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HomeMy WebLinkAboutPINEAULT, GABRIELA (2) INSUfiANCE ON FILE WORK ttOAYI11rrPRnf EFr; �[ UIV�IL�7�SV71 t !'R A 0 -5-12 02S_-_,_- ]v-Za2s-Zs4 CITY CLERK DATE; OCT 2 1 2025 y Q: htbwtj (M October 14, 2025 Gabriela Pineault("Speaker/Performer") 20104 Pintado Irvine, CA 92618 Re: Speaker/Performer En ag gement Agreement This letter represents your agreement with the City of Santa Ana ("City") as entered into on the above date for the engagement described below: 1. Event Description: Traditional Aztec performance during Celebrando Dia de los Muertos Event. See Exhibit A, attached hereto and incorporated herein,for more details. 2. Date(s): October 25,2025 3. Event Time(s): 10:00 - 11:00 am 4. Location: Delhi Library, 505 E. Central St., Santa Ana, 92704, Santa Ana("Property") 5. Compensation: Not to exceed $1,200.00 (payable by check within 30 calendar days of event); Speaker/Performer must provide IRS form W-9 before payment can be made. 6. Equipment provided by City: Speakers and Microphone 7. Equipment provided by Speaker/Performer: All equipment necessary,including without limitations laptop/music. 8. City Contact Person(for coordinating purposes only): Dylan Dario 9. Independent Contractor: Speaker/Performer shall, during the entire term of this Agreement,be construed to be an independent contractor and not an employee of the City. This Agreement is not intended nor shall it be construed to create an employer-employee relationship, a joint venture relationship,or to allow the City to exercise discretion or control over the professional manner in which Speaker/Performer performs the services that are the subject matter of this Agreement; however, the services to be provided by Speaker/Performer shall be provided in a manner consistent with all applicable standards and regulations. Speaker/Performer 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. 10. Indemnification: Speaker/Performer,his or her agents, or employees (if applicable)agrees to and shall indemnify, defend,and hold harmless the City,its officers,agents,employees,consultants,special counsel,and representatives from and against all loss, expenses, or liability(including costs and attorney's fees)arising from the negligence or willful misconduct of Speaker/Performer,his or her agents, or employees. 11. Release: Speaker/Performer accepts the Property and any City-provided equipment used in connection with the performance in their "as-is" condition, with all faults. Speaker/Performer fully releases, waives and discharges forever any and all claims, demands, rights, and causes of action of any kind or nature against, and covenants not to sue,City,its elected officials,officers,employees,agents and volunteers,and all persons acting on behalf of,by, through or under each of them, under any present or future laws, statutes, or regulations for any claim or event relating to the condition of the Property or City-provided equipment or Speaker/Performer's use thereof. Speaker/Performer Agreement—Gabricla Pincault Page 2 12. Insurance Requirements are attached hereto and incorporated herein as Exhibit B. 13. The City shall have the right and royalty-free Iicense to simulcast or produce and show a tape-delayed broadcast of Speaker/Performer's presentation to the City community or general public, through webcast or any other means. This license shall be non-exclusive and the copyright shall remain with the Speaker/Performer. Copies of Speaker/Performer's presentation may be maintained by the City, and Speaker/Performer consents to use of such recordings. 14. Speaker/Performer is solely responsible for payment of royalty fees,performance fees,or similar fees that may be required by unions or similar organizations. Speaker/Performer shall indemnify the City against any liability or damages, including attorney's fees,that may arise as a result of violation by Speaker/Performer of copyright laws. 15. Speaker/Performer shall not discriminate because of race, color, creed, religion, sex, marital status, sexual orientation, age, national origin, ancestry, disability, or any other basis protected by applicable law in connection with any activities related to this Agreement. 16. This Agreement shall in all respects shall be interpreted,enforced,and governed exclusively by and under the laws of the state of California. Both parties 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. 17. This Agreement represents the complete and exclusive statement between the City and Speaker/Performer regarding the subject matter herein and supersedes any and all other agreements, oral or written, between the parties. This Agreement may not be modified except by written instrument signed by the City and by an authorized representative of Speaker/Performer. CITY OX SANTA 14A SPEAKER/PERFORMER Gah-rela Aim& GIb'111a P1111111101116. 1a 14n].Poi) ALVARO NUNEZ GABRIELA PINEAULT City Manager Owner ATTEST: APPROVED AS TO FORM: ,5 3A� 4` '1 1 ,r.,a{� By: JENNI . 14 L NATHAN T.MA INEZ City Cle Assistant City Attorney RECOMMENDED FOR APPROVAL: Aon1l,:oss0.l won BRIAN STERNBERG Executive Director, Library Services Agency Speaker/Performer Agreement—Gabriela Pineault Page 3 Exhibit A SCOPE OF SERVICES SPEAKER/PERFORMER INFORMATION: Name: Gabriela Pineault Address: 20104 Pintado,Irvine,CA 92618 Phone Number: 951.642.1867 Email Address: folkloremexicano nail.com EVENT: Celebrando Dia de Ios Muertos LOCATION: Delhi Library, 505 E. Central St. Santa Ana, Ca. 92704 TERM: One-time event: Saturday, October 25,2025 COMPENSATION: Not to exceed$1,200.00 DESCRIPTION: Della Library will be celebrating Day of the Dead with a spectacular Aztec dance performance by Gabriela Pineault and her dance group Leyenda Ballet Folklorico/Folklore Mexicano. The presentation will be conducted in person. It will be hosted by Brissa Petrey,Librarian for the Adult Services at the Delhi Public Library The presentation is free and anyone can attend.It will take place one time on Saturday,October 25,2025 from 10-11 a.m. Speaker/Performer will be compensated$1,200.00 for the presentation. Speaker/Performer Agreement--Gabriela Pineault Page 4 EXHIBIT B INSURANCE REQUIREMENTS Speaker/Performer shall procure and maintain for the duration of the agreement,the following insurance coverages: MINIMUM SCOPE AND LIMIT OF INSURANCE Speaker/Performer 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 Speaker/Performer 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. If Speaker/Performer 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 Speaker/Performer. 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 Speaker/Perfonner including materials, parts, equipment, and personnel furnished in connection with such work or operations. 2. CGL and AL 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 Speaker/Performer for City. 3. All required insurance policies:For any claims related to this contract,Speaker/Performer'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. 4. All required insurance policies: A severability of interest provision must apply for all the additional insureds, ensuring that Speaker/Performer'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 notice shall be provided to City for policy cancellation or non-renewal due to non-payment. 6. Certificate Holder on each Evidence of Insurance certificate shall be: City of Santa Ana Attention: Library Services, Dylan Dario 20 Civic Center Plaza, M-42 Santa Ana, CA 92701. The name and 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 Speaker/Performer 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 Speaker/Performer Agreement—Gabrieia Pineault Page 5 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 Speaker/Performer 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 Speaker/Performer'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: 1. The retroactive date must be shown and must be before the date of the contract or the beginning of work. 2.Insurance must be maintained and evidence of insurance must be provided for at least three(3)years after completion of work. 3. 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, Speaker/Performer must purchase"extended reporting"coverage for a minimum of three(3)years after completion of work. Subcontractors Speaker/Performer shall require and verify that all sub-contractors maintain insurance meeting all the requirements stated herein, and Speaker/Performer 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, i i4 Gabriela Pineault- Speaker-Performer Agreement - unsigned Final Audit Report 2025-10-16 Created: 2025-10-15 By: Dylan Dario(ddario@santa-ana.org) Status: Signed Transaction ID: CBJCHBCAABAAFrocb_o-zx5OdlKrk6xvgyCnJinNxdly "Gabriela Pineault- Speaker-Performer Agreement - unsigned" H istory "J Document created by Dylan Dario (ddario@Santa-ana.org) 2025-10-15-3:06:43 PM GMT o- Document emailed to Brian Sternberg (bsternberg@santa-ana.org)for signature 2025-10-15-3:06:47 PM GMT in Email viewed by Brian Sternberg (bsternberg@santa-ana.org) 2025-10-15-4:31:03 PM GMT d4 Document e-signed by Brian Sternberg (bsternberg@Santa-ana.org) Signature Date:2025-10-15-4:31:36 PM GMT-Time Source:server c Document emailed to Gabriela Pineault (folkloremexicano@gmail.com)for signature 2025-10-15-4:31:38 PM GMT Email viewed by Gabriela Pineault (folkloremexicano@gmail.com) 2025-10-16-5:18:13 PM GMT do Document e-signed by Gabriela Pineault(folkloremexicano@gmail.com) Signature Date:2025-10-16-5:19:03 PM GMT-Time Source:server Q Agreement completed. 2025-10-16-5:19:03 PM GMT Adobe Acrobat Sign SPECIAL EVENT LIABILITY GROUP INSURANCE TRUST DATE CERTIFICATE OF INSURANCE ENDORSEMENT 10/10/2025 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE ENDORSEMENT DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. PRODUCER: SPECIAL EVENT INSURANCE DEPARTMENT CONTACT INFORMATION: HUB International Insurance Services Inc. PHONE 9256096547 F AX 9256096550 3000 Executive Parkway,Suite 300 EMAIL sDecialevent(a)hubinternational com San Ramon,CA 94583 INSURER(S)AFFORDING COVERAGE NAIC# CA License#0757776 INSURER A: Colony Insurance Company 39993 NAMED INSURED: Gabriela Pineault 616 Cantor Irvine,CA 92618 COVERAGES This is to certify that the policies of insurance listed below have been issued to the insured named above for the event date(s)indicated below. Notwithstanding any requirement,term o 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. INSURED MEMBER INSR TYPE OF INSURANCE ENDORSEMENT COVERAGE EFFECTIVE 1 LIMITS LFR NUMBER EXPIRATION DATE A GENERAL LIABILITY EACHOCCURRENCE $2,000,000 X COMMERCIAL GENERAL LIABILITY 51616 10/25/2025 DAMAGE TO RENTED PREMISES $1,000,000 (Ea acwrsencey CLAIMS-MADE OCCURRENCE MEDEXP(Anynneper ) $5,000 PERSONAL B ADV INJURY $2,000,000 GENERAL AGGREGATE $4,000,000 PRODUCTS-COMKOP AGG $4,000,000 LIQUOR LIABILITY PER OCCURRENCE(AGGREGATE I NCLLJCED IN GENERAL LIABILITY NIA AGGREGATE) MASTER POLICY#103 GL 0021111 -EFFECTIVE DATE 11112025;EXPIRATION 1/1/2026 DESCRIPTION OF OPERATIONS!LOCATIONS City of Santa Ana,its City Council,its officers,officials,employees,agents and volunteers,20 Civic Center Plaza,Santa Ana,CA 92701 Ware included as an additional insuredis)per attached endorsement T5409.0118,Policy is Primary and Non-contributing per attached endorsement T1095-0108;Waiver of Subrogation applies per attached endorsement CG 24 04 05 09. Event Type: Performer Event date(s): 1 012 5/2 0 2 5 CERTIFICATE HOLDER APPROVED CANCELLATION By Tu Tran Nguyen at 1:18 pm,Oct 96,2025 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Santa Ana RMD approval only due to ACCORDANCE WITH THE POLICY PROVISIONS. Attention:Library Services,Dylan Dario Director's decision to waive AUTHORIZED REPRESENTATIVE 20 Civic Center Plaza,M-42 certain requirements Santa Ana,CA 92701 Dig y TitallyuT r a signedn Tu Tran b Nguyen I127:07-07'00' POLICY#103 GL 0021111 COMMERCIAL GENERAL LIABILITY T5409-0118 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 Named of Additional Insured Person(s)or Organization(s) City of Santa Ana, its City Council,its officers,officials,employees,agents 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. Section II - Who Is An Insured is amended to include as additional insured the person(s) or organization(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 omissions 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. T5409-0118 ©ISO Properties,Inc.,2004 Page 1 of I POLICY#103 GL 0021111 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NON-CONTRIBUTING INSURANCE (Third-Party) This endorsement modifies insurance under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS, 4. Other Insurance, and all subparts thereof, as contained in the policy is deleted in its entirety and replaced with the following condition as respects the Third Party shown below: 4. Other Insurance a. With respect to the Third Party shown below, the insurance provided by this policy shall be primary and non-contributing insurance. Any and all other valid and collectible insurance available to such Third Party in respect of operations performed by you under written contractual agreements with said Third party for a loss covered by this policy, shall in no instance be considered as primary, co-insurance, or contributing insurance. Rather, any such other insurance shall be considered excess over and above the insurance provided by this policy. Third Party to whom this endorsement applies is: City of Santa Ana.its City Council,its officers officials,employees, accents and volunteers.20 Civic Center Plaza Santa Ana,CA 92701 Absence of a specifically named Third Party above means that the provisions of this endorsement apply as required by written contractual agreement with any Third Party for whom you are performing operations. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. T1095-0108 Includes Copyrighted material of ISO Properties,Inc.with its permission. Page 1 of 1 POLICY 4103 GL 0021111 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: Any person or organization to whom or to which you are obligated by virtue of a written contract to waive your right of recovery. 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 contact with that person or organization and included in the "products-completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. CG 24 04 05 09 Contains material copyright,Insurance Services Office,Inc.,with its permission. Page 1 of I Get your digital proof of insurance & membership card on the AAA App »)Download the app. Glick AAA.com/app75 Eledroilla proof of insurance may not be vulid as proof in all slates.Please keep your hard eapywrsiar on hand.Mod be a ounenlAAA member and insured through AAA louse this feature.Avallabte for WhoneG and smartphones for Android'"'.Message,data and roaming roles may apply, ---------------------------------------------------------------------------------------------------------------------i I California Evidence of Liability Insurance VEHICLES ON POLICY 80s"N's Interinsurance Exchange of the Automobile Club YEAR MAKE VEH I.D.# ' NAIC#:15598 2007 TYTA CAMRY CE.ILE/XLEISE JTNBE46K973029673 2020 VLVO S90 LW B T6 MOMENTUM LVYA22MK8LP176773 Named Insured Policy Number:CAA131761142 GABRIELA PINEAULT I I ' W I ' w � z ' o DRIVERS ON POLICY 2 PINEAULT,GABRIELA C r Effective Date:08/25/2025 Expiration Date:08/25/2026 I ' I ' I ' This policy complies with Sections 16056 or 16500.5 of the California Vehicle Code,Coverage subject to policy terms and limits. I ----—---------—---------—--------------------- ------ - --------—------------------- ----- IF YOU HAVE AN ACCIDENT CALL OUR 2417 AAA CLAIMS HOTLINE 1-800-672-5246 I I After an accident,exchange Information with the other party and follow these 5 easy steps: r ' I Step 1: Pull vehicle over to a safe place.Get the names,addresses, Step 4: Take photos of the vehicles involved,damages and and phone numbers of all persons involved in the accident,e.g., surrounding area of the accident,if it is safe to do so. j pedestrians,witnesses,other passengers,etc. W i z Step 5: Call our AAA Claims Hotline at 800-672-5246 to report the ; Step 2: Take photos of or write down the other person's driver's o loss.If necessary,we will arrange to have your vehicle towed.Our license Information and other vehicle's license plate number, W provider's tow trucks always display the AAA emblem. I including state of registration. I r Do not admit responsibility for or discuss the circumstances of the accident Step 3: Take photos of or write down the other person's insurance with anyone other than the police or an authorized Auto Club claims card information. representative.Do not disclose your policy limits to anyone. i For questions or changes to your policy,call 1-877-422-2100,Monday through Friday from 7 a.m.to 9 p.m,or Saturday from 8 a.m.to 5 p.m. L-------------------------------------------------------------------------------------------------- r------------------ Evidence of financial responsibility shall at all times be carried in the vehicle. In addition,we suggest that each listed driver carry a card.Linder California law,drivers and owners of a motor vehicle must be able to Call our AAA Claims show proof of financial responsibility at all times. Insurance information has already been submitted Hotline of -800-672-5246 directly to the DMV electronically, submit this document to DMV only if specifically requested by DMV. These cards become invalid and should be destroyed on the expiration or termination date of the policy. ----------------------------------------------------------------.------------------------------------�__------------� California Evidence of Liability Insurance VEHICLES ON POLICY saInterinsurance Exchange of the Automobile Club YEAR MAKE VEH I.D.NAIC#:15598 2007 TYTA CAMRY CEtLEIXLEISE JTNBE46K973029673 2020 VLVO 890 LWB T6 MOMENTUM LVYA22MKBLP176773 Named Insured Policy Number:CAA131761142 GABRIELA PINEAULT r W ' r W ' , � I ' = I d DRIVERS ON POLICY 0 PINEAULT,GA13RIELA C Effective Date:08/25/2025 Expiration Date:08/25/2026 I I I This policy complies with Sections 16056 or 16500.5 of the California ' Vehicle Code.Coverage subject to policy terms and limits. ._-R—-------......-...,.,....................., ---..........n—----------------- __ _----......—-------—------- .... i IF YOU HAVE AN ACCID N'r CALL OUR 2417 AAA CLAIMS HOTLINE 1-800-672-5246 i t i After an accident,exchange information with the other party and ; follow these 5 easy steps: ; r ' Step 1: Pull vehicle over to a safe place.Gel the names,addresses, Step 4: Take photos of the vehicles involved,damages and I and phone numbers of all persons involved in the accident,e.g., surrounding area of the accident,if it is safe to do so. ' pedestrians,witnesses,other passengers,etc. w i Step 5: Call our AAA Claims Hotline at 800-672-5246 to report the Step 2: Take photos of or write down the other person's driver's loss.If necessary,we will arrange to have your vehicle towed.Our license information and other vehicle's license plate number, o provider's tow trucks always display the AAA emblem. 1 I Including state of registration. I I Do not admit responsibility for ordiscuss the circumstances of the accident Step 3: Take photos of or write down the other person's insurance with anyone other than the police or an authorized Auto Club claims card information. representative.Do not disclose your policy limits to anyone. 1 � I For questions or changes to your policy,call 1-877-422-2100,Monday through Friday from 7 a.m.to 9 p.m.or Saturday from 8 a.m.to 5 p.m. ---------------------------------- -------- -------------------- ' 1��5U91 8165(10124) CERTIFICATE OF INSURANCE ENDORSEMENT SPECIAL EVENT LIABILITY GROUP INSURANCE TRUST,A RISK PURCHASING GROUP Certificate# 51616 FACILITY OWNER-Additional Insured:(if multiple,continued PRODUCER: CA License#0757776 on next page) HUB International Insurance Services Inc. City of Santa Ana,its City Council, its officers,officials,employees, 3000 Executive Parkway,Suite 300 agents and volunteers,20 Civic Center Plaza, Santa Ana,CA 92701 San Ramon,CA 94583 PH:925 609 6547 FX:925 609 6550 s ecialevent hubinternationaLGom EVENT HOLDER-Named Insured:(if multiple,continued on EVENT INFORMATION next page) Gabriela Pineault TYPE OF EVENT: Performer 616 Cantor EVENT DATE(S): 10/2512025 Irvine,CA 92618 EVENT LOCATION($); Delhi Library-505 E.Central St.Santa Ana,CA 92704 This is to certify that the policies of insurance listed below have been issued to the insured named above for the event date(s)indicated above. 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. INSURER A: COLONY INSURANCE COMPANY INSR LTR Type of Insurance Policy Number Effective Expiration Policy Limits Each Occurrence $2,000,000 General Aggregate $4,000,000 Personal&Advertising Injury $2,000,000 Products/Completed Operations $4,000,000 Commercial Aggregate General Liability 103 GL 0021111 11112025 11112026 Damage to Premises Rented to You $1,000,000 Medical Payments $5,000 Liquor Liability Each Occurrence (Aggregate included In General NIA Liability Aggregate) COVERAGE TERMS: Occurrence Farm(CG 0001) The coverage afforded by this insurance is primary and non-contributing with any Host Liquor liability Included. insurance held by the "Additional Insured" as Named Insured,when the "Additional Insured" is shown on this Certificate of Insurance Endorsement as "Additional Insured" Full Liquor Liability Included when a or WHEN REQUIRED BY WRITTEN CONTRACT. separate premium has been charged. COVERAGE EXCLUSIONS:(REFER TO POLICY FOR COMPLETE LISTING OF EXCLUSIONS) Communicable Diseases Specific Events are excluded from coverage. Please see second page for list of excluded events. --Sexual Abuse$Molestation Terrorism On behalf of the Risk Purchasing Group and each Member,the Trustee has declined coverage for the Terrorism Risk Insurance Act(TRIA). Additional Insureds,next page Second Page of Certificate Certificate# 51616 OTHER ADDITIONAL INSUREDS: 1 2 3 4 5 6 7 8 9 10 11 12 13 CANCELLATION: Should the above described policy(s)be canceled before the expiration date thereof,the issuing company MY endeavor to mail 30 days written notice to the insured event holder and additional Insureds listed. �] AUTHORIZED REPRESEMTATIVE= �/ ,,,_._�.�, DATE ISSUED: 10110/2025 Third Page of Certificate Certificate# 51616 SPECIFIC EVENT EXCLUSIONS The following types of events are specifically excluded and no coverage for them exists on the policies listed on the front page of this Certificate of Insurance: Aircraft 1 Aviation All Terrain Boarding Ballooning 1 Balloon Rides Base Jumping Bouldering Events Boxing,Wrestling Bungee Jumping Carnival Rides Circuses Concerts with single performances exceeding 6 hours of performance time Contact Karate I Martial Arts Contact Sports Diving Football(except passing camps with no contact drills) Hang Gliding Hockey Jousting Kayaking, Rafting or Canoeing in greater than Class 3 rapids Lacrosse 1 Rugby Mechanical Amusement Rides or Services and Gyroscope Rides Motorized Sporting Equipment Mosh Pits Mountain Biking Power Boat Racing Professional Sporting Activity; Games, Races, Contests of a professional nature Pyrotechnics 1 Explosives Rap or Heavy Metal Concerts Raves Rock Climbing, Climbing Wall Rodeo I Roping Events(includes practice) Scuba Diving Tractor 1 Truck Pulls Zip Line 1 Zip Lining i