HomeMy WebLinkAboutHURLEY, PATRICK (3) N-2026-113
SAY 1 82�26
,�:p�snt�} RECREATION SERVICES AGREEMENT WITH
p2sti nee Sor trAVI o CO") PATRICK HURLEY FOR GUITAR LESSONS
THIS AGREEMENT is made and entered into on this 7"' day of May, 2026 by and
between Patrick Hurley, an individual("Provider"), 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 Provider maybe collectively referred to as the"Parties"
or individually as a"Party."
RECITALS
A. The City desires to retain a recreation service provider having special skills,resources and
knowledge to provide basic guitar lessons 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 it is
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 COV1D-19 guidance and restrictions.
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. Provider shall not attend a class or teach any class if Provider is sick or has any
symptom(s)associated with COVID-19 including but not limited to,fever above 100.4,
chills, cough, shortness of breath, loss of taste or smell, nausea, muscle or body aches,
vomiting, headache, sore throat or diarrhea.
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d, Provider will not attend class or teach a class if Provider or any member of Provider's
household has been asked to quarantine or self-isolate due to symptoms of COVID-19
or a positive test result for COVID-19.
e. Provider acknowledges that, to the extent that City is able to and chooses to conduct
classes indoors, this Agreement will also cover classes conducted at one of City's
recreational centers during the term of this Agreement,
f. City reserves the right to change the location(s) at which the services contemplated by
this Agreement are provided.
g. Provider shall comply with the City's recreation class policy manual and any other City
rules and regulations regarding the operation,of recreation classes.
2. COMP>EINSATION
a, In consideration for the provision of the programs set forth in E,xhibit 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 Ten Thousand Dollars and Zero cents
($10,000).
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.
Provider agrees that City shall retain thirty percent(30%) of all gross revenue received
from program participants as an administrative fee.
3. TERM
This Agreement shall commence on July 1, 2026 and end on. June, 30, 2027 unless
terminated earlier in accordance with Section 14 below. The term of this Agreement may be
extended for up to one(1) one-yeas period upon a writing executed by the City Manager and 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 the
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
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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.
5. INSURANCE
Insurance requirements attached hereto as Exhibit B.
6. INDEMNIFICATION
Provider agrees to and shall
gr l all indemnify, defend and hold harmless the City, its officers,
agents,employees,consultants,special counsel,and representatives from liability: (1)for personal I
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, agents,employees, or other
persons acting on their behalf which .relates to the services described in section I of this
Agreement; and(Z) from any claim that personal injury, damages,just compensation,restitution,
judicial or equitable relief is due by reason of the teens 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 infonunation 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 information, but also information transferred orally, visually, electronically, or by G
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
rightflA 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.
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B. COVID-1.9 ASSU'MPTION 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-1 9,.some people have become seriously
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
a. 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.
b. No immediate family members of either the Mayor, City Council Member, or any
,appointed City Official, including appointed board and commission members, as
defined under the Citp's Municipal Code,whose position with the City shall award or
influence the award of this Agreement, or any competing contract or amendment
thereof, shall be employed in any capacity by the Provider or have any other direct or
indirect financial benefit-or interest in this Agreement.
c. The section also prohibits the awarding of any agreement, contract, grant, or any
amendment to those awards, to any former full-time employee for one-year from date
of employee separation except for any Ca1PERS retiree as authorized by City Council
resolution
d. Provider must comply with all conflict of interest laws, ordinances, and regulations
now in effect or hereafter to be enacted during the term of this Agreement.The Provider
warrants that it is not now aware of any facts which conflict with the prohibitions
defined above. If Provider hereafter becomes aware of any facts that might reasonably
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be expected to create a conflict of interest, it must immediately make full written
disclosure of such facts to the City. Full written disclosure must include, but is not
limited to, identification of all persons implicated and a complete description of all
relevant circumstances.Failure to comply with the provisions of this paragraph will be
a material breach of this Agreement.
e. Provider covenants that none of its directors, officers, employees, or agents shall
participate in selecting or administrating any subcontract supported(in whole or in part)
by City fiends stemming from the Agreement where the awarding of the subcontract
has any direct or indirect financial benefit or interest to any individual, as defined in
subsections (b) and (c) above,
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 assign 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
sexuaI.based crime, have a conviction for a violent felony as defined in California Penal Code
Section 667.5(e), 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, 190-190A and 192(a), 205, 206,
207-209.5, 211, 21-2, 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
f
An notice tender,demand delive
ry,cry, 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 f
the manner provided in this Section, to the following persons:
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
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With copy to: Executive Director of 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) 57.1-4211
To Provider: Patrick.Hurley
14920 Minneola Ct.
Tustin, CA 92780
llesoaul97 i c aot.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 snail,
communication shall be effective or deemed to have been given three (3) days alter 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 tennis of this Agreement and
any attachments hereto, the terms of this Agreement shall prevail. This Agreement niay not be
modified except by written instrument sigmed 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, 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.
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14. TERMINATION
a. This Agreement may be terminated by the City upon thirty(30) days written notice of
termination.
b. Termination or cancellation of classes by the Provider must be given to the City, in
writing, 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.
15. 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.
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16. 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.
17. JMSDICTION--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.
18. 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 governmental agencies.
19. SEVERABILITV
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
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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.
20. EXHIBITS
All Exhibits referenced herein and attached hereto shall be incorporated as if fully set forth
in the body of this Agreement.
21. 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.
IN WITNESS WHEREOF, the Parties hereto have executed this Agreement the date and
year first above written.
ATTEST: CITE' O ANTA A
1-44,0
4
Y'
ni er L. Il "'-A Alvaro Nunez
City Clerk , City Manager
APPROVE FORM:
SONIA R. CARVALHO PROVIDER:.
City Attorney
�r
Patrick Hurlf (May 12,2026 10:01:57 PDT)
Jonathan T, Martinez Patrick Hurley
Assistant City Attorney
RECOMMENDED FOR APPROVAL:
4Hawk Scott
Exec ' erector of Parks,
Recreation and Community Services Agency
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EXH-MI .'A.
SCOPE OF SERVICES
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SCOPE OF SERVICES
Program Overview:
This Scope of Services outlines the responsibilities and expectations for engagement of
Provider(or "Instructor') to provide guitar classes for ages 9 years and older at City recreation
facilities and parks, as defined below. The aim is to promote musical art and wellness in the
community by offering affordable recreation opportunities that encourage creative activity and
teamwork.
A. Program and Class Offerings-
I. Seasonal programs and class offerings may include, but are not limited to the
following class options:
1. Basic Guitar
ii. Instructor 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. i
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).
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lil. Class Size
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1. 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.
ii. Class ratio of participants to instructor(s)will be setfor each classto ensure
effective instruction and safety based on statewide standards.
iii. 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 Instructor, that
the class shall be cancelled. Instructor will be under no obligation to
provide services for the cancelled classes, and the City will have no further
obligations to-pay Instructor compensation for the remaining classes that
were cancelled in that session.
iv. Class Pees
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1. Class pricing is dependent on session length per season and subject to
City staff approval. Class pricing is limited to no more than a 6% increase
annually.
ii. Each participant shall pay class registration fees as established by City.
Instructor may not waive class participation/registration fees. Only i
registered participants paid in full may participate in class.
iii. Any refunds to participants will be made in accordance with City policy,
B. Instructor Responsibilities:
L Planning and delivering engaging and age-appropriate guitar classes as defined '
by class curriculum and description to be approved by City staff.
li. Ensuring the safety and well-being of all participants during class sessions.
■ Instructor will 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.
• Instructor 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
60 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 s
needs, facility availability, and alignment with City goals.
iv. Adhering to all City policies and procedures related to the use of facilities and i
interaction with participants.
iv. Adhering to all City deadlines for required documentation.
vi. The instructor'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 Instructor.
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viii. Instructor shall provide all materials, supplies, equipment, records and personnel.
Instructor shall be responsible for repairing and maintaining all equipment and
suppliesy, and ensuring that if is in good working condition. Instructor shall ensure
cleanup 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:
1. City shall manage participant registration and class information through
registration software. Instructor shall be granted access to the class raster on the
City registration system and is responsible for tracking attendance.
U. City shall collect all enrollment fees through the registration software. Instructor
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 Instructor 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
Instructor. Publicity may also include flyers created by City. Instructor 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). Instructor will request dates and
times for the c[ass(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 Instructor.
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EXHIBIT B
INSURANCE REQUIREMENTS
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Insurance Requirements
Prior to undertaking performance of work under this Agreement,Provider shall maintain and shall require
subcontractors, if any, to obtain and maintain insurance, as described below, for the entire Term of this
Agreement, against claims for injuries to persons or damage to property which may arise from or in
connection with services, products and materials supplied. Total cost of such insurance shall be borne by
Provider.
M MIUM SCOPE AND LIBT OF INSURANCE l
1. Commercial General Liability(CGL): Insurance Services Office Form CG 00 01covering COL
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. Required policy limits can be met with primary and umbrolla/excess
insurance policies.
2. Automobile Liability(AL):Insurance Services Office Form CA 00 01 covering Code I(any auto),
with limits no less than$1,000,000 per accident for bodily injury and property damage.In the event
Provider does not maintain commercial automobile liability insurance, City will accept evidence
of personal automobile insurance, provided that such policy is endorsed for business use and
provides coverage with a minimum limit of$1,000,000. Required policy limits can be met with
primary and unibrella/excess insurance policies.
3. Workers'Compensation(WC).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, policy or
employee,for bodily injury or disease.Coverage is not required if Provider has no employees and
signs request to waive such insurance, Contractor attests that its workers' compensation coverage
extends to all persons who will be working with the City under the agreed scope of services.
4. Sexual Abuse or Molestation Liability(SAML): If the work will include contact with minors, I
and the COL policy referenced above is not endorsed to include affirmative coverage for sexual
abuse or molestation, Provider shall obtain and maintain a policy covering Sexual Abuse and
Molestation with a limit of no less than$1,000,000 per occurrence or claim.
If Provider maintains broader coverage and/or higher limits than the minimum requirements for each line
of coverage 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 above required insurance policies are to contain or be endorsed to contain the following provisions:
1. City of Santa Ana,its City Council, its officers,officials, employees,agents, and volunteers are to '
be covered as additional insureds on Provider's CGL, AL, and SAML policies 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.
2. Provider's 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
Provider's CGL, AL, and WC policies which arise from work performed by Provider under this
Agreement.
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3. 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.
4. 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.
S. Insurance policy(ies) 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
alter thirty(30)clays 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 clue to non-payment,
h. Certificate Holder on each Evidence oflnsurance certificate shall be: City of Santa Ana,Attention:
Parks, Recreation, and Conununity Services Agency,20 Civic Center Plaza M-23, Santa Ana, CA
92701,The name and location of project must be included in the Description of Operations section
of each certificate,
Acceptability of Insurers
Insurance is to be placed with insurers authorized to conduct business in the State; of California with a
current A.M. Best rating of no less than A:VI1, 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 before
work begins, However,failure to obtain the required documents prior to the work beginning shall not:waive
Provider's obligation to provide theta.
City reserves the right to require complete, certified copies of all required insurance policies, including
endorsements required by these specifications,at any time.
Special Events Coverage
Special events coverage is available and can be purchase([ by Provider. Use this link to learn snore:
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Special tusks 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.
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ACC>RaP CERTIFICATE OF LIABILITY INSURANCE DA01I/1212026 '
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:
Bene-Marc Athletic Insurance Agency#OE67789 PHONE (800)247-1734 FAX No
6301 Southwest Bouievard,Suite 101 E-MAIL contact@bene-marc.com
ADDRESS;
Fort Worth,Texas 76132 INSURERS AFFORDING COVERAGE NAIL#
INSURER A: HDI Global Specialty SE AA-1120822
INSURED INSURER B: AXIS Global Accident&Health Insurance Company 37273
Southern California Municipal Athletic Federation(SCMAF)
PO Box 3605 INSURER C:
South El Monte,CA 91733 INSURERD:
SCMAF Member: Pat Hurley-Basic Guitar INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: 9066-57159 REVISION NUMBER: REVISED 02/0512026
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 ADDTYPEOFINSURANCE INSD WVDSUBR POLICY NUMBER MMfDIOf Y YYF Y MMlDD[YYY LTR Y LIMITS
X COMMERCIALGENERAL.LIABILITY EACH OCCURRENCE $ 1,000,00().00
18LB8383 01101/2026 01/01/2027 DAMAGE TO RENTED
CLAIMS-MADE FRIOCCUR PREMISES Eaoccurrence $ _ 100,000.00
MED EXP(Any one person) $ 5,000.00
A X X Abuse& Molestation PERSONAL&ADV INJURY s 1,000,000,00
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 5,000,000.00
POLICY JEC PROT F] LOC 1,000,000OOC./2,000,000Agg. PRODUCTS-COMPIOPAGG S 1,000,000.00
OTHER: Participant Liability $ 1,000,000.00
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
IF.
accident
ANY AUTO BODILY INJURY{Per person) 5
OWNED SCHEDULED BODILY INJURY(Paracc§dent) 5
AUTOS ONLY AUTOS
HIRED NON-OWNED PROPERTY DAMAGE 5
AUTOS ONLY AUTOS ONLY Per accident
5
UMBRELLA LIAR OCCUR EACH OCCURRENCE $
EXCESS LIAR CLAIMS-MADE AGGREGATE $
DED RETENTIONS $
WORKERS COMPENSATION PER OTH-
AND EMPLOYERS'LIABILITY Y!N STATUTE ER
ANYPROPRIETORIPARTNER!EXECUTIVE ❑ NIA
F,L.EACH ACCIDENT $
OFFICERfM EMBER EXCLU DED7
IMandatory in NHI E.L.01SFASE-FA EMPLOYEE 5
ff yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
B Participant Accident Medical SRPO-50256-243 01101/2026 01/01/2027 Deductible: $0.00 Limit: $5,000.00
DESCRIPTION OF OPERATIONS!LOCATIONS 7 VEHICLES (ACORD 101.Additional Remarks Schedule,may be attached it more space is required)
This policy includes a blanket additional insured endorsement that provides additional 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 E1602AJ-1112.The General Liability policy contains an endorsement for Waiver of Transfer of Rights of Recovery Against Others to Us per attached form CG
24 04 05 09.Gity of Santa Ana entity,it's officers,officials.agents and it's volunteers are additional insured.
Coverage for SCMAF member approved activities for which a premium is paid and reported to the Company.
SCMAF Member: Pat Hurley-Basic Guitar APPROVED
Coverage is limited to the following activity dates: 0 1 1 1 212 6-0 313 012 6
By Tu Tran Nguyen at 2:37 pm,Feb 09, 21726
CERTIFICATE HOLDER CANCELLATION
City of Santa Ana Risk Management SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
20 Civic Center Plaza
AUTHORIZED REPRESENTATIVE
Santa Ana,CA 92701 1/vAl+ I{,4�1 r�t,J�✓, F`�'}]J,,
Alisa Lynn Hall
iD 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016103) The ACORD name and loge are registered marks of ACORD
POLICY NUMBER: 18LB8383 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 Or anization s
City of Santa Ana Risk Management
20 Civic Center Plaza
Santa Ana, CA 92701
City of Santa Ana, its City Council, officers, officials, employees, agents, and volunteers
Information required to com lete 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 13
POLICY NUMBER: 18LB8383 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 at Santa Ana Risr Management
20 Civic Center Plaza
Santa Ana.CA 92701
City of Santa Ana,Its City Council,oTaceis,officials,employees,agents,and volunteers
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV--
Conditions:
We waive any right of recovery we may have against the person or organization shown in the Schedule above
because of payments we make for injury or damage arising out of your ongoing operations or "your work" done
under a contract with that person or organization and included in the"products-completed operations hazard". This
waiver applies only to the person or organization shown in the Schedule above.
CG 24 04 05 09 0 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- E1602AJ-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 Risk Management
20 Civic Center Plaza
Santa Ana,CA 92701
City of Santa Ana,its City Council,officers,officials,employees,agents,and volunteers
Policy Number : 18LB8383
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
EI602AJ-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
CITY OF SANTA ANA
Risk Management a division of Human Resources
Managing Risk through Awareness and Action
AFFIDAVIT OF EXEMPTION FOR WORKERS' COMPENSATION INSURANCE
me and Titfe of Vcndor R ("Representative"),attest that I am an authorized
ePresentative)
representative of \---'
11 ("Company"),and
(ConsultantlCompany Name)
Possess the authority to legally bind Company.
It' 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 s r% E S S
(S 'cestobepmridedund_gU.rnent/eontraet} ("Services"):
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 rcr�dering the Agreement
null and void and Company will be fully liable for any and all damages.
Sigr»atury `�--
to
`Paint Name _^
Tale
o\vo 5--� cvU � Q� 1�•� Q� I �0m
Caatact Information,i.e.,Telephone Number and/or Email Addrrsss
1NG: DAILURI TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL
AN EMpLoYER TO CRIMINAL PENALTIES AND CIVIL FINES A L,
W p�S14AI-L SU11JEOUSANT DOLLARS($100,000).IN ADDITION TO THE COST OF TO
AND Ht jNDRED DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE L q$OR
ONE ATIO ORNEy'S FEES. CODE,
GG ST,AND
FNTI R �pensatlon insuranm
Affidavit of f ernPuan for Workers �1.1a.2o�a
CITY OF SANTA ANA
Risk Management a division of Human Resources
Managing Risk through Awareness and Action
AFFIDAVIT OF EXEMPTION FOR AUTOMOBILE LIABILITY INSURANCE
("Representative"),attest that I am an authorized
� ame end Tide af'Vendor Reprexe0tativel
representative of (` �,� Com an
(Conszd-ElCom ("Company"),y'},and
y 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 1 1� �`(\� ("Services"):
( rrvices to be prodded under agteemewcontract)
During the course and scope of Company's agreement with the City of Santa Ana,
Company employees,consultants,representatives,and agents will not use and/or drive
any Company owned/rented/leased/borrowed vehicles to perform Services to,for,or on
behalf of City of Santa Ana,
If at any time it is found that Company is not adhering to any and/or all of the statements in this
document and does not maintain the minimum automobile liability insurance coverage as
i required in the Agreement,it will be considered a breach of Agreement rendering the Agreement
null and void and Company will be fully liable for any and all damages
signature
oa:e
Print Name
Title
Canwcr[nfomuUion,i. .,Telephone Number and/or mail Address �� ` C V W\
Affidavit of Exemption for Automobile Liability Insurance
11.12.2024