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HomeMy WebLinkAboutZEPEDA DE LEON, ILIANA C. INSURANCE ON EILi_ N-2025-141 WORK MAY PROCEED UNTIL INSURANCE EXPIRES CITY �ArICI_El;r; ARTS AND CULTURE ARTIST GRANT PROGRAM AGREEMENT BETWEEN �JUN 121025 THE CITY OF SANTA ANA AND ILIANA C ZEPEDA DE LEON W This Artist Grant Agreement ("Agreement") ) is made and entered this 13T" day of January, 2025, 1 by and between 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"), and Iliana C Zepeda De Leon ("Grantee") for the purpose of providing grant funding pursuant to the Investing in the Artist Grant Program. City and Grantee may herein individually be referred to as a "Party" and collectively be referred to as the "Parties" to the Agreement. RECITALS: A. On November 21, 2024, the Arts and Culture Commission reviewed all applicants and recommended that Grantee be awarded an artist grant based on its Application for its art project ("Project"). A true and correct copy of Grantee's Application is attached hereto as Exhibit A and incorporated herein by reference. B. In undertaking the performance pursuant to this Agreement, Grantee represents that it is skilled and knowledgeable in the arts and culture arena and that the Project created or performed hereunder will be created or performed in compliance with such standards as may reasonably be expected from an artist. 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. Term. This Agreement shall be effective upon signature by both Parties and shall expire one year from the date first written above, unless terminated earlier in accordance with this Agreement. 2. Funding. 2.1. Subject to Grantee's performance of all required actions under this Agreement, City shall provide funding, in three disbursements, as detailed below, of an amount not to exceed Seven Thousand Dollars ($7,000) ("Grant Amount" or"Grant"). 2.2. Grantee will be paid in three (3) installments. First payment will be one-third of the funding amount provided above or $2,333.33 and will be provided within thirty (30) days of the full execution of the Agreement by the Parties along with a complete invoice submitted by Grantee. The second payment will be the second one-third of the funding amount provided above or $2,333.33 and will be provided within thirty (30) days after the Grantee submits to the City all the proper receipts and invoices up to the mid-point of the Project. The third and final payment will include the remaining amount of $2,333.34 and will be issued within thirty (30) days after the Grantee submits to the City all the proper receipts, invoices, and final report for the Project. 2.3. Appropriate performance of the Grantee will be determined by City in its sole discretion. City reserves the right to cease funding after the first or second disbursement detailed above, and to be reimbursed the initial payment(s), if Grantee's performance is determined to be insufficient or unacceptable in the City's sole discretion. 2.4. City represents that there is no correlation or connection between its selection of individuals for grant awards and an individual's business relationship or potential business relationship with City. 1 3. Grant Activities. Grantee agrees: 3.1. To perform the activities described in Grantee's Grant Application and Timeline submitted to City for consideration dated October 21, 2024, a copy of which is attached as Exhibit A and incorporated into this Agreement as if set out in full. 3.2. To submit all reports (each, a "Report"), which shall include, at a minimum, the items set forth as required by the Application. No personally identifiable information shall be included in any of the Reports, except where specifically requested. The Reports shall be in a format that is reasonably acceptable to City. City may request additional information as City, in its sole discretion, determines is necessary to monitor performance of this Agreement. City shall have the right to use any Reports submitted by Grantee, or any portion thereof, for any reason. 3.3. To maintain all pertinent financial and accounting records pertaining to this Agreement in accordance with generally accepted accounting principles and ether procedures reasonably specified by City. Upon termination or expiration of this Agreement or request by City, Grantee shall provide, at its expense, copies of all financial and accounting records produced by Grantee arising out of this Agreement. 3.4. To allow audits, compliance or special reviews and inspections, including on-site inspection, with or without prior notice, of Grantee's facilities by City or by third parties designated by City, or their authorized representatives. Grantee shall provide its full cooperation for any such audit, review or inspection, including providing timely access, for examination and copying of records (including computerized records) pertinent books, documents, papers, computer programs and records and reasonable access to its personnel 3.5. To ensure that any areas utilized for the Project are maintained and restored to a well- maintained, safe, sanitary, and clean condition, and kept free of any hazardous waste at all times. All equipment associated with the installation of the artwork, trash and debris shall be removed and cleaned up on a daily basis. If applicable to the Project, Grantee shall place a drop cloth or similar barrier on the ground below the artwork while installation is underway, which barrier shall be removed each day upon completion of an installation session. 3.6. The Project may not contain advertising, religious art, sexual content, negative or violent imagery, convey political partisanship or include any hidden, subliminal, or camouflaged messages or statements of any kind or nature. Appropriateness of the content of the Project will be determined by City in its sole discretion. 3.7. The Project may not include any breach of intellectual property, trademarks, brands, or images of illegal activity, and the Grantee must be the copyright holder for the Project. It is the sole responsibility of the Grantee to obtain any and all applicable copyrights or trademarks associated with the artwork for the Project. 3.3. To be responsible for the maintenance of the Project, which includes, but is not limited to, graffiti removal, touch-up, and restoration, for the duration of the Project's existence. 3.9. If the artwork is a mural, it must be covered in an anti-graffiti coating at the Grantee's expense. 3.10. The City holds all rights to public art on City property, and as such the Project artwork may be removed at the sole discretion of the City. Should the Project artwork be defaced and/or not repaired, maintained, preserved and/or conserved, the City has the authority to repair, maintain, preserve, and/or conserve the Project artwork, or alternatively, the City has the sole authority to 2 remove, alter, or destroy the Project artwork. Grantee will have first right of refusal to restore said Project artwork. If Grantee is unwilling to perform or unable to be contacted within a reasonable time, the City has the right to request the services needed from a different artist, in the City's sole discretion. 3.11. Grantee shall execute and deliver to City any instruments that City may reasonably require to confirm ownership of any artwork. 4. Termination. 4.1. City may immediately terminate this Agreement upon one or more of the following: 4.1.1. Grantee's violation of any federal, state or local law or regulation. 4.1.2. Grantee's breach of any of the terms or conditions of this Agreement, including the Application and Timeline, or any unapproved deviation from said documents that has not been cured within 30 days of written notice of such breach. 4.2. In the event the Agreement is terminated under Section 4.1, City reserves the right to require Grantee to refund any or all grant funds awarded to Grantee under this Agreement, and Grantee agrees to refund to City any or all grant funds awarded under this Agreement. 5. Limitation of Liability. 5.1. IN NO EVENT SHALL CITY BE LIABLE FOR ANY INDIRECT, SPECIAL, INCIDENTAL OR CONSEQUENTIAL DAMAGES OR EXPENSES FOR ANY NEGLIGENCE, BREACH OF CONTRACT OR ANY OTHER ACT ARISING OUT OF OR RELATING TO THIS AGREEMENT OR THE ACTIVITIES COVERED HEREUNDER. 5.2. Section 5 and Section 6 do not limit Grantee's rights, including its ability to seek recovery, against anyone other than City, its City Council, officials, directors, officers, employees, agents, successors, assigns and volunteers. 6. Indemnification. 6.1. Grantee shall defend, indemnify, protect and hold harmless the City, and its City Council, elected and appointed officials and officers, employees, members, volunteers, or agents from and against all claims for damages, liability, cost and expense (including without limitation attorney's fees) arising out of or alleged by third parties to be the result of the negligent acts, errors or omissions or the willful misconduct of the Grantee, and Grantee's employees, subcontractors or other persons, agencies or firms for whom Grantee is legally responsible in connection with the execution of the work covered by this Agreement. Grantee shall have no duty to indemnify or hold harmless the City if claims, damages, liability, costs, expenses (including without limitation, attorney's fees) arise from the sole negligence or sole willful misconduct of the City subsequent to declaration by the Grantee. Grantee's obligations shall survive the termination of this Agreement. 6.2. Grantee agrees to hereby fully release and forever discharge the City from any and all claims, demands, damages, losses, and liabilities (hereinafter collectively referred to as "claims"), which are or may be related to or in any way connected with the negligence or willful misconduct of its officers, officials, employees, or agents in connection with the creation, painting, performance or installation of the Project hereunder. 3 6.3. Grantee further agrees that City may in good faith and on reasonable terms settle any such claims and that City'.s right to indemnification shall extend to any such settlement, provided City has given notice of such claim and its intent to settle. City's right to indemnification is in addition to, and may be exercised independently of, any remedy held by City under this Agreement, at law or in equity. The indemnity provision set forth in this Agreement shall survive the termination or expiration of this Agreement indefinitely. 7. Insurance 7.1 Prior to undertaking performance of work under this Agreement, Grantee shall maintain and shall require its subcontractors, if any, to obtain and maintain insurance as described below: MINIMUM SCOPE AND LIMIT OF INSURANCE Grantee shall maintain limits of insurance coverage in the following minimum amounts and shall be at least as broad as: • Commercial General Liability(CGL): Insurance Services Office Form CG 00 01 covering 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. • Automobile Liability (AL): Insurance Services Office Form CA 00 01 covering Code 1 (any auto), with combined single limits of $1,000,000. In the event Grantee does not maintain commercial automobile liability insurance, City will accept evidence of personal automobile insurance with existing limits, which can be lower than $1,000,000. • Workers' Compensation (WIC): 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, per employee, per policy for bodily injury or disease. This requirement can be waived if Grantee has no employees. If Grantee maintains broader coverage and/or higher limits than the minimums shown above, City requires and shall be entitled to the broader coverage and/or the higher limits maintained by Grantee. Any available insurance proceeds in excess of the specified minimum limits of insurance and coverage shall be available to City. Other Insurance Provisions The insurance policies are to contain, or be endorsed to contain, the following provisions: 1. CGL and AL policies: 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 Grantee including materials, parts, equipment, and personnel furnished in connection with such work or operations. 2. All required insurance policies: 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 Grantee for City. 3. All required insurance policies: For any claims related to this contract, Grantee's insurance coverage shall be primary and any insurance maintained by City, its City 4 Council, its officers, officials, employees, agents, or volunteers shall not contribute with it. 4. All required insurance policies: A severability of interest provision must apply for all the additional insureds, ensuring that Grantee'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. 5. Each insurance policy 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 shall be provided to City for policy cancellation or non-renewal due to non-payment. 6. Certificate Holder on each Evidence of Insurance certificate shall be: City of Santa Ana, Attention: Executive Director, Community Development Agency, 20 Civic Center Plaza M-25, Santa Ana, CA 92701. The name and location of event should be included in the Description of Operations section of each certificate. 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:VI I, unless otherwise acceptable to City. Verification of Coverage Grantee 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 to City before work begins. However, failure to obtain the required documents prior to the work beginning shall not waive Grantee'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. Subcontractors Grantee shall require and verify that all sub-contractors maintain insurance meeting all the requirements stated herein, and Grantee shall ensure that City is an additional insured on insurance required from sub-contractors. 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. 8. General Provisions. 8.1. Grantee shall acquire prior written permission from City for any use of the City name or logo in association with the Project. 8.2. If any parts of this Agreement are held to be invalid or unenforceable, the remaining parts of the Agreement shall continue to be valid and enforceable. 8.3. Grantee shall comply with all governmental requirements that may now or in the future become applicable to the activities under this Agreement. 5 8.4. This Agreement, including all exhibits, Application, and any amendments or schedules hereto, contain the full understanding and agreement of the Parties with respect to its subject matter, and no waiver, alteration or modification of any of the provisions to this Agreement shall be binding unless in writing and signed by an authorized officer of both Parties. 8.5. No waiver by either Party or any breach, default, or series of breaches or defaults, and no failure, refusal, or neglect of either Party to exercise any right, power, or option given to it under this Agreement or to insist upon strict compliance with the terms of this Agreement shall constitute a waiver of these provisions with respect to any subsequent breach or waiver by either Party or its right at any time thereafter to require exact and strict compliance with provisions of this Agreement. 8.6. Any notice or other communication required or permitted to be made or given by either Party pursuant to this Agreement will be in writing and will be deemed to have been duly given: (i) five (5) business days after the date of mailing if sent by registered or certified U.S. mail, postage prepaid, with return receipt requested; (ii) when transmitted if sent by facsimile, provided a confirmation of transmission is produced by the sending machine; or (iii) when delivered if delivered personally or sent by express courier service. All notices to City shall include a reference to the Project title. All notices will be sent to the other Party at its address as set forth below or at such other address as such Party will have specified in a notice given in accordance with this section: Grantee: Iliana C Ze eda De Leon 1000 B. Bishop St., Apt L-4 Santa Ana, CA 92701 City: City of Santa Ana City Clerk (M-30) 20 Civic Center Plaza P.O. Box 1988 Santa Ana, CA 92702 FAX (714) 647-6956 8.7. This Agreement is subject to all applicable local, State and Federal laws. 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. 8.8. Grantee agrees to comply with all applicable equal opportunity and affirmative action laws as appropriate, Grantee shall not discriminate because of race, color, religion, sex, gender identity, gender expression, marital status, sexual orientation, age, national origin, ancestry, medical condition, military or veteran status, genetic information, request for family care leave, request for leave for an employee's own serious health condition, request for pregnancy disability leave, disability, or otherwise as defined and prohibited by applicable law, in the recruitment, selection, 6 training, utilization, promotion, termination or other employment related activities. Grantee affirms that it is an equal opportunity employer (if applicable) and shall comply with all applicable federal, state and local laws and regulations. 8.9. Any funds provided under this Agreement that are not expended, obligated or otherwise committed by the termination or expiration of this Agreement shall be immediately returned to City. 8.10. Grantee grants to City a non-exclusive, irrevocable, transferable, royalty free, worldwide license to use, reproduce, display, distribute, and prepare derivative works, in any form or media at the discretion of the City for the Project conceived, performed or created as a result of this Agreement. 8.11. Grantee and any of the Grantee's agents, employees or representatives are,for all purposes under this Agreement, an independent contractor and shall not be deemed to be an employee of the City, and none of them shall be entitled to any benefits to which City employees are entitled including but not limited to, overtime, retirement benefits, work's compensation benefits, injury leave or other leave benefits. 8.12. Neither Party shall assign any rights or obligations under this Agreement. 8.13. Each Party 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. 8.14. Each Party warrants that they have executed this Agreement knowingly, freely and voluntarily and with full knowledge of its legal consequences. All Parties involved warrant and represent that, prior to executing this Agreement, each Party has had the opportunity to review and consider this matter with legal counsel, and that the terms of this Agreement, and its consequences, are fully understood by each Party. 8.15. This Agreement represents the entire agreement and understanding between the Parties, and supersedes any and all prior agreements and understandings between the Parties, whether oral or written. 8.16. Each undersigned represents and warrants that its signature herein below has the power, authority and right to bind their respective Parties to each of the terms of this Agreement, and shall indemnify City fully, including reasonable costs and attorney's fees, for any injuries or damages to City in the event that such authority or power is not, in fact, held by the signatory or is withdrawn. {Signatures on following page} 7 IN WITNESS WHEREOF, the Parties hereto have executed this Agreement the date and year first above written. I ATTEST: °T';.� CITY OF S NTA ANA 6 JENNIF L. H L ALVARO NUNEZ Cit City Manager APPROVED AS TO FORM: GRANTEE: SONIA R. CARVALHO City Attorney al'tOtA r 4- < y: Andrea Gard& iller N e: lliamlf 8 Zep eda De Leon Assistant City Attorney Title: ARTIST RECOMMENDED FOR APPROVAL: M HAEL L. GARCIA Executive Director Community Development Agency 8 EXHIBIT A INVESTING IN THE ARTS GRANT PROGRAM APPLICATION 9 Project Timeline GATE ACTION OUTCOME April 2025 Event Marketing Begins Marketing May 2025 Buy Material/ Preparation for class Preparation June Art Class 4:00pm-8:00pm Class 2,2025 (set up 2pm) June 9, Begin Marketing Art Show (invitations to Marketing/Invitations 2025 participants, community, and partners) June 28, Art Show 4:00-9:00 pm Show 2025 (set up 2pm) June 31, Thank you emails/communication Communication 2025 Arrange art piece pick up July 2025 Pick up Art Return Art Line Item Budget PERSONNEL Description of Personnel Grant (contracted instructors, lecturer honorarium, Total Compensation Funds artist stipend, etc.) Requested Artist stipend $2,500 $2,500 Assistant stipend $1,000 $ 1,000 EQUIPMENT, MATERIALS,AND SUPPLIES Item Unit Total Grant (equipment, materials, supplies) Quantity Cost Cost Funds Requested Clay bags 3 $16.25 $48.75 $48.75 Modeling Clay Tools 2 $31.99 $63.98 $63.98 Pottery Brushes for Glazing 2 $24.99 $54.60 $54.60 Ceramics Sponges (24 pk) 2 $12.99 $28.38 $28.38 Underglaze Mayco (paint) 13 $19.95 $259.35 $259.35 Aardvark Clay's CTG-08 Transparent- 1 3 $1.95 $5.85 $5.85 lb. Cookie Cutter Set 2 $18.98 $38 $38 Stencils Set 2 $24.99 $99.96 $99.96 Kiln 1 $2,950 $2,950 $2,950 SPECIAL EVENTS Description Grant Funds (permits,fees, facility rental for project, Total Cost Requested marketing) Insurance $325 $325 Line Item Budget—Page 2 Enter budget categories and projected expenditures for the proposed program: Expenditures Total Expenditures Funded By Organization Category Funded By Other Total Program Budget Santa Ana Sources Budget Grant (Including fin-kind) Administrative Staff Salaries and n/a n/a n/a Benefits imi Contractual/Professional $4,000 n/a n/a n/a Services/Stipends Equipment, Material, Supplies $3,499 n/a n/a n/a Special Events Production n/a n/a n/a n/a Marketing n/a n/a n/a n/a TOTAL $7,000 n/a n/a n/a PROGRAM REVENUE LIST ALL OTHER PROGRAM RESOURCES "Funding Source" total must equal "Total Pro ram Budget" listed alcove. FUNDING SOURCE AMOUNT Santa Ana Artist Grant $6,999 Pending Funding Sources n/a TOTAL PROGRAM BUDGET $7,000 ACo CERTIFICATE OF LIABILITY INSURANCE DATE IYYYY) OS/2812028/2025 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: Next First Insurance Agency,Inc. PHONE t (855)222-5919 FAX PO Box 60787No. Palo Alto,CA 94306 E-MAIL ADDRESS: support@nextinsurance.com INSURERS AFFORDING COVERAGE NAIC# INSURERA: State National Insurance Company,Inc. 12831 INSURED INSURER B Iliana Zepeda De Leon Iliana Zepeda De Leon INSURER C: 1000 E Bishop St Santa Ana,CA 92701 INSURER D INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:893032668 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. ILTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER MM DPOLIDIYCY EYYY MMIDDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000.00 CLAIMS-MADE �OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $100,000.00 MED EXP(Any one person) $15,000.00 A X X NXT9YLJKKK-00-GL 05/19/2025 05/19/2026 PERSONAL&ADV INJURY $1.000,000.00 GENT AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $2,000,000.00 X POLICY PRO- ❑ JECT LOC PRODUCTS-COMP/OP AGG S2,000,000.00 OTHER. S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident $ $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION SPERTUTE OERTH- AND EMPLOYERS'LIABILITY Y 1 N TA ANYPROPRIETOPJPARTN ERIEXECUTI VE OFFICERlMEMBER EXCLUDED? N/A E.L.EACH ACCIDENT 5 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S Each Occurrence: $1,000,000.00 A Professional Liability NXT9YLJKKK-00-GL 05/19/2025 05/19/2026 Aggregate: $2,000,000.00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) The Certificate Holder is City of Santa Ana,Attention:Executive Director,Community Development Agency.A Waiver of Subrogation applies in favor of this Certificate Holder on the following policies:General Liability.This Certificate Holder is an Additional Insured on the General Liability policy on a primary and non-contributory basis.This Certificate Holder is an Additional Insured on the General Liability policy with respect to ongoing operations.This Certificate Holder is an Additional Insured on the General Liability policy with respect to completed operations.All Certificate Holder privileges apply only if required by written agreement between the Certificate Holder and the insured,and are subject to policy terms and conditions. Name of event: Clay in the Community Tu Tra n Dig,Wlys,gnedby APPROVED Location:1000 E.Bishop St.Santa Ana CA 92701 Tu Tran Nguyen Nguyeoa:26:56 07'00' g Tu Train Nguyen of 4:25 m,May 29,2025 n 16r26:56-0T00' YP Y CERTIFICATE HOLDER CANCELLATION City of Santa Ana,Attention:Executive Director, LIVE CERTIFICATE Community Development Agency — SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Civic Center M-25 Santa THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Santa Ana,CA 92727011 ACCORDANCE WITH THE POLICY PROVISIONS, r• AUTHORIZED REPRESENTATIVE Click or scan to view ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: NXT9YLJKKK-00-GL 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 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 05 09 O Insurance Services Office, Inc., 2008 Page 1 of 1 ❑ COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED ADDITIONAL INSURED -- PRIMARY INSURANCE This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Additional Insured Person or Organization: City of Santa Ana, its Cityy Council,officers,officials,employees,agents,and volunteers 20 Civic Center Piz#MI Santa Ana,CA 92701 I. SECTION II-WHO IS AN INSURED is amended to include the person or organization 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 omissions of those acting on your behalf: 1. In the performance of your ongoing operations;or 2. In connection with your premises owned by or rented to you. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. II. With respect to the insurance afforded to these additional insureds, the following is added to SECTION III— LIMITS OF INSURANCE: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. III. Coverage provided to the additional insured shown in the SCHEDULE is afforded on i) a primary basis, ii) a noncontributory basis, or iii) a primary and noncontributory basis in accordance with the applicable written contract between you and the additional insured. Ali other terms and conditions of the policy remain unchanged. NXT-0084 BM Gl_0218 Includes material copyrighted by Insurance Services Office, Inc. used with its Page 1 of 1 permission POLICY NUMBER: NXT9YLJKKK-00-GL COMMERCIAL GENERAL LIABILITY CG20100413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Locations Of Covered Operations City of Santa Ana, its City Council,officers,officials, CA employees,agents,and volunteers 20 CMc Center Piz#M-25 Santa Ana,CA 92701 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional organization(s) shown in the Schedule, but only exclusions apply: with respect to liability for "bodily injury", "property This insurance does not apply to "bodily injury" or damage" or "personal and advertising injury" "property damage"occurring after: caused, in whole or in part, by: 1. Your acts or omissions; or 1. All work, including materials, parts or equipment furnished in connection with such 2. The acts or omissions of those acting on your work, on the project (other than service, behalf; maintenance or repairs) to be performed by or in the performance of your ongoing operations for on behalf of the additional insured(s) at the the additional insured(s) at the location(s) location of the covered operations has been designated above. completed; or However: 2. That portion of "your work" out of which the injury or damage arises has been put to its 1. The insurance afforded to such additional intended use by any person or organization insured only applies to the extent permitted by other than another contractor or subcontractor law; and engaged in performing operations for a 2. If coverage provided to the additional insured is principal as a part of the same project. required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 10 0413 0 Insurance Services Office, Inc., 2012 Page 1 of 2 i C. With respect to the insurance afforded to these 2. Available under the applicable Limits of additional insureds, the following is added to Insurance shown in the Declarations; Section III--Limits Of Insurance: whichever is less. If coverage provided to the additional insured is This endorsement shall not increase the required by a contract or agreement, the most we applicable Limits of Insurance shown in the will pay on behalf of the additional insured is the Declarations. amount of insurance: 1. Required by the contract or agreement; or Page 2 of 2 © Insurance Services Office, Inc., 2012 CG 20 10 04 13 POLICY NUMBER: NXT9YLJKKK-00-GL COMMERCIAL GENERAL LIABILITY CG 20 37 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Or anization s Location And Description Of Completed Operations City of Santa Ana,its City Council,officers, officials, Art Classes services in CA em loyees,agents,and volunteers 20 Civic Center Piz#M-25 Santa Ana, CA 92701 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following is added to organization(s) shown in the Schedule, but only Section III--Limits Of Insurance: with respect to liability for "bodily injury" or If coverage provided to the additional insured is "property damage" caused, in whole or in part, by required by a contract or agreement, the most we "your wank" at the location designated and will pay on behalf of the additional insured is the described in the Schedule of this endorsement amount of insurance: performed for that additional insured and included in the "products-completed operations 1. Required by the contract or agreement; or hazard". 2. Available under the applicable Limits of However: Insurance shown in the Declarations; 1. The insurance afforded to such additional whichever is less. insured only applies to the extent permitted This endorsement shall not increase the applicable by law; and Limits of Insurance shown in the Declarations. 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 37 0413 © Insurance Services Office, Inc., 2012 Page 1 of 1 CITY OF SANTA ANA Risk Management a division of Human Resources U Managing Risk through Awareness and Action AFFIDAVIT OF EXEMPTION FOR WORKERS' COMPENSATION INSURANCE I �I 12 M ("Representative"),attest that I am an authorized —' (Name and Tit a of Vendorr Repre�tativc) representative of 4, (�10 ?�I� ("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 ("Agreement")to provide t)h LALS SlAd" ("Services"): (Services to be provi d nder agrcemendcontract) During the course and scope of Company's agreement with the City of Santa Ana,Company will not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if Company should become subject to the workers' compensation provisions of Section 3700 of the Labor Code,Company shall forthwith comply with the provisions and provide proof of workers' compensation coverage immediately. 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 workers'compensation 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 )a<< — -lei �e��0�.��► -- Print Name Title 74144,C)AL79l[3 F- . L&I —��a� ' .�d�,•t Contact Informs ton.i.e..Telep one.ArVer and/or mat Address WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSANT DOLLARS($100,000).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST,AND ATTORNEY'S FEES. Affidavit of Exemption for Workers'Compensation Insurance 11.12.2024 CITY OF SANTA ANA Risk Management a division of Human Resources Managing Risk through Awareness and Action A° AFFIDAVIT OF EXEMPTION FOR AUTOMOBILE LIABILITY INSURANCE I, 1l IXhi[ —k" �QLpaA ("Representative"),attest that I am an authorized (Name and Titl of Vendor Representative) representative of Qi ("Company"), and �T(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 ("Agreement")to provide L14 A- way q I ecyV A"w ("Services"): (Services to a pro%lde&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. §jj--14a4 ot ;Lo^ ---- MA11111- Signature W Print V'amc I-itlr Contact Information,i.e.,-Telephone Number and/or E m-07rdNss Affidavit of Exemption for Automobile Liability Insurance 11.12.2024