HomeMy WebLinkAboutRELAMPAGO DEL CIELO, INC. (7) INSURANCE ON FILE
WORK MAY PROCEED N-2025-180
UNTIL IN�JURANGTE EXPIRN
CJTY CLFRK
Flid -' JUL 2 Z 2075 ARTS AND CULTURE ARTIST GRANT PROGRAM AGREEMENT BETWEEN
THE CITY OF SANTA ANA AND RELAMPAGO DEL CIELO, INC.
G P A This Artist Grant Agreement ("Agreement") is made and entered this 1311 day of January, 2025,
Tram I_e (p7_) 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 Relampago Del
Cielo, Inc. ("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 two 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 two (2) installments. First payment will be one-half of the funding
amount provided above or$3,500 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
and final payment will include the remaining amount of$3,500 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.
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 other 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.
3.8. 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
remove, alter, or destroy the Project artwork. Grantee will have first right of refusal to restore said
2
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.
8. 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:VII, 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 CGI.
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: Relampago Del Cielo, Inc,
600 W. Santa Ana Boulevard, Suite 214-A
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
4y
I
IN WITNESS WHEREOF, the Parties hereto have executed this Agreement the date and year
first above written.
i
ATTEST: CITY OF SANTA ANA
I
oY I
IF- H L "" a' ALVARO NUIVEZ
City Clerk City Manager
APPROVED AS TO FORM: GRANTEE:
SONIA R. CARVALHO
City Attorney
4Andrea
W&ft /1 )4,, A'
G cla- filler Name: MarlenePena-Marin
Assistant City Attorney Organization: Relampago Del Cielo, Inc.
Title:Artistic Director
RECOMMENDED FOPI APPROVAL
MICHAEL L. GARCIA
Executive Director
Community Development Agency
8
EXHIBIT A
INVESTING IN THE ARTS GRANT PROGRAM
APPLICATION
9
Project Timeline
"Input your information directly onto this form and upload onto 5ubmittable.com.
DATE ACTION OUTCOME
10/20/24 Submit City Permit Application Permission granted
1/15/25 Finalize performance schedule and content Performance schedule complete and ready
to begin rehearsals
2/15/25 Host auditions and finalize dancer assignments Performers selected and ready to begin
rehearsals
3/15/25 Finalize permits and production schedule City permission complete, date and location
finalized, and Production company contract
finalized
6/30/25 Finalize costuming and staging Costumes with tailoring are complete
7/31/24 Complete Rehearsal Schedule Production is ready for final dress
rehearsals
8/2— Complete Dress Rehearsals All preparations are finalized and ready for
8/3/24 the public performance
8/9/25 Host 50th Anniversary Ballet Folklorico Concert Project Complete
m M ,
c
0 c
CD o z (D < -09 M : 7 m «
\ ( � 2_ § M CD 0 ° r §
+
§ w k » $ D ¢
m Q o B
g n §
o R E E � (
§ ] 7 2 ƒ q §
0 § \ # ] 2 Q ] CL
J p Q' m
q rD ■
L c q
o
V C
(AEA ( �
CL �
k �
c
R w @ ¥ / CD
A ) M
OQ
M ° (D �
U 0.
§ D
r -
13
k k Uc � a)� 00 w
kkkok CL
r+ §R
o -
U s
B
-CA. if� 4fl- IA- 2 ]
Pi N
0
R R R w
o 0 0
o
0
&
0 0 C n
G
0 0 W -n
R n §
0 2 § L
� e �
CD
/ �
o E
v 0 q
o $
o �
m _
n D m
CD CL
0 ƒ Q E 2 <
E� a) r+ e 7 e 7 m
\ / O cm = � 7 -1
@ _
CL ƒ � (D § R /
Ln A g 7 ƒ C � /
0 LA r $ C § 7
� m n - � a
k ° O
CL
d cu (D
0) 2 � q
CL / 7 �
7 C ° k
m m "a
70.
CL
7
> � - 2
CL � (D
00 - � 7
0 § ®
r+ q § m
2 m I
0 0
m � / kkko
7 /t § �0 C. d n
0
§ &
/ m ..
c 0
jh- 2 -0
0 2
o g
]
r
a -n
7 0 0 CL
00 V)
� � � � CD
(P 2
0 � k %
r
B a .
2
D m
=r oJ 2 q
rD
]
> n 0 � k n q
] m
0 � / z $
D $ ° & "
/ co
\ o / » = m
0) «
k § D "LaA n
r o E r
7 ct =LA
3 c
ƒ 0 n m _0
Q m e k k § a)
c ® a CL
G) 2 R
m O / g
] rD
a) E
n o q
3 o tn -tn Vb
NJ
kq ;a CD � Ili
2 M R 2 E / E
�
2 >
O
o o x
7 7 C
ƒ 00
m m 0 D o 0 0
§ o
c
IA c W
t CL q
c N o o n@
R 0 0 0 r+ �
0 0 A
q 0 z F � � @
q C) 19) 9"
C 0 0 k
lu
<
�
vi-
LrI
� 0 to C)
o 1-
0 0 R 0 -
C 0
ACC)RbP DATE(MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE 5/12f2025
7'THlSCEPTIFICATF IS ISSUERS ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOTAFFIRMATIVELY OR NEGATIVELY
AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BYTHE POLL CI ES HFLOW.THI S CERTIFI CAT E OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETW EEN THE ISSUING INSURER(S),
AUTHORIZED REPRESENTATIVE OR PRODUCER,ANDTHE CERTIFICATE HOLDER.
IMPORTANT:IFthe certificate holder is an ADDITIONAL-INSURED,the pollcy(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.Astatementort th(s certificate does not confer rights to the certificate holder in lieu ofsuch endorsement(s).
PRODUCER CONTACT
NAME: Gabe Diaz
Gabriel Diaz(976132M) PHONE FAX
2706 Harbor Blvd Ste 201 (A/c.NO,FXT):714-434-7600 (A/C,NO): n/a
E-MAIL
Costa Mesa CA 92626-5119 ADDRESS: gdiaz@farmersagent.com
INSURER(S)AFFORDING COVERAGE NAIC N
INSURED INSURERA: Truck Insurance Exchange 21709
BOX 3158 O DEL ClELO, INC. INSURER B; Farmers Insurance Exchange 21652
PO BOX
f3Jri INSURERC: Mid Century Insurance Company 21687
INSURER D:
SANTA ANA CA 92703 INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS I5TO CERTIFYTHAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAME ABOVE FOR THE POLICY PERIOD INDICATED.NO-PAJITHSTANDING ANY
REQUIP.EMENT,7ERIV OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENTWITH RESPECTTO WHICH TH€S CERTIFICATE MAY BEISSUEDOR MAY PERTAIN,THE INSURANCE AFFORDED BYTHE
POLICIES DESCRI BED HEREIN IS SUBJECTTOALL THE TERMS,EXCWSIONS AND CONDITIO NS OFSUCH POLICI ES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ,r
INSR TYPEOFINSURANCE ADDTL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS
LTR INSD WVD (Mint/DD/Y)rYY) (MM/DD/YYYY)
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000
.�/CL DAMAGE TO RENTED $
AIMS-MADE OCCUR j�i PREMISES(E-1 Occurrence) 75,000
MED EXP(Any one person) $ 5,000
A Y Y 604334509 03107/2025 03/07/2026 PERSONAL&ADVINJURY $ 2,000,000
GEN'L AGGREGATE LIMIF APPLIES PER: GLNERAL AGGREGATE $ 4,000,000
I POLICY ❑ PROJECT ❑ LOC PRODUCTS-COMP/OPAGG $ 2,000,OCJO
i
OTHER: $
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT $ 2000,000
{Ea accident}
ANVAUTO BODILY INJURY(Per person) $
OWNEDAUTOS SCHEDULED
A BODILYIN]URY(Peraccidenk)$
ONLY AUTOS y Y 604334509 03/0712025 03107/2026
HIREDAUTOS NON-05NNED PROPERTY DAMAGE $
ONLY AUTOSONLY (Peraccident)
$
UMSRELLA LIAR OCCUR EACH OCCURRENCE
EXCESS LIAR CLAIMS-MADF AGGREGATE $
DED I REfENfION$ $
WORKERS COMPENSATION PER OTHER $
AND EMPLOYERS'LIABILITY STATUTE
ANYPROPRIETOR/PARTNER,' Y/N E.L.EACH ACCIDENT $
EXECUTIVE OFFICER/MEMBER N/A
- EXCLUDED?(Mandatory in NH)
E.£.nISFASE-EA EMPLOYEE 5
j 0yes,descri he under DESCRIPTION OF
I OPERATIONS below E-L DISEASE-POLICY LIMIT 3
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
00 W SANTA ANA BLVD,SANTA ANA,CA 92701;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,
nd personnel furnished in connection with such work or operations. Waiver of Subrogation applies.Location: Centennial Park-City of Santa Ana,3000 W
Edinger Ave.,Santa Ana,CA 92704,Concert in The Park. Digit,fly sign
Tu Tran byT-T-
9vY1
CERTIFICATE HOLDER CANCELLATION Nguyen D.[e:m2s urn2
07:24:23.01' '
City of Santa Ana,ATTN:Executive Director, SHOU LD ANY OF THE ABOVE D ESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
Community Development Agency DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
20 Civic Center Plaza,M-25 A U TH ORR VZ D A&P R ESENTATIVE Gabriel A.Diaz
SANTA ANA CA 92701
ACORD 25(2016/03) :cD1988-2015
1-17b9 Il-IS The ACORD narne and logo are registered marks of ACORD APPROVED
By Tu Tran Nguyen at 7:23 am,Jul 02, 2025
ACOR" CERTIFICATE OF LIABILITY INSURANCE FDATEIMMIDDIYYYY)
III06/04/2025
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 Aidee Lopez
StateFarm Aidee Lopez Insurance Agency Inc HO No Ext, 714 775 309Q arc No
1415 S Broadway St E-MAIL
Santa Ana CA 927D7 INSURER($)AFFORDING COVERAGE NAIL#
INSURER A: State Farm Fire and Casualty Company 25143
INSURED INSURER B:
Relampago De Cielo,Inc INSURER C;
Pp Box 3158 INSURER D: Q
E�
Santa Ana CA 92703 INSURER E
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.
IN SR ADD SUB POLICY E P LI UY E X P
TYPE OF INSURANCE
LTR INSD WVD POLICY NUMBER MMIODIYYYY) 1MM/DDfYYYYJ LIMITS
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $
CLAIMS-MADE El OCCUR DAMAGE TO RENTED
PREMISES Ea occurrence $
MED EXP(Any one person) $
PERSONAL&ACV INJURY $
GENT AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $
PRO-
POLICY F7 JECT F7 LOD PRODUCTS-COMPOEAGG $
OTHER $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
Ea accident $
ANY AUTO BODILY INJURY(Per person) S
OWNED SCHEDULED
AUTOS ONLY AUTOS BODILY INJURY(Per accident) S
HIRED NON-OWNED
AUTOS ONLY AUTOS ONLY Per accident $
$
UMBRELLA LIAB OCCUR EACH OCCURRENCE S
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DEO I I RETENTION S $
WORKERS COMPENSATION PER OTH-
AND EMPLOYERS'LIABILITY $
ANY PROPRIETORIPARTNERfEXECUTIVE Y r N E.L.EACH ACCIDENT $ 1,QOQ,QDQ
X OFFICERIMEMSER EXCLUDED? ❑ NIA 92-TA-JB73-6 09/15/2024 09/15/2025
{Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 1,000,000
If yes,describe under
DESCRIPTION OF OPERATIONS below I I I I E.L.DISEASE-POLICY LIMIT $ 11000,000
DESCRIPTION OF OPERATIONS r LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may 6e attached if more space Is required)
600 W SANTA ANA BLVD,SANTA ANA,CA 92701;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.Waiver of Subrogation applies,Location:Centennial Park-City of Santa Ana,
3000 W Edinger Ave.,Santa Ana,CA 92704,Concert In The Park.
APPROVED
CERTIFICATE HOLDER CANCELLATION By Tu Tran Nguyen at 7:23 am,Jul 02, 2025
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Santa Ana,Attention:Executive Director,Community ACCORDANCE WITH THE POLICY PROVISIONS.
Development Agency,20 Civic Center P#aza M-25,Santa Ana, AUTHORIZED REPRESENTATIVE
CA 92701 Completed by an authorized State Farm representative.If signature
is required, please contact a State Farm agent.
rJ 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD
1001486 132849.14 04-13-2022
POLICY NUMBER: 6OL133-45-09 BLJ8INESS01ltlN5RS
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE RE&D IT CANSFULLY.
ADDITIONAL INSURED - DESIGNATED PERSON
OR ORGANIZATION
This endorsement modifies insurance provided under-the following,.
BUSIN SSOAERS POLICY
SCHEDULE*
Name Of Person or Organization-,
CITY OF SANTA AAA AND ITS
OFFICERS, AGENTS & EMPLOYEES
Information required to complete this Schedule, if not shown on this endorsement, will be stjown in the
The following Is added to Paragraph 0. Who Is An
Insured in the Sualnessownere Liability Coverage
Form:
4, Any person or organization shown in the Sched-
ule Is also an-insured, but only with respect to
liability arising out of your ongoing operations
or premises owned by or rented to you.
IT IS FURTHER AGREED THAT THIS III SURANCE SHALL BE PRIMARY AND
NOM CONTRIBUTORY 8UT ONLY IN TUB EVENT OF INSURED' S SOLE
NEGLIGENCE.
Sig 04 48 01 97 Copyright, Insurance Services Office, Inc., 1997 Page I of 1 0
.............
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC'04 03 00
(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'agreemont from us,.)
You must rn intain payroll records aoc:urately segregating the remuneration of your employees while eligaged in the
work-.described in the Schedule,
The.additional premium for this endorsement shall be of the California workers`-compensation premium
otherwise due,on such remuneration,
.Schedule
Person or Organization Job Description
CITY OF SANTA ANA RISK CONTRACT- $7,000 CODE. 8868
MANAGMENT DIVISION
CITY OF SANTA ANA
CITY OF SANTA ANA,
ITS COUNCIL, OFFICERS,
OFFTCALS,EMPLOYRES, AGENTS,
AND VOLUNTEERR
20 CTVTC CENTER PLAZA
SANTA ANA Chi 9'2701-4058
This ondorsemont changes the policy to,which it is-attaohe.d and is.effectiue on tho date issued unl oss othorAse slated,
(The information below is required only when this endorsement is issued,subsequent to preparation of thepolicy.)
Endorsement Effective a9/15/24 PollcyNo. 92-TA-J873-6 Endorsement No.
Insured RELAMPAGO DEL CIELO, INC Insurance Company State Farm J'ire .and Casualty Company
Countersigned B:y
WC.04 03 06.
(Ed. 4-84) 1007722 124282.2 01-25-2019
MIS ENM4+iBY+7EMEN i%nIrQPRL`GES Q ME POLICY.A e PL.Ir E READ ITMR-FULL t yq�
E06
9 at EdItlan
WAIVERF TRANSFER OF RIGHTS
AGAINST OTHERS TO US
04/26/24 60433-45.09
Effeetine pate Policy Number
This endorsement modifies insurance Provided underthe following:
BUSINESSOWNERS commoN POUCY CONDIT ONS-SP00o9
SCHEDULE
City of Santa Ana, Its City Council,officers,officials,employees,agents and volunteers
(if no entry appears above,information required to complete this Endorsementmust beshown in the Declarations as
applicable to this endorsement.)
The provisions of the Businessowners Common Policy Conditions are modified by this endorse'nentasfollows:
ConditionK� Transkrof Rights OfRecoveryAgainstt
OftmTo Us in the Businessowrlers Common Policy
Conditions is amended by the addition ofthe following:
3. We waive any right of recovery we may have against
the person or organization,shown in the Schedule
above because of paym4n£s we make for Injury or
damage arising out ofyour ongoing operations or
your worm done under a contractvAth that person
or organization and Included in the products-
completed operations hazard.This waiver applies
onlyto the person or organization shown in the
Schedule above,
This Insurance Is also considered primary and
Non-contributory.
We will advise all additional insureds,within 30 days or sooner,
in writing,should said policy cancel for any reason whatsoever.
Thisendorsement is part ofyour policy.Itsupersedes and controls anything to the contrary.It is othermsesubject to,all the
terms ofthe policy.
E3306-E01 6-97 Includes Copyright Material lnsuranceSeMcesCaifice,lnc.,7 992 PAGE t OF 1
91-�3ao E3.900101
CITY OF SANTA ANA
Risk Management a division of Human Resources z"'✓
Managing Risk through Awareness and Action '
AFFIDAVIT OF EXEMPTION FOR AUTOMOBILE LIABILITY INSURANCE
PIr it'd?/""("Representative"),attest that I am an authorized
ante and Title of Vendor epresentative)
t I
representative off ( r ("Company"), and
(C nsul e t/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
/&
("Agreement")to provide 11 VeS fI M �n l i tli 1 y r b5� c. y?G. �ir*Services-):
(SeplVices to be provided under agreement/contract) IIJ
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
documcnt 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
ze46W
pelTa
Print Na
1
Title
:214 qqTlatl
Contact Information,i.e.,Telephone Number and/or Email Address
Affidavit of Exemption for Automobile Liability Insurance 11.12.2024