Loading...
HomeMy WebLinkAboutJUNGE, CIARA INSURANCE ON FILE WORK MAY PROCEED? UNTIL_INSURANCE EXPIRrS N-2025-215 01 o1 U CITY CLERK °ATEAUG 2 0 2025 o:PRcSA (*a) CITY OF SANTA ANA Pe.rni Perez(vz) RECREATION SERVICES AGREEMENT WITH CIARA JUNGE FOR DANCE PROGRAMMING THIS AGREEMENT is made and entered into on this 5th day of August, 2025 by and between Clara Junge, an individual ("Provider"), and the City of Santa, a charter city and Municipal Corporation organized and existing under the Constitution and laws of the State of California("City"). City and Provider are also referred to as "the Parties." RECITALS A. The City desires to retain a recreation service provider having special skills,resources and knowledge to provide dance 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 they are 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 applicable guidance and public health orders. 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. City reserves the right to change the location(s) at which the services contemplated by this Agreement are provided. d. Provider shall comply with the City's recreation classes policy manual and any other City rules and regulations regarding the operation of recreation classes. PageIof10 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 annual revenue to Provider shall not exceed Twenty-Five Thousand Dollars and Zero cents ($25,000.00). b. Payment to Provider shall be made monthly within thirty (30) days following completion of the last class taught by Provider the prior month. 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. e. Provider agrees that City shall retain thirty percent(30%)of all gross revenue received from program participants as an administrative fee. d. City and Provider agree that all payments due and owing under this Agreement shall be made and 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. c. Payment need not be made for work that fails to meet the standards of performance set forth in the Recitals which may reasonably be expected by the City. f. Provider is responsible for payment to substitute instructors and Provider agrees that City is not responsible for payment directly to substitute instructors. 3. TERM This Agreement shall commence on October 1,2025 and end on September 30,2026 unless terminated earlier in accordance with Section 14 below. The term of this Agreement may be extended for a one-year period by a writing executed by the City Manager and the City Attorney. 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 tht. 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. Page 2 of 10 5. INSURANCE Provider shall procure and maintain for the duration of the agreement, the following insurance coverages: Minimum Scope and Limit of Insurance. Provider 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 Provider 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 Vendor has no employees. • If Provider 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 Provider. 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: • CGL, SAML 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 Provider including materials, parts, equipment, and personnel furnished in connection with such work or operations. • 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 Provider for City. • All required insurance policies: For any claims related to this contract, Provider'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. • AIL required insurance policies: A severability of interest provision must apply for all the additional insureds, ensuring that Provider'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. • 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 Page 3of10 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. The name and the location of event should be included in the Description of Operations section of each certificate. Self-Insured Retentions. Self-insured retentions must be declared to and approved by the City. City may require Provider to purchase coverage with a lower retention or provide proof of ability to pay losses and related investigations, claim administration, and defense expenses within the retention. 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. Provider 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 Entity before work begins. However, failure to obtain the required documents prior to the work beginning shall not waive Provider'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. Claims Made Policies. If any of the required policies provide coverage on a claims-made basis: • The retroactive date must be shown and must be before the date of the contract or the beginning of work. • Insurance must be maintained and evidence of insurance must be provided for at least three(3)years alter completion of work. • If coverage is canceled or non-renewed, and not replaced with another claims-made policy form with a retroactive date prior to the contract effective date, Company must purchase "extended reporting" coverage for a minimum of three (3) years after completion of work. Subcontractors. Provider shall require and verify that all sub-contractors maintain insurance meeting all the requirements stated herein, and Provider shall ensure that City is an additional insured on insurance required from subcontractors. 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 G. INDEMNIFICATION Provider agrees to defend, and shall indemnify and hold harmless the City, its officers, agents, employees, Providers, 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, substitutes, 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 infonnation, 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 RISK 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 assignn 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) or 236.1(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 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: Ciara Junge 1101 W. Stevens Ave.,#215 Santa Ana, California 92707 (510)326-3370 ciarajLmge@gmaii.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. 13. ASSIGNMENT The experience, knowledge, capability and reputation of Provider were a substantial inducement for City to enter into this Agreement.Therefore, except for substitutes listed in Exhibit Page 7 of 10 A, 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 immediately pursuant to any federal, state, county or local health order making it impossible to hold classes. For any other reason, this Agreement may be terminated by 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 Provider outside of Section 14(a). must be given to the City 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. WAIVER No waiver of breach, failure of any condition, or any right or remedy contained in or granted by the provisions of this Agreement shall be effective unless it is in writing and signed by the party waiving the breach, failure, right or remedy.No waiver of any breach, failure or right,or remedy shall be deemed a waiver of any other breach, failure, right or remedy, whether or not similar, nor shall any waiver constitute a continuing waiver unless the writing so specifies. 16. 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. 17. 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. 18. 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 Page 8 of 10 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. 19. 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 govermnental agencies. 20. 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. 21. EXHIBITS All Exhibits referenced herein and attached hereto shall be incorporated as if fully set forth in the body of this Agreement. 22. 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. (signatures appear on following page] Page 9 of 10 SIGNATURE PAGE FOR RECREATION SERVICES AGREEMENT WITH CIARA JUNGE FOR DANCE PROGRAMMING IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first above written. ATTEST CITY OF SA TA ANA o= = ) (All ennifer L. 11 Alvaro Nunez City Clerk City Manager APPROVED AS TO FORM: PROVIDER: SONIA R. CARVALHO City Attorney B Crcua.7wj� [ara luege;AvSs.,o,s is-isse Poe} onathan T. Martin z Ciara Junge Assistant City Attorney RECOMMENDED FOR APPROVAL: )�9"bof— Hawk Scott Executive Director of Parks, Recreation and Community Services Agency 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 dance classes for ages 18 years and older 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 physical activity and teamwork. A. Program and Class Offerings: L Seasonal programs and class offerings may include, but are not limited to the following class options: • Salsa • Bachata ii. Provider 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 • 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. • Class ratio of participants to Provider(s)will be set for each class to ensure effective instruction and safety based on statewide standards. • 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 Provider, that the class shall be cancelled. Provider will be under no obligation to provide services for the cancelled classes, and the City will have no further obligations to pay Provider compensation for the remaining classes that were cancelled in that session. iv. Class Fees • 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. • Each participant shall pay class registration fees as established by City. Provider may not waive class participation/registration fees. Only registered participants paid in full may participate in class. • Any refunds to participants will be made in accordance with City policy. B. Provider Responsibilities: L Planning and delivering engaging and age-appropriate dance 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. • Providerwill 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. • Provider 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 64 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 Provider'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 Provider. viii. Provider shall provide all materials, supplies, equipment, records and personnel. Provider shall be responsible for repairing and maintaining all equipment and supplies, and ensuring that it is in good working condition. Provider 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. Provider 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. Provider 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 Provider 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 Provider. Publicity may also include flyers created by City. Provider 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). Provider 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 Provider. D. INSURANCE REIMBURSEMENT This Agreement contemplates a reimbursement of up to $1,500 for the cost of insurance as required by Section 5 of this Agreement, subject to proof acceptable to the Director of Parks, Recreation, and Community Services or their designee. A� 0 DATE(MMIDOfYYYYI `� CERTIFICATE OF LIABILITY INSURANCE 07/2212025 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: PHOEAX Bene-Marc Athletic Insurance Agency#OE67789 WCN o (800)247 1734 A/C No): 6301 Southwest Boulevard,Suite 101 E-MAIL contact@bene-marc.com ADDRESS: Fort Worth,Texas 76132 INSURER(S)AFFORDING COVERAGE NAICiI INSURER A: IHDI Global Specialty SE AA-1120822 INSURED INSURER B: AXIS Global Accident&Health Insurance Company 37273 Southern California Municipal Athletic Federation(SCMAF) PCs Box 3605 INSURER C South El Monte,CA 91733 INSURER D SCMAF Member Clara Junge-Salsa& Bachata Dance Classes INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: 9066-55782 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. INSR TYPE OF INSURANCE A➢OL.SUBR POLICY EFF POLICY EXP LTR POLICY NUMBER MMI➢DNYYY MMIDOfiYYY LIMITS X COMMERCIALGENERALLIABILITY EACH OCCURRENCE $ 1,000,000.001 18LB7323 01101/2025 01101/2026 DAMAGE TO RENTED CLAIMS-MADE O OCCUR PREMISES Ea occurrence $ 100,000.00 MED EXP{Any one person} $ 5,000.00 A X X PERSONAL&ADV INJURY $ 1,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 5,000,000.00 JECT POLICY PRO LOC PRODUCTS-COMPIOPAGGS 1,000,000.00 OTHER: Participant Liability $ 1,000,000.00 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) S HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per acciden9 5 UMBRELLA LIAB OCCUR EACHOCCURRENCE S EXCESS LIAR HCLAIMS-MADE AGGREGATE S DED I RETENTIONS $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANYPROPRIETCRIPARTNERIEXECUTIVE ❑ EL EACH ACCIDENT 5 OFFICEWMEMSER EXCLUDED? NIA (Mandatory in NH) E-L.DISEASE-EA EMPLOYEE 5 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ B Participant Accident Medical SRPO-50256-243 01/01/2025 01101/2026 Deductible, $0.00 Limit: $5,000.00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) This policy includes a blanket additional insured endorsement that provides addilicnai insured status to the certificate holder per form CG 20 26 07 04 The General Liability policy contains Primary and Non Contributory wording per endorsement E 1 602AJ-1 112.The General Liability pelicy contains an endorsement for Waiver of Transfer of Rights of Recovery Against Others to Us per attached form CG 24 04 05 09_City of Santa Ana,its City Council,officers,officials employees,agents and volunteers are named additional insured. Coverage for SCMAF member approved activities for which a premium is paid and reported to the Company. SCMAF Member: TU Tran Digitally Signed by Clara Junge-Salsa&Bachata Dance Classes rurran Nguyen Date:2025.09.11 Coverage is limited to the following activity dates: 10101125-12131125 Nguyen 12:52:37-0�'00' APPROVED CERTIFICATE HOLDER CANCELLATION ByTu Tran Nguyen at 12:52pm,Aug 11,2025 City of Santa Ana,its City Council,officers,officials,employees, agents,and SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE volunteers THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 20 Civic Center Plaza M-23 AUTHORIZED n HallSEN7ATIVE ( A+i4A/ R ya Santa Ana,CA 92702 Alisa Lynn Hall O 1988-2015 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 Name Of Additional Insured Persons Or Organization(s) 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. 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 0 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 re uired 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-Gompleted 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 This Endorsement changes the Policy. Please read it carefully. COMMERCIAL GENERAL LIABILITY ENDORSEMENT PRIMARY AND NON-CONTRIBUTORY AMENDATORY - E1802AJ-1112 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTSICOMPLETED 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 Policy Number: 18LB7323 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. 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 E1602AJ-1112 Page 1 of 2 (iii) 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. c. 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 E1602AJ-1112 Page 2 of 2 GEICU Important Information Here are your Policy Identification Cards We've provided two (2)cards for each vehicle on your policy. Need additional ID cards? The GEICO Mobile app is the quickest way to get additional ID cards. You can also send a copy of your ID cards to anyone that needs them right from the app! Evidence of Insurance Here are your Evidence of Liability Insurance Cards.Two cards have been provided for each vehicle insured. One card must be carried in the proper insured vehicle. Proof of insurance is required to register or renew the registration of your vehicle.A law enforcement officer can ask you to prove that you have liability insurance meeting the basic requirements of California law. A violation of these requirements can result in a fine of up to: $1,000 for the first time; $2,000 for additional times. Also, a judge can have your vehicle impounded. False proof of insurance may result in a fine up to$750 and 30 days in prison. JAMES DARNELL JACKSON 1101 W STEVENS AVE APT 215 SANTA ANA CA 92707 Cut Along the Dotted Line Cut Along the Dotted Line --------------------------------------------------------• ---------------------------------------------------__-_--- California Evidence of Liability Insurance California Evidence of Liability Insurance G" =IC(a GEICO General Insurance Company GOG"0 GEICO General Insurance Company PO BOX 9506 Fredericksburg,VA 22403-9506 PO BOX 9506 Fredericksburg,VA 22403-9506 NAIC Code 2017 HONDA ACCORD NAIC Code 2017 HONDA ACCORD ; 35882 Vehicle ID No.JHMCR6F54HC030930 35882 vehicle ID No.JHMCR6F54HC030930 Policy Number I Effective Date Expiration Date Policy Number Effective Date Expiration Date 6187-23-57-56 06/12/25 12/12/25 6187-23-57-56 06/12/25 12/12/25 Named Insureds) Address Named Insured(s) Address James Darnell Jackson 1101 W Stevens Ave Apt 215 j James Darnell Jackson 1101 W Stevens Ave Apt 215 Santa Ana CA 92707 Santa Ana CA 92707 2017 HONDA ACCORD : 2017 HONDA ACCORD Additional'Drivers Additional Drivers Ciara Nicole Junge Clara Nicole Junge This pnllcy complies with Sections 16066 or 16500.5 of the California Vehicle Code. This policy compiles with Sections 16056 or 13,500.5 of the Californla Vehicle Code. i i i GEIC0 Need another form of proof of insurance? You may need the Insurance Binder for most finance companies, dealerships or vehicle registrations. Scan this code to get another form of proof of insurance immediatelyt L�1 5.1 l If your address changes, update it using the app or log in to geico.com. By keeping your information up-to-date, you'll continue to receive important policy documents. Cut Along the Dotted Line Cut Along the Dotted Line 2017 HONDA ACCORD �� �� ; 2017HONDAACCORD GEiC© Evidence of financial responsibility shall at all times be o Evidence of financial responsibility shall at all times be carried in the vehicle. carried in the vehicle. • Insurance information has already been submitted directly o Insurance information has already been submitted directly to the DMV electronically,submit this document to DMV ; to the DMV electronically,submit this document to dMV only if specifically requested by DMV. ; only if specifically requested by DMV. ; ; ; ; ; ; If you're in an accident: If you're in an accident'. _........_..... - • Stay at the scene and find a safe area. Stay at the scene and find a safe area. • Do not admit fault or disclose your coverage limits. j Do not admit fault or disclose your coverage limits. Call the police,and gather driver and vehicle Call the police,and gather driver and vehicle information. ; information. • Find any witnesses and get their contact information. Find any witnesses and get their contact information. To report a claim To report a claim Go to geico.comlclaims,use the GEICO Mobile app or call Go to geico.comlctaims,use the GElCO Mobile app or call 1-800-841-3000. 1-800-841-3000. U4CA (08-24) U4CA (08-24) GEIC0, Important Information Here are your Policy Identification Cards We've provided two (2)cards for each vehicle on your policy. Need additional ID cards? The GEICO Mobile app is the quickest way to get additional ID cards. You can also send a copy of your ID cards to anyone that needs them right from the app! Evidence of Insurance Here are your Evidence of Liability Insurance Cards. Two cards have been provided for each vehicle insured. One card must be carried in the proper insured vehicle. Proof of insurance is required to register or renew the registration of your vehicle. A law enforcement officer can ask you to prove that you have liability insurance meeting the basic requirements of California law. A violation of these requirements can result in a fine of up to: $1,000 for the first time; $2,000 for additional times. Also, a judge can have your vehicle impounded. False proof of insurance may result in a fine up to $750 and 30 days in prison. JAMES DARNELL JACKSON 1101 W STEVENS AVE APT 215 SANTA ANA CA 92707 Cut Along the Dolled Line Cut Along the Dotted Line --------------------------------------------------------• --------------------------------------------------------- California Evidence of Liability Insurance California Evidence of Liability Insurance ; GEICC1y GEICO General Insurance Company GEI�(3 GEICO General Insurance Company PO BOX 9506 Fredericksburg,VA 22403-9506 PO BOX 9506 Fredericksburg,VA 22403-9506 NAIC Code 2025 HONDA HR-V NAIC Code 2025 HONDA HR V 35882 Vehicle ID No.3CZRZ1 H71SM753860 35882 Vehicle ID No.3CZRZ1 H71 SM753860 Policy Number Effective Date Expiration Date Policy Number I Effective Date Expiration Date 6187-23-57-56 06/12/25 12/12/25 ; 6187-23-57-56 06/12/25 12/12/25 Named Insured(s) Address Named Insured(s) Address James Darnell Jackson 1101 W Stevens Ave Apt 215 James Darnell Jackson 1101 W Stevens Ave Apt 215 Santa Ana CA 92707 Santa Ana CA 92707 2025 HONDA HR V : 2025 HONDA HR-V ' Additional Drivers Additional Drivers Clara Nicole Junge Ciara Nicole Junge i This policy complies with Sections 16056 or 16600.5 of the California Vehicle Code, ; This policy complies with sections 16055 or 16500.6 of the California Vehicle Code. i i GEICM Need another form of proof of insurance? You may need the Insurance Binder for most finance companies, dealerships or vehicle registrations. Scan this code to get another form of proof of insurance immediately[ .. M If your address changes, update it using the app or log in to geico.com. By keeping your information up-to-date, you'll continue to receive important policy documents. Cut Along the Dotted Line Out Along the Dotted Line ____---_-----_---- _- ______________ _____, 2025 HONDA HR-V GE1CM 2025 HDNDA HR-V GEICO, : • Evidence of financial responsibility shall at all times be Evidence of financial responsibility shall at all limes be carried in the vehicle. carried in the vehicle. • Insurance information has already been submitted directly; • Insurance information has already been submitted directly to the DMV electronically,submit this document to OMV to the DMV electronically,submit this document to DMV only If specifically requested by DMV. only if specifically requested by DMV. If you re in an accident: If you're in an accident: • Stay at the scene and find a safe area. Stay at the scene and find a safe area. Do not admit fault or disclose your coverage limits. Do not admit fault or disclose your coverage limits. • Call the police,and gather driver and vehicle Call the police,and gather driver and vehicle information. information. • Find any witnesses and get their contact information. Find any witnesses and get their contact information. To report a claim To report a claim Go to geico.com/claims,use the GEICO Mobile app or call Go to geico.com/claims,use the GEICO Mobile app or call 1-800-841-3000. 1-800-841-3000. Need a tow or roadside assistance? Need a tow or roadside assistance? Using the GEICO Mobile app is a quick and easy way to Using the GEICO Mobile app Is a quick and easy way to request Emergency Road Service. request Emergency Road Service. U4CA (08-24) U4CA(08-24) G E I CD GEICO GENERAL INSURANCE COMPANY VERIFICATION OF COVERAGE (SEE BELOW UNDER CAUTIONARY NOTE) MAILING ADDRESS Policy Number: 6187235756 JAMES DARNELL JACKSON Effective Date: 06-12-25 1101 W STEVENS AVE APT 215 Expiration Date: 12-12-25 SANTAANACA 92707 Registered State: CALIFORNIA To whom it may Concern: This letter is to verify that we have issued coverage under the above policy number for the dates indicated in the effective and expiration date fields for the vehicle listed. This should serve as proof that the below mentioned vehicle meets or exceeds the financial responsibility requirement for your state. This verification of coverage does not amend, extend or alter the coverage afforded by this policy, Vehicle Year: 2025 Make: HONDA Model: HR-V VIN: 3CZRZ1 H71 SM753860 COVERAGES LIMITS DEDUCTIBLES Bodily Injury Liability Each Person/Each Occurrence $30,000/$60,000 Property Damage Liability $50,000 Uninsured&Underinsured Motorists Each Person/Each Occurrence $30,000/$60,000 Comprehensive(Excluding Collision) $200 Ded Collision $500 Ded/Waiver Emergency Road Service Full Rental Reimbursement $45 Per Day/$1,350 Max X Lienholder X Additional Insured Interested Party HONDA FINANCIAL 10801 Walker St#140 CYPRESS,CA 90630 Additional Information: Issue Date: 2025-07-10 If you have any additional questions, please call 1-800-841-3000. CAUTIONARY NOTE:THE CURRENT COVERAGES,LIMITS,AND DEDUCTIBLES MAY DIFFER FROM THE COVERAGES,LIMITS AND DEDUCTIBLES IN EFFECT AT OTHER TIMES DURING THE POLICY PERIOD.THIS VERIFICATION OF COVERAGE REFLECTS THE COVERAGES,LIMITS,AND DEDUCTIBLES AS OF THE ISSUED DATE OF THIS DOCUMENT WHICH 15 SHOWN UNDER"ADDITIONAL INFORMATION'OR IF AN ISSUED DATE IS NOT SHOWN,THE DATE OF THIS FACSIMILE OR EMAIL. U33(12-24) CITY OF SANTA ANA Risk Management a division of Human Resources Managing Risk through Awareness and Action AFFIDAVIT OF EXEMPTION FOR WORKERS' COMPENSATION INSURANCE l C i a ra Junge Re resentative(" p "), attest that I am an authorized. (Name and Title of Vendor Representative) representative of C i a ra Junge ("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 provide Dance Instruction ("Agreement")to p ("Services"): (Services to be provided under as eement/eontract) 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 professional 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. C;111 a"fl 7/23/2025 Signature Date Ciara Junge Print Name Lead Dance Instructor Title 510.326.33701 ciarajunge@gmail.com Contact Information,i.e.,Telephone Number and/or Email 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