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HomeMy WebLinkAboutHOLISTIC YOGA & HEALTH, LLCINSURANCE ON FiLE N-2025-095 WORK MAY PROCEED UNTIL INSURANCE EXPIRES CITY CLERK DATE. RECREATION SERVICES AGREEMENT WITH HOLISTIC YOGA & HEALTH, LLC, APR 16 2025 FOR YOGA CLASSES b. i wAGO THIS AGREEMENT is made and entered into on this 24th day of February 2025 by b6Nl Poy to) and between Holistic Yoga & Health, LLC., a California limited liability company ("Provider"), and the City of Santa Ana, a charter city and municipal corporation organized and existing under the Constitution and laws of the State of California ("City"). City and Provider may be collectively referred to as the "Parties" or individually as a "Party." RECITALS A. The City desires to retain a recreation service provider having special skills, resources and knowledge to provide yoga classes in its recreation class program. B. Provider represents that it is able and willing to provide such services to the City. C. In undertaking the performance of this Agreement, Provider represents that it is knowledgeable in their field and that any services performed by Provider under this Agreement will be performed in compliance with such standards as may reasonably be expected. D. The Parties acknowledge that the City intends to provide recreational activities to the public but must balance the need to comply with all COVID-19 guidance and restrictions. NOW THEREFORE, in consideration of the mutual and respective promises, and subject to the terms and conditions hereinafter set forth, the Parties agree as follows: 1. SCOPE OF SERVICES a. Provider shall perform those services as set forth in Exhibit A to this Agreement. b. All classes operated pursuant to this Agreement for conducting recreation classes at City facilities, including parks, will comply with all applicable guidance and public health orders, including those from the Centers for Disease Control ("CDC"), California Department of Public Health ("CDPH"), the Orange County Health Care Agency ("OCHCA") and the City itself for as long as those orders and guidance remain in place. Provider will remind participants of these guidelines. To the extent that Provider needs assistance with enforcing any rules or requirements, Provider will contact a City Parks' employee or City security for assistance. c. Provider shall not attend a class or teach any class if Provider is sick or has any symptom(s) associated with COVID-19 including but not limited to, fever above 100.4, chills, cough, shortness of breath, loss of taste or smell, nausea, muscle or body aches, vomiting, headache, sore throat or diarrhea. Page 1 of 10 d. Provider will not attend class or teach a class if Provider or any member of Provider's household has been asked to quarantine or self -isolate due to symptoms of COVID-19 or a positive test result for COVID-19. e. Provider acknowledges that, to the extent that City is able to and chooses to conduct classes indoors, this Agreement will also cover classes conducted at one of City's recreational centers during the term of this Agreement. f City reserves the right to change the location(s) at which the services contemplated by this Agreement are provided. g. Provider shall comply with the City's recreation class policy manual and any other City rules and regulations regarding the operation of recreation classes. 2. COMPENSATION a. In consideration for the provision of the programs set forth in Exhibit A, City agrees to pay, and Provider agrees to accept as total payment for their services for the City, seventy percent (70%) of all gross revenue received from program participants. Total revenue to Provider shall not exceed twenty-five thousand dollars and zero cents ($25,000.00). b. Payment by City shall be made within forty-five (45) days following completion of the last class taught by Provider the prior month, subject to City accounting procedures. City and Provider agree that all payments due and owing under this Agreement shall be made through Automated Clearing House (ACH) transfers. Provider agrees to execute the City's standard ACH Vendor Payment Authorization and provide required documentation. Upon verification of the data provided, the City will be authorized to deposit payments directly into Provider's account(s) with financial institutions. 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. c. City shall be responsible for collecting all fees from program participants. Provider shall not collect fees but will refer all interested participants to City for registration information. Provider agrees that City shall retain thirty percent (30%) of all gross revenue received from program participants as an administrative fee. 3. TERM This Agreement shall commence on March 1, 2025 and end on February 28, 2026 unless terminated earlier in accordance with Section 14 below. The term of this Agreement may be extended by a writing executed by the City Manager and the City Attorney. Page 2 of 10 4. INDEPENDENT CONTRACTOR Provider 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 manner in which Provider performs the services which are the subject matter of this Agreement; however, the services to be provided by Provider shall be provided in a manner consistent with all applicable standards and regulations governing such services. Provider 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. Provider is not an agent, representative or employee of City and Provider shall have no authority to act on behalf of the City. 5. INSURANCE Prior to undertaking performance of work under this Agreement, Instructor shall maintain and shall require subcontractors, if any, to obtain and maintain insurance, as described below, for the entire Term of this Agreement, against claims for injuries to persons or damage to property which may arise from or in connection with services, products and materials supplied. Total cost of such insurance shall be borne by Instructor. Minimum Scope and Limit of Insurance: • Commercial General Liability (CGL): Insurance Services Office Form CG 00 01covering CGL on an "occurrence" basis, including products and completed operations, property damage, bodily injury and personal & advertising injury with limits no less than $1,000,000 per occurrence and $2,000,000 aggregate. Required policy limits can be met with primary and umbrella/excess insurance policies. • Automobile Liability: Insurance Services Office Form CA 00 01 covering Code 1 (any auto), with limits no less than $1,000,000 per accident for bodily injury and property damage. In the event Instructor does not maintain commercial automobile liability insurance, City will accept evidence of personal automobile insurance. • Workers' Compensation: as required by the State of California, with Statutory Limits, and Employer's Liability Insurance with limit of no less than $1,000,000 per accident, policy or employee, for bodily injury or disease. Coverage is not required if Instructor has no employees and signs request to waive such insurance. • Sexual Abuse or Molestation Liability (SAML): If the work will include contact with minors, and the CGL policy referenced above is not endorsed to include affirmative coverage for sexual abuse or molestation, Permittee shall obtain and maintain a policy covering Sexual Abuse and Molestation with a limit of no less than $1,000,000 per occurrence or claim. • If Instructor maintains broader coverage and/or higher limits than the minimum requirements for each line of coverage shown above, City requires and shall be entitled to the broader coverage and/or the higher limits maintained by Instructor. Any available insurance proceeds in excess of the specified minimum limits of insurance and coverage shall be available to City. Page 3 of 10 Other Insurance Provisions. The above required insurance policies are to contain or be endorsed to contain the following provisions: • City of Santa Ana, its City Council, its officers, officials, employees, agents, and volunteers are to be covered as additional insureds with respect to liability arising out of work or operations performed by or on behalf of the Instructor including materials, parts, equipment, and personnel furnished in connection with such work or operations. • Instructor's Insurance company(ies) agrees to waive all rights of subrogation against City, its City Council, its officers, officials, employees, agents, and volunteers for losses paid under the terms of any policy which arise from work performed by Instructor under this Agreement. • For any claims related to this contract, Instructor's insurance coverage shall be primary and any insurance maintained by City, its City Council, its officers, officials, employees, agents, or volunteers shall not contribute with it. • A severability of interest provision must apply for all the additional insureds, ensuring that Instructor's insurance shall apply separately to each insured against whom a claim is made or suit is brought, except with respect to the insurer's limits of liability. • Insurance policy(ies) required herein shall provide that coverage shall not be canceled, suspended, voided, reduced in coverage or in limits, non -renewed by the carrier, or materially changed except after thirty (30) days prior written notice has been given to City. Ten (10) days prior written notice shall be provided to City for policy cancellation or non -renewal due to non-payment. • Certificate Holder on each Evidence of Insurance certificate shall be: City of Santa Ana, Attention: (Name of Department Staff Responsible for Agreement), Address of Department Responsible for Agreement, M-XX, Santa Ana, CA 92701. Acceptability of Insurers. Insurance is to be placed with insurers authorized to conduct business in the State of California with a current A.M. Best rating of no less than A:VII, unless otherwise acceptable to City. Verification of Coverage. Instructor shall furnish City with original Certificates of Insurance including all required amendatory endorsements (or copies of the applicable policy language effecting coverage required by this clause) and a copy of the Declarations and Endorsement Page of the CGL policy listing all policy endorsements before work begins. However, failure to obtain the required documents prior to the work beginning shall not waive Instructor's obligation to provide them. City reserves the right to require complete, certified copies of all required insurance policies, including endorsements required by these specifications, at any time. Special Events Coverage. Special events coverage is available and can be purchased by Instructor. Use this link to learn more: https://2sparta.com/selip application.php. Special Risks or Circumstances. City reserves the right to modify these requirements, including limits, based on the nature of the risk, prior experience, insurer, coverage, or other special circumstances. Page 4 of 10 6. INDEMNIFICATION Provider agrees to and shall indemnify, defend and hold harmless the City, its officers, agents, employees, consultants, special counsel, and representatives from liability: (1) for personal injury, damages, just compensation, restitution, judicial or equitable relief arising out of claims for personal injury, including death, and claims for property damage, which may arise from the negligent operations of the Provider 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; and (2) from any claim that personal injury, damages, just compensation, restitution, judicial or equitable relief is due by reason of the terms of or effects arising from this Agreement, to the extent that the injury, damages, just compensation, restitution, judicial or equitable relief is caused by the negligence of the Provider. This indemnity and hold harmless agreement applies to all claims for damages, just compensation, restitution, judicial or equitable relief suffered, or alleged to have been suffered, by reason of the events referred to in this Section or by reason of the terms of, or effects, arising from this Agreement. City may make all reasonable decisions with respect to its representation in any legal proceeding. In no case will Provider be required to indemnify or hold harmless the City from injury, damages, just compensation, restitution, judicial or equitable relief caused by the negligence of the City. 7. CONFIDENTIALITY If Provider receives from the City information which due to the nature of such information is reasonably understood to be confidential and/or proprietary, Provider 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, including but not limited to student records. Confidential information includes not only written information, but also information transferred orally, visually, electronically, or by other means. Confidential information disclosed to either Party by any subsidiary and/or agent of the other Party is covered by this Agreement. The foregoing obligations of non-use and nondisclosure shall not apply to any information that (a) has been disclosed in publicly available sources; (b) is, through no fault of the Provider disclosed in a publicly available source; (c) is in rightful possession of the Provider without an obligation of confidentiality; (d) is required to be disclosed by operation of law; or (e) is independently developed by the Provider without reference to information disclosed by the City. 8. COVID-19 ASSUMPTION OF RISI{ AND WAIVER Provider acknowledges that Provider could be exposed to persons that may have COVID- 19 providing services pursuant to this Agreement. Provider understands that interacting with any person currently comes with the inherent risk of exposure to COVID-19 and that COVID-19 is highly contagious. Provider assumes the risks associated with providing services pursuant to this Agreement, namely potential exposure to COVID-19. Provider acknowledges that while some people have no symptoms or mild symptoms from COVID-19, some people have become seriously Page 5 of 10 ill requiring hospitalization and that some people have died from COVID-19. Provider acknowledges that persons over the age of 65 and persons with underlying health conditions are at greater risk of contracting COVID-19 and are potentially risking serious injury or death. Provider is agreeing to provide classes pursuant to this Agreement and does so of Provider's own free will. Provider intends to be legally bound by this assumption of risk, release and waiver and to bind Provider's heirs, personal representatives, next of kin and anyone who may make a claim on Provider's behalf. Provider knowingly releases and waives any and all claims that Provider may have or could have in the future and includes any claims resulting from potential exposure or actual exposure to COVID-19, this includes claims for personal injury, transmittal of COVID-19 to others, and/or wrongful death. Provider agrees to hold harmless, defend and indemnify the City, its public officials, officers, employees, volunteers, and agents from any and all claims for liability or damages, including those for exposure to or diagnosis with COVID-19 as a result of providing services pursuant to this Agreement. 9. CONFLICT OF INTEREST Provider 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. 10. BACKGROUND CHECK Provider shall ensure that all employees, subcontractors, and any volunteers are fingerprinted and background checked prior to conducting any work pursuant to this Agreement. Provider shall not assign any employee, agent, subcontractor, volunteer or the Provider personally to provide services pursuant to this Agreement, if that employee, agent, subcontractor, volunteer, or the Provider personally are required to register as a sex offender under California Penal Code Section 290 et seq, have a conviction for any crime of moral turpitude, have a conviction for a sexual based crime, have a conviction for a violent felony as defined in California Penal Code Section 667.5(c), or has a conviction for a serious felony as defined in California Penal Code Section 1192.7(c). Disqualifying convictions include but are not limited to, violations of California Penal Code Sections 37, 128, 136.1 with Section 186.22, 187, 190-190.4 and 192(a), 205, 206, 207-209.5, 211, 212, 212.5, 213, 214, 215, 218-219, 220, 236.1(b) or236.1(c), 243.4, 261, 261.5, 273.5, 262, 264.1, 266, 266c, 266h, 266i, 266j, 267, 269, 272, 273a, 273ab, 273d, 285, 286, 288, 288a, 288.2, 288.3, 288.4, 288.5, 288.7, 289, 290, 311.1, 311.2, 311.3, 311.4, 311.10, 311.11, 314, 347(a), 368, 417(b), 451(a),518 with 186.22, 647.6, 653f(c), 664 and 187, 667.5(c), 18745, 18750, or 18755, 12022.53, 11418(b)(1) or (b)(2); Business and Professions Code Section 729. 11. NOTICE Any notice, tender, demand, delivery, or other communication pursuant to this Agreement shall be in writing and shall be deemed to be properly given if delivered in person or mailed by first class or certified mail, postage prepaid, or sent by fax or other telegraphic communication in the manner provided in this Section, to the following persons: Page 6 of 10 To City: City Clerk City of Santa Ana 20 Civic Center Plaza (M-30) P.O. Box 1988 Santa Ana, CA 92702-1988 Fax (714) 647-6956 With 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 Fax (714) 571-4211 To Provider: Holistic Yoga & Health, LLC Attn: Woomyung Son 13041 Galway Street #D Garden Grove, CA 92844 gardengrove(a,bodvnbrain.com A Party may change its address by giving notice in writing to the other Party. Thereafter, any communication shall be addressed and transmitted to the new address. If sent by mail, communication shall be effective or deemed to have been given three (3) days after it has been deposited in the United States mail, duly registered or certified, with postage prepaid, and addressed as set forth above. If sent by fax, communication shall be effective or deemed to have been given twenty-four (24) hours after the time set forth on the transmission report issued by the transmitting facsimile machine, addressed as set forth above. For purposes of calculating these time frames, weekends, federal, state, County or City holidays shall be excluded. 12. EXCLUSIVITY AND AMENDMENT This Agreement represents the complete and exclusive statement between the City and Provider regarding the subject matter herein, and supersedes any and all other agreements, oral or written, between the parties. In the event of a conflict between the terms of this Agreement and any attachments hereto, the terms of this Agreement shall prevail. This Agreement may not be modified except by written instrument signed by the City and by an authorized representative of Provider. The parties agree that any terms or conditions of any purchase order or other instrument that are inconsistent with, or in addition to, the terms and conditions hereof, shall not bind or obligate Provider or the City. Each Party to this Agreement acknowledges that no representations, inducements, promises or agreements, orally or otherwise, have been made by any Party, or anyone acting on behalf of any Party, which is not embodied herein. Page 7 of 10 13. ASSIGNMENT The experience, knowledge, capability and reputation of Provider were a substantial inducement for City to enter into this Agreement. Therefore, Provider 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. 14. TERMINATION a. This Agreement may be terminated by the City upon thirty (30) days written notice of termination. In such event, Provider shall be entitled to receive, and City shall pay Provider, compensation for all services rendered prior to the effective date of termination. b. Termination or cancellation of classes by the must be given to the City, in writing, at least thirty (30) days prior to termination/cancellation. Failure to provide adequate cancellation notice to the City may put future contracting of business with the City at risk and will result in the City's retention of ten (10%) percent of the final payment to Provider. 15. RECORDS Provider shall use attendance sheets generated and supplied by the City to record attendance in each class. Provider shall keep these and any other records in connection with the work to be performed under this Agreement and shall permit City, upon request, to review such records for a period of three (3) years from the date of final payment to Provider under this Agreement. 16. NON-DISCRIMINATION Provider shall not discriminate because of race, color, creed, religion, sex, marital status, sexual orientation, gender identity, gender expression, gender, medical conditions, genetic information, or military and veteran status, age, national origin, ancestry, or disability, as defined and prohibited by applicable law, in the recruitment, selection, teaching, training, utilization, promotion, termination or other employment related activities or any services provided under this Agreement. Provider affirms that it is an equal opportunity employer and shall comply with all applicable federal, state and local laws and regulations. 17. 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. Page 8 of 10 18. LICENSES Provider 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. 19. SEVERABILITY In the event that one or more of the phrases, sentences, clauses, paragraphs or sections contained in this Agreement shall be declared invalid or unenforceable by valid judgment or decree of a court of competent jurisdiction, such invalidity or unenforceability shall not affect any of the remaining phrases, sentences, clauses, paragraphs or sections of this Agreement, which shall be interpreted to carry out the intent of the Parties hereunder. 20. EXHIBITS All Exhibits referenced herein and attached hereto shall be incorporated as if fully set forth in the body of this Agreement. 21. AUTHORITY The person(s) executing this Agreement on behalf of the Parties hereto warrant that they are duly authorized to execute this Agreement on behalf of said Parties and that by so executing this Agreement, the Parties hereto are formally bound to the provisions of this Agreement. [signature page follows] Page 9 of 10 SIGNATURE PAGE TO RECREATION SERVICES AGREEMENT WITH HOLISTIC YOGA & HEALTH, LLC, FOR YOGA CLASSES IN WITNESS WHEREOF, the Parties hereto have executed this Agreement the date and year first above written. ATTEST: APPROVED AS TO FORM: SONIA R. CARVALHO City Attorney c� Jonathan T. Martin Assistant City Attorney RECOMMENDED FOR APPROVAL: Hawk Scott Executive Director of Parks, Recreation and Community Services Agency CITYZA.NTA Alvaro Nunez City Manager Ii:�IiD C �1100lY1�11111q &;l Waomyung 5a (Feb ,202513.50 PST) Woomyung Son Owner Page 10 of 10 Exhibit A SCOPE OF SERVICES Program Overview: This Scope of Services outlines the responsibilities and expectations for engagement of Provider to provide yoga and fitness classes for ages 18 years and up at City recreation facilities and parks, as defined below. The aim is to promote health and wellness in the community by offering affordable recreation opportunities that encourage creative activity and teamwork. A. Program and Class Offerings: Seasonal programs and class offerings may include, but are not limited to the following class options: i. Yoga and Tai Chi ii. Instructor shall teach such or similar classes at available City facilities to be designated by the City on a schedule agreed upon by the parties, in writing, for each class session or term, including the location, specific days and hours when classes will be held, and holidays to be observed, in accordance with City's needs. Provider and City agree that class locations and/or scheduling are subject to change due to unforeseen events or needs beneficial to the class participants. The Parties agree that changes to scheduling or location of classes shall be agreed upon, in writing, prior to the allowance of said change(s). iii. Class Size i. At the City's discretion and upon mutual agreement, the minimum and maximum number of participants required for each class will be determined to ensure the quality and safety of the class participants. ii. Class ratio of participants to instructor(s) will beset for each class to ensure effective instruction and safety based on statewide standards. iii. If the minimum registration has not been reached by the second class, it is up to the discretion of the City upon mutual agreement with Instructor, that the class shall be cancelled. Instructor will be under no obligation to provide services for the cancelled classes, and the City will have no further obligations to pay Instructor compensation for the remaining classes that were cancelled in that session. iv. Class Fees t i. Class pricing is dependent on session length per season and subject to City staff approval. Class pricing is limited to no more than a 5% increase annually. ii. Each participant shall pay class registration fees as established by City. Instructor may not waive class participation/registration fees. Only registered participants paid in full may participate in class. iii. Any refunds to participants will be made in accordance with City policy. B. Instructor Responsibilities: Planning and delivering engaging and age -appropriate yoga and fitness classes as defined by class curriculum and description to be approved by City staff. ii. Ensuring the safety and well-being of all participants during class sessions. ■ Instructor will immediately report to City staff, by phone or email, any injuries as a result of class participation, damages to the facility that could cause potential injury to a class participant and/ or require facility repairs. • Instructor will notify parent/ guardian of minors under the age of 18 and city staff regarding any injuries experienced during class. iii. Submitting seasonal program proposals to City staff for seasonal approval of class descriptions, details, and schedules. Proposals must be submitted in writing by way of the provided City form(s) to City staff for review and approval at least 60 days prior to the start of the new season, unless otherwise specified by City staff. City staff will review and approve written proposals based on community needs, facility availability, and alignment with City goals. iv. Adhering to all City policies and procedures related to the use of facilities and interaction with participants. V. Adhering to all City deadlines for required documentation. vi. The instructor's organization is responsible for fingerprinting, monitoring, and managing all staff that will be instructing. vii. Promotion of class(es) with City approved marketing materials outside of City managed platforms. Publicizing on additional channels and networks outside of City platforms is the sole responsibility of the instructor. 2 viii. Instructor shall provide all materials, supplies, equipment, records and personnel. Instructor shall be responsible for repairing and maintaining all equipment and supplies, and ensuring that it is in good working condition. Instructor shall ensure clean-up of the facilities and materials to ensure the safety and effectiveness of instruction. The City will not responsible for any damage, repairs, misplaced, or stolen supplies or equipment, and will not be responsible for storing supplies or equipment. C. City Responsibilities: i. City shall manage participant registration and class information through registration software. Instructor shall be granted access to the class roster on the City registration system and is responsible for tracking attendance. ii. City shall collect all enrollment fees through the registration software. Instructor shall not accept enrollment fees directly from a participant, and shall only collect materials fees that are pre -approved by City and published in advance as a part of the program marketing. Such material fees shall be collected by Instructor at the first scheduled class meeting. No additional fees shall be collected for materials, uniforms, awards, etc. without written approval and advanced advertising. iii. City shall provide publicity for class(es) seasonally in the City's recreation magazine (published seasonally). City shall have the sole discretion to decide what information will be included in the recreation magazine about the class and Instructor. Publicity may also include flyers created by City. Instructor created flyers are encouraged, but must be finalized by City to include use of City logos before distribution. iv. City shall provide a location for the class(es). Instructor will request dates and times for the class(es) seasonally, in writing. The City will confirm the class(es) schedule seasonally. Location selection is based on need, size of class, type of activity and availability, and is reserved at the discretion of the City. v. City shall provide refunds to participants when: • The participant formally requests to drop the class before the second schedule class meeting. ■ The class is canceled by City or Instructor. 3 AC"RbF CERTIFICATE OF LIABILITY INSURANCE 11i DA 03/11/2025 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Bene-Marc Athletic Insurance Agency #OE67789 6301 Southwest Boulevard, Suite 101 Fort Worth, Texas 76132 PNC NEs. (800) 247-1734 ac No E-MAR contact@bene-marc.com ADDRESS: INSURERS AFFORDING COVERAGE NAICN INSURERA: HDI Global Specialty SE AA-1120822 INSURED Southern California Municipal Athletic Federation (SCMAF) INSURER B: AXIS Global Accident & Health Insurance Company 37273 PO Box 3605 INSURER C: INSURER D: South El Monte, CA 91733 INSURERS: SCMAF Member: Holistic Yoga & Health, LLC - Yoga, Meditation, Tai Chi NSURERF: COVERAGES CERTIFICATE NUMBER: UUDs-obfuz REVISION NUMBER: Revised 04/09/2025 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OFIN$URANCEJUM ADDL SUBR POLICYNUMBER POLICY EFF IMMIDDIVY)FIF1 POLICY EXP fINIMIDIVYYYY1LIMITS X COMMERCIAL GENERAL LIABILITY OCCUR CLAIMS -MADE 18LB7323 01/01/2025 01/01/2026 EACH OCCURRENCE $ 1,000,000.00 q REWEo PREMISES Ea occurrence $ 100,000.00 MED EXP(Any one person) $ 5,000.00 PERSONAL &ADV INJURY S 1,000,000.00 A X X Abuse & Molestation AGGREGATE LIMIT APPLIES PER: PODCV ❑ JECT ❑ LOG GENERAL AGGREGATE $ 5,000,000.00 GEN'L 1,000,000 Occ./2,000,000 Agg. PRODUCTS - COMP/GP AGO $ 1,000,000.00 Participant Liability $ 1,000,000.00 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accident $ _ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ WORKERS COMPENSATION ANDEMPLOYERS'LABILITY YIN ANYPROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBEREXCLUDED9 NIA PER OTH- STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) Use. describe under DESCRIPTION OF OPERATIONS held. E.L. DISEASE -POLICY LIMIT $ B Participant Accident Medical SRPO-50256-243 01/01/2025 01/01/2026 Deductible: $0.00 Limit: $5,000.00 Tu ran Digi lly gnedb TU TranN u DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101. Additional Remarks Schedule, maybe attached if more space is required) N U en Date 2025A9J2 9 Y oee,:sa-dro3• This policy Includes a blanket additional insured endorsement that provides additional insured status to the wnificate holder per form CG 20 26 07 04. The General Liability policy contains Primary and Non Contributory.arding per endorsement El 602AJ-1 112, The General Liability policy contains an endorsement for Waiver of Transfer of Rights of Recovery Against Others to Us per attachetl form CG 24 04 05 OgG ty of Santa Ana entity, it's officers, officials. agents and its volunteers are additional insured. Coverage for SCMAF member approved activities for which a premium is paid and reported to the Company. SCMAF Member: Holistic Yoga & Health, LLC -Yoga, Meditation, Tai Chi APPROVED Coverage is limited to the following activity dates: 03/05125-05128/25; 06102125-09/30/25: 10101/25-12/31/25 By Tu Train Nguyen at 8:31 am, Apr 17, 2025 CERTIFICATE HOLDER CANCELLATION City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Attention: Parks, Recreation, and Community Services Agency THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 20 Civic Center Plaza M-23 Santa Ana, CA 92702 A REPRESENTATIVE `. 6 /U' L ALisa isa Lynn n Hall 91988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 18LB7323 COMMERCIAL GENERAL LIABILITY CG 20 26 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Of City of Santa Ana, its City Council, officers, officials, employees, agents, and volunteers. 20 Civic Center Plaza M-23 Santa Ana, CA 92702 Declarations, Section II — Who Is An Insured is amended to in- clude as an additional insured the person(s) or organi- zation(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omis- sions of those acting on your behalf: A. In the performance of your ongoing operations; or B. In connection with your premises owned by or rented to you. CG 20 26 07 04 0 ISO Properties, Inc., 2004 Page 1 of 1 13 POLICY NUMBER: 18LB7323 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: City of Santa Ana, Its City council, officers, officials, employees, agents, and volunteers 20 Civic Center Plaza M-23 Santa Ana, CA 92702 Information required to complete this Schedule if not shown above will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV — Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or 'your work' done under a contract with that person or organization and included in the "products -completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 06 09 © Insurance Services Office, Inc., 2008 Page 1 of 1 ❑ This Endorsement changes the Policy. Please read it carefully. COMMERCIAL GENERAL LIABILITY ENDORSEMENT PRIMARY AND NON-CONTRIBUTORY AMENDATORY - E1602AJ-1112 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE City of Santa Ana, its City Council, officers, officials, employees, agents, and volunteers 20 Civic Center Plaza M-23 Santa Ana, CA 92702 Policy Number: 18LB7323 SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS, paragraph 4. Other Insurance is hereby deleted and replaced with the following: 4. Other Insurance If other valid and collectible insurance is available to the insured for a loss we cover under Coverages A or B of this Coverage Part, our obligations are limited as follows: a. Primary Insurance This insurance is primary except when Paragraph b. below applies. If this insurance is primary, our obligations are not affected unless any of the other insurance is also primary. Then, we will share with all that other insurance by the method described in Paragraph c. below. However, with respect to any other valid and collectible insurance available to a person or organization as scheduled above, this insurance shall be primary to other available sources, except where the liability of such person or organization is caused by his, her, or its own negligence. Nothing herein shall be construed to make this Policy subject to the terms, definitions, conditions and limitation of any other insurance. b. Excess insurance (1) This insurance is excess over: (a) any of the other insurance, whether primary, excess, contingent or on any other basis: (i) that is Fire, Extended Coverage, Builder's Risk, Installation Risk or similar coverage for "your work"; (ii) that is Fire insurance for premises rented to you or temporarily occupied by you with permission of the owner; All other terms and conditions of the Policy remain unchanged_ El602AJ-1112 Page 1 of 2 (Ili) that is insurance purchased by you to cover your liability as a tenant for "property damage" to premises rented to you or temporarily occupied by you with permission of the owner; or (iv) if the loss arises out of the maintenance or use of aircraft, "autos" or watercraft to the extent not subject to Exclusion g. of Section I — Coverage A — Bodily Injury And Property Damage Liability. (b) any other primary insurance available to you covering liability for damages arising out of the premises or operations, or the products and completed operations, for which you have been added as an additional insured by attachment of an endorsement. (2) When this insurance is excess, we will have no duty under Coverages A or B to defend the insured against any "suit" if any other insurer has a duty to defend the insured against that "suit". If no other insurer defends, we will undertake to do so, but we will be entitled to the insured's rights against all those other insurers. G. Method Of Sharing In the instance where we are primary, we will be non-contributory. In any other instance, we will contribute as follows: If all of the other insurance permits contribution by equal shares, we will follow this method also. Under this approach each insurer contributes equal amounts until it has paid its applicable limit of insurance or none of the loss remains, whichever comes first. If any of the other insurance does not permit contribution by equal shares, we will contribute by limits. Under this method, each insurer's share is based on the ratio of its applicable limit of insurance to the total applicable limits of insurance of all insurers. (1) When this insurance is excess over other insurance, we will pay only our share of the amount of the loss, if any, that exceeds the sum of: (a) The total amount that all such other insurance would pay for the loss in the absence of this insurance; and (b) The total of all deductible and self -insured amounts under all that other insurance. (2) We will share the remaining loss, if any, with any other insurance that is not described in this Excess Insurance provision and was not bought specifically to apply in excess of the Limits of Insurance shown in the Declarations of this Coverage Part. _ All other terms and conditions of the Policy remain unchanged _ E 1602AJ-1112 Page 2 of 2 ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE 4/9/20OIYVYY) 4/9I2025 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(fes) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Ann Woman EG Insurance Agency, Inc PHONE 71q 533-7089 ac No Exe: ( ) (A/C,No: (714)533-8873 616 S Euclid St. ADDRESS: ann@egins.com INSURER(SI AFFORDING COVERAGE NAIC# INSURER A: HISCOX INS CO rNC 10200 Analteim CA 92802 INSURED INSURER B: EMPLOYERS PREFERRED INS CO 10346 HOLISTIC YOGA & HEALTH LLC INSURER C : 13041 GALWAY ST STE D INSURER D : INSURER E : GARDEN GROVE CA 928491660 INSURERF: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE INSO VIVO POLICY NUMBER (MM/DD/YYYY) (MMIDD/YYYY) LIMITS x COMMERCIAL GENERALLIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE FKIOCCUR PREMISES (Ed occurrence) $ 100,000 MED FXP (Any one person) $ 5,000 PERSONAL S ADV INJURY $ 1,000,000 A Y Y Pt00.247.053.5 05/03/2024 05/03/2025 GyEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY ❑PECT RG- �LOC J PRODUCTS - COMP/OP AUG $ Included $ OTHER: AUTOMOBILE LIABILITY UUMBiNED 61NULE$ (Ea accident) BODILY INJURY (Per Person) $ ANY AUTO OWNED 5CHEOULEO AUTOS ONLY AUTOS (Per accident) BODILY INJURY Pident $ HIRED NON -OWNED AUTOS ONLV AUTOS ONLY (Peraccident) $ UMBRELLA LIAR EACH OCCURRENCE $ HOCCUR AGGREGATE $ EXCESS LIAO CLAIM&MADE DED RETENTION It $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOWPARTNEWEXEOUTIVE FFICERIMEMSER EXCLUDED? �Y NIA Y EIG265479006 07/02/2024 07/02/2025 Vy TR r� STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE$ 1,000,000 (Mandatory In NH) If yes, describe under E.L. DISEASE -POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS below A Professional Liability 1`100.247.053.5 05/03/2024 05/03/2025 Each Claim Aggregate i500,000 $500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) Yoga studio City of Santa Ana, its City Council, officers, officials, employees, agents and volunteers under written contract are named as additional insureds with respect to General Liability. All terms and conditions are based upon the actual policies. APPROVED By Tu Tran Nguyen at 8:31 am, Apr 17, 2025 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Santa Ana, its City Council, (com. in ACORD 101) ACCORDANCE WITH THE POLICY PROVISIONS. Attention: Parks, Recreation, and Community Services Agency AUTHORIZED REPRESENTATIVE 20 Civic Center Plaza M-23 -. Santa Ana CA 92702 @ 1988.2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: LOC #: AC"MY ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY EG Insurance Agency, Inc NAMED INSURED HOLISTIC YOGA & HEALTH LLC POLICY NUMBER P100.246.319.5, P100.247.053.5, EIG265478006 CARRIER HISCOX INS CO INC NAIC CODE 10200, 102C EFFECTIVE DATE: THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate Of Liability Insurance "Certificate Holder Name: City of Santa Ana, its City Council, officers, officials, employees, agents and volunteers ACORD 101 (2008101) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-CALIFORNIA We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 2 % of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description With respect to all employees subject to the workers' compensation laws of the state of California, any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. This policy is subject to a minimum charge of $250 for the issuance of waivers of subrogation This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) This endorsement, effective 07/02/2024 Policy No. EIG 2654780 06 Issued to HOLISTIC YOGA & HEALTH LLC Premium $1,079 Countersigned at at 12:01 AM standard time, forms a part of Of the EMPLOYERS PREFERRED INS. CO. Carrier Code 00920 Endorsement No. on By: Authorized Representative WC 04 03 06 (Ed. 4-84) © 1998 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved. Auto Liability (Non -Use Agreement) Date 316/25 City of Santa Ana Risk Management Division 20 Civic Center Plaza Santa Ana, CA 92702 Re: Auto Insurance Requirement Dear City of Santa Ana Risk Management Division: Holistic Yoga & Health, LLC has intent to enter into an agreement with the City of Santa Ana. Throughout the course of this agreement, Holistic Yoga & Health, I attests to the following: 1 Holistic Yoga & Health, LLC will not use/drive any vehicle during the course and scope of the services provided in the agreement/contract. 2 Holistic Yoga & Health, LLC will not use any owned/rented/leased vehicles during thecourse and scope of the services provided in the agreement/contract. 3 Holistic Yoga & Health, LLC consultants/independent contractors/employees utilize their personal vehicles/non-company owned, borrowed, or rented/leased vehicles for transportation to and from work and if applicable carry their own automobile insurance. By signing below, I, Roxanne M. Zavala attest that I possess the legal authority to enter into an agreement with the City of Santa Ana as well as the legal authority to attest to the statements above. If at any time it is found that Holistic Yoga & Health, is not adhering to any/all statements in this document and has not provided the minimum Auto liability insurance coverage of $1 million per occurrence, the contract will be considered null and void andthe company will be held fully liable for any and all damages. Signature:, r_,_ u c �o✓ ex Name: Roxanne M. Zavalabehalf of Ht Job Title: Instructor LLL/// Company Name: Holistic Yoga & Health, LLC Contact Phone:310-901-4267 Email Address: rzavala@anoroc.com _4c ® DATE(MM/DD/YYYY) ACC OR" � CERTIFICATE OF LIABILITY INSURANCE 4/9/2026 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Ann Wormac EG Insurance Agency,IncPHONE ,A/C,No,Ext: 714)533-7089 (A/C No) (714)533-8873 616 S Euclid St. ADDRESS: ann@egins.com INSURER(S)AFFORDING COVERAGE NAIC# Anaheim CA 92802 INSURER A: HISCOX INS CO INC 10200 INSURED INSURER B: EMPLOYERS PREFERRED INS CO 10346 HOLISTIC YOGA&HEALTH LLC INSURER C: 13041 GALWAY ST STE D INSURER D: INSURER E: GARDEN GROVE CA 928441660 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS x COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ 100,000 MED EXP(Any one person) $ 5,000 A Y Y P100.247.053.6 05/03/2025 05/03/2026 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY ECT LOC PRODUCTS-COMP/OP AGG $ Included OTHER: $ AUTOMOBILE LIABILITY (Ea accident) $ ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED HF<UHEK I Y DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) UMBRELLA LAB OCCUR EACH OCCURRENCE $ EXCESS LAB HCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PER 1R_ - AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 BOFFICER/MEMBER EXCLUDED? Fy] N/A Y EIG265478007 07/02/2025 07/02/2026 Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Yoga studio City of Santa Ana,its City Council,officers,officials,employees,agents and volunteers under written contract are named as additional insureds with respect to General Liability. All terms and conditions are based upon the actual policies. APPROVED By Tu Tran Nguyen at 2:58 pm,Apr 29,2026 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City of Santa Ana,its City Council,(coot.in ACORD 101) ACCORDANCE WITH THE POLICY PROVISIONS. Attention:Parks,Recreation,and Community Services Agency AUTHORIZED REPRESENTATIVE 20 Civic Center Plaza M-23 — Santa Ana CA 92702 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: _ LOC#: ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED EG Insurance Agency, Inc HOLISTIC YOGA&HEALTH LLC POLICY NUMBER P100.247.053.6, P100.246.319.6, EIG265478007 r RIER NAIC CODE SCOX INS CO INC 10200, 102C I EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate Of Liability Insurance —Certificate Holder Name: City of Santa Ana, its City Council,officers,officials,employees,agents and volunteers ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 40 HI SCOX Hiscox Insurance Company Inc. Policy Number: P100.247.053.6 Named Insured: HOLISTIC YOGA& HEALTH LLC Endorsement Number: 7 Endorsement Effective: 05/03/2025 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - AUTOMATIC STATUS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II — Who Is An Insured is amended to include as an additional insured any per- son(s) or organization(s) for whom you are performing operations or leasing a premises when you and such person(s) or organiza- tion(s) have agreed in writing in a contract or agreement that such person(s) or organiza- tion(s) be added as an additional insured on your policy. Such person or organization is an additional insured only with respect to lia- bility for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: 1. In the performance of your ongoing opera- tions; or 2. In connection with your premises owned by or rented to you. A person's or organization's status as an addi- tional insured under this endorsement ends when your operations or lease agreement for that additional insured are completed. CGL E5421 CW(02/14) Includes copyrighted material of Insurance Services Office, Inc., with its Page 1 of 1 permission. 40 HI SCOX Hiscox Insurance Company Inc. Policy Number: P100.247.053.6 Named Insured: HOLISTIC YOGA& HEALTH LLC Endorsement Number: 20 Endorsement Effective: 05/03/2025 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy, pro- vided: 1. you have agreed in a written contract or agreement to add such additional insured to a policy providing the type of coverage af- forded by this policy; and 2. you have agreed in a written contract or agreement with such additional insured that this insurance would be primary and would not seek contribution from any other insur- ance available to the additional insured. CGL E5581 CW(03/16) Includes copyrighted material of Page 1 of 1 Insurance Services Office, Inc., with its permission hA I"I I SC'OX Hiscox Insurance Company Inc. Policy Number: P100.247.053.6 Named Insured: HOLISTIC YOGA& HEALTH LLC Endorsement Number: 21 Endorsement Effective: 05/03/2025 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. MODIFIED WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV—Conditions: You may waive your rights against another party so long as you do so in writing prior to: (i) an offense arising out of your business that caused a "personal and advertising injury"; or (ii) an "occurrence" that caused "bodily injury" or"property damage". CGL E5402 CW(03/10) Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-CALIFORNIA We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 0 % of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description CITY OF SANTA ANA. ITS CITY COUNCIL. OFFICERS. OFFICIALS. EMPLOYEES!AGENTS. VOLUNTEERS 20 CRRC CENTER PLAZA M-23 SANTA ANA, CA 92702 The charge for this endorsement is S 250 This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) This endorsement, effective 07/02/2025 at 12:01 AM standard time, forms a part of Policy No. EIG 2654780 07 Of the EMPLOYERS PREFERRED INS. CO. Carrier Code 00920 Issued to HOLISTIC YOGA & HEALTH LLC Endorsement No. Premium $1,036 �/ Countersigned at on By: /`— �K�•t- Authorized Representative WC 04 03 06 (Ed. 4-84) _t 1998 by the Workers'Compensation Insurance Rating Bureau of California All rights reserved CITY OF SANTA ANA Risk Management a division of Human Resources Managing Risk through Awareness and Action 0 AFFIDAVIT OF EXEMPTION FOR AUTOMOBILE LIABILITY INSURANCE I Woomyung Son ("Representative"),attest that I am an authorized (Name and Title of Vendor Representative) representative of Holistic Yoga&Health, LLC ("Company"), and (Consultant/Company Name) possess the authority to legally bind Company. In my capacity as Representative of Company, I represent and confirm the following, as relates to the agreement between Company and City of Santa Ana, agreement number N-2025-095 ("Agreement")to provide Yoga and Tai Chi Classes ("Services"): (Services to be provided under agreement/contract) During the course and scope of Company's agreement with the City of Santa Ana, Company employees, consultants, representatives, and agents will not use and/or drive any Company owned/rented/leased/borrowed vehicles to perform Services to, for, or on behalf of City of Santa Ana. If at any time it is found that Company is not adhering to any and/or all of the statements in this document and does not maintain the minimum automobile liability insurance coverage as required in the Agreement, it will be considered a breach of Agreement rendering the Agreement null and void and Company will be fully liable for any and all damages. Signature Date 000 M/Yy+9r S)r Print ame LA/YIeV Title Cs�aPd Pr t-oyQQ xv) .". Cam Contact Wnuation,i.e.,Teleph ne Number and/or Email Address Affidavit of Exemption for Automobile Liability Insurance 11.12.2024 CI TY OF SANTA ANA •Y, RISK MANAGEMENT a division of HUMAN RESOURCES Managing Risk through Awareness and Action Agreement to Indemnify, Hold Harmless and Defend Title of Event/Activity: Yoga and Tai Chi Event Date: 03/01/2025 to 02/28/2026 Description of Event/Activity: Yoga and Tai Chi Classes Business or Organization Name: Holistic Yoga& Health, LLC Full Name of Authorized Representative of Business/Organization: Woomyung Son Title of Authorized Representative: Owner In the event the above named Business or Organization does not maintain Improper Sexual Conduct a/k/a Sexual Molestation and Abuse Liability a/k/a Sexual/Physical Abuse/Molestation, or similar insurance coverage, it nevertheless is obligated to and agrees to indemnify, defend, and hold harmless, at its own expense, the City of Santa Ana, its City Council, officers, officials, agents, volunteers and employees from and against all suits or actions, claims, loss, damage, liability, cost or expense, including reasonable attorney's fees, against allegations of physical, emotional, sexual, and/or financial abuse, which may arise from the negligent or intentional actions of any of its contractors, sub-contractors, agents, employees, volunteers, or other persons acting on their behalf while participating in the above titled Event/Activity. By signing this document, the undersigned represents that he/she/they has full authority to bind said Business or Organization named above. Ni-1�11�ttcl's'b �III,, � Authorized Representative SignatI4 of Authoriz epresentative Date of Business or Organization(Print Name) of Business or Organization