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HomeMy WebLinkAboutSANTIAGO PARK ARCHERS 1NSUP,a,i\lCE of r11_,. WORK MAY PROCEED V OWNCURANCE FXPIK, /I n oz2 _. N-2025-244 'A'T'L EE§tQ 2 3 2025 G�nol�Sar�gen` otDz) FACILITY USE AGREEMENT WITH SANTIAGO PARK ARCHERS FOR USE OF THE SANTIAGO PARK ARCHERY RANGE THIS FACILITY USE AGREEMENT is made and entered into on 5th day oflune, 2025 by and between Santiago Park Archers, a California non-profit corporation ("User"), and the CITY OF SANTA ANA, a charter city and municipal corporation organized and existing under the Constitution and laws of the State of California ("City"). City and User are also referred to as "the Parties." RECITALS A. The City is the owner of Santiago Park, including the Santiago Archery Range, located at 600 E. Memory Lane in the City of Santa Ana. B. User is a California non-profit mutual benefit corporation. C. City acknowledges the community need for programs such as those offered by User that encourage Santa Ana residents to engage in archery related activities and offer such activities in a safe environment. The parties agree as follows: I. GRANT OF PERMISSION AND FACILITIES TO BE USED City hereby grants User the limited, non-exclusive right to utilize designated areas of Santiago Park and its archery range ("Facilities") pursuant to the terms set forth in Exhibit A, attached hereto and incorporated herein by reference. 2. PUBLIC PURPOSE City acknowledges the public benefit provided by User to the City of Santa Ana through its uses and that User is a non-profit mutual benefit corporation. User shall be charged an annual rate under this Agreement, as set forth in Exhibit A. 3. TERM This Agreement shall commence on the date first written above, for a term of five (5) years, unless terminated earlier in accordance with the terms of this Agreement. The term of this Agreement may be extended for up to two (2), one (1) year periods upon a writing executed by the City Manager and City Attorney. 4, COMPLIANCE WITH RULES AND REGULATIONS User shall use and occupy the Facilities in a safe and careful manner and shall comply with all applicable local, state, and federal laws in its use of and activities in the Facilities, including as to the conduct of its employees, agents, clients, customers, guests, Page I of 9 and others using the Facilities by reason of this Agreement. User shall also comply with all rules and regulations of City in effect during its use of the Facilities. Failure to abide by such laws, rules, or regulations, or any condition of this Agreement, may result in the immediate termination of this Agreement in the sole discretion of the City. 5. BACKGROUND CHECKS User shall ensure that all employees, subcontractors, and any volunteers are fingerprinted and background checked prior to conducting any work pursuant to this Agreement. User shall not assign any employee, agent, subcontractor, volunteer or the User personally to provide services pursuant to this Agreement, if that employee, agent, subcontractor, volunteer, or the User 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.` 6. INDEMNIFICATION User agrees to and shall indemnify, protect, defend, and hold harmless City, its officers, agents, employees, consultants, special counsel, and representatives from and against any and all claims, damages,judgments, attorney's fees,costs and expenses arising out of, involving, or in connection with the use of the Facilities or the acts or omissions of User, its officers, agents, employees, volunteers, guests, or invitees, whether or not such acts or omissions constitute permitted uses of the Facilities. 7. INSURANCE Without limiting User's indemnification obligations, User agrees to obtain and maintain during the term of the Agreement, and to require its subcontractors, if any, to obtain and maintain, insurance as described below: User shall procure and maintain for the duration of the contract insurance against claims for injuries to persons or damages to property which may arise from or in connection with the performance of the work hereunder and the results of that work by the User, his agents, representatives, employees or sub-Users. Minimum Scope and Limit of Insurance. Coverage shall be at least as broad as: Page 2 of 9 • 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. If a general aggregate limit applies, either the general aggregate limit shall apply separately to this project/location (ISO CG 25 03 or 25 04) or the general aggregate limit shall be twice the required occurrence limit. • Workers' Compensation: as required by the State of California, with Statutory Limits, and Employer's Liability Insurance with limit of no less than $1,000,000 per accident for bodily injury or disease. (Not required if organization has no employees). • If the User maintains broader coverage and/or higher limits than the minimums shown above, the City requires and shall be entitled to the broader coverage and/or the higher limits maintained by the User. Any available insurance proceeds in excess of the specified minimum limits of insurance and coverage shall be available to the City. Other Insurance Provisions. The insurance policies are to contain,or be endorsed to contain, the following provisions: Additional Insured Status. The City, its officers, officials, employees, and volunteers are to be covered as additional insureds on the CGL policy with respect to liability arising out of work or operations performed by or on behalf of the User including materials, parts, or equipment furnished in connection with such work or operations. General liability coverage can be provided in the form of an endorsement to the User's insurance (at least as broad as [SO Form CG 20 10 It 85 or if not available, through the addition of both CG 20 10, CG 20 26, CG 20 33, or CG 20 38; and CG 20 37 if a later edition is used). Primary Coverage. For any claims related to this contract, the User's insurance coverage shall be primary coverage at least as broad as ISO CG 20 0104 13 as respects the City, its officers, officials, employees, and volunteers. Any insurance or self-insurance maintained by the City, its officers, officials, employees, or volunteers shall be excess of the User's insurance and shall not contribute with it. Notice of Cancellation. Each insurance policy required above shall provide that coverage shall not be canceled, except with notice to the City. Waiver of Subrogation. User hereby grants to City a waiver of any right to subrogation which any insurer of said User may acquire against the City by virtue of the payment of any loss under such insurance. User agrees to obtain any endorsement that may be necessary to affect this waiver of subrogation, but this provision applies regardless of whether or not the City has received a waiver of subrogation endorsement from the insurer. Page 3 of 9 i Self-Insured Retentions. Self-insured retentions must be declared to and approved by the City. The City may require the User 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. The policy language shall provide, or be endorsed to provide,that the self-insured retention may be satisfied by either the named insured or City. Acceptability of Insurers. Insurance is to be placed with insurers authorized to conduct business in the state with a current A.M. Best's rating of no less than A:VII, unless otherwise acceptable to the City. Verification of Coverage. User shall furnish the City with original Certificates of Insurance including all required amendatory endorsements (or copies of the applicable policy language effecting coverage required by this clause) and a copy of the Declarations and Endorsement Page of the CGL policy listing all policy endorsements to City before work begins. However, failure to obtain the required documents prior to the work beginning shall not waive the User's obligation to provide them.The City reserves the right to require complete, certified copies of all required insurance policies, including endorsements required by these specifications, at any time. 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. CONFLICT OF INTEREST CLAUSE User 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. 9. FORCE MA.IUERE In the event that the Facilities are rendered unavailable due to destruction, partial or total, acts of nature, work stoppages or other labor disturbances, civil commotion, war, or any other action by governmental agencies,or for any reason beyond the control of City, City shall have the right to terminate this Agreement without penalty. 10. LICENSES AND PERMITS User represents and warrants that it, and any agents, independent contractors, subcontractors, vendors, or others acting on its behalf under or with respect to this Agreement, will at all times during the term of this Agreement have and maintain in force any and all licenses, permits, or approvals required by law for the conduct of User's activities under this Agreement. Page 4 of 9 11. DAMAGE TO FACILITIES User shall be liable for any damage to the Facilities caused by any act of negligence of User, its partners, agents, servants, contractors, representatives, guests, employees, invitees, or customers. City may, at its option, repair such damage, and User agrees to reimburse City for the total cost of repair. 12. PROPERTY BELONGING TO USER City shall not be responsible for lost,stolen,or damages property belonging to User, its partners, agents, servants, contractors, representatives, guests, employees, invitees, or customers. 13. NOTICE Any notice, tender, demand, delivery, or other communication pursuant to this Agreement shall be in writing and directed to the addresses below or such addresses as either party may later specify in writing. Notice is deemed effective on the date it is given if hand-delivered or received by facsimile that day. Notice given by U,S. mail shall be deemed to have been given three (3) business days after it is deposited in the U.S. mail, postage prepaid and addressed as follows: To City: City Clerk City of Santa Ana 20 Civic Center Plaza(M-30) P.O. Box 1988 Santa Ana, California 92702-1988 With copies to: Executive Director of Parks, Recreation and Community Services City of Santa Ana 20 Civic Center Plaza(M-75) P.O. Box 1988 Santa Ana, California 92702 and City Attorney City of Santa Ana 20 Civic Center Plaza(M-29) P.O. Box 1988 Santa Ana, California 92702 To User: SANTIAGO PARK ARCHERS 2542 N. Spurgeon St Santa Ana, California 92706 Page 5 of 9 14. EXCLUSIVITY AND AMENDMENT This Agreement represents the complete and exclusive statement between the City and User regarding the subject matter herein, and supersedes any and all other agreements, oral or written, between the parties regarding the use of the Facilities. 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 User. 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 User 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 are not embodied herein. 15. ASSIGNMENT User 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. User shall not allow any other person or entity to use the Facilities without the prior written consent of City. 16. TERMINATION This Agreement may be terminated by the City upon thirty(30)days written notice. 17. NONDISCRIMINATION User 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. User 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 determined and governed by the laws of the State of California. Both parties further agree that Orange County, California, shall be the venue for any action or proceeding that may be brought or arise out of, in connection with or by reason of this Agreement. Page 6 of 9 19. Al C![ORITY Each undersigned represents and �,�arrants that its signature herein below has the power, authority and right to bind their respective parties to each of the terms of this Agreement. IN WITNESS WHEREOF, the Parties hereto have executed this Agreement the date and year first above written. s+xr ATTEST: °` CITY OF SANTA ANA tt.•+ TZnnifer � ll Alvaro Nunez Citv Cler City Manager APPROVED AS TO FOR,II: SANTIAGO PARK ARCHERS SONIA R. CARVALHO City Attorney lonttthanT. Martinc�'Z Name: Assistant City Attorney Title: ';e5i(a- RECOMMENDED FOR APPROVAL: Hawk Scott f xecutivc Director of Parks, Recreation, And Community Services Agency Pa'e 7 of ) EXHIBIT A t. Use a. Santiago Archery Chub ("User") will have access to the Santiago Park Archery Range ("Range") every Tuesday evening from 6:30 p.m. to 8:30 p.m. b. User will also have the ability to host 2 additional events outside of their standard Tuesday evening use with an attendance of under 40 people. i. User must provide the City with a minimum of 4 weeks advance written notice of the special event. Any requests outside of this 4- week timeframe will be considered but not guaranteed. Any event larger than 40 people must be submitted to the Special Events Office for additional permit approval. These additional events (under 40 people) are covered under this Agreement without additional fees. 2. Equipment a. City Parks Maintenance Division will provide, at its expense, a total of 9 Arrolast target bales. The additional, 91h bale will be installed at a shorter distance for younger participants. b. Purchase of new bales will take place the month following final signatures of this agreement and yearly thereafter. c. Installation and maintenance of bales will be the responsibility of User. I Storage a. User will have access to the on-site building in the southeastern corner of the Range to store targets, equipment, and other maintenance supplies. User shall be permitted only one key to the building and may only access the building during the days/hours as detailed below: i. Per Section l.a., above, every Tuesday evening from 6:00 p.m. until 9:00 P.M. ii. Per Section l.b.,above,for special events upon written confirmation with the City confirming the date(s) and times for said events. iii. Per Section 2.c.,above,for installation and maintenance of the bales described therein, which regularly occurs annually during the first week of January, between the hours of 10:00 a.m.through 2:00 p.m. City and User agree that maintenance schedules may be subject to change, upon written confirmation from the City, to allow for reasonable scheduling changes, including inclement weather. b. User is responsible for keeping its identified storage area clean, accessible, and orderly during the duration of the agreement, so that City Personnel could access the building/area with relative ease. c. User will notify City Parks Maintenance immediately of any building issues, including damage, vandalism, and/or theft at the facility. Page 8 of 9 4. Payment a. User will be charged an annual amount of$1,040.00 payable on the first of the month following execution of this agreement and the anniversary each year thereafter. b. This fee includes the use of the facility contemplated in Section 1, above. c. The fee in Section 4(a), above, will be based on the Group 3 Resident Recreation Rate in the Miscellaneous Fee ,Schedule. [f the Fee Schedule changes, the annual rate will change to match the current adopted Fee Schedule. Page 9 of 9 Sadler Sports:NFAA Insurance Plan DATE(MMI DDl YYYY) "%.— CERTIFICATE OF LIABILITY INSURANCE 09112/2025 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERT$FiCATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOVV.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(1es)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions afthe policy,certain policies may require an endorsement,A statement on this certificate does not confer rights to the certificale holder in lieu of such endorsement(s)- PRODUCER CONTACT NAME:Sports Dept SADLER&COMPANY,INC, PHONE(Al C.No.Ext):800A22-7370 1 FAX(Af C,No):803-256-4017 P.O.BOX 6806 E-MAIL ADDRESS:nlaa@sadlersports.com COLUMBIA,SOUTH CAROLINA 29250-5866 PRODUCER CUSTOMER IDq: INSURED Dl Bf A NATIONAL FIELD ARCHERY ASSOCIATION,INC Santiago Park Archers INSURER(S)AFFORDING COVERAGE NAILA 33901 Golden Lantern Street Apt A INSURER A:Granite Stale Insurance Company 23809 Dana Point,CA 92629 INSURER B:National Union Fire Insurance Company of Pittsburg,PA 19445 INSURERC: Application ID:456747 INSURER D: 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 DESORIBED HEREIN 15 SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSD TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR WVD (MM1 ODf YYYY) (MM1DDr YYYYj A GENERAL LIABILITY X X EACH OCCURRENCE $1.000,000 ®COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES L]CLAIMSMADE ®OCCUR (Ea occurrence) $300,000 Il MEDICAL EXPENSES(olherthan EXCLUDED 07:21AM ET 12:01 AM ET participants) ❑ 9RAIL34503537-01 06l1712025 0G1171202G PERSONAL&ADV INJURY(par $1,000.000 GEN'L AGGREGATE LIMITAPPLIES member club) PER: GENERAL AGGREGATE(per g3,p00.040 event)❑POLICY []PROJECT ❑LQC PRODUCTS-COMP)OF AGO $1.000,400 ®OTHER:Event LEGAL LIAB TO PARTICIPANTS $1.000,00 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT(Ea L]ANY AUTO Accident) L]ALL OWNED AUTOS BODILY INJURY(Per person) L]SCHEDULED AUTOS L]HIRED AUTOS BODILY INJURY(Per accident) NON-OWNED AUTOS PROPERTY DAMAGE(Per accident) L]UMBRELLA LIAB OCCUR EACH OCCURRENCE L]EXCESS LIAB L]CLAIMS-MADE M OEDUCTIBLE AGGREGATE L]RETENTION WORKERS COMPENSATION PER STATUE AND EMPLOYERS'LIABILITY OTHER ANY PROPRIETOR! PARTNER I EXECUTIVE Y1 N E.L.EACH ACCIDENT OFFICER f MEMBER NIA EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EOMPLOYEE If yes.describe under DESCRIPTION OF OPERATIONS helow E.L.DISEASE-POLICY LIMIT g PARTICIPANT ACCIDENT EXCESS MEDICAL $50,000 ($250 Deductible Per Claim) 92AID34501955-03 07:21 AM ET 12:01AM ET 061171202 006/171202fi ADaD sla,aap DESCRIPTION OF OPERATIONS)LOCATIONS I VEHICLES(Attach ACORO 101,Additional Remarks Schedule,may be attached if mare space is required) RECOVERED Notice to PoIlcyholder THIS POLICY IS ISSUED BY YOUR RISK RETENTION GROUP_YOUR RISK RETENTION GROUP MAY NOT BE SUBJECT TO ALL OF THE INSURANCE LAWS AND REGULATIONS OF YOUR STATE.STATE INSURANCE INSOLVENCY GUARANTY FUNDS ARE NOT AVAILABLE FOR YOUR RISK RETENTION GROUP. NOTE:The Participant Accident policy,if included above,is not part of the ERS Risk Purchasing Group Association,Inc. WAIVER OF RIGHT OF RECOVERY:Wewaiver all rights of recovery when you have agreed la waive your rights when required by a written contract.However,this provision only applies dthe wrtllen contract was executed prior In the dare a fthe"occurence Cod holder is named as an additional insured with respects to the operations afthe named insured. CERTIFICATE HOLDER CANCELLATION RELATIONSHIP: SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Property Owner!Lessor DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE(company A) The City of Santa Ana,its officers,officials, employees,and volunteers 20 Civic Center Plaza Santa Ana,CA 92701 Coverage is only extended to U.S.events and activities —NOTICE TO TEXAS INSUREDS_The Insurer for the purchasing group may not be subject to all the insurance Jaws and regulations of the Stale of Texas, ACORD 25(2014101) O 1988-2014 ACORD CORPORATION.All rights reserved. The ACORD name and logo are registered marks of ACORD Tu Tran 03g°zlip sl9^ed by T,i T e APPROVED e9i+Yt Date'202i,n9,17 Nguye 1 .r3m,c-ora0' By Tu Tran Nguyen at 2:33 pm,Sep 17,2025 Sadler Sports:NFAA Insurance Plan ISO I Commercial General Liability Forms 107101104 POLICY NUMBER:9RAIL34603637-01 COMMERCIAL GENERAL LIABILITY INSURED:Santiago Park Archers CG 20 26 0413 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 1.Name of Additional Insured Person(s)or Organizations(s): The City of Santa Ana,Its officers,officials,employees,and volunteers 20 Civic Center Plaza Santa Ana,CA 92701 (information required to complete this Schedule,if not shown above,will be shown in the Declarations.) A.Section II-Who is An Insured is amended to include as an B.With respect to the insurance afforded to these additional additional insured the person(s)or organization(s)shown In the insureds,the following is added to Section III-Limits Of Insurance: Schedule,but only with respect to liability for"bodily Injury","property damage"or"personal and advertising injury"caused,in whole or in If coverage provided to the additional insured is required by a part,by your acts or omissions or the acts or omissions of those contract or agreement,the most we will pay on behalf of the acting on your behalf: additional Insured is the amount of insurance: 1.In the performance of your ongoing operations;or 1.Required by the contract or agreement;or 2.In connection with your premises owned by or rented to you. 2.Available under the applicable Limits of Insurance shown in the Declarations; However: whichever is less. 1.The insurance afforded to such additional insured only applies to the extent permitted by law;and This endorsement shall not increase the applicable Limits of 2.If coverage provided to the additional insured is required by a Insurance shown in the Declarations. contract or agreement,the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. Date Added:06/17/2025 07:21:56 AM CG 20 26 04 13 Page 1 of 7 Copyright.Insurance Services Office,Inc.,2012 ENDORSEMENT THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement, effective 12:01 A.M.: 01/01/2025 Forms a part of Policy No.: AIL0003450353701 AMENDMENT OF LIMITS -- INSURED MEMBER This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM The Limits of Insurance shown in the Supplemental Declarations, or wherever they may appear, apply separately to each "insured member." With respect to this endorsement, "insured member" means the entity or entities indicated below by an "x"in the box for which premium has been paid for coverage under this policy: ® First Named Insured ® Club ❑ Team ❑ Concessionaire ❑ League ❑ Association ❑ Vendor ❑ Instructor ❑ Organization ❑ Exhibitor ❑ Other(describe here): However, the Limits of Insurance do not apply separately to the following: a. The individual persons, subsidiaries, affiliates or other entities that area part of the"insured member'when the "insured member" is not an individual }person; or b. Any person, subsidiary, affiliate or other entity that qualifies as an insured or an additional insured under this policy that is not an "insured member." All other terms and conditions of the policy remain the same. Authorized Representative 128492(11-21) Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 1 with its permission. ENDORSEMENT THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement, effective 12:01 A.M.; 01/01/2025 Forms a part of Policy No.: AIL0003450353701 COMMERCIAL GENERAL LIABILITY BROADENED COVERAGE ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM A. SECTION I - COVERAGES, COVERAGE A - BODILY INJURY AND PROPERTY DAMAGE LIABILITY, subsection 2. Exclusions, paragraph a. is replaced by: a. Expected or Intended Injury "Bodily injury"or"property damage" expected or intended from the standpoint of the insured. This exclusion does not apply to"bodily injury"or"property damage" resulting from the use of reasonable force to protect persons or property, B. SECTION I - COVERAGES, COVERAGE A - BODILY INJURY AND PROPERTY DAMAGE LIABILITY, subsection 2. Exclusions, paragraph g.(2) is replaced by: (2) A watercraft you do not own that is: (a) Less than fifty-one (51)feet long; and (b) Not being used to carry persons or property for a charge; C. SECTION I - COVERAGES, COVERAGE B - PERSONAL AND ADVERTISING INJURY LIABILITY, subsection 2. Exclusions, paragraphs b. and c. are replaced by: b. Material Published With Knowledge of Falsity "Personal and advertising injury" arising out of publication of material, including, but not limited to, oral, written, televised, videotaped or electronically transmitted publication of material, if done at the direction of the insured with knowledge of its falsity. c. Material Published Prior To Policy Period "Personal and advertising injury" arising out of publication of material, including, but not limited to, oral, written, televised, videotaped or electronically transmitted publication of material, whose first publication took place before the beginning of the policy period. D. SUPPLEMENTARY PAYMENTS -COVERAGES A AND B, paragraphs Il.b. and 'I.d. are replaced by: b. Up to $1,000 for the cost of bail bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverage.applies. We do not have to furnish these bonds. d. All reasonable expenses incurred by the insured at our request to assist us in the investigation or defense of the claim or"suit," including actual loss of earnings up to$500 a day because of time off from work. E. SECTION II -WHO IS AN INSURED, paragraph 3.a. is replaced by: i a. Coverage under this provision is afforded only until the one hundred eightieth (180th)day after you acquire or form the organization or the end of the policy period, whichever is earlier; F. The following are added to SECTION IV-COMMERCIAL GENERAL LIABILITY CONDITIONS, paragraph 2. Duties In The Event of Occurrence, Offense, Claim Or Suit: i e. Knowledge of the "occurrence," offense, claim or "suit" by the agent, servant, or "employee" of an insured shall not in itself constitute your knowledge unless one of your officers, manager or partners has received notice of the "occurrence," offense, claim or"suit." 128497(11121) includes copyrighted material of Insurance Services Office, Inc., Page 1 of 3 with its permission. f. Failure by the agent, servant or"employee"of an insured (other than an officer, manager or partner) to notify us of an "occurrence" shall not constitute a failure to comply with paragraphs a. and b. of this condition. G. The following is added to SECTION IV-COMMERCIAL GENERAL LIABILITY CONDITIONS: Unintentional Error or Omission Any unintentional error or omission in the description of or failure to completely describe, any premises or operations intended to be covered by this Coverage Part will not invalidate or affect coverage for those premises or operations. However, you must report such error or omission to us as soon as practicable after its discovery. H. The following is added to SECTION IV—COMMERCIAL GENERAL LIABILITY CONDITIONS, paragraph 8.Transfer of Rights of Recovery Against Others to Us: Waiver of Transfer of Rights of Recovery Against Others to Us (Waiver of Subrogation) -Automatic We waive any right of recovery against any person or organization, because of any payment we make under this Coverage Part, to whom the insured has waived it right of recovery in a written contract or agreement. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person or organization prior to loss, I. With respect to this endorsement, SECTION V-DEFINITIONS, paragraphs 3.and 14. are replaced by: 3. "Bodily injury"means bodily injury,sickness or disease sustained by a person.This includes mental anguish,mental injury, shock, fright, humiliation, emotional distress or death resulting from bodily injury, sickness or disease. 14, "Personal and advertising injury" means injury, including consequential "bodily injury," arising out of one or more of the following offenses: a. False arrest, detention or imprisonment; b. Malicious prosecution or abuse of process; c. The wrongful eviction from, wrongful entry into, or invasion of the right of private occupancy of a room, dwelling or premises that a person occupies, committed by or on behalf of its owner, landlord or lessor; d. Any publication of material including, but not limited to oral, written, televised, videotaped or electronically transmitted publication of material that slanders or libels a person or organization or disparages a person's or organization's goods, products or services; e. Any publication of material, including but not limited to oral, written, televised, videotaped or electronically transmitted publication of material that violates a person's right of privacy; f. The use of another's advertising idea in your"advertisement'; or g. Infringing upon another's copyright, trade dress or slogan in your"advertisement". J. Broadened Coverage—Damage to Premises Rented to You 1. The word fire is replaced with the phrase fire or explosion where it appears in: a. SECTION I - COVERAGES, COVERAGE A - BODILY INJURY AND PROPERTY DAMAGE LIABILITY, subsection 2. Exclusions, paragraph j. Damage to Property; b. SECTION I - COVERAGES, COVERAGE A - BODILY INJURY AND PROPERTY DAMAGE LIABILITY, subsection 2. Exclusions, last paragraph; c. SECTION III -LIMITS OF INSURANCE, subsection 6.; and d. SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, subsection 4. Other Insurance, paragraph b.(1)(a)(ii). 128497(11/21) Includes copyrighted material of Insurance Services Office, Inc., Page 2 of 3 with its permission. CITY OF SANTA ANA Risk Management a division of Human Resources b s Managing Risk through Awareness and Action AFFIDAVIT OF EXEMPTION FOR WORKERS' COMPENSATION INSURANCE l Samuel Sanchez Re resentative(" p "),attest that I am an authorized (Name and Title of Vendor Representative) santiago park archers representative of ("Company"), and (Consultant/Company Name) possess the authority to legally bind Company. In my capacity as Representative of Company, I represent and confirm the following, as relates to the agreement between Company and City of Santa Ana, agreement number ("Agreement")to provide facility use agreement for park archery range ("Services"): (Services to be provided under agreement/contract) 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. 8128/25 Signature Date Samuel Sanchez Print Name Vice-President Title (949) 300-9989 , ssanchezg@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