground markings Ji:" the John F. Kennedy Elementary School. as set forth in Exhibit A to this Agreement. 2. COMPENSATION a. City agrees to pay, and Consultant agree~ to accept as total payment for its services, the rates and charges identilled in Exhibit A. The total sum tu be expended under this Agreement shall not exceed $2.000.00 during the term of this Agreement. b. Payment by City shall be made within thirty (30) days following reccipt of proper invoice evidencing \\lork 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 hy City. 3. TERM This Agreement shall commence on the date first \-vritten above and terminate on Dccember 31,2006_ nnless terminated earlier in accordance with Section 12. beluw, The term ur this Agreement may be extended upon a \"Tiling ~x~cul~d by th~ l~xecllti\/e Director of the Community Development Agency and the City Attorney. 4. IN1H2PENDENT 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 10 exercise discretion or control over the professional manncr in which Consultant pcrforms 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 helow: a. Due to the nature or the agreement, no insurance will be required. b. \\/orker"s Compensation Insurance. In accordance with the provisions ofSectioll 3300 oftne T ,sboe Code, Consultant, if Consultant has any employees, is required to be insured against liability for \vorker's compensation or to undertake self-insurance. Prior to commencing the performance of the work under this Agreement, Consultant agrees to ohtain and maintain any employer's liability insurance with limits not less than $1.000,000 per accidenl. 6, INDEMNIFICATION Consultant agrees to and shall indemnify and hold harmless the City, its omeers, agents, employees, consultants, special counsel, and representatives lrom liability: (I) {Clf 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, emptoyees, or other persons acting on their behalf which relates to the services deserihed in section 1 of this Agreement. 7, CO."!FlDENTlALlTY 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 per!(wmance 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 inelude all nonpublic information. Confidential information includes not only \vritten information, but also information transferred orally, visually, electronically, or by other means. 2 Conlidential information disclosed to either party hy any subsidiary and/or agent of the other party is covered by this Agreemenl. The loregoing obligations of non-use and nondisclosure shall not apply to any information that (aJ 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 ofthc Consultant without an obligation of conJidentiality; (d) is required to be disclosed by operation of law; or (e) is independently devcloped by the Consultant without rekrenee to information disclosed by the City, 8. CONFLICT OF INTERF:ST CLAlISE Consultant covenants that it presently has no interests and shall not have interests, direct or indirect, \vhich would contlict 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 lirsl class or certilied mail, postage prepaid, or sent by telefaesimile or other telegraphic communication in the manner provided in this Section, to tht: 1ullowing persons: To City: Clerk of the City Council City of Santa Ana 20 Civic Center Plaza (M-30) P.O. Box Ins Santa Ana, CA 92702-1988 tclefaesimile (714) 647-6956 With courtesy copy to: Executive Director of the Community Development Agency City of Santa Ana 20 Civic Center Plaza (M-2\) P.O. Rox 198R Santa Ana. California 92702 telet~'esimile (714) 647-65S0 To Consultant: Croquis Design , Mr. Javicr~ J'11lt!!'l Z- 229 N. Bush Street Sanla Ana, California 9270 I A party may change its address by giving notice in writing to the other party. If sent by mail, communication shall be effective or deemed to have been given three (3) days after it has been deposited in the United States maiL duly registered or certified, with postage prepaid, and addressed as set forth above. If sent by telefaesimile, 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 leames, 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 contlict between the terms of this Agreement and any attachments hereto, the terms of this Agreement shall prevail. This Agreemeut may not be modi lied 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, ur in addition to, the terms and conditions hereof, shall not bind or obligate Consultant nor the City. bach 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. ASSIGNMF,NT Inasmuch as this Agreement is intended to secure the specialized services of ConsultnnL Consultant may not assign, transfer, delegate, or subcontract any interest herein \vithoul the prior \vriUen conscnt ofthc 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 ahility to have any of the services which arc the subject to this Agreement performed by City personnel or by other consultants retained hy City. 12. TERMINATION This Agreement may be terminated hy 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 ufsuch notice of termination, subject to the following conditions: u. 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 specitied in the Recitals of this Agreement. 13. I>ISCRIMINATlON Consultant shall not discriminate because of race, COIOL creed, religion, sex, marital status, sexual orientation, age, national origin, ancestry', or disability, as defined and prohibited 4 by applicabh: la\\!, in the recruitment, selection, training, utilization, promotion, termination or other employment related activities. Consultant aj]jrms 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. ioterpretation. performance, and enlorcement 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 he hrought or arise out of in connection v./ith or by reason of this Agreement. 15, PROFESSIONAL LICENSES Consultant shall, throughout the term of this Agreement, maintain all necessary licenses, permits, approvals, vvaivers, and exemptions necessary for the provision of the services hereunder and required by the laws and rcgulations of the United States. the State of California, thc City of Santa Ana and all other governmental agencies. Consultant shall notify the City immediately and in writing or its inability to obtain or maintain such permits, licenses. approvals, \vaivcrs, and exemptions. Said inability shall be cause for terminatiun of this Agreement. 16, MISCELLANEOUS PROVISIONS a. Each undersigned n:pn:sents and v,.'arrants that its signature hereinhelow has the pO\VCL 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 attanlcy's fees, for any injuries or damages to City in the event that such authority or povvcr is not, in fact, held by the signatory or is withdrawn. b. All Exhibits reiereneed herein and attached hereto shall be incorporated as if tillly set forth in the body of this Agreement. II II II II II II II 5 IN WITNESS WIIEREOF, the parties hereto have executed this Agreement the date and yem llrst above written. ATTEST: CITY OF SANTA ANA ~~~- PATRICIA E. ilEAL Y Clerk of the C''''!!leil :J-lfJ J,.....DA VIO N. JEAM City Manager ~ APPROVED AS TO FORM: JOSEPH W. FLETCHER City Attorney ~; ,,, y ,'.", By: i tlu.c,;jt,,"~,L.41 J .aura Sheedy Assistant City Attorney RECOMMENDED FOR APPROVAL: CROQUIS DESIGN ST~~~IARDlNG Deputy City Manager of Development Services -?~~ JAVIER ." aenz- Owner Tax 10# GCJ -d3.'/U/() 6 CROQUIS DESIGN PROPOSAL FOR SERVICE MAY 23, 2006 CITY OF SANTA ANA C/O JOHN F. KENNEDY ELEMENTARY SCHOOL CROQUIS DESIGN Santa Ana, CA 92701 1 714457-1442 is ,craq uis@sbcglabal,net The parties agree thaI tbe lnformatiflll ;nl],i, l''''I'""d Sh,llllll)( be disclosed OUlsidl' of Client organization and shall not be duplicated, used, or dildoscd in whole or in pan Ii)] ;my purp",e lllhn than (0 evaluale the proposal, prm.ided that if a contract is awarded to Croquis as a result of or in connectioll wjth Ihe "lhmi"j'lIl of Ihis pmpmal, Clienl shall have the right to duplicate, use ordisdO>e the information to the extent provided by the contract. This re,triction does 001 limilthe righl of client to \j!e information contained in lhe proposal if it is Obli1ined from another source without te:;lrictJun. EXHIBIT A PROPOSAL FOR SERVICE: John F. Kennedy Elementary School CROQUIS DESIGN I Scope of Work' Schoolyard Graphic Markings Croquis Design will paint various educational school playground markings for John F, Kennedy Elementary School, (as listed belowJ 11 Redesign of existing schoolyard markings Proiect Delivery Croquis Design will deliver the final proiect os painted graphic schoolyard markings on various schoolyard playground surfaces. II Prolect A55umpfions: The scope of work and cost estimates included within this proposal is contingent upon the assumptions below. Any assumptions found invalid or untrue will have an effect on estimated schedules and costs. 1. John F. Kennedy Elementary School is responsible for miscellaneous cleaning services associated with or required for the completion of any project of any portion of the project. 2. Croquis Design will provide the necessary artwork so that John F. Kennedy Elementary School can achieve consistency between its educational programs and the proposed schoolyard morkings. Artwork formats will be: JPEG, TIFF, PDF ond PSD. 3. John F. Kennedy Elementary School and Orange County on Track will supply the necessary paint and painting materials for the scope of the project. 4. Croquis Design IS responsible for delivery of the actual schoolyard graphic markings. Though Croquis Design can aSSist the client with schoolyard surface preparation and cleaning, Croquis Design is ultimately not responsible for such matters. "Croqui~ De~ign i~ nol responsible for producing deliverabla~ thai fall out~ide the outlined specifications. III Client Relations and ResponSibilities To establish an effective channel of communication between Croquis Design and John F. Kennedy Elementary School, Mark l. Von Horn will be the project manager. The praject manager is your primary point of contact with Croquis Design. Hence, all emails, telephone calls, faxes and letters should be directed to the praieet manager. Compliance with these policies Will ensure expeditious responses to your requests. The project manager will relurn all calls and respond to emoillnquires and requests Within the next working day; likewise, Croquis Design expects compliance to 011 administrative requirements. Project Manager: Mark L. Van Horn Ass.istant Principal John F. Kennedy Elementary School 1300 E. McFadden Avenue Santo Ano, CA 92705 Phone: 17141972.5700 Fox: 1714) 972.5799 Email: mvanhorn@sausdl12.ca.u5 page 2 of 4 PROPOSAL FOR SERVICE: John F. Kennedy Elementary School CROQUIS DESIGN IV Project Deliverables 1) MILESTONE 1: Design approved for look and composition relative to John F. Kennedy Elementary School educational standards. 2) MILESTONE 2; Production progression in stages. 3) MILESTONE 3: Project completion painted on schoolyard grounds. V. Project Schedule The project will adhere to the following schedule. The slart date of the proiect is dependent upon the completion of all required contracts and adherence to the project payment. Project Timeline: Start Production 5/30/2006 Design Concepts and Elements: Design Revisions and Approval: Design Concept Implementation: Due 5/31/2006 Milestone 1 , Due 6/01/2006 Milestone 2 Due 6/30/2006 Milestone 3 *Pleme note that any delays on the c1ienl side will directly affect the timeline and target completion dote of the project. VI Fees & Payment Schedule The deliverables in this Proposal for Service will be created and delivered for the following fees: John F. Kennedy Elementary Schoolyard Graphic Markings: $2,000.00 School Visits and Photography Drawings and Sketches: Paint labor; 1 hr. @ $40/hr. 8hrs, @ $70/hr. 20hrs. @ $70/hr. $ 40.00 $ 560,00 $ 1,400.00 $ 2,000.00 Total 29hrs. This fee includes all school visits, photography, drawings and sketch resources from Croquis Design, and 011 typical materials costs of presentations and deliverables. Any non.stondard material expenses will be billed at cost, with prior approval of Client. Other reimbursable expenses, if any, will be billed at cost. All expenses are subject to Client's prior written approval, and submission of appropriate documentation evidencing such expenses. page 3 01 4 ~ u ~ "' o Z Q '" ~ >- to => U ~ " e " ~ '" ~'" ~ 0;<; ><~ ....~ ~5 68 UN ~r <( e "'u "' ~ c r ~ .... c ~~ u ~ 5 "J <~ '" "'2- ~t5 , , E f- ID ~~ , · , " C'! w g ~g ! ~ (") ua> Z c U . 0.:0 u '" ....~ 8~ z 0 u EB ~ ~ t; ~ ~ ~1~~ wc:""-o... ~~~~ 2"8<<.0 Z"'u~ w.. ~ c'e; c< u.::u..i<0! ZOllJ;; :r:oc:::> Q~~~ , . -fT " I! 'E I "^ ',' , . '" . ," "' '-I ' J 1m " .. . :.a..,~.. !--~-;:;5 ......m W~ ~"'.." g g: <: .~. M ':, a~ , " . ~ 'I :,'1: . 'I:. I' w, it :) iNJW;,;~'.) ~ t OJ < f-~ Z'" w<( or =>u ....z "'3 " Z Q N= ::> ~0m Oz>< O'-u ::I:Oii: u~.:c ",=>>- "'~ Q "' N ~0 Oz 0- :c~ u::> "'m /' ;...t. "';""I~~ _" J ./..""'1'1 '/,',,:f.J ,~/ '" ~ =0 ~Z !<(~ uZ "'6 ~u z "' ~ ' .., '~" ,:---1,./ '\~,r,,; . 'IIi',1 .. )1" ...",\h i-J, l' j ... 'l5 ... ~ ~ g:() ~;> "' " '" z~ ~8 0: u '" " '" z~ ~8 ~o: u "' VO"'~~"'~ l~;l'=' Jl.t"rt~II-,~.fb:K::lt] NO.9ffi ~1 Santa Ana Unified School District DA T~ JUNf 22, 2006 PAG~S: '1. (INCLUDING CDIlER) R~fERENCE: KENNEDY aseNTARY SCHOOL To Deborah Sanchez, Manager NAME: Federal Empowerment Zone AHTOHETTE M. ROBERTO c/o Ann Hawkins OFFICE OF THE DEPUTY SUPERlNTENDENT PtiONE; (714) 558-551) fAX': (7'.)558-5694 DURGENT DFOIl REVIEW DPLEASE COMII~T DI't.EASE IlEPLY DPLEASE RECYCLE FAXTRANSMRTALFORM Letter of aceeptance, as you requested. Thank you. T".p1lCOdI"lIf..__beC<lnl'denlio<..~ tl\'1I'" _ey_..... ~"...""._tor_ TO. 0._1>\1. any uneulhor'Iled Pfr$Ol'\f. If you ~.......lNs ,.,....In error. ple... (I) do not,"" .. (II) reply 110 the .eJlderthat you IEICCivcd the IMSSlIge in etrOI. and ll~ emse or desIrnr lhe~. If uan.ud..ion ia incompl.te, pl.... coil ('1'14) 558055U. 1601 2aD~ Che9~nut Avenue. '&nta kna, CA 92701-63JJ l!lb/~.!./~ l..~: 1':1 Jl..I"f'l J:1t:.1'I'I::.11 ~ ':b4'(b::Jt::ll!l 1'IJ.9fl5 (;IB2 _ ;.. 11&. Santa Ana Unlfted ~=!~~~~~ "iii"" June 21, 2006 Deborah Sandlez, Manager Federal Empowerment lDne 4'" Floor Ross Annex 20 Civic Center Plaza, M.2l Santa Ana, CA 92704 Re: Playground Murals Kennedy Elementary School Dear Ms. Sanchez: The proposed murals 10 be painted on the playground asphalt III Kennedy Elementary School funded tlvouglt the Federal Weed and Seed Project have been occepted. The scope of wort involves the following: l> Snail mural with letters of the alphabet on the kindergarten playground l> Clllmpillar mural with the numbers I -30 on the kindergarten playgrOlDld l> Time tables mural on the elementary playground )> .Safe Passage" walkway from bungalows to lunch area with shape patterns and _kip Munting (3_, 6_, 70, 8s, 9s) )> Concennic CiIeular Maze )> Enhancement of existing hopscoteh designs with eolors and sight words We al_o WIlIlt to thanI:: you for every1hing thAI you do for the children of this ifC/ll community. Your work toucbcs the lives of many. Sincerely, [) e~~- J Russo o uty Superintendent :MlI 1601 Eo.. CIl.._ Avonu.. Sonia Ana, CA 92701.6322 (71.' 558.5501 BOARD Of EDUCA110N AUdrey Yllnpla.N*jl. Ph.D., htf;idtnt oil Rob Jtjcha~ 'Yke Prwldonl &1 Tm.Jcro. Cktk. Rosemarie AvU., MehaN.. ' J..... ~ Membet WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjury, the (NilnlerTitl~) following declaration: (Organization Name) that during the term of my , City of Santa Ana, I will not I certify on behalf of contract with the employ any person in any manner so as to become subject to the workers' compensation laws of Cali fomi a, and agree that if! should become subject to the workers' compensation provisions of Section 3700 ofthe Labor Code, I shall forthwith comply with those provisions. DATE: By: Name: Title: Telephone: ___ WAR]\;ING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS HNLA WFLL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (SIOO,OOO). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 Of TIlE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. N- ZDOIo-Ob'il Company Name Here Memo To: Mr. Javier Sanez From: Deborah Sanchez - Weed and Seed Coordinator cc: Mark Van Horn, Kennedy Elementary Date: 6/26/2006 Re: John F. Kennedy Elementary School Attached is the contract to perform design and painting services on the playground area at John F. Kennedy elementary school. Please review, sign and send back to my attention the enclosed contract copies. I wiil then proceed in obtaining final signatures and send back to you a fully executed agreement. In regards to the grant that this work is being performed under, I have received approval for your work to commence after the grant deadline of June 30, 2006. However, this project must be completed, inVOiced and paid prior to September 3D, 2006. Please contact Mr. Mark Van Horn at Kennedy to arrange a start date and access to the play yard. If you have any questions about the contract or invoice process, please contact me at 714-647-6548. Thank you for your services. Your designs will be thoroughly enjoyed by the children of Kennedy elementary. Deborah Sanchez Weed and Seed Coordinator N ~2.~tlb- exs,8' Mitre-Ramirez, Norma From: Sent: To: Subject: Sheedy, Laura Wednesday, July 26, 20069:12 AM Mitre-Ramirez, Norma RE: Croquis Design Agreement Hi Norma When I state that insurance is not required, I am only talking about the Commercial General Liability insurance. We are required to make sure the people we contract with have Workers Camp insurance. However, they only need workers camp if they actually have employees. In this case, I believe he does not have employees. I have attached a declaration that consultants may sign indicating they are not subject to workers compo Let me know ~1 have any questions. WORKERS' PENSATION FORM,( Thanks Laura Sheedy Assistant City AUorney (714) 647-5201 THIS COMMUNICATION AND ANY ATTACHMENTS MAY CONTAIN LEGALLY PRIVILEGED AND/OR OTHER CONFIDENTIAL INFORMATION. IF YOU ARE NOT THE INTENDED RECIPIENT(S) OR THE EMPLOYEE OR AGENT RESPONSIBLE FOR DELIVERY OF THIS COMMUNICATION TO THE INTENDED RECJPIENT(S) OR BELIEVE THAT YOU MAY HAVE RECEIVED THIS COMMUNICATION IN ERROR, YOU ARE HEREBY NOTIFIED THAT ANY DISSEMINATION, DISTRIBUTION, COPYING, OR. OTHER USE OF THE INFORMATION CONTAINED IN THIS COMMUNICATION IS STRICTLY PROHIBITED. PLEASE REPLY TO THE SENDER INDICATING THE FACT OF THE ERROR AND DELETE THE COpy YOU RECEIVED FROM YOUR COMPUTER. From: Mitre-Ramirez, Norma Sent: Wednesday, July 26, 2006 8:30 AM To: Sheedy, Laura Subject: Croquis Design Agreement Hello Laura, Just wondering if insurance is needed or not (or 5a does not cancel out the statement in 5b) In the agreement under 5a. it reads that "(d)ue to the nature of the agreement, no insurance will be required" however, 5b does mention of the need of Worker's Camp. Insurance if consultant has employees. Thank you, Norma << File: 06.pdf>> 1 N_2006-068 WORKERS' COMPENSATION DECLARATION Jt/i'!/( ~M Z hereby affirm under penalty ofpcrjury, the (;..lam<;:/Tille:) following declaration: I certify on bchalfof CrtJf-tl/.sp'>/1/J that during the term of my (Organization Name) (,/ contract with the , City of Santa Ana, I will not employ any person in any manner so as to become subject to the workers' compensation laws of Cahfomia, and agree that if! should bccomc subject to the workers' compensation provisions of Section 3700 ofthe Labor Code, 1 shall forthwIth comply DATE: f2-zF2> By: Cr d/ a /$ c(J,e f/1/] '/. Y Name: ~ /lVI c~ 5<'9E#Z- Title:fi5/?n #/pc/#a/ <./ . Telephone: (7/'I) 'f J?~ I YV 2---- / WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS U'-JLAWFUL, AKD SHALL SUBJECT AN EMPLOYER TO CRIMIKAL PENALTIES AND CIVIL FP.-lES CP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, I'-JTEREST, AND ATTORNEY'S FEES.